Pharmacologic and nonpharmacologic options for pain relief during labor: an expert review.

Labor pain is among the most severe types of physical pain that women may experience during their lifetime. Thus, pain relief is an essential part of medical care during childbirth. Epidural analgesia is considered to be the most efficient method of pain relief during labor. Nevertheless, patient preferences, contraindications, limited availability, and technical failure may require the use of alternative pain reliving methods during labor including systemic pharmacologic agents, and nonpharmacologic methods. Nonpharmacologic methods for pain alleviation during vaginal birth have become popular over the years, either as a complement to pharmacologic agents or at times as the principal therapy. Methods such as relaxation techniques (ie, yoga, hypnosis, and music), manual techniques (ie, massage, reflexology, and shiatsu), acupuncture, birthing ball, and transcutaneous electrical nerve stimulation are considered safe, although the evidence supporting their effectiveness for pain relief is not as robust as it is for pharmacologic agents. Systemic pharmacologic agents are mostly administered by inhalation (nitrous oxide) or through the parenteral route. These agents include opioids such as meperidine, nalbuphine, tramadol, butorphanol, morphine, and remifentanil, and non-opioid agents such as parenteral acetaminophen and nonsteroidal anti-inflammatory drugs. Systemic pharmacologic agents suggest a diverse armamentarium of medication for pain management during labor. Their efficacy in treating pain associated with labor varies, and some continue to be used even though they have not been proven effective for pain relief. In addition, the maternal and perinatal side effects differ markedly among these agents. There is a relative abundance of data regarding the effectiveness of analgesic drugs compared with epidural, but the data regarding comparisons among the different types of alternative analgesic agents are scarce, and there is no consistency regarding the drug of choice for women who do not receive epidural pain management. This review aims to present the available data regarding the effectiveness of the different methods of relieving pain during labor other than epidural. The data presented are mainly based on recent level I evidence regarding pharmacologic and nonpharmacologic methods for pain relief during labor.

The effect of ylang oil and lemon oil inhalation on labor pain and anxiety pregnant women: A randomized controlled trial.

BACKGROUND: and purpose: To date, there has been very limited experimental research on the impact of ylang ylang oil and lemon oil inhalation labor pain. This study was conducted to investigate the effects of aromatherapy, one of the non-pharmacological pain methods, on anxiety and labor pain in the active phase in primiparous pregnant women. METHODS: A randomized controlled trial design was used in the study, which was conducted with 45 primiparous pregnant women. Volunteers were randomized into the lemon oil group (n = 15), ylang-ylang oil group (n = 15), and control group (n = 15) by using the sealed envelope method. The visual analog scale (VAS) and the state anxiety inventory were applied to the intervention and control groups before the application. After the application, the VAS and the state anxiety inventory were applied at 5-7 cm dilatation and the VAS was applied alone at 8-10 cm dilatation. The trait anxiety inventory was applied to the volunteers after delivery. RESULTS: The mean pain scores at 5-7 cm dilatation in the intervention groups (lemon oil 6.90, ylang ylang oil, 7.30) were significantly lower than in the control group (9.20) (p = 0.005). There was no significant difference between the groups in terms of their mean pre-intervention and 5-7-cm-dilatation anxiety scores (p = 0.750; p = 0.663), mean trait anxiety scores (p = 0.094), and mean first-and fifth-minute Apgar scores (p = 0.051; p = 0.051). CONCLUSION: It was found that aromatherapy applied by inhalation at labor reduced the perception of labor pain but had no effect on anxiety.

Determining the effect of inhalation and lavender essential oil massage therapy on the severity of perceived labor pain in primiparous women: A randomized controlled trial.

BACKGROUND: This research aimed to reveal the effect of lavender essence inhalation and the massage therapy applied with lavender oil on the severity of labor pain of primiparous women. METHODS: This randomized controlled trial was conducted with three groups. Pregnant women participating in the study were randomly divided into control group (n=40), lavender essence inhalation group (n=44) and lavender essence massage (n=37) groups. The applications were divided in three for each phase in the first stage of labor (early, active and transition). Thereafter sacral compression and circular massage were applied for 15 minutes on the lower back (waist) region of the participants by using 2 drops of lavender oil in each phase of labor; 2 drops of lavender oil were dripped onto the palms of the participants in the inhalation group by the researcher and they were asked to inhale it for 3 minutes. Research data were collected using Personal Information Form (PIF), Visual Analogue Scale (VAS) and Postpartum Assessment of Women Survey (PAWS). RESULTS: The results of the research revealed that the labor pain perceived by the women who were applied inhalation and massage therapy using lavender essential oil were milder compared to the control group (p<0.05). Another finding of the research revealed that the lavender oil inhalation gave the best results in the latent phase, however the massage therapy with lavender oil was more effective in the active and transition phases. CONCLUSION: Inhalation and massage therapy applied using lavender essential oil contributed to the alleviation of perceived labor pain. For this reason, massage therapy and inhalation applications using lavender oil are recommended to be applied by midwives as a complementary method to adapt to labor pain during delivery.

Transcutaneous Electrical Nerve Stimulation for Post-Cesarean Birth Pain Control: A Randomized Controlled Trial.

OBJECTIVE: To evaluate whether transcutaneous electrical nerve stimulation (TENS) reduces opioid use after cesarean birth. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of TENS after cesarean birth, with the primary outcome of opioid use during the first 60 hours postoperatively. Secondary outcomes included pain scores and satisfaction with pain control on each postoperative day, duration of postoperative hospitalization, and adverse effects of TENS. We estimated 60 patients in each arm for 80% power to detect a 25% decrease in opioid use, assuming 10% attrition. To assess for a placebo effect, an additional 60 patients were randomized to no TENS during recruitment for secondary analyses comparing opioid use, pain scores, and pain control satisfaction between no TENS and placebo TENS. Analysis was by intention-to-treat. RESULTS: From January 2020 through March 2021, we enrolled 180 participants-60 per group. Baseline characteristics were similar across groups. Median (interquartile range) opioid consumption in the first 60 hours postoperatively, in morphine milligram equivalents, was 7.5 (0-30) with active TENS and 0 (0-22.5) with placebo TENS (P=.31). There were no significant differences in pain scores, satisfaction with pain control, or postoperative length of stay. In the no TENS group, median (interquartile range) opioid consumption in the first 60 hours postoperatively was 7.5 (0-21.9), similar to that in the placebo group (P=.57). There were also no significant differences in pain scores or pain control satisfaction between participants allocated to no TENS and those allocated to placebo TENS. CONCLUSION: Use of TENS after cesarean birth did not change hospital opioid consumption, pain scores, or length of postoperative stay. There was no evidence for a placebo effect of TENS on opioid use or pain scores. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT04399707. FUNDING SOURCE: Cardinal Health.

The effect of continuous supportive care on birth pain, birth fear, midwifery care perception, oxytocin use, and delivery time during the intrapartum period: An experimental study.

BACKGROUND: Intrapartum professional midwifery support can improve the coping skills with the fear of childbirth and birth pain, increase the perception of the woman, and prevent negative experiences. However, there are relatively few studies supporting this postulation. AIMS: To investigate the effects of supportive care given during labor on birth pain, birth fear, perception of midwifery care, oxytocin use, and delivery time. PATIENTS AND METHODS: This is a quasi-experimental study. We collected the data between January and June 2019 in a province in Central Anatolia, Turkey. Primiparous 102 pregnant women were included in the study. However, we excluded five pregnant women from the intervention group and four pregnant women from the control group as emergency cesarean section developed. In total, 93 pregnant women, 46 in the continuous supportive care intervention group, and 47 in the usual intrapartum care control group were evaluated. The following tools were used to collect data: The Delivery Fear Scale, a Visual Analog Scale for perceived pain, the Scale of Women's Perception for Supportive Care Given During Labor, and labor outcomes information form. RESULTS: The participants in the intervention group receiving continuous intrapartum supportive care had less fear of birth and lower birth pain in the active and transitional stages of labor, their midwifery care perception increased, and the duration of labor was shorter (P < 0.05). However, there was no significant difference in oxytocin use between the two groups at 95% confidence interval (-0.265-0.091) (p > 0.05, Cohen's d = 0.2). CONCLUSION: Pregnant women who received continuous intrapartum supportive care had less fear of birth and reduced labor pain in active and transitional stages of labor. In addition, with the continuous supportive care provided, the perception of midwifery care of the pregnant women increased and the duration of labor decreased. Therefore, midwifery care support should be provided to women throughout their labor and delivery process.

Effect of intrapartum vitamin D levels on labor pain.

AIM: Vitamin D has widespread receptor distribution in the body, and therefore it has vital roles in numerous pathophysiological conditions. It also affects pain manifestation through its functions at various stages of the pain pathways. This study aimed to investigate the effects of intrapartum vitamin D levels on pain experienced by women during the first stage of labor. METHODS: A total of 127 term-nulliparous women at the early stage of labor were included in the study. Serum 25 (OH) vitamin D levels were measured at the beginning of labor to determine intrapartum vitamin D levels. Labor pain was assessed using the Visual Analog Scale at different stages of cervical dilation (VAS0 , VAS1 , VAS2 ). Postpartum pain (VASpp ) and women's birth satisfaction score (BSS) were also evaluated during the early postpartum period. RESULTS: There was a moderate negative correlation between vitamin D and VAS0 and VAS1 (r2  = 0.4, p = 0.000; r2  = -0.570, p = 0.000, respectively), and a weak negative correlation between vitamin D and VAS2 (r2  = -0.373, p = 0.000). No significant correlation was found between vitamin D and BSS and length of labor (p = 0.127, p = 0.126, respectively). CONCLUSION: In nulliparous women with low vitamin D levels, the first stage of labor and the early postpartum period may be more painful. To facilitate management of labor pain, during the antenatal period vitamin D levels should be monitored, and in cases where the levels are deficient, vitamin D supplementation should be started.

[Effect of transcutaneous electrical acupoint stimulation combined with epidural labor analgesia on postpartum depression].

OBJECTIVE: To observe the effect of transcutaneous electrical acupoint stimulation (TEAS)combined with epidural analgesia on postpartum depression and to explore its underlying mechanism. METHODS: One hundred and twenty cases of full-term primiparous women with singleton pregnancy were selected from May 2018 to November 2018 in Jinzhong Maternal and Child Health Hospital. The parturients with labor analgesia requirement were randomly divided into the epidural group and the combination group, and the parturients without labor analgesia requirement were used as the control group, with 40 cases in each group. Patients in the control group did not receive labor analgesia and were treated according to the routine procedures of natural delivery; patients in the epidural group received epidural labor analgesia; patients in the combination group received TEAS at bilateral Hegu(LI4), Sanyinjiao(SP6) and Zusanli(ST36) (2 Hz/100 Hz, the current intensity is gradually increased from 15 mA, and the treatment was performed every 2 h, 20 min each time) combined with epidural labor analgesia. The visual analogue scale (VAS) scores were recorded when the uterine orifice opened to 3, 6, 8, 10 cm. Plasma glutamate was measured using high-performance liquid chromatography before analgesia, at the end of the third stage of labor and 42 days after delivery, and Edinburgh postnatal depression scale (EPDS) score was measured at 42 days after delivery. RESULTS: In comparison with the control group, the VAS score, EPDS score and the incidence of postpartum depression of the epidural group and the combination group were significantly lower(P<0.05), and the combination group had significant decrease than those in epidural group (P<0.05). Immediately before analgesia, there was no statistically significant difference in glutamate levels among the 3 groups (P>0.05). Compared with the control group, at the end of the third stage of labor and 42 days postpartum, the glutamate levels of the epidural group and the combination group were significantly reduced(P<0.05), and the combination group decreased more significantly than the epidural group (P<0.05). CONCLUSION: TEAS combined with epidural analgesia can reduce the incidence of postpartum depression, possibly by down-regulating plasma glutamate level and relieving of labor pain.

Acupressure for labor pain management: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the efficacy/effectiveness of acupressure as an adjunct to standard procedures during labor and delivery, compared with standard procedures with/without sham acupressure, in randomized controlled trials (RCTs). METHODS: Ten main databases were searched from their inception until 31 January 2018. Two reviewers independently extracted data concerning the effects of acupressure on pain intensity, labor duration, mode of delivery, use of medications and adverse events. A meta-analysis of these measures was performed using RevMan 5.3. Pooled standardized mean differences (SMDs) or odds ratios (ORs) for the above outcomes were estimated with a fixed or random effects model, according to the heterogeneity. RESULTS: A total of 13 RCTs including 1586 enrolled patients met the eligibility criteria. Acupressure plus standard procedures (ASP) for labor management significantly reduced pain sensation, compared with sham acupressure plus standard procedures (SASP) and standard procedures (SP) alone. The analgesic effect of acupressure was immediate and persisted for at least 60 min (all p < 0.01). Compared with the untreated control groups, the acupressure group had a shorter duration of labor, especially the first stage of labor (SMD = -0.76, 95% confidence interval (CI) = -1.10 to -0.43; p < 0.001; I2 = 74%) and second stage of labor (SMD = -0.37, 95% CI = -0.59 to -0.18; p < 0.001; I2 = 0%). Data suggesting that acupressure reduced the Cesarean section rate was inconclusive. The use of pharmacologic agents (oxytocin and analgesics) did not differ between the ASP, SASP and SP groups. No adverse events were reported in this limited number of studies. CONCLUSION: Moderate evidence indicates that acupressure may have promising effects on labor pain and duration. However, high-quality trials to verify these findings are warranted.

Tecnologias não invasivas para o alívio da dor na parturição / Non-invasive technologies for pain relief in parturition / Tecnologías no invasivas para el alivio del dolor durante en el parto

Objetivo: Analisar as tecnologias não invasivas de alívio da dor no parto e nascimento. Método: Revisão integrativa de literatura, com 13 artigos obtidos nas bases de dados Web of Science, Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde, SciVerse Scopus TopCited, Medical Literature Analysis and Retrieval System Online e a biblioteca virtual Scientific Electronic Library Online entre o período de 2010 a 2016. Resultados: Observou o uso de mais de duas tecnologias não farmacológicas no processo de parto e nascimento, como aromaterapia isolada ou somada a mais uma tecnologia; aplicação isolada de frio e/ou calor; uso da bola suíça/bola de parto. Conclusão: A utilização de novas tecnologias no processo parturitivo resgata a autonomia da mulher frente ao seu corpo

Objective: To analyze the non-invasive technologies of pain relief in labor and birth. Method: Integrative literature review, with 13 articles from the Web of Science database, Cumulative Index to Nursing and Allied Health Literature databases, Latin American and Caribbean Literature in Health Sciences, SciVerse Scopus TopCited, Medical Literature Analysis and Retrieval System Online, and the library Scientific Electronic Library Online between 2010 and 2016. Results: Observed the use of more than two non-pharmacological technologies in the delivery and birth process, such as aromatherapy alone or added to another technology; isolated application of cold and / or heat; use of the Swiss ball / birth ball. Conclusion: The use of new technologies in the parturition process rescues the autonomy of women in front of their bodies

Objetivo: Analizar tecnologías no invasivas de alivio del dolor en el parto y el nacimiento. Método: Revisión integrativa de literatura, con 13 artículos de las bases de datos de Web of Science, de Contenido etiquetado de la literatura y la literatura en América Latina y el Caribe, en Ciencias de la Salud, SciVse Scopus TopCited, Medical Literature Analysis and Retrieval System Online y la biblioteca Scientific Electronic Library virtual en línea entre el periodo de 2010 a 2016. Resultados: Observó el uso de más de dos tecnologías no farmacológicas en el parto y el proceso de parto, como la aromaterapia sola o agregada a otra tecnología; aplicación aislada de frío y / o calor; uso de la bola suiza / bola de nacimiento. Conclusión: El uso de nuevas tecnologías en el proceso de parto rescata la autonomía de las mujeres frente a sus cuerpos

Marijuana During Labour: A Survey of Maternal Opinions.

OBJECTIVE: There is increasing use of marijuana during pregnancy, and online accounts indicate that women are considering use of marijuana for labour pain. However, the number and attitudes of women who would consider this are unknown. METHODS: In a university hospital, over a period of 1 month, a total of 132 women with vaginal deliveries completed a survey exploring attitudes towards labour analgesia and marijuana use. Patients who would and would not consider marijuana for labour pain were compared using chi-square analysis. RESULTS: The percentages of respondents who reported having epidural or intravenous analgesia were 83% (95% confidence interval [CI] 76-89) and 30% (95% CI 23-38), respectively, with 87% (95% CI 79-92) and 86% (95% CI 71-94) being satisfied. However, 34% (95% CI 26-43) of the respondents reported that they would consider the use of marijuana for labour pain. Of these, 25% (95% CI 14-41) had previously used marijuana for pain compared with 0% (95% CI 0-0) who had not, and 72% (95% CI 56-84) thought it acceptable to use marijuana non-medically compared with 35% (95% CI 26-47) who did not (P < 0.001 for both). The greatest worry was the effect of marijuana on the baby, with 26% (95% CI 19-34) being highly worried and 26% (95% CI 19-34) being extremely worried. Many women (60%; 95% CI 51-68) indicated a lack of knowledge of the side effects of marijuana in labour. However, 59% (95% CI 50-67) of respondents said they would feel comfortable discussing this topic with their obstetrician. CONCLUSION: One third of women would consider the use of marijuana for labour pain, although many are unsure of its effects. Most women would feel comfortable discussing this topic with their obstetrician.

Relation between Length of Exposure to Epidural Analgesia during Labour and Birth Mode.

OBJECTIVE: To appraise the relationship between the length of exposure to epidural analgesia and the risk of non-spontaneous birth, and to identify additional risk factors. This study is framed within the MidconBirth project. STUDY DESIGN: A multicentre prospective study was conducted between July 2016 and November 2017 in three maternity hospitals in different Spanish regions. The independent variable of the study was the length of exposure to epidural analgesia, and the dependent variable was the type of birth in women with uncomplicated pregnancies. The data was analyzed separately by parity. A multivariate logistic regression was performed. The odds ratios (OR), using 95% confidence intervals (CI) were constructed. MAIN OUTCOME MEASURES: During the study period, 807 eligible women gave birth. Non-spontaneous births occurred in 29.37% of the sample, and 75.59% received oxytocin for augmentation of labour. The mean exposure length to epidural analgesia when non-spontaneous birth happened was 8.05 for primiparous and 6.32 for multiparous women (5.98 and 3.37 in spontaneous birth, respectively). A logistic regression showed the length of exposure to epidural during labour was the major predictor for non-spontaneous births in primiparous and multiparous women followed by use of oxytocin (multiparous group). CONCLUSIONS: The length of exposure to epidural analgesia during labour is associated with non-spontaneous births in our study. It highlights the need for practice change through the development of clinical guidelines, training programs for professionals and the continuity of midwifery care in order to support women to cope with labour pain using less invasive forms of analgesia. Women also need to be provided with evidence-based information.

Knowledge and use of sterile water injections amongst midwives in the United Kingdom: A cross-sectional study.

BACKGROUND: The use of sterile water injections (SWI) for the relief of pain in labour is popular amongst midwives in countries such as Sweden and Australia. Anecdotal reports suggest the procedure is used less commonly in the United Kingdom (UK) and that a number of barriers to introducing the practice may exist. OBJECTIVE: The objective of this study was to explore the awareness and use of SWI amongst midwives in the UK. DESIGN: A cross-sectional study using an internet-based questionnaire. PARTICIPANTS: Midwives with Nursing and Midwifery Council Registration and currently practicing. SETTING: The questionnaire was distributed via the Royal College of Midwives Facebook page and Twitter account. Invitations to participate were also sent to Heads of Midwifery to distribute to staff. FINDINGS: Three hundred and ninety-eight midwives completed the survey. Eighty-two percent of midwives did not use SWI in practice although 69% would consider learning the procedure. There was considerable variation in techniques amongst midwives that did provide SWI. The lack of available practice guidelines and the advice from the National Institute for Health and Care Excellence to not use SWI were cited as the main barriers. KEY CONCLUSIONS: SWI use is uncommon in the UK although midwives are interested in incorporating the procedure into practice. IMPLICATIONS FOR PRACTICE: National guidance on SWI and the lack of information and training is restricting the use of the procedure in practice, despite SWI being widely used in other countries and being effective in the treatment of pain in labour.

Parenteral opioids for maternal pain management in labour.

BACKGROUND: Parenteral opioids (intramuscular and intravenous drugs including patient-controlled analgesia) are used for pain relief in labour in many countries throughout the world. This review is an update of a review first published in 2010. OBJECTIVES: To assess the effectiveness, safety and acceptability to women of different types, doses and modes of administration of parenteral opioid analgesia in labour. A second objective is to assess the effects of opioids in labour on the baby in terms of safety, condition at birth and early feeding. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (11 May 2017) and reference lists of retrieved studies. SELECTION CRITERIA: We included randomised controlled trials examining the use of intramuscular or intravenous opioids (including patient-controlled analgesia) for women in labour. Cluster-randomised trials were also eligible for inclusion, although none were identified. We did not include quasi-randomised trials. We looked at studies comparing an opioid with another opioid, placebo, no treatment, other non-pharmacological interventions (transcutaneous electrical nerve stimulation (TENS)) or inhaled analgesia. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the quality of each evidence synthesis using the GRADE approach. MAIN RESULTS: We included 70 studies that compared an opioid with placebo or no treatment, another opioid administered intramuscularly or intravenously or compared with TENS applied to the back. Sixty-one studies involving more than 8000 women contributed data to the review and these studies reported on 34 different comparisons; for many comparisons and outcomes only one study contributed data. All of the studies were conducted in hospital settings, on healthy women with uncomplicated pregnancies at 37 to 42 weeks' gestation. We excluded studies focusing on women with pre-eclampsia or pre-existing conditions or with a compromised fetus. Overall, the evidence was graded as low- or very low-quality regarding the analgesic effect of opioids and satisfaction with analgesia; evidence was downgraded because of study design limitations, and many of the studies were underpowered to detect differences between groups and so effect estimates were imprecise. Due to the large number of different comparisons, it was not possible to present GRADE findings for every comparison.For the comparison of intramuscular pethidine (50 mg/100 mg) versus placebo, no clear differences were found in maternal satisfaction with analgesia measured during labour (number of women satisfied or very satisfied after 30 minutes: 50 women; 1 trial; risk ratio (RR) 7.00, 95% confidence interval (CI) 0.38 to 128.87, very low-quality evidence), or number of women requesting an epidural (50 women; 1 trial; RR 0.50, 95% CI 0.14 to 1.78; very low-quality evidence). Pain scores (reduction in visual analogue scale (VAS) score of at least 40 mm: 50 women; 1 trial; RR 25, 95% CI 1.56 to 400, low-quality evidence) and pain measured in labour (women reporting pain relief to be "good" or "fair" within one hour of administration: 116 women; 1 trial; RR 1.75, 95% CI 1.24 to 2.47, low-quality evidence) were both reduced in the pethidine group, and fewer women requested any additional analgesia (50 women; 1 trial; RR 0.71, 95% CI 0.54 to 0.94, low-quality evidence).There was limited information on adverse effects and harm to women and babies. There were few results that clearly showed that one opioid was more effective than another. Overall, findings indicated that parenteral opioids provided some pain relief and moderate satisfaction with analgesia in labour. Opioid drugs were associated with maternal nausea, vomiting and drowsiness, although different opioid drugs were associated with different adverse effects. There was no clear evidence of adverse effects of opioids on the newborn. We did not have sufficient evidence to assess which opioid drug provided the best pain relief with the least adverse effects. AUTHORS' CONCLUSIONS: Though most evidence is of low- or very-low quality, for healthy women with an uncomplicated pregnancy who are giving birth at 37 to 42 weeks, parenteral opioids appear to provide some relief from pain in labour but are associated with drowsiness, nausea, and vomiting in the woman. Effects on the newborn are unclear. Maternal satisfaction with opioid analgesia was largely unreported. The review needs to be examined alongside related Cochrane reviews. More research is needed to determine which analgesic intervention is most effective, and provides greatest satisfaction to women with acceptable adverse effects for mothers and their newborn.

Efficacy of aromatherapy for reducing pain during labor: a randomized controlled trial.

BACKGROUND: Many strategies for labor pain management have been studied, including aromatherapy, which is a noninvasive, alternative medicine used as an adjunct for labor pain control. Nevertheless, the results were contradictory. Therefore, we conducted this study to determine the effectiveness of aromatherapy for reducing pain during labor. METHODS: A randomized controlled trial was carried out on Thai laboring primigravidae who were a low-risk singleton pregnancy undergoing vaginal delivery. All participants, both study and control group, received standard obstetric care. Aromatherapy was only provided to the study group during the first stage of labor. The women rated their pain intensity by rating scales at different stages of labor. The primary outcome was pain scores and the secondary outcomes were necessity of painkiller usage, labor time, aromatherapy-associated complications, route of delivery, and Apgar scores. RESULTS: A total of 104 women were recruited, 52 in each group. Baseline characteristics and baseline pain scores were comparable. The median pain score of latent and early active phase was lower in the aromatherapy group, 5 vs 6 and 7 vs 8, respectively. The mean differences of pain scores between latent and early active phase and the baseline were significantly lower in the aromatherapy group, 1.88 vs 2.6 (p = 0.010) and 3.82 vs 4.39 (p = 0.031), respectively. Late active phase pain scores and other perinatal outcomes were not significantly different. CONCLUSION: Aromatherapy is helpful in reducing pain in latent and early active phase, and can probably be used as an adjunctive method for labor pain control without serious side effects.

'Tough love': The experiences of midwives giving women sterile water injections for the relief of back pain in labour.

OBJECTIVE: To explore midwives' experiences of administering sterile water injections (SWI) to labouring women as analgesia for back pain in labour. DESIGN: A qualitative study, which generated data through semi-structured focus group interviews with midwives. Data were analysed thematically. SETTING: Two metropolitan maternity units in Queensland, Australia. PARTICIPANTS: Eleven midwives who had administered SWI for back pain in labour in a randomised controlled trial. FINDINGS: Three major themes were identified including: i. SWI, is it an intervention?; ii. Tough love, causing pain to relieve pain; iii. The analgesic effect of SWI and impact on midwifery practice. KEY CONCLUSIONS: Whilst acknowledging the potential benefits of SWI as an analgesic the midwives in this study described a dilemma between inflicting pain to relieve pain and the challenges encountered in their discussions with women when offering SWI. Midwives also faced conflict when women requested SWI in the face of institutional resistance to its use. IMPLICATIONS FOR PRACTICE: The procedural pain associated with SWI may discourage some midwives from offering women the procedure, providing women with accurate information regarding the intensity and the brevity of the injection pain and the expected degree of analgesic would assist in discussion about SWI with women.

The effect of aromatherapy with lavender essence on severity of labor pain and duration of labor in primiparous women.

OBJECTIVE: The aim of this study was to investigate the effect of Lavender essence inhalation on severity of labor pain and duration of labor. METHODS AND MATERIALS: This single-blind, randomized clinical trial was conducted on 120 pregnant women in two groups. The experimental group received 2 drops of Lavender essence inhaled at three stages (4-5, 6-7, 8-9 cm cervical dilation) and severity of the labor pain and duration of labor was measured before and after intervention. The control group was treated with distilled water as a placebo in the similar ways, too. RESULTS: The results showed that difference in the labor pain before and after intervention in two groups was significant (P = 0/001). But there was no difference in mean duration of the active phase and the second stage of labor between the two groups. CONCLUSION: Lavender essence aromatherapy may be an effective therapeutic option for pain management for women in labor.

A randomized controlled trial comparing Pentazocine and Chamomilla recutita for labor pain relief.

BACKGROUND: Traditional birth attendants in Pakistan sometimes use a homeopathic remedy, Chamomilla for labor pain relief. Our study compares this homeopathic remedy for pain relief in labor with a commonly used parenteral analgesic in a hospital setting. No systematic study has been conducted previously to study the effect of chamomile, which may be affordable and available in community settings. METHODS: A double blind randomized controlled trial was carried out at Islamic International Medical College Trust. Ninety-nine normal pregnant women were randomly assigned into three groups. Each group received one of the three trial drugs; Chamomile, Pentazocine or placebo. The efficacy of labor analgesia was assessed by using Visual Analogue Scale (VAS) for pain intensity. Indicators of maternal and child health were recorded as were adverse effects of the drugs. RESULTS: Mean pain scores in the three groups were calculated and compared. The difference in mean VAS scores in Pentazocine and Chamomilla recutita group as compared with placebo was not statistically significant. No significant adverse effects were noticed in any group except slight headache and dizziness in three parturients in Pentazocine group. CONCLUSION: Neither Pentazocine, or Chamomilla recutita offer substantial analgesia during labor.

Pain relief in childbirth: changing historical and feminist perspectives.

Pain during human childbirth is ubiquitous and severe. Opium and its derivatives constitute the oldest effective method of pain relief and have been used in childbirth for several thousand years, along with numerous folk medicines and remedies. Interference with childbirth pain has always been criticised by doctors and clergy. The 19th century saw the introduction of three much more effective approaches to childbirth pain; diethyl ether, chloroform and nitrous oxide. Access to pain relief was demanded by the first wave of feminist activists as a woman's right. They popularised the use of 'twilight sleep', a combination of morphine and scopolamine, which fell into disrepute as its adverse effects became known. From the 1960s, as epidural analgesia became more popular, a second wave of feminists took the opposite position, calling for a return to non-medicalised, female-controlled, 'natural' childbirth and, in some cases, valorising the importance of the pain experience as empowering for women. However, from the 1990s, a third wave of feminist thought has begun to emerge, revalidating a woman's right to choose a 'technological', pain-free birth, rather than a 'natural' one, and regarding this as a legitimate feminist position.

Functional discomfort and a shift in midwifery paradigm.

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.