Toolbox: Promoting Comfort in Labor

Resources and Tools

To show the list of resources and tools available within each category, click "Click to Expand" under the category subhead. Click on the icon to the left of the resource you wish to download or, in the case of a weblink, be taken to. You can also search our entire library of resources and tools by keyword, category or topic by going to our "Browse All' page

Improvement Stories

LinkAromatherapy as a Care Intervention
Aromatherapy was implemented at Park Nicollet's Methodist Hospital as a natural, supportive and evidence based intervention in order to increase their patient centered approach and decrease pharmaceutical interventions.

LinkPromoting Comfort in Labor: Nurses Implement Use of Acupressure
The High River Hospital Community Maternity Program added accupressure to their wide range of comfort/support skills in caring for women in active labor.

LinkPrenatal Shared Decision-Making for Analgesia and Anesthesia in Labor
Spectrum Health Gerber Memorial OB/GYN created a prenatal workflow to improve women’s knowledge of the possible beneficial and harmful effects of epidural anesthesia and explore alternative methods of pain relief.

LinkGerber Memorial Hospital: Team Approach to Epidural Education and Informed Consent
Learn about the team approach to epidural education and informed consent resulted in high rate of nonpharmacologic management at Gerber Memorial Hospital.

LinkVanderbilt University Medical Center Introduces Nitrous Oxide
Learn how Vanderbilt University Medical Center introduced nitrous oxide as a pain management method for labor and delivery.

Audit Tools

DocumentsComfort and Coping Audit Tool
Measure and track your progress using evidence-based process and outcome measures with this audit tool.

Model Policies

DocumentsUMMC Guideline for Ambulation and Upright Positioning
This document provides a guideline for providers and nurses to assist women in active labor with ambulation and upright positioning, to promote spontaneous labor progress, shorten first stage of labor, enhance maternal comfort and coping, and reduce cesarean births. Developed by the team at the University of Minnesota Medical Center.

DocumentsNitrous Oxide Policy
This model policy and consent form for the use of intrapartum/immediate postpartum nitrous oxide can help you introduce this option in your setting.


LinkNon-Pharmacologic Pain Relieving Strategies (NICE)
This interactive web-based algorithm is based on NICE guideline (UK) for Intrapartum Care in Healthy Women and Their Babies During Childbirth and addresses non-pharmacologic pain relieving strategies including hydrotherapy.

DocumentsRoberts Coping Scale and Algorithm
A nursing tool to guide assessment and appropriate interventions related to the laboring woman's level of coping.

Clinical Education/Staff Training Resources

LinkPeanut Balls for Labor: A Valuable Tool for Promoting Labor Progress
Link to instructions on the use of the peanut ball for comfort during labor

DocumentsAcupressure Points For Labour
This handout provides information about acupressure points to use during labor to promote comfort.

DocumentsClarifying Your Feelings About Pain and Medications in Childbirth
An assessment tool to help the clinician review how a woman feels about the role and use of medications in her labor process. Created by Penny Simpkin, PT.

DocumentsEmotional Support During Labor Competency Checklist (AWHONN)
This interactive web-based algorithm is based on NICE guideline (UK) for Intrapartum Care in Healthy Women and Their Babies During Childbirth and addresses non-pharmacologic pain relieving strategies including hydrotherapy.

DocumentsPain and Coping Assessment Interventions During Labor (AWHONN)
Model policy describing use of Hydrotherapy (water in a tub or shower) to promote relaxation and provide comfort for a laboring woman, developed by AWHONN.

Patient Education

LinkVisual Aids for Labor and Birthing Positions
This website offers visual examples of positions to promote comfort in labor. Created by The Royal College of Midwives, London, England.

DocumentsGerber Memorial Epidural Education Form
Epidural anesthesia consent form developed by Gerber Hospital that lists in detail expected results, technique, potential risks and other considerations for a woman deciding on pain management methods during labor.

DocumentsGerber Memorial Birth Plan
A template for clients to use to develop a birth plan. This can then be used by the health care team to discuss plans and support a women's choices. Created by Spectrum Health Gerber Memorial Hospital.

LinkRoadmap of Labor: A Framework for Teaching About Normal Labor
Penny Simkin's Roadmap of Labor is a patient education tool that can be used to aid in decision making about care during labor

Position Statements/Related Guidelines/Toolkits

LinkNitrous Oxide for Labor Analgesia (ACNM)
Link to download the pdf of the ACNM Position Statement "Nitrous Oxide for Labor Analgesia" August 2011

LinkPosition Statement on Waterbirth (ACNM)
Link to PDF download of ACNM's position Statement on Waterbirth (April 2014

LinkHigh Touch Nursing Care During Labor
Link to a three part video series providing instruction in labor support for intrapartum nurses, sponsored by InJoy Productions/AWHONN.

LinkEvidence-Based Nursing Care-Labor Support Skills (LAMAZE)
Link to information on a one-day workshop offering hands-on instruction in labor support, sponsored by Lamaze International.


DocumentsPromoting Comfort in Labor Bundle
The Promoting Comfort in Labor Bundle is a resource developed by the ACNM for the Reducing Primary Cesarean Project. This bundle aims to support evidence based use of non-pharmacologic and pharmacologic comfort measures to reduce unnecessary cesareans.


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