Comparative Effectiveness of Pain Management Strategies During Labor and Delivery

Abstract

Background:
Labor pain is widely recognized as one of the most intense forms of pain experienced by women, significantly impacting the birthing experience. Effective pain management during labor is essential not only for maternal comfort and satisfaction but also for favorable obstetric outcomes. A wide range of pharmacological and non-pharmacological strategies are used worldwide, yet comparative effectiveness remains under-investigated, particularly in the Saudi Arabian context.
Methods:
A systematic review was conducted following PRISMA guidelines. A comprehensive search of PubMed was performed using keywords such as “labor pain,” “pain management,” “epidural,” “non-pharmacological methods,” and “Saudi Arabia.” The search strategy included Boolean operators and MeSH terms. Studies were screened by two independent reviewers, with disagreements resolved by consensus. Inclusion criteria comprised clinical trials and cohort studies that evaluated pain relief interventions during labor. Data extraction included study design, population, intervention, and outcomes. Risk of bias was assessed using the Cochrane risk of bias tool.
Results:
Twelve studies met the inclusion criteria, encompassing a mix of clinical trials and cohort studies. Pharmacological methods, particularly epidural analgesia, were shown to reduce labor pain by up to 95% and were associated with higher maternal satisfaction but also with an increased odds ratio for instrumental delivery (1.21) and cesarean section (1.60). Non-pharmacological approaches such as the Bonapace Method, acupressure, and water immersion also demonstrated statistically significant reductions in pain levels and fewer obstetric interventions. Awareness and utilization of pain relief methods in Saudi Arabia were notably low, with up to 79.8% of women unaware of available options.
Conclusions:
Both pharmacological and non-pharmacological interventions are effective in labor pain management, but each comes with distinct benefits and risks. Greater awareness and individualized care approaches are essential, particularly within cultural contexts such as Saudi Arabia.