Augustinsson LE, Bohlin P, Bundsen P, Carlsson CA, Forssman L, Sjöberg P, Tyreman NO Pain relief during delivery by transcutaneous electrical nerve stimulation. Pain. 1977; 4:(1)59-65

Benfield RD, Hortobágyi T, Tanner CJ, Swanson M, Heitkemper MM, Newton ER The effects of hydrotherapy on anxiety, pain, neuroendocrine responses, and contraction dynamics during labor. Biol Res Nurs. 2010; 12:(1)28-36

Berman BM Cochrane Complementary Medicine Field. About The Cochrane Collaboration (Fields). 2006; (1)

Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ. 2011; 343

Undisturbed birth. 2011. (accessed 10 January 2017)

Care Quality Commission. 2013. (accessed 10 January 2017)

Carvalho B, Cohen SE Measuring the labor pain experience: delivery still far off. Int J Obstet Anesth. 2013; 22:(1)6-9

Chen YW, Wang HH The effectiveness of acupressure on relieving pain: a systematic review. Pain Manag Nurs. 2014; 15:(2)539-50

Cluett ER, Burns E Immersion in water in labour and birth. Cochrane Database Syst Rev. 2009; (2)

London: The Stationery Office; 1993

da Silva FMB, de Oliveira SMJV, Nobre MRC A randomised controlled trial evaluating the effect of immersion bath on labour pain. Midwifery. 2009; 25:(3)286-94

Dick-Read G, 2nd edn. London: Pinter and Martin; 2013

Diego MA, Field T, Sanders C, Hernandez-Reif M Massage therapy of moderate and light pressure and vibrator effects on EEG and heart rate. Int J Neurosci. 2004; 114:(1)31-44

Dowswell T, Bedwell C, Lavender T, Neilson JP Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. Cochrane Database Syst Rev. 2009; (2)

Eberhard J, Stein S, Geissbuehler V Experience of pain and analgesia with water and land births. J Psychosom Obstet Gynaecol. 2005; 26:(2)127-33

Eckert K, Turnbull D, MacLennan A Immersion in water in the first stage of labor: a randomized controlled trial. Birth. 2001; 28:(2)84-93

Enkin M, Keirse M, Neilson J, Crowther C, Duley L, Hofmeyr J, 3rd edn. Oxford: Oxford University Press; 2000

Ernst E, Köder K An overview of reflexology. Eur J Gen Pract. 1997; 3:(2)52-7

Field T Pregnancy and labor massage. Expert Review of Obstetrics & Gynecology. 2010; 5:(2)177-81

Field T, Diego M Vagal activity, early growth and emotional development. Infant Behav Dev. 2008; 31:(3)361-73

Field T, Hemandez-Reif M, Taylor S, Quintino O, Burman I Labor pain is reduced by massage therapy. J Psychosom Obstet Gynaecol. 1997; 18:(4)286-91

Foureur M Creating birth space to enable undisturbed birth. In: Fahy K, Foureur M, Hastie C (eds). sydney: Books for Midwives; 2008

Hajiamini Z, Masoud SN, Ebadi A, Mahboubh A, Matin AA Comparing the effects of ice massage and acupressure on labor pain reduction. Complement Ther Clin Pract. 2012; 18:(3)169-72

Harris PE, Cooper KL, Relton C, Thomas KJ Prevalence of complementary and alternative medicine (CAM) use by the general population: a systematic review and update. Int J Clin Pract. 2012; 66:(10)924-39

Hernandez-Reif M, Field T, Krasnegor J, Hossain Z, Theakston H, Burman I High blood pressure and associated symptoms were reduced by massage therapy. J Bodyw Mov Ther. 2000; 4:(1)31-8

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J Continuous support for women during childbirth. Cochrane Database Syst Rev. 2011; (2)

International Association for the Study of Pain. IASP Taxonomy: Pain. 2014. (accessed 10 January 2017)

Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev. 2012; (3)

Karlsdottir SI, Halldorsdottir S, Lundgren I The third paradigm in labour pain preparation and management: the childbearing woman's paradigm. Scand J Caring Sci. 2014; 28:(2)315-27

Kenyon C Risk management standards in midwifery are no substitute for personal knowledge and accountability. Complement Ther Clin Pract. 2009; 15:(4)209-11

Kimber L, McNabb M, Mc Court C, Haines A, Brocklehurst P Massage or music for pain relief in labour: a pilot randomised placebo controlled trial. Eur J Pain. 2008; 12:(8)961-9

Klomp T, Manniën J, de Jonge A, Hutton EK, Lagro-Janssen ALM What do midwives need to know about approaches of women towards labour pain management? A qualitative interview study into expectations of management of labour pain for pregnant women receiving midwife-led care in the Netherlands. Midwifery. 2014; 30:(4)432-8

Lally JE, Murtagh MJ, Macphail S, Thomson R More in hope than expectation: a systematic review of women's expectations and experience of pain relief in labour. BMC Med. 2008; 6:(7)

Leap N Being with women in pain — do midwives need to rethink their role?. British Journal of Midwifery. 1997; 5:(5)263-3

Leap N, Anderson T The role of pain in normal birth and the empowerment of women, 2nd edn. In: Downe S Edinburgh: Churchill Livingstone; 2008

Leap N, Hunter B Approaches to pain in labour.London: Routledge; 2016

Leap N, Sandall J, Buckland S, Huber U Journey to confidence: womens experiences of pain in labour and relational continuity of care. J Midwifery Womens Health. 2010; 55:(3)234-42

Lechner W, Jarosch E, Sölder E, Waitz-Penz A, Mitterschiffthaler G [Beta-endorphins during childbirth under transcutaneous electric nerve stimulation]. Zentralbl Gynakol. 1991; 113:(8)439-42

Lee H, Ernst E Acupuncture for labor pain management: A systematic review. Am J Obstet Gynecol. 2004; 191:(5)1573-9

Lee SL, Liu CY, Lu YY, Gau ML Efficacy of warm showers on labor pain and birth experiences during the first labor stage. J Obstet Gynecol Neonatal Nurs. 2013; 42:(1)19-28

Levett KM, Smith CA, Dahlen HG, Bensoussan A Acupuncture and acupressure for pain management in labour and birth: A critical narrative review of current systematic review evidence. Complement Ther Med. 2014; 22:(3)523-40

Lowe NK The nature of labor pain. Am J Obstet Gynecol. 2002; 186:(5)S16-S24

Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, Schubiner H, Keefe FJ Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol. 2011; 67:(9)942-68

Madden KL, Turnbull D, Cyna AM, Adelson P, Wilkinson C Pain relief for childbirth: the preferences of pregnant women, midwives and obstetricians. Women Birth. 2013; 26:(1)33-40

Mathew AM, Francis F Effectiveness of Foot Reflexology in Reduction of Labour Pain among Mothers in Labour Admitted at PSG Hospital, Coimbatore. International Journal of Nursing Education. 2016; 8:(3)11-15

Melzack R, Wall P, 2nd edn. London: Penguin Books; 2008

Moghimi-Hanjani S, Mehdizadeh-Tourzani Z, Shoghi M The Effect of Foot Reflexology on Anxiety, Pain, and Outcomes of the Labor in Primigravida Women. Acta Med Iran. 2015; 53:(8)507-11

Mollart L, Adams J, Foureur M Pregnant women and health professional's perceptions of complementary alternative medicine, and participation in a randomised controlled trial of acupressure for labour onset. Complement Ther Clin Pract. 2016; 24:167-73

National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies. 2016. (accessed 10 January 2017)

NHS Choices. Complementary and alternative medicine. 2016. (accessed 23 January 2017)

Nicholls S, Hauck YL, Bayes S, Butt J Exploring midwives perception of confidence around facilitating water birth in Western Australia: A qualitative descriptive study. Midwifery. 2016; 33:73-81

London: NMC; 2012


Pallivalappila AR, Stewart D, Shetty A, Pande B, McLay JS Complementary and Alternative Medicines Use during Pregnancy: A Systematic Review of Pregnant Women and Healthcare Professional Views and Experiences. Evid Based Complement Alternat Med. 2013; 2013:1-10

London: RCM; 2012

London: RCM; 2014

Russell K, Walsh D, Scott I, McIntosh T Effecting change in midwives waterbirth practice behaviours on labour ward: an action research study. Midwifery. 2014; 30:(3)e96-e101

Samuel C, Ebenezer I The effects of reflexology on pain threshold and tolerance in an ice-pain experiment in healthy human subjects. Complement Ther Med. 2008; 16:233-37

Sanders R Functional discomfort and a shift in midwifery paradigm. Women Birth. 2015; 28:(3)e87-e91

Silva Gallo RB, Santana LS, Jorge Ferreira CH, Marcolin AC, Polineto OB, Duarte G, Quintana SM Massage reduced severity of pain during labour: a randomised trial. J Physiother. 2013; 59:(2)109-16

Simkin P, Ancheta P Dysfunctional labor: General considerations, 3rd edn. In: Simkin P, Ancheta P (eds). London: Wiley-Blackwell; 2011a

Simkin P, Ancheta P The labor progress toolkit: Part 2. Comfort measures, 3rd edn. In: Simkin P, Ancheta P (eds). London: Wiley-Blackwell; 2011b

Simkin P, Bolding A Update on nonpharmacologic approaches to relieve labor pain and prevent suffering. J Midwifery Womens Health. 2004; 49:(6)489-504

Smith CA, Collins CT, Cyna AM, Crowther CA Complementary and alternative therapies for pain management in labour. Cochrane Database Syst Rev. 2006; (4)

Smith CA, Levett KM, Collins CT, Crowther CA Relaxation techniques for pain management in labour. Cochrane Database Syst Rev. 2011a; (12)

Smith CA, Collins CT, Crowther CA Aromatherapy for pain management in labour. Cochrane Database Syst Rev. 2011b; (7)

Smith CA, Collins CT, Crowther CA, Levett KM Acupuncture or acupressure for pain management in labour. Cochrane Database Syst Rev. 2011c; (7)

Spiby H, Henderson B, Slade P, Escott D, Fraser RB Strategies for coping with labour: does antenatal education translate into practice?. J Adv Nurs. 1999; 29:(2)388-94

Stark MA, Craig J, Miller MG Designing an intervention: therapeutic showering in labor. Appl Nurs Res. 2011; 24:(4)e73-e77

Stark MA, Miller MG Barriers to the use of hydrotherapy in labor. J Obstet Gynecol Neonatal Nurs. 2009; 38:(6)667-5

Sullivan DH, McGuiness C Natural labor pain management. Int J Childbirth Educ. 2015; 30:(2)20-5

Tillett J, Ames D The uses of aromatherapy in womens health. J Perinat Neonatal Nurs. 2010; 24:(3)238-45

Tiran D, 2nd edn. Edinburgh: Churchill Livingstone; 2000

Uvnas-Moberg KLondon: Pinter and Martin; 2011

Van der Gucht N, Lewis K Women's experiences of coping with pain during childbirth: a critical review of qualitative research. Midwifery. 2015; 31:(3)349-58

Vickers A, Zollman C ABC of complementary medicine: massage therapies. BMJ. 1999; 319:(7219)1254-7

Walsh D, 2nd edn. London: Routledge; 2012

Whitburn LY, Jones LE, Davey MA, Small R Women's experiences of labour pain and the role of the mind: an exploratory study. Midwifery. 2014; 30:(9)1029-35

Zwelling E Overcoming the Challenges. MCN Am J Matern Child Nurs. 2010; 35:(2)72-8

Non-pharmacological pain management strategies for labour: Maintaining a physiological outlook

02 February 2017
Volume 25 · Issue 2


Negotiating the pain and discomfort of labour can be challenging for women, their partners and the midwives attending their births. In current midwifery practice, there are a number of women who express a desire to experience the whole range of sensations accompanying physiological birth without the use of pharmacological agents while retaining a sense of control and dignity. Guidance is available around non-pharmalogical strategies for pain management in labour. Midwives can use the philosophy of normality to thoughtfully support and guide women and their partners, helping them to choose strategies that work with the underlying physiology of pain while enabling women to feel empowered in their birth experience.

Labour pain is complex and multifaceted, existing within an individual perception and context, and arising from individual physiology, psychology and cultural perspectives. Notions of ‘normal labour’ differ depending on cultural background, spiritual practice and a woman's phenomenological experiences (Karlsdottir et al, 2014). The International Association for the Study of Pain (IASP, 2014) defines pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage’—a distinction from the physiological normal role of pain in a birthing context, which may be challenging for both women's perception and midwifery facilitation (Sanders, 2015). The National Institute for Health and Care Excellence (NICE, 2016) prompts practitioners to reflect on how midwives’ ideologies and beliefs influence how women are supported to handle the experience of labour discomfort (Nursing and Midwifery Council (NMC), 2015; Leap and Hunter, 2016). This article focuses on midwives' capacity, through understanding non-pharmacological strategies, to facilitate practice based on ‘working with pain’ (Leap, 1997) rather than ‘pain relief’.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month