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

General Conclusions on the Use of Nonpharmacologic Methods to Relieve Pain and Suffering in Labor

The techniques discussed in this article share several common properties:

  1. Many are comparable or superior to parenteral opioids in their capacity to reduce pain sensations, but none are as effective as epidural analgesia.

  2. Unlike parenteral opioids and epidural analgesia, they have few, if any, serious side effects and require few safety precautions or extra safety equipment.

  3. They can be combined safely or used sequentially to increase their total effect.

  4. They may be used instead of or as an adjunct to pain relief medications.

  5. They are inexpensive and most are relatively easy to use.

  6. The burden of pain control is not borne solely by the caregiver, but jointly by the woman, her labor support, and her caregivers. The woman is less dependent, and, in turn, the caregivers are able to assume more of a supportive and assistive role and less of a directive role during her labor.

  7. They encourage active participation by the woman. She chooses the self-comfort measures and uses her own capabilities and support team to follow through.

  8. They maintain or restore a sense of control to the woman. When given encouragement, support, and unconditional acceptance of her coping style, her self-confidence grows. A woman who is confident in using her own resources can cope with labor better, which leads to a sense of well-being and mastery and less likelihood of suffering.

  9. They tend to be rated highly in terms of satisfaction and a desire to repeat them in a future labor. Even though their pain-relieving capability is modest or short-lived, they contribute positively to the psychoemotional, spiritual, social, and cultural aspects of her birth experience. When all aspects of the labor and birth are considered and respected, the likelihood of the woman suffering may significantly decrease.

Many of the techniques have been inadequately studied, and there appears to be little interest from funders to finance research on these seemingly simple, safe, and innocuous measures. We urge more research attention to these promising techniques. However, in the absence of clear scientific confirmation of their effectiveness, acceptability must be based on other criteria: absence of harm and preferences of each individual woman. Hospital birth environments, staff training, policies, and customs should be modified to accommodate the use of effective nonpharmacologic comfort measures, with the goal of reducing suffering in labor. This can be facilitated with comfort measures that provide sufficient pain relief and enhance the woman's sense of control and her satisfaction with her birth experience.


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