Chapter 7Chapter 7

Nursing Management of Pain During Nursing Management of Pain During Labor and Birth Labor and Birth

Education for ChildbearingEducation for Childbearing

• Ideally, educational preparation for childbirth begins prior to conception

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Types of Classes AvailableTypes of Classes Available

• Gestational diabetes mellitus

• Early pregnancy

• Exercise for pregnant women

• Infant care

• Breastfeeding

• Sibling

• Grandparent

• Adolescent childbirth

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Variations of Basic Childbirth Variations of Basic Childbirth Preparation ClassesPreparation Classes

• Refresher

• Cesarean birth

• Vaginal birth after cesarean

• Adolescent

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Content of Childbirth Preparation Content of Childbirth Preparation ClassesClasses

• Changes of pregnancy

• Fetal development

• Prenatal care

• Hazardous substances to avoid

• Nutrition

• Common discomforts

• Work, benefits of exercise

• Coping with labor and delivery

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Childbirth and PainChildbirth and Pain

• How childbirth pain differs from other pain– Part of a normal birth process– Woman has several months to prepare for

pain management– Is self-limiting and rapidly declines after birth

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Factors that Influence Labor PainFactors that Influence Labor Pain

• Pain threshold- pain perception- least amt of sensation• Pain tolerance- pain one is able to perceive• Sources of pain during labor- dilatation stretching, reduction in

uterine blood supply during contraction, pressure of fetus on pelvis structure, stretching of vagina and perineum

• Central nervous system factors– Gate control theory- small diameter nerve fibers (stroke)– Endorphins –natural body substances similar to morphine

• Maternal conditions– Cervical readiness– Pelvis– Labor intensity– Fatigue

• Fetal presentation and position

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Nonpharmacological Pain Nonpharmacological Pain ManagementManagement

• Advantages– Nonpharmacological methods do not harm the

mother or fetus– They do not slow labor if they provide

adequate pain control– They carry no risk for allergy or adverse drug

effects

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Methods of Childbirth PreparationMethods of Childbirth Preparation

• Dick-Read method- fear- tension- pain cycle

• Bradley method- husband-coached childbirth

• Lamaze method-responds to contraction with relaxation rather than tension

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Selected Nonpharmacological Pain Selected Nonpharmacological Pain Relief MeasuresRelief Measures

• Relaxation techniques- showers, decrease muscle tension

• Skin stimulation- variations of massage– Effleurage- stimulates lg diameter nerve fibers- stroke abd in

circular motion– Sacral pressure- firm pressure against lower back to relieve

back pain during labor

• Thermal stimulation• Positioning• Diversion and distraction• Breathing

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Skin StimulationSkin Stimulation

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BreathingBreathing

• First stage– Slow-paced- cleansing breath ending with contraction (6-9

breaths/min)– Modified-paced- more rapidly and shallow. Begins and ends

with cleansing breath – Patterned-paced- focus on pattern of breathing

• Constant pattern- pant-pant-pant blow• Stairstep pattern- pant-blow, pant-pant blow, pant-pant-pant

blow, pant-pant-pant-pant-blow• Second stage

– Used when pushing- cleansing breath, then take another breath and pushes down while exhaling to count of 10. blows out, takes a deep breath and pushes again while exhaling

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Breathing PatternsBreathing Patterns

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How to Recognize and Correct How to Recognize and Correct HyperventilationHyperventilation

• Signs and symptoms– Dizziness– Tingling of hands and

feet– Cramps and muscle

spasms of hands– Numbness around

nose and mouth– Blurring of vision

• Corrective measures– Breathe slowly, especially

when exhaling– Breathe into cupped

hands– Place a moist washcloth

over the mouth and nose while breathing

– Hold breath for a few seconds before exhaling

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Nursing TipNursing Tip

• If a woman is successfully using a safe, nonpharmacological pain control technique, do not interfere

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Pharmacological Pain Pharmacological Pain ManagementManagement

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Relationship of Pregnancy to Relationship of Pregnancy to Analgesia and AnesthesiaAnalgesia and Anesthesia

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• Pregnant woman at higher risk for hypoxia

• Sluggish GI tract can result in increased risk of vomiting and aspiration

• Aortocaval compression increases risk of hypotension and shock

• Effect on fetus must be considered

Pharmacological MethodsPharmacological Methods

• Advantages– Using medications during labor allows the

mother to be more comfortable and relaxed. – Increased relaxation will aid in her ability to

participate in her care.

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Pharmacological Methods Pharmacological Methods (cont.)(cont.)

• Limitations– Any medication used must be considered for

its potential impact on the condition of the fetus.

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Analgesics and Adjunctive DrugsAnalgesics and Adjunctive Drugs

• Narcotic (opioid) analgesics– Avoid if birth anticipated within 1 hour

• Narcotic antagonist- Narcan to reduce respiratory distress

• Adjunctive drugs- enhance pain-relieving of analgesics and reduce nausea. Hydroxyzine IM using Z-track

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Regional Analgesics and AnestheticsRegional Analgesics and Anesthetics

• Regional anesthesia usually involves placement of anesthetic in epidural or subarachnoid space

• The meninges around the spinal cord – Dura mater– Arachnoid mater– Pia mater

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Types of Anesthesia for ChildbirthTypes of Anesthesia for Childbirth

• Anesthetic method- blocks pain and motor responses• Local infiltration- episiotomy• Pudendal block- blocking pudendal nerves on each side

of pelvis. Goes to vagina and to perineum (S.E. hematoma)

• Epidural block- epidural space while in sitting position• Subarachnoid (spinal) block- similar to epidural block.

One time injection• General anesthesia- emergency C section with no time

for epidural block or C section who refuses epidural block

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Epidural and Spinal AnesthesiaEpidural and Spinal Anesthesia

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Epidural Blood PatchEpidural Blood Patch

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Epidural BlockEpidural Block

• Limitations– Abnormal blood clotting– Infection in area of injection or systemic

infection– Hypovolemia

• Adverse Reactions– Maternal hypotension- LR rapidly before

block begins– Urinary retention- insert catheter

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General AnesthesiaGeneral Anesthesia

• Adverse effects in the mother– Regurgitation with

aspiration of gastric contents

– Can result in chemical injury to lungs

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• Adverse effects in the neonate– Respiratory depression– Aggressive

resuscitation may be necessary

Pharmacological TechniquesPharmacological Techniques

• The nurse’s role– Begins at admission– Woman’s preference for pain relief– Keep side rails up– Provide education regarding procedures and

expected effects– Observe for hypotension

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