A woman’s confidence in her ability to cope appears to influence her experience of labor pain more than any other factor.

Published in the American Journal of Obstetrics & Gynecology, May 2002

Labor Pain Highly Individualized, “Modifiable”:

According to the research findings, labor pain is influenced by many factors specific to the individual woman and her environment. Many of these factors are “modifiable” and offer the potential to enhance comfort and reduce pain. These include:

  • features of the birth environment;
  • levels of fear and anxiety;
  • a woman’s coping strategies and expectations.

A woman’s confidence in her ability to cope appears to influence her experience of labor pain more than any other factor.

“There is a striking difference between labor pain experienced in the context of helplessness, suffering and loss, and pain experienced in the context of coping resources, comfort and a sense of accomplishment,” said Maureen Corry, executive director of the Maternity Center Association.

The research found that the choices women make about labor pain methods have a profound effect on their labor, birth experiences and outcomes. “There is no perfect method to relieve labor pain. All methods involve trade-offs between risks and benefits. Therefore, women need full information from the best available evidence on benefits and risks of labor pain methods well before labor begins so they can weigh options, get answers to their questions, clarify their preferences and make care arrangements (e.g. choosing a provider and birth setting), that will accommodate their needs and preferences,” said Ms. Corry. “This information should be available again during labor.”

Key Findings: Epidural Analgesia

In the U.S., the most popular method of labor pain relief is epidural analgesia (more than 50% of women have epidurals). Research reveals that although an epidural can completely block labor pain for most women — a major benefit — it also is associated with significant risks that many women may not be aware of. To make informed decisions about its use, women should be aware that epidural analgesia is likely to alter the normal processes of labor and birth, resulting in the routine use of other interventions to monitor, prevent, or treat associated side effects. Routinely used interventions include: electronic fetal monitoring (EFM), frequent blood pressure measurements, and intravenous drips (IVs). Other interventions and drugs are more likely with epidurals, including “pitocin”, (a drug to intensify contractions), bladder catherization, vacuum extraction or forceps for women who have difficulty pushing the baby out, and drugs to control high blood pressure. In addition, babies may receive invasive tests and/or antibiotic treatment in response to increased incidence of fever in mothers with epidurals.

“This interplay of side effects and additional drugs, tests, and procedures which may in turn lead to other side effects is known as a “cascade of intervention”, according to Ms. Corry.

Key Findings: Other Methods of Pain Relief — Narcotics, Nitrous Oxide and Non-drug Methods

The second most common form of labor pain relief for U.S. women is opioids (natural or synthetic narcotics such as Demerol or Stadol) injected into a muscle or vein). Although about 45 percent of women in the U.S. use these narcotics, the best available research raises considerable concerns about their ability to relieve labor pain and the short and long-term effects of these drugs on babies.

Many women in Canada, England and other nations find nitrous oxide helpful for labor pain relief; however, this inhaled gas is available in only a few hospital obstetric units in the U.S. Its advantages include: satisfactory enough pain relief for many women; appears safe for mother, fetus, and baby; simple and inexpensive to use; does not interfere with labor physiology; and does not require presence of an anesthesiologist.

Non-drug methods include baths, continuous support during labor, movement and positioning during labor, and sterile water injections into the skin to relieve the common experience of low back pain. Baths can be used safely and are becoming more popular as a method of temporary pain relief in labor. Research shows that use of upright positions during labor and squatting while pushing may speed labor and increase the mother’s comfort levels. A doula or other trained companion providing continuous support to women in labor can help with many non-drug approaches that provide physical and emotional comfort. Doulas can also offer guidance and support to the women’s partners and facilitate communication between the woman and the hospital staff. Continuous support during labor helps to reduce pain, provides other well-established benefits (e.g. shorter labor, less use of pain medication, higher levels of self esteem, increase in breast feeding, increased bonding with the baby), and has no known drawbacks.

“Non-drug approaches can help all women, regardless of their pain medication choices They are safe and provide welcome pain relief, but are not widely available to women in the U.S.,” according to Corry.

Resources:

The Childbirth Connection (formerly Maternity Center Association) website (www.childbirthconnection.org.) has a detailed section that presents information based on the findings from the labor pain research to help women make informed decisions in preparation for their own labors and births. Separate pages describe the best evidence on various options, offer tips and tools for decision-making, and link to additional resources.

Childbirth Connection is collaborating with, and offering technical support to, professionals and advocates working to implement this best evidence. For example, Kaiser Permanente, the country’s largest health maintenance organization, plans to translate findings from The Nature and Management of Labor Pain into clinical practice guidelines for labor pain management.

The “Especially for Professionals” section of the Childbirth Connection website (www.childbirthconnection.org.) includes labor pain resources for professionals, including material from its labor pain initiative that was not included in the special journal issue.

Executive Summary of The Nature and Management of Labor Pain Available Upon Request, or can be downloaded by going to http://www.childbirthconnection.org/article.asp?ck=10185.
Contacts: Maureen Corry, Executive Director, Maternity Center Association, at 212 777-5000, ext. 4; Eileen Masciale at 631 665-2163