Pharmacological pain relief and women´s birth experience: a systematic review.

BACKGROUND

There is increasing interest in health care systems worldwide for maternal satisfaction with childbirth experience. The World Health Organisation (WHO) launched a recommendation 2018 regarding women's right to equal and fair intrapartum care, where the importance of pharmacological pain relief was highlighted. Our objective with this systematic review was to summarize and assess the current knowledge regarding the impact of obstetric pharmacological pain relief on maternal satisfaction with childbirth.

METHODS

The databases Pub Med, Cochrane, EMBASE and CINAHL were searched for studies in the English language published after 1998 that investigated the effect of pharmacological pain relief on women´s birth experience after vaginal delivery. Studies reporting assessments of subjective satisfaction with childbirth in women planned for vaginal delivery were selected. The results were summarized narratively. For studies where comparable association measures were available, forest plots are presented. Due to heterogeneity of research questions and indirectness of measuring instruments, no meta-analyses were performed.

RESULTS

A total of 15,136 women were included from 18 studies. Two randomized controlled studies, nine cohort studies, six cross-sectional studies and one case control study, all had a moderate or high risk of bias. The studies used inconsistent methods to measure outcomes; therefore, no conclusion could be drawn regarding a possible correlation between pharmacological pain relief and overall birth experience.

CONCLUSIONS

This systematic review could not show a correlation between pharmacological pain relief and women´s experiences of childbirth, mainly due to large heterogeneity between studies. To evaluate pain relief during labour and improve women´s childbirth experiences, high-quality research is warranted.

TRIAL REGISTRATION

The study was registered in PROSPERO (prospective register of systematic reviews) 18 Dec 2018 (ID 116744).