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Dealing with labor pain: four ‘natural’ options 

When it comes to pain management during labor and delivery, some women want natural options to narcotics or an epidural. Dr. Judith Reichman considers continuous labor support, water immersion, hypnosis and acupuncture as alternatives.
/ Source: TODAY

Q: I’m pregnant and I’m worried about the pain during labor and delivery. I’d prefer not to have an epidural or take narcotics. What can I count on to help?

A: According to a recent report, you are in a minority. The 2006 Listening to Mothers II survey, which questioned 1,573 women who gave birth in U.S. hospitals, showed that 76 percent of these women had epidural or spinal analgesia during labor (and I assume most of them requested this). Of these women, 81 percent found this type of analgesia to be “very helpful.”

The report also found that 22 percent of the surveyed women were given pain-diminishing narcotics — 40 percent of these women found these to be “very helpful” and 35 percent said they were “somewhat helpful.” Obviously, the concern about narcotic use just prior to the birth is that the drug can get into the newborn’s system and affect his or her breathing. So timing is important and this type of medication is preferably given hours before the delivery.

Also, 69 percent of the women in the survey used one or more nonpharmacological methods during labor to relieve discomfort and found them to be helpful. The Cochrane group — which analyzes multiple studies in order to establish whether a procedure or medical intervention is truly “evidence based,” and in many respects is now the gold standard in determining the efficacy of a procedure — has also compared and analyzed multiple studies on these methods for pain relief.

One of the methods found to be beneficial in the Listening to Mothers II survey was continuous labor support; almost half of the women found it to be “very helpful.” Usually the support person was a doula, midwife or nurse (I guess in this survey husbands didn’t count!). Their help came in the form of touch, massage, application of cold and heat, emotional support, providing a steady flow of information to the mom-to-be and helping with communication between the mom-to-be and the labor and delivery staff. A Cochrane meta analysis (and here’s where I get statistical) of 15 randomized, controlled studies involving nearly 13,000 women did indeed find a significant decrease in the use of epidural and spinal analgesia, forceps and Caesarian section when continuous labor support was given. These women also had an increased likelihood of vaginal delivery, and reported 33 percent less distress and dissatisfaction in their labor versus the control groups that did not receive support.

Another method that also seems to be helpful iswater immersion.Although only 6 percent of women in the Listening to Mothers survey used it, 48 percent of them said the method was “very helpful” and 43 percent said it was “somewhat helpful.” A 2004 Cochrane meta analysis of eight trials, which included almost 3,000 women, found that there were fewer abnormal fetal positions in women who got into a warm bathtub. There was also decreased pain in the first 30 minutes of labor and no increase in infection. Two of these eight studies did find, though, that labor was prolonged.

There are other techniques that weren’t considered in the Listening to Mothers II survey, but have been considered in Cochrane reports. For example, a review of five trials that included 749 women found hypnosis (or hypnobirthing) to perhaps be effective in decreasing the need for pharmacological narcotics. The problem with hypnosis, however, is that you need an appropriately trained person. Plus, it may take time to get into the hypnotic state required to diminish the sensation of pain.

Finally, acupuncture has also been used to relieve pain during labor and delivery. However, it’s hard to find an acupuncturist who is on call and can come into the labor room when needed. Some midwives in Europe do take courses in acupuncture, but this is not commonly practiced by midwives in U.S. labor rooms.

Dr. Reichman’s bottom line: If you don’t want to get an epidural or take narcotics during labor, your best strategy is to have a trained person by your side for emotional and physical support. However, know that if your labor is prolonged, very painful or requires operative delivery, an anesthesiologist is there to help — and not hurt — you or your baby.

Dr. Judith Reichman, the TODAY show’s medical contributor on women’s health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, “Slow Your Clock Down: The Complete Guide to a Healthy, Younger You,” which is now available in paperback. It is published by William Morrow, a division of .

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.