Nursing Management of Pain During Labor and Birth Chapter 7 Nursing Management of Pain During Labor and Birth No notes

Objectives Define each key term listed. Describe factors that influence a woman’s comfort during labor. List the common types of classes offered to childbearing families. Describe the methods of childbirth preparation. No notes

Objectives (continued) Discuss the advantages and limitations of nonpharmacological methods of pain management during labor. Discuss the advantages and limitations of pharmacological methods of pain management. Explain nonpharmacological methods of pain management for labor, including the nursing role for each. Explain each type of pharmacological pain management including the nursing role for each. No notes

Education for Childbearing No notes

Types of Classes Available Gestational diabetes mellitus Early pregnancy Exercise for pregnant women Infant care Breastfeeding Sibling Grandparent Adolescent childbirth Ideally, educational preparation for childbirth begins prior to conception. Discuss content for each of the classes. Review the period in the pregnancy in which each of the classes should be taken.

Variations of Basic Childbirth Preparation Classes Refresher Cesarean birth Vaginal birth after cesarean Review Health Promotion Considerations on page 155.

Content of Childbirth Preparation Classes Benefits of exercise Pain control methods for labor Discuss the availability of prenatal classes in your community. Who teaches the classes in your area? Are there costs?

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 Nurses must remember that each client’s pain is individualized. Discuss different perspectives concerning the pain and discomfort associated with labor and delivery.

Factors that Influence Labor Pain Pain threshold Sources of pain during labor Central nervous systems factors Gate control theory Endorphins Maternal conditions Cervical readiness Pelvis Labor intensity Fatigue Fetal presentation and position Identify sources of pain during labor. What maternal factors can contribute to a painful labor and delivery experience?

Nonpharmacological Pain Management Advantages of nonpharmacological methods Limitations of nonpharmacological methods Nonpharmacological methods of pain management can be used alone for a woman desiring a labor experience without medication or in conjunction with pharmacological methods. Point out some advantages of nonpharmacological methods of pain management during the labor experience. Identify the best means to prepare the woman and her partner for the use of nonpharmacological methods of pain management.

Methods of Childbirth Preparation Dick-Read method Bradley method Lamaze method The Dick-Read method incorporates the concepts of fear, tension, and pain. The Bradley method emphasizes slow abdominal breathing and relaxation techniques. The Lamaze method uses mental conditioning and breathing techniques to occupy the patient’s mind. Who might be best suited for each of these methods?

Selected Nonpharmacological Pain Relief Measures Progressive relaxation Neuromuscular dissociation Touch relaxation Relaxation against pain Effleurage Sacral pressure Thermal stimulation Positioning Diversion and distraction Hydrotherapy A combination of nonpharmacological relief measures can be utilized by any single patient. Discuss and demonstrate these methods. Ask for class input concerning methods they have used or seen in the clinical setting.

Nonpharmacological Techniques Relaxation techniques Skin stimulation Effleurage Sacral pressure Thermal stimulation Positioning The nurse’s role Diversion and distraction Focal point Imagery Music Television No notes

Skin Stimulation Skin stimulation evokes nerve fiber responses which are able to reduce or inhibit painful sensations. Why should a patient be instructed to alternate methods of skin stimulation? Skin stimulation, if repeated in the same site over time, will become less effective.

Breathing First stage Second stage Slow paced Modified paced Patterned paced Second stage Breathing techniques are most effective when the woman has had the techniques reviewed prior to the onset of labor. Review the timing of implementing breathing techniques.

As a class, review the patterns listed on the slide As a class, review the patterns listed on the slide. Include the timing and use of each of the techniques.

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 No notes

Nursing Tip If a woman is successfully using a safe, nonpharmacological pain control technique, do not interfere No notes

Pharmacological Pain Management No notes

Physiology of Pregnancy & its Relationship to Analgesia & Anesthesia A unique relationship exists between pregnancy and the use of pharmacological pain management techniques. 1. The pregnant woman has an increased risk for hypoxia. 2. Reduced GI activity can promote nausea and vomiting. 3. There is an increased incidence of hypotension and the onset of shock. Review the underlying physiological factors which are responsible for these physiological changes.

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. Review misconceptions that exist concerning the use of medications in labor.

Pharmacological Methods Limitations Any medication used must be considered for its potential impact on the condition of the fetus. What is the relationship of timing of medication administration to the stage of the woman’s labor?

Analgesics and Adjunctive Drugs Narcotic (opioid) analgesics Narcotic antagonist Adjunctive drugs Narcotics are used most frequently. What are 2 commonly used narcotics? Narcotic antagonists are used to reverse the respiratory depression associated with opioid use. Name a narcotic antagonist. Adjunctive drugs enhance the actions of analgesics and reduce nausea. Name an adjunctive medication used for the laboring patient.

Regional Analgesics and Anesthetics The meninges around the spinal cord Dura mater Arachnoid mater Pia mater Regional analgesia is the administration of an anesthetic in the epidural or subarachnoid space. How would you compare and contrast analgesics and anesthetics?

Types of Anesthesia for Childbirth Anesthetic method Local infiltration Pudendal block Epidural block Subarachnoid (spinal) block General anesthesia Review nursing implications for the various types of anesthesia.

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Epidural Blood Patch When a spinal headache results, the anesthesiologist or CRNA can perform a blood patch. Review the technique used for the epidural blood patch.

General Anesthesia Adverse effects in the mother Adverse effects in the neonate General anesthesia is seldom used for vaginal deliveries or cesarean births. Discuss instances in which general anesthesia might be used.

Question for Review What is the most important nursing responsibility after an epidural or spinal block analgesia during labor and delivery? No notes

Review Objectives Key Terms Key Points Online Resources Critical Thinking Questions Review Questions No notes