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PSYC 207 > 1-KNOWLEDGE ABOUT Labour pain > Flashcards

1-KNOWLEDGE ABOUT Labour pain Flashcards

1
Q

how is it portrayed in the mass media?

A
  • it is a self-evident, indisputable fact
  • unavoidable except through pain meds
  • so bad it makes you want to die
    it make women and their mothers go mad… and sometimes turn violent on men
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2
Q

how is labour pain portrayed in alternative media

A

only ONE of the many sensations during labour!!
other sensations:
- bliss
- joy
- satisfaction
- ecstacy
- excitement

can be more powerful than the pain!

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3
Q

what is the source of the big differences in perspectives on birth?

A

are NOT between female and note…
is more between people who have experienced and/or been present during a natural, intervention-free childbirth versus those who have not

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4
Q

what is the primary source of this collective view of labour pain?

A

culture!!

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5
Q

what is information?

A

sensory data we obtain with its context and meaniing
- stories
- imaged
- numbers
- words
- visceral sensations
- feels

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6
Q

what is knowledge?

A

inferences we draw and theories we construct from our interpretations of the information we have

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7
Q

two ways in which new information can fail to change our knowledge

A
  1. it’s credibility is assessed as low – information is discarded
  2. credibility is assessed as acceptable, but it clashes with our pre-existing knowledge – info retained but but integrated into knowledge
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8
Q

issue with childbirth simulations

A

the muscles that cause contractions DO NOT EXIST in men
the type of muscle is different
- myometrium of the uterus only contains smooth muscle fibres

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9
Q

skeletal muscles vs smooth muscles

A

skeletal muscles
- attached to the bones
- help us move around
- can be willingly controlled
- part of the somatic nervous system

smooth muslces
- found in most of the internal organs
- canNOT be willingly controlled
- part of the autonomic nervous system

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10
Q

when does the non-pregnant uterus contract?

A
  • all the time, spontaneously
  • during menstruation
  • during orgasm
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11
Q

what happens to the nerves in the uterus during pregnancy

A

at term there is almost complete DENERVATION of the uterus
- loss of nerve supply

pregnancy-induced hypoalgesia
- decreased sensitivity to painful stimuli

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12
Q

Motor denervation in the pregnant uterus

A
  • orchestrated by ovarian hormones
  • helps in maintaining uterine quiescence
  • inhibition is relative rather than absolute
  • uterine tone (to do with how taut the uterus is) maintenance remains, but there is resistance to coordinated contractions
  • control of contractility becomes predominantly hormonal
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13
Q

Myometrium

A

uterine muscle
- innervated through autonomic nerve fibres
- denervated during pregancy
- middle and most prominent layer
- mostly of smooth muscle fibres united by connective tissue with many elastic fibres

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14
Q

endometrium

A

uterine lining
- glands and tiny blood vessels
- release of hormones
- innermost layer

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15
Q

sensory denervation in the pregnant uterus

A
  • not very well understood or appreciated
    -could serve to reduce contractility (stretch sensations can induce contraction of the myometrium and other muscles)
  • may be selective to the uterine muscle
    - stretch sensations from the myometrium would be essentially undetectable
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16
Q

common explanations of pain associated with normal labour contractions

A
  • stretching of the cervix
  • contraction of uterine muscle
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17
Q

issue with common explanations of labour pain according to scientific knowlegde

A
  • stretch receptors in the uterus disappear during pregnancy
  • stretch receptors in the cervix disappear at the onset of labour
  • muscle fibres in the cervix are almost completely replaced by connective tissue
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18
Q

Stages of labour

A

Stage 1: the uterus contracts and stretches the cervix to open to approx. 10cm diameter

stage 2: the baby passes through the “birth canal” and is born

stage 3: the placenta is born (‘expelled’)

post partum: uterus contracts in order to return to its original shape

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19
Q

when is the longest, hardest, and potentially most painful part of giving birth?

A

getting to full dilation (10 cm diameter) at the end of stage 1, beginning of stage 2

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20
Q

when is pain during labour felt?

A
  • only during contractions
    - spaced 2 mins apart, 30 sec duration
  • strongest sensations come from the inside of the body
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21
Q

back labour

A

exception to when pain during labour is felt!
it’s oriented in a way that is unusual

  • pain may continue to be felt in between contractions
  • the strongest sensations are felt at the lower back
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22
Q

some potential explanations for labour pain that are not currently contradicted by scientific knowledge

A
  • vasoconstriction of uterine blood vessles
  • release of chemicals from muscle exertion
  • inflammation
  • reduced oxygen delivery to tissues (schema)
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23
Q

why does intense physical exertion hurt?

A

injecting muscle metabolites evokes sensations of muscle fatigue and pain

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24
Q

vasoconstriction of uterine blood vessels

A
  • contractions reduce blood flow to the uterus (and the baby)
    - the contrasting myometrium compresses the blood vessels that course through it
    - some hypoxia (low oxygen) happens during each contraction
  • innervation of blood vessels and the endometrium remains during pregnancy and childbirth
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25
Q

what is the modern Western cultural view of pain

A

very hedonic!!
“pain is BAD”

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26
Q

benefits of normal labor pain

A
  • guides the birthing woman through the birth process
    - how to move, how to stand, what to do
  • focuses the woman’s mental and physical resources on the birth process
  • can regulate the strength of contractions
    - greatly benefits the baby and mother
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27
Q

transport of oxygen, nutrients, and waste products in the placenta

A

placenta is like. LIVER!
Baby blood circulation is separate from mom – there’s a lil bit of transfer but its really small

some of the fetus’s blood vessels are containing in a tiny hairlike projections (VILLI) of the placenta

the mother’s blood passes through the space surrounding the VILLI (intervillous space)

only a thin membrane (PLACENTAL MEMBRANE) separates the mother’s blood in the intervillous space from the fetus’s blood in the villi

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28
Q

what does pain release and suppress?

A

the release of:
- stress-related hormones and neurotransmitters
- endogenous opioids

suppress:
- oxytocin, the hormone that causes labour contractions

pain can reduce the strength and duration of contractions, esp. during stage 1 of labour

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29
Q

Nociception

A

encoding and processing of harmful stimuli in the nervous system, leading to a body’s ability to sense potential harm

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30
Q

difference between NOCICEPTION and PAIN

A

NOCICEPTION = the sensory process that produces the nerve signals that trigger pain

PAIN = subjective experience (aching sensation)

Pain =/= harm

they can occur in absence of each other!!

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31
Q

what is pain hugely dependent on?

A

CONTEXT!!!

  • our own mind and the conceptual framework with which we interpret the experience
  • the people around us, with their own conceptual frameworks that determine what these people say to us and how they view us
    - pain = useful indication of wellbeing?
    - OR pain = unnecessary suffering?
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32
Q

how does warm water affect birth?

A

reduces pain significantly
- vascular vessels
- relaxes uterine muscles

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33
Q

standing up for birth vs laying down on back for birth

A

standing up is majorly more comfortable and less painful than lying on one’s back

why?
- veins on back -> reduce cirulation
- harder to move!! more restrictive! it is now an unnecessary pain

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34
Q

subdivisions of nociceptive input

A

VISCERAL

NON-VISCERAL (SOMATIC)

35
Q

What Carries Visceral nociceptive input

A

internal organs of the body

carried largely by C Fibres

36
Q

What carries Non-visceral (somatic) nociceptive input

A

from body parts that are not internal organs

carried largely by A-delta fibres

37
Q

Noxious sensory input carried by

A

carried by A-delta and C-fibres ascending nociceptive fibres

38
Q

A-delta nerve fibre

A
  • evolutionarily new!
  • fast pain!
  • myelinated sheath
  • 1-5 micrometer diameter
39
Q

C nerve fibre

A
  • evolutionarily old!
  • slow pain
  • non-myelinated sheath

70% of all nociceptive fibres :o

40
Q

exteroception

A

perception of things that are external to su

41
Q

proprioception

A

the sense of where one’s own body is in space

signals from joints, tendons, muscles

42
Q

visceroception

A

the sense of the physiological condition of the body (specifically internal organs)

signals from inner organs

43
Q

interoception types

A

proprioception

visceroception

44
Q

Placebo analgesia

A

when positive expectations reduce pain

45
Q

nocebo hyperalgesia

A

when NEGATIVE expectations INCREASE pain

46
Q

algesia

A

sensitivity to pain

47
Q

hyperalgesia

A

extreme sensitivity to pain

48
Q

analgesia

A

the inability to feel pain (in practice, often partial)

49
Q

expecting pain creates a state of anticipatory anxiety, which:

A

increases muscle tension and any related pain

increases stress and weakens the body’s own ability to cope with pain

suppresses endogenous optiods

50
Q

baby skull

A

the bone is NOT fused together!
- allows for movement, and can overlap
there is an opening in the skull!

51
Q

moulding of the baby skull during labour

A
  • lets the baby fit more easily through the pelvis
  • allowed by the softness of the bones and their loose connections at the sutures
  • within a few days after birth, the shape of the head returns to normal
52
Q

how do we know whether a baby is in pain?

A
  • crying
  • facial expressions
  • body movement
  • physiological stress response
53
Q

early beliefs about babies’ sensitivity to pain

A
  • newborns were not sensitive to pain
  • experiments with painful stimulation on newborns found little reaction at day 1, but increased reactions by day 12
  • concluded that:
    • newborns had limited sensitivity to pain
  • first week to 10 days was a period of hypoesthesia (abnormally weak sense of pain, heat, cold, or touch)
54
Q

early beliefs about newborn reactions to painful stimuli

A
  • a local reflex — did not go to brain
  • had no mental/emotional importance
  • brain at birth is highly immature bc it is still largely unmyelinated
55
Q

ancient view of the uterus

A

used to be considered the cause of female ailments by the greek and egyptians
- greeks believes it moved around the body

56
Q

perimetrium

A

outer connective tissue of the uterine wall

57
Q

uterus = layers of interlacing smooth muscle fibres?

A

many resources describe 3 separate layers going in different directions.. but is controversial and something that scientific knowledge doesn’t have a clear answer to yet

in late pregnancy, thick muscle fibres merge and intertwine to form an interlacing network

58
Q

Enteric Nervous system

A

motility of esophagus, stomach, and intestines, as well as the secretion of digestive enzymes and acids

59
Q

opioid

A

any substance that acts on the opioid receptors of the body

60
Q

narcotic

A

any psychoactive compound with sleep-inducing properties and is a CNS depressant

61
Q

cocaine

A

naturally occuring local anesthetic

62
Q

procaine

A

1st synthetic derivation of cocaine
followed by the development of lidocaine

63
Q

bupivacaine

A

most common local anesthetics found in epidurals

64
Q

fentanyl

A

most common opioids found in epidurals

65
Q

topical anesthesia

A

most common
applied externally
rapid onset with high concentration
dentistry!

66
Q

infiltration anesthesia

A

applied through injection
used for minor surgical procedures
dentistry!

67
Q

diffusion of drugs depends mainly on:

A

far solubility!!!

68
Q

congenital analgesia

A

people born with inability to experience pain

69
Q

factors that influence the experience of pain

A

cultural factors
- philosophical and religious beliefs

cognitive/psychological factors

meaning that people ascribe to their pain

70
Q

visceral pain

A

activation of nociceptors of the internal organs
- innervated by c fibres

sensitive to distension, ischemia, inflammation
tends to be vague, deep, dragging
associated with nausea and changes in heart rate and most importantly it can also evoke emotional responses

71
Q

effect of oxytocin

A

causes the calm reaction

key role in human sexual behaviour – orgasm increases a flood of oxytocin into the bloodstream
important for mother-baby bond

72
Q

non-pregnant vs pregnant uterus physiology

A

uterus at term:
heavier, larger volume, larger height, larger width

smooth muscle fibres at term:
larger length and larger width

73
Q

uterine quiescence

A

state of quieting
takes more hormonal release to trigger contractions
not absolute – DECREASE in spontaneous contractions

74
Q

nerves in the non-pregnant uterus vs pregnant

A

in non-pregnant:
ends of axon dendrites of the PNS end very close to the muscle
- muscle receives influence of release of NT

during pregnancy:
- disconnection between neurons and muscle fibres
- nerve endings almost disappear in pregnant uterus!

75
Q

motor vs sensory denervation

A

Motor – if the neurons that produce contractions move away from the muscle

sensory – neurons that carry up sensations has moved away (sensory is not felt as much)

76
Q

motor INnervation in the non-pregnant uterus

A

autonomic control over contractility
- neural fibres exit the spinal cord, innervating all pelvic cavity organs, including the uterus, bladder, and rectum
- sympathetic fibres exit at higher levels along the spinal cord (T10-L2) than parasympathetic fibres (S2-4)

77
Q

How does autonomic control over smooth muscles work

A

nerve fibres release NT onto muscle cells through autonomic varicosities

78
Q

sensory innervation in the uterus vs cervix and vagina

A

sensory nerves from the uterus enter the spinal cord at higher levels (T10-L1) than those from the cervix and upper part of the vagina

79
Q

types of visceral sensations

A

distension/stretch
inflammation
ischemia – a part of your body isn’t getting enough blood

80
Q

density of nerves to smooth muscle fibres in uterus?

A

in comparison to other smooth muscles of the body (which tend to be richly innervated) the uterus has a relatively low density of nerves to smooth muscle fibres

during pregnancy, under the influence of ovarian hormones, this density decreases even further:
- hypertrophy (increase and growth of muscle cells) of uterin myocytes
- decrease in number of nerve fibres

81
Q

what happens to the pregnant uterus in terms of uterine quiescence

A
  • enters into a special state of uterine quiescence
  • in late pregnancy (37-40 weeks) it starts becoming active again
    • spontaneous ongoing contractions
    • “practice” (braxton hicks) contractions
82
Q

when does the pregnant uterus contract strongly?

A
  • orgasms in pregnancy
  • labour and birth
  • the post-partum period
83
Q

post-partum

A

uterus contracts in order to return to its original shape

PSYC 207 (9 decks)

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