Pain Management for Childbirth Flashcards
Nurses educate & support patients during the childbirth process
What makes childbirth pain different from other types of pain?
* Part of a normal process
* Able to prepare for pain
* Has a foreseeable endpoint
* Intermittent
* Emotional impact w/birth
If this pain is normal and short-lived, why do we need to intervene?
When pain exceeds a client’s tolerance, it can have negative effects on both the mother & her fetus
* Increases the woman’s metabolic rate & her need for O2
* Pain & anxiety can escalate this & increase catecholamine production (body enters fight-or-flight); resulting in fetal metabolic acidosis
* Reduces blood flow to uterus & placenta
* Protection of brain, heart, & adrenals in mother; triggers hypoxic status in fetus in dysfunctional labor patterns & prolonged pain
> Puts mother @ risk for C-section
* Alleviate pain & reduce anxiety
Poor pain control disrupts the pleasure of the birthing experience for both partners
- Mother can have difficulty bonding w/her newborn; reduces sexual desire; partner feels inadequate; may not want to experience childbirth again (negative memory)
What factors contribute to a woman’s response to labor pain?
Physical & psychological factors
Physical Factors Affecting Childbirth Pain
Sources of Pain
Tissue ischemia
Cervical dilation
Pressure & pulling on pelvic structures
Distension of the vagina & perineum (common during pushing)
Factors Influencing the Perception or Tolerance of Pain
Intensity of labor
Fetal position & size
Characteristics of the pelvis
Fatigue
Intervention of caregivers
Types of Pain
___ (a deeper, more generalized pain, can’t quite pinpoint from where) versus ___ (e.g. directly related to stretching of perineal tissue & adjacent structures; happens at delivery; localized to the area)
visceral
somatic
Psychosocial Factors Affecting Childbirth Pain
Culture (i.e. loud & vigorous expressions of pain versus stoicism)
Anxiety & fear
Previous pain experience
Preparation for childbirth
Support system
So we know it is important to manage labor pain, but how do we do it?
Nonpharmacologic Pain Management
Nonpharmacologic Pain Management Techniques
* Support general comfort
* Reduce anxiety & fear
* Promote relaxation
* Utilize mind-body stimulation
* Supplement w/hydrotherapy
* Distract w/mental stimulation
* Educate on proper breathing techniques
- Hydrotherapy can reduce BP & edema & increase diuresis; you CAN continuously monitor the fetus during this (note that textbook stated you could not)
Nonpharmacologic Pain Management Techniques - Advantages
* Do not slow labor progress
* No side effects
* No risk of allergies
* No sedative effects
* Can be used in combination w/pharmacologic measures
Nonpharmacologic Pain Management Techniques - Disadvantages
* May not achieve desired level of pain control
Pharmacologic Pain Management - Special Considerations When Medicating Pregnant Women
* Any rx taken by a pregnant woman may affect her fetus (direct vs indirect effects)
* Rx’s may have effects during pregnancy that they do not have in someone who is not pregnant
* Rx’s can affect the course & the length of labor
* Complications may limit the choice of pharmacologic pain management
* Women who need other therapeutic rx’s, use herbal or botanical preparations, or practice substance abuse may have few safe choices for labor pain relief
Regional Pain Management Techniques
* Paracervical Anesthesia
* Pudendal Block
* Local Infiltration Anesthesia
* Epidural Block
* Combined Spinal-Epidural Anesthesia
* Subarachnoid (Spinal) Block
?
Provides comfort during 1st stage of labor; does not help for pushing
Does not affect labor progress or sensory motor function; mother can be up, moving, walking, etc.
Helps to diminish the sensation of cervical dilation; the visceral pain that may be felt
Does not provide relief for 2nd stage of labor = ?
Paracervical anesthesia
pushing
?
Done for suturing or cutting
Injected into perineal tissues to provide anesthetic response
There is a short delay between the administration & the onset of the numb feeling
This can burn at injection but is NORMAL
Local Infiltration Anesthesia
?
Used to anesthetize the lower vagina & part of the perineum
Helps an individual who needs an episiotomy; helps provide anesthesia for vaginal birth
Contractions & pain will still be felt; used during pushing & after delivery for repair of lacerations
* Use local anesthesia on the perineum
Pudendal Block
?
Can be used for vaginal & Cesarean birth
Typically has an indwelling catheter
Epidural Block
?
Occurs when a woman sits or gets up and experiences an awful, 10/10 headache; feels better laying down
Can do a blood patch; prevents leakage of CSF
Spinal headache
Levels of anesthesia for cesarean versus vaginal birth
True is in labor with her first baby. Her cervix is dilated 6 cm, effacement is 100%, and the fetus is at a +1 station. True’s contractions occur every 3 minutes, last 50 to 60 seconds, and are of strong intensity. True stiffens her body during contractions and interacts little with her husband or the nurse at those times. True states that her pain is getting worse with the contractions, and the nurse provides options for True to help her manage her pain.
Use an X for the nursing actions below that are indicated (appropriate or necessary), contraindicated (could be harmful), or non-essential (makes no difference or not necessary) for the client’s condition at this time.
