Relaxation techniques for pain management in labour
Abstract
Background
Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined currently available evidence supporting the use of relaxation therapies for pain management in labour.
Objectives
To examine the effects of relaxation methods for pain management in labour on maternal and perinatal morbidity.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2010), The Cochrane Complementary Medicine Field's Trials Register (November 2011), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 4), MEDLINE (1966 to 30 November 2010), CINAHL (1980 to 30 November 2010), the Australian and New Zealand Clinical Trial Registry (30 November 2010), Chinese Clinical Trial Register (30 November 2010), Current Controlled Trials (30 November 2010), ClinicalTrials.gov, (30 November 2010) ISRCTN Register (30 November 2010), National Centre for Complementary and Alternative Medicine (NCCAM) (30 November 2010) and the WHO International Clinical Trials Registry Platform (30 November 2010).
Selection criteria
Randomised controlled trials comparing relaxation methods with standard care, no treatment, other non‐pharmacological forms of pain management in labour or placebo.
Data collection and analysis
Three review authors independently assessed trials for inclusion and extracted data. Data were checked for accuracy. Two review authors independently assessed trial quality. We attempted to contact study authors for additional information.
Main results
We included 11 studies (1374 women) in the review. Relaxation was associated with a reduction in pain intensity during the latent phase (mean difference (MD) ‐1.25, 95% confidence interval (CI) ‐1.97 to ‐0.53, one trial, 40 women) and active phase of labour (MD ‐2.48, 95% CI ‐3.13 to 0.83, two trials, 74 women). There was evidence of improved outcomes from relaxation instruction with increased satisfaction with pain relief (risk ratio (RR) 8.00, 95% CI 1.10 to 58.19, one trial, 40 women) and lower assisted vaginal delivery (RR 0.07, 95% CI 0.01 to 0.50, two trials, 86 women). Yoga was associated with reduced pain (mean difference (MD) ‐6.12, 95% CI ‐11.77 to ‐0.47), one trial, 66 women), increased satisfaction with pain relief (MD 7.88, 95% CI 1.51 to 14.25, one trial, 66 women), satisfaction with the childbirth experience (MD) 6.34, 95% CI 0.26 to 12.42, one trial, 66 women), and reduced length of labour when compared to usual care (MD ‐139.91, 95% CI ‐252.50 to ‐27.32, one trial, 66 women) and when compared with supine position (MD ‐191.34, 95% CI ‐243.72 to ‐138.96, one trial, 83 women). Trials evaluating music and audio analgesia found no difference between groups in the primary outcomes pain intensity, satisfaction with pain relief, and caesarean delivery. The risk of bias was unclear for the majority of trials.
Authors' conclusions
Relaxation and yoga may have a role with reducing pain, increasing satisfaction with pain relief and reducing the rate of assisted vaginal delivery. There was insufficient evidence for the role of music and audio‐analgesia. However, there is a need for further research.
PICOs
Plain language summary
Relaxation techniques for pain management in labour
The pain of labour can be intense, with body tension, anxiety and fear making it worse. Many women would like to go through labour without using drugs, or invasive methods such as an epidural, and turn to complementary therapies to help to reduce their pain perception and improve management of the pain. Many complementary therapies are tried, including acupuncture, mind‐body techniques, massage, reflexology, herbal medicines or homoeopathy, hypnosis, music and aromatherapy. Mind‐body interventions such as relaxation, meditation, visualisation and breathing are commonly used for labour, and can be widely accessible to women through teaching of these techniques during antenatal classes. Yoga, meditation and hypnosis may not be so accessible to women, but together these techniques may have a calming effect and help the women to manage by providing a distraction from pain and tension. The review of eleven randomised controlled trials, with data reported on 1374 women, found that relaxation techniques and yoga may help manage labour pain. However, in these trials there were variations in how these techniques were applied in the trials. Single or limited number of trials reported less intense pain, increased satisfaction with pain relief, increased satisfaction with childbirth and lower rates of assisted vaginal delivery. More research is needed.
