Analgesia and coping with
labor pain can prevent suffering during childbirth. Nonpharmacologic methods help women manage
labor pain. Strong evidence is available for the efficacy of continuous one-to-one support from a woman trained to provide nonmedical care during labor, immersion in warm water during first-stage labor, and sterile water injected intracutaneously or subcutaneously at locations near a woman's lumbosacral spine to reduce back-
labor pain. Sterile water
injections also reduce the incidence of cesarean deliveries.
Nitrous oxide labor
analgesia is not potent, but helps women relax, gives them a sense of control, and reduces and distracts their perception of
pain. It is inexpensive; can be administered and discontinued safely, simply, and quickly; has no adverse effects on the normal physiology and progress of labor; and does not require intensive monitoring or co-interventions. Parenteral
opioids provide mild-to-moderate
labor pain relief, but cause side effects. Although observational studies have found associations between maternal use of
opioids and neonatal complications, little higher level evidence is available except that
meperidine is associated with low Apgar scores. Patient-controlled
intravenous administration of
remifentanil provides better
analgesia and satisfaction than other
opioids, but can cause severe side effects; continuous monitoring of arterial oxygen saturation,
anesthesia supervision, one-to-one nursing, and availability of
oxygen are recommended. The demand for inexpensive, simple, safe but effective
labor pain management for women will undoubtedly increase in places that lack wide access to it now.