The drugs DO work: Painkillers are more effective than massage, TENS machines and hypnosis during labour
00:23 GMT, 14 March 2012
New findings: Taking drugs to relieve pain in labour works better than alternatives such as massage, TENS machines and hypnosis, research has found
Taking drugs to relieve pain in labour works better than alternatives such as massage, TENS machines and hypnosis, new research has found.
Painkillers such as an epidural, as well as gas and air, are more effective than softer approaches.
However, a review of 310 studies found that they do have more side-effects.
Experts found that epidural, combined spinal epidural (CSE) and inhaled gas and air effectively managed pain in labour.
CSEs relieved pain more quickly than traditional or low dose epidurals while epidurals resulted in higher rates of assisted delivery, such as forceps or ventouse, and women were more likely to suffer problems such as high blood pressure and fever.
Women taking gas and air were more likely to experience vomiting, nausea and dizziness, the study also found.
Meanwhile, being immersed in water, relaxation techniques, acupuncture, massage and non-opioid drugs such as sedatives were described as interventions that 'may work' with fewer adverse effects.
Both relaxation and acupuncture decreased the use of forceps and ventouse in delivery, with acupuncture also decreasing the number of Caesarean sections.
But the team found there was 'insufficient evidence' to make judgments on whether treatments such as hypnosis, sterile water injections, aromatherapy, TENS machines or opioids such as pethidine were more effective than dummy treatments for managing pain in labour.
In comparison with other opioids, more women receiving pethidine experienced side-effects including drowsiness and nausea, according to the research from the Cochrane Collaboration.
The experts, from universities including Liverpool, Warwick and Manchester, said: 'Overall, women should feel free to choose whatever pain management they feel would help them most during labour.
'Women who choose non-drug pain management should feel free, if needed, to move on to a drug intervention.
Softer approach: Having a massage during labour will not be as effective at reducing pain as painkillers are but will result in fewer adverse effects
'During pregnancy, women should be told about the benefits and potential adverse effects on themselves and their babies of the different methods of pain control.
'Individual studies showed considerable variation in how outcomes such as pain intensity were measured and some important outcomes were rarely or never included – for example, sense of control in labour, breastfeeding, mother and baby interaction, costs and infant outcomes.
'Further research is needed on the non-drug interventions for pain management in labour.'
Peter Brocklehurst, professor of women's health and director of the Institute for Women's Health at University College London, added: 'This important “review of reviews” clearly shows that many methods of pain relief in labour, particularly non-drug methods such as massage and immersion in water, are not well researched.
'For example, we have good evidence about how effective epidurals are, but we also know they have problems, including an increased risk of forceps and ventouse births.
'On the other hand, when it comes to many other, non-drug interventions such as massage and TENS, the evidence base is much poorer.
'This does not mean that these methods don't work – just that we don't know whether they do or do not work because the research needed to know this has not been done.
'Altogether this means that women may be using methods which are not effective, or being denied methods which are effective and which may improve their labour without them having to use epidurals.'