Aim

To examine current research on pain in labour in midwifery-led care settings so learning may be taken to improve childbirth pain experiences and birth satisfaction across all models of maternity care.

Methods

A qualitative systematic review following the Thomas & Harden (2008) reference approach and the PRISMA reference reporting guideline was carried out. Specific search terms were used to search three databases — MEDLINE, the Maternity and Infant Care (MIC) database and PsycInfo — in addition to citation tracking and reference checking taking place in January 2025. Qualitative and mixed-methods papers published since 2010 from high-income countries were included. Studies fitting the criteria were quality appraised and a data-extraction tool was designed and used with data analysed and thematically synthesised.

Findings

Four studies were included and the developed themes were ‘antenatal preparation for self-efficacy’; ‘importance of a trusted caregiver for self-confidence’; and ‘non pharmacological pain management techniques’, alongside ‘varying encounters with pain and its positive impact’. Overall, these findings demonstrated the importance of tools to enhance self-efficacy, which can have a positive impact on birth experience in midwifery-led care settings.

Conclusions

While there was a surprisingly limited number of studies related to this topic, overall, we found women reported positive pain management strategies in midwifery-led settings. Here, relational midwifery care alongside a range of non-pharmacological approaches supported enhanced self-efficacy and positive experiences. Further research should explore the differences between birth place settings to explore how all service-user experiences can be enhanced.