Pregnant women in labor have a whole range of choices when it comes to pain management; from epidurals and opioids to massage and hypnosis. Which method work best? An extensive study by British researchers found that epidurals are more effective, but come with more side effects for mother and child. Drug-free pain relief methods also work and with fewer side effects, but more research is needed on their effectiveness.
Researchers from Liverpool, Warwick and Manchester Universities joined forces in a review over 300 labor pain studies for the Cochrane Collaboration. a respected international research group.
The review found sound evidence that epidurals – an injection of painkilling drugs between the spinal bones – do relieve pain from labor. But epidurals increase the number of vaginal births needing a forceps, an instrument used to help deliver a baby in distress. Epidurals also increase the risk of low blood pressure for the mother, as well as other side effects such as difficulty urinating.
There was more limited evidence for inhaled pain relievers, such as nitrous oxide gas, during labor, although the research still supports their use. Inhaled analgesia was associated with nausea, vomiting and dizziness.
Local anaesthetic nerve blocks and non-opioid drugs (Tylenol and NSAIDs) also may help women through labor pains, but nerve blocks also caused giddiness, sweating and tingling. And more babies had low heart rates.
Women seeking a more natural childbirth can use several pain management methods that don’t involve drugs, including water immersion, relaxation techniques, acupuncture and massage. Women reported pain relief and better satisfaction from all four methods. Relaxation and acupuncture also reduced the use of forceps, and acupuncture reduced the number of caesarean sections.
“Most methods of non-pharmacological pain management are non-invasive and appear to be safe for mother and baby, however, their efficacy is unclear, due to limited high quality evidence,” the study’s authors noted. “In many reviews, only one or two trials provided outcome data for analysis and the overall methodological quality of the trials was low. High quality trials are needed.”
The researchers found “insufficient evidence to make a judgment” on the effectiveness of painkilling opioids (injections of pethidine and related drugs), as well as hypnosis, biofeedback, sterile water injections, aromatherapy and TENS (a mild electric current passed through the skin).
The authors say women should be told about the benefits and adverse effects of all available pain relief methods. And they should feel free to use whatever pain management they think would help them most. Women who choose to have drug-free labor should also have a back-up plan for pain relief if their initial choice is not effective during the birth.