5.1b Factors Influencing Pain Response

Question 1

Psychological Factors Influencing Pain Response

Answer 1

• Fatigue
• Interval and duration of contractions
• Fetal size
• Rapidity of fetal descent
• Maternal position
• Maternal mobility during labor

Question 2

B-Endorphins

Answer 2

• Endogenous Opioids secreted by pituitary gland
• Increases during pregnancy, labor and birth
• As levels increase, pain threshold rises

Question 3

Culture

Answer 3

• Sociocultural background may impose what is acceptable/unacceptable behavior during labor
• Cultural/Religious belief systems can also influence how patients manage their pain

Question 4

Anxiety

Answer 4

• Associated with increased pain
• May cause heightened catecholamine, decreased blood flow, increased muscle tension which intensifies pain.
• Increased pain then increases fear and anxiety which slows the progression of labor and lowers the ability to cope with pain.

Question 5

Supportive Environment

Answer 5

• Different for different patients
• Influenced by philosophy of care such as birth plan and value of nonpharmacological pain relief
• Individuals present during birth
• Styles of communication from their partner
• Overall health quality of support

Question 6

Supportive Physical Space

Answer 6

• Place that is safe, private, calming
• Light, noise and temperature
• Comfortable chairs
• Access to showers
• Patients personal items

Question 7

Chinese women

Answer 7

• Acceptable to exhibit pain but may try to conceal it

- Impolite to accept something when asked the first time so pain relief may need to be offered more than once.

Question 8

Middle eastern (Arab) women

Answer 8

• Vocal in response to labor pain

- May prefer medication for pain relief

Question 9

Japanese Women

Answer 9

• Stoic (enduring) of labor pain

- May request medication if pain becomes severe

Question 10

South East Asian Women

Answer 10

• May endure severe pain before requesting relief

Question 11

Hispanic Women

Answer 11

• Stoic until late in labor (when they become vocal and request pain relief)

Question 12

African American Women

Answer 12

• Expresses pain openly

- Response to medication for pain relief varies

Question 13

Previous Experience

Answer 13

• Affects patients ability to cope with pain

Nulliparous - Experience increased perception of pain during labor due to more fatigue and longer labor.

Question 14

Gate Control Theory

Answer 14

• Only a limited amount of sensations can travel along a sensory nerve pathway to the brain
• This theory takes advantage of this by “closing” a gate preventing pain stimuli from reaching the brain
• Done by introducing positive stimuli causing sensory pathways to become distracted
• Allows brain to accept more positive stimuli and less negative stimuli

Examples

• Massage
• Aromatherapy
• Hypnosis
• Music
• Guided Imagery
• VR

Question 15

Comfort

Answer 15

• Best way is to provide caring, empathetic nursing approach
• Supportive
• Offer positive feedback
• Encouragement
• Reminders that what they are experiencing is a normal process

Question 16

Support

Answer 16

• Satisfaction is dictated by how well their personal expectations are met such as quality of support and interactions with the patient
• Also dictated by how well a patient can stay in control

Question 17

How to Support Women during Labor

Answer 17

• Provide companionship and re-assurance
• Positive reinforcement and praise for patients efforts
• Encourage distractions and non-pharmacological pain relief
• Nourishment (if allowed by OB health provider)
• Assist with personal hygiene
• Offer information/advice
• Involve patient in decision making
• Convey patient requests to healthcare provider
• Create relaxing environment
• Use calm and confident approach