If you think about pain association... early stage labor is more visceral whereas 2nd stage of labor is more somatic.
So if you are going to apply warm compresses in early stages of labor... just base on what I mentioned, it will not help.
You can use epidural in early stages of labor. ACOG no longer recommend using arbitrary dilatation for epidurals.
Epidural does lengthen labor but it DOES NOT increase cesarean. This is from Uptodate 2010.
Actually, regarding the bolded statement, it depends. If you use a dilute local anesthetic solution, you are less likely to prolong labor as compared to more concentrated solutions. If you combine the dilute local with narcotic you can get just as good pain relief as with a more concentrated solution. I believe Cynthia Wong out of Chicago has published a couple of good articles on the topic.
If it's really early in the labor process, I'll do a CSE, but I won't start the infusion until they complain of pain again. This reduces the risk of developing tachyphylaxis to the local anesthetic if they are slow to dilate. I've seen patients go as long as 6 hours before needing anything.
Placement of an epidural can also hasten the progress of labor, especially in someone who is already in a good contraction pattern. I've seen many times where shortly after placing the epidural the patient's cervix changes rapidly. This is more common in the multiparous women, but also happens in primips. The theory behind this is that by producing pain relief you are decreasing the amount of circulating epinephrine. Epinephrine at concentrations typically present in the body has mainly beta1 and beta2 effects. The beta2 effects contribute to a form of tocolysis.
Anyway getting back to the original poster's question, warm compresses/massage may help back pain to a degree, and like any other method of distraction they may help with contraction pain to a degree (remember, part of pain is perception). In someone with a high pain threshold this may be adequate.
But quite frankly, I don't see these techniques as helping very much for the average person. At the place where I did residency we had nurse midwives who delivered patients. We got called to those rooms to place epidurals just as much as we got called to the rooms of non-midwife patients.
OB is the only setting where society feels pain is acceptable, and some even welcome it. This says a lot about the role of society in individual decisions.
