Chapter 17 Maximizing Comfort for the Laboring Woman

Chapter 17 Maximizing Comfort for the Laboring Woman Maternity & Women’s Health Care, 11 th Edition by Lowdermilk, Perry, Cashion, and Alden Instructor: La. Tricia Perry, MSN, RN

Pain During Labor and Birth Neurologic origins Ø Visceral Ø Referred Ø Somatic Perception of pain Expression of pain

Pain During Labor and Birth (cont. ) Factors influencing pain response Ø Physiologic factors Ø Culture Ø Anxiety Ø Previous experience Ø Gate-control theory of pain Ø Comfort Ø Support Ø Environment

Nonpharmacologic Pain Management Childbirth preparation methods Relaxing and breathing techniques Ø Focusing and relaxation Ø Breathing techniques Hyperventilation Effleurage and counterpressure Music Water therapy (hydrotherapy)

Nonpharmacologic Pain Management (cont. ) Transcutaneous electrical nerve stimulation Acupressure and acupuncture Application of heat and cold Touch and massage Ø Therapeutic touch Hypnosis

Nonpharmacologic Management of Discomfort Biofeedback Aromatherapy Intradermal water block

Pharmacologic Pain Management Sedatives Analgesia and anesthesia Systemic analgesia Opioid (narcotic) agonist analgesics Opioid agonist–antagonist analgesics Opioid antagonists

Pharmacologic Pain Management (cont. ) Nerve block analgesia and anesthesia Ø Local perineal infiltration anesthesia Ø Pudendal nerve block Ø Spinal anesthesia (block) Postdural puncture headaches Epidural blood patch

Pharmacologic Pain Management (cont. ) Nerve block analgesia and anesthesia Ø Epidural anesthesia/analgesia Lumbar epidural anesthesia/analgesia Combined spinal-epidural analgesia Epidural and intrathecal opioids Ø Contraindications to epidural blocks Ø Epidural effects on the newborn Ø Nitrous oxide for analgesia Ø General anesthesia

Care Management Informed consent for anesthesia Timing of administration Preparation for procedures Administration of medication Intravenous route Intramuscular route Regional anesthesia Safety and general care

Key Points Nonpharmacologic pain and stress management strategies alone or in combination with pharmacologic methods manage discomfort Gate-control theory of pain and the stress response are basis for many nonpharmacologic methods of pain relief

Key Points (cont. ) Type of analgesic or anesthetic is determined in part by the stage of labor and method of birth Sedatives may be appropriate for women in prolonged early labor to decrease anxiety or promote sleep or therapeutic rest

Key Points (cont. ) Naloxone (Narcan) is an opioid antagonist that can reverse opioid effects Pharmacologic control of discomfort requires collaboration among health care providers and the laboring woman

Key Points (cont. ) Nurse must understand medications, expected effects, potential adverse reactions, and methods of administration Maintenance of maternal fluid balance is essential during spinal and epidural nerve blocks

Key Points (cont. ) Maternal analgesia or anesthesia can affect neonatal neurobehavioral response Opioid agonist–antagonist analgesics with preexisting opioid dependence may cause symptoms of abstinence syndrome

Key Points (cont. ) Epidural anesthesia and analgesia are the most effective pharmacologic pain relief methods for labor General anesthesia rarely used for vaginal birth but may be used for cesarean birth or when rapid anesthesia is needed in an emergency