Cheyenne County Hospital Childbirth Class Candi Douthit, BSN, RN Pain Relief Efforts Cheyenne County Hospital Childbirth Class Candi Douthit, BSN, RN

Causes of Pain in Labor Pain comes several sources in labor, emotional, functional, and physiological. Knowing what is causing the pain can better help you deal with it. Know that a certain amount of pain in labor is functional, telling the body what is going on and allowing you to help yourself.

Causes of Pain in Labor Emotional-cause may be fear, lack of knowledge, fear of unknown Can actually cause and intensify pain Education/knowledge of what is coming helps Functional-cervical dilation, contractions, descent of the baby, position, procedures Muscles are working and may cause pain. Can be reduced with relaxation techniques Holding breath and fighting contractions-hinders progression; lessens oxygen to the muscles

Causes of Pain in Labor Functional-cervical dilation, contractions, descent of the baby, position, procedures (continued) Position is very important; change positions to find comfort Procedures; can cause pain by mechanism, fear, anxiety, limiting mobility Physiological: derivations from normal Back labor, arrested labor, different baby positions, history of back injuries

Coping Styles: What Comforts You? Childbirth is a challenging experience, both physically and emotionally Reflecting on things that help in other challenging situations can give you ideas for what kids of support will be most helpful to mom in labor

Normal Coping Mechanisms Ask Yourself: When you are mentally, physically, and emotionally exhausted, where do you find new energy? When you want to help someone, but feel like you don’t know how to help, how do you cope?

Why are coping and relaxation so important during labor? The Triangle: When fear decreases, muscle tension decreases, and pain decreases, etc.

Gate Theory of Pain Nerve messages from the organs in the belly travel to the brain more slowly than messages from surface nerves, like those in the skin, and sensory organs. By sending lots of pleasurable messages to the brain on these fast pathways you help to keep the brain too busy to focus on the pain!

Learning Styles Visual Learner: Tend to respond to comfort techniques that work with visual images Focal points, attractive surroundings, familiar objects, visualization Auditory Learner-prefer sounds Music, being read to, encouragement Praise, singing, being sung to May help to vocalize through contractions Kinesthetic Learner- movement and touch Changing positions, walking, rocking All forms of massage

Personality Styles Introvert/Introspective If normally quiet and reflective, and is likely to turn to inner resources, will probably do likewise in labor Sit quietly by her Create a quiet, dark, safe, relaxed environment The goal is to minimize interruptions, support her in her own way of working through labor

Personality Styles Extrovert/Active Types: If normally loud and outgoing, turns to friends for help, needs to “do something” to solve problems, will do likewise during labor. Try movement, massage, breathing, focal points Distractions are key. Support people are her coaches. © Janelle Durham, 2004. www.TransitiontoParenthood.com

Ways to Cope with Labor Environment: Environment is something you can control. Make yourself comfortable, will aid in your ability to relax and focus on the job at hand Lighting-lowering them can make you relax Quiet-not being asked questions/talking during contraction, use hushed tones Support-can be your spouse, support person, friend, etc. Knowing you are not alone having people with you physically to help you with massage, providing information, performing tasks, etc Music Aromatherapy-lavender, eucalyptus, orange-energy

Ways to Comfort a Laboring Woman During labor many of us feel helpless when it comes to comforting the laboring woman. Massage her face to help release stress and relax her. Remind her to go to the bathroom every 1-2hrs. A full bladder is not only uncomfortable but can stall labor. Try cool compresses on her neck and face. Even lightly washing her face can feel good when she is working so hard. Encourage her to drink fluids and eat to comfort if allowable. Eating and drinking restore her energy for the marathon of labor.

Ways to Comfort a Laboring Woman Help her change positions. Some positions will provide pain relief, others may feel more painful. Do what works for her Counter pressure with contractions to the low back can feel very good with back labor. She can tell you where to push. Be there for her, even if she says she doesn’t want to be touched, being there for her is very important.

Ways to Comfort a Laboring Woman Try the shower or tub. Water is relaxing and provides alternate sensation distracting from the pain. Use a heat pad, ice sock or warm blanket to her low back, limbs or perineum to help her Remind her of why she’s doing this: the baby! Don’t take criticism or harshness from her personally. You are her “safe person” who she can express her pain and frustration to. Sometimes it really hurts, but know she is just trying to manage her pain, not be hurtful to you.

Massage Techniques A good backrub is welcome anytime, but particularly when pregnancy makes your back HURT! During labor, massage can really ease the pain and also increases the pleasurable sensations to lessen the pain.

Basics of a Massage Lightly stroke the back on either side of the spine, working from the shoulders downward and back up With your thumbs on either side of the base of the neck, stroke outward, and back along the shoulders. Stroke down one side of the back using deep pressure with the palm of one hand, followed by a light stroke with the fingers of the other hand. Glide your hands upward and repeat on the other side of the back, ending at the buttocks.

Basics of a Massage Rotating your thumbs on either side of the spine, move your hands up the back from the buttocks to the shoulders, then let your hands glide down to the buttocks. End by repeating step one in the reverse direction.

Massage It helps keep a constant, soothing rhythm and to keep at least one hand in contact with the back at all times. Use cream or oils to help the hands slide on the skin. Stop all or part of the massage if it hurts. Hand massagers will be given to you when you arrive at the hospital.

Words of Encouragement Hang in there! A note of support without pressure You’re doing a great job! She may not believe you even if it is true. Her experience is what is going on inside. She may feel out of control even if she isn’t showing it on the outside. I love you. Think of the baby… You are going to be a great mother. Some laboring women have fears they won’t be a good mother (question themselves, if I can’t even get through labor, how will I be a good mom) Keep going! A nod of approval during a long labor, as in “I know you are tired, but you’re doing great, so let’s keep going” Just a bit more. Be sure it is just a bit more, otherwise you lose credibility I am really proud of you.

Things NOT to Say This is taking so long. If you are feeling, tired, achy, hungry, annoyed, just think about how she is feeling. Don’t verbalize it to her. That’s going to be a big baby. A doctor walked in when a woman was pushing, this comment made the mom question for the 1st time whether she could do it or not. Here comes a contraction Mom usually know they are coming, doesn’t need commentary. Also don’t say how big they are, she is feeling how painful they are This is why men don’t have babies. Not really helpful in labor and delivery I wonder what’s on TV Don’t pay more attention to the TV than your wife.

Husband/Support Person’s Role Reduce fear through information, reminders about what you’ve learned, and by showing her you are calm, confidence and faith in her ability to do this. Reduce tension through breathing, relaxation techniques, and stretching to loosen up. Reduce pain through movement, reminders to go to the bathroom, massage, heat, etc

Husband/Support Person’s Role Be creative with lots of low-key pleasant sensations. Touch: massage, light touch, stroking. Holding hands, shower Hearing: music, encouragement Visual: pretty things Smell: aromatherapy, familiar smells Taste: comforting snacks, drinks

Husband/Support Person’s Role Know your loved one’s coping mechanism and support that…work to provide what they need to help them cope with labor Encouragement Coaching Massage Talk through hopes and fears Update friends and family Reassure her that you are in this together

Relaxation and Breathing Techniques

Our brains will only perceive what we are concentrating on, everything else is a distraction “With relaxation and breathing techniques, you can consciously choose to make yourself think about them and not the pain of the contractions. (CC, 1997).”

Relaxation Purpose of Relaxation Techniques Relaxation is an active, conscious release of tension Doing physical relaxation techniques which release the voluntary muscles helps to reduce physical tension, reducing pain It can also lead to a feeling of emotional wellbeing and security; this in turn reduces anxiety, which reduces our sensitivity to pain

Relaxation During early labor, it is easy to remain relaxed. Use this time to develop a good pattern that will stay with you as labor becomes more intense.

Relaxation Techniques Tension Hold and Release: Beginning with your toes, moving up to the head, flex each muscle in turn, making it as tight as possible, then relax it completely. Allows you to feel and recognize tension, and feel the relief of releasing tension.

Relaxation Techniques Passive Relaxation Focus attention on your toes and feet. Just let go. Think how warm and relaxed they are. Focus on ankles and calves, think how loose and comfortable they are, and so on, up to your head, relaxing and releasing tension. Do deep, abdominal breathing.

Relaxation Techniques Roving Body Check Breathe in, choosing a muscle to focus on. Breathe out, releasing all of the tension in the muscle with the exhale. Breathe in, moving your attention to another muscle. Exhale and relax. Can be done with your partner calling out the muscle to focus on with each breathe Good quick relaxation method to use between contractions.

Relaxation Techniques Touch Relaxation: During labor, it’s wonderful if the partner can see where the mom has tension and encourage her to release that (touch or verbal) Most effective if practiced in advance Practice tensing the muscles, then having him touch the muscle. You release the tension, imagine that it’s flowing out of your body through his hand.

Breathing Techniques Relaxation tips to ease labor pain | BabyCenter

Purpose of Breathing Techniques Provide oxygen to mom and baby. If muscles are well oxygenated, function more effectively, less pain. Relaxation: rhythmic breathing promotes physical relaxation by reducing muscle tension, and promotes emotional relaxation by reducing anxiety Distraction: breathing techniques provide a means for distracting the woman from her pain of labor, giving her something to focus on other than contractions.

When to Use Breathing Techniques No special breathing techniques are necessary in early labor. Begin using when you can no longer walk and talk during contractions. Always use the most basic technique possible, using the least effort required to manage each contraction.

The Cleansing Breath How to: At the beginning of each contraction, take a deep breath in through your nose, then exhale through your mouth. When contraction is complete, take another deep breathe, stretch or yawn to release tension Benefits: distraction, good oxygenation to mom and baby, informs others when contractions are beginning and ending

Slow, Relaxed, Abdominal Breathing How to: Inhale slowly through your nose, allowing your belly to expand first, then your chest. Exhale slowly through your mouth, pursing your lips. Breathing should be slow and relaxed, about half your normal rate When to use: use it through as much of labor as possible. Some women use it for their entire labor. May get to a point where you can’t relax this much. Benefits: Relaxing, slow, and effortless. Many women find that breathing slowly can induce a sense of peacefulness and safety that helps to release tension.

Light Breathing How to: Inhale and exhale through the mouth. Lips are relaxed, with a slight smile. On exhale, make a soft “hee” sound. Avoid hyperventilation. Relaxed shallow, rapid breathing, slower exhale. When to use: when deep breathing is no longer effective with contractions Benefits: Helps with relaxation, distracts attention from contractions

Conclusion Labor is a process, the more you are able to relax through it, the more you can work with your body to accomplish your goal of having the baby. Take time before labor to consider which of these interventions will be most helpful to you. The staff will remind you of these interventions throughout labor, so don’t worry if you forget.