Nonpharmacologic Labor Pain Management | Newton-Wellesley Hospital (2022)

Comfort measures that provide natural pain relief can be very effective during labor and childbirth. Birthing techniques such as hydrotherapy, hypnobirthing, patterned breathing, relaxation, and visualization can increase the production of endogenous endorphins that bind to receptors in the brain for pain relief. Other methods of comfort therapy such as effleurage (light rhythmic stroking of the abdomen), massage, emptying the bladder, and hydrotherapy can provide pain relief and reduce the need for narcotic analgesia or anesthesia by naturally creating competing impulses in the central nervous system that can prevent the painful stimuli of labor contractions from reaching the brain.

Learn more about natural birthing techniques:

  • Birthing Ball
  • Patterned Breathing
  • Beverages
  • Movement and Position Changes
  • Superficial Heat and Cold
  • Counter-Pressure
  • Touch and Massage
  • Aromatherapy
  • Hydroptherapy
  • Focus and Distraction
  • Audio-analgesia

Birthing ball
Few labor tools are as simple, beneficial, and versatile as the birthing ball. Birthing balls are professionally made for use in physical therapy and have been used for years to properly exercise and rehabilitate patients. The birthing ball has now found a new home in birthing centers and hospital obstetric departments across the country. The ball easily withstands the pressure applied by the weight of the laboring woman.

(Video) Dr. Kim Vacek: Non-pharmacological Pain Interventions

It is safe to use the birthing ball with both the external and internal electronic fetal heart monitor.

If your amniotic membranes are ruptured, and the baby is still quite high (meaning how high the baby is in the pelvis, or pelvic station), depend on your nurse or care provider (physician or midwife) to tell you if it is safe to use the ball. If the baby remains “high,” active labor and use of the birthing ball may help to bring the baby down into the pelvis. If you are allowed to sit in a chair or walk in the hallways, it is safe to use the birthing ball.

When using the birthing ball, it is important to have your birth partner “spot” you at all times. The safest way for your birth partner to spot you is to have him/her sit in a chair with legs apart, while you sit on the birthing ball positioned in between them. Other positions are discussed below.

Use of the birthing ball is becoming much more common. Because it is one of the newest pieces of “birthing equipment,” substantial formal research has not been completed which will confirm the advantages of using it as a labor aid. Still, it is undeniable that many laboring women find the birthing ball effective as a comfort measure during labor.

(Video) Managing Pain During Labor without Medication

Here are just a few reasons for using the birthing ball during labor:

  • Sitting on the birthing ball keeps the baby properly aligned in the pelvis
  • The ball encourages pelvic mobility
  • Pregnant women find it easier to get up and down from the ball than a standard chair or sofa during labor
  • The ball encourages the baby to drop down further (descend) into the pelvis by allowing gravity to work with the laboring mother
  • The ball allows the laboring woman to shift her weight, rock her pelvis, and find comfortable positions to labor in more easily
  • The ball can be used when in the hands and knees position. This decreases the pressure and stress on the hands and wrists that traditionally affect the length of time the position can be used.

Patterned Breathing
These breathing techniques provide comfort and focus while enhancing labor progress. Patterned breathing enhances oxygen flow to your baby and is also vital to the contracting uterus.

Beverages
You should stay well hydrated while laboring. Laboring women may have clear liquids such as water, juice, broth, ice, and Popsicles.

Movement and Position Changes
You may experience less pain in some positions than in others during labor. Laboring women tend to find upright positions most comfortable such as sitting, standing, and walking. Many choose a lying down position as labor advances. Moving about during labor is usually more comfortable than staying still and can help labor progress by the simple effects of gravity and the changing shape of the pelvis. It may also relieve pain by shifting pressure and allowing the baby to move. You may try sitting, kneeling, standing, lying down, getting on your hands and knees, and walking.

(Video) Nonpharmacological Management of Pain

Superficial Heat and Cold
Heat can be effective when applied by using a hot water bottle, hot moist towels, or warm blankets. Superficial cold can come from an ice bag, washcloths soaked in ice water, or a bag of frozen peas. Hot compresses applied to the lower abdomen, groin or perineum, a warm blanket over the entire body and ice packs to the lower back or perineum can help alleviate labor pain. Using heat or cold on separate parts of the body at the same time can provide particularly effective pain relief. For example, apply a cool cloth to the forehead with warmth on the lower back. For maximum effect, change the heat and cold locations frequently, about every twenty minutes.

Counter-pressure
Counter-pressure consists of steady, strong force applied to one spot on the lower back during contractions using the heel of the hand, or pressure on the side of each hip using both hands. Counter-pressure helps alleviate back pain during labor, especially in those women experiencing “back labor.”

Touch and Massage
Touch can convey pain-reducing messages. A hand placed on a painful spot, a pat of reassurance, stroking the cheek in an affectionate gesture, or a tight embrace can communicate a message of caring to the laboring woman.

Purposeful massage of the hand or other parts of the body also communicates caring. Massage takes the form of light or firm stroking, vibration, kneading, deep circular pressure, and continual steady pressure. Stroking or rubbing the neck, shoulders, back, thighs, feet or hands is an effective pain-reliever. No fancy techniques are required. Receptors in the brain receive the sensations of pleasure from the massage blocking reception of the painful stimuli of labor. Bare skin receives the signal best and unscented powders and lotions are helpful for massage.

(Video) Non-Pharmacological Pain Relief For Labour | Back Labour

Aromatherapy
Aromatherapy is the use of essential oils such as lavender, rose, camomile, and clary sage. These can be administered in a variety of ways including in oil during a massage, in hot water as a bath or footbath, a drop in the palm or on the forehead of the laboring woman or a drop on a warm face cloth. Aromatherapy reduces stress and tension during labor. Beware, however, that pregnant and laboring women are highly sensitive to smell. Be sure that you use a scent that you enjoy. Stop any comfort measure if and when it is no longer working for you.

Hydrotherapy
Hydrotherapy during labor (techniques using water) can be emotionally soothing and can also help with pain relief. Many of the private bathrooms in our labor suites include a Jacuzzi tub. The Jacuzzi can be used to recline in the bubbling water or by sitting on a shower stool to use the hand-held shower massage during active labor. Many women are comforted by the combination of warmth, water pressure, and the sound of the water. Advocates of hydrotherapy even suggest that immersion in water may accelerate labor, decrease blood pressure, and increase a laboring woman’s feeling of control over her birth.

Focus and Distraction
Many methods of coping with pain rely on the laboring woman’s ability to focus and use mind-diverting activities. Fear and anxiety cause the release of stress hormones. You can ease these feelings by envisioning a pleasant scene or, at times, visualizing what is actually happening such as the cervix opening or the baby moving down. Focusing one’s attention is a deliberate activity and is aided by verbal coaching, visualization, self-hypnosis, and concentration on a visual, auditory, or tactile stimulus.

Distraction is a more passive form of focusing attention by using stimuli from the environment that will draw attention away from your pain. Attention focusing and distraction are usually used with other strategies and may not be useful for severe pain.

(Video) Nonpharmacological Pain Relief During Labor

These techniques are meant to help you reduce fear, anxiety, and pain, and can also be helpful with any discomfort you may experience after the birth of your baby.

Audio-analgesia
Audio-analgesia (music, talk) are used to control pain in numerous situations including dental work, post-operative pain, burn treatment, and childbirth. Many childbirth educators use music in their classes to create a peaceful and relaxing environment and they advocate for its use during labor as an aid to relaxation. Audio-analgesia for pain relief consists of soothing music between and during contractions.

Music creates a pleasant and relaxing environment and music transmitted through earphones can block out disturbing, distracting, or unpleasant sounds. Carefully chosen music can also reinforce rhythmic breathing patterns, massage strokes or facilitate focusing one’s attention. Music preferences vary widely. Feel free to choose your own music and bring your CDs with you. Each labor room at Newton-Wellesley Hospital is equipped with a Bose CD/Radio

FAQs

What are non pharmacological interventions for labor pain? ›

Comfort measures that provide natural pain relief can be very effective during labor and childbirth. Birthing techniques such as hydrotherapy, hypnobirthing, patterned breathing, relaxation, and visualization can increase the production of endogenous endorphins that bind to receptors in the brain for pain relief.

What are 3 types of pain management available during labor? ›

The three main medical pain-relieving options for labour include: Nitrous oxide. Pethidine. Epidural anaesthesia.
...
Epidural anaesthesia
  • The anaesthesia may not be complete and you may still experience some pain. ...
  • After the epidural has been inserted, your blood pressure may drop, causing you to feel faint and nauseated.

What is one nonpharmacological measures that the nurse should implement to manage pain for labor clients during the latent phase of labor? ›

When women are observed or admitted for pain or fatigue in latent labor, techniques such as education and support, oral hydration, positions of comfort, and nonpharmacologic pain management techniques such as massage or water immersion may be beneficial.

What are the different pain management techniques for labor? ›

Medicine-free ways to handle pain during labor include:
  • hypnosis.
  • yoga.
  • meditation.
  • walking.
  • massage or counterpressure.
  • changing position.
  • taking a bath or shower.
  • listening to music.

What are non-pharmacological strategies? ›

Non-pharmacological strategies include physical therapy, invasive procedures, psychological treatments and psychotherapy, which together with pharmacological therapies play a key role in the integrated approach to pain.

Why is non-pharmacological pain management important? ›

Previous research has suggested that using nonpharmacologic therapies to manage chronic pain may be effective not only in decreasing pain and improving function but also in reducing longer-term adverse effects such as substance use disorders and suicide attempts.

What are the 4 P's in labor? ›

The ability of the fetus to successfully negotiate the pelvis during labor and delivery depends on the complex interactions of four variables: uterine activity, the fetus, the maternal pelvis and maternal well-being. This is also known as the four Ps: power, passage, passenger and psyche.

What is the most common pain relief method during birth? ›

An epidural block (sometimes referred to as “an epidural”) is the most common type of pain relief used for childbirth in the United States. In an epidural block, medication is given through a tube placed in the lower back. For labor and vaginal delivery, a combination of analgesics and anesthetics may be used.

What are 3 non opiate approaches to pain relief? ›

But there are many non-opioid treatments available for pain, including prescription and over-the-counter aspirin, ibuprofen, and acetaminophen; nondrug remedies such as massage and acupuncture; and high-tech treatments using radio waves and electrical signals.

What are non pharmacologic nursing strategies for pain management give examples? ›

Non-pharmacological methods

These include measures for pain such as repositioning, elevating, using pillows for guarding and support, cooling measures, ice or heat therapy, light massage, mild stretching as allowed as well as using techniques such as imagery, meditation and distraction.

What are some non-pharmacological nursing strategies? ›

The most common non-pharmacological pain management methods include music therapy, relaxation techniques, repositioning, the use of a cold compress, respiratory and deep breathing exercises, massage, diet, prayer, exercise,20 the use of calming voices, and the provision of information.

What are some natural ways to reduce pain and stress during labor? ›

Non-medical pain relief during labour
  1. Active birth. Staying active is one of the most helpful things you can do to manage the pain of labour and birth. ...
  2. Massage and heat. Massage and hot packs can ease your pain in labour. ...
  3. Water immersion. ...
  4. Relaxation. ...
  5. Aromatherapy. ...
  6. Acupuncture. ...
  7. TENS. ...
  8. Sterile water injections.

What is the most effective pain management? ›

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are most effective for mild to moderate pain that's accompanied by swelling and inflammation. These drugs are commonly used for arthritis and pain resulting from muscle sprains, strains, back and neck injuries, or menstrual cramps.

What is a labor pain simulator? ›

It's typically used as a pain-reliever by administering mild electrical currents to the muscles in pain, but on a higher setting creates mild discomfort to pain, depending on the tolerance of the participant.

What are two means of natural pain management in active labor? ›

Natural Pain-Relief Methods (Also Called Natural Childbirth)

Relaxation techniques, such as deep breathing, music therapy, or biofeedback. A soothing atmosphere. Moving and changing positions frequently. Using a birthing ball.

What are 2 important non-pharmacological nursing interventions for a patient with chronic pain? ›

Provide non-pharmacological comfort measures.
...
Some examples of alternative and complementary therapies that can provide the patient with comfort are:
  • Meditation.
  • Prayer.
  • Magnets.
  • Chiropractic services.
  • Homeopathy.
  • Reiki.
  • Music therapy.
  • Acupuncture.

What is the difference between pharmacologic and non pharmacologic pain relief? ›

Pharmacological strategies consider the use of drugs to treat and relieve pain. Nonpharmacological strategies favor other modalities of care, especially during the modulation stage of the painful experience.

What are the non-pharmacological management methods for lower back pain? ›

Several nonpharmacologic, noninvasive therapies are available for low back pain, including exercise, complementary and alternative therapies (such as spinal manipulation, acupuncture, massage, and mind–body interventions), psychological therapies (such as cognitive behavioral and operant therapy), physical techniques ( ...

What are some non medication alternatives to relieve the patient's pain? ›

Here's a rundown of the most commonly used alternative treatments for chronic pain.
  • Acupuncture. Once seen as bizarre, acupuncture is rapidly becoming a mainstream treatment for pain. ...
  • Marijuana. ...
  • Exercise. ...
  • Chiropractic manipulation. ...
  • Supplements and vitamins. ...
  • Therapy. ...
  • Stress-reduction techniques.

Why is poor pain management common in hospitals? ›

Studies have revealed that a number of factors contribute to inadequate pain management: provider negligence, fragmented care, nurses' lack of adequate knowledge of and attitudes towards pain, and the lack of a system that engages, empowers and motivates nurses [11,12,13].

What is the meaning of non-pharmacological interventions? ›

Non-pharmacological intervention: defined as any sort of intervention not directly involving a medication; attempting to optimise a complex patient's healthcare needs21 or to better manage their chronic illness.

What are the 7 cardinal movements of labor? ›

The fetus negotiates the birth canal and rotational movements are necessary for descent. Anglo-American literature lists 7 cardinal movements, namely engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.

What causes Bandl's ring? ›

It is unclear what causes Bandl's ring. It is believed that prolonged labor may play a role in the development of a constriction ring [4]. Dystocia has also been implicated as both a cause and an effect [1]. The incidence of Bandl's ring is suggested to be 0.02% or one in every 5000 live births [5].

What are the 5 factors that affect labor and delivery? ›

At least five factors affect the process of labor and birth. These are easily remembered as the five Ps: passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychologic response.

How can I manage labor pains without an epidural? ›

Some natural pain management methods include:
  1. Breathing techniques, such as those taught in Lamaze.
  2. Massage.
  3. Essential oils or aromatherapy.
  4. Meditation.
  5. Hypnosis.
  6. Music therapy.
  7. Taking a warm bath or shower.
  8. Walking around.
30 Jun 2020

Which painkiller is best in pregnancy? ›

Paracetamol is the painkiller of choice for use in pregnancy and its use does not require medical supervision. It is not uncommon for women to have used other types of painkiller early in pregnancy before finding out they are pregnant. In general, this type of use is not expected to harm the baby.

Which of the following is a method to reduce pain during delivery without using medication? ›

Some of the techniques include hypnobirthing, mental relaxation, using music to create a soothing environment and having labor support. There are many ways to decrease pain in labor without the use of medications. These comfort measures can be very effective in providing some degree of pain relief.

What are three non pharmacological interventions? ›

Those may include, but are not limited to, mental health assessment, therapy, skills building, parenting assistance or family therapy. Medication should be only one part of a comprehensive treatment plan.

What is the most effective non opioid pain killer? ›

Many patients find that ibuprofen, a non-steroidal anti-inflammatory (NSAID), is all they need. In cases where ibuprofen alone is not enough, studies show that a combination of ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) actually works better than opioids following dental surgery.

Is there a non opioid painkiller? ›

Some examples of non-opioid pain medications include over the counter medications such as Tylenol (acetaminophen), Motrin (ibuprofen), and Aleve (naproxen). Some prescription medications may also be used to manage pain. Neurontin (gabapentin) is often prescribed to manage nerve pain.

Why are non pharmacological interventions important? ›

Non-pharmacological interventions manage pain, reduce stress, encourage positive changes in mood, reduce in depression, and increase awareness of self and environment (Blackburn et al., 2014). Some of the different types of non- pharmacological interventions are support groups, family support, and music therapy.

What are non pharmacological interventions for pain? ›

What are some non-drug treatments for pain?
  • Acupuncture involves stimulating acupuncture points. ...
  • Biofeedback techniques use electronic devices to measure body functions such as breathing and heart rate. ...
  • Electrical stimulation involves using a device to send a gentle electric current to your nerves or muscles.
27 Aug 2018

What are non pharmacological interventions in clinical practice? ›

Non-pharmacological interventions (NPI) or non-pharmacological therapies (NPT) are defined as any non-chemical intervention, which is theoretically supported, targeted and replicable, performed on a patient or caregiver and potentially capable of obtaining a relevant benefit [12].

How does massage relieve pain? ›

Therapeutic massage may relieve pain by way of several mechanisms, including relaxing painful muscles, tendons, and joints; relieving stress and anxiety; and possibly helping to “close the pain gate” by stimulating competing nerve fibers and impeding pain messages to and from the brain.

What helps ease the pain of contractions? ›

Warm water helps to relax between contractions, eases body aches, including back aces, improves circulation and is a safe and effective form of pain relief. Showers: Warm water helps with relaxation and decreases maternal tension during the peak of the contractions. Partners are invited to join to help with support.

What's the best way to ease contractions? ›

11 Ways to Ease Contractions Without Drugs
  1. Find a Soothing Environment. ...
  2. Choose Your Team Carefully. ...
  3. Learn About Labor and Delivery. ...
  4. Express Your Fears. ...
  5. Practice Rhythmic Breathing. ...
  6. Use Imagery and Visualization. ...
  7. Take a Warm Shower or Bath. ...
  8. Keep Moving.
30 Aug 2022

Is it possible to have a natural pain free birth? ›

How many people experience painless birth? We found a 1998 article in the American Journal of Nursing that suggested that 1% of people, or 1 in 100, do not experience pain during labor or childbirth.

What are some non-pharmacological nursing strategies? ›

The most common non-pharmacological pain management methods include music therapy, relaxation techniques, repositioning, the use of a cold compress, respiratory and deep breathing exercises, massage, diet, prayer, exercise,20 the use of calming voices, and the provision of information.

What are some different interventions used during childbirth? ›

Common Medical Interventions You Should Know About (Just in Case!)
  • Early induction.
  • Induction by artificial rupture of membranes.
  • Induction with Pitocin.
  • IV fluids.
  • Epidural and anesthesia.
  • Movement restrictions.
  • Continuous electronic fetal monitoring (EFM)
  • Directed pushing.

What are non pharmacologic nursing strategies for pain management give examples? ›

Non-pharmacological methods

These include measures for pain such as repositioning, elevating, using pillows for guarding and support, cooling measures, ice or heat therapy, light massage, mild stretching as allowed as well as using techniques such as imagery, meditation and distraction.

What are 2 important non-pharmacological nursing interventions for a patient with chronic pain? ›

Provide non-pharmacological comfort measures.
...
Some examples of alternative and complementary therapies that can provide the patient with comfort are:
  • Meditation.
  • Prayer.
  • Magnets.
  • Chiropractic services.
  • Homeopathy.
  • Reiki.
  • Music therapy.
  • Acupuncture.

What are three non pharmacological interventions? ›

Those may include, but are not limited to, mental health assessment, therapy, skills building, parenting assistance or family therapy. Medication should be only one part of a comprehensive treatment plan.

How do you relieve pain without medication? ›

8 non-invasive pain relief techniques that really work
  1. Cold and heat. These two tried-and-true methods are still the cornerstone of relieving pain for certain kinds of injuries. ...
  2. Exercise. ...
  3. Physical therapy and occupational therapy. ...
  4. Mind-body techniques. ...
  5. Yoga and tai chi. ...
  6. Biofeedback. ...
  7. Music therapy. ...
  8. Therapeutic massage.
28 Jul 2017

What is the most common pain relief method during birth? ›

An epidural block (sometimes referred to as “an epidural”) is the most common type of pain relief used for childbirth in the United States. In an epidural block, medication is given through a tube placed in the lower back. For labor and vaginal delivery, a combination of analgesics and anesthetics may be used.

What are the 4 P's of labor and delivery? ›

The ability of the fetus to successfully negotiate the pelvis during labor and delivery depends on the complex interactions of four variables: uterine activity, the fetus, the maternal pelvis and maternal well-being. This is also known as the four Ps: power, passage, passenger and psyche.

What is the most common way to manage a patient's pain during labor? ›

Epidural: This is the most common type of pain relief used during labor. If you choose to have an epidural, an anesthesiologist will insert a needle and a tiny tube, called a catheter, in the lower part of your back.

What are 3 non opiate approaches to pain relief? ›

But there are many non-opioid treatments available for pain, including prescription and over-the-counter aspirin, ibuprofen, and acetaminophen; nondrug remedies such as massage and acupuncture; and high-tech treatments using radio waves and electrical signals.

Videos

1. "Non-Pharmacologic Pain Management Strategies" by Catherine Dowling for OPENPediatrics
(OPENPediatrics)
2. Pain Management During Labor, Regional Anesthesia - Maternity Nursing - Labor & Delivery (L&D)
(Level Up RN)
3. Non-Pharmacological Approaches to Pain | Beaumont Integrative Medicine
(Beaumont Health)
4. Can Holding a Comb Help During Labour? | Non pharmacological Pain Management
(Ilenia Mazzoli)
5. Non Pharmacological pain management during labour by Mr. John Musonda | 8th TWCS 2022
(Texila e-Conference)
6. Labor Pain Management
(Catherine Tsai)

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