Labor Analgesia: A Systematic Review and Meta-Analysis of Non-Pharmacological Complementary and Alternative Approaches to Pain during First Stage of Labor

Abstract

the aim of the study was to conduct a meta-analysis to evaluate the efficacy of non-invasive and nonpharmacological techniques on labor first-stage pain intensity. Literature databases were searched from inception to May 2021, and research was expanded through the screening of previous systematic reviews. Inclusion criteria were: (1) population: women in first stage of labor; (2) intervention: non-pharmacological, non-invasive, or minimally invasive intrapartum analgesic techniques alternative and/or complementary to pharmacological analgesia; (3) comparison: routine intrapartum care or placebos; (4) outcomes: subjective pain intensity; and (5) study design: randomized controlled trial. Risk of bias of included studies was investigated, data analysis was performed using R version 3.5.1. Effect size was calculated as difference between the control and experimental groups at posttreatment in terms of mean pain score. A total of 63 studies were included, for a total of 6146 patients (3468 in the experimental groups and 2678 in the control groups). Techniques included were massage (n = 11), birth balls (n = 5) mind-body interventions (n = 8), heat application (n = 12), music therapy (n = 9), dance therapy (n = 2), acupressure (n = 16), and transcutaneous electrical nerve stimulation (TENS) (n = 8). The present review found significant evidence in support of the use of complementary and alternative medicine for labor analgesia, and different methods showed different impact. However, more high-quality trials are needed.

Effects of Acupoint Stimulation Combined with Low-frequency Pulsed Electrotherapy on Labor Pain in Women undergoing Trial of Labor: protocol for a stepped wedge cluster randomized controlled trial

“…Previous studies have primarily focused on comparing non-pharmacological pain relief methods, such as TENS or acupoint massage, with pharmacological pain relief methods (1,20,34). However, there is limited research addressing the impact of using pharmacological pain relief after non-pharmacological methods have been employed.…”

“…In modern medicine, the analgesic mechanism of acupoint stimulation can be partially explained by the Gate Control Theory. By applying massage stimulation to the body surface, nociceptive transmission is inhibited (20). In addition, acupoint stimulation can also activate Mu opioid receptors, increase serum endorphins, and promote the release of adrenocorticotropic hormone from the anterior pituitary, thereby reducing pain (21).…”

Application of epidural analgesia in obstetric hospitals of Ukraine and its alternative

“…У систематичному огляді [52] досліджено сильні сторони багатьох НММЗ у зменшенні пологового болю на першому етапі та порівняння їхніх ефектів. Його результати підтверджують, що масаж, пологовий м'яч, точковий масаж і відволікання значно впливали (p=0,001) на зменшення інтенсивності болю під час пологів.…”

Non-Pharmacological Pain Management in Labor: A Systematic Review

“…Yoga ranked first in reducing first stage labor duration. While acupressure, massage, and yoga reduced the duration of the second stage of labor, respectively, based on Hu et al's results [96], Melillo et al's [72] systemic review examined the strengths of many NPPM methods in reducing labor pain during the first stage and compared their effects. Their results confirm that massage, birth ball, acupressure, and distraction had a large and significant effect (p = 0.001) on reducing labor pain intensity.…”