The Nature and Management of Labor Pain: Executive summary

Caton, Donald; Corry, Maureen P.; Frigoletto, Fredric D.; Hopkins, David P.; Lieberman, Ellice; Mayberry, Linda J.; Rooks, Judith P.; Rosenfield, Allan; Sakala, Carol; Simkin, Penny; Young, Diony

doi:10.1016/s0002-9378(02)70178-6

Cited by 74 publications

(43 citation statements)

References 22 publications

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“…Previous interventions for childbirth pain and fear have focused almost exclusively on: a) pharmacologic pain management strategies that are important to provide as available options under the standard of care but also pose health risks for the mother and fetus [31], and b) childbirth education that is geared toward increasing factual knowledge about the stages and mechanics of labor and birth, potential problems faced in labor and delivery, and medical interventions that are available to address those problems. Childbirth education is the primary mechanism by which pregnant women learn strategies for coping with pain in labor, yet in its standard form it may fail to reduce fear of childbirth [5].…”

Section: Discussionmentioning

confidence: 99%

Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison

Duncan

Cohn

Chao

et al. 2017

BMC Pregnancy Childbirth

170

142

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BackgroundChildbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment. Empirically validated childbirth preparation options are lacking for pregnant women facing this problem. Mindfulness approaches, now widely disseminated, can alleviate symptoms of both chronic and acute pain and improve psychological adjustment, suggesting potential benefit when applied to childbirth education.MethodsThis study, the Prenatal Education About Reducing Labor Stress (PEARLS) study, is a randomized controlled trial (RCT; n = 30) of a short, time-intensive, 2.5-day mindfulness-based childbirth preparation course offered as a weekend workshop, the Mind in Labor (MIL): Working with Pain in Childbirth, based on Mindfulness-Based Childbirth and Parenting (MBCP) education. First-time mothers in the late 3rd trimester of pregnancy were randomized to attend either the MIL course or a standard childbirth preparation course with no mind-body focus. Participants completed self-report assessments pre-intervention, post-intervention, and post-birth, and medical record data were collected.ResultsIn a demographically diverse sample, this small RCT demonstrated mindfulness-based childbirth education improved women’s childbirth-related appraisals and psychological functioning in comparison to standard childbirth education. MIL program participants showed greater childbirth self-efficacy and mindful body awareness (but no changes in dispositional mindfulness), lower post-course depression symptoms that were maintained through postpartum follow-up, and a trend toward a lower rate of opioid analgesia use in labor. They did not, however, retrospectively report lower perceived labor pain or use epidural less frequently than controls.ConclusionsThis study suggests mindfulness training carefully tailored to address fear and pain of childbirth may lead to important maternal mental health benefits, including improvements in childbirth-related appraisals and the prevention of postpartum depression symptoms. There is also some indication that MIL participants may use mindfulness coping in lieu of systemic opioid pain medication. A large-scale RCT that captures real-time pain perceptions during labor and length of labor is warranted to provide a more definitive test of these effects.Trial registrationThe ClinicalTrials.gov identifier for the PEARLS study is: NCT02327559. The study was retrospectively registered on June 23, 2014.

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Section: Discussionmentioning

confidence: 99%

Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison

Duncan

Cohn

Chao

et al. 2017

BMC Pregnancy Childbirth

170

142

View full text Add to dashboard Cite

show abstract

“…Nonpharmacological measures for relief of labour pain are relatively neglected in the health and medical literature , and often too much attention is paid to pain management with medication when pain in labour and birth is discussed. The conventional medical approach to the management of pain in labour and delivery has increasingly come to rely on the use of anaesthetic and analgesic drugs, in spite of reservations within the medical establishment itself .…”

Section: Discussionmentioning

confidence: 99%

“…Some authors write about different approaches to working with pain that are shaped by opposing attitudes and beliefs . Labour pain is one of the major concepts in women's descriptions of giving birth to a child and has been described as a major concern of childbearing women and their families . Some research results have indicated that there is something unique about labour pain, as it is a natural phenomenon, a natural part of giving birth and linked to the bringing forth of new life .…”

Section: Introductionmentioning

confidence: 99%

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The third paradigm in labour pain preparation and management: the childbearing woman's paradigm

Karlsdóttir

Halldórsdóttir

Lundgren

2013

Scandinavian Caring Sciences

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In this paper, we are presenting a study within the third paradigm in labour pain preparation and management: the childbearing woman's paradigm - the first and second being the midwifery and the medical paradigm, respectively. Midwives can play a major role in working with women in their preparation and management of labour pain. In the future, more research has to be done to illuminate this essential part of the childbearing woman's paradigm.

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“…This practice is markedly more common than reported in a 1989 survey of all WA obstetric units (42%) and 1996 survey of Perth midwives where 51% would not usually top‐up an epidural in the second stage for nulliparas 5,10 . However, of six small randomised studies only one showed a significant reduction in the instrumental delivery rate and the data from these trials are insufficient for conclusions about mode of delivery and length of labour 4,11 …”

Section: Discussionmentioning

confidence: 97%

Management of labour among women with epidural analgesia

Roberts

Raynes‐Greenow

Upton

et al. 2003

Aust NZ J Obst Gynaeco

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To assess current practices in the labour management of low risk primiparous women with epidural analgesia we surveyed delivery suites in New South Wales (NSW) that annually provide at least 100 epidurals to 'standard primipara'. Epidural rates among 'standard primipara' at these hospitals ranged from 14 to 85% (median 46%). Continuous epidural infusion was the most commonly used technique (63%). For 'standard primipara' with an epidural 62% of units usually augmented labour with oxytocin, 89% discontinued the epidural in second stage and 67% had policies of delayed pushing. There is wide variation in epidural availability and in labour management, perhaps reflecting the limited evidence for effective interventions to reduce any unintended effects of epidural analgesia.

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The Nature and Management of Labor Pain: Executive summary

Cited by 74 publications

References 22 publications

Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison

Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison

The third paradigm in labour pain preparation and management: the childbearing woman's paradigm

Management of labour among women with epidural analgesia

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