Management of Discomfort in Labor & Birth (exam 2) Flashcards
components of physiologic pain
- dilation and stretching of cervix
- distention of lower uterine segment
- uterine muscle cell ischemia
- pressure by presenting part on abdominal structures
- referred pain -> nearby structures
originates in the uterus and radiates to the abdominal wall, lumbar sacral area of the back, iliac crests, gluteal area, and down the thighs
referred pain
differences in pain in people
individual behavioral responses to pain
factors influencing pain response
- culture
- anxiety
- previous experience and learned coping skills
- childbirth preparation
- support and environment
- people tend to react in ways that are acceptable in their culture
- some women react to pain by becoming silent and avoiding interaction with others, some scream/verbalize distress, some may be verbally abusive to those around her
strategies of pain management
- relaxation (relax selected muscle groups)
- distraction (focal imagery)
- touch and massage
- effleurage and counter pressure
- music
- water therapy (hydrotherapy)
light stroking of abdomen or back in rhythm with the patient’s breathing during a contraction
effleurage
steady pressure applied to sacral area
esp. helpful when back pain is caused by the baby in the occiput posterior position
counterpressure
lifts the occiput off the nerves -> some relief
provides distraction and reduces the perception of pain during UC
controlled breathing techniques
controlled breathing techniques during 1st stage of labor
relaxation -> increases size of abdominal cavity -> promotes fetal descent
controlled breathing techniques in the 2nd stage of labor
used to increase abdominal pressure and assist in bearing down (pushing with UC)
all breathing patterns begin and end with
relaxing cleansing breath in through the nose and out through the mouth
breathing techniques
- slow-paced breathing
- modified-paced breathing
- pant-blow (used during transition to help control urge to push SE -> hyperventilation and resp alkalosis)
most difficult time to maintain control of breathing
transition phase of 1st stage of labor when cervix is dilating 8-10cm
- the pant-blow technique is suggested during this time
symptoms of respiratory alkalosis
Lightheaded
Dizzy
Tingling of fingers
Circumoral numbness or blueness
pharmacologic pain management effects on fetus
- drugs may cross placenta
- drugs -> maternal hypotension and reduce placental perfusion
pharmacologic pain management effects on the course of labor
- may slow progress If given too early
- may impair natural urge to push
given to take away perception of contractions (does not stop them) until they get an epidural
Stadol (narcan will not reverse)
systemic analgesia
- Goal is adequate pain relief without increasing maternal or fetal risks
- Pain relief without affecting the progress of labor
- Stage/phase and progress of labor determines type of analgesia or anesthesia
Pentobarbital (Nembutal) or Secobarbital
Barbiturates
- Relieve anxiety… induce sleep
- May be administered in early labor to alter a dysfunctional pattern
- Not used in active labor because of CNS depression in newborn
- Prolonged latent phase of labor…woman get tired and frustrated but hurts just enough can’t sleep or rest.
- Often sleep/awake can cope with active labor better.
- Seconal is no longer available, but is discussed in the book
Promethazine (Phenergan) and Hydroxyzine (Vistaril)
Ataractics
- Reduces anxiety, apprehension & N&V
- Increases sedation
- Thought to potentiate opioid analgesic medication effects (actually impairs efficacy of opioids)
- Antiemetic effect
- May contribute to maternal hypotension and neonatal depression
antiemetic that potentiates the effects of opioids
Reglan
why should you not use benzodiazepines
disrupts newborn thermal regulation
1 stress to newborn
COLD
administration of systemic medications during labor
- IV preferred over IM because onset of action is faster and duration more predictable
- IV medication injected slowly through the distal port (nearest the IV insertion site)
- or an epidural pump
- deliver while a patient is at the top of the contraction so that mother gets most of the drugs (fetal vasoconstriction)