Statement of Values, Principles and Objectives



To clarify and openly communicate the rationale for undertaking The Nature and Management of Labor Pain, and the values, principles, and objectives underlying the project, the Steering Committee developed and finalized the statement that appears below. The Committee made this statement available to all who were invited to join the project, including prospective authors of commissioned papers and those invited to attend the symposium where the papers were presented.

Statement of Values and Principles

This statement describes the values, principles, and beliefs that led to the initiation of this project and have guided its planning and implementation.

Pain during labor and birth

The time from the onset of labor through the early postpartum period is exceptionally memorable and important for most mothers. The anticipation of labor pain and the experience itself are generally leading concerns of childbearing women and their families. Labor pain varies from woman to woman, and the degree of pain any woman will experience may be difficult to predict. For some, labor pain is severe, and severe pain may have adverse effects on the mother, the fetus, and their labor.

Methods for relief of labor pain

Most women want and need some kind of assistance to relieve or help them cope with pain during labor and birth, and women's preferences for specific types of assistance vary. Research conducted in different settings in the United States and in other societies reveals that many different methods have been used for these purposes. It is important to determine the advantages and disadvantages of all methods that are used or may be appropriate for use in the United States, and to use this information to inform policy, practice, education, and research. This information should be widely available to women and to the physicians, midwives, and nurses who care for them during labor. All hospitals that provide care to women during childbirth should offer a choice of reasonably safe and effective methods for pain relief, including methods that involve the use of drugs and methods that do not use drugs.

Informed decision-making

Every woman has the right to full, objective, effectively communicated information about benefits and risks of all reasonably feasible methods for relieving pain during labor and birth, including both pharmacological and non-pharmacological methods. To the extent that it is available, this information should be derived from the evidence-based paradigm, and should include:
  • how each method works, how it is applied, women's likelihood of being helped, and the speed, duration, and expected degree of relief;

  • direct and indirect effects of each method on the normal processes of labor and birth, including: other interventions that must be used or may be required, expected impact on women's ability to move about and have physical control, and expected impact on their mental state;

  • complications and side effects associated with each method, their rate of occurrence for mothers and for infants, and impacts on breastfeeding and mother-newborn interaction; and

  • any financial costs to the woman and her family associated with each method.
Women should receive this information well before the onset of labor to enable them to consider their preferences and seek additional information. As needed or desired, every woman should have access to professional assistance to support her learning and decision-making processes. During labor, caregivers should again offer such full and balanced information and support.

Within limits of safety, every woman has the right to choose which methods will be used to relieve her pain, to be supported in her decisions by skilled and willing personnel, and to change her mind at any time. Coercion to accept or refuse one or another method is unacceptable.

The evidence-based paradigm

Commitment to evidence-based care involves a paradigm change that is gaining increasing acceptance within the U.S. health care system. Due to time constraints and the burgeoning literature, dedicated health professionals struggle to identify and gain access to relevant research, and to incorporate conclusions from valid studies into clinical care and other professional activities. The "systematic review" is a relatively recent way to gather and synthesize results of the best available research. Systematic review methodology was developed to assess evidence and draw conclusions while minimizing the many forms of bias and error that can affect the outcome of more conventional and less formal "narrative reviews."

To the extent possible, the papers prepared and presented at this symposium adhered to these increasingly accepted standards for minimizing bias and error in research reviews. Without this commitment, the process would not have fallen within the evidence-based paradigm.

The "truth" of a matter as complicated as labor pain and its management is difficult to ascertain fully, accurately, and objectively. Nevertheless, our goal was to use the evidence-based framework to seek truth in these matters and to use what we learn through this process to guide further actions in this area.

Objectives

The objectives of the Labor Pain Symposium are to identify actions that could be taken now, based on the best current available information, to:
  • make accurate information about labor pain and methods to relieve it available and easily accessible to the relevant clinical and other health professionals,

  • make accurate, meaningful information on these subjects available and easily accessible to childbearing women and the general public,

  • improve women's access to a choice of reasonably safe and effective pharmacological and non-pharmacological methods for pain relief during labor,

  • assure that women receive full information on all methods of labor pain relief that are available in their place of birth and have the freedom to choose which of these methods they will use, and

  • identify important gaps in the knowledge base, and develop and address research priorities.

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Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families.
Most recent page update: 2/20/2006