Oh Baby! Treating Labor Pains

Labor pain most effectively treated by drug based methods over non drug ones says evidence

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Among the most painful rites of passage for moms is the first one: labor. But with the many methods available for reducing labor pain, which ones has research proven most effective?

A new review of the research on ways to lessen labor pain from The Cochrane Library attempts to answer that question and found that drug-based approaches have more evidence backing their effectiveness up than non-drug methods.

"Plan ahead for how you want to decrease labor pain when giving birth."

The non-drug methods that showed some effectiveness, however, were better tolerated by women compared to the drug-based approaches found to be most effective but with more side effects.

Lead author James Neilson, of the Department of Women's and Children's Health at the University of Liverpool in England, and fellow researchers looked at 15 previous reviews of the literature from Cochrane and added three non-Cochrane reviews, combining the data from 310 different research trials.

They divided all the methods investigated in the studies into three groups: "what works," what "may work," and "insufficient evidence" for effective pain relief.

The methods falling under "what works" included painkillers given by epidural, combined spinal epidural and inhalation, but these methods also had more adverse effects, including nausea and vomiting from inhaled painkillers and low blood pressure from epidural.

In the "may work" category, there was some, but less, evidence supporting the effectiveness of soaking in water, relaxation, acupuncture, local anesthetic nerve blocks and non-opioid medication; there was no evidence supporting massage as a way to relieve labor pain.

However, all these "may work" approaches had fewer adverse reactions and still were reported as satisfactory by women for reducing the pain.

The "insufficient evidence" group included all the methods with the least amount of research backing up their effectiveness: hypnosis, biofeedback, aromatherapy, injected or intravenous opioids, sterile water injection and transcutaneous electrical nerve stimulation, or TENS.

"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 labor," Neilson said. "It remains important to tailor approaches to women's individual needs and circumstances."

The study recommends additional research on the non-drug options the researchers classified as "may work" or "insufficient evidence" because only one or two trials from their review looked at each of these methods.

In fact, the trials involving hypnosis, biofeedback, sterile water injection, aromatherapy and massage combined included fewer than 1,000 women.

Neilson said that TENS, while popular among women and midwives, is not recommend currently 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," Neilson said.

The study appeared online March 13 in The Cochrane Library's Cochrane Database of Systematic Reviews. The research was funded by the National Institute for Health Research.

Reviewed by: 
Review Date: 
March 13, 2012
Last Updated:
March 13, 2012