The Nature and Management of Labor Pain: Executive summary,☆☆,

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Abstract

This report describes the background and process for a rigorous project to improve understanding of labor pain and its management, and summarizes the main results and their implications. Labor pain and methods to relieve it are major concerns of childbearing women, with considerable implications for the course, quality, outcome, and cost of intrapartum care. Although these issues affect many women and families and have major consequences for health care systems, both professional and public discourse reveal considerable uncertainty about many questions, including major areas of disagreement. An evidence-based framework, including commissioned papers prepared according to carefully specified scopes and guidelines for systematic review methods, was used to develop more definitive and authoritative answers to many questions in this field. The papers were presented at an invitational symposium jointly sponsored by the Maternity Center Association and the New York Academy of Medicine, were peer-reviewed, and are published in full in this issue of the journal. The results have implications for policy, practice, research, and the education of both health professionals and childbearing women. (Am J Obstet Gynecol 2002;186:S1-15.)

Section snippets

Background: Origins and rationale for The Nature and Management of Labor Pain

Labor pain and methods to relieve it are major concerns of childbearing women and their families, with considerable implications for the course, quality, outcome, and cost of intrapartum care. Although these issues affect approximately 4 million women and families annually in the United States alone and have major consequences for health care systems, both professional and public discourse revealed considerable uncertainty, with major areas of disagreement and controversy about the safety and

Process and methods

The Maternity Center Association asked Judith Rooks to direct the project and entered into partnership with the New York Academy of Medicine for the purpose of planning and holding the symposium. The meeting was jointly sponsored by and held at the New York Academy of Medicine.

A multidisciplinary steering committee was formed comprising 12 members with expertise in anesthesiology, bioethics, childbirth education, consumer advocacy, epidemiology, journalism, labor support (doula care),

Results

The following summaries of The Nature and Management of Labor Pain project papers will provide an introduction and orientation to the papers themselves. These overviews cannot substitute for the individual papers, which are exceptionally comprehensive. Both the papers developed with the systematic review methods and their summaries below are generally longer than papers that, out of necessity, used a more conventional approach to review of literature. The summaries appear in the order of

Implications for practice

The Nature and Management of Labor Pain project has used an open and systematic process to identify and assess the best available research to answer leading questions facing professionals and childbearing women. Until they are superceded by new and updated reviews of equivalent or greater rigor, these are arguably the best available answers to the specific questions addressed.

The Steering Committee believes that the major conclusions from these papers should inform pain-related decision making

Implications for research

As is clear from the accompanying papers, this identification and summary of the best available research clarifies that many critical gaps in knowledge remain. Space limitations preclude an in-depth discussion here, and readers are referred to the papers themselves. The committee would, however, like to identify one important research gap that is evident across all of the methods papers. By and large, the comparison groups in available studies of the effects of pain relief methods reflect needs

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  • Cited by (0)

    Convened by the Maternity Center Association, New York City.

    ☆☆

    The views expressed by the Steering Committee do not necessarily reflect those of the agencies, institutions, and organizations with which its members are affiliated.

    Reprint requests: Maureen P. Corry, MPH, Executive Director, Maternity Center Association, 281 Park Ave South, New York, NY 10010.

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