Comfort promotion and

pain management

Mrs.Mahdia Shaker Kony

Mrs. Mahdia Kony 2

(1) Continuous labor support

• Involves offering a sustained presence to the laboring woman by:

• Providing emotional support

• Comfort measures

• Advocacy

• Information and advices

• Support for the partener

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(1) Continuous labor support

Support can be provided by:

1. Woman's family

2. A midwife

3. A nurse

4. Any one close to the woman

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Roles of companion

• Assist the woman to ambulate• Repositioning the client• Use breathing technique• Aid with the use of acupressure• Massage• Music therapy• Therapeutic douche• Help in the birth plan

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(2)Hydrotherapy

• Advantages of warm water:1- release muscle tension2- soothing stimulation of nerves in the skin3- Promote vasodilatation4- Reversal of sympathetic nervous

response5- Reduction in catecholamine

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(3) Ambulation and position

Maternal position in labor has consequences for both maternal comfort and fetal well-being.

The dorsal supine position with the gravid uterus resting on the aorta and inferior vena cava can cause decreased cardiac output and relative placental hypoperfusion.

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(3) Ambulation and position

• Changing position every 30 min.

• Sitting, walking, kneeling, standing, lying down, getting on hands and knees,

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(4) Acupuncture and Acupressure

• Acupuncture involves stimulating key trigger points with needles.

• The purpose of acupuncture is to restore qi( channels of energy) , thus diminishing pain.

• Acupressure involves the application of affirm finger or massage at the same trigger points to reduce the pain sensation.

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(4) Acupuncture and Acupressure

• Holding and squeezing the hand of the woman in labor may trigger the point most commonly used.

• Some acupressure points are found along the spine, neck, shoulder, toes, and soles of the feet.

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(5) Attention focusing and imaginary

• Uses many of the senses and the mind to focus on stimuli.

• The woman focus on tactile tactile stimuli e.g. touch, massage, or stroking,

• May focus on auditory stimuli e.g. music and verbal encouragement.

• Visual stimuli• Breathing, relaxation, positive thinking,

and positive visualisation.

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(6) Therapeutic touch and massage

• Massage works as a form of pain relief by increasing the production of endorphins in the body which reduce the transmission of signals between nerve cells and thus lower the perception of pain.

• Massage of the neck, shoulder, back, thighs, feet, and hands.

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(7) Breathing techniques

• The woman concentrate on slow-paced rhythmic breathing.

• Verbal commands from her partner supply an ongoing auditory stimulus to her brain.

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Analgesic Drugs

• Common analgesic regimens are listed in 14-1 page 535

• An analgesic that is appropriate during one phase of labor may be entirely inappropriate at another time.

• Narcotics are best avoided until the active phase of labor is reached (i.e. 4 cm of dilation in the primigravida and 5 cm in the multipara).

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Side effect of parenteral narcotics:

• It cross the placenta and may depress the fetus.

• Loss of either reactivity (acceleration above baseline) or short-term variability in the fetal heart rate tracing.

• Respiratory depression • Decreased alertness• Inhibit sucking • Delay in effective feeding.

Mrs. Mahdia Kony 15

Analgesic Drugs

o A narcotic antagonist, preferably naloxone hydrochloride (Narcan), in both the adult (0.4 mg intravenously or intramuscularly) and neonatal (0.1 mg per kg) doses, should be readily available when these drugs are in use.

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Regional Anesthesia

• Many experts consider regional anesthesia the preferred method for vaginal delivery.

• If there is any concern about interpreting the fetal monitor tracing a regional anesthetic is preferred over parenteral

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Methods of regional analgesia

• The available methods include:

• epidural

• spinal

• caudal

• paracervical

• and pudendal block

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Epidural anesthesia

• provides the most effective labor pain relief.– Through proper technique, it is possible to

alleviate significant discomfort while maintaining sufficient motor function to allow ambulation in the first stage and effective pushing in the second stage.oRisks include hypotension, respiratory arrest,

toxic drug reaction, and rare neurologic complications.

Mrs. Mahdia Kony 19

Spinal anesthesia

usually in the form of a low saddle block (so designated because the area anesthetized would occupy a saddle) is used for delivery.

Mrs. Mahdia Kony 20

Paracervical block

• a popular form of analgesia because it is simple and reliable and seemed very safe for the patient.– It has fallen out of use because of its frequent

association with transient fetal bradycardias following placement of the block.

– Bradycardia has been associated in particular with bupivacaine (Marcaine).

Mrs. Mahdia Kony 21

Pudendal block

• provides anesthesia in the distribution of the pudendal nerve.– It usually is reserved for the actual delivery,

for outlet forceps or, for repair of the perineum after delivery.

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