Pain relief for women in labour: A rapid review for patient decision aid
For this rapid review, commissioned by Haukeland University Hospital, we aimed to summarise research syntheses on the effectiveness of pain management options for vaginal childbirth, both concerning the mother and the baby/newborn/infant.
The pain that women experience during labour is affected by multiple physiological and psychosocial factors and its intensity can vary greatly. Most women in labour require some pain relief and a wide range of pain management methods are offered and used by women during childbirth.
Eight Cochrane reviews were included as our evidence base for pain management interventions for women in labour, seven quantitative and one qualitative. The interventions were grouped into non-invasive, non-pharmacological and pharmacological. Nine comparisons were included. The certainty of the evidence ranged from very low to moderate. Moderate certainty evidence showed that:
- Immersion in water compared to no immersion probably improves satisfaction with pain relief and makes little or no difference to perineal trauma.
- Companionship helped women to have a positive birth experience.
- Acupuncture compared to usual care probably makes little difference to augmentation with oxytocin.
- TENS compared to placebo or usual care probably makes no difference to satisfaction with pain relief.
- Epidural compared to placebo or no intervention probably slightly improves satisfaction with pain relief and reduces Caesarean sections.
- Epidural compared to continuous support probably makes little or no difference to satisfaction with pain relief, assisted vaginal birth, caesarean section, long-term headache or long-term backache.
Some of the outcomes of interest were rarely measured, such as satisfaction with childbirth experience, breastfeeding or adverse effects. The interventions were most often compared to usual care or placebo, however, a detailed description was often lacking.