Pain Management During Labour Flashcards
what factors need to be considered in terms of an individual’s pain?
genetics, culture, psyhcological factors, previous experiences, expectations, intentions
outline the “discuss” pain management strategy
Discuss labour pain in context of it being purposeful
In a safe and supportive space
Support the person
Communicate sensitively
Use active listening
Share info
Satisfaction with birth experience is influenced by pain management
what do the sensory nerves sense?
touch, temp, proprioception, pain
How is deep tissue pain transmitted?
via unmyelinated C fibers
differentiate between a delta and a beta fibers
a delta: fast and acute pain
a beta: touch, vibration, localisation of pain
what part of the brain is involved in the feeling of pain?
cerebral cortex
what main nerve is involved in labour pain?
pudendal nerve
compare epidural and spinal injection sites
epidural L3-4, spinal L2-3 since block needs to be higher
what opioids used in labour?
morphine and fentanyl
when would morphine be given on its own?
in early labour if the woman is very anxious
what is the main consideration when giving opioids in labour?
timing of administration related to est time of birth
how does N2O cause analgesic actions?
through mediated activation of opioid receptors in the midbrain
how does N2O modulate nociceptive pathways?
through release of noradrenaline and activation of alpha 2 adrenoreceptors in dorsal horn of spinal cord
what are neuraxial anaesthesia options
spinal or epidural
describe the cauda equina
group of nerves and nerve roots stemming from distal end of spinal cord, L1-L5
what do nerves in cauda equina innervate?
legs, bladder, anus, peri
how do morphine and fent block pain sensation?
by acting on pre and post synaptic opioid receptors in dorsal horn of spinal cord
list the risks/disadvantages of epidural
low BP, urinary retention, mat resp depression, sedation, hyperthermia, pruritus, increased risk assisted birth
describe bupivacaine toxicity
dizziness, confusion, metallic taste, lip tingling, seizures, cardiotoxicity
describe difference in bupivacaine solution in spinal vs epidural
heavier solution used in spinal (glucose) to weigh it down and reduce likelihood of reaching brain
list some non-pharm pain relief options in labour
shower, massage, rocking, breathing/relaxation techniques, distractions, aromatherapy, acupuncture/pressure, hypnosis, yoga, TENS, sterile water injections, water immersion
how do non-pharm pain strategies work?
control what enters pain gate, stimuli can close gate to stop pain entering brain
