There is not enough research on many popular pain relief methods for labour, British experts say today.
Evidence is fairly strong that drug-based approaches for relieving labour pain, such as epidural, are effective. But widely used non-drug approaches have barely been studied.
Professor James Neilson of Liverpool University, UK, and colleagues carried out a Cochrane Review published of pain management in labour. They analysed the results of 18 previous reviews covering 310 research trials. They placed the interventions into three categories: "what works", what "may work", and those that have "insufficient evidence".
"There is better evidence for the effectiveness of drug-based approaches for relieving labour pains than non-drug approaches," they found.
Epidurals, combined spinal epidural (spinal block) and inhalation (nitrous oxide, or gas and air) were placed in the first category. But these were associated with significant side-effects such as low blood pressure, nausea and vomiting.
Water birth, relaxation, acupuncture, massage and local anaesthetic nerve blocks or non-opioid drugs "may work" based on the current clinical evidence, say the authors. These brought fewer side-effects and women reported "improved satisfaction with pain relief".
Finally, hypnosis, biofeedback, sterile water injection, aromatherapy, transcutaneous electrical nerve stimulation (TENS) and injected or intravenous opioids were found to have "insufficient evidence" of effectiveness.
Professor Neilson says: "Women should be told about the benefits and adverse effects of different pain relief methods, but should feel free to choose whatever form of pain relief they feel would help them most during labour.
"The discordance of views between women, clinicians and guidelines reflects a poor evidence base and the uncertainty should be resolved by a definitive clinical trial."
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