MIDIRS Essence > April 2008 > Informed Choice

Non-epidural strategies for pain relief in labour

Originally posted on Apr 2008

The pain of labour is often described by women as being ‘totally different’ to any other type of pain that they have ever experienced. It is, arguably, as unique and individual as the women themselves, who experience these life-changing events. It is also widely recognised that the pain relief and coping measures that focus on preventing ‘suffering’ rather than completely eliminating pain build a woman’s self-confidence, help her to maintain a sense of control and well-being, and improve her perceptions of her birth experience (Simkin & Bolding 2004). The experience of the pain associated with labour, as with any other unknown experience, is closely linked to expectation. The element that best predicts a woman’s experience of labour pain is her level of self-confidence in her ability to cope with labour (Lowe 2002). Where the labouring woman copes well, even when her labour pain is at its most intense, self-satisfaction, fulfilment, and a sense of accomplishment are most often reported, and the negative effects of ‘suffering’ with pain, are often felt to have been reduced (Simkin & Bolding 2004). Women’s expectations of labour as a whole (eg their involvement in decision making and care given) appear to be of more importance to their overall satisfaction with their labour experience than the perceived effectiveness of pain management (Page 2006).

Fulfilling expectations, facilitating choice and control, and supporting shared decision-making are all central to the ethos of woman-centred care. Therefore, effective strategies for coping with the pain of labour are a key component of intrapartum care. Denise’s article about midwives’ use of complementary therapies highlights the range of therapies that are now becoming increasingly available, and reflect women’s interest in pain relief methods that do not have a pharmacological base.

MIDIRS Informed Choice title, Non-epidural strategies for pain relief in labour provides evidence-based information that includes objective summaries of the available research evidence on complementary therapies, or, where this is lacking, alternative forms of evidence in the form of robust audit and descriptive and observational studies. The ethos of Informed Choice is to provide women with reliable and accurate information that assists them in making the right choices for themselves and their babies. It is clear that no single method for coping with the pain of labour and childbirth will meet the needs of every labouring woman. Women benefit most from having a range of options and strategies from which they may choose, with an understanding that they may change their mind at any time and will be fully supported by their caregiver throughout.

Health professionals and caregivers in contact with pregnant women can support them in achieving their choices by ensuring that labouring women are provided with up-to-date, objective, evidence-based information on the advantages and disadvantages associated with the various methods of pain relief available. In order to effect this, it is equally important that there is a wide choice of complementary therapies on offer, and that health professionals, where appropriate to their scope of practice (NMC 2004), are accredited, knowledgeable and competent in their use (NMC 2008). Where this is achieved, practitioners are able to offer assistance and support to the women who use them. This should also include helping women to access complementary therapists and to work alongside these practitioners as needed.

Non-epidural strategies for pain relief in labour presents the best available scientific evidence on the effectiveness, as well as the advantages and disadvantages associated with various forms of non-epidural pain relief. Topics covered are:

use of opioids

nitrous oxide (Entonox (N2O) inhalation)

intradermal water injections

continuity of caregivers during pregnancy and childbirth

continuous, one-to-one labour support from a midwife or doula

comfort measures, that include:

minimizing noxious stimuli

maternal positioning/mobility

massage/touch

immersion in water

acupuncture and acupressure

hypnosis

transcutaneous electrical nerve stimulation (TENS)

aromatherapy

application of superficial heat or cold

cognitive strategies.

Offering women a choice of pain relief options and providing individualised care lies at the heart of contemporary maternity service provision and government health policy (DH 2004, DH 2007, NICE 2007). However, this ethos can only be realised where women are provided with sufficient reliable and accurate information, and are able to understand the benefits and disadvantages associated with each option. Only where this is achieved, are women able to be fully involved in the decision making process. The significance of this has been corroborated in the systematic review of fourteen studies (Hodnett 2002), which found that having an active say in decision making was a key issue in women’s satisfaction with their experience of childbirth.

The information presented in this title should enable practitioners to explore a range of pain relief measures with women prior to the start of their labour. Where a woman shows an interest in a particular form of pain relief, more specific information, discussion and rehearsal might be required. This will help increase the woman’s self-confidence in her ability to cope with labour.

Informing women about resources, such as antenatal classes, literature, websites, videotapes, and complementary therapists, can also help a woman to identify what she needs to adequately prepare her for her labour and birth experience.

References:


Department of Health (2007). Maternity matters: choice, access and continuity of care in a safe service. London: DH Publications.


Department of Health (2004). National Service Framework for children, young people and maternity services: maternity services. London: DH. 27-30.


Hodnett E D (2002). Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol 185(5 suppl):S160-72.


Lowe N K (2002). The nature of labor pain. Am J Obstet Gynecol 186(5 suppl):S16-24.


National Institute for Health and Clinical Excellence (2007). Intrapartum care: care of healthy women and their babies during childbirth. London: NICE.


Nursing & Midwifery Council (2008). The Code: standards of conduct, performance and ethics for nurses and midwives. London: NMC.


Nursing & Midwifery Council (2004). Midwives rules and standards. London: NMC.


Page L A, McCandish R eds (2006). The New Midwifery science and sensitivity in practice. 2nd ed. Edinburgh: Elsevier.


Simkin P, Bolding A (2004). Update on non-pharmacological approaches to relieve labor pain and prevent suffering. J Midwifery Womens Health. 49(6):489-504.
www.infochoice.org

Vicky Carne | Head of Midwifery | MIDIRS

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