COMPARATIVE EFFECTIVENESS OF PAIN-RELIEF METHODS DURING LABOUR: A LITERATURE REVIEW
Abstract
Effective management of labour and childbirth pain is one of the goals of modern obstetric care. This review compares the effectiveness of pharmacological and non-pharmacological methods of pain relief during labour and childbirth, based on recent randomized controlled trials, meta-analyses, and systematic reviews.
Epidural and combined spinal-epidural techniques provide the most profound and reliable pain relief with high maternal satisfaction, although they prolong the second stage of labour and require specialist monitoring. Systemic opioids – pethidine, fentanyl, and remifentanil – offer moderate analgesia; updated remifentanil protocols have improved safety and maternal autonomy where neuraxial services are limited. Nitrous oxide remains a safe, reversible alternative with limited efficacy.
Among non-pharmacological methods, evidence supports hydrotherapy, massage, acupuncture, acupressure, transcutaneous electrical nerve stimulation (TENS), relaxation and breathing techniques, and continuous emotional support. Emerging data highlight the benefits of sterile water injections for lower-back pain, as well as music therapy, mindfulness, virtual reality, peanut-ball positioning, aromatherapy, and thermal therapy as safe and complementary methods of relieving labour pain. These methods enhance maternal comfort and satisfaction and reduce anxiety and perceived pain intensity.
Comparative evidence confirms that no single intervention is universally superior. A multimodal, individualized approach that integrates pharmacological precision with supportive, behavioural, and sensory-based techniques offers the most effective pathway for improving maternal experience during labour.
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