Analgesia in labour: alternative techniques

Abstract

There is a consumer-led trend towards greater use of non-pharmacological methods of labour analgesia. Some methods reduce pain and the need for pharmacological analgesia or help women to cope better with the pain. There are few randomized controlled trials but maternal satisfaction is often high. Any technique that promotes mental and physical relaxation decreases anxiety and catecholamine levels and should promote increased uterine perfusion, more efficient and less painful uterine contractions, shorter labour, less oxytocin use and less fetal distress. Transcutaneous electrical nerve stimulation (TENS) water blocks, massage, warm water and acupuncture probably act by inhibiting pain inputs at the spinal level (the ‘gate control theory’), and through endorphin release and distraction. Continuous one-to-one support may be provided by a midwife, partner, other birthing partner or trained lay woman (doula). Massage of the lower back, abdomen, shoulders and neck may be soothing and relaxing. A woman may be hypnotized professionally or practice self-hypnosis to tolerate pain better than when she is wide-awake. Aromatherapy may be useful; essential oils of herbs and plants may be inhaled, ingested or absorbed through the skin. Water blocks are another technique in which sterile water is injected intradermally, usually in four spots over the borders of the sacrum, to relieve low back pain in early labour for up to 2 hours. Acupuncture using needles, pressure or electrical stimulation has been used for pain relief in labour with limited success.