top of page

Additional Labour Advice

  • Have continuous support in labour. This has been shown to reduce the risk of c-section and epidural use.
  • Staying mobile to reduce pain, shortens labour by 1 hour, reduces low blood pressure.
  • Upright position while pushing for woman without epidural lowered the likelihood of operative vaginal birth, abnormal baby heart rate pattern, and episiotomy, but increased the likelihood of second degree tear and blood loss > 500mL.
  • Delayed pushing: The PEOPLE trial showed women with an epidural who delayed pushing (maximum two hours) had more spontaneous and fewer difficult births.
  • Restrictive episiotomy policy: less posterior perineal trauma, less suturing, and fewer complications, with no difference for most pain measures or severe vaginal and/or perineal trauma. When the perineum is preventing delivery, particularly if the fetal heart rate is abnormal, an episiotomy may expedite a vaginal birth. Selective mediolateral episiotomy should be considered in women considered at increased risk of obstetrical anal sphincter injury (OASI), such as nulliparous women requiring assisted vaginal birth (especially forceps) or those with a history of prior OASI.
2011 Cochrane review (n=1,525) of warm perineal compresses in labour versus no intervention showed a reduction in third and fourth degree perineal tears from 5% to 2.5% (absolute risk reduction [ARR] 2.5%; number needed to treat [NNT]=40 to prevent one anal sphincter injury. Warm packs late second stage to crowning reduces 3rd and 4th degree tears and postpartum pain and 3 mo incontinence.

A 2013 Cochrane review (n=2,500) of antenatal perineal massage (hyperlink here) showed modest reductions in episiotomy rate, perineal trauma, and pain.

No evidence to support enema routinely.

Pain relief (epidural should stay on until the baby is born). If her pain tolerance is reached, release of catecholamines inhibits ongoing labour progress, and anxiety leads to more endogenous catecholamines. So an epidural, or other pain modalities (such as hypnosis) at this time helps to progress labour.

Techniques that activate peripheral sensory receptors to reduce pain in active labour:

  • Superficial heat and cold
  • Immersion in water during labour (such as the bath at Labour and Delivery)
  • A 2009 systematic review (n=828) found that women randomized to intradermal sterile water injections had significantly reduced visual analogue pain scores for up to two hours and a reduced Caesarean section rate (4.6%) compared to a saline comparison group (9.9%) (RR 0.51, 95% CI 0.30–0.87).


Birth 2007;34(4):282-90

ALARM 2014

bottom of page