Nonpharmacological interventions reduce labor pain and shorten labor

Reference

Gallo RBS, Santana LS, Marcolin AC, Duarte G, Quintana SM. Sequential application of non-pharmacological interventions reduces the severity of labour pain, delays use of pharmacological analgesia, and improves some obstetric outcomes: a randomised trial. J Physiother 2018;64(1):33-40.

Synopsis

This was a well-designed single-blinded randomized controlled trial to assess the clinical benefits of a specific series of nonpharmacological interventions on women's perception of labor pain and duration of labor. Primigravid women (N = 80) were included if they had a low-risk pregnancy and intact membranes, and presented in spontaneous labor at 37 or more weeks' gestation. Women were excluded if they had already received pharmacological analgesia. The interventions were applied by 1 of 2 physical therapists. The interventions consisted of pelvic motion exercises on a Swiss ball at 4 cm to 5 cm of cervical dilation, lumbosacral (T10 - S4) massage at 5 cm to 6 cm, and a warm shower at 7 cm or more. Each intervention lasted 40 minutes (or less, if labor progressed to the next stage before the 40 minutes were up). Women assigned to a control group received routine care. Women in both groups were asked to avoid pharmacological analgesics as much as possible. The primary outcome was reduction in pain intensity as measured on a 100-mm visual analog scale, with a difference of at least 13 mm considered clinically meaningful. For the Swiss ball intervention the mean pain reduction was 24 mm (95% CI 15 - 34), the mean pain reduction was 14 mm (4 - 25) for the massage, and the shower reduced the pain by a mean of 17 mm (5 - 29). Requests for analgesic medication were delayed in the intervention group, with requests at a mean of 1.9 cm greater cervical dilatation (1.5 - 2.4). Total duration of labor was a mean 72 minutes shorter in the intervention group (NS), and the expulsive phase was significantly shorter in the intervention group (mean 18 minutes; 5 -30). Of other secondary outcomes respiratory distress was less likely among neonates of the women in the intervention group (absolute risk reduction 0.15;0.03 - 0.29; number needed to treat = 7; 3 - 31).