Pharmacologic and nonpharmacologic options for pain relief during labor: an expert review

Zuarez-Easton, Sivan; Erez, Offer; Zafran, Noah; Carmeli, Julia; Garmi, Gali; Salim, Raed

doi:10.1016/j.ajog.2023.03.003

Cited by 33 publications

(18 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We suggest that pregnant patients (especially in the Polish population) have insufficient information about nonpharmacological pain relief methods. Therefore, patients immediately reach for pharmacological approaches (intravenous or epidural) in pain, omitting nonpharmacological, highly effective ways [ 28 , 29 , 30 , 31 , 32 , 33 ]. Increasing patients’ awareness about possible nonpharmacological analgesia methods during childbirth is crucial.…”

Section: Discussionmentioning

confidence: 99%

Results of Induction of Labor with Prostaglandins E1 and E2 (The RIPE Study): A Real-World Data Analysis of Obstetrical Effectiveness and Clinical Outcomes of Pharmacological Induction of Labor with Vaginal Inserts

et al. 2023

View full text Add to dashboard Cite

Despite extensive knowledge of the mechanisms responsible for childbirth, the course of labor induction is often unpredictable. Therefore, labor induction protocols using prostaglandin analogs have been developed and tested to assess their effectiveness in labor induction unequivocally. A total of 402 women were collected into two groups—receiving vaginal Misoprostol or vaginal Dinoprostone for induction of labor (IOL). Then, the patients were compared in groups depending on the agent they received and their gestational age. Most patients delivered within 48 h, and most of these patients had vaginal parturition. Patients who received the Dinoprostone vaginal insert required statistically significantly more oxytocin administration than patients who received the Misoprostol vaginal insert. Patients who received the Misoprostol vaginal insert used anesthesia during labor statistically more often. Patients who received Misoprostol vaginal inserts had a statistically significantly shorter time to delivery than those with Dinoprostone vaginal inserts. The prevalence of hyperstimulation was similar in all groups and remained low. Vaginal Misoprostol-based IOL is characterized by a shortened time to delivery irrespective of the parturition type, and a lower need for oxytocin augmentation, but also by an increased demand for intrapartum analgesia administration. A vaginal Dinoprostone-based IOL protocol might be considered a more harmonious and desirable option in modern perinatal care.

show abstract

Section: Discussionmentioning

confidence: 99%

Results of Induction of Labor with Prostaglandins E1 and E2 (The RIPE Study): A Real-World Data Analysis of Obstetrical Effectiveness and Clinical Outcomes of Pharmacological Induction of Labor with Vaginal Inserts

et al. 2023

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…[5] Nonpharmacological coping strategies, such as hydrotherapy, massage therapy, music therapy and transcutaneous electrical nerve stimulation, involve techniques other than medication and have been investigated extensively in previous studies. [6][7][8][9][10] Studies have explored the effects of various strategies, such as epidurals and opioids to reduce labor pain while considering women experiences and views. [11,12] Although empirical evidence indicates that different medical interventions can alleviate the pain that women experience during childbirth, the outcomes have been inconclusive.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of different strategies for reducing labor pain: A Bayesian analysis

Feng,

Zhu,

Zhang

et al. 2024

Medicine

View full text Add to dashboard Cite

Background: The effectiveness of different medical interventions in managing labor pain has yielded mixed results. Therefore, this systematic review and network meta-analysis aimed to provide a comprehensive summary of the available evidence on the impact of different strategies for reducing labor pain. Methods: We systematically searched 3 English databases (Pubmed, Embase and the Cochrane Library) from inception to January 2023. Randomized controlled trials (RCTs) or controlled clinical trials that investigating the effects of different strategies for reducing labor pain were included in this network meta-analysis. Risk of bias (ROB) was assessed using the Cochrane ROB tools. Network meta-analysis was performed using the R software (version 4.2.1) with gemtc package. Results: A total of 9 studies involving 823 patients, including 9 treatments (acupressure, birth ball exercise, Bonapace method, distraction techniques, ice pressure, LI4 acupressure, lidocaine spray, smartphone-based music intervention and placebo). The surface under the cumulative ranking (SUCRA) shows that Bonapace method ranked first (SUCRA, 79.5%), LI4 acupressure ranked second (SUCRA, 65.6%), distraction technique ranked third (SUCRA, 57.6%), birth ball exercise ranked fourth (SUCRA, 51.8%). Conclusions: According to the results of the network meta-analysis, among the different strategies examined, the Bonapace Method stands out as the most effective nonpharmacological intervention for reducing labor pain. The results of this meta-analysis can aid both patients and healthcare professionals in choosing the most effective techniques to reduce labor pain.

show abstract

“…The most common pharmacological strategy used to manage labour pain is the administration of epidural opioids [2]. This strategy is popular because of its widespread availability, ease of use, and low cost.…”

Section: Introductionmentioning

confidence: 99%

Pharmacological labour pain interventions: South African midwives’ perspective

Parkies,

Murray,

Okafor

2024

BMC Nurs

View full text Add to dashboard Cite

Background Women of childbearing age feel great about giving birth, but the pain could be excruciating depending on their pain tolerances. Midwives requires obstetrical knowledge and skills such as pain management during labour and safety. We explored midwives’ perspectives on the utilisation of pharmacological pain alleviation interventions during labour in selected hospitals in Matjhabeng Municipality, Free State province, South Africa. A qualitative study was undertaken, involving a sample of ten midwives, using a semi-structured interview guide. The interviews were audio-recorded and transcribed verbatim. Tesch’s open coding data analysis method was applied to analyse the data. The midwives were restricted to use Pethidine and Phenergan prescribed by doctors for labour pain relief, which disrupted labour pain management and obliged them either to wait for a physician or follow telephone instructions. According to the midwives, women taking Pethidine and Phenergan encountered adverse effects and discomfort. Midwives identified high workload, inadequate personnel, lack of skill and knowledge, lack of medication availability, and lack of infrastructure as the primary challenges of administering pharmacological methods to women in labour. The lack of standing orders, which delays the administration of medications pending a physician’s prescription, constituted an additional difficulty. In the instance that Pethidine and Phenergan were unavailable or ineffective for some women, the midwives recommended that women be administered alternative pharmacological pain relievers. They also advocated for institutionalization of pharmacological guidelines allowing them to use their discretion when treating labour pain. Midwives can only utilise a few standardised and regulated pharmacological medications for labour pain management. The midwives’ ability to administer pharmacological pain relief during labour was hampered by a high workload burden, insufficient staff, lack of skill and understanding, drug unavailability, and inadequate infrastructure. Midwives advocated for supported guidelines that would allow them to treat labour pain at their discretion. Intersectoral stakeholders are required to improve midwife skills and attitudes. Health facilities need to train and supply analgesics to midwives. Midwives ought to be familiar with pharmacological pain relievers.

show abstract

Pharmacologic and nonpharmacologic options for pain relief during labor: an expert review

Cited by 33 publications

References 67 publications

Results of Induction of Labor with Prostaglandins E1 and E2 (The RIPE Study): A Real-World Data Analysis of Obstetrical Effectiveness and Clinical Outcomes of Pharmacological Induction of Labor with Vaginal Inserts

Results of Induction of Labor with Prostaglandins E1 and E2 (The RIPE Study): A Real-World Data Analysis of Obstetrical Effectiveness and Clinical Outcomes of Pharmacological Induction of Labor with Vaginal Inserts

Efficacy of different strategies for reducing labor pain: A Bayesian analysis

Pharmacological labour pain interventions: South African midwives’ perspective

Contact Info

Product

Resources

About