Development of a full-process non-pharmacological labor pain management protocol for vaginal delivery: a Delphi study

BackgroundNon-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.ObjectiveTo 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.MethodsGuided 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.ResultsThe 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.ConclusionThis 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.