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

2. 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

3. 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

4. Education for Childbearing
No notes

5. 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.

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

7. 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?

8. 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.

9. 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?

10. 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.

11. 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?

12. 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.

13. 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

14. 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.

15. 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.

16. 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.

17. 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

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

19. Pharmacological Pain Management
No notes

20. 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.

21. 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.

22. 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?

23. 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.

24. 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?

25. 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.

26. No notes

27. 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.

28. 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.

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

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