Labor Pain Test Flashcards
What is effleurage?
Any light massage that glides over the skin but does not use pressure or movement of deep muscle masses. It is performed by the woman or her partner or labor support. Rhythmic slow circles are “drawn” with finger tips on the abdomen, thighs or arms.
What is the Gate control theory?
The balance of painful and non-painful stimuli reaching your consciousness determines the perception of pain and its severity.
Pain fibers taking the pain stimulus to the brain are smaller and the sensation travels slower than the touch fibers, which are loch. When touch and pain are stimulated simultaneously, the touch sensation travels to the brain and “closes the Gate” in the brain, limiting the amount of pain perceived by the brain.
EMPOWER BIRTH from Labor tools
Encouragement Massage Position Open Mind Walking Empty Bladder Refreshments
Breathing Imagery Relaxation Trust Honor the Process Surroundings
How can you establish your relaxation routine?
- Select a time to relax when you are not disturbed.
- Set aside time each day and dedicate yourself to that time.
3, Choose a comfortable practice spot that has a soft, dim light. - Be sure your bladder is empty
- Wear clothes that are not binding and use a soft throw over your body to ensure that you are warm.
- Use any relaxation music that you plan to listen to during labor.
What are the benefits to using a birth ball during labor?
- Mothers may find it easier to sit on in the last months of pregnancy.
- Encourages pelvic mobility
- Allows the mother freedom to rock her pelvis, change her position, and shift her weight for comfort.
- Encourages fetal descent as the mother remains sitting in an upright posture taking advantage of gravity
- Helps keeps the fetus well aligned in the pelvis.
- Provides perineal support without undue pressure.
- Sitting on warm compresses on the ball will maximize perineal relaxation.
- Encourages rhythmic movement.
- Puts less strain on the hands and arms when mother is in the hands and knees position
- May speed up labor.
- Helps widen pelvic outlet to its maximum.
- Beneficial for techniques with “failure to progress.”
What are positions for pushing?
Sitting: ideal for caregiver to see and assist; most likely if you are medicated
Squatting: allows for greatest diameter of the pelvis; can hasten expulsion stage
Side-Lying: good choice when baby is large or coming too quickly
Hand and Knees: good position if you have intense back labor; can help rotate a posterior baby
Tug of War pull: beneficial for women who have had epidurals; should only be used after baby’s head has descended into the pelvis
What are position for labor?
Walking: ease of pain and back pressure; gravity
Sitting on Birth Ball: eases perineal pressure, aids in descent
Side-lying: relaxation, reduces elevated BP
Hands and Knees: relief of painful back labor
Leaning forward: takes pressure off back, helps rotate the baby
Squatting: encourages proper fetal alignment, opens the pelvis 1-2cm wider than other positions
Swaying/slow dancing: provides mobility to pelvis, uses gravity to speed up labor
Touch relaxation
Still touch: partner holds his or her hands firmly in place until he or she feels you release your tension
Firm pressure: partner applies pressure with fingertips or whole hand on tense area. Partner gradually releases pressure
Stroking: partner lightly or firmly strokes the tense area; strokes away from the center of mom’s body
Massage: partner firmly rubs or kneads tense muscles
Positions and Movements for Labor and Birth Handout
Standing: takes advantage of gravity during and between contractions
Walking: causes changes in pelvic joints, encouraging rotation and descent
Standing and leaning forward on partner, bed, or birth ball: relieves backache and encourages rotation of OP fetus
Slow dances: causes changes in pelvis joints, encouraging rotate and descent
Lunge: widens one side of the pelvis and encourages rotation of OP baby
Sitting upright: good resting position
Sitting on toilet: helps with pushing and may relax perineum
Semi-sitting: easy position to get into, may increase back pain
Rocking chair: may speed labor because of rocking movement
Sitting, leaning forward: relieves backache
Hands and knees: helps relieve back; assists rotation of baby in OP position
Open knee-chest position: encourages baby’s head out of the pelvis during contractions, reduces pressure on swollen cervix
Side-lying: good resting position, useful to slow a very rapid second stage
Squatting: takes advantage of gravity and widens pelvic outlet
Lap Squatting: reduces strain on knees and ankles and allows for ore support of mother
Supported Squat: takes advantage of gravity and lengthens mother’s trunk allowing more room for fetus to get into position
Dangle: same as supported squat but easier on the partner
What are some common sayings about pain in childbirth?
Women should have pain in childbirth.
Women don’t have to feel pain in childbirth
Pain serves a purpose in childbirth.
Pain is counterproductive in childbirth.
What is a Biblical perspective on childbirth?
Our work in labor was a directive from God, not a corrective God was assigning us a labor of love to help us maintain his intended order for creation. It connects us with God as the one who labored to birth creation. It attaches women to their children and gives women appropriate gender roles.
What is our role as childbirth educators?
To do our best to PROTECT through education, empowerment, and advocacy, this loving directive by God for women.
To protect this labor of love required of them that they might live in such a way that they bring order and health to their family and world, starting with birth!
What are the different coerces of labor pain?
Functional
Physiological
Emotional
What are functional sources of pain in childbirth?
Stretching of the cervix
Pressure of the baby on nerves in and near the cervix and vagina
Tension and stretching of the supporting ligaments of the uterus and pelvic joints during contractions and descent of the baby
Pressure on the urethra, bladder, and rectum
Stretching of the pelvic floor muscles and vaginal tissues
Vaginal examination
Contractions
What are physiological sources of labor pain?
The result of abnormal events, or events that are deviations from normal
Extreme back pain that can occur with a posterior labor
Pain from a uterine rupture
Exhaustion and fatigue increase the intensity of pain
Varicose veins, high BP, fever, headache, CPD, placental abruption
What are emotional sources of labor pain?
fear
anxiety
trauma
Fear tension pain fear tension pain (Dick Reed)
Our brain responds to fear by releasing adrenalin which results in dilation of the pupils, increased heart rate, and dry mouth. Our body begins pumping blood away from our internal organs to give us speed and strength
What does pain felt in normal labor serve to do?
Pain in a normal labor serves as an important messenger, ensuring labor progress. It informs those involved about the appropriate management of labor.
What does labor pain trigger the release of?
Endorphins, a woman’s natural pain relieving hormones
Explain the positive feedback loop
The neocortex needs to be turned off and the primal brain turned on. This involves the hormones oxytocin, endorphins, adrenaline, and prolactin. The uterus contracting stronger tells the brain to increase the release of hormones. If you take away the pain of contractions, everything comes to a screeching halt.
What benefit does labor provide for the baby?
It prepares baby from the changes that are coming as it enters the world.
What are the rates of respiratory complication for baby’s that go through labor and those that don’t?
Vaginal birth–.6%
Some labor than a c-section - 5.6%
No labor and a c-section - 12.4%
What factors determine a woman’s attitudes to pain?
Her beliefs and expectations about pain and childbirth.
the personal goals she has set for motherhood
Her earlier life experiences
Her previous experiences giving birth
What factors can increase or decrease the degree of labor pain a woman perceives?
Previous experiences with pain, medical care, and childbirth
Knowledge about birth from people, books, and other media
Cultural background
General health
Perception of herself as one who can or cannot deal with pain
Frequency of contractions
Size and position of the baby
Freedom to move around in labor
Degree of fatigue, anxiety and fear
Sense of aloneness verses support
Degree of confidence and preparedness
Describe the mind-body connection
The association of pain with childbirth is an example of a universally help conditioning and has become the source of needless suffering because of the myths that surround it.
If you listen to affirmations of positive, normal birth it will contribute to positive conditioning.
words/suggestion/thoughts –> feelings –> beliefs –>behavior –>positive or negative experience
The birth process is a ? process
brain
What part of the woman’s brain orchestrates childbirth?
Her autonomic nervous system, not under her conscious control
What part of the brain is active in labor and delivery?
the primitive part of the brain, or brain stem
What gland is also considered to be a gland that releases birthing hormones?
The primitive brain; it must secrete the hormones necessary for effective uterine contractions
Where do inhibitions come from?
The neocortex, or new brain, which enables us to be scientific, rational, and to communicate through language
What accompanies the release of the hormones necessary for the birth process?
reduction in the activity of the new brain; thus at a certain stage of normal birth, women have to divorce themselves from their surroundings and drift into another planet
What are main components to keeping the neo-cortex turned off?
light and silence, not asking the mother a lot of questions.
What becomes a key element during a woman’s labor?
darkness
What can sometimes relax pelvic muscles by discharging emotions that block further progress in labor?
true words spoken
What is another way in which the mind-body connection is made obvious in birth?
the separation of the placenta from the uterine wall
According to Michel odent, the length of labor is…
proportional to the number of people around
What is counterproductive during labor?
Eye to eye contact
What is the fetal ejection reflex?
the reflex right before the baby comes out. The woman expresses that she cannot do it anymore (help me, get this baby out, etc.).
It is immediately followed by a series of irresistible contractions. The maternal body has the sudden tendency to be upright.
The risk of dangerous tears is eliminated and the placenta typically separations.
What are the 3 R’s?
Relaxation
Rhythm
Ritual
What are the three coping mechanisms that are universal to women in labor?
Relaxation
Rhythm
Ritual
Women who cope well in labor always use what?
relaxation, either during or between contractions or constantly.
What is relaxation?
The art of releasing muscle tension, the cornerstone of comfort during labor.
What is key to coping better in labor?
identifying where in your body that you hold tension and releasing it.
How can mom set a good pattern for herself in labor?
By consciously working to remain relaxed during contractions in early labor.
What are the benefits to relaxation?
Conserving energy and reducing fatigue
Calms the mind and reduces stresses
Reduces pain
The mental concentration involved focuses your attention away form the pain of contractions
What forms can rhythm take in labor?
Rhythmically breathe, moan, or chant
Curl or uncurl their toes
wanting someone else to talk, stroke, or moan with them
Calms the mind and has a lulling effect
What are rituals?
They include relaxation, breathing, and attention focusing to help women in early labor establish an effective style of coping.
As labor progresses women will adapt these rituals to help them cope.
What can the partner or doula do if the mother feels unable to continue a ritual?
Help her re-establish or create a new one
What does the effective use of rituals accomplish?
It helps mom adapt to labor and get through it
What are some examples of unplanned rituals?
Rocking in a rocking chair in rhythm with breathing
Silently repeating: “Be still like the mountain; flow like the river.”
Partner or doula stroking her lower leg up and down in rhythm to her breathing
Partner softly and rhythmically counting her breaths
What do almost all activities involving physical coordination and mental discipline require?
Regulating breathing for effective and efficient performance.
What is used along with relaxation and other comfort methods during labor and why?
Breathing, to enhance relaxation and relive pain. It conserves your energy and gets you the most oxygen with each inhale
What does each birthing method rely on?
Some form of patterned breathing
What is abdominal breathing?
The most natural breathing that we do when we are sleeping.
What is the problem with chest breathing?
it tends to increase a woman’s tension which increases the cycle of pain and fear. Bradley: fear, chest breathing, tension, pain, fear
What are the benefits of abdominal breathing?
Natural Uses less energy Lowers blood pressure Conducive to relaxation Self-regulating Uses capacity of the lungs Avoids hyperventilation
What is the key in breathing techniques?
Avoiding hyperventilation
What causes hyperventilation?
When the balance of oxygen and carbon dioxide in the blood is altered, causing lightheadedness or dizziness and a tingling sensation in your fingers or around your mouth. When breathing too deeply, too fast, or both, you can cause hyperventilation.
Usually taking long slow breath will calm the hyperventilation.
What can contribute to hyperventilation?
Tension
How can hyperventilation be corrected if it does occur?
Re-breathing her own air by breathing into cupped hands, a paper bag, or surgical mask (to restore carbon dioxide to a normal level)
Having her hold her breath after a contraction until she feels the need to take a breathing.
Relaxing and reducing tension, a shower, bath massage, touch relaxation, or music may help
How can you practice relaxation?
Lay down on your side with plenty of pillows to make yourself comfortable or sit in a comfortable chair with your head and arms supported.
Begin practicing in a calm and quiet atmosphere and progress to noisier more active surroundings.
What are the different ways women prefer to cope with labor?
Some prefer to “tune into it” while others prefer distraction and concentration on external stimuli
What is attention focusing?
Focusing in order to cope with the pain of labor. Women can focus on something internal while closing their eyes, or external.
What are some ways that women visualize and use internal focus to cope with labor?
Visualizing the effectiveness of their contractions
Images that are calming like the beach or mountaintop
Being above their contractions like a seagull
Seeing the contraction as a hurdle or a hill or wave
What are some examples of an external focus point?
This can be really helpful in medicated labors. Some may want to focus on their partner’s face, a picture on the wall, a picture or outfit of the baby.
Some focus on a line such as the edge of a window and follow it during the length of the contractions
What do many women find it helpful to focus on?
touch, including rhythmic massage, stroking, pressure, or tight embrance
What are examples of sounds that can be focused on?
Listening to a favorite musical recording, music playlist, voice of a birth partner/doula, or nature sounds like rain or ocean
What is an effective technique for maintaining a sense of control while releasing tension?
Rhythmic vocalization, such as a poem or verse
What are some physical activities that can be used as a focusing technique?
Breathing in a particular way, swaying, rocking, walking, dancing, massage or stroking
What are massage and touch techniques?
firm stroking, rubbing or kneading are soothing and relaxing during pregnancy and labor
Where is massage particularly comforting?
The neck, shoulders, back, thighs, feet, and hands
Firm pressure on one spot such as your hips, thighs, shoulders, or hand.
What are some ways to relax in warm water?
Bath, whirlpool bath or shower.
The warmth and buoyancy of the water or gentle massage provided by the shower or jets
Leaning over a ball, having her head elevated on a pillow, or sitting on a birth ball or bench in the shower.
What do studies say regarding bathing after rupture of membranes?
There is no greater incidence of infection in women who bathed with ruptured membranes and those who bathed with membranes intact.
What other benefits do baths or showers provide?
They sometimes lower blood pressure and help a woman’s labor progress as long as they do not enter before 4cm dilation.
Where is heat effective?
Heat can be very soothing when applied to the lower abdomen, back, groin, or perineum
When is cold beneficial?
It is good when pushing and she needs something cold on her face.
It is also get when they are in the hot water of a tub so that they don’t get overheated.
What items can be used as cold packs?
Ice bag, frozen wet washcloths, a rubber glove rilled with crushed ice, bag of frozen peas
Why does mom need to be warm?
So that labor does not slow down or stop.
Where can cold be placed to provide relief during labor?
On the lower back and applying to the perineum immediately after birth.
For cold packs to bring comfort, the mom must be comfortably warm
What is a good rule regarding temperature?
The person holding the hot or cold pack should be able to hold it in her hands for several seconds without pain
The pack should be covered with a layer or two of toweling to protect mom’s skin
When should hot and cold be avoided?
If the mom has had anesthesia that has caused the loss of sensation, use of hot/cold packs should be avoided because she cannot gauge if it is too hot or cold.
Why is movement a useful comfort measure?
Changing position frequently (every 30 minutes) help relieve pain and may help her progress by adding the benefits of gravity and by allowing changes in the shape of the pelvis
What are different positions a woman can take?
sit, kneeling, standing, sawing from side to side, rocking, rhythmic movements.
What position might give mom a greater sense of active involvement or control?
upright position
What birth ball size is best for most women?
65 centimeter
Smaller than 5 foot 2, 55cm
Bigger than 5 foot 10, 75cm
What can help prevent the ball from slipping?
cover it with a towel or pad during labor
When do most women lose their appetites?
When active labor begins
How long do women need fluids?
throughout labor
What can mom drink during normal labor?
water, tea, juice, popsicles, or Gatorade (nothing too acidic)
Why is hydration important?
Her contractions will feel better and she can cope better, she will also have more energy.
How often should mom empty her bladder and why?
Every 45 minutes, a full bladder can slow labor progress and increase mom’s pain.
What can a mom have if oral liquids are restricted?
Ice chips, frozen juice bar, or a sour lollipop
What is the most upsetting aspect of labor for most women?
The idea of losing control in labor
What do women fear?
They fear the pain will get so intense that they will say things they will regret later. To prevent this some use anesthesia. Other work on self-help techniques
What is one of the undeniable facts about labor?
You cannot consciously control your labor or your contractions.
When may women feel a loss of control?
When everything is done for them. Many women want to participate in decisions about their care during labor.
Feeling left out makes them feel out of control
Why do some women take childbirth classes?
With the idea that the educator will help them reach their goal of being calm, confident, and controlled in labor
What can be a key to getting a baby out naturally?
Moaning, groaning, wailing, rocking, white-knuckling, and “losing control”
What does what each woman need in labor reflect?
Her individuality. Natural labor means doing what comes naturally for her
What is it that women are most afraid of “losing”?
It is important to ask women what it means to them
What does losing it in labor mean to you?
what is your fear about losing it in labor?
How much of your concern is about what you would think of yourself and what others would think about you?
If you completely lost it in labor, what would you be doing?
How might losing it in labor be helpful to you?
What are the two basic philosophies on labor?
There are those who know how to support women through the pain and work of labor, but who also have the wisdom and experience to recognize labors where drugs may be the best option.
There are professionals who consider it unnecessary or foolish to endure any pain that drugs can do away with.
What is one of our roles as doulas?
To encourage moms to give up and surrender.
When she feels like she is losing control, encourage her to accept and embrace it. Fighting the moment will only feed into her sense of desperation
What way do most people want women to respond to childbirth?
Quietly
What is one of the unexpected gifts of labor?
Finding your voice
This can be the first time some women have said no, don’t touch me, go away, etc.
What are some ways in which women use their voice in labor?
Give the baby a moving order
talk to her cervix telling it to open
Strong labor can require power and aggression, and a string of profanity
Chants are empowering and effective because they unify body and mind
A mom’s uninhibited complete expression merges with her pain and momentarily dissipates it
What does fear cause in labor?
A surge of adrenaline which slows down labor
What can the birth companion do during labor?
Close the door
Telling observers who are uncomfortable with her sounds that this is helping her
ask for a different nurse
Encouraging moms that are making high pitched or scared sounds (like fear caught in the throat) to lower their tones
How is co-chanting helpful and what are some tips?
It can provide validation and eliminate self-consciousness especially in a hospital. Let the sound emerge fro the mother
Only one person in the room should co-chang
Match her sound, intensity, and volume.
Don’t start before or after her, or be louder or quieter than her
Why are different positions important in labor and birth?
Increased comfort/reduced pain
Distraction
Enhanced sense of control
Can change the size and shape of the pelvis so the baby’s head can move down
Help with frequency, length, and efficiency of contractions
Gravity can help the baby move down
Ensure continuous oxygen supply to the fetus
Reduction in the length of labor
How much shorter was labor on average for those who moved around?
50%
What are sphincters?
These are circular muscle groups that remain contracted so that the openings of certain organs are held closed until something needs to pass through.
The sphincter’s job is to relax and expand so that it can open comfortable and wide enough to allow passage.
The cervix and vagina behave like sphincters in birth.
When do sphincter function best?
In an atmosphere that is relaxed. They are affected by emotions
What are the 4 sphincter laws?
- Excretory, cervical, and vaginal sphincters function best in an atmosphere of intimacy, familiarity and privacy.
- Sphincters cannot be opened at will and do not respond well to commands such as push or relax.
- When a person’s sphincter is in the process of opening it may suddenly close down if that person becomes upset, frightened, humiliated, or self-conscious
- The state of relaxation of the mouth and jaw is directly correlated to the ability of the cervix, vagina, and anus to open to full capacity.
What factors help sphincters open in labor?
Laughter Slow deep breathing Immersion in warm water Positive and loving words spoken Trust and love in the caregivers
