Update on Nonpharmacologic Approaches to Relieve Labor Pain and Prevent Suffering
Penny Simkin, PT and April Bolding, PT
Journal of Midwifery Womens Health 49(6):489-504, 2004.

The control of labor pain and prevention of suffering are major concerns of clinicians and their clients. Nonpharmacologic approaches toward these goals are consistent with midwifery management and the choices of many women. We undertook a literature search of scientific articles cataloged in CINAHL, PUBMED, the Cochrane Library, and AMED databases relating to the effectiveness of 13 non-pharmacologic methods used to relieve pain and reduce suffering in labor. Suffering, which is different from pain, is not an outcome that is usually measured after childbirth. We assumed that suffering is unlikely if indicators of satisfaction were positive after childbirth. Adequate evidence of benefit in reducing pain exists for continuous labor support, baths, intradermal water blocks, and maternal movement and positioning. Acupuncture, massage, transcutaneous electrical nerve stimulation, and hypnosis are promising, but they require further study. The effectiveness of childbirth education, relaxation and breathing, heat and cold, acupressure, hypnosis, aromatherapy, music, and audioanalgesia are either inadequately studied or findings are too variable to draw conclusions on effectiveness. All the methods studied had evidence of widespread satisfaction among a majority of users.


Supporting the Laboring Woman without Injuring Oneself and How the Childbirth Educator can Help
April Bolding and Penny Simkin
International Journal of Childbirth Education (ICEA journal), January 2008


The physical demands placed on labor support people, such as birth partners and birth doulas, are perhaps greater than on anyone else on the birth team, with the exception of the birthing mother. This article outlines nine guiding principles of self care and body mechanics to reduce the likelihood of injury to the labor support person. We have identified eight common labor support tasks and have photos demonstrating the improper and proper way of performing these tasks. Childbirth educators can help impart this knowledge to birth partners by weaving these guidelines throughout their childbirth preparation classes, while correctly modeling the safest way to perform these important tasks.


Informed Choice Leaflet published by Midirs
Pain relief and coping measures that focus on preventing suffering rather than completely eliminating pain build a woman?s self-confidence, help her to maintain a sense of control and well-being, and improve her perceptions of her birth experience.
In fact, the element that best predicts a woman's experience of labour pain is her level of self-confidence in her ability to cope with labour. Satisfaction, fulfilment, and a sense of accomplishment are often high, and disappointment is avoided when the woman copes well, even when the pain she is experiencing is great.
This leaflet is published in the UK by the Midwifes Information and Resource Service. Please download the.pdf file above to read this leaflet.


Lose Your Mummy Tummy: A book and DVD review
April Bolding
BIRTH journal 34:1; March 2007

A review of Julie Tupler and Julie Gould's book and DVD Lose Your Mummy Tummy.


Tera Schreiber
Parent Map; September 2009

This articles explores how birth changes women's bodies - what's normal and what's not - and how to keep a healthy outlook on these changes.
Tera includes information from an interview done with April.


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The Great Starts Guide is a FREE consumer guide, which includes articles on the different types of childbirth providers and birth places, summaries of recommendations on what policies, services and intervention rates expectant parents should look for, and survey responses and quotes from new parents about how they feel about the care they received.The emphasis throughout the Guide is on informed choice. There is no one perfect place for all women to birth. Finding the best place for you depends on your values, priorities, and medical needs. The more information you have about your options, the better job you can do of finding the caregivers that will help you have the best possible birth experience. It is available for download here.


There is also a special local version of the Guide for King County, Washington. Every few years, we survey local hospitals, birth centers, and midwifery practices to learn more about their policies, services, and intervention rates. An administrator from the service (e.g. head nurse of obstetrics at a hospital) completes the survey. In the interest of transparency, we’re making all our data available to you here. You can also look up more details on individual providers than is available in the report in the Guide. The raw data is the first worksheet in each of these spreadsheets: hospitals’ responses, birth centers, nurse-midwives, and out-of-hospital midwives. We’ve reviewed recommendations for maternity care practices from a wide range of organizations and researchers, and used them to develop ranking criteria which allow expectant parents to compare between their options for caregivers. For example, parents can compare ranks for how well a service supports non-drug comfort techniques, or whether they work to avoid unnecessary interventions. We are not advocating for any particular choice in caregiver or birthplace. We are giving parents the information they need to guide them in asking their own questions about what option is best for them. Download the Great Starts Guide for King County with results from our local survey here.


We offer the Great Starts Guide free of charge so that everyone can access this vital information. However, it does take many long hours of work to create the Guide, so we ask you to consider a donation of $10 to Parent Trust to help support this project and other work by our agency.