Pain Management during Labor and Birth Chapter 9: Pain Management during Labor and Birth

The Pain of Labor and Childbirth Labor pain differs from other types of pain because it is associated with a normal physiologic process, increases in intensity as the desired outcome (birth) approaches, and is predictable. Sources of pain during the first stage of labor are the thinning and stretching of the cervix in response to uterine contractions. Sources of pain during the second stage of labor are the stretching of tissues in the perineum as the fetus descends.

The Pain of Labor and Childbirth (cont.) Factors that influence the woman's experience of labor pain include her threshold and tolerance to pain, age, parity, anxiety level, culture, physical conditioning, length of labor, size and position of the fetus, induced versus natural labor, and whether or not the labor is dysfunctional.

Pain Management Principles and Techniques Major principles of labor pain management include that women are more satisfied when they have control over the pain experience; caregivers commonly underrate the severity of pain; and women who are prepared for labor usually report a more satisfying experience than do women who are not prepared. Nonpharmacologic interventions to relieve labor pain include continuous labor support, comfort measures, various relaxation techniques, intradermal water injections, and acupressure and acupuncture.

Pain Management Principles and Techniques (cont.) Relaxation techniques that help a woman cope with labor include patterned breathing, attention focusing, movement and positioning, effleurage, water therapy, and hypnosis.

Pain Management Principles and Techniques (cont.) Most nonpharmacologic interventions are noninvasive, address emotional and spiritual aspects of birth, and promote the woman's sense of control over her pain. Disadvantages include that many of the interventions require special training and/or practice before birth, and these methods are not effective for every woman.

Effleurage. The woman uses her fingertips to lightly touch her abdomen using circular strokes. This form of light touch often decreases the sensation of pain in early labor. The woman’s partner uses the palm of his hand to apply counterpressure to the woman’s lower back.

Location of intradermal water injections Location of intradermal water injections. The nurse administers four sterile water injections to relieve the pain of back labor.

Pain Management Principles and Techniques (cont.) Analgesia reduces the sensation of pain. Anesthesia partially or totally blocks all sensation to an area of the body. Advantages of opioid administration during labor include an increased ability for the woman to cope with labor, and the medications may be nurse-administered. Disadvantages include short-term pain relief requiring frequent repeat doses of the medication, frequent occurrence of uncomfortable side effects, such as nausea and vomiting, pruritus, drowsiness, and neonatal depression; and pain is not eliminated completely.

Epidural or intrathecal anesthesia. A Epidural or intrathecal anesthesia. A. The laboring woman is correctly positioned for epidural anesthesia. B. Shaded area shows location of epidural placement. C. The different locations for an epidural and an intrathecal needle are shown.

Pharmacologic Interventions Types of regional anesthesia include pudendal block, epidural anesthesia, combined epidural/spinal anesthesia, and spinal block A pudendal block provides pain relief for the birth. Epidurals provide pain relief during labor. Complications associated with epidural and spinal anesthesia include hypotension, maternal fever, pruritus, respiratory depression, urinary retention, and spinal headache.

Pharmacologic Interventions (cont.) General anesthesia is risky for the pregnant woman because of the increased risk for aspiration. It is risky for the fetus because the medications cross the placenta and may result in severe neonatal depression that requires intensive resuscitation. Malignant hyperthermia is a rare, life-threatening complication of general anesthesia. Dantrolene sodium is the treatment of choice for malignant hyperthermia.