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Update on Nonpharmacologic Approaches to Relieve Labor Pain and Prevent Suffering


  • Penny Simkin PT,

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    • 1Penny Simkin, PT, is in private practice as a childbirth educator, doula, and birth counselor in Seattle, Washington. She serves on the editorial board of Birth: Issues in Perinatal Care and the boards of consultants of the International Childbirth Education Association, Seattle Midwifery School, and other organizations.

  • April Bolding PT

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    • 2April Bolding, PT, is a physical therapist, certified childbirth educator, doula, and water fitness instructor in Seattle, Washington.

1100 23rd Ave. East, Seattle, WA, 98112. E-mail:


The control of labor pain and prevention of suffering are major concerns of clinicians and their clients. Nonpharmacologic approaches toward these goals are consistent with midwifery management and the choices of many women. We undertook a literature search of scientific articles cataloged in CINAHL, PUBMED, the Cochrane Library, and AMED databases relating to the effectiveness of 13 non-pharmacologic methods used to relieve pain and reduce suffering in labor. Suffering, which is different from pain, is not an outcome that is usually measured after childbirth. We assumed that suffering is unlikely if indicators of satisfaction were positive after childbirth. Adequate evidence of benefit in reducing pain exists for continuous labor support, baths, intradermal water blocks, and maternal movement and positioning. Acupuncture, massage, transcutaneous electrical nerve stimulation, and hypnosis are promising, but they require further study. The effectiveness of childbirth education, relaxation and breathing, heat and cold, acupressure, hypnosis, aromatherapy, music, and audioanalgesia are either inadequately studied or findings are too variable to draw conclusions on effectiveness. All the methods studied had evidence of widespread satisfaction among a majority of users.