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

2. Education for Childbearing Ideally, educational preparation for childbirth begins prior to conception Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.2

3. Types of Classes Available Gestational diabetes mellitus Early pregnancy Exercise for pregnant women Infant care Breastfeeding Sibling Grandparent Adolescent childbirth 3Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

4. Variations of Basic Childbirth Preparation Classes Refresher Cesarean birth Vaginal birth after cesarean Adolescent 4Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

5. Content of Childbirth Preparation Classes Changes of pregnancy Fetal development Prenatal care Hazardous substances to avoid Nutrition Common discomforts Work, benefits of exercise Coping with labor and delivery 5Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

6. Childbirth and Pain How childbirth pain differs from other pain –Part of a normal birth process –Woman has several months to prepare for pain management –Is self-limiting and rapidly declines after birth 6Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

7. Factors that Influence Labor Pain Pain threshold Sources of pain during labor Central nervous system factors –Gate control theory –Endorphins Maternal conditions –Cervical readiness –Pelvis –Labor intensity –Fatigue Fetal presentation and position 7Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

8. Nonpharmacological Pain Management Advantages –Nonpharmacological methods do not harm the mother or fetus –They do not slow labor if they provide adequate pain control –They carry no risk for allergy or adverse drug effects 8Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

9. Methods of Childbirth Preparation Dick-Read method Bradley method Lamaze method 9Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

10. Selected Nonpharmacological Pain Relief Measures Relaxation techniques Skin stimulation Effleurage Sacral pressure Thermal stimulation Positioning Diversion and distraction Breathing 10Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

11. Skin Stimulation 11Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

12. Breathing First stage –Slow-paced –Modified-paced –Patterned-paced Constant pattern Stairstep pattern Second stage –Used when pushing 12Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

13. 13Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. Breathing Patterns

14. How to Recognize and Correct Hyperventilation Signs and symptoms –Dizziness –Tingling of hands and feet –Cramps and muscle spasms of hands –Numbness around nose and mouth –Blurring of vision Corrective measures –Breathe slowly, especially when exhaling –Breathe into cupped hands –Place a moist washcloth over the mouth and nose while breathing –Hold breath for a few seconds before exhaling 14Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

15. Nursing Tip If a woman is successfully using a safe, nonpharmacological pain control technique, do not interfere 15Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

16. Relationship of Pregnancy to Analgesia and Anesthesia 16 Pregnant woman at higher risk for hypoxia Sluggish GI tract can result in increased risk of vomiting and aspiration Aortocaval compression increases risk of hypotension and shock Effect on fetus must be considered Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

17. Pharmacological Methods Advantages –Using medications during labor allows the mother to be more comfortable and relaxed. –Increased relaxation will aid in her ability to participate in her care. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.17

18. Pharmacological Methods (cont.) Limitations –Any medication used must be considered for its potential impact on the condition of the fetus. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.18

19. Analgesics and Adjunctive Drugs Narcotic (opioid) analgesics –Avoid if birth anticipated within 1 hour Narcotic antagonist Adjunctive drugs 19Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

20. Regional Analgesics and Anesthetics Regional anesthesia usually involves placement of anesthetic in epidural or subarachnoid space The meninges around the spinal cord –Dura mater –Arachnoid mater –Pia mater 20Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

21. Types of Anesthesia for Childbirth Anesthetic method Local infiltration Pudendal block Epidural block Subarachnoid (spinal) block General anesthesia 21Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

22. 22Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. Epidural and Spinal Anesthesia

23. Epidural Blood Patch 23Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

24. General Anesthesia Adverse effects in the mother –Regurgitation with aspiration of gastric contents –Can result in chemical injury to lungs 24 Adverse effects in the neonate –Respiratory depression –Aggressive resuscitation may be necessary Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

25. Pharmacological Techniques The nurse’s role –Begins at admission –Woman’s preference for pain relief –Keep side rails up –Provide education regarding procedures and expected effects –Observe for hypotension 25Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

26. Review Objectives Key Terms Key Points Online Resources Critical Thinking Questions Review Questions 26Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.