Non-pharmacological nursing interventions used for pain management during labor and birth

1. Accueil /
2. Pregnancy /
3. Childbirth /

It’s possible to relieve labour pain without medication. The options available to you depend on various factors.

In this fact sheet

• Giving birth without pain medication
• Support
• Movement and changes in position
• Relaxation and breathing techniques
• Self-hypnosis
• Massages
• Acupressure and reflexology
• The Bonapace method
• Water immersion
• Other methods
• Things to keep in mind

Every mother-to-be envisions the birth of her child differently. The experience of pain during childbirth also varies widely from one woman to the next. For this reason, you should listen to your wants and needs and feel free to use whichever pain-relief method you’re most comfortable with, whether or not it involves pharmacological intervention.

Giving birth without pain medication

The most difficult aspect of childbirth is managing the pain. How you react to labour pain will primarily be determined by your preparedness and level of confidence. Other factors, such as your mental state, energy level, the position of the baby in your pelvis, and your health condition may also affect your perception of pain during labour.

Some women want to give birth without resorting to pain medication. Others prefer alternative pain management methods, resorting to pharmacological intervention only if necessary.

Whether or not they involve medication, pain-relief methods during childbirth can be complementary. This fact sheet covers the most common forms of non-pharmacological intervention. You can indicate the methods that interest you in your birth plan.

Support

The support you receive during childbirth is essential to effectively managing the pain. It’s best to have continuous support from the moment you go into labour.

In other words, you should have your partner, your doula, or a loved one by your side. Your support person will see to your needs, offer comfort and reassurance, and help you communicate with your care team.

Studies have shown that a woman’s satisfaction with the experience of childbirth and her sense of control are greater if she’s supported by a loved one, particularly if this person is her partner or a family member.

Continuous support during childbirth has a number of benefits:

• Shorter labour
• Fewer obstetric interventions, which increases the likelihood of spontaneous vaginal delivery
• Lower perception of pain
• Decreased use of analgesia
• Decreased anxiety, which helps the mother relax and persevere

Research has also shown that if the mother’s partner feels useful and competent during labour, there will be lasting benefits for both the couple and their newborn. Here are some examples:

• Communication within the couple is improved
• The father-child bond is established more quickly
• The couple’s relationship grows stronger
• Both mother and father feel a greater sense of parenting competence, which positively affects their parenting behaviour

Some women decide to hire a doula, even if their partner will be present at the birth. Part of the doula’s role in such cases is to bring the parents closer together so that they can support one another and share a sense of pride. This helps them gain confidence in their role as new parents.

If a woman is alone at the time of delivery, the nursing staff can provide continuous support throughout her labour, adapting to her needs while respecting her values and wishes.

Movement and changes in position

Walking between contractions and frequently changing position stimulates the progress of labour. In addition to making it easier for the baby to descend into the pelvis, these movements decrease your perception of pain while increasing your comfort and your baby’s well-being.

During labour, women are advised to change positions every 15–30 minutes. Trust your instincts. You’ll be able to sense what your body needs and recognize which positions aren’t working.

Keep in mind, however, that it’s generally recommended to avoid lying on your back for more than 30 minutes at a time. Staying in this position can reduce blood flow to the baby and cause your blood pressure to drop. It can also reduce the diameter of your pelvis, making it harder for the baby to pass through. What’s more, it tends to be less comfortable than other positions.

Here are some effective positions to try during labour:

• Vertical position [seated, semi-seated, standing, squatting, hanging]: Accelerates cervical dilation and helps the baby descend
• Lateral position [lying on your side]: Allows you to rest while facilitating the progression of labour
• Hands and knees or leaning forward: May facilitate the baby’s rotation

Certain accessories can help you get into a more comfortable position.

• Exercise ball: Supports the perineum and lower back and improves posture, balance, and coordination
• Birth seat: Can make it easier to get into squatting positions
• Bar: Very useful for hanging positions
• Cushions: Can be used to relieve pressure points or to help keep your pelvis tilted when you’re lying down
• Massage chair: Specially adapted to leave room for your belly

You can practise using these accessories during pregnancy to prepare for when you’re in labour. You’ll feel more in control of your body and more confident if you keep yourself moving.

During the second stage of labour, it’s important to change positions every 15 minutes. There are several you can try:

• Squatting: Opens up the pelvis
• Lateral position [lying on your side]: Changes the axis of the pelvis, making it wider while decreasing pressure on the perineum
• Hands and knees: Facilitates the baby’s rotation
• Seated or semi-seated: May promote the contraction of the uterus [and therefore shorten stage 2 of labour] and the baby’s descent into the birth canal. This position also gives you a better view of the baby.

Relaxation and breathing techniques

Fear and anxiety can cause muscle tension that increases your perception of pain. Relaxation techniques can help you stay calm and distract you from the pain.

A quiet, warm, and intimate atmosphere is a good starting point for reducing pain during childbirth. For example, you can try dimming the lights and playing soft music.

According to some experts, adding a few drops of essential oil to your bath water or massage oil may improve your well-being, reduce your anxiety, and decrease your perception of pain. You can also try dabbing a drop on your wrist, brow ridge, or pillow, or on a compress. This practice is known as aromatherapy.

In addition to relaxation techniques, breathing methods [such as the Lamaze approach] may help reduce pain and increase satisfaction with the experience of childbirth. Try to take slow, deep breaths. When breathing is a conscious act and not simply automatic, it promotes relaxation and ensures good oxygen flow to your baby. Try not to breathe too quickly, as this could cause you to hyperventilate.

Self-hypnosis

Self-hypnosis and related techniques, such as sophrology, can help you stay present during your delivery and approach it with a positive mindset. The goal is to reach a level of concentration where your perception of pain is reduced and replaced by pleasant thoughts. However, hypnosis is contraindicated in people with a history of psychosis or psychiatric disorders.

Massages

Being touched or massaged, or simply having your hand held by your support person, can make your pain more bearable, especially in the first stage of labour. Massages can relax tense muscles and reduce anxiety. Experts say that massages improve blood circulation and impede pain messages to and from the brain. Massages are also a way for the mother’s partner to be involved during labour.

Acupressure and reflexology

Acupressure is a technique that involves stimulating specific areas of the body to provide an anesthetic effect and reduce the pain of contractions. Since acupressure doesn’t require as much precision as acupuncture, it can be carried out by your partner with very little instruction. This technique can have different effects depending on which points are stimulated [e.g., relieves nausea or pain, stimulates labour or delivery of the placenta].

Acupressure reduces the use of oxytocin, a drug used to stimulate labour, in patients whose amniotic membranes have ruptured [i.e., their water has broken]. It also shortens labour by about 50 minutes and reduces the likelihood of a caesarean section or a forceps- or vacuum-assisted delivery.

Like acupressure, reflexology aims to reduce pain by stimulating specific pressure points, but only on the hands, feet, and ears. Reflexology can be used, among other things, to reduce the duration of labour and better regulate contractions.

The Bonapace method

The Bonapace method is a technique to physically and psychologically prepare for childbirth through yoga poses, breathing routines, physical exercises, and massages. It also involves meditation and mental imagery. With the Bonapace method, the mother’s partner has an important role during delivery, allowing the couple to strengthen their bond.

This approach requires parents to complete several weeks of preparatory training during pregnancy. There is also a book on the principles of the method [see Resources section].

Water immersion

At most birth locations, you can take a warm bath to relax and improve labour efficiency. To enjoy all the benefits of a bath, your belly must be completely immersed. Being in the water eases your movements and helps your baby get into position. In addition, the warmth of the water promotes better blood circulation in your uterus and helps relax your muscles.

Studies have shown that bathing during the first stage of labour can reduce pain, stimulate labour, and improve maternal satisfaction with the birthing experience. These effects are more pronounced when you first enter the water. During the first hour of use, the bath slows your awareness of the steadily increasing pain.

After one to two hours, however, the bath’s positive effects diminish, and it can even slow down labour. At this point, you can use another pain relief method and return to the bath later to experience its calming effects.

Other methods

The following methods require special tools or assistance from health care personnel.

TENS: While there’s no clear verdict on the effectiveness of TENS [transcutaneous electrical nerve stimulation], TENS units are available at some hospitals. You have full control over the device, which works by sending a low-intensity electrical impulse into your lower back, causing a tingling sensation. The purpose of TENS is to block pain signals, promote the release of pain-relieving hormones [endorphins], and reduce anxiety. TENS seems to be especially effective at the start of labour, as it helps your body build up endorphins before the pain becomes too great. TENS appears to be more effective in alleviating back pain.

Sterile water injection: If you choose this method, a nurse will inject small amounts of sterile water at specific locations on your lower back. You’ll experience a brief initial stinging sensation at the injection sites, followed by 45–120 minutes of pain relief. Note that this method specifically targets lower back pain and will not lessen pain in the abdomen or pelvis.

Hot or cold compresses: It can help to apply a hot or cold compress to the area where you feel the most pain [e.g., back, lower abdomen, perineum]. Compresses are safe to use throughout labour.

Things to keep in mind

• You should feel free to use whatever pain-relief method you’re most comfortable with, whether or not it involves drug intervention.
• Non-pharmacological pain relief measures can be complementary.
• Continuous support during labour plays an essential role in managing the pain.

Photo: iStock/BanksPhotos

Resources

Please note that hyperlinks to other websites are not updated regularly, and some may have changed since publication. If a link is no longer valid, use search engines to find the information you’re looking for.

Websites

• Information on doulas: aqan-qad.com
• Information on the Bonapace method: www.bonapace.com

Books

• Bolduc-Boutin, Diane. Et Dieu créa la femme . . . Mais . . . Quebec City, Les Éditions ATMA Internationales, 2013, 370 pp.
• Bonapace, Julie. Accoucher sans stress avec la méthode Bonapace. Montreal, Les Éditions de l’Homme, 2013, 150 pp.
• Brabant, Isabelle. Une naissance heureuse : bien vivre sa grossesse et son accouchement. Montreal, Fides, 2013, 575 pp.
• Gaskin, Ina May. Le guide de la naissance naturelle : retrouver le pouvoir de son corps. Paris, Mama Éditions, 2012, 496 pp.

Bibliography

• Allais, Gianni, et al. “Acupuncture in labor management.” Minerva Ginecologica, vol. 55, no. 6, 2003, pp. 503–510.
• Bonapace, Julie, et al. “Evaluation of the Bonapace Method: A specific educational intervention to reduce pain during childbirth.” Journal of Pain Research, vol. 6, 2013, pp. 653–661.
• CHUM Birthing Centre. “Votre accouchement : gérer la douleur de façon naturelle.” Montreal, Centre de littératie en santé du CHUM, 2013, 4 pp. www.chumontreal.qc.ca
• Cluett, Elizabeth R., and Ethel Burns. “Immersion in water in labour and birth.” Cochrane Database of Systematic Reviews, no. 2, 2009, art. no. CD000111.
• Derry, Sheena, et al. “Intracutaneous or subcutaneous sterile water injection compared with blinded controls for pain management in labor.” Cochrane Database of Systematic Reviews, no. 1, 2012, art. no. CD009107.
• Doré, Nicole, and Danielle Le Hénaff. From Tiny Tot to Toddler: A practical guide for parents from pregnancy to age two. Quebec City, Institut national de santé publique du Québec. www.inspq.qc.ca
• Hodnett, Ellen D., et al. “Continuous support for women during childbirth.” Cochrane Database of Systematic Reviews, no. 7, 2013, art. no. CD003766.
• Institut national de santé publique du Québec. “Travail et accouchement : composer avec la douleur.” Le portail d’information prénatale. www.inspq.qc.ca
• Jones, Leanne, et al. “Pain management for women in labour: An overview of systematic reviews.” Cochrane Database of Systematic Reviews, no. 3, 2012, art. no. CD009234.
• Lawrence, Annemarie, et al. “Maternal positions and mobility during first stage labour.” Cochrane Database of Systematic Reviews, no. 8, 2013, art. no. CD003934.
• Ladewig, Patricia W., et al. Soins infirmiers en périnatalité. 5th ed., Pearson ERPI, 2019.
• Lothian, Judith A. “Lamaze breathing: What every pregnant woman needs to know.” The Journal of Perinatal Education, vol. 20, no. 2, 2011, pp. 118–120.
• Simkin, Penny, and April Bolding. “Update on nonpharmacologic approaches to relieve labor pain and prevent suffering.” Journal of Midwifery & Women’s Health, vol. 49, no. 6, 2004, pp. 489–504.
• Smith, Caroline A., et al. “Aromatherapy for pain management in labour.” Cochrane Database of Systematic Reviews, no. 7, 2011, art. no. CD009215.
• Smith, Caroline A., et al. “Relaxation techniques for pain management in labour.” Cochrane Database of Systematic Reviews, no. 12, 2011, art. no. CD009514.
• Smith, Caroline A., et al. “Massage, reflexology and other manual methods for pain management in labour.” Cochrane Database of Systematic Reviews, no. 2, 2012, art. no. CD009290.
• American Academy of Pediatrics Committee on Fetus and Newborn and American College of Obstetricians and Gynecologists Committee on Obstetric Practice. “Immersion in water during labor and delivery.” Pediatrics, vol. 133, no. 4, 2014, pp. 758–761.