1. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Chapter 13 Promoting Patient Comfort During Labor and Birth Edited by Catherine Marin, MSN/Ed©, WHCNP, RN

2. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Pain During Labor and Birth  Shaped by past experiences  Assessing pain  Physiological, psychological indicators  Patient responses  May be intensified by fear, anxiety, fatigue

3. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Physical Causes of Pain Labor and Birth

4. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Pain Neurology  Uterine ischemia  Visceral pain—dull and aching  Referred pain  Somatic pain—sharp, burning, prickling

5. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Pain Perception and Expression  Highly personal and subjective  Affected by gender, culture, ethnicity, and past experiences  Physiological/affective expression  Increased catecholamines  Increased blood pressure and heart rate  Altered respiratory pattern

6. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Factors Affecting Maternal Pain Response  Physical  Physiological  Psychological  Anxiety, fear, previous experience  Support systems, childbirth preparation  Environmental

7. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Pain Pathways and Childbirth  Multidimensional phenomenon  Affective, physiologic, behavioral, sensory, cognitive  Neural pathway for pain  Gate-control theory

8. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Benefits of Comfort and Support Pain Perception

9. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Nonpharmacological Pain Relief Measures  Maternal position and movement  Breathing techniques  Music  Relaxation techniques  Other attention-focusing strategies  Guided imagery

10. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Massage and Touch  Effleurage  Counterpressure  Therapeutic touch  Healing touch

11. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Other Therapies for Comfort  Hydrotherapy, hypnotherapy, aromatherapy  Application of heat and cold  Biofeedback, TENS, intradermal water block  Acupressure/acupuncture

12. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Pharmacological Pain Relief Measures  Timing  Nonpharmacological and pharmacological measures promote positive experience  Informed consent

13. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Pharmacological Measures  Sedatives and antiemetics  Barbiturates  Benzodiazepines  H 1 -Receptor antagonists

14. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Analgesics and Anesthetics  Systemic  Opiod agonist analgesics  Opiod agonist-antagonist analgesics  Opiod antagonists

15. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Nerve Block Analgesia, Anesthesia  Regional anesthesia  Local perineal infiltration anesthesia  Pudendal nerve block  Spinal anesthesia block  Complications: maternal hypotension, decreased placental perfusion, ineffective breathing pattern

16. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postdural Puncture Headache  Leakage of cerebrospinal fluid  Intensified in upright position  Auditory and visual problems  Autologous epidural blood patch  Discharge instructions

17. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Epidural Anesthesia or Analgesia Block  Local anesthetic—epidural space  Pain relief from contractions  Pain relief from birth  Opioid and local anesthetic agent

18. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Lumbar Epidural  Advantages  Minimal trauma to fetal skull  No fetal respiratory depression  Complication  Maternal hypotension

19. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal Hypotension  Prevention  Preload IV fluids  Requires constant nursing attendance  Monitor vital signs

20. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Disadvantages of Epidural  Limited mobility  Common side effects  Accidental injection into blood vessel  Sympathetic blockage  Urinary retention, bladder distention

21. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Other Nerve Blocks  Combined spinal-epidural analgesia  Epidural and intrathecal opioids  Ongoing nursing assessments essential

22. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley General Anesthesia  Major risks  Pre-operative preparation  Cricoid pressure  Anesthetic gases and medications  Recovery room nursing care

23. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Nursing Care Related to Comfort Measures  Assessment  Ongoing and collaborative  Diagnoses  Anxiety  Ineffective coping  Acute pain

24. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Nursing Care  Expected outcomes  Plan of care  Individualized  Modified as needed  Collaborative approach