Update on Nonpharmacologic Approaches to Relieve Labor Pain and Prevent Suffering

Penny Simkin, PT; April Bolding, PT


J Midwifery Womens Health. 2004;49(6) 

In This Article

Childbirth Education

Childbirth education (prenatal or antenatal education) consists of individual or group classes designed to inform pregnant women and their partners about labor and birth, early parenthood, and infant feeding. Prenatal classes come in various formats and cannot be considered a single entity.[70] Classes vary in theoretical perspectives, purposes, and goals of preparation, qualifications of instructors, number and length of classes, and population served.[71] Most prenatal classes are sponsored by hospitals or provider groups who employ the teachers. These classes are often based on the assumption that parents will receive epidural analgesia and other pharmacologic and medical intervention. They may not cover nonpharmacologic pain measures or self-help measures. Other community-based childbirth education organizations, such as Lamaze International, the International Childbirth Education Association, the American Academy of Husband-Coached Childbirth, Birthing from Within, and Birthworks, teach nonpharmacologic pain management, including relaxation, breathing techniques, attention focusing, movement/positioning, and other self-help comfort techniques that the woman and her support team can call upon in labor and birth.

Effectiveness of Childbirth Education in Reducing Pain and Suffering During Labor

Our literature search identified no recent trials of the effects of childbirth education on pain or prevention of suffering. The most recent meta-analysis concluded that there is insufficient evidence to determine the effects of person-to-person antenatal education for childbirth.[71] Although it is impossible to draw evidence-based conclusions on the pain-relieving effects of childbirth education, its popularity testifies to a desire for parents to learn about this major life transition. Approximately 70% of first-time mothers and 19% of mothers who have experienced one or more births took childbirth classes between 2000 and 2002, according to the "Listening to Mothers" survey.[38]

There are few drawbacks to taking childbirth classes. There usually is cost and time involved, but the classes are completely voluntary and there often are several to choose from. The quality of information and length of the classes vary with each program, and the organization's goals and objectives may differ from the recipient's, so she should become informed about the classes and then choose the one that will best meet her needs.

Despite insufficient evidence on its influence on pain and suffering, childbirth education appears to be valued by expectant parents. As mentioned in the introduction, the best predictor of how a woman is going to experience labor pain is her self-confidence in her ability to cope with labor.[1] Although natural childbirth and active participation by parents (along with discussion of situations in which medications and interventions may be indicated) remain a focus of some classes, most focus more on preparation for conventional medicalized birth and a passive role for parents. If learning nonpharmacologic methods of managing labor pain is a goal, seeking out programs that teach these skills and boost the woman's self-confidence is essential.


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