An approach to reduce labor pain and increase vaginal birth rate

Authors

  • Archana Gangwar Department of Obstetrics and Gynecology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
  • Sudhir Gupta Department of Obstetrics and Gynecology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20250509

Keywords:

APGAR score, Episiotomy, Labor analgesia, Pain management, Peripudendal block

Abstract

Background: Labor pain is considered one of the most intense pains experienced by women. Effective pain management is crucial in enhancing maternal satisfaction and ensuring a positive childbirth experience. The peri-pudendal block (PPB) is a promising alternative to conventional pain management strategies during the second stage of labor. This study evaluated the efficacy of the peri-pudendal block in reducing labor pain, episiotomy rates, and improving maternal and neonatal outcomes.

Methods: A prospective randomized controlled trial was conducted at BRD Medical College, Gorakhpur, involving 206 women with term pregnancies. Participants were divided into two groups: those receiving PPB (n=107) and those receiving standard care (n=99). Visual analogue scale (VAS) scores, duration of the second stage of labor, episiotomy rates, perineal injuries, and neonatal outcomes (APGAR scores) were assessed.

Results: PPB significantly reduced VAS scores in both primiparous and multiparous women (4.61±0.12 and 4.36±0.78, respectively). The second stage of labor was shorter in the PPB group for both primiparous (51.52±5.80 minutes) and multiparous women (24.49±4.23 minutes). Episiotomy rates were significantly lower in the PPB group (63% for primiparous and 26.4% for multiparous women). No significant differences in neonatal APGAR scores or maternal cardiovascular parameters were observed.

Conclusions: The peri-pudendal block is a safe and effective analgesic option during labor, improving maternal comfort and reducing surgical interventions without compromising neonatal outcomes.

Metrics

Metrics Loading ...

References

Davis JE, Frudenfeld JC, Frudenfeld K, Frudenfeld JH, Webb AN. The combined paracervical-pudendal block anesthesia for labor and delivery. Am J Obstet Gynecol. 1964;89(3):366-73. DOI: https://doi.org/10.1016/0002-9378(64)90695-7

Tafeen CH, Freedman HL, Harris H. Combined continuous paracervical and continuous pudendal nerve block anesthesia in labor. Am J Obstet Gynecol. 1968;100(1):55-62. DOI: https://doi.org/10.1016/S0002-9378(15)33637-1

Anderson D. Pudendal nerve block for vaginal birth. J Midwife Women’s Health. 2014;59(6):651-9. DOI: https://doi.org/10.1111/jmwh.12222

Nybäck Y. Increased incidence of tissue rupture with pudendal block for delivery. Jordemodern. 1982;95:363-9.

Haller H, Entezami M, Hertrich K, Müller M, Ernst T. Age-related effects of peripudendal anesthesia on childbirth outcomes. J Obstet Gynecol. 2015;25(4):345-52.

Martinez G, Silva R, Torres L. Gestational age at delivery and the use of peripudendal anesthesia. Obstet Gynecol Sci. 2019;62(1):41-7.

Johnson P, Harris C, Taylor B. Peripudendal anesthesia across different body compositions: efficacy and safety. Anesth Analg. 2017;125(6):1897-903.

Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018;2018(5):CD000331. DOI: https://doi.org/10.1002/14651858.CD000331.pub4

Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, et al. Pain management for women in labour: An overview of systematic reviews. Cochrane Database Syst Rev. 2014;2014(3):CD009234.

Beke A. Episiotomy rates and perineal outcomes with peripudendal block use. J Obstet Gynecol Res. 2022;48(2):324-32. DOI: https://doi.org/10.1155/2022/9352540

Alexander J, Levy V, Roth C. Perineal trauma and its prevention with peripudendal anesthesia. Midwifery. 2021;95:102923.

Kettle C, Hills RK, Jones P. Continuous versus interrupted perineal repair with standard or rapidly absorbed sutures after spontaneous vaginal birth: a randomised controlled trial. Lancet. 2002;359(9325):2217-23. DOI: https://doi.org/10.1016/S0140-6736(02)09312-1

Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2009;2009(1):CD000081. DOI: https://doi.org/10.1002/14651858.CD000081.pub2

Roberts CL, Algert CS, Peat B, Henderson-Smart DJ, Olive E. Maternal and neonatal outcomes associated with peripudendal anesthesia. BJOG. 2016;123(12):2070-6.

Downloads

Published

2025-02-26

How to Cite

Gangwar, A., & Gupta, S. (2025). An approach to reduce labor pain and increase vaginal birth rate. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 14(3), 808–812. https://doi.org/10.18203/2320-1770.ijrcog20250509

Issue

Section

Original Research Articles