by Cassandra R. Elias
In what's sure to be a controversial study, the Cochrane Library has concluded that there is strong evidence that drug-based pain relieving methods are more effective at relieving labor pain than non-drug approaches.
The researchers brought together the results of 15 previous Cochrane reviews and three non-Cochrane reviews, including data from 310 trials in total.
They split the interventions into three categories:
1) Methods that "work"
2) Methods that "may work"
3) Methods with "insufficient evidence that they work"
Painkilling drugs given by epidural, combined spinal epidural (CSE) and inhalation fell under the first category of "what works." These methods had the highest number of adverse effects. For instance, participants would often experience nausea and vomiting triggered by inhaled painkillers and hypotension due to epidurals.
The second group of pain relief methods, although less well-supported by clinical evidence, were tolerated better by the participants. The women reported that their satisfaction with pain relief improved for all methods except massage. There was less evidence gathered for water immersion, relaxation, acupuncture, massage and local anesthetic nerve blocks or non-opioid drugs. The authors classed these interventions as "may work" methods to handle pain relief during labor.
The third group of pain relief interventions, classified as having "insufficient evidence of working," included hypnosis, biofeedback, sterile water injection, aromatherapy, transcutaneous electrical nerve stimulation (TENS) and injected or intravenous opioids.
Study leader James Neilson, of the Department of Women's and Children's Health at the University of Liverpool, in Liverpool, United Kingdom, said, "Women should be told about the benefits and adverse effects of different pain relief methods but should feel free to choose whatever form of pain relief they feel would help them most during labour."
The study calls for more research on the non-drug interventions. Although non-drug interventions are generally considered safe, the evidence for the study was only based on one or two trials. Fewer than 1,000 women took place in the trials for hypnosis, biofeedback, sterile water injection, aromotherapy and massage.
What do you think about this study? Has your experience with non-drug methods been different than this study would suggest? How do you think this study impacts the push for natural birth methods?
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