PAIN MANAGEMENT DURING LABOR
METHODS FOR PAIN MANAGEMENT
(DURING LABOR)
• Most of the methods advocated are based
on three premises:
o Discomfort during labor can be
minimized if a woman comes into labor
informed about what is happening and
prepared with breathing exercises to
use during contractions
o Discomfort during labor can be
minimized if a woman’s abdomen is
relaxed and the uterus is allowed to
rise freely against the abdominal wall
with contractions
o Pain perception can be altered by
distraction techniques or by the gating
control theory of pain perception
METHODS
A. The Bradley (Partner-Coached)
Method
• Originated by Robert Bradley
• Based on the premise that
childbirth is a joyful natural process
and stresses the important role of a
woman’s partner during
pregnancy, labor, and the early
newborn period.
• The Bradley Method emphasizes
that birth is a process:
o mothers are encouraged to
trust their bodies and focus on
diet and exercise throughout
pregnancy;
o it teaches couples to manage
labor through deep breathing
and the support of a partner or
labor coach
• a system of natural labor
techniques in which a woman and
her coach play an active part
• a simple method of increasing self-
awareness, teaching a woman how
to deal with the stress of labor by
tuning in to her own body
• The Bradley Method encourages
mothers to trust their bodies using
natural breathing, relaxation,
nutrition, exercise, and education
B. The Psychosexual Method
• Was developed by Sheila Kitzinger
in England during the 1950s.
• It stresses that pregnancy, labor,
and birth, and the early newborn
period are important points in a
woman’s life cycle.
• In includes a program of conscious
relaxation and levels of progressive
breathing that encourages a
woman to “flow with” rather than
struggle against contractions.
o Conscious relaxation
• Deliberately relaxing 1 set
of muscles, then another,
until her body is completely
relaxed
o Cleansing breath
• To begin all breathing
exercises and end each
exercise.
• Woman breathes in deeply
and exhales deeply.
• It limits the possibility of
hyper- and hypoventilation
• If Respiratory alkalosis
develops:
o Breath into a paper bag
causes rebreathing of
CO2
o Consciously controlled
breathing
• Level 1
o Slow, chest breathing
of comfortable but full
respirations.
o 6 – 12 breaths/min.
o Used for early
contractions
 PAIN MANAGEMENT DURING LABOR
• Level 2 C. The Dick-Read Method
o Lighter and more rapid
than Level 1
o Up to 40 breaths/min.
o For contractions with 4
– 6 cm cervical dilation
• Level 3
o More shallow and more
rapid breathing
o Rate is 50 – 70
breaths/min. D. The Lamaze Method
o Exhalation must be a
little stronger than
inhalation to prevent
hypoventilation
o Keep the tip of the
tongue against the roof
of her mouth to prevent
oral mucosa from
drying.
o Use for transition
contractions (8 – 10 cm
cervical dilation)
• Level 4
o A “pant–blow” pattern
o 3 or 4 quick breaths,
then a forceful
exhalation (breath –
breath – breath – huff)
• Level 5
o Quiet, continuous, very
shallow panting.
o About 60 breaths/min.
o Used during strong
contractions, or 2nd
stage of labor to
prevent the woman
from pushing before
full dilatation
• Is based on the approach proposed
by Grantly Dick-Read, an English
physician.
• The premise is that fear leads to
tension, which leads to pain.
• A woman achieves relaxation and
reduced pain by focusing on
abdominal breathing during
contractions.
• One of the most often taught in the
U.S.
• Based on the theory that through
stimulus-response conditioning,
women can learn to use controlled
breathing to reduce pain during
labor
• Was originally termed the
psychoprophylactic method.
o Focuses on preventing labor
pains by use of the mind.
• Lamaze is a method of childbirth
developed by French obstetrician
Ferdinand Lamaze.
• The core of Lamaze is focused on
the utilization of controlled
breathing to cope with pain.
• Lamaze International states that its
goal is to, "increase women's
confidence in their ability to give
birth".
6 MAJOR CONCEPTS
1. Labor should begin on its own,
not be artificially induced.
2. Women should be able to move
freely throughout labor, not be
confined to bed.
3. Women should receive
continuous support during
labor.
4. No routine interventions such
as IV fluids are needed.
 PAIN MANAGEMENT DURING LABOR

5. Women should be allowed to

assume a non-supine (upright
or side-lying) position for birth.
6. Mother and baby should be
housed together following
birth, with unlimited
opportunity for breast-feeding

EFFLEURAGE
• Light abdominal massage
• Additional technique to encourage
relaxation and displace pain in the Lamaze
Method.
• A woman traces a pattern on her abdomen
with her fingertips.
• Serves as a distraction technique

FOCUSING
• Focusing intently on an object (sensate
focus)
o Photograph of her partner or children
o A graphic design
• The woman concentrates on the object
during contractions

IMAGERY
• Imagining being in a calm place, such as on
a beach