Comfort and Pain In Labor

Question 1

What are the 2 types of pain?

Answer 1

1) somatic –> deep or superficial

2) visceral = caused by ischemia or inflammation

Question 2

What are the 2 types of nociceptors?

Answer 2

1) a-delta fibers = myelinated –> fast

2) c-fibers = unmyelinated –> slow

Question 3

What stimuli are activated during labor?

Answer 3

1) mechanical from uterine stretching

2) chemical (e.g. glutamate, bradykinin, acetylcholine)

Question 4

What are the 2 pathways via which pain travels to the brain in the first stage of labor?

Answer 4

1) neospinothalamic tract

2) paleospinothalamic tract

Question 5

How is pain transmitted in the first stage of labor?

Answer 5

pain fibers of contracting uterus insert at spinal nerves T10-L1

Question 6

What is the effect of increased catecholamines during pain response?

Answer 6

1) slow GI and GU motility
2) alter coagulation
3) alter immune responses

Question 7

What effect does epinephrine have on labor?

Answer 7

is a tocolytic

Question 8

What causes pain during contractions?

Answer 8

1) distension of uterine tissues

2) dilation of cervix

Question 9

How is pain transmitted in the second stage of labor?

Answer 9

pain fibers inserting at S2 to S4

Question 10

What causes pain in the second stage of labor?

Answer 10

distension of:

1) vagina
2) perineum
3) pelvic floor

Question 11

What are the 2 pathways via which pain travels to the brain in the second stage of labor?

Answer 11

pudendal nerves

Question 12

true or false:

pain relief is more important to birth satisfaction than the ability to cope with pain

Answer 12

false

Question 13

According to Kolcaba, what is the first dimension of comfort?

Answer 13

the technical senses

1) relief - comfort need is met/there is a return to normal functioning
2) ease - state of calmness or contentment; required for effective performance
3) transcendence - state of feeling self-motivated to overcome problems

Question 14

According to Kolcaba, what is the second dimension of comfort?

Answer 14

the contexts of experience

1) physical
2) sociocultural
3) psychospiritual
4) environmental

Question 15

Describe the gate theory of pain

Answer 15

method of modulating pain

• stimulate A-delta fibers
• impulses rapidly traverse to dorsal horn –> “close a gate”
• slower C-fiber impulses blocked –> cannot transmit deeper pain signals

Question 16

Describe the neuromatrix theory of pain

Answer 16

pain = dynamic; 3 components:

1) physical
2) psychological
3) behavioral

Question 17

What is the “talking down” method?

Answer 17

helps laboring person maintain sense of control and decrease pain

1) get person’s attention
2) position self close to person’s face
3) talk in a low voice so person is quiet to hear

Question 18

What are factors that influence a birthing person’s response to labor?

Answer 18

• psychological preparation
• expectations
• psst experiences of pain
• fear of childbirth
• emotional support during labor
• culture
• genetics
• hx dysmenorrhea
• nighttime (more pain)
• unfamiliar setting
• lack of self-efficacy

Question 19

When should pregnant people be counseled on pain management during labor?

Answer 19

during pregnancy

Question 20

What does continuous support in labor mean?

Answer 20

one support person who provides care to one laboring person and is physically present t/o labor

Question 21

Who provides the most effective continuous labor support?

Answer 21

trained doulas

vs relatives, partners, nurses, etc

Question 22

What is hydrotherapy?

Answer 22

the use of water for pain relief and relaxation during childbirth

Question 23

What is the mechanism by which hydrotherapy works?

Answer 23

increase in hydrostatic pressure + shift of extracellular fluid into circulation –> central blood volume bolus –> increases cardiac output –> decreases catecholamine levels

Question 24

When should hydrotherapy be utilized?

Answer 24

during active labor

water immersion in latent stage –> longer labor

Question 25

What is acupuncture?

Answer 25

needling of specific points along meridian pathway --> promotes blood circulation --> stimulates flow of Qi

Question 26

What is the mechanism by which acupuncture works?

Answer 26

- stimulates production of endogenous opioids (endorphins) | - secretes neurotransmitters that maintain normal physiology and provide comfort

Question 27

What is acupressure?

Answer 27

applying firm, steady pressure to acupoints using thumb and finger

Question 28

Describe acupoint "spleen 6"

Answer 28

- four finger breadths above malleolus, along tibia - should be a tender point - labor augmentation - encourage efficient labor - reduce cervical lip - reduction of labor pain - reduction of length of labor

Question 29

Describe acupoint "large intestine 4"

Answer 29

- highest place on metacarpal bone on radial aspect (b/w thumb and index finger) - reduces labor pain - promotes stronger and/or more coordinated contractions

Question 30

Describe acupoint "bladder 32"

Answer 30

- place 4 fingertips on point b/w lumbar vertebra and sacral crest --> slide fingers over until slight depression = sacral foramen - aim for middle finger being in second sacral foramen - basically it's a little divot in between the spine and yer buttcheek - reduction of labor pain - induction of labor

Question 31

Describe acupoint "gallbladder 21"

Answer 31

- on shoulder, directly above nipple; palpate deeply for most tender spot - facilitates fetal descent in active phase and second stage

Question 32

Describe acupoint "bladder 60"

Answer 32

- depression b/w lateral malleolus and Achilles tendon | - relieves lower back pain

Question 33

Describe acupoint "bladder 67"

Answer 33

- dorsum of pinky toe, kind of at base of nail - version of breech to cephalic presentation - with LI4, used to reduce labor pain - stimulates uterine contractions

Question 34

Describe acupoint "liver 3"

Answer 34

- in hollow b/w metacarpals of first and second toes - softens cervix - reduces labor pain

Question 35

Describe acupoint "stomach 36"

Answer 35

- 4 finger breadths below kneecap w/ leg flexed + 1 finger breadth lateral to tibial crest - relief of maternal exhaustion - relief of N/V, hiccups, belching

Question 36

What are contraindications to acupuncture/pressure?

Answer 36

1) fetal intolerance to labor 2) uterine tachysystole 3) tetanic contractions 4) preterm gestation 5) other conditions where contractions are contraindicated (e.g. placenta previa)

Question 37

What are sterile water papules?

Answer 37

intradermal injections of sterile water in lower lumbosacral area to relieve back pain

Question 38

What is the mechanism by which sterile water papules work?

Answer 38

distension of skin --> noxious stimulation of nociceptors and mechanoreceptors --> release of endorphins + stimulation of A delta fibers (gate theory)

Question 39

How long do sterile water papules work?

Answer 39

45mins to 3h

Question 40

What is hynosis?

Answer 40

mind-body techniques to induce profound relaxation w/in state of focused attention

Question 41

When is hypnosis most effective?

Answer 41

during prenatal stage

Question 42

When is hypnosis contraindicated?

Answer 42

1) hx of psychosis | 2) severe mental health condition

Question 43

Which scents are most commonly used for pain relief?

Answer 43

1) lavender | 2) frankincense