No. 355-Physiologic Basis of Pain in Labour and Delivery: An Evidence-Based Approach to its Management

J Obstet Gynaecol Can. 2018 Feb;40(2):227-245. doi: 10.1016/j.jogc.2017.08.003.


Objective: To review the evidence relating to nonpharmacological approaches in the management of pain during labour and delivery. To formulate recommendations for the usage of nonpharmacological approaches to pain management.

Options: Nonpharmacological methods available for pain management during labour and delivery exist. These should be included in the counselling and care of women.

Evidence: PubMed and Medline were searched for articles in French and English on subjects related to "breastfeeding," "pain," "epidural," "anaesthesia," "analgesia," "labour," "labor," and combined with "gate control theory," "alternative therapies," "massage," "position," "mobility," "TENS," "bathing," "DNIC," "acupuncture," "acupressure," "sterile water injection," "higher center," "control mind," "cognitive structuring," "holistic health," "complementary therapy(ies)," "breathing," "relaxation," "mental imagery," "visualization," "mind focusing," "hypnosis," "auto-hypnosis," "sophrology," "mind and body interventions," "music," "odors," "biofeedback," "Lamaze," "Bonapace," "prenatal training," "gymnastic," "chanting," "haptonomy," "environment," "transcutaneous electrical stimulus-stimulation," "antenatal education," "support," "continuous support," "psychosocial support," "psychosomatic medicine," "supportive care," "companion," "intrapartum care," "nurse," "midwife(ves)," "father," "doula," "caregiver," " hormones," "oxytocin," "endorphin," "prolactin," "catecholamine," "adrenaline," and "noradrenaline" from 1990 to December 2015. Additional studies were identified by screening reference lists from selected studies and from expert suggestions. No language restrictions were applied.

Validation methods: The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice are ranked according to the method described in this report.

Benefits, risks, and cost: The nonpharmacological method encourages an incremental approach to pain management that contributes to reduced interventions through optimal use of the woman's neurophysiologic and endocrine resources and a better understanding of the physiology of stress and pain during labour.

Guideline update: The guideline will be reviewed 5 years after publication to decide whether all of part of the guideline should be updated. However, if important new evidence is published prior to the 5-year cycles, the review process may be accelerated for a more rapid update of some recommendations.

Sponsors: This guideline was developed with resources funded by The Society of Obstetricians and Gynaecologists of Canada.

Summary statements: RECOMMENDATIONS.

Keywords: Nonpharmacological pain management; delivery; labour.

Publication types

  • Practice Guideline

MeSH terms

  • Analgesia, Obstetrical
  • Canada
  • Female
  • Humans
  • Labor Pain* / diagnosis
  • Labor Pain* / metabolism
  • Labor Pain* / physiopathology
  • Labor Pain* / therapy
  • Labor, Obstetric* / metabolism
  • Labor, Obstetric* / physiology
  • Pain Management
  • Pregnancy