• Central Nervous System Control;
  • diffuse noxious inhibitory control;
  • epidural analgesia;
  • gate control theory;
  • maternal outcomes;
  • meta-analysis;
  • neonatal outcomes;
  • nonpharmacologic approaches;
  • obstetric intervention;
  • pain relief in labor



To assess the effects of nonpharmacologic approaches to pain relief during labor, according to their endogenous mechanism of action, on obstetric interventions, maternal, and neonatal outcomes.

Data source

Cochrane library, Medline, Embase, CINAHL and the MRCT databases were used to screen studies from January 1990 to December 2012.

Study selection

According to Cochrane criteria, we selected randomized controlled trials that compared nonpharmacologic approaches for pain relief during labor to usual care, using intention-to-treat method.


Nonpharmacologic approaches, based on Gate Control (water immersion, massage, ambulation, positions) and Diffuse Noxious Inhibitory Control (acupressure, acupuncture, electrical stimulation, water injections), are associated with a reduction in epidural analgesia and a higher maternal satisfaction with childbirth. When compared with nonpharmacologic approaches based on Central Nervous System Control (education, attention deviation, support), usual care is associated with increased odds of epidural OR 1.13 (95% CI 1.05–1.23), cesarean delivery OR 1.60 (95% CI 1.18–2.18), instrumental delivery OR 1.21 (95% CI 1.03–1.44), use of oxytocin OR 1.20 (95% CI 1.01–1.43), labor duration (29.7 min, 95% CI 4.5–54.8), and a lesser satisfaction with childbirth. Tailored nonpharmacologic approaches, based on continuous support, were the most effective for reducing obstetric interventions.


Nonpharmacologic approaches to relieve pain during labor, when used as a part of hospital pain relief strategies, provide significant benefits to women and their infants without causing additional harm.