Comparing non-invasive obstetric nursing care technologies and medicalized strategies for pain relief in labor

Background: labor pain has been pointed out as one of the main reasons for the use of invasive and medicalized procedures during labor. In contrast, the number of studies seeking alternative and effective strategies for pain... [ view full abstract ]

Background: labor pain has been pointed out as one of the main reasons for the use of invasive and medicalized procedures during labor. In contrast, the number of studies seeking alternative and effective strategies for pain relief is increasing, while preserving the physiological process of childbirth. Objective: To discuss non-invasive obstetric nursing care technologies (TNICEO) as demedicalized strategies for pain relief in childbirth compared to medicalized strategies. Method: systematic review of literature on different strategies, medicalized and demedicalized, used in obstetrics, to obtain pain relief in labor. The literature search was based on the question: what medicalized and demedicalized strategies are used for pain relieve in labor? The study followed the steps: choice of theme, definition of inclusion and exclusion criteria, categorization of studies, analysis and presentation of results. Articles were found in the databases LILACS, SciELO, PubMED / MEDLINE, BIREME, Science Direct, Cochrane Data Base, and Citeweb and ICM-IJC. We found 1,298 articles using the keywords: Pain relief, Pain, Labor pain, Humanization of care, Analgesia, Epidural anesthesia, General anesthesia, Cesarean, Fentanyl, Medicalization, Demedicalization, Cryotherapy, Non-pharmacological methods, Non Invasive care, Bupivacaine. Inclusion criteria were articles published in Portuguese and English from 2006 to 2016; Refer to medicalized and/or demedicalized strategies used for pain relief in childbirth. Of all articles, nine were selected, dealing with medicalized strategies and ten demedicalized strategies. Results: the use of non-invasive obstetrical nursing care provided good results in obtaining pain relief in women in the parturition process. The following aspects were highlighted in the literature regarding the strategies adopted for pain relief: freedom of movement during labor, fully achieved with the use of TNICEO and restricted with analgesia, Maternal hypotension and other adverse effects present with of drug analgesia and absent in the use of TNICEO; Higher cost of using drugs compared to TNICEO. Conclusion: Non-invasive care technologies compared to pharmacological methods for pain relief, besides their effectiveness, presented cost advantages, besides favoring woman as protagonist during childbirth. Other studies must be carried out in order to deep knowledge on this topic. Nevertheless, adopting TNICEO should be stimulated among nurse midwives.