Management of Labor Pain: Non-pharmacological and Pharmacological Interventions for Pain Control During Childbirth

Purpose of ReviewLabor and delivery is accompanied by significant pain, likely the most severe pain most women will experience in their lifetime. Though physiological in nature, the majority women choose to receive analgesia for this reason. Being a multifaceted process, including both mind and body elements, different pharmacological and non-pharmacological modalities can be used to alleviate pain. This review covers basics and emerging evidence and discusses advantages and disadvantages of non-pharmacological, non-interventional pharmacological, and interventional techniques.Recent FindingsMultiple non-pharmacological techniques, including relaxation techniques, hydrotherapy, acupuncture and acupressure support pain alleviation during labor, and are continued to be studied; most of the current evidence is retrospective in nature. The addition of dexmedetomidine and remifentanil to the pharmacological milieu increases the spectrum of available interventions for those patients who are either averse or contraindicated to neuraxial anesthesia. Dural-puncture epidurals and programmed intermittent epidural bolus administration of epidural medications may reduce the amount of medication needed while increasing maternal satisfaction, and thus increasing the safety margin of these techniques.SummaryEpidural analgesia remains the gold standard for labor analgesia, as it provides the safest and most effective analgesia during labor and the potential for extension to cesarean anesthesia. Intravenous analgesics, mostly opioids, provide an alternative in those contraindicated, with an increase in side effects and decrease in efficacy. Non-pharmacological methods should be incorporated into multimodal approaches to labor analgesia, and in a select group of population may be the sole support for labor and delivery.