Scientific evidence on non-pharmacological methods for relief of labor pain

Integrative review in the MEDLINE/PUBMED, SCOPUS, CINAHL, LILACS, and BDENF databases, limiting to studies published between 2013 and 2018, in Portuguese, English, and Spanish. The PICo methodology was used to build the research question and select the controlled and uncontrolled descriptors, which were combined with the “AND”, “OR,” and “NOT” Boolean operators.

Results

A total of 19 articles were selected. The non-pharmacological methods found were: acupuncture and its core variations (acupressure and auriculotherapy) (29.17%), hydrotherapy (25%), perineal exercises with the Swiss ball (16.67%), thermal therapies (8.33%), and other methods (20.83%).

Conclusion

Acupuncture and acupressure worked on both physiological aspects of pain and the subjective nature of pain. The warm bath, music therapy, aromatherapy, and breathing techniques promoted relaxation and decreased the levels of anxiety. Thermal therapies contributed to local analgesia in regions affected by pain. Exercises with the Swiss ball were important for pain relief, and the vertical position was important for labor.

Labor pain; Labor, obstetric; Pregnant women; Complementary therapies; Obstetric nursing

Methodology	Variables	Descriptors type	Selected descriptors
P (Population)	Parturient	CD	“Pregnant women”; “Expectant Mothers”; “Women, Pregnant”
I (Interest)	Non-pharmacological methods of relief	CD	(NOT) “drug therapy”; “Complementary Therapies”; (NOT) pharmacotherapy
I (Interest)	Non-pharmacological methods of relief	UD	“Non-medicational”; “Nonpharmacological”
Co (Context)	Labor pain	CD	“Labor Pain”; “Labor Stage, First
Co (Context)	Labor pain	UD	“Obstetric Pain”; “Labor, Obstetric”
MEDLINE/PubMed®		(((((“Pregnant women” OR Pregnant OR Pregnan*))) NOT ((“Pharmacotherapy” OR “drug therapy”))) AND ((“Labor pain” OR “Obstetric Pain” OR “Pain Management”))) AND ((“Non-medicational” OR “Nonpharmacological” OR “Complementary Therapies”))
CINAHL		((“Expectant Mothers” OR “Women, Pregnant” OR “Pregnant Women” OR Pregna n*)) NOT ((“drug therapy” or pharmacotherapy or medications or drugs)) AND ((“Labor Stage, First” OR “Labor, Obstetric” OR “Labor Pain” OR “Obstetric Pain”) ) Limiters: Academic journals Restrict by Language: - Portuguese Restrict by Language: - Spanish Restrict by Language: - English Search Modes - Boolean /phrase
SCOPUS		( TITLE-ABS-KEY ( ( “Pregnant women” OR “Pregnant Woman” OR pregnant OR pregnan* ) ) AND TITLE-ABS-KEY ( ( “Non-medicational” OR “Non-pharmacological” ) ) AND TITLE-ABS-KEY ( ( “Labor pain” OR “Obstetric Pain” ) ) ) AND ( LIMIT-TO ( LANGUAGE, “English” ) OR LIMIT-TO ( LANGUAGE, “Portuguese” ) OR LIMIT-TO ( LANGUAGE, “Spanish” ) ) AND ( LIMIT-TO ( DOCTYPE, “ar” ) )
LILACS e BDENF		(tw:((“pregnant women” OR Pregnant OR pregnan*))) AND (tw:((“Labor, Obstetric” OR “labor pain”) )) AND (tw:((“Non-medicational” OR “Non-pharmacological” OR “Complementary Therapies”))) AND (instance:”regional”) AND ( db:(“LILACS” OR “BDENF”))

Author (year)	NPM	Type of study	Findings
Gallo et al. (2018)⁽¹¹⁾	Swiss ball/ Hydrotherapy (aspersion bath)	Randomized trial	The EG had significantly lower pain intensity immediately after the Swiss ball, massage, and aspersion bath, enabling delay and reduction of the use of pharmacological analgesia.
Henrique et al. (2018)⁽¹²⁾	Hydrotherapy (aspersion bath)/ Swiss ball	Randomized trial	The pain, anxiety, and release of epinephrine decreased in the group using perineal exercises with the ball (ball group). The levels of β - endorphins increased in the ball group after the intervention, and it showed a significant difference in the capacity to cause these effects.
Koyucu et al. (2018)⁽¹³⁾	Hydrotherapy (sterile water injections)	Randomized trial	Mean pain scores at 30 minutes after the injections were significantly lower in the EG. The mean decrease in pain scores after 30 min was significantly higher in the EG.
Surucu et al. (2018)⁽¹⁴⁾	Music therapy	Randomized trial	After the first hour, a significant reduction in pain was reported in the EG, and the mean anxiety scores became lower in favor of the EG; the correlation was statistically significant.
Valiani et al. (2018)⁽¹⁵⁾	Auriculotherapy	Randomized trial	Statistical analysis showed that the severity of labor pain in the EG (auriculotherapy) was lower than that of the CG.
Yildirim, et al. (2018)⁽¹⁶⁾	Acupressure	Randomized trial	The results show that application of ice in the LI4 region was effective at 80 minutes. There was a reduction in labor time of approximately one hour with the EG parturients as compared to those in the CG.
Hamlacı et al. (2017)⁽¹⁷⁾	Acupressure	Randomized trial	Applying acupressure to point LI4 was considered effective in reducing the perception of labor pain and shortening the labor time (p <0.05). The mothers were satisfied with the treatment but found it insufficient to control the pain.
Lee, et al. (2017)⁽¹⁸⁾	Hydrotherapy (sterile water injections)	Qualitative Study with semi-structured interviews	The women in this study considered sterile water injections to be an effective analgesia with few side effects. Parturients used the analgesia period to support their goals, either of rest during labor, or to increase their ability to focus on the childbirth itself.
Yuksel et al. (2017)⁽¹⁹⁾	Breathing exercises	Randomized trial	The time in the expulsive period and the pain scores of those in the EG presented a statistically significant decrease (p<0.05) when compared to the CG.
Taavoni et al. (2016)⁽²⁰⁾	Swiss ball / Thermotherapy	Randomized trial	The mean value in pain scores in the thermotherapy group was lower than that in the CG, at 60 and 90 min post-intervention (p<0.05). There were significant differences between pain scores in the Swiss ball group throughout the study when compared to the CG.
Cherobin, et al. (2016)⁽²¹⁾	Auriculotherapy	Qualitative study Convergent methodology	In the first 30 minutes, 15 (79%) of the treated women felt some pain relief. After one hour, six (46%) remained with the same degree of pain, and four (31%) had greater relief.
Mafetoni et al. (2016)⁽²²⁾	Acupressure	Randomized trial	Pain scores were lower in the acupressure group immediately after (value=<0.0001) and one hour after treatment (p-value=0.0001), as compared to CG and PG.
Mathew et al. (2016)⁽²³⁾	Reflexology	Quasi-experimental study	The mean pain score (6.81) was significantly higher in the CG when compared to the score (4.67) of the EG.
Dehcheshmeh et al. (2015)⁽²⁴⁾	Music Therapy/ Acupressure	Randomized trial	Pain scores were significantly lower in the music therapy group and cryotherapy groups when compared to the CG (p<0.05), without significant differences between them.
Dabiri et al. (2014)⁽²⁵⁾	Acupressure	Randomized trial	The difference in pain scores between the EG and CG was significant (p<0.001), but there was no significant difference (p=0.942) in the dilation time period of both groups as well as compared to the PG.
Kaviani et al. (2014)⁽²⁶⁾	Aromatherapy	Randomized trial	The mean perception of pain intensity in the EG was lower than that in the CG at 30 and 60 minutes post-intervention (p <0.001).
Barbieri et al. (2013)⁽²⁷⁾	Hydrotherapy (aspersion bath)/ Swiss ball	Randomized trial	There was a reduction in the pain of the two EGs, but no significant differences between the results of the hydrotherapy and the Swiss ball when compared to each other. However, significant results were obtained when both methods were used.
Shirvani et al. (2013)⁽²⁸⁾	Cryotherapy	Randomized trial	The degree of pain was lower in the EG during periods of dilation and expulsion. The duration of these periods was significantly lower in the EG when compared to the CG.
Lee et al. (2013)⁽²⁹⁾	Hydrotherapy (sterile water injections)	Randomized, quasi-experimental study	Four sterile water injections caused smaller pain scores when compared to only one injection.

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E-mail: actapaulista@unifesp.br

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[1] Corresponding author Victor Hugo Alves Mascarenhas E-mail: victor.hugo.sama@gmail.com