2.6.1 Non-pharmacological methods of pain relief

An important task of the birth attendant is to help women cope with labour pain. This may be achieved by pharmacological pain relief, but more fundamental and more important is the non-pharmacological approach, starting during prenatal care by providing reassuring information to the pregnant woman and her partner, and if need be to her family. Empathetic support, before and during labour, from caregivers and companions, can reduce the need for pharmacological pain relief and thus improve the childbirth experience (see 2.5).

Apart from support during labour (the most important factor) there are several other methods to alleviate labour pain. The first is the opportunity to assume any position the woman wishes, in or out of bed, during the course of labour. This means that she should not be restricted to bed, and certainly not to the supine position, but that she should have the freedom to adopt upright postures such as sitting, standing, or walking, without interference by caregivers, especially during the first stage of labour (see 3.2).

There are several non-invasive, non-pharmacological methods of pain relief that can be used during labour. Many women find relief of pain by the use of a shower or a bath. Touch and massage by a companion are often felt to be helpful. The same holds true for methods that help women cope with pain by attention-focusing techniques like patterned breathing, verbal coaching and relaxation, drawing a woman’s attention away from her pain. These methods are sometimes applied in combination with other strategies, including a range of psychosomatic approaches to support a woman in labour such as hypnosis, music and biofeedback. The practices are experienced as useful by many women, they are harmless and can be recommended.

Specific non-pharmacological methods for relief of pain in women in normal labour include methods that activate peripheral sensory receptors (Simkin 1989). Among the newest of these is transcutaneous electrical nerve stimulation (TENS). The self-administered nature of this technique has contributed to its success among many women, but its availability is limited to high-resource areas of the world, and its effectiveness has not been demonstrated in randomized trials (Erkolla et al 1980, Nesheim 1981, Bundsen et al 1982, Harrison et al 1986, Hughes et al 1986, Thomas et al 1988). Other techniques are the use of superficial heat and cold, acupuncture, immersion in water, herbs and aromatherapy with fragrant oils. For most of these techniques randomized trials to establish their effectiveness are not available yet. These practices should undergo the same process of critical review as is required for pharmacological intervention. The same holds true for a semi-pharmacological method as intradermal injections of sterile water at four spots in the lower back area (Enkin et al 1995).

In conclusion, all cultures have their own ways of attending and coaching pregnant women, some of them explain their customs in a magic way, others try to give a more logical explanation for the system they apply. A common feature of many of these methods is the intense attention paid to the woman during pregnancy and childbirth; perhaps this is the reason why so many pregnant women find them comforting and helpful. The reports that women find them comforting are mainly observational, but nevertheless a number of these methods are harmless, and their use by women who experience relief of pain by them may be justified. Training in counselling and inter-personal communication skills is vital for all who care for childbearing women (Kwast 1995a).