Pain management for women in labour – an overview

Women’s experience of pain during labour varies greatly. Some women feel little pain whilst others find the pain extremely distressing.  A woman’s position in labour, mobility, and fear and anxiety or, conversely, confidence may influence her experience of pain. Several drug and non-drug interventions are available, and in this overview we have assessed 18 systematic reviews of different interventions used to reduce pain in labour, 15 of these being Cochrane reviews.

Most of the evidence on non-drug interventions was based on just one or two studies and so the findings are not definitive.  However, we found that immersion in water, relaxation, acupuncture and massage all gave pain relief and better satisfaction with pain relief. Immersion and relaxation also gave better satisfaction with childbirth. Both relaxation and acupuncture decreased the use of forceps and ventouse, with acupuncture also decreasing the number of caesarean sections. There was insufficient evidence to make a judgement on whether or not hypnosis, biofeedback, sterile water injection, aromatherapy, and TENS are effective for pain relief in labour.

Overall, there were more studies of drug interventions. Inhaled nitrous oxide and oxygen (Entonox®) relieved pain, but some women felt drowsy, nauseous or were sick.  Non-opioid drugs (e.g. sedatives) relieved pain and some gave greater satisfaction with pain relief than placebo or no treatment, but satisfaction with pain relief was less than with opioids. Epidurals relieved pain, but increased the numbers of births needing forceps or ventouse, and the risk of low blood pressure, motor blocks (hindering leg movement), fever and urine retention. Combined spinal-epidurals gave faster pain relief but more women had itching than with epidurals alone, although urinary retention was less likely to be .. to download http://summaries.cochrane.org/CD009234/pain-management-for-women-in-labour—an-overview

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