This chapter considers non-pharmacological methods of pain relief used during labour (pharmacological methods will be covered in Chapter 6). The woman’s experience of pain in childbirth is unique to her (Waldenstrom et al 1996) and mediated by her previous experiences (Niven & Gijspers 1990), and her social and cultural circumstances (Seymour 1997). For some women experiencing pain in labour is linked to their spiritual beliefs (Hall 2001, Walsh 2007, Hall & Taylor 2008). The link between a woman’s expectations and experience of pain are linked with her level of satisfaction with labour and antenatal education regarding what to expect (Lally et al 2008).The individual needs of women vary and what works for one person may not suit the next. However, it is suggested that the attitudes of the birth attendants have an effect on what ways women choose in order to cope with pain of labour (Leap & Anderson 2008). They go on to write about different views of either wanting to relieve pain for women, or to want to help women ‘work with’ their pain, which is related to the caregivers’ own attitudes and beliefs.

It is often remarked that the pain of labour is quickly forgotten, consumed by the joy associated with the safe arrival of the baby. However, in a review of the literature, Niven & Murphy-Black (2000) conclude that labour pain, although not always recalled with accuracy, is not completely forgotten. In a study asking women of their memory of pain 2 months and 1 year after the birth, 47% of women still remembered the same level of pain after 1 year, with 35% remembering the pain as less severe (Waldenstrom 2003). In order to help minimize the degree of pain experienced, the midwife will need a range of strategies that she can suggest and support the woman with. Women may also have their own ideas – perhaps passed on from other women or methods that they have previously used themselves (Spiby et al 2003).

Box 4.1 shows the identified theories about the purpose of pain in labour (from Leap & Anderson 2008).

As labour progresses, so, too, does the length and duration of uterine contractions. In addition, the cervix dilates and the pelvic floor and vagina stretch as the presenting part of the fetus descends the birth canal. Thoracic, lumbar and sacral nerves transmit the resultant painful stimuli (Hamilton 2003). The balance of hormones, such as oxytocin, beta-endorphins and adrenaline, will also have an effect on the pain a woman experiences (Buckley 2005). Fear of labour appears to have a direct link to how women experience pain (Saisto 2001). What a woman may well have been coping with quite easily may become more and more difficult to endure.

Women have always sought to cope with their labour pain by using a range of behaviours and practices. The use of pharmacological methods of pain relief is often associated with unwanted side-effects (Walsh 2007). Employing the use of non-pharmacological methods has the potential to delay (or prevent) the use of medication and the subsequent total dose received (Simkin & O’Hara 2002). A large prospective study (Green 1993) found that women who avoided the use of medication were also more likely to be satisfied with the birth than those who used drugs. Women who want to keep drug use to a minimum during labour are more likely to do so (Green et al 1998), as are those who have confidence in their ability to cope or ‘self-efficacy’ for labour (Lowe 1989).

One of the important features of non-pharmacological methods of coping in the early stages of labour is distraction. Later in labour women may need to ‘go into themsleves’ (Thompson 2004:33) and not be disturbed (Odent 2002). Each time another strategy is employed, time has moved on and, hopefully, so has the labour. They must, however, be significant, appropriate, realistic strategies, as the woman will soon grow to distrust the midwife’s judgment if she suggests the impossible. The concept of ‘working with the pain’ (Leap & Anderson 2008) demonstrates that the process is active and not passive. Non-pharmacological techniques often involve the continued presence of a midwife or birth partner, which has been shown to reduce the need for pharmacological methods of pain relief (Hodnett et al 2007).

Although this chapter focuses on non-pharmacological methods, in practice women will often combine these with pharmacological methods to achieve a level of coping that meets their specific plans and needs. As methods such as breathing techniques also have the additional benefit of reducing panic and helping the woman to stay calm, such methods should be encouraged throughout labour if pharmacological methods are also employed (Spiby et al 2003).