**4. Conclusion**

The studies revealed that transcutaneous electrical nerve stimulation, immersion bath, acupuncture and acupressure, touch, massage, continuous support, hydrotherapy, and music therapy are effective methods for pain relief during labor. Besides this, they reduce pain perception, levels of anxiety, and stress and indicated laboring mothers who used these methods did not report the need for pharmacological methods.

Although these methods are cost-effective and non-invasive, there are barriers that impediment to using the techniques as per needed. Perceived barriers can be broken up into three categories: barriers related to the patient, the clinicians, and the health-care system as a whole. To be successful in the use of non-pharmacological pain relief in labor, obstetric caregivers must have to develop positive attitude toward non-pharmacological labor analgesia and women need to be aware of different alternatives available to them.

All future randomized trials must be adequately powered in evaluation of complementary and alternative techniques for pain management in labor as they are needed for improving the quality and reporting of future trials. In particular, consideration should be given to the analysis and reporting of the person providing the intervention, for example, their training, length of experience, and relationship to the woman.

Finally, the findings of this chapter point to the need of clinical research particularly in midwifery care focusing on the use of these and other nonpharmacological strategies for pain relief during labor, aiming to humanize care for women during labor.
