Pain Management During Childbirth Flashcards
1
Q
How does childbirth pain compare with other types of pain?
A
- This pain is part of a normal process rather than injury
- Transient, It is not constant, has a foreseeable end
2
Q
What are the physiological effects of labor pain?
A
- Increased metabolic rate in demand for O2;
— Pain and anxiety escalate, her already high metabolic rate by increasing production of Catecholamines (Epinephrine and Norepinephrine), cortisol and glucagon - Hyperventilation: She then breathes too fast to get more O2 and exhales too much CO2 having less 02 to share with a fetus
- The increase production of catecholamines and Inhibits, the uterine response to oxytocin and contraction, become shorter, less frequent and effective, slowing the labor process
3
Q
What are the two types of pain?
A
- Somatic
- Visceral
4
Q
What is visceral pain?
A
- a slow deep pain that is poorly localized. It is often described as dull or aching. Dominates the first stage of labor as the uterus contracts, and the cervix dilates.
5
Q
What is somatic pain?
A
- is faster, sharp pain that can be precisely localized. Somatic pain is most prominent during the late part of the first stage of labor, and during the second stage of labor as the descending fetus puts direct pressure on the maternal tissues.
6
Q
What are the sources of pain?
A
- Tissue ischemia
- Cervical dilation
- Position of fetus
- Pressure and pulling of pelvic structures
- Distention of vagina and perineum
7
Q
What is tissue ischemia?
A
not good- resting phase in contraction causes ischemia and pain
8
Q
What is the most common cause/source of pain?
A
Cervical dilation
- Pain stimuli from cervical dilation, enter the spinal cord at: T10, T11, T12, L1
9
Q
How does the position of the fetus cause pain?
A
If the occiput is on the posterior= back pain
10
Q
Pain stimuli from vaginal and perineal distention travel through the pudendal nerve and enter the spinal cord at:
A
S2,S3,S4
11
Q
What is relaxin?
A
- relaxes ligaments, especially in feet, feet grow (women may wear larger shoes)
- the influence of relaxin hormone on the pelvic joints Increases backache, and Sacroiliac pressure
12
Q
Factors influencing pain perception:
A
- Intensity of labor (stage of labor)
- Cervical readiness (can you give medication directly onto the cervix to help cervix ripen)
- Fetal position (vertex most favorable, posterior occiput causes back pain)
- Characteristics of pelvis
- Fatigue (how long has she been pushing? Is she anemic)
- Psychosocial factors (has she had traumatic delivery in the past, or heard horror stories?) (dont say just relax)
13
Q
Non-pharmacological pain management
A
- Relaxation
- Environmental comfort (cooling measures, dim lights)
- Hydrotherapy (water births)
- Cutaneous stimulation (touching, massage, effleurage- gently rubbing finger tips over abdomen)
- Mental stimulation (distraction)
- Breathing
14
Q
Pharmacologic agents
A
- Regional epidural block:
- Spinal (subarachnoid) block
- Pudendal block: local anesthetic
- Opioid analgesic
- General anesthesia
15
Q
Regional epidural block:
Advantages
A
- Relieves discomfort
- Gives mother more strength for second stage of labor
- Mother is awake
- Less risk to infant than general anesthesia
