Search

Background Labour pain is an individual experience embedded in a socio-cultural context. In childbirth, the father’s involvement provides important support to the mother during labour. However, few published studies have evaluated couples’ experiences of paternal involvement and labour pain management in the Chinese context. Aim This study aimed to understand the experience of labour pain management and the father’s involvement in childbirth from the perspectives of women and their partners in Hong Kong. Methods An exploratory qualitative design was adopted. A purposive sample of 45 Chinese parents was recruited at the postnatal unit of a regional hospital. Data were collected through semi-structured face-to-face interviews within 1 month after birth. The data were subjected to content analysis. Findings The findings revealed six major themes: the mothers’ experience of labour pain, effectiveness of pain relief measures, mothers’ perceptions of support from their partners, mothers’ perceptions of support from healthcare professionals, fathers’ experience of involvement in childbirth and suggested improvements to maternity services. Discussion Chinese mothers experienced intense labour pain and used various pain relief measures. Both parents considered the involvement of fathers and support from healthcare professionals to be highly significant during childbirth. Conclusions This study highlights the need for a family-centred model of care during childbirth that involves both parents in the decision-making process. Chinese maternity services should implement individualised birth plans that acknowledge both parents’ expectations and preferences, thus promoting a positive childbirth experience for the parents.

Labour is the process of opening and thinning of the cervix and the foetus descending into the birth canal. Pain in the first stage of labour is due to cervical dilatation, lower uterine segments, the presence of opposing prisoners, the pull and injury to the muscle tissue and ligaments that support the structure above. Back massage technique is one of the methods to reduce labour pain. The purpose of this study is to determine the effect of back massage on the reduction of labour pain during the active phase. This type of research uses a quasi-experimental design with a non-equivalent control group. The sample of this research was 31 women who were taken by accidental sampling at BPM Yusida Edward Palembang. The instrument used was an observation sheet to measure labour pain. The results of univariate analysis of most mothers experienced severe pain 48.4%, moderate pain 44.4%, pain very severe 3.2% and after back massages most of the mothers felt moderate pain 71%, mild pain 16%, severe pain 13%. Bivariate data analysis techniques used the Kolmogorov-Smirnov normality test and paired sample T-test. The conclusion of this study is that back massage influences the reduction of labour pain during the active phase. Therefore, it is recommended for health workers, especially midwives, to improve the quality of childbirth care services using back massage techniques to reduce labour pain in the first stage.

Background Aromatherapy is a treatment method that applies fragrant extracts from herbal plants, existed long ago in medical history as a major treatment approach and now used as an auxiliary treatment and sometimes a major treatment for pain and stress management, including those that occur in labour. Aim We aimed to conduct a meta-analysis of randomised controlled trials of the effectiveness of aromatherapy on labour pain and duration reduction. Methods We searched the Pubmed, EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar and Clinicaltrials.gov for randomised controlled trials investigating the effectiveness of aromatherapy on labour pain and duration. Results A total of 17 trials with low-risk labouring women were included for meta-analysis using the Review Manager 5.3. Meta-analyses showed that aromatherapy reduced labour pain in the transition phase and the duration of active phase and third stage labour; a trend toward shortened duration was observed in the second stage. Also, aromatherapy had no influences on emergency caesarean section, membrane rupture, and spontaneous labour onset. Conclusion Our findings suggest that aromatherapy is effective in reducing labour pain and duration, and generally safe to the mothers. However, due to the heterogeneity across trials in some of the outcomes, further trials with device-based pain measurements, larger sample size, and more stringent design, should be conducted before strong recommendation.

Maternal fever during labour epidural analgesia is not uncommon and could be associated with potential neonatal and maternal sequelae. Proposed mechanisms of epidural fever include disequilibrium of thermoregulation, infection or inflammation caused by either mechanical or drug related factors. Current evidence suggest that a primary acute inflammatory response with potential secondary inflammatory releasing mediators could be the most plausible pathophysiology. Potential management options include reducing the duration of labour or by reducing inflammatory process. However, studies involving use of steroids to reduce inflammation have found an increased risk of asymptomatic neonatal bacteraemia. Paracetamol has also not been found to prevent maternal epidural fever. Further research is required to understand the process mechanisms so that associated neonatal and maternal complications could be reduced.

Pain is defined as "an unpleasant sensory or emotional experience associated with actual or potential tissue injury". Labour pain is encountered during contractions in labour, and patient satisfaction correlates closely to how well it is managed. Doctors commonly encounter acute pain in clinical practice which can be treated simply by applying some basic rules. However, pain due to labour requires specific management which falls outside the basic principles of acute pain management and it is important for practitioners who look after these patients to understand what can be offered. This review considers the basic principles of each of these techniques using common clinical scenarios. The type of analgesia given will determine where labour takes place and this will be reflected in each case. Specifically, the World Health Organisation (WHO) analgesia ladder is not applicable in these patients because the periodic nature and the intensity of labour pain renders this model obsolete, although is applicable after delivery.

Neuraxial analgesia is considered the gold standard in labour analgesia, providing the most effective pain relief during childbirth. Improvements have enhanced the efficacy and safety of epidural analgesia through better drugs, techniques and delivery systems. This review describes the history of epidural labour analgesia and recent improvements in labour epidural analgesia. We discuss the role of the combined spinal epidural technique, low-concentration local anaesthetic-opioid epidural solutions, patient-controlled epidural analgesia, and programmed intermittent or automated mandatory boluses in the maintenance of epidural labour analgesia. We also review the newer interactive techniques for drug delivery, such as computer-integrated patient-controlled epidural analgesia and variable frequency automated mandatory bolus. Finally, we discuss future clinical research developments, including the use of data analytics and long-term outcomes associated with childbirth pain management.

Labour neuraxial analgesia failure may lead to inadequate pain relief and patient dissatisfaction. This may occur due to difficulty in epidural placement during the initiation of, or during the maintenance of epidural analgesia. In this review, we investigate the risk factors associated with labour neuraxial analgesia failure and present the recent evidence to improve epidural space identification. Demographic and anaesthetic factors that may increase breakthrough pain are discussed. We also examine the effect of different regimens of local anaesthetic agents and analgesic adjuvants on the quality of analgesia. The use of patient controlled epidural analgesia and novel epidural delivery systems such as the role of intermittent epidural automated boluses are explored.

Objective To investigate associations between maternal country of birth and other migration related factors (length of residence, reason for migration, paternal origin) and epidural analgesia for labour pain in nulliparous women in Norway. Design Population-based register study including nulliparous migrant women (n = 75,922) and non-migrant women (n = 444,496) with spontaneous or induced labour. Data were retrieved from the Medical Birth Registry and Statistics Norway, 1990–2013. Odds ratios (OR) with 95% confidence intervals (CI) were estimated by logistic regression, and adjusted for maternal age, marital status, maternal education, gross income, birth year, hospital size and health region. Main outcome Epidural analgesia for labour pain. Results Epidural analgesia was administered to 38% of migrant women and 31% of non-migrant women. Compared with non-migrants, the odds of having epidural analgesia were lowest in women from Vietnam (adjOR 0.54; CI 0.50–0.59) and Somalia (adjOR 0.63; CI 0.58–0.68) and highest in women from Iran (adjOR 1.32; CI 1.19–1.46) and India (adjOR 1.19; CI 1.06–1.33). Refugees (adjOR 0.83; CI 0.79–0.87) and newly arrived migrants (adjOR 0.92; CI 0.89–0.94) had lower odds of epidural analgesia. Migrant women with a non-migrant partner (adjOR 1.14; CI 1.11–1.17) and those with length of residence ≥10 years (adjOR 1.06; CI 1.02–1.10) had higher odds. Conclusion The use of epidural analgesia varied by maternal country of birth, reason for migration, paternal origin and length of residence. Midwives and obstetricians should pay extra attention to the provision of adequate information about pain relief options for refugees and newly arrived migrants, who had the lowest use. publishedVersion

Questions: In the active phase of the first stage of labour, does transcutaneous electrical nerve stimulation (TENS) relieve pain or change its location? Does TENS delay the request for neuraxial analgesia during labour? Does TENS produce any harmful effects in the mother or the foetus? Are women in labour satisfied with the care provided? Design: Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis. Participants: Forty-six low-risk, primigravida parturients with a gestational age > 37 weeks, cervical dilation of 4cm, and without the use of any medications from hospital admission until randomisation. Intervention: The principal investigator applied TENS to the experimental group for 30minutes starting at the beginning of the active phase of labour. A second investigator assessed the outcomes in both the control and experimental groups. Both groups received routine perinatal care. Outcome measures: The primary outcome was pain severity after the intervention period, which was assessed using the 100-mm visual analogue scale. Secondary outcomes included: pain location, duration of the active phase of labour, time to pharmacological labour analgesia, mode of birth, neonatal outcomes, and the participant's satisfaction with the care provided. Results: After the intervention, a significant mean difference in change in pain of 15mm was observed favouring the experimental group (95% CI 2 to 27). The application of TENS did not alter the location or distribution of the pain. The mean time to pharmacological analgesia after the intervention was 5.0hours (95% CI 4.1 to 5.9) longer in the experimental group. The intervention did not significantly impact the other maternal and neonatal outcomes. Participants in both groups were satisfied with the care provided during labour. Conclusion: TENS produces a significant decrease in pain during labour and postpones the need for pharmacological analgesia for pain relief. Trial registration: NCT01600495. [Santana LS, Gallo RBS, Ferreira CHJ, Duarte G, Quintana SM, Marcolin AC (2016) Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. Journal of Physiotherapy 62: 29–34]

Objective To determine and critically examine maternity attitudes surrounding labour pain and how midwives can best facilitate women navigating intrapartum discomfort without relying on ‘pain-relief’ strategies or immediate recourse for analgesic assistance. Approach This article examines current literature using seminal research and wider international perspectives, exploring the complex and fluctuating needs of women negotiating the composite factors of labour discomfort are investigated. Findings Factors such as birth environment, fear, midwifery presence, and self-efficacy, have a significant impact on the uptake of intrapartum analgesia. A holistic view of intrapartum discomfort is needed to shift the current paradigm of pathologising labour pain into one which situates it as a source of positive physiology and functional discomfort. Conclusion Continuing to practice with a pharmacological outlook, aiming to rid the labouring body of discomfort, is reductionist for both midwives and women. Midwives must seek to employ a new lexicon with which to communicate and facilitate women within the dynamic and continually changing territory of labour. If this conceptual shift is realised, the subsequent positive sequalae of women rediscovering their innate birthing capabilities could create a situation where birth can be considered as an aesthetic peak experience, improving satisfaction on both sides of the midwife-mother diad.

A woman's pain during labour plays a dominant role in childbirth. The midwife's role is to assess the degree of pain experienced during labour. When professionals respond to labour pain with acknowledgement and understanding, the woman's sense of control and empowerment is increased, which could contribute to a positive experience of childbirth. The aim of this study is to describe how labour pain in Swedish delivery wards is assessed and documented.This quantitative descriptive study was designed as a national survey performed through telephone interviews with the representatives of 34 delivery wards in Sweden.The majority of the participating delivery wards assessed and documented women's labour pain, but in an unstructured manner. The wards differed in how the assessments and documentation were performed. In addition, almost all the delivery wards that participated in the survey lacked guidelines for the assessment and documentation of the degree of pain during labour. The findings also showed that the issue of labour pain was sometimes discussed in the delivery wards, but not in a structured or consistent way.

Introduction Pregnant women in traditional cultures often use herbal medicines to facilitate childbirth and reduce labour pain. The aim of this study was to evaluate the effects of Dill seed on duration of the active phase and intensity of labour pain in parturient women. Materials and methods This retrospective cohort study evaluated the effects of Dill seed on duration of active phase and intensity of labour pain in 85 parturient women who consumed a tea made from Dill seed (case group) and 85 parturient women who consumed no medicines during labour (control group). Data collection instruments were a questionnaire, data recording sheet, Sonny Kidd and Visual Analogue Scale (VAS). All statistical analyses were performed by SPSS 16. Results The results showed that in the first stage of labour pain the average duration of active phase in the case group was 4.21 ± 2.6 h compared with 6.01 ± 3.4 h in the control group ( p = 0.001). The comparison of pain intensity in the two groups was not statistically significant ( p > 0.05), but progress of labour in the case group was more than the control group ( p = 0.001). Conclusion This study showed that a tea made from Dill seed can be used in the initial stages of labour without any side effects on mother and foetus to reduce labour pain.

Summary Labour pain is one of the worst pains known to women. Labour pain induces multisystem changes in the mother which may have an effect on the baby as well. Although neuraxial analgesia is considered the Gold Standard for labour analgesia, not every maternity hospital has the facilities to administer it. Women themselves for various reasons may not want to consider the neuraxial blockade. We have given the detailed account of the hazards of labour pain and the non-neuraxial methods of labour analgesia with their current scientific evidence. In this review we have given the detailed account of the non-neuraxial methods of labour analgesia and their current scientific evidence. Every pregnant woman should be told the various methods of pain relief and her wish should be respected.

PROBLEM AND BACKGROUND: There is a lack of literature about what constitutes good midwifery care for women who have epidural analgesia during labour. It is known that an increasing number of women receive epidural analgesia for labour pain. We also know that while women rate the painkilling effect of the epidural analgesia as high, in general, their satisfaction with labour is unchanged or even lower when epidural analgesia is used.QUESTION: How do women experience being in labour with epidural analgesia, and what kind of midwifery care do they, consequently, need?METHODS: A field study and semi-structured interviews were conducted on a phenomenological basis. Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby. They were interviewed the day after the birth and again 2 months later. The involved midwives were interviewed 2-3h after the birth.FINDINGS: Initiation of epidural analgesia can have considerable implications for women's experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence. Another important finding refers to the labouring woman's relationship with the midwife, which represents an essential influencing factor on the woman' experience of labour. Within this relationship, some rather unnoticed matters of communication and recognition appear to be of decisive significance.CONCLUSION: After initiation of epidural analgesia the requirements of midwifery care seem to go beyond how women verbalise and define their own needs. The midwife should be attentive to the labouring woman's type of emotional reaction to epidural analgesia and her possible intricate worries.

to investigate the reliability and validity of the Acceptance Symptom Assessment Scale (ASAS) in assessing labour pain.a test-retest approach was used to assess reliability and validity.labour ward with approximately 2,400 deliveries annually in western part of Sweden.forty-seven pregnant women in the latent or active phase of labour.a total of five pain assessments with both the ASAS and the VAS were conducted in three sessions.correlation between ASAS and VAS.both scales demonstrated high and significant test-retest correlations (r=0.83-0.92; p0.001). High and significant alternative-form reliability correlations (r=0.76-0.93, p0.001) were found between ASAS and VAS ratings at all five assessments. Construct validity was established when both the ASAS and the VAS identified a pain reduction (p0.001) 2 hrs after birth, compared to the previous assessment. Over two-thirds of the women preferred the ASAS to the VAS, mainly (n=30) because the ASAS provided more choices relating to the pain experience, making it possible to label pain acceptable/unacceptable.the ASAS is interchangeable with the VAS for assessing labour pain. Over two-thirds of the women preferred it to the VAS.

Labour pain is one of the most severe pains known to man. Whilst neuraxial analgesia is the gold standard for achieving complete analgesia in labour, many women do not desire such high-tech pain relief. Many women want to be able to ‘cope with the pain of labour' rather than annihilate the pain completely; for many of these women non-neuraxial techniques will suffice. This article evaluates many of the current non-neuraxial techniques that are employed in labour wards throughout the UK.

Background Sevoflurane has favourable physical qualities for inhaled analgesia during labour pain. The aim of this preliminary study was to identify its optimum concentration. Methods In this open-labelled escalating-dose study, 22 parturients in labour self-administered sevoflurane at 10 contractions using an Oxford Miniature Vaporiser. The inspired concentration was increased by 0.2% after each contraction from 0% to 1.4% or decreased if sedation occurred. Visual analogue scores (0–100 mm) for pain intensity, pain relief, sedation, mood and coping were measured after each contraction. Results The median (IQR [range]) pain relief and sedation scores increased from 44 (43–56 [4–93]) mm and 55 (43–56 [0–98]) mm at 0.2% sevoflurane, to 74 (72–78 [50–80]) mm and 71 (71–73 [33–97]) mm at 1.2% sevoflurane, respectively. Pain relief scores did not show any significant increase above 0.8% whilst sedation continued to increase, with excessive sedation occurring at 1.2% sevoflurane. No significant changes in other scores were measured. Conclusions We concluded that the optimal sevoflurane concentration in labour was 0.8%. This concentration allows a safety margin and balances the risk of sedation with the benefit of pain relief in labour.

Systemic labour pain treatment with opioids and inhaled nitrous oxide has for many decades frequently been used in medically developed countries. Self-administered nitrous oxide (50% in oxygen) has never gained the same popularity in the USA as in the UK or Scandinavia but the use of opioids, mainly pethidine, has generally been widespread in spite of well-known negative effects on the postnatal adaptation of the newborn. Since the often very intense labour pain seems to respond very poorly even to highly sedating doses of parenteral opioids, their frequent use during delivery and parturition has to be questioned. Self-administered inhalation of nitrous oxide 50% in oxygen also has a limited efficacy for relieving labour pain but because it is mainly devoid of adverse effects on the baby or on the parturient its future use in obstetrics can be defended more easily, either as a sole agent in women with low labour pain scores or in early labour preceding epidural analgesia.

The expected and experienced labour pain of 99 primiparous women, aged from 17-40 years, was compared in this prospective study. The Visual Analogue Scales and the Present Pain Intensity of the McGill Pain Questionnaire were used to assess expected pain prenatally and experienced pain intrapartum ( 8cm cervical dilatation) and 2 hours postpartum. A significant difference was found between expected pain and pain experienced during early and transitional labour. Generally, the level of pain expected was that of active labour and not the intensity of reported pain experienced in transitional labour.

This prospective study evaluated the extent to which the analgesic procedures available resulted in efficient pain relief in 833 Finnish parturients. Their pain ratings were recorded according to their own assessment of pain intensity during labour before and after pain management and according to their total pain experience recalled on the third day after delivery. Only regional blocks significantly diminished pain scores during labour and a striking decrease in pain level (P < 0.0001) was maintained until the second stage by epidural analgesia (EDA) alone. The EDA-group consisted mainly of the primiparous (71%) with induced (17%) and most painful deliveries. After delivery 60% of parturients in this group recalled labour pain as being very severe or intolerable. This was partly due to delays in receiving epidural blockade and partly due to the parturient's reticence in requesting analgesia. Pain relief was rated as excellent or good by 94% of the EDA group but by only 50% of the remaining patients.

The experiences of 890 parturients were studied across Finland during one week to determine how they experienced labour pain and how effective they regarded the means to alleviate it. The majority of women (72%) had been afraid of labour and 88% had intended to request some pharmacological pain relief. 84% of primiparous and 72% of multiparous rated their pain severe or unbearable. Epidural analgesia was found to be the most effective method in the first stage of labour, but in the second this superiority was no longer apparent. Unfortunately, it seems to be readily available only during office hours in spite of the fact that the majority of deliveries happen outside of that time.

The analgesic efficacy and safety of tramadol 50 mg, 100 mg and pethidine 75 mg, administered intramuscularly were compared in a randomized, double-blind clinical trial in 90 pregnant women with labour pain. Pain relief was measured by a 4-point verbal rating scale 10, 20, 30, 45 and 60 min after the administration of study drugs. The average total pain relief score within the first hour was 0.9 with tramadol 50 mg, 1.7 with tramadol 100 mg and 1.7 with pethidine 75 mg. In comparison to both tramadol doses the administration of pethidine was associated with a significantly higher frequency of adverse events and a significantly lower respiratory rate in the neonates. The results indicate that tramadol 100 mg is as effective as pethidine 75 mg but has a superior safety profile.

Refereed/Peer-reviewed

The majority of parturients experience severe or unbearable pain during labour when asked shortly after delivery but memory of labour pain fades rapidly over the ensuing months. Labour pain is an individual experience and is influenced by personal aspirations, cultural factors, peer group and carer pressures. The most satisfied women were those who expected more pain, those who were satisfied with the analgesia received and also those who received good pain relief. It is essential to provide timely information, support and choice of pain relief tailored to the individual parturient.

Obstetric anaesthetists usually look after fit, pregnant women who may already have made their decisions regarding the pain relief options they would like to use during labour. With the emphasis on patient autonomy, choice and patient-centred care, coupled with the changing nature of labour pain and mode of delivery, obstetric anaesthetists often face a challenge in terms of the provision of good evidence-based information. Women obtain information from a myriad of sources including relatives, friends, magazines, books, and the Internet, as well as from health-care workers. Providing good information at an early stage is important as it forms the central core of consent and also improves the women’s self esteem-and care, and can lead to increased satisfaction. It is important for health-care workers to realize that giving information is a process over a period of time, ideally when the parturient is most interested and receptive. This may be during the antenatal period, once labour pain has started or even after delivery, to answer any queries that may arise. Research has shown that, despite the influence of pain or drugs, women like to be informed and are capable of recalling information. A variety of techniques to impart information can be utilized, including group or individual talks, leaflets and videos, the use of information cards and pain relief algorithms in patient-friendly language. The medico-legal literature reminds us that the largest contributory factor in complaints leading to possible litigation is the lack of communication and information given to the parturient before and after the event.

This study examined the relationship between partner support, use of pain control techniques and epidural anaesthesia in 80 primiparous women. It was found that the use of psychological 'pain control' techniques did not reduce the intensity of labour pain, nor did their use enable women to do without an epidural anaesthesic. However, the use of techniques did correlate with reduced frequency of anaesthesia when women were consistently supported and encouraged throughout labour, and when the labour was relatively short.

From the dawn of history until the beginning of the nineteenth century, the conduct of labour was commonly left to the care of unskilled women. Over this period of some three thousand years, the processes of labour remained shrouded in superstition and folklore, much of which still persists in today's “old wives' tales.” The use of the term “labour pain” as a synonym for uterine contraction, still remains in our medical literature, hallowed by such a powerful authority as the Bible.