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Chapter 7

Chapter 7. Nursing Management of Pain During Labor and Birth. The differences in childbirth pain. Part of the normal birth process Woman has several months to prepare It is self limiting and rapidly declines after birth Pain in the birth process can be beneficial.

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Chapter 7

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  1. Chapter 7 Nursing Management of Pain During Labor and Birth

  2. The differences in childbirth pain • Part of the normal birth process • Woman has several months to prepare • It is self limiting and rapidly declines after birth • Pain in the birth process can be beneficial

  3. Pain Threshold and Tolerance • Threshold is the perception of pain or the least amount of sensation that a person perceives as painful • Tolerance the amount of pain one is willing or able to endure.

  4. Sources of labor pain • Dilation & stretching of cervix • Reduced uterine blood supply • Pressure of fetus on pelvic structures • Stretching of vagina & perineum

  5. Factors the modify pain are found in the “P”s of labor • Cervix • Pelvis • Contraction or labor intensity • Fatigue • Fetal presentation and position • Psychosocial factor such as culture

  6. Nonpharmacological Pain Management • Relaxation techniques • Skin stimulation, effleurage, sacral pressure • Positioning • Diversion/distraction • Imagery • Breathing techniques • Hydrotherapy • Intradermal water block B F Menu

  7. Gate Control Theory of Pain Management

  8. Large and small nerve fibers

  9. Effleurage

  10. Accupressure

  11. Acupressure; sacral area

  12. Other Gate Control Methods • Warm compresses • Cold compresses • Palm and foot rubbing • TENS monitors

  13. TENS Monitor

  14. Interdermal Water Injections

  15. Breathing for Relaxation

  16. Breathing Techniques • Each breathing pattern begins and ends with a cleansing breath • First-stage breathing • Slow-paced breathing • Modified-paced breathing • Patterned-paced breathing • Second-stage breathing • Push breathing; open glottis • Remember to breathe for the baby B F Menu

  17. Principles of Breathing • Don’t start too early • Change to another pattern when one doesn’t work. • Panting/blowing to prevent pushing when needed. • Watch for hyperventilation • Open glottis breathing for good oxygenation

  18. Hyperventilation • Dizziness • Tingling of hands & feet • Cramps and muscle spasms of hands • Numbness around nose and mouth • Blurring of vision

  19. Corrective measures for hyperventilation • Breathe slowly especially in exhalation • Breathe into cupped hands • Place a moist washcloth over the mouth and nose while breathing • Hold breath for a few seconds before exhaling

  20. Hydrotherapy • May slow down labor in the latent phase • Need to observe for increased body temperature in Mom • Need to monitor fetal heart response to hydrotherapy • Maintain hydration with oral fluids while in tub.

  21. Pharmacological Pain Management • Analgesics and adjunctive drugs • Regional analgesics and anesthetics • Local infiltration • Pudendal block • Epidural block • Subarachnoid block (spinal block) • General anesthesia B F Menu

  22. Analgesics and adjunctive drugs • Narcotics • Demorol and Fentanyl • Opiod agonist/antagonist • Stadol and Nubaine • Ataractics (analgesic potentiators) • Phenergan and Vistaril

  23. Notes on Narcotics • IV with a peak of 5-10 minutes • IM with a peak of 50 minutes • Can cause respiratory depression in newborn if given within 2 hours of birth • May reduce beat to beat variability in FHR

  24. Notes on Opioid agonist/antagonist • The antagonist effect causes less respiratory depression however, • DO NOT GIVE in women who are drug addicts it will put them in withdrawal

  25. Notes on Analgesic Potentiators • Reduce anxiety and potentiat eht effects of narcotics • Antinausea, antiemetic effects • May decrease beat to beat variability in FHR

  26. NARCAN • Opioid antagonist • Must have on hand as the antidote of narcotic sedation • May cause withdrawal symptoms in addicted patient

  27. Regional anesthesia B F Menu

  28. Epidural location

  29. Epidural Location

  30. Epidural Space

  31. General Area of Numbness

  32. Epidural Issues • Correct placement; migration • Hypotension • Urinary Retention • Decreased urge to push • Slows Labor • Respiratory • Infection • Hematoma • Effects on infant • Wet tap

  33. Incorrect placement • Test dose given • Subarachnoid: numbness, loss of movement • Vein: numbness around the mouth, ringing in the ears, visual disturbances, jitteriness

  34. Other side effects • Hypotension • Given a bolus of fluid before epidural • Urinary retention • Can delay birth or contribute to hemorrhage after birth • Check for distension, catheterize • Compromised fetal oxygenation

  35. Blood Patch for a wet tap

  36. Adverse Effects of Pharmacological Methods • Systemic opioid • Fetal respiratory depression • Pudendal block • Vaginal hematoma • Epidural and subarachnoid block (spinal block) • Maternal hypotension and urinary retention • Spinal headache with subarachnoid block • General anesthesia • Maternal: aspiration of stomach contents • Fetus: respiratory depression B Menu

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