1. Chapter 27 The Comfort and Support in Labor

2. Factors influencing women`s perceptions and experience of labor  Biological factors  Psychological factors  Social factors  Spiritual factors  Cultural factors  Educational factors Types of support: One to one support midwife to women support The language of child birth Understanding childbirth processes Mobility and position Culture, movement and position

3. Types of support: One to one support Much midwifery and medical research has indicated that the one-to-one support by a midwife in labour reduces the need for analgesia and improves the birth experience of the mother. It also shortens the length of the labour. This is reaffirmed in the Modernizing Maternity Care document (MCWP 2006), which concludes that maternity services should develop the capacity for every woman to have a designated midwife to provide care in established labour for 100% of the time

4. The language of child birth The terms ′pain′ and ′labour′ are suggestive of difficulty and trouble. ′The skill of watching what you are saying is essential′ (Robertson 2003, p 63), when dealing with women during childbirth. A huge difference is made if sensitivity is used when explanations are provided or when information is given, to women. A lot of the terminology is medical, masculine and negative (Robertson 2003). The midwife is now able to rely on research, evidence and her/his decision-making skills to provide care. The relationship between the woman and the midwife is important and can also impact on how the woman perceives the pain of labour

5. Understanding childbirth processes for midwifery purposes to explain what occurs during labour. The discomfort of labour is caused by the descent of the fetal head further into the pelvis. It is also caused by pressure on the cervix and the stretching of the vaginal walls and pelvic floor muscles, as descent of the presenting part occurs. It is therefore not suitable to use pain-relieving measures used in other medical circumstances, as the purpose is not to stop or impair the birth process (or contractions), but to let the labour progress normally, with the descent of the presenting part and with the rotation of this. The reactions of the woman to labour and to the discomfort of this varies greatly. So then must the response of the midwife. Answers and solutions are needed to support and enable the woman to cope with the birthing process.

6. Mobility and position Mobility during labour improves both the woman's experience and the outcome of labour. The uterine action is more effective, labour is shortened, there is a reduced need for pharmacological analgesia and oxytocin augmentation. The risk of fetal compromise is lowered. It is documented that recumbent positions result in supine hypotension, diminished uterine activity and a reduction in the dimensions of the pelvic outlet (Walsh 2000). Women who take up an erect position during labour experience less pain, have significantly less perineal trauma and have fewer episiotomies. Restriction of movement can actually compromise labour

7. The birth plan The document that describe the women request during all the stages This plan could be adjusted or change depend upon the progress and the situation How women control the pain during labor? Pain control during labor should be woman centered The pain is the empowerment during labor The ability to control pain and tolerate vary from woman to women Women experience, attitude and culture affect on the issue Midwife role is to encourage Self control is the most important Women need to understand that labor and control pain are challenge (relaxation, deep breathing

8. The physiology of pain Pain stimulus and pain sensation Pain is caused by stimulus pain receptors effect Pain can be increase or decreased affect by sensory factors For example fear and anxiety increase the pain in some cases Painful stimulus affect on other organ such as heart beat, bp, sweating (sympathetic nervous system effect ) Pain transmission Pain pathway originates in the sensory nerve ending at the site of trauma The impulse travels along the sensory nerve into the nerve rooting in the spinal cord The labor pain can be classified as acute pain as differ than chronic pain receptors or nerve fibers Pain can be recognized by sensory function for example one receptor for each sensation (heat, cold, pressure ect.)

9. Method of controlling pain Natural non pharmacological Pharmacological non pharmacological Homeopathy (see chapter 50) Prepared from plan and still widely used in many country Different from country to country Has positive and negative effect Hydrotherapy Immersion in water during labor as a tool of analgesia and pain relief This method relieve muscle spasm and increase gravity and enhance labor Advantage natural process as no oxytocin less augmentation no medical intervention, decrease labor time and decrease the use of pain releif

10. Music therapy This type of therapy used to provide relaxation tech. Used in early stage Used as type of support TENS This is transcutaneous electrical nerve stimulation Use as pain relief by It is a tool that produce electrical charge across the skin which :  prevent pain signal go to uterus,cervix and vagina  stimulating the natural production of endorphin and enkephalins  Decrease the incoming pain stimuli

11. Contraindication of TENS Risk of affecting fetal monitoring Skin allergies Not preferred by the mother In proper skill of applications Not controlling the pain Pharmacological Methods Of Pain Control 1.Opiate drug (pethidine) It is the most systemic narcotic analegesia Route IM Dose 50-150mg Action 20 min. 2.Diamorphine: provide effect for up to 4 hr. in labor less use than pethidine 3.Meptazinol Dose 100-150, active 4hr.

12. Midwifery care Observe VS and drug effect Monitor fetal Side effect of drug Inhalation analgesia  Entonox Gas mixed consist of 50% oxygen and 50% nitroxide Consider the most inhalation drug of use that affect CNS receptors Regional [epidural analgesia] Sensory nerve blocking via spinal cord  Procedure  Position  complication

13. Procedure Done by specialist anesthetist Done under aseptic technique complications Dural puncture Consequent headache Respiratory arrest Fetal compromise Loss of bladder sensation Neural damage