Providing Comfort During Labor & Birth
Providing Comfort
n Concerns about the discomfort and pain involved in labor and birth dominate the thoughts of childbirth.
n Use neutral terms-contraction instead of pain
n Pharmacologic agents pose risks for both mother (hypotension) and fetus (bradycardia).
n Experience of Pain During Childbirth
n Etiology of Pain:
n During contractions, blood vessels constrict, reducing the blood supply to uterine and cervical cells, resulting in anoxia to muscle fibers. Anoxia causes pain.
n Stretching of cervix and perineum
n Pressure of fetal presenting part on tissues, organs.
n Physiology of Pain:
n Basic protective mechanism that alerts a person that something is happening.
n Perception of Pain:
n Pain is perceived differently
n Body produces endorphins (naturally opiate like substances)
n Factors Influencing Pain Perception:
n Fetal position, fear, anxiety, worry, expectation of pain, body image, and self-efficacy.
Pain Relief Measures
n Empowering women and their partners with information so they can decide how to best relieve pain during labor.
n Support From a Coach
n Emotional involvement of husband
n May need someone else to coach
n Alternative Therapies For Pain Relief
n Based on gate control theory concept that distraction can be effective in preventing the brain from processing pain sensations coming into the cortex.
Alternative Therapies For Pain Relief
n Relaxation
n Focusing and Imagery
n Breathing Techniques
n Herbal Preparations-raspberry leaves, fennel, life root. Blue cohosh toxic.
n Aromatherapy and Essential Oils-Lavender and Jasmine
n Heat and Cold Applications
n Bathing or Hydrotherapy
n Therapeutic Touch and Massage
n Yoga
n Reflexology-pressure to hands, feet, and ears.
n Crystal or Gemstone Therapy-specific positioning to be effective.
n Hypnosis
n Biofeedback
n Transcutaneous Electrical Nerve Stimulation-TENS T10-L1
n Acupressure and Acupuncture
n Intracutaneous Nerve Stimulation-injection of sterile water or saline along borders of sacrum.
Pharmacologic Pain Relief
n Analgesia-reduces or decreases awareness of pain.
n Anesthesia-causes partial or complete loss of sensation.
n Ask about allergies to medications.
n Virtually all medications cross the placenta.
n No aspirin for pain.
n Goals:
n Relax the woman and relieve her discomfort, yet have minimal systemic effects on her uterine contractions, her pushing effort, or the fetus.
n Medications with a molecular weight > 1000 cross the placenta poorly those with a molecular weight < 600 cross very readily.
n Narcotic Analgesics
n Potent analgesic effects-causes fetal CNS depression.
n Intrathecal Narcotics:
n Injection into the spinal cord. (Morphine)
n Catheter is introduced into the subarachnoid space of the spinal cord.
n Takes effect in 15 to 30 min. and lasts 4 to 7 hours.
n May need pudental block in late labor.
n Additional Drugs:
n Tranquilizers (vistaril, phenergan)
n Regional Anesthesia:
n Injection of a local anesthetic to block specific nerve pathways. (Marcaine, Nesacaine)
n Block sodium and potassium transport in the nerve membrane.
n Allow the woman to be completely awake and aware of what is happening.
n May or may not be aware of contractions.
n Helps prevent postpartal hemorrhage.
n Epidural Anesthesia (Peridural Blocks):
n Anesthetic agent placed just inside the ligamentum flavum in the epidural space. Level L4-5, L3-4 or L1-2
n Blocks spinal nerve roots in the space and sympathetic nerve fibers with them.
n Blocks pain for labor and birth.
n CSF is not entered with epidural. No HA.
n Spinal headache due to leakage of CSF or instillation of air into CSF.
n Concerns:
n Hypotension
n Keep on side afterwards
n Tends to prolong second stage of labor.
n Technique for Administration:
n Lumbar epidural anesthesia done at 5 to 6 cm dilated.
n Pt. lies on side or sits upright.
n Clean lumbar area with antiseptic solution.
n Local anesthetic injected into skin at L3-4
n 3 to 5” needle is passed into epidural space.
n Catheter is passed through needle into space and needle is withdrawn and catheter is taped into place.
n Test with a local anesthetic solution through cathether, wait 5 min. check legs for flushing, and warmness, evidence that it is in place.
n Produces anesthesia up to level of the umbilicus in 10 to 15 min, lasts 40 min to 2 hours.
n Monitor VS temp will increase.
n Bladder will fill without woman knowing so void q 2 hours. I&O
n PCEA
n Combined Spinal Epidural Technique
n Anesthesiologist administers-inserts epidural needle then a fine spinal needle into CSF. A narcotic agonist (fentanyl) is added to CSF and needle is withdrawn.
n Immediate pain relief
n Spinal (Subarachnoid) Anesthesia:
n Used less frequently today.
n Local anesthetic agent (Marcaine or Naropin) is injected using lumbar puncture technique into subarachnoid space (CSF) L3-4 interspace. Rises to T10.
n IV of LR solution for hydration.
n Spinal headache due to leakage of CSF or instillation of air into CSF.
n Have woman lie flat and give analgesic.
n Medication for Pain Relief During Birth
n Natural pressure anesthesia.
n Local Anesthetics
n Local infiltration:
n Injection of anesthetic into superficial nerves of the perineum (Lidocaine). Along borders of vulva.
n Lasts 1 hour
n Pudendal Nerve Block:
n Injection of local anesthetic near the right and left pudendal nerves at the level of the ischial spine.
n Injection made through vagina
n Relives pain in 2 to 10 min., lasts for 1 hour
n General Anesthesia
n Never preferred due to dangers of hypoxia and inhalation of vomitus.
n Pentothal plus 6 other drugs available.
n Endotracheal tube.
n Infant may need resuscitation.
Comfort During Labor
n Reduce Anxiety With Explanations of Labor Process:
n Clear understanding of what to expect.
n Do not know or may not remember.
n Provide Comfort Measures:
n Reposition or walk
n Ice chips, wet cloth
n Change pads frequently
n Clean gown, shower
n Pharmacologic pain relief