1. reduction of fear and anxiety by thorough education in the processes of childbearing;
2. promotion of the concept that childbirth can be a drug-free, pleasurable experience ('psychoprophylaxis') (2, 7);
3. a variety of postures for labour, eg. leaning over a bean bag, intermittent ambulation, rocking;
4. conditioning exercises to strengthen back and abdominal muscles and relax pelvic joints;
5. a pleasurable, quiet and (sometimes) dimly-lit environment with soothing music (4);
6. psychological exercises and conditioned reflexes;
7. breathing control and mental exercises that focus on the breathing pattern;
8. hot packs, gentle massage and warm showers; and
9. a supportive partner who acts as a 'coach'.
Education and psychological preparation of women for labour often results in a valuable reduction in the pain scores and the reaction to pain experienced by them (6) (Figure 58.1). These parturients are less apprehensive and more cooperative (5). The antenatal classes offer a good opportunity to educate mothers about the alternative pharmacological and regional analgesia techniques available.
Only about 10-20% of women do not require some form of pain relief. Since many mothers will not be able to carry on in labour without assistance and will require some additional pain relief, it is most important that these parturients should not feel frustration at having failed. In an obstetric unit where regional analgesia is available but not actively promoted and where the bulk of these alternative techniques are available to mothers in labour, experience has shown that the epidural rate over the last twenty years has been stable at over 40% (Figure 64.1). Painless labour should never be promised to any mother who undertakes to study and practise a method of psychological preparation for labour (1).
References:
1. Gatt SP and Lacy L Analgesia and anaesthesia in obstetrics.
In: Handbook of Obstetrics and Gynaecology. (Leader L, Bennett M, Wong F, Eds) 4th ed. Chapter 8, Chapman and Hall Medical. In press, Mar 1996.
2. Brownridge P, Wood M. Soothing the pain of childbirth. Flinders Media, Flinders Medical Centre. 1992
4. Chantigian R. Non-Pharmacological methods for pain relief in obstetrics. In: Clinics in Anesthesiology - Obstetric analgesia and anesthesia. Ostheimer GW Editor. WB Saunders, Philadelphia, 197-207 1986
5. Climie CR and Gatt SP. Analgesia and Anaesthesia in obstetric practice. In: Handbook of obstetrics and gynaecology. (Wren BG, Lobo RA, Eds) 3rd ed. , ch 8, Chapman and Hall medical pp 189-206. 1987
6. Melzack R, Taenzer P, et al Labour is still painful after prepared childbirth training. Can Med Ass J 125:357-363 1981
7. Bonica J. Principles and practice of obstetric analgesia and anesthesia. Principles and practice of obstetric analgesia and anesthesia. (Bonica J Ed) FA Davis Philadelphia. pp 764-820 1967