The Nature and Management of Labor Pain



The Nature and Management of Labor Pain: core documents

Why The Nature and Management of Labor Pain was carried out

How the labor pain systematic and narrative reviews were carried out

Review results

Ongoing work to use review results to educate professionals, women and the media and to improve practice




Why The Nature and Management of Labor Pain was carried out

From 2000 to 2002, Childbirth Connection (then known as Maternity Center Association) inaugurated its ongoing involvement with labor pain issues by carrying out The Nature and Management of Labor Pain. To address confusion and uncertainty about the nature of labor pain and the beneficial and harmful effects of specific labor pain relief methods, this project clarified current knowledge about these matters through a series of systematic reviews (when possible) and narrative reviews (when not). The objective of this work was to ensure that pregnant women have access to full and complete information about labor pain and pain relief well before labor and again during labor, and to inform health professionals, the media and other key groups about review results. Childbirth Connection also works to ensure that women have access to a choice of methods for labor pain relief and make informed decisions, according to their needs, preferences, and circumstances.

How the labor pain systematic and narrative reviews were carried out

To address these objectives, Maternity Center Association (now known as Childbirth Connection) convened a multi-disciplinary Steering Committee of national leaders with expertise in anesthesiology, bioethics, childbirth education, consumer advocacy, epidemiology, journalism, labor support, midwifery, neonatology, nursing, obstetrics, pediatrics, physical therapy, and public health.

The Steering Committee issued a statement of Values, Principles and Objectives to make these matters transparent (see box above).

The Committee developed the scope of work for a series of planned reviews on specific methods for labor pain relief and related topics to help ensure that all important questions would be addressed and to limit duplication. The Committee specified that, where possible, the commissioned papers would use systematic review methodology. A subcommittee developed guidelines for authors (PDF) on systematic review methodology, and the Steering Committee invited leading researchers with topical expertise to prepare papers according to explicit scopes of work and the project guidelines. The full Committee met as an editorial board to review drafts of the papers and support authors in revising and strengthening the papers.

Maternity Center Association established a partnership with the New York Academy of Medicine to hold a meeting to present and discuss the commissioned papers. The Nature and Management of Labor Pain: An Evidence-based Symposium was held at the Academy in May 2001. About 130 participants gathered to hear the papers, to hear commentary from two panels, and to discuss the issues at length. To ensure a balance of participants across all professions and organizations involved with labor, attendance was by invitation only.

Following the meeting, authors finalized their papers and submitted them for publication. The peer-reviewed papers were published in a supplement to American Journal of Obstetrics and Gynecology (see box above). The issue includes an Executive Summary from the Steering Committee, which describes this work and the main results in detail and is available without charge on this site (see box above).

Review results

Seven systematic reviews and four narrative reviews were commissioned and published in the special issue. Please see the Steering Committee's Executive Summary (click in box above) for a detailed overview of the project process and methods and results of the reviews, which covered many related key questions and many outcomes.

Systematic reviews were carried out and published on the following topics (with lead authors in parentheses):
  • unintended effects of epidural analgesia for labor pain relief (one paper by Ellice Lieberman, another by Barbara L. Leighton)
  • side effects of epidural analgesia for labor pain relief (Linda J. Mayberry)
  • parenteral opioids for labor pain relief (Leanne Bricker)
  • nitrous oxide for labor pain relief (Mark A. Rosen)
  • nonpharmacologic labor pain relief measures: continuous labor support, baths, touch and massage, maternal movement and positioning, and intradermal water blocks for back pain relief (Penny P. Simkin)
  • pain and women's satisfaction with the experience of childbirth (Ellen D. Hodnett).


Narrative reviews were carried out and published on the following topics (with lead authors in parentheses):
  • the nature of labor pain (Nancy K. Lowe)
  • historical overview of labor pain analgesia (Donald Caton)
  • paracervical block for labor pain relief (Mark A. Rosen)
  • patterns of use of labor pain relief methods and maternal choice issues (Theodore R. Marmor).

Ongoing work to use review results to educate professionals, women and the media and to improve practice

This carefully coordinated evidence-based process clarified the state of the science for many related clinical questions, and Childbirth Connection and many others have been using results of the papers to strengthen policy, practice, research, and both professional and consumer education. Childbirth Connection has carried out media outreach to make key labor pain research results accessible to childbearing families and the general public.

The papers have been widely cited, and results are being incorporated into health professional education programs. A number of derivative reports have been prepared, including two companion papers, an editorial and a consumer handout in American Family Physician

Childbirth Connection's Listening to Mothers® surveys have further explored important labor pain questions from the perspective of mothers themselves, and are continuing to fill in gaps in knowledge in this area. For example, the surveys include data on rates of use of a wide range of pharmacologic and nonpharmacologic measures, ratings of the measures used, and knowledge about effects of epidural analgesia. Listening to Mothers II results, which will be reported in fall 2006, will enable a charting of pain relief trends and will provide data on additional pain relief topics.

Related links, below, provide access to Childbirth Connection's in-depth labor pain resources developed from the systematic reviews and related labor pain work for consumers and journalists.

Most recent page update: 9/11/2012


© 2014 National Partnership for Women & Families. All rights reserved.

Founded in 1918, Childbirth Connection has joined forces with and become a core program of the National Partnership for Women & Families. Together, these two women's health powerhouses are transforming maternity care in the United States.
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