Pain relief: Poor evidence for non-drug approaches in labor

There is better evidence for the effectiveness of drug-based approaches for relieving labour pains than non-drug approaches. These are the findings of an all-encompassing publishing in The Cochrane Library, which draws together results from a number of previous reviews on the subject.

Many different approaches are used to relieve pain in labour, but not all are supported by strong evidence. The researchers brought together the results of 15 previous Cochrane reviews and three non-Cochrane reviews, including data from 310 trials in total. To try to distinguish between well-supported and less well-supported approaches, they decided to split interventions into three categories.

Painkilling drugs given by epidural, combined spinal epidural (CSE) and inhalation fell under the first category, "what works". There was less evidence for immersion in water, relaxation, acupuncture, massage and local anaesthetic or non-opioid drugs. The authors classed these interventions as "may work". However, more adverse effects were associated with the interventions for which there was the best evidence, including caused by inhaled and hypotension due to epidural. The second group of pain relief approaches, although less well-supported by , were better tolerated, with women reporting improved satisfaction with pain relief for all except massage. The least supported or "insufficient evidence" group of pain relief interventions included hypnosis, biofeedback, sterile water injection, aromatherapy, transcutaneous electrical nerve stimulation (TENS) and injected or intravenous opioids.

"Women should be told about the benefits and adverse effects of different pain relief methods, but should feel free to choose whatever form of pain relief they feel would help them most during labour," said lead author of the study, James Neilson of the Department of Women's and Children's Health at the University of Liverpool in Liverpool, UK. "It remains important to tailor approaches to women's individual needs and circumstances."

The overview study calls for more research on the non-drug interventions that researchers grouped into the second and third categories. Although generally safe, for most of these interventions, evidence was based on just one or two trials. Fewer than 1,000 women have taken part in trials for each of hypnosis, biofeedback, sterile water injection, aromatherapy and massage. TENS is popular and widely recommended by midwives but not by the National Institute for Health and Clinical Excellence. "The discordance of views between women, clinicians and guidelines reflects a poor evidence base and the uncertainty should be resolved by a definitive clinical trial," said Neilson.

More information: Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP. Pain management for women in labour: an overview of systematic reviews. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD009234. DOI: 10.1002/14651858.CD009234.pub2

Related Stories

Pain relief can now be based on solid evidence

Sep 07, 2011

A Cochrane Review of data relating to about 45,000 patients involved in approximately 350 individual studies has provided an evaluation of the effect you can expect to get if you take commonly used painkillers at specific ...

Pain-free childbirth? Get real!

Mar 14, 2008

A pain-free and drug-free labour may be many expectant mothers’ dream but a review in the open access journal BMC Medicine reveals that reality hits hard. Most women's labour experiences differ markedly from their expect ...

Acetaminophen Alone Works Well for Postpartum Pain

Mar 17, 2010

For many mothers of newborns, lingering pain from the delivery can interfere with their first days with their infant. A recent review examined whether over-the-counter medications containing acetaminophen - Tylenol for example ...

Recommended for you

Is egg freezing an empowering option for women?

Nov 17, 2014

Katie Hammond, a PhD candidate in the Department of Sociology researching the experience of egg donation in Canada, discusses the recent decision by tech giants Facebook and Apple to offer egg freezing to ...

Peripheral nerve blocks OK for migraines in pregnancy

Nov 14, 2014

(HealthDay)—For migraines that do not respond to medications, peripheral nerve blocks may be a treatment option in pregnant women, according to research published online Nov. 5 in Obstetrics & Gynecology.

Hearing the heart of the mother and her baby

Nov 14, 2014

A group of students from the Autonomous Metropolitan University of Mexico (UAM-I) developed a technological portable prototype able to diagnose health conditions in the mother and in the baby by monitoring ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.