This website is intended for healthcare professionals.
Subscriber log in
Trial log in

Water as non-pharmacological pain management in labour

Ann-Marie De Leo

Masters student at Edith Cowan University, Western Australia

Sadie Geraghty

Co-ordinator of Master of Midwifery Practice at Edith Cowan University, Western Australia

20(3); ePub: 1 March 2017


 (March 2017)

The use of Complementary and Alternative Medicine (CAM) in maternity care has risen over the past two decades. An increasing number of women seek non-pharmacological pain management during labour and birth. The use of hydrotherapy - or water immersion - during labour offers women a naturalistic approach to pain relief, and may prove more beneficial than conventional pharmacological pain management. The practice of midwifery incorporates the promotion of physiological birth, and the use of showers and warm baths or pools provides women with an opportunity to experience the natural process of birth, while providing alternative comfort measures to women who opt for non-pharmacological pain relief during labour and birth.    

Hypnosis and hypnobirthing for labour - a critical selective narrative review

Alys Einion

Associate Professor of Midwifery at Swansea University

 (December 2016)

The provision of woman-centred care is at the heart of midwifery practice, and there appear to be increasing numbers of women choosing alternative forms of support for their childbearing journey. Women are often fearful of the experience of labour and birth, and in particular express concern about pain and its management; the literature shows that fear of childbearing is associated with increased pain (Leeman et al 2003). Although there are many pharmacological and non-pharmacological approaches to managing the pain of labour, these depend on availability, women’s preferences, and on the woman’s perception of their efficacy. This literature review focuses on the use of hypnosis, including complex programmes of antenatal preparation known as hypnobirthing, as a means of coping with the experience of labour and birth. A key word search of the literature was carried out to identify published research and literature on this topic. The articles chosen for critical review will be evaluated and explored.

Use of complementary therapies for low risk post dates pregnancy: a national survey

Tara Pauley

Research Midwife, Hinchingbrooke Healthcare NHS Trust

Sangeeta Pathak

Consultant Obstetrician, Hinchingbrooke Healthcare NHS Trust

Beccy Percival

Practice Development Midwife, Hinchingbrooke Healthcare NHS Trust

 (October 2016)

Use of complementary and alternative medicines (CAM) is increasing throughout pregnancy, including post-dates women, with the aim of reducing medicalisation; however, the clinical effectiveness of CAM is not proven. The aim of this study (Pathak and Pauley 2015) was to investigate the use of CAM for low risk post-dates women in the UK. An online questionnaire was sent to health care professionals involved in providing care to pregnant women. Massage, aromatherapy and hypnobirthing were the top three modalities reported. Only 58 per cent of respondents reported formal training. Seventy four per cent of respondents reported not auditing their practice of CAM. To conclude it was found that the clinical effectiveness of CAM is yet to be proven and that more research in this area is required.

Redemptive birth

Lina Duncan

Midwife in Mumbai, India

 (May 2016)

Many of us are in the business of improving birth. Some of us are decades into our journeys of midwifery, whilst others are fresh students aspiring to give our best in this new profession. This article looks at ways to redeem birth from two aspects: for the mother; and for the midwife. I work in an international community in a developing country, in a privatised system. Although different from the UK, birth is birth. Women, their families and midwives will be able to relate to similar experiences. Ultimately my goals are likely to be the same as those in other parts of the world. I address issues of the workplaces in which we operate, the role of midwives in redeeming birth outcomes, and how we may better serve women and each other.

Aromatherapy in midwifery practice

Dr Alys Einion

Associate professor in midwifery at Swansea University

 (May 2016)

Aromatherapy is a complementary therapy that uses essential oils of plants to achieve therapeutic effects. Midwives can offer complementary therapies to women if they have been trained in their use and follow the required professional frameworks for regulation, permissions, monitoring and insurance. This article explores the use of aromatherapy to ease a common condition of pregnancy: that of lower back pain. This may be due to the lordosis of pregnancy, caused by the hormone relaxin - which increases in pregnancy and causes greater flexibility of joints and connective tissue - and by changes in body mass and centre of gravity; but it could also be caused by something else, such as strain or repeated movement. Any midwife offering aromatherapy should ensure that all other potential conditions and contraindications have been considered before commencing treatment, and would carry out a full assessment including taking a detailed history.

Hypnobirth within the NHS: Time to ditch the parent craft?

Teri Gavin-Jones

Specialist midwife for parent education at Colchester Hospital and co-director of a hypnobirth training company

 (May 2016)

Antenatal education within the National Health Service (NHS) is a service in decline within some hospital trusts. Classes on offer are being moved into online formats or discontinued completely. Whilst research into antenatal education remains limited, what is known is that good birth preparation is of value. “Participative preparation for childbirth can enhance women’s overall satisfaction with the childbirth experience” (Schrader McMillan et al 2009: 49). There are pockets of excellent antenatal education within the NHS, but no system for regulating the quality and content. Traditional ‘parent craft’ classes can be oversubscribed, turning what should be a participative group into an audience. Offering good quality antenatal education has the potential to increase normality, improve the birth outcome and the experience of both woman and her birth partner. Is it time to ditch the parent craft and implement dynamic woman-focused education?

RESEARCH UNWRAPPED Yoga for prenatal depression: a systematic review and meta-analysis  

Maeve Regan

First year student midwife at University of Central Lancashire, with a background in research, at the time of writing

 (May 2015)

Yoga for prenatal depression: a systematic review and meta-analysis, Gong H et al (2015) BMC Psychiatry, 15(1): 14 This paper explores the role of yoga in reducing depressive symptoms for pregnant women. The research was appraised using the Critical Appraisal Skills Framework (CASP) checklist for systematic reviews (2014) and the Cochrane handbook for systematic reviews (Higgins and Green 2008). This paper is published open access in BMC Psychiatry Journal, making the results freely available to anyone interested

Hypnotherapy: the salutogenic solution to dealing with phobias

Maria Williamson

Hypnotherapist and midwife, East Lancashire Hospitals NHS Trust

Colette Gregory

Outpatients manager and supervisor of midwives, East Lancashire Hospitals NHS Trust

 (May 2015)

Evidence suggests that around a quarter of women can suffer from an intense fear of giving birth (tocophobia). This can be costly to these women in terms of enduring negative effects of the increased use of medical interventions associated with tocophobia. Other issues, such as white coat hypertension, can also be problematic in pregnancy. This article describes the establishment of a hypnotherapy service within the antenatal day assessment unit at East Lancashire Hospitals NHS Trust and recounts a recent case study in which the use of hypnotherapy was employed to help Rebecca, a white coat hypertension sufferer, to successfully manage her condition.

Hypnotherapy for birth

Maggie Howell

Hypnotherapy trainer and writer

 (May 2014)

There are many misunderstandings about hypnotherapy for birth and how best to support a woman who has chosen to use it. This article brings together experiences of midwives who have attended women in labour using hypnotherapy, and aims to help birth professionals understand a bit more about hypnotherapy and how they can best support women who are using it. It is a personal account from a hypnotherapy trainer reflecting on her encounters with midwives as they share experiences of observing hypnotherapy in action.

Osteopathy: helping pregnant women in pain

Sara Randall

Midwife at Watford General Hospital, osteopath and lactation consultant in private practice, lecturer at the British College of Osteopathic Medicine and qualified in medical acupuncture, kinseology taping and laser treatment for postnatal women

 (May 2014)

Various therapies are accessed by women who are looking to enhance the experience of pregnancy or to relieve pain from pregnancy-related ailments. This article gives an introduction to how osteopathy may help women presenting with pain. It includes an overview of a case study, in order that midwives can gain insight into how osteopathic medicine approaches and applies knowledge of anatomy and physiology to improve biomechanics that may have become sub optimal giving the symptom of pain. An underlying philosophy of structure governs function.

Use of acupuncture during labour

David Carr

Lecturer in maternal and fetal medicine at University College London, specialist registrar in obstetrics and gynaecology at University College London Hospitals NHS Foundation Trust and associate editor of an acupuncture journal

Jeanne Lythgoe

Lecturer in midwifery at University of Salford and supervisor of midwives at Bolton NHS Foundation Trust.

Both are course leaders and lecturers at an association of medical practitioners interested in acupuncture

 (May 2014)

Acupuncture is becoming widely recognised as an effective method of pain relief and is being increasingly integrated within the NHS, particularly for the treatment of tension-type headache, migraine and low back pain. Acupuncture during labour has been shown by a Cochrane review to reduce labour pain intensity, increase patient satisfaction and limit the use of pharmacological analgesia (Smith et al 2011) and epidural anaesthesia (Nesheim and Kinge 2006). It may therefore be particularly suited to labouring women who wish to avoid more invasive forms of pain relief. Furthermore, women receiving acupuncture in labour appear to experience additional benefits including shorter labours and reduced rates of instrumental vaginal birth (Smith et al 2011). In the UK, intrapartum acupuncture is usually provided by professional acupuncturists, but in countries such as Germany and Scandinavia it is widely given by midwives. A midwife-delivered acupuncture service appears to be a similarly feasible and cost-effective option in the UK and is currently being piloted at University College London Hospitals NHS Trust.

The multisensory approach to birth and aromatherapy

Kathryn Gutteridge

Consultant midwife and clinical lead for low-risk care at Sandwell and West Birmingham Hospitals NHS Trust

 (May 2014)

The birth environment continues to be a subject of midwifery discourse within theory and practice. This article discusses the birth environment from the perspective of understanding the aromas and aromatherapy for the benefit of women and midwives. The dynamic between the olfactory system and stimulation of normal birth processes proves to be fascinating. By examining other health models of care we can incorporate simple but powerful methods that can shape clinical outcomes. There is still more that midwives can do by using aromatherapy in the context of a multisensory approach to make birth environments synchronise with women’s potential to birth in a positive way.

Benefits of infant massage

Jane Day

Midwife and nurse and a qualified infant massage instructor

 (May 2014)

After spending three months as a clinical midwifery tutor at a remote hospital in Zambia, where I helped to train student midwives and other students, my interest in infant massage was ignited, having witnessed the benefits of massage to both mother and baby. Once back in the UK, I trained and qualified as a massage instructor with an international infant massage training organisation, which has led me to work extensively with parents and babies, offering one-to-one and group courses. It has been a privilege to be able to teach parents the valuable skill of infant massage, and consequently pass on the benefits both physiological and psychosocial.

The role of yoga: breathing, meditation and optimal fetal positioning

Sarah Oakley and Elinor Evans

Yoga teacher trainers at a school specialising in yoga for fertility, pregnancy, postnatal health and mother and baby care

 (May 2014)

Yoga is considered a good form of exercise in pregnancy (NHS Choices recommend exercise such as yoga, amongst others) to help women keep fit during their pregnancy and prepare for the birth. But apart from the physical postures, yoga has plenty to offer. The breathing and meditation techniques keep pregnant mothers healthy and relaxed, and provide the mental focus to aid childbirth. In this article we look at yogic breathing and meditation techniques for midwives to recommend to expectant mothers, and some postures that specifically help to encourage an optimal fetal position.