Alternative Approaches to Pain Relief During Labor

For the management of pain, conventional medicine focuses moreon the physical side, while alternative methods deal mainlywith emotional considerations.

These methods are popular because they emphasize the individualpersonality, and the interaction between mind, body and environment. They are attractive to people who want to be more involvedin their own care and feel that such therapies are more in harmonywith their personal philosophies. Those seeking alternatives are not necessarilydissatisfied with conventional medicine, but attempt to supplementrather than replace traditional care.

Alternative methods applicable to labor paincan be divided into:

1. mind–body interventions
2. alternativesystems of medical practice
3. manual healing
4. bioelectromagneticand physical methods
5. alternative medication

Mind–Body Interventions

Mind–body interventions are based on the interconnectednessof mind and body and on the power of each to affect the other.Many mind–body interventions are applied to chronic illness,but this technique also appears to be applicable to the acutesituation of delivery.

Psychoprophylactic Methods

Dick-Read method- the method assumes that childbirth pain is a pathologic responseproduced by fear, apprehension and tension. Therefore it essentialto teach women the anatomic and physiologic facts of childbirth,and to instruct them in physical and mental relaxation. Bothapproaches are alleged to diminish pain by familiarizing thepregnant woman with the process of childbirth and by creatingan atmosphere of confidence.

Lamaze method - This method was first optimistically called‘painless childbirth’, but later the more appropriateterm ‘fearless childbirth’ was applied. It is basedon the Pavlovian concept of conditioned reflex training. Byfocusing on certain breathing patterns or concentration pointssuch as a mark on a nearby wall, it should be possible to blockpain messages to the brain.

Bradley's method- emphasizes natural childbirth, with the parentsworking as a team. Students of this method are taught aboutdeep abdominal breathing and an understanding of the labor anddelivery process. Rather than trying to block out pain, Bradley'smethod encourages concentrated awareness that works throughthe pain.

Leboyer's Method- Frédéric Leboyer described his method in Francein 1974 in his book ‘Birth without violence’. Inspiredby Indian yoga, this method focuses on providing a better welcomefor the newborn. In contrast to the usual environment, withtoo much light and noise stressing the baby, Leboyer proposescalm for mother, father and professionals, and darkness, littlenoise and a warm bath for the newborn. For the comfort of themother during delivery, Leboyer considers that serenity obtainedthrough attention to the baby raises the pain threshold. Therehas been no specific evaluation of the effects on labor pain.However, couples express a high degree of satisfaction. AlthoughLeboyer's method is rarely used now as described in the 1970s,many birth practitioners still consider it to have a positiveeffect, with gentle and heightened attention for the newborn.

Hypnosis- The word hypnosis originates from the Greek ‘hypnos’meaning ‘sleep’ but in fact, it is not sleep but astate of focused concentration in which the patient can be relativelyunaware, but not completely blind to her surroundings. Duringhypnosis, suggestions may be made, focusing on diminishing awarenessof pain, fear and anxiety. The woman is prepared with initialhypnotic experiences that include three steps: absorption ofthe words or images presented by the therapist, dissociation,a suspension of critical judgment, and responsiveness.  Hypnosis seems to reduce fear, tension and painduring labor and to raise the pain threshold.

A few negative effects of hypnosis have been reported, includingmild dizziness, nausea and headache. These seem to be associatedwith failure to dehypnotize the patient properly. Caution shouldbe used in patients vulnerable to psychotic decompensation.

Biofeedback- Biofeedback uses monitoring instruments to provide feedbackto patients, i.e. physiological information of which they arenormally unaware. Electrodes feed information to a monitoringbox that registers the results by a sound or a visual meterthat varies as the monitored function increases or decreases.For women in labor, several biofeedback-assisted relaxationtechniques have been introduced.

i.e when tension of the abdominal muscles is monitored, asuterine contractions occur the woman focuses on relaxingthe abdominal muscles. 

Yoga- Yoga, a method of Indian origin, proposes control of mind andbody. Between the different types of yoga, ‘energy yoga’can be applied to pregnancy and delivery. Through special trainingof breathing, it achieves changes in levels of consciousness,relaxation, receptivity to the world and inner peace. Accordingto professionals who use this technique for delivery, yoga shortensthe duration of labor, decreases pain and reduces the need foranalgesic medication. However, we have not found any scientificconfirmation of these assertions.

Sophrology- The word sophrology derives from two Greek words, ‘sos’harmony or serenity and ‘phren’ conscience or spirit.This technique derived from Indian yoga was introduced in Europeduring the 1960s. Its purpose is to improve the control of bodyand spirit through three degrees of dynamic relaxation: concentration,contemplation and meditation. Applied to obstetrics, bettercontrol of the delivery process is expected. 

Haptonomy- Derived from the Greek words ‘hapsis’ affectivityand ‘nomos’ knowledge, haptonomy can be definedas the science of affectivity. Specificzones of affectivity are reported to improve the contact betweenfather, mother and baby and to help to share emotions. In practice,haptonomy is appreciated by couples during pregnancy, but itseems to be used irregularly during labor, particularly becauseteams in charge of delivery are not always aware of its existence. 

Music Therapy-  Music addresses many of the physical and psychological needsof patients. In obstetrics, a slow and restful type of musicmay be used as a sedative to promote relaxation during the earlystage of labor. Music with a steady beat may be used as a stimulantto promote movement during the latter stages. The literaturefindings are discordant.

Alternative Systems of Medical Practice

Acupuncture-Acupuncture may produce effects through several different mechanisms.One hypothesis is that acupuncture points have electrical propertiesthat, when stimulated, may alter the level of chemical neurotransmittersin the body. Another hypothesis is that endorphins are releaseddue to activation of the hypothalamus. The effects of acupuncturehave also been attributed to alterations in the natural electricalcurrents or electromagnetic fields in the body.

Specific anatomic parts of the body are stimulated for therapeuticpurposes. This can be done in the usual way with needles, butpractitioners may also use heat, pressure, impulse of magneticenergy, burning by a preparation of the herb Artemia vulgaris,electrical stimulation or surface electrodes at acupunctureloci.

Acupressure Systems- Acupressure is a descendant of Chinese manipulative therapyin which points are stimulated by pressure, using hands, fingersand thumbs. Acupressure supposedly promotes the circulationof blood, the harmony of yin and yang and the secretion of neurotransmitters,thus maintaining the normal functions of the human body andenhancing well being.

Homeopathy- Homeopathy involves the use of diluted substances that causesymptoms in their undiluted form. According to homeopathic theory,remedies stimulate the self-healing mechanism. 

Based on these Principles

1. any substance, which can produce symptoms in a healthy person, can cure similar symptoms in a person who is sick.
2. give the least amount of medicine necessary to evoke a healing response

Manual Healing

Manual healing methods used today during delivery include therapeutictouch and massage therapy.

Therapeutic Touch -The purpose of therapeutic touch in labor is to communicatecaring and reassurance. Painful contractions of the uterus canbe treated by the application of pressure with the hands tothe woman's back, abdomen, hips, thighs, sacrum or perineum. 

Massage Therapy- The practice of massage varies from the tickling massage of‘kung fu’ to a firm massage.

Bioelectromagnetic Applications and Physical Methods

Transcutaneous Electrical Nerve Stimulation- TENS involves administration of low voltage electrical stimulithrough flat electrodes applied to the skin. TENS units consistof a stimulator and two pairs of electrodes. The upper electrodesare taped at the level of the tenth thoracic to the first lumbarroot and the lower pair at the level of the second to fourthsacral nerves. The stimulator has two channels for the two pairsof electrodes.

Sterile Water Blocks- Counter-irritation is the process by which localized pain maybe relieved by irritating the skin in the same dermatomal distribution.For example, the uterus is supplied by the lower thoracic spinalcord segments. Some of these receive stimuli from the skin ofthe lower back and the sacrum. Labor analgesia may be producedby counter-irritation of this area. Irritation can be achievedby intracutaneous injection of sterile water papules over thesacrum with a fine needle. 

Hydrotherapy-The popularity of undergoing part of labor in water has increaseddramatically around the world.The clinical impression of practitioners who use hydrotherapyis that their patients experience shorter and less painful labor. Research also shows that cervical dilatation rate andpain relief could be improved in patients duringthe first stage of labor, by having a bath.

Alternative Medications

Herbal Medicine- Various herbal remediesare used during the prenatal period to ‘prepare’the uterus and cervix for childbirth and ease pain during laborand delivery. Labor pain can be treated specifically with motherwort.Raspberry leaf has been shown to shorten the second part of labor and also lower the rate of forceps deliveries 

Aromatherapy- combines the physiological effects of massage with the useof essential oils.  Massage aroundthe lower back with jasmine, juniper, geranium, clary sage,rose and lavender have been reported to provide subjective benefitin labor.

Whereas physicians do not need to be experts in the managementof alternative therapies, they should at least possess somebasic knowledge of complementary medicine, since, thedemand for complementary medicine will probably continue torise.