Management of Discomfort Chapter 16 Management of Discomfort Mosby items and derived items © 2006 by Mosby, Inc.

Discomfort during Labor and Birth Pain and discomfort experienced during labor have two neurologic origins: visceral and somatic Neurologic origins Visceral pain: from cervical changes, distention of lower uterine segment, and uterine ischemia Located over the lower portion of abdomen Referred pain: originates in uterus, radiates to abdominal wall, lumbosacral area of back, iliac crests, gluteal area, and down the thighs Mosby items and derived items © 2006 by Mosby, Inc.

Discomfort during Labor and Birth Neurologic origins Somatic pain: pain described as intense, sharp, burning, and well localized Stretching and distention of perineal tissues and pelvic floor to allow passage of fetus, from Distention and traction on peritoneum and uterocervical supports during contractions, and from lacerations of soft tissue Mosby items and derived items © 2006 by Mosby, Inc.

Discomfort during Labor and Birth Perception of pain Threshold remarkably similar in all, regardless of gender, social, ethnic, or cultural differences Differences play definite role in person’s perception of and behavioral responses to pain Mosby items and derived items © 2006 by Mosby, Inc.

Discomfort during Labor and Birth Expression of pain Pain results in physiologic effects and sensory and emotional (affective) responses Emotional expressions of suffering often seen Increasing anxiety Writhing, crying, groaning, gesturing (hand clenching and wringing), and excessive muscular excitability Cultural expression of pain varies Mosby items and derived items © 2006 by Mosby, Inc.

Discomfort during Labor and Birth Factors influencing pain response Physiologic factors Culture Anxiety Previous experience Childbirth preparation Comfort and support Environment Mosby items and derived items © 2006 by Mosby, Inc.

Nonpharmacologic Management of Discomfort Nonpharmacologic measures often simple, safe, and inexpensive Provide sense of control over childbirth and measures best for woman Methods require practice for best results Try variety of methods and seek alternatives, including pharmacologic methods, if measure used is not effective Mosby items and derived items © 2006 by Mosby, Inc.

Nonpharmacologic Management of Discomfort Childbirth education Dick-Read method Lamaze method Bradley method HypnoBirthing Birthing from within Childbirth and Postpartum Professional Association (CAPPA) Mosby items and derived items © 2006 by Mosby, Inc.

Nonpharmacologic Management of Discomfort Relaxing and breathing techniques Relaxation Imagery and visualization Music Touch and massage Breathing techniques Effleurage and counterpressure Water therapy (hydrotherapy) Mosby items and derived items © 2006 by Mosby, Inc.

Nonpharmacologic Management of Discomfort Relaxing and breathing techniques Transcutaneous electrical nerve stimulation Acupressure Applications of heat and cold Hypnosis Biofeedback Aromatherapy Intradermal water block Mosby items and derived items © 2006 by Mosby, Inc.

Pharmacologic Management of Discomfort Sedatives Analgesia and anesthesia Anesthesia Systemic analgesia Opioid agonist analgesics Opioid (narcotic) agonist–antagonist analgesics Co-drugs Ataractics Opioid (narcotic) antagonists Mosby items and derived items © 2006 by Mosby, Inc.

Pharmacologic Management of Discomfort Nerve block analgesia and anesthesia Local perineal infiltration anesthesia Prudendal nerve block Spinal anesthesia (block) Disadvantages Medication reactions (allergy) Hypotension Ineffective breathing Headache Autologous epidural blood patch Mosby items and derived items © 2006 by Mosby, Inc.

Pharmacologic Management of Discomfort Nerve block analgesia and anesthesia Epidural anesthesia/analgesia Lumbar epidural anesthesia/analgesia Caudal epidural block Walking epidural analgesia Epidural and intrathecal opioids Mosby items and derived items © 2006 by Mosby, Inc.

Pharmacologic Management of Discomfort Nerve block analgesia and anesthesia Epidural anesthesia/analgesia (cont’d) Contraindications to epidural blocks Maternal refusal or inability to cooperate Antepartum hemorrhage Anticoagulant therapy or bleeding disorder Infection at the injection site Allergy to the anesthetic drug Refractory maternal hypotension Mosby items and derived items © 2006 by Mosby, Inc.

Pharmacologic Management of Discomfort Nerve block analgesia and anesthesia Epidural anesthesia/analgesia (cont’d) Effects of epidural block on neonate Paracervical (uterosacral) nerve block Nitrous oxide for analgesia Mosby items and derived items © 2006 by Mosby, Inc.

Pharmacologic Management of Discomfort General anesthesia Mosby items and derived items © 2006 by Mosby, Inc.

Mosby items and derived items © 2006 by Mosby, Inc. Care Management Plan of care and interventions Nonpharmacologic interventions Informed consent Timing of administration Preparation for procedures Mosby items and derived items © 2006 by Mosby, Inc.

Mosby items and derived items © 2006 by Mosby, Inc. Care Management Plan of care and interventions (cont’d) Administration of medication Intravenous route Intramuscular route Spinal nerve block Signs of potential problems Safety and general care Anesthesia in the obese woman Mosby items and derived items © 2006 by Mosby, Inc.

Mosby items and derived items © 2006 by Mosby, Inc. Care Management Plan of care and interventions (cont’d) Maternal hypothermia after analgesia and anesthesia Defined as core body temperature of less than 35° C Caused by effects of analgesia and anesthesia May result in cardiovascular, pulmonary, circulatory, hematologic, neurologic, or renal complications Mosby items and derived items © 2006 by Mosby, Inc.