Maximizing comfort in the laboring Women: Chapter 14 Flashcards
laboring women experience a significant amount of discomfort and pain as well as a variety of other challenging Sensations
although labor and birth are considered to be natural processes
So neurologic origins of pain during labor and childbirth there are three types of pain experienced by women during the first stage of Labor
Visceral pain:
Referred pain:
Somatic pain:
Pain management: neurologic origins
from cervical changes, distention of lower uterine segment, and uterine ischemia (First and third stages of labor)
contractions cause cervical dilation and effacement
uterine ischemia results from compression of the arteries supplying the myometrium during uterine contractions the pain from distention of the lower uterine segment stretching of cervical tissue as it efaces and dilates pressure and traction on adjacent nerves and structures and uterine ischemia during the first stage of Labor is visceral pain
Visceral pain:
originates in uterus, radiates to abdominal wall, lumbosacral area of back, iliac crests, gluteal area, and down thighs
Is located over the lower portion of the abdomen
originates when the pain that originates in the uterus radiates and that’s what referred pain is it
doesn’t women who or anybody really who’s actually had their abdomen opened up during surgery and closed and stitched back up people will complain of severe shoulder pain after an abdominal surgery there’s nothing wrong with her shoulder they have trapped air that is causing referred pain to the shoulders so that’s what referred pain is a woman in labor will have referred pain during most of the first stage of Labor the woman usually has discomfort only during contractions and is free from pain between the contractions during the second stage of Labor the woman has so much pain which is often described as intense sharp burning and very well localized as you can see down here and be well actually no skip down to see there’s seat this pain results from the following distention and traction on the peritoneum and uteruservical supports during contraction pressure against the bladder and rectum stretching and distention of the perineal tissues and laceration of the soft tissues of the cervix vagina and perineum so most of this pain they said they stop they feel the contractions but what they’re complaining of most is right here this red area
Referred pain:
pain described as intense, sharp, burning, and localized
Stretching and distention of perineal tissues and pelvic floor to allow passage of fetus from distention and traction on peritoneum and uterocervical supports during contractions and lacerations of soft tissue
Second stage
Is right here this red area which would make sense they’re about to give birth to a baby pain experience or the third stage of Labor or when the placenta is delivered and the after Pains of that early postpartum period or uterine similar to the pain experienced early in the first stage of Labor so that would be more visceral pain
Somatic pain:
Physiologic Factors
Culture
Anxiety
Previous experience
Gate-Control Theory of Pain
Comfort
Environment
Factors influencing pain
can affect the intensity of childbirth pain and we know pain is tough because it is very subjective you’ll see one woman react one way and another woman react to completely different way in the same phase of Labor fatigue can decrease or if she just worked at 12 hour shift at night and then gets home and then her labor starts she’s already tired it’s going to be harder for her to cope
Physiologic Factors
culture imposes certain behavioral expectations regarding acceptable and unacceptable behavior when experiencing pain recognize that although a woman’s behavior and response to pain may very according to her cultural background it may not actually reflect the intensity of the pain she is experiencing it is the nurses role to assess the woman for the physiologic effects of pain increases
Culture
anxiety is commonly associated with increased pain during labor mild anxiety is considered normal for a woman excessive anxiety and fear however cause more catecholamines secretion which will increase stimuli to the brain and increase that pain perception this is anxiety and fear heightened muscle tension increases in the effectiveness of uterine contractions decrease we often call this the bear tension pain cycle as the fear elevates detention the body tightening up and using a lot of energy will increase which will make you sore and worn out and will increase the pain which will also increase the anxiety which will increase the tension so if I can never ending cycle challenge
Anxiety
Childbirth for a healthy young woman maybe her first experience was significant pain and as a result she may not have developed effective pain coping strategies this is what we talk about when we’re referring to previous experience women who’ve had three and four kids know exactly what to expect their neighbors are shorter typically is each with each child and they know what to expect so they’re a little less afraid of the painful experiencing experiences in her life may have a really hard time coping if she’s not prepared adequately
Previous experience
helps explain the way hypnosis and the pain relief techniques taught in childbirth preparation classes work to relieve the pain of Labor according to this Theory pain Sensations travel along sensory nerve Pathways to the brain but only a limited number of Sensations or messages can travel through these nerve pathways so using distraction techniques you can they work by closing down a hypothetic gate in the spinal cord that’s preventing the pain signal from reaching the brain and the perception of pain is there by diminished so obstetric pain management techniques that utilize distraction include massage a back massage or effleurage of the abdomen aromatherapy hypnosis music guided imagery there’s there’s quite a few different ways that we can distract the pain signal from reaching the brain and thus decrease the perception the main impetus behind the gate control theory as it relates to pain to a positive stimulus by using all of the five senses to accept the more positive stimulus and pay less attention to the negative
Gate-Control Theory of Pain
Comfort the most helpful interventions enhancing Comfort are caring nursing approach in a supportive presence which leads you to support evidence indicates that a woman satisfaction with her labor and birth experience is determined by how well her personal expectations of childbirth and the quality of support and interaction she receives from her caregivers women who have continuous support beginning early and labor or less likely to use pain medications or epidural analgesia or anesthesia and are more likely to experience a spontaneous vaginal birth and express satisfaction with their childbirth experience
Comfort
important because if they’re very stressed out if there’s a lot of lighting if there’s a lot of people in the room it’s a lot of noise in the room that’s what you may think is being more of a distraction technique actually has the opposite effect where it’s more like a living room environment or a home environment or have home births because it’s the most comfortable place that you know to help with that nonpharm management
Environment
many non-pharmacologic measures is comparable to or even Superior to that of opioids that are administered parentally
In the past few years attendance a child with education classes has declined increasing numbers of women are utilizing online childbirth education rather than attending traditional classes
Encourage nonpharm first - need know how cope with pain
Nonpharmacologic measures often simple, safe, few adverse reactions, and inexpensive
Provide sense of control over childbirth
Methods require practice for best results
Try variety of methods and seek alternatives, including pharmacologic methods, if measure used is not effective
Non-pharmacologic pain management
choose them first before going to pharmacologic measures many of the non-pharmacologic methods for relief of discomfort are taught in different types of prenatal preparation classes or the women or couple may have searched the internet or reads various books and articles on the subjects in advance
however any of these methods require practice for best results because of the increased use of epidural analgesia or anesthesia nurses may be less likely to encourage women to use non-pharmacologic measures in part because these methods may be viewed as more complex and time consuming
Lamaze, Bradley, breathing techniques, touch, hydrotherapy, hypnosis, music
Lamaze and Bradley are several childbirth prepared methods women can take classes with their Partners however in the past few years attendance
some other techniques would be distraction techniques to attention focusing techniques like breathing paste breathing imagery Pace breathing
effleurage which is that light stroking usually of the woman’s abdomen counter pressure so back lower back pain is very effectively comforted with some steady pressure applied to Mom’s hips Touch Massage the feet the the shoulders the back application of heat or cold acupressure some countries use something called a transcutaneous electrical nerves stimulation or TENS unit during labor and especially in the postpartum
increase in aromatherapy though especially with the invention of Doterra and Young Living
hypnosis
music
Nonpharmacologic measures often simple, safe, few adverse reactions, and inexpensive
