Pain Management of Postpartum Flashcards
labour pain is unique to every person based on various contributing factors including
physiologic, emotional, social, and cultural factors
physical causes of pain during labour include
- cervical stretching
- hypoxia of uterine muscle due to a decrease in perfusion during contractions
- pressure on urethra, bladder, and rectum
- distention of muscles of pelvic floor
pain during first stage is associated with
ischemia of uterus during contractions
pain in second stage is caused by
stretching of vagina and perineum and compression of pelvic structures
non-pharmacological approaches are largely directed at prevention of
suffering
pharmacological approaches are directed at eliminating
physical sensation of labour pain
non-pharmacological measures may include
- labour support
- hydrotherapy
- hypnosis
- ambulation and position changes
- transcutaneous electrical nerve stimulation (TENS)
- acupuncture and acupressure
- attention focusing and imagery
- therapeutic touch and massage
- breathing techniques
- effleurage
gate control theory of pain
proposes that local physical stimulation can interfere with pain stimuli by closing a hypothetical gate in the spinal cord, thus block pain signals from reaching the brain
continuous labour support
- emotional support
- comfort measures
- advocacy
- information and advice
- support from partner
hydrotherapy helps because
- warmth and buoyancy of being in water help to release muscle tension
- provides soothing of nerves in skin, promoting vasodilation, reversal of sympathetic nervous response, and a reduction in catecholamines
hydrotherapy can cause slowing of labour contractions if
pt is not in active labor - 5 cm dilated
changing position frequently at least every _____ minutes helps to relieve pain
30 minutes
position changes may help to speed labour by adding benefits of
gravity and changing the shape of the pelvis
what position should be avoid during labour
supine b/c it can cause compression of the vena cava and decreased blood return to the heart resulting in a profound hypotensive episode
epidural analgesia
injection of a local anesthetic agent and an opioid analgesic agent into the lumbar epidural space
epidural may slightly decrease _______ stage of labour and may increase the rate on _________
second stage of labour and may increase the rate on instrument-assisted vaginal deliveries as well as oxytocin administration
epidural is typically entered through the _________________ vertebrae
third and fourth lumbar vertebrae
epidurals are contraindicated for people with a previous history of
- spinal surgery or spinal abnormalities
- coagulation defects
- cardiac disease
- infections
- untreated hypovolemia
- may be contraindicated for pts receiving anticoagulation therapy
complications of epidurals include
- n+v
- hypotension
- fever
- pruritus
- intravascular injection
- fever
- allergic reaction
- respiratory depression
epidural effects on fetus during labour may include
fetal distress secondary to mom experiencing hypotension
to minimize hypotension after epidural has been places patient should avoid
supine position
pudendal nerve block
injection of local anesthetic into pudendal nerves near ischial spine
pudendal nerve block provides pain relief to
lower vagina, vulva, and perineum
pudendal nerve block is used in the _______ stage of labour or for
second stage of labour or for an episiotomy, or an operative vaginal birth with putlet forceps or vacuum extractor
pudendal nerve block must be administered ____ minutes before it would be needed to ensure its full effect
15 minutes
complication are uncommon with pudendal nerve block but there is a risk of
transient fetal bradycardia from this procedure
general reserved for emergency ___________ births
cesarian
