Chapter 7 Nursing Management of Pain During Labor

Chapter 7 Nursing Management of Pain During Labor and Birth Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.

Objectives Define each key term listed. Describe factors that influence a woman’s comfort during labor. List the common types of classes offered to childbearing families. Describe the methods of childbirth preparation. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 2

Objectives (continued) Discuss the advantages and limitations of nonpharmacological methods of pain management during labor. Discuss the advantages and limitations of pharmacological methods of pain management. Explain nonpharmacological methods of pain management for labor, including the nursing role for each. Explain each type of pharmacological pain management including the nursing role for each. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 3

Education for Childbearing Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 4

Types of Classes Available Gestational diabetes mellitus Early pregnancy Exercise for pregnant women Infant care Breastfeeding Sibling Grandparent Adolescent childbirth Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 5

Variations of Basic Childbirth Preparation Classes Refresher Cesarean birth Vaginal birth after cesarean Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 6

Content of Childbirth Preparation Classes Benefits of exercise Pain control methods for labor Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 7

Childbirth and Pain How childbirth pain differs from other pain Part of a normal birth process Ø Woman has several months to prepare for pain management Ø Is self-limiting and rapidly declines after birth Ø Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 8

Factors that Influence Labor Pain threshold Sources of pain during labor Central nervous systems factors Gate control theory Ø Endorphins Ø Maternal conditions Cervical readiness Ø Pelvis Ø Labor intensity Ø Fatigue Ø Fetal presentation and position Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 9

Nonpharmacological Pain Management Advantages of nonpharmacological methods Limitations of nonpharmacological methods Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 10

Methods of Childbirth Preparation Dick-Read method Bradley method Lamaze method Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 11

Selected Nonpharmacological Pain Relief Measures Progressive relaxation Neuromuscular dissociation Touch relaxation Relaxation against pain Effleurage Sacral pressure Thermal stimulation Positioning Diversion and distraction Hydrotherapy Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 12

Nonpharmacological Techniques Relaxation techniques Skin stimulation Effleurage Sacral pressure Thermal stimulation Positioning The nurse’s role Diversion and distraction Focal point Imagery Music Television Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 13

Skin Stimulation Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 14

Breathing First stage Slow paced Ø Modified paced Ø Patterned paced Ø Second stage Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 15

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How to Recognize and Correct Hyperventilation Signs and symptoms Dizziness Ø Tingling of hands and feet Ø Cramps and muscle spasms of hands Ø Numbness around nose and mouth Ø Blurring of vision Ø Corrective measures Breathe slowly, especially when exhaling Ø Breathe into cupped hands Ø Place a moist washcloth over the mouth and nose while breathing Ø Hold breath for a few seconds before exhaling Ø Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 17

Nursing Tip If a woman is successfully using a safe, nonpharmacological pain control technique, do not interfere Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 18

Pharmacological Pain Management Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 19

Physiology of Pregnancy & its Relationship to Analgesia & Anesthesia Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 20

Pharmacological Methods Advantages Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.

Pharmacological Methods Limitations Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.

Analgesics and Adjunctive Drugs Narcotic (opioid) analgesics Narcotic antagonist Adjunctive drugs Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 23

Regional Analgesics and Anesthetics The meninges around the spinal cord Dura mater Ø Arachnoid mater Ø Pia mater Ø Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 24

Types of Anesthesia for Childbirth Anesthetic method Local infiltration Pudendal block Epidural block Subarachnoid (spinal) block General anesthesia Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 25

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Epidural Blood Patch Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 27

General Anesthesia Adverse effects in the mother Adverse effects in the neonate Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 28

Question for Review What is the most important nursing responsibility after an epidural or spinal block analgesia during labor and delivery? Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 29

Review Objectives Key Terms Key Points Online Resources Critical Thinking Questions Review Questions Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. 30