Evidence Lacking In Benefits Of Non-Drug Pain Relief In Labor

Bad news for woo-woo.

There is better evidence for the effectiveness of drug-based approaches for relieving labour pains than non-drug approaches. These are the findings of an all-encompassing publishing in The Cochrane Library, which draws together results from a number of previous reviews on the subject.

Many different approaches are used to relieve pain in labour, but not all are supported by strong evidence. The researchers brought together the results of 15 previous Cochrane reviews and three non-Cochrane reviews, including data from 310 trials in total. To try to distinguish between well-supported and less well-supported pain relief approaches, they decided to split interventions into three categories.

Painkilling drugs given by epidural, combined spinal epidural (CSE) and inhalation fell under the first category, "what works". There was less evidence for immersion in water, relaxation, acupuncture, massage and local anaesthetic nerve blocks or non-opioid drugs. The authors classed these interventions as "may work". However, more adverse effects were associated with the interventions for which there was the best evidence, including nausea and vomiting caused by inhaled painkillers and hypotension due to epidural. The second group of pain relief approaches, although less well-supported by clinical evidence, were better tolerated, with women reporting improved satisfaction with pain relief for all except massage. The least supported or "insufficient evidence" group of pain relief interventions included hypnosis, biofeedback, sterile water injection, aromatherapy, transcutaneous electrical nerve stimulation (TENS) and injected or intravenous opioids.

More evidence for "if it cannot hurt, it cannot help."

There is a reason why "what works" works.