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


We searched the literature for relevant systematic reviews, meta-analyses, and prospective controlled trials in the English language by using PUBMED, CINAHL, AMED, and the Cochrane Library. The following techniques, arranged roughly in order of findings of effectiveness, were reviewed: 1) continuous labor support: 2) hydrotherapy, 3) intradermal water blocks, 4) movement and positioning, 5) touch and massage, 6) acupuncture, 7) hypnosis, 8) transcutaneous electrical nerve stimulation (TENS), 9) aromatherapy, 10) heat and cold, 11) childbirth education, 12) self-help techniques such as patterned breathing and relaxation, and 13) music and audioanalgesia. Despite a large number of published articles, there are relatively few prospective trials of effectiveness of many of the techniques. We include them in our assessments of efficacy, when available. If no such trials exist, we refrain from assessing efficacy. We summarize relevant findings from published systematic reviews or meta-analyses and update these with summaries of more recently published studies. We recommend that the reader retrieve the original reviews for more complete presentations on each non-pharmacologic method.

Table 1 summarizes the psychophysiologic mechanisms through which each method is thought to effect pain reduction.


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