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WHO recommendations: pain management for a positive childbirth

Massage, warm packs and relaxation techniques may contribute to a positive childbirth experience.

An updated Cochrane systematic review, led by Professor Caroline Smith, has found massage and warm packs may aid in a positive childbirth experience (opens in a new window) by reducing pain,reducing the duration of labour and improving the mother’s sense of control and emotional experience of labour.1 NICM researchers also found the use of some relaxation therapies, yoga, or music may possibly be helpful (opens in a new window) with reducing the intensity of pain,2 and in helping women feel more in control and satisfied with their labours.

The two reviews are part of a series of Cochrane reviews examining pain management in labour and are included in the latest World Health Organization’s updated guidelines Intrapartum care for a positive childbirth experience,(opens in a new window) recommendation 21 and 22.

World Health Organization (WHO) say evidence to support this guideline was derived from a number of sources by the systematic review teams and methodologists working in collaboration with the WHO Steering Group.

Care option

Recommendation

Category of recommendation

Relaxation techniques for pain management

  1. Relaxation techniques, including progressive muscle relaxation, breathing, music, mindfulness and other techniques, are recommended for healthy pregnant women requesting pain relief during labour, depending on a woman’s preferences.
 Recommended

Manual techniques for pain management

  1. Manual techniques, such as massage or application of warm packs, are recommended for healthy pregnant women requesting pain relief during labour, depending on a woman’s preferences.
 Recommended

Professor Smith states in the two systematic reviews that while the techniques may have a role for pain management for childbirth, the quality of evidence does vary from low to very low and few trials reported on the key GRADE outcomes, suggesting that there is a need for further research to address these limitations of the evidence.

References:

  1. Smith CA, Levett KM, Collins CT, Crowther CA. Relaxation techniques for pain management in labour. Cochrane Database Syst Rev. 2011;(12):CD009514. http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD009514.pub2/full (opens in a new window)
  2. Smith CA, Levett KM, Collins CT, Dahlen HG, Ee CC, Suganuma M. Massage, reflexology and other manual methods for pain management in labour. Cochrane Database Syst Rev. 2018;(3):CD009290 http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD009290.pub3/full (opens in a new window)
  3. WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. http://www.who.int/reproductivehealth/publications/intrapartum-care-guidelines/en/ (opens in a new window)