Pain Management During Labor Flashcards
What is the whole goal of using pain management during labor?
Goal is to make it as empowering and enjoyable as possible. We want to preserve control & confidence.
What are the sources of pain in labor?
The Cervix dilating and effacement is very painful. The uterus muscle cells being hypoxic during contractions. Stretching of the lower uterine segment And pressure on surrounding structures.
What happens to the cervix in labor that makes it painful?
It dilates & undergoes effacement. This is a 1) source of pain.
What happens to the uterus muscles that makes it painful?
The uterus muscles go through hypoxia during contractions & this is painful.
What happens to the lower uterine segment that makes birth painful?
The lower uterine segment has to stretch and that is painful.
What happens to the surrounding organs of the female reproductive system that causes pain?
The reproductive organs put pressure on other organs during contractions & this is very painful.
How present is pain during labor? What is the exception of this? And why?
Intermittent or comes and goes with contractions. Fetus in occiput posterior presentation will cause more pain in labor due to pressure on the sacrum (The baby face is turned frontwards in labor instead of the back of the head facing us)
Should a nurse ever doubt a patient’s pain? Why do we want them to overcome the pain for baby’s sake?
No. We need to acknowledge that the pain is real but we are going to want them to overcome the pain. If she is in pain, she may tense up. This can decrease uterine blood flow and harm the baby. We want her to work with her contractions.
What should we try to utilize before offering pharmaceutical pain meds?
Non-pharmaceutical pain relief. - some women only ever need this
At what point of care do we identify coping strategies? What does this mean?
Admission. We want to know how prepared they are. - Have they done research, taken classes, read books, etc - People might bring their own devices
How do we as the nurse need to be encouraging to the mother?
We can do this verbally & physically. Some moms may even be alone. Remind her that she is a strong woman who can do this and her body is built for this. Our presence is important
If two hours have gone by and the mother is only a tiny amount of station better, how should we handle this?
We need to focus on positives. Focus on the progress! - And we need to do this with any type of progress in pregnancy. Not just station
What do we need remind mom of when she may not want a C-section?
The goal is to have the baby at the end of the day. Gotta do whatever we can to get it done.
Do we judge for using pharmacological agents in labor? Is accepting meds failure?
No! We want her to have a positive experience. Accepting medications is not failure.
Before giving any mother medications for labor, what do we need to do? Why?
Do assessment of where exactly they are in labor first. We do this bc depending on the stage of labor she is in, some meds can affect the baby. Ex: some meds can make baby sleepy and then they won’t come out breathing like they should.
What was Grantly Dick-Reads philosophy with labor?
Fear of unknown increased tension and pain in labor. He wanted to educate women so that they weren’t in the unknown. 1930 book publish
What was Doctor Lamaze known for when it came to labor and delivery? Why don’t we use all of his teachings today?
Lamaze focused on controlled muscle relaxation with conditioned breathing during labor. It was a way to work with contractions and not fight . His teachings got a little complicated. Now, we just women to breath.
What did Bradley promote for childbirth? What group participates in this?
He practiced partner coaching (husband coaching). Also discouraged medications in labor. - there’s a newton group who does this. Safe word used to indicate desire for medications as to not undermine the non-med effort.
How do we prepare women for labor today? What is the practice for different media sources?
We give them options and try to have a plan. But it is all subject to change. When it comes to media sources, then we need to make sure it is credible.
What is the Gate Control Theory?
By providing other stimuli during contractions, we can block the painful stimuli from entering the nerve pathway. - There’s only so much room for stimuli for the pathway.
What are some basic, easy non-pharmacologic interventions for dry mouth and hygiene?
Moisturize mouth with lip balm, ice, gum, mints Can brush teeth and use mouthwash to - mouth breathing makes it dry
How can we decrease anxiety for the mom?
Anticipatory guidance or keeping her informed
T/F Physical presence of nurse is important What if you just medicated her with …. ?
True. Very much so. Decreases anxiety Dim the lights & leave her be
What if you don’t have good rapport with the mom? Quality of encouragement?
Can make switches if need be. - Rapport is very, very important. Give patient sincere encouragement
Should you assume you know what the mom wants and needs during labor?
Ask them if they want to do anything first. Then suggest some things for them if they don’t know.
Should you put your hand near the mom’s face?
No! Instead maybe hold her hand.
Why might we change mom’s position? How can we help with bed hygiene?
Changing mom’s position can help with pain and discomfort. Change bed linens. Both these things can help mom in labor and make her feel better.
Most important caring nurse approach?
Tell her you are there for HER. - or tell them that you will listen to support person too
Describe Intradermal Water Blocks What part of labor are these helpful in? How long can relief last?
It is an injection of sterile water in 4 different pressure points of the lower back to reduce pain. Early labor Can last for about 2 hours
What size needle is needed for Intradermal Water Blocks? What does administration feel like? Are these common?
25 G needle (for 4 pressure points) Feels a like a sting Not common. Usually educated ones know about it
When will they use a sedative in labor? Why? What if we give it in active labor? Good time frame to not give this?
Early labor. Specifically false labor. Not a pain med. A sedative reduces anxiety and induces sleep since they are still in the latent phase.
What if we give a sedative in active labor? Good time frame to not give this? Examples of sedatives
If a woman is in active labor and we give this, we can end up with fetal respiratory depression. Don’t give if she is 12 hrs out. Reglan and Zofran
Describe Systemic Analgesics effect Does this have an affect on the baby? What about the med level?
Systemic meds raise pain relief threshold to actually relieve pain and no loss of consciousness Yes it can affect the baby by making baby drowsy and thus decreased variability.
The meds will stay in the baby system longer though since they recycle their fluid.
Class of drugs that falls under systemic analgesics? What do these opioids do again?
Narcotics/opioids Raise pain threshold just like the systemic analgesics.
