Transcript Pain Management During Labor and Birth Chapter 9

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Explain how the pain of labor and birth differs from other
types of pain.
Describe sources of labor pain.
List factors influencing the woman’s experience of labor
pain.
Discuss principles of labor pain management.
Compare nonpharmacologic interventions to manage labor
pain.
Explain various relaxation techniques that help a woman
cope with labor.
Differentiate analgesia from anesthesia.
Describe advantages and disadvantages of opioid
administration.
Compare methods of regional anesthesia.
Explain major complications associated with epidural and
spinal anesthesia.
Discuss reasons general anesthesia is risky for a pregnant
woman and her fetus.


Pain is -multidimensional
◦ Individual
◦ Subjective
◦ Sensory experience
Many factors influence the way a client perceives
pain
◦ Physiological
◦ Psychological
◦ Emotional
◦ Environmental
◦ Sociocultural
Learning objective #1

Unique
◦ Different from other types of pain (usually
pain is warning sign of injury)
◦ Increased intensity desired and positive
(greater intensity is associated with
approaching birth)
◦ Occurs in predictable pattern (begins
without warning, but once established it is
predictable, respite between)
Learning objective #1

Physiology and characteristics of labor and birth
pain
◦ Different origination points depending on stage
of labor and different characteristics
 First stage (similar to other types of
abdominal pain)
‒Pain from cervix and lower uterine segment
‒Characteristics like other pain
‒Diffuse in nature
‒Occurs in the lower abdomen
‒May be referred to the lower back, buttocks,
and thighs
Learning objective #2
◦ Different origination points depending on
stage of labor and different characteristics
 Second Stage
‒Pain from perineum and birth canal (as
the fetus descends)
‒Described as “coming in waves”
 Birth
‒Described as most extreme pain
‒“Burning” pain in perineum
Learning objective #2

Factors influencing labor pain
◦ Multidimensional experience
◦ Psychosocial
 The level of the woman’s fear and anxiety
 The woman’s culture
 The circumstances surrounding the birth
experience (planned or unplanned, wanted
or not wanted, preterm or term)
Learning objective #3

Factors influencing labor pain
◦ Physiologic
 Physical condition of the woman
 Use of pharmacologic methods
 Age of the woman
 Length of labor experience
Learning objective #3

General concepts of pain
◦ Pain threshold
 The level of pain necessary for an
individual to perceive pain
◦ Pain tolerance
 The ability of an individual to withstand
pain once it is recognized
Learning objective #3
The pain of labor and birth is unique to the woman giving birth. It
is a multidimensional experience consisting of many factors.
What is one of those factors?
a. The number of generations in the woman’s family who
are living
b. The significant other’s ability to cope
c. The woman’s culture
d. The societal association of the significant other’s family
c. The woman’s culture
Rationale: Many factors influence the pain of labor and birth,
making it a multidimensional experience. Examples of
psychosocial influences include the level of the woman’s fear
and anxiety, her culture, and the circumstances surrounding
the birth experience, such as whether the pregnancy is
planned or unplanned, the child is wanted or unwanted, the
birth is preterm or term, and the fetus is living or dead.

Principles of pain relief during labor
◦ Women are more satisfied when they have
control over the pain experience
◦ Caregivers commonly underrate the severity
of pain
◦ Women who are prepared for labor usually
report a more satisfying experience than do
women who are not prepared
Learning objective #4

Non-Pharmacologic Pain Interventions
◦ Continuous labor support-doula
◦ Comfort measures-do not underestimate
◦ Relaxation techniques-helps to facilitate labor
process
 Patterned breathing
 Attention focusing (imagery)
 Movement and positioning
 Touch and massage
 Water therapy
 Hypnosis
Learning objectives # 5&6

Non-pharmacologic pain interventions (cont.)
◦ Intradermal water injections-sterile water
injections
can effectively relieve pain of back labor
◦ Acupressure and acupuncture
Learning objective #6

Advantages and disadvantages of non-pharmacologic
interventions
◦ Advantages
 Noninvasive
 Address emotional and spiritual aspects of birth
 Promote women’s sense of control over pain
◦ Disadvantages
 Many of the interventions require special training
and/or practice before birth
 These methods are not effective for every woman
Learning objectives #5


Analgesia and sedation
◦ The use of medication to reduce the
sensation of pain
 Sedatives given to promote sedation and
relaxation
 Opioids given to promote analgesia during
labor
Anesthesia
◦ The use of medication to partially or totally
block all sensation to an area of the body
 Local, regional, general
Learning objective #7


Advantages and Disadvantages of Opioid
Administration
◦ Advantages
 an increased ability for a woman to cope with
labor
 The medications may be nurse-administered
◦ Disadvantages
 Frequent occurrence of uncomfortable side
effects, such as nausea and vomiting, pruritus,
drowsiness, and neonatal depression
 Pain is not eliminated completely
Learning objective #8

Types of anesthesia
◦ Local anesthesia
 Used to numb the perineum just before
birth to allow for episiotomy and repair
◦ Regional anesthesia
 Involves blocking a group of sensory
nerves that supply a particular organ or
area of the body
◦ General anesthesia
 Not used frequently in obstetrics because
of the risks involved

Types of regional anesthesia
◦ Pudendal block-pain relief for the birth
◦ Paracervical block-pain relief during labor
◦ Epidural anesthesia-pain relief during labor
◦ Intrathecal anesthesia-provides pain relief
until the epirdural begins to work
Learning objective #9

Complications Associated With Epidural and
Spinal Anesthesia
◦ Hypotension
◦ Maternal fever
◦ Shivering
◦ Pruritus
◦ Inadvertent injection into the blood stream
◦ Spinal headache
◦ Fetal distress
Learning objective #10

Life-Threatening Complications Occurring With
General Anesthesia
◦ Failed intubation-due to physiological changes:
trachea and thorax
◦ Aspiration-often premedicated
◦ Malignant hyperthermia-(rare) inherited
condition that causes sustained muscle
contractions in the presence of certain
anesthetic agents
Learning objective #11








Early signs:
severe muscle rigidity, tachycardia, irregular
heart rhythm, decreased O2
saturation,
cyanosis
Late Sign:
Body temperature can rapidly increase to lethal
levels
Treatment:
Dantrolene Sodium intravenously
Nursing Care:
Careful assessment for hypoventilation and
uterine atony
Learning objective #11
Tell whether the following question is true or
false.
Malignant Hyperthermia is a potential
complication of general anesthesia that has
genetic origins.
True
Rationale: Malignant hyperthermia is a rare, but
potentially life-threatening complication of
general anesthesia. It is an inherited
condition that causes sustained muscle
contractions in the presence of certain
anesthetic agents.
CS

The nurse is holding a prenatal education class on
pain management. She is developing a brief handout
for the parents to take home on various types of pain
management. (Learning Objectives 4, 5 & 7)

List and provide a brief description of nonpharmacologic options for labor pain management.

List and provide a brief description of pharmacologic
options for labor pain management.

Compare the types of regional anesthesia.
DT




A patient on the L&D unit has been in labor for four
hours with an epidural block for pain management
for the last hour. The patient’s blood pressure has
been averaging 125/70 to 130/72. During a routine
nursing assessment, the patient’s blood pressure has
decreased to 100/60 and the fetal heart rate pattern
exhibits a decrease in variability with an occasional
late deceleration.
What is the physiologic basis for what is happening?
What is a priority nursing diagnosis related to this
event?
What are the immediate nursing actions that the
nurse should do? (Remember the physiologic changes
that are occurring.)