An exploration of the benefits and drawbacks of intrapartum pain management strategies

02 September 2014
15 min read
Volume 22 · Issue 9

Abstract

The advantages and disadvantages of pain management strategies in labour demand comprehensive midwifery exploration, with equal attention to psychological, physiological and pharmaceutical methods. This review of relevant literature discusses an array of options and their clinical sequelae from a midwifery perspective. Often intrapartum pain management is reductionist in approach, being cited around pharmacological options, negating the influential and holistic possibilities of a wider therapeutic perspective. In order to facilitate truly woman-centred care, midwives must endeavour to educate themselves and inform their practice to offer myriad of diverse coping strategies. An innate understanding of the ramifications that each strategy may have is fundamental, not only on women's perceptions and lived experience of their birth, but on the midwifery management implications which each strategy affords. Sharing this midwifery expertise enables women to self-direct their own individualised care plans in partnership with midwives, facilitating informed decisions regarding their journey through the unknown territory of labour.

‘Labour pain is not associated with pathology but with the most basic and fundamental of life's experiences’ (Lowe, 2002: 16).

An integral part of the labour process, pain poses challenges to both women and midwives despite the position of normality it holds in the maternity context. Pain is most commonly defined as ‘an unpleasant sensory and/or emotional experience associated with perceived or actual tissue damage’ (International Association for the Study of Pain (IASP), 2014). Because of the subjectivity, perception variations and phenomenological nature of labour pain, it may be useful to employ McCaffery's consideration that within the context of nursing sciences pain is ‘whatever the experiencing person says it is, existing whenever he or she says it does’ (1979: 11). Labour is arguably one of the only contexts in which pain is a normal, physiological process, rather than pathological in nature; nevertheless it challenges women emotionally, psychologically and physiologically. It is the midwife's role to support and enable women to make their individual choice for passage through the terrain of pain management options. The exploration of advantages and disadvantages of pain management strategies in labour is often perceived from the pharmacological perspective. However, in order to facilitate womancentred care, midwives must work in a holistic rather than institutionalised manner, appreciating the diversity of the women in their care. This demands a wider perception and contemplation of the benefits and drawbacks of pain management; considering each woman's psychospiritual and physiological clinical picture, birth location and environment, and the impact that each strategy can have on the individual experience.

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