Development of a full-process non-pharmacological labor pain management protocol for vaginal delivery: a Delphi study.
- 1Delivery Room, Women and Children's Hospital of Ningbo University, Ningbo, Zhejiang, China.
- 2Postpartum Maternal and Child Health Centers, Women and Children's Hospital of Ningbo University, Ningbo, Zhejiang, China.
Abstract
Background
Non-pharmacological strategies can complement pharmacological labor analgesia, yet their clinical use is often fragmented across techniques and labor stages, limiting consistent and continuous support during vaginal delivery.Objective
To develop a consensus-based, implementation-oriented clinical practice protocol that organizes full-process non-pharmacological labor pain management from prenatal preparation through early postpartum evaluation.Methods
Guided by the Manchester pain management model and CREDES recommendations, this Delphi-based protocol development study generated an initial framework through structured evidence review, focus group discussion, and expert consultation. Eleven interdisciplinary experts completed two anonymous Delphi rounds. Group-level statistical feedback and anonymized comments from round 1 informed the round-2 questionnaire, and predefined consensus criteria guided protocol finalization.Results
The response rate was 100% in both rounds, and the expert authority coefficient was 0.92. First-round coefficients of variation ranged from 0.00 to 0.28; Kendall's W values were 0.230, 0.215, and 0.208 for primary, secondary, and tertiary items, respectively (P = 0.021, 0.001, and < 0.001). Second-round coefficients of variation ranged from 0.00 to 0.19; cold therapy (D4-4; CV = 0.19) was retained as a conditional item requiring individualized assessment. Kendall's W values were 0.240, 0.225, and 0.212, respectively (P = 0.010, 0.001, and < 0.001). The final protocol comprised five primary domains, 20 secondary items, and 57 tertiary items integrating pain-management objectives, team building, dynamic assessment, mechanism-organized interventions, shared decision-making, and outcome evaluation from prenatal preparation to 24 h postpartum.Conclusion
This study shows that dispersed evidence on non-pharmacological labor pain management can be translated through multidisciplinary consensus into a coherent full-process clinical pathway. The protocol offers a standardized framework to complement pharmacological analgesia and support consistent, individualized care; its feasibility, acceptability, and clinical effects require prospective multicenter evaluation.
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BibTeX
@article{xie2026development,
title = {{Development of a full-process non-pharmacological labor pain management protocol for vaginal delivery: a Delphi study.}},
author = {Xiaoxing Xie and Rongrong Wu and Jianwen Zhang and Yan Shen and Xinqun Li},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1849246},
url = {https://europepmc.org/article/MED/42908957},
note = {CC BY},
}
RIS
TY - JOUR
TI - Development of a full-process non-pharmacological labor pain management protocol for vaginal delivery: a Delphi study.
AU - Xiaoxing Xie
AU - Rongrong Wu
AU - Jianwen Zhang
AU - Yan Shen
AU - Xinqun Li
PY - 2026
DA - 2026/10/07
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1849246
UR - https://europepmc.org/article/MED/42908957
AB - Background Non-pharmacological strategies can complement pharmacological labor analgesia, yet their clinical use is often fragmented across techniques and labor stages, limiting consistent and continuous support during vaginal delivery.Objective To develop a consensus-based, implementation-oriented clinical practice protocol that organizes full-process non-pharmacological labor pain management from prenatal preparation through early postpartum evaluation.Methods Guided by the Manchester pain management model and CREDES recommendations, this Delphi-based protocol development study generated an initial framework through structured evidence review, focus group discussion, and expert consultation. Eleven interdisciplinary experts completed two anonymous Delphi rounds. Group-level statistical feedback and anonymized comments from round 1 informed the round-2 questionnaire, and predefined consensus criteria guided protocol finalization.Results The response rate was 100% in both rounds, and the expert authority coefficient was 0.92. First-round coefficients of variation ranged from 0.00 to 0.28; Kendall's W values were 0.230, 0.215, and 0.208 for primary, secondary, and tertiary items, respectively (P = 0.021, 0.001, and < 0.001). Second-round coefficients of variation ranged from 0.00 to 0.19; cold therapy (D4-4; CV = 0.19) was retained as a conditional item requiring individualized assessment. Kendall's W values were 0.240, 0.225, and 0.212, respectively (P = 0.010, 0.001, and < 0.001). The final protocol comprised five primary domains, 20 secondary items, and 57 tertiary items integrating pain-management objectives, team building, dynamic assessment, mechanism-organized interventions, shared decision-making, and outcome evaluation from prenatal preparation to 24 h postpartum.Conclusion This study shows that dispersed evidence on non-pharmacological labor pain management can be translated through multidisciplinary consensus into a coherent full-process clinical pathway. The protocol offers a standardized framework to complement pharmacological analgesia and support consistent, individualized care; its feasibility, acceptability, and clinical effects require prospective multicenter evaluation.
SN - 2296-858X
ER -