Chapter 17 Maximizing Comfort for the Laboring Woman Maternity & Women’s Health Care, 11 th Edition by Lowdermilk, Perry, Cashion, and Alden Instructor: LaTricia Perry, MSN, RN

Pain During Labor and Birth  Neurologic origins  Visceral  Referred  Somatic  Perception of pain  Expression of pain

Pain During Labor and Birth (cont.)  Factors influencing pain response  Physiologic factors  Culture  Anxiety  Previous experience  Gate-control theory of pain  Comfort  Support  Environment

Nonpharmacologic Pain Management  Childbirth preparation methods  Relaxing and breathing techniques  Focusing and relaxation  Breathing techniques  Hyperventilation  Effleurage and counterpressure  Music  Water therapy (hydrotherapy)

Nonpharmacologic Pain Management (cont.)  Transcutaneous electrical nerve stimulation  Acupressure and acupuncture  Application of heat and cold  Touch and massage  Therapeutic touch  Hypnosis

Nonpharmacologic Management of Discomfort  Biofeedback  Aromatherapy  Intradermal water block

Pharmacologic Pain Management  Sedatives  Analgesia and anesthesia  Systemic analgesia  Opioid (narcotic) agonist analgesics  Opioid agonist–antagonist analgesics  Opioid antagonists

Pharmacologic Pain Management (cont.)  Nerve block analgesia and anesthesia  Local perineal infiltration anesthesia  Pudendal nerve block  Spinal anesthesia (block)  Postdural puncture headaches  Epidural blood patch

Pharmacologic Pain Management (cont.)  Nerve block analgesia and anesthesia  Epidural anesthesia/analgesia  Lumbar epidural anesthesia/analgesia  Combined spinal-epidural analgesia  Epidural and intrathecal opioids  Contraindications to epidural blocks  Epidural effects on the newborn  Nitrous oxide for analgesia  General anesthesia

Care Management  Informed consent for anesthesia  Timing of administration  Preparation for procedures  Administration of medication  Intravenous route  Intramuscular route  Regional anesthesia  Safety and general care

Key Points  Nonpharmacologic pain and stress management strategies alone or in combination with pharmacologic methods manage discomfort  Gate-control theory of pain and the stress response are basis for many nonpharmacologic methods of pain relief

Key Points (cont.)  Type of analgesic or anesthetic is determined in part by the stage of labor and method of birth  Sedatives may be appropriate for women in prolonged early labor to decrease anxiety or promote sleep or therapeutic rest

Key Points (cont.)  Naloxone (Narcan) is an opioid antagonist that can reverse opioid effects  Pharmacologic control of discomfort requires collaboration among health care providers and the laboring woman

Key Points (cont.)  Nurse must understand medications, expected effects, potential adverse reactions, and methods of administration  Maintenance of maternal fluid balance is essential during spinal and epidural nerve blocks

Key Points (cont.)  Maternal analgesia or anesthesia can affect neonatal neurobehavioral response  Opioid agonist–antagonist analgesics with preexisting opioid dependence may cause symptoms of abstinence syndrome

Key Points (cont.)  Epidural anesthesia and analgesia are the most effective pharmacologic pain relief methods for labor  General anesthesia rarely used for vaginal birth but may be used for cesarean birth or when rapid anesthesia is needed in an emergency