Pharmacological Pain Management for Childbirth: A Scoping Review Protocol

ABSTRACT

Background

Childbirth is often a profoundly painful experience for women. The World Health Organization (WHO) recommends epidural analgesia or opioids as primary pharmacological pain management options for labor. However, many other methods of analgesia are available today, although they have different evidence backgrounds. This scoping review will map the literature on these pharmacological pain management methods for vaginal childbirth, examining their effectiveness, risks, and side effects to provide a comprehensive overview.

Methods

The scoping review will be conducted in accordance with the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) checklist. A broad systematic search will be performed across multiple databases, including a backward citation search of the included articles. Data extraction will include study characteristics, population characteristics, analgesia type, and outcomes.

Results

The results will be presented using a narrative synthesis as well as descriptive statistics in tables, figures, or graphs as appropriate.

Conclusion

The scoping review aims to map the newest existing knowledge on pharmacological pain management for women during labor. Furthermore, we will identify research gaps in this area to help shape the direction for future research.

1. Introduction

1.1. Background

Childbirth is widely recognized as one of the most intense pain experiences a woman can encounter in a lifetime [1]. Both physical and psychological factors contribute to the severity of pain perception during labor [2]. Each birth experience is unique, and women have varying pain thresholds as well as preferences concerning pain management during labor [3]. Recognizing these factors is crucial in order to provide individualized pain management and promote a positive birth experience. Among many non‐pharmacological methods for pain relief, such as relaxation techniques and massage, the World Health Organization (WHO) recommends epidural analgesia and parenteral opioids as primary pharmacological options [4]. However, a wide range of other pharmacological and non‐pharmacological options are available—although with different evidence backgrounds [5]. This scoping review aims to map the newest existing literature on pharmacological pain management methods for vaginal childbirth, comparing their effectiveness, risks, and side effects. By providing a comprehensive overview of available options, this review will also identify key gaps in the literature to help shape future research directions.

1.2. Objective

This scoping review aims to provide an overview of existing literature on intrapartum pharmacological pain management options for vaginal childbirth.

We will address this objective by answering the following research questions:

1. What types of pharmacological pain management methods for labor have been reported in the literature?

2. How is the assessment of labor pain and the effectiveness of each method of analgesia conducted?

3. Which benefits, side effects, and risks are reported intrapartum on each method?

4. What are the characteristics of currently available studies in terms of pain management method, study design, population, and geographical placement?

2. Methods

This protocol is created in accordance with the Preferred Reporting Items for Systematic Review and Meta‐Analysis protocols (PRISMA‐P) [6]. The following scoping review will be conducted using the JBI methodology [7] and will be reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) checklist [8].

2.1. Inclusion Criteria

This scoping review will include all primary studies concerning pharmacological pain management for labor, including randomized controlled studies (RCTs), quasi‐RCTs, cohort studies, case–control studies, cross‐sectional studies, and qualitative studies. Case reports and reviews will be excluded. Publications in all languages will be included. Articles in languages other than English or Danish will be translated using Google Translate. Studies published within the last decade will be included; hence, studies published before the year of 2015 will be excluded.

2.1.1. Population

The scoping review will include original studies concerning pharmacological pain management for adult women (> 18 years) undergoing vaginal childbirth. Animal studies will be excluded.

2.1.2. Concept

All original studies concerning pharmacological pain management for vaginal childbirth will be included. Hence, studies regarding analgesia for cesarean section will be excluded.

2.1.3. Context

All studies conducted on hospitals, clinics, or other healthcare facilities will be included, regardless of geographical placement.

2.2. Information Sources

The scoping review will be based on systematic research in the following databases: MEDLINE/PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar. Clinicaltrials.gov will be screened for relevant unpublished trials. Additionally, the reference list of the included articles will be scanned to consider all possible relevant studies.

2.3. Search Strategy

The search strategy will be made in collaboration with a Health Science information specialist with experience in scoping reviews. The initial search strategy in PubMed is depicted in Table 1. The search string will include MeSH terms and free text searches using an asterisk as truncation to include all variations of a word. Filters were used to limit the search to human studies concerning adults over 18 years of age with publication years after 2015.

TABLE 1.

Initial search in PubMed performed on March 23, 2025.

Search	Query	PubMed results
#1	“Parturition”[MeSH] OR “Labor, Obstetric”[MeSH] OR “Delivery, Obstetric”[Mesh] OR “Labor Pain”[MeSH]	145,501
#2	Labor[tiab] OR Labour[tiab] OR Birth*[tiab] OR Childbirth*[tiab]	567,886
#3	“Pain”[MeSH] OR “Labor Pain”[MeSH] OR “Pain Management”[MeSH] OR “Pain Measurement”[MeSH]	532,455
#4	Pain*[tiab] OR Pain relief[tiab] OR Pain management[tiab] OR Pain control[tiab] OR Pain treatment[tiab]	952,443
#5	“Analgesics”[MeSH] OR “Analgesia, Obstetrical”[MeSH] OR “Analgesia, Epidural”[MeSH] OR “Anesthesia, Obstetrical”[MeSH] OR “Anesthetics, Local”[MeSH] OR “Drug Therapy”[MeSH]	1,772,283
#6	Analge*[tiab] OR Pharmaco*[tiab] OR Drug*[tiab]	2,865,399
#7	(#1 OR #2) AND (#3 OR #4) AND (#5 OR #6)	8599
#8	(#1 OR #2) AND (#3 OR #4) AND (#5 OR #6) Filters: Humans, from 2015 – 2025, Age > 18	1227

2.4. Study Records

All identified studies will be uploaded to Covidence—a web‐based screening and data extraction tool [9]. Duplicates will be removed. Two independent reviewers will screen records for eligibility and will resolve discrepancies through discussion. If necessary, an independent third reviewer will be involved. Data charting will be conducted using a predefined form by a single reviewer and subsequently verified by other reviewers. The data charting form may be refined during the review process, with any changes documented in the final report.

2.5. Data Items

The extracted data variables will include study characteristics (author, title, publication year, etc.), population characteristics (age, population size, primipara/multipara, etc.), analgesia details, and outcomes (effectiveness, side effects, etc.). Table 2 shows an initial data charting form.

TABLE 2.

Preliminary data charting form.

Study characteristics –Author(s) –Title –Publication year –Study design –Country

Population characteristics –Age –Population size –Parity status

Analgesia details –Pain assessment –Method of analgesia

Outcomes –Effectiveness –Benefits –Side effects –Risks

Key findings

2.6. Outcomes

The primary outcome will be to map the range of intrapartum pharmacological pain management strategies for vaginal childbirth reported in the literature within the last decade. The secondary outcome will be to describe the reported benefits, side effects, and risks associated with these methods.

2.7. Data Synthesis

Quantitative data will be summarized using descriptive statistics and presented in tables, figures, or graphs as appropriate. A narrative synthesis will be used to describe how the findings relate to the objectives of the scoping review.

2.8. Quality of Evidence

Consistent with scoping review methodology, a formal risk of bias assessment will not be conducted [10]. The quality of evidence will be discussed qualitatively, if relevant, but no systematic evaluation of quality will be performed.

3. Discussion

The scoping review aims to map the current literature on pharmacological pain management methods used during childbirth. It will provide a comprehensive overview of the range of methods, along with their reported benefits, side effects, and risk profiles. The strengths of the review include a predefined and published protocol, as well as adherence to the JBI methodology and PRISMA‐ScR guidelines. Furthermore, this scoping review will utilize a broad and systematic search strategy with inclusion of all studies regardless of study design, population, or geographical placement. A limitation to the scoping review will be the absence of a formal risk of bias assessment of included studies. Additionally, the scoping review will only include studies from the last decade, with the risk of excluding some valuable studies; however, with the intention to focus on the newest research and to eliminate outdated pain management methods. Furthermore, the comparison of different types of analgesia, along with a large heterogeneity of study designs, may make comparison of study results difficult.

4. Conclusion

The individual nature of childbirth and the diverse pain tolerances of women make direct comparisons of pharmacological pain management strategies difficult. This scoping review will contribute by mapping the existing evidence on this clinically significant area. By providing a comprehensive overview of available interventions and their reported effects, this review will identify research gaps and provide a foundation for future studies in pain management approaches for women during childbirth.

Author Contributions

All authors will meet the recommendations for authorship defined by The International Committee of Medical Journal Editors.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data sharing does not apply, as this study protocol does not generate or analyze new data.