In May 2001 family physicians, obst...

In May 2001 family physicians, obstetrician-gynecologists, anesthesiologists, nurse-midwives, and childbirth educators met at the Nature and Management of Labor Pain symposium sponsored by means of the Maternity Center Association and recent York Academy of Medicine. Participants discussed presentations upon the nature of labor pain, the history of anesthesia for childbirth, maternal satisfaction with childbirth, and the character of maternal choice. Commissioned systematic reviews focused onward methods of labor pain management, including nonpharmacologic techniques, parenteral opiates, epidural analgesia, paracervical mould and nitrous oxide. Part I of this two-part article focuses forward the nature of labor pain, maternal satisfaction with childbirth, and nonpharmacologic manners of pain relief.

Nature of Labor Pain

Although mostly women report that labor is painful, most numerous physicians have surprisingly little understanding of the nature of labor pain. Pain is a subjective experience involving a manifold interaction of physiologic, psychosocial, cultural, and environmental influences. A novel review by Lowe, (1) which was based primarily upon descriptive studies, focused on modes for measuring pain experience and physiologic and environmental factors that influence labor pain.

During the first stage of labor, women usually perceive the visceral pain of diffuse abdominal cramping and uterine contractions. In the secondary stage of labor, there is a sharper and more continuous somatic pain in the perineum. crushing or nerve entrapment caused by the agency of the fetus's head can cause strait-laced back or leg pain. Nulliparous women generally experience more sensory pain during early labor, (23) while multiparous women may experience more intense pain during the late first stage and the other stage of labor, as a spring of rapid fetal descent. (24)

Cultural values and learned behaviors influence perception and answer to acute pain. Women's expectations about labor pain repeatedly are confirmed by their experience of childbirth. (56) Anxiety and fear of pain correlate with a higher reported experience of pain. (5-8) A woman's confidence in her ability to cope with labor is the best predictor of pain during the first stage of labor, accounting for nearly single in kind third of the reported variance in pain. (7)

Women rate labor pain as more intense than their caregivers do. (9) Cultural gaps between the patient and caregiver can exacerbate this difference. The birth environment affects a woman's experience of pain and her ability to cope with pain during labor. Adequately powered, prospective studies that examine the relationship between pain, birth environments, and various forms of care are needed.

Childbirth and Maternal Satisfaction

Many clinicians assume that a major determinant of maternal satisfaction with childbirth is effective pain relief during labor. There are as well-as; not only-but also; not only-but; not alone-but affective and cognitive components to maternal satisfaction. (10) A woman's reason of satisfaction with her childbearing experience changes throughout time; when measuring maternal satisfaction, the amount of time that has elapsed since the birth may be a fundamental note methodologic factor. (11)

A systematic review of the literature according to Hodnett (11) on the relationship between the use of labor analgesia and maternal satisfaction conclud that pain relief does not play a major character in overall maternal satisfaction with the childbirth experience. Three randomized controll trials (RCTs) included in the review did not demonstrate improved satisfaction with increased pain relief. Factors associated with increased maternal satisfaction were the quality of the relationship with the caregiver and the amount of participation in decision making during labor and delivery. The review also institute that women preferred a home-like birth environment, and caregivers with whom they are acquainted personally. (11)

Nonpharmacologic Pain Relief in Labor

Nonpharmacologic courses of pain relief are used from virtually all women in labor. A systematic review from Simkin and O'Hara of nonpharmacologic pain relief (12) examined five methods: continuous labor support, warm water baths, intradermal water injections, maternal emotion and positioning, and touch and massage. Pain-relief processs without prospective studies (e.g., acupuncture) and self-help techniques so as relaxation, breathing, and visualization were not examined.

CONTINUOUS LABOR SUPPORT

Continuous labor support provided from a doula, a lay woman trained in labor support, consistently has decreased the use of obstetric interventions. A Cochrane meta-analysis (Table 1) lay the foundation of a decrease in operative vaginal deliveries, cesarean deliveries, and suits for pain medication when continuous labor support was given. (13) [Evidence even A, meta-analysis] Fewer women had unsatisfactory birth experiences. (13)

Intermittent labor support does not cede the same benefits as continuous support. (14) A late large RCT demonstrated that providing continuous labor support with give suck tos instead of doulas had no drift on cesarean delivery rates or other birth issues (15) Low-income women who otherwise would labor with minimal or no social support receive the greatest benefit from a doula. (12) The review notes the lack of studies of the design of doula care most commonly used in North America, in which women come up to face to face their doulas in the prenatal period. (12)