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Nonpharmacologic approaches to management of labor pain

Penny Simkin, PT
Michael C Klein, MD, CCFP, FAAP, FCFP, ABFP
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Kristen Eckler, MD, FACOG


The management of labor pain is a major goal of intrapartum care. There are two general approaches: pharmacologic and nonpharmacologic. Pharmacologic approaches are directed at eliminating the physical sensation of labor pain, whereas nonpharmacologic approaches are largely directed at prevention of suffering. Suffering may be defined in terms of any of the following psychological elements: a perceived threat to the body and/or psyche; helplessness and loss of control; distress; insufficient resources for coping with the distressing situation; fear of death of the mother or baby [1]. Although pain and suffering often occur together, one may suffer without pain or have pain without suffering.

Most women use nonpharmacologic approaches for managing labor pain, with or without pharmacologic approaches [2]. The nonpharmacologic approach to pain management includes a wide variety of techniques that address not only the physical sensations of pain, but also attempt to prevent suffering by enhancing the psycho-emotional and spiritual components of care. In this approach, pain is perceived as a normal accompaniment of most labors. The woman is educated and assisted by her caregivers, childbirth educators, and support people to take an active role in decision-making and in using self-comforting techniques and nonpharmacologic methods to relieve pain. Her caregivers and support people also help her by providing reassurance, guidance, encouragement, and unconditional acceptance of her coping style. By taking an active role in decision-making and receiving appropriate support, women are more likely to be able to transcend their pain and experience a sense of mastery, control, and well-being, factors associated with their ability to cope with labor [1].

A systematic review of studies on women's expectations and experiences of pain and pain relief during labor and their involvement in the decision-making process found a gap between their expectations and their actual experiences [3]. They were inadequately prepared for the reality of labor pain and were unable to make informed choices about pain relief. In order to close this gap, women need information prenatally about the risks and benefits of both pharmacologic and nonpharmacologic methods of pain management, and opportunities to practice in nonpharmacologic pain relief methods.

This topic will explore the variety of nonpharmacologic methods of management of pain during labor and the evidence of their efficacy. Most birthing facilities offer at least some of these techniques; however, some procedures, such as acupuncture, usually require credentialing and may not be available in all birth settings. An overview of systematic reviews of pain management in labor concluded that there was some evidence of efficacy for water immersion, relaxation, acupuncture, and massage, but it was unclear whether the following techniques are effective: hypnosis, biofeedback, sterile water injection, aromatherapy, and transcutaneous electrical nerve stimulation (TENS) [4].

Pharmacologic methods of pain relief are reviewed separately. (See "Pharmacologic management of pain during labor and delivery".)


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Literature review current through: Apr 2017. | This topic last updated: Oct 29, 2015.
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