Pain Management During Labor

Non-Pharmacological Pain Management During Labor

Pain during childbirth is generally handled with pharmacological techniques. Pain medications are widely used throughout hospitals in the labor and delivery units, including intramuscular and intravenous pain medications, regional and local anesthesia, and epidurals and spinal blocks. Non-pharmacological techniques for pain relief during labor is a generally new concept. More people throughout the United States are using alternative and complementary medicine for various purposes, and women in labor are starting to follow this trend. Labor units in hospitals generally don’t offer non-pharmacological techniques for pain relief. Non-pharmacological techniques for pain management during labor should be offered in conjunction with, or in lieu of pharmacotherapy.

There are many techniques to try in the realm of alternative and complementary medicine when it comes to pain relief. Those that have been implicated for the use of pain management during labor are aromatherapy, music, and immersion in water.

Aromatherapy

Aromatherapy is becoming increasingly popular among women as well as midwives. One study that used aromatherapy to promote maternal comfort during labor stated that the women in the study were offered aromatherapy to relieve pain, anxiety, nausea, vomiting, and also to strengthen contractions (Burns, Blamey, Ersser, Barnetson, and Lloyd, 2000). More than 50% of the women in the study said that the aromatherapy was helpful and only 14% stated that it was unhelpful. The study also stated that, overall, the use of aromatherapy appeared to have reduced the need for additional pharmacological pain relief in the women (Burns et al.). An unexpected finding from this study was the aromatherapy may have the prospective capability to enhance labor contractions for women in dysfunctional labor (Burns et al.).

Aromatherapy can be used by mothers during labor or mothers in the latent phase of labor. It can also be used as a perineal lavage after delivery. Several women in the study used the essential oils to calm themselves before the insertion of a spinal block. Of the women in this particular study, 61% used the oils to relieve feelings of anxiety and fear, 7% of the women used it as pain relief, 6% used the oils to improve contractions and 14% used it to reduce feelings of nausea and vomiting. The midwives that were in charge of the care administered to the women said that 50% of the aromatherapy administrations were helpful (Burns et al. 2000).

An interesting part of this study was the less than 14% of the women who were given the essential oil of rose for anxiety had a regional anesthetic block or an epidural, and 67% had a spontaneous vaginal delivery (Burn et al., 2000). The study also found that overall, the women who had used aromatherapy to reduce fear and anxiety had less chances of using an epidural for pain relief and had a higher chance of having a spontaneous vaginal delivery than the women in the control group who did not use aromatherapy (Burns et al.).

Another interesting fact is that in the study center where the study was conducted, the use of pethidine declined during the years of the study. Of the women who used aromatherapy, 13% also used pethidine in 1990. In 1997, this reduced to only 0.2% (Burns et al., 2000).

The study also found that a high number of women who used essential oils did not need any additional pain relief measures at all during labor. Of the women who had spontaneous labor, 9% of primigravida and 20% of multigravida used no additional pain relief during their labor. These figures are significantly less than the statistics reports by the National Birthday Trust (Burns et al., 2000). The use of the essential oils were also used as a treatment for dysfunctional labor, and resulted in many women not requiring an oxytocin infusion to enhance their labor (Burn et al.).

Music Therapy

Music is widely used throughout the world to aid in relaxation and distraction from everyday lives. The use of music is therapeutic and an effective strategy in pain management and the many physiological benefits make it an ideal complement in the management of pain during childbirth. Mothers and caregivers can plan to use music to aid in prenatal preparation and use it as an important adjunct in pain and as well as stress management during childbirth.

“In childbirth the physical and emotional responses of the brain and body to music, and particularly rhythm, may be a significant factor in the capacity of music to alleviate stress, pain or both” (Browning, 2000). This study used music that was categorized as being anxiolytic. Anxiolytic music was defined as having no extremes in rhythm, melody or dynamics. Also, instrumental music was preferred over vocal music. This study found that using music decreased the cardiovascular and endocrinological stress response, as well as a decreased need for medications such as analgesics, anesthetics, and sedatives.

Several women stated that the use of music during labor helped them to concentrate on their support people, and others stated that the music helped them to withdraw from the pain.

Immersion in Water

More often than aromatherapy or music therapy, baths are used to help relax the mind and body after a long day’s work, or to help clear the mind from stressful situations. Leisurely baths are depicted as the perfect way to escape. Recently, bathing in warm water during labor has been reported to increase the comfort level and to reduce painful contractions in women during labor.

In this study, of the women who were offered to take a warm bath to help reduce pain and increase comfort, 71% of the women chose to use the bath (Eckert, Turnbull, MacLennan, 2001). The study also found that 17% of the women who used the bath needed no additional pain relief measures. When women were asked during a survey of how painful were the contractions, on a scale from 0 to a 100, the women in the bath group reported lower pain scores than women in the routine care group.

Conveying Ideas

To convey the idea of offering non-pharmacological pain relief measures as part of routine care, several techniques can be used. In the unit, presentation boards and flyers would be most beneficial. Short oral presentations would be beneficial for hospital-wide education. I would first gather support from other nurses for my idea, then contact administration and convey my idea. I would advocate for a change in current policies to include the offering of alternative and complementary pain relief measures for women in labor as part of a normal routine care for patients. I would make informational brochures that can be kept in the rooms for patients to look through.

Barriers to Change

Barriers that might exist to this change are the belief that traditional pain medications are enough. Physicians might be resistant to this change since it might interfere in the birthing process, such as having music might distract the physician from concentrating on the delivery. Certain smells such as with the aromatherapy might induce nausea in some people, such as the nurses, physicians or family members. Another barrier might be that women who have never heard of these alternative pain relief measures might be reluctant to try them. Methods to overcome these barriers are to educate mothers and health care providers about the possible benefits of using non-pharmacological pain management in addition to pain medication.

Conclusion

In conclusion, pharmacological pain relief measures are widely used for pain relief during labor and delivery. Non-pharmacological pain relief measures are an important addition to the traditional pain medications. There are many more techniques to try other than music, aromatherapy, and baths. The key is to use what makes the mother feel most comfortable.

References

Browning, C. A. (2000, December). Using Music During Childbirth. Birth: Issues in Perinatal Care, 27(4), 272-276.

Burns, E.E., Blamey, C., Ersser, S.J., Bartnetson, L., & Lloyd, A.J. (2000). An Investigation into the Use of Aromatherapy in Intrapartum Midwifery Practice. Journal of Alternative and Complementary Medicine, 6(2), 141-147.

Eckert, K., Turnbull, D., & MacLennan, A. (2001, June). Immersion in Water in the First Stage of Labor: A Randomized Controlled Trial. Birth: Issues in Perinatal Care, 28(2), 84-93.