Alternative Therapies in Labor: Nursing Support for Pain Relief

Introduction

More and more women are seeking out less invasive, non-pharmacological methods of pain management during labor. This trend has contributed significantly to the popularity of what researchers call "complementary methods of pain management" (Smith, Collins, Cyna & Crowther, 2003). Traditional forms of pain management include the use of epidural anesthesia and other narcotic drugs to help deaden and reduce pain. Many of these methods, however, come with unwelcome side effects — side effects that might be avoided if alternative therapeutic techniques were used in conjunction with, or instead of, traditional methods.

Nurses are at laboring women's bedsides throughout the delivery process, and it is therefore important that they are aware of any alternative therapeutic techniques available during labor to help lessen a woman's experience of pain. In recent years, a number of alternative therapeutic approaches have been introduced into the labor and delivery unit. Some of the more common techniques adopted by laboring women for pain management and stress relief include acupuncture, meditation, hypnosis, massage, and aromatherapy. The extent to which these therapies are supportive and beneficial is not yet completely understood. It is important, however, that laboring women have access to complementary therapies to improve their childbirth experience as much as possible, so that the end result is a positive outcome.

The purpose of this research is to explore the phenomenon of alternative therapeutic intervention during labor and childbirth from the perspective of laboring mothers. The aim is to gain an understanding of the issues that influence patients' perceptions of pain during childbirth and the likelihood of a positive outcome. In addition, the researcher attempts to identify what measures support staff, including nurses, can adopt to enable patients during the labor and childbirth process.

Problem Statement: Do alternative therapeutic interventions have a positive effect on patients' perceptions of pain and labor outcome during childbirth, and how can nurses adopt these measures to improve patient outcomes? The study also attempts to uncover which alternative therapeutic interventions are most likely to result in maternal satisfaction and a positive outcome post-delivery.

Purpose and Problem Statement

Hypothesis: Members of the nursing staff involved in laboring mothers' daily patient care can have a positive impact on patients' comfort level and outcome when alternative therapeutic interventions are adopted during the labor process. Secondary to this, the use of acupuncture, massage, and hypnosis during labor and childbirth improves the laboring experience and contributes to a positive outcome.

There is a substantial body of evidence supporting the exploration of alternative therapeutic intervention during the childbirth process. The following is a review of some of the most recent research related to this subject.

Ramnero, Hanson, and Kihlgren (2002) conducted an investigation of acupuncture treatment during labor as a method of decreasing pain intensity and increasing relaxation. Their randomized controlled trial examined 90 women in labor and assessed pain and relaxation during labor and delivery. The results showed that acupuncture is a positive alternative or complement for women in labor who would rather forgo analgesia. The study suggested that relaxation increased and the experience of pain intensity decreased for patients receiving acupuncture treatment at the time of labor.

Literature Review of Complementary Labor Therapies

Another study conducted by Huntley, Coon, and Ernst (2004) systematically reviewed randomized controlled trials examining complementary and alternative therapies for addressing labor pain. Their study examined the following forms of therapy: biofeedback, hypnosis, intracutaneous sterile water injections, massage, and respiratory autogenic training. The results proved largely inconclusive, with the exception of intracutaneous sterile water injections, which did reduce perceived pain in patients.

In a similar study conducted by Smith, Collins, Cyna, and Crowther (2003), however, acupuncture and hypnosis were shown to be effective alternative or complementary methods for reducing perceived pain during labor. Their study included seven trials of varying modalities of pain management, including aromatherapy, massage, music, hypnosis, and acupuncture.

Simkin and Bolding (2004) suggest that there is sufficient evidence to support the use of baths, intradermal water blocks, and maternal movement and positioning as nonpharmacologic approaches toward controlling labor pain and preventing suffering. Their studies also suggest that acupuncture, massage, hypnosis, and even transcutaneous nerve stimulation may be beneficial; however, these approaches require further study before accurate conclusions can be drawn regarding their efficacy. Other less scientifically validated methods, including aromatherapy and music, have not been sufficiently studied, or the results have been too vague to draw adequate conclusions.

Kannan, Jamison, and Datta (2001) suggest that factors other than pharmacological pain relief influence a woman's perceptions of labor and childbirth, and thus whether she perceives a positive outcome. Their studies find evidence supporting the importance of discussing pre-labor expectations and preparing mothers for unexpected occurrences during labor as critical to a positive outcome. Women who were supported by staff in anticipating both positive and challenging aspects of labor were more likely to report satisfaction regardless of their outcome.

Ketterhagen, VandeVusse, and Berner (2002) show that nurses may benefit patients by learning self-hypnosis techniques and informing pregnant women of them during delivery. Their study suggests that self-hypnosis may help manage pain by allowing women to control their anxiety and discomfort "by inducing a focused state of relaxation" (p. 335).

Women's experience of pain during labor and delivery varies considerably. Lundgren and Dahlberg's (1998) model of care provides a framework for understanding women's experience and perceptions of pain management and outcome during childbirth. Their assumptions suggest that four themes help identify the meanings women assign to their childbirth experience: a woman's ability to trust in herself and her body, trust in the caregiver and partner, the manner in which a mother transitions into motherhood, and the acceptance that pain is difficult to describe completely and is often contradictory.

The essential element for defining pain management, according to Lundgren and Dahlberg, is establishing a non-objectifying view of the body, a "presence in the delivery process," and establishing a meaning connected to motherhood (Lundgren & Dahlberg, 1998, p. 106). The researchers conclude that nurses and midwives can help birthing women "find their own ability to cope, and should interfere only when asked" in order to help facilitate the natural birthing process (Lundgren & Dahlberg, 1998, p. 105).

Members of the nursing staff provide much-needed support to laboring patients by meeting physical and emotional needs throughout the childbearing process. As more and more patients turn to alternative or non-pharmacological therapies for support during labor, it is important that nurses educate themselves regarding these measures so they can inform patients of the effective options available for mitigating pain.