Pain Management During Childbirth (Video Notes)

Vocabulary-style flashcards covering key concepts, terms, and definitions from the Pain Management During Childbirth notes.

Nonpharmacologic pain management

Pain relief methods in labor that do not involve medications (e.g., relaxation, breathing techniques, hydrotherapy, massage, cutaneous stimulation, aromatherapy, music, imagery); advantages include mobility and fewer side effects, but may not fully eliminate pain.

Pharmacologic pain management

Use of medications or regional/general anesthesia to relieve labor pain; involves systemic analgesics, neuraxial techniques, or general anesthesia with careful risk–benefit assessment for mother and fetus.

Gate-control theory

Idea that pain transmission is modulated at the spinal cord dorsal horn, where stimulation of large-diameter fibers can close the gate to small-diameter pain fibers, reducing perceived pain.

PAIN acronym

P = Purposeful, A = Anticipated, I = Intermittent, N = Normal; a framework used to describe labor pain characteristics for teaching and planning coping strategies.

Visceral pain

Slow, deep, poorly localized pain from uterine contractions and cervical dilation; dominates during first-stage labor.

Somatic pain

Quick, sharp, well-localized pain from tissue strain and fetal descent; most prominent in late first stage and second stage.

Four sources of labor pain

Tissue ischemia, cervical dilation, pressure/pulling on pelvic structures, and distention of the vagina and perineum.

Occiput posterior (OP) position

Fetal head is oriented toward the mother's sacrum; back labor is common; rotation to occiput anterior (OA) can ease pain and labor progression.

Occiput anterior (OA) position

Fetal head facing the mother's front; contractions become more regular and labor often progresses more efficiently.

Asynclitic fetus

Head tilted toward the shoulder relative to the birth canal, potentially causing inefficient labor and more discomfort.

Pelvic anatomy and labor

Size and shape of the pelvis influence labor course, fetal presentation, and rotation; abnormalities can prolong labor.

Fatigue in labor

Fatigue lowers pain tolerance and coping ability, lengthening labor and increasing perceived pain.

Interventions that may increase pain

IV lines, fetal monitoring, vaginal exams, amniotomy, and internal monitoring can limit mobility and heighten discomfort if not well explained.

Culture as a psychosocial factor

Sociocultural background shapes pain perception, expression, and coping; individual variation within cultural groups must be respected.

Race and pain in childbirth

Racial/ethnic biases and disparities can increase fear and anxiety, influencing pain perception and management choices.

Anxiety and fear in labor

High anxiety increases muscle tension and pain perception, diverting oxygen and energy away from labor progress.

Preparation for childbirth

Education and rehearsal reduce fear, set realistic expectations, and teach coping skills; partner involvement and classes improve outcomes.

Doula

A professional labor support person who provides information, emotional and physical support; continuous support is associated with fewer interventions.

Standards for pain management (The Joint Commission)

Pain management is an essential part of care; clients should be involved in assessment and management using nonpharmacologic and pharmacologic strategies.

Nonpharmacologic technique advantages

Supports mobility and control, no drug side effects, potential endorphin release from movement, and can be effective in early labor.

Nonpharmacologic technique limitations

May not achieve complete pain relief; often used in combination with pharmacologic methods or when labor is rapid.

Categories of nonpharmacologic techniques

Relaxation, cutaneous stimulation, hydrotherapy, mental stimulation, and breathing techniques.

Relaxation in labor

Foundation of coping strategies; promotes uterine blood flow, efficient contractions, and reduced muscle tension and pain.

Hydrotherapy in labor

Water therapy (shower, tub, whirlpool) for relaxation and analgesia; may reduce need for pharmacologic analgesia; infection risk not increased with proper guidelines.

Mental stimulation in labor

Cognitive techniques (imagery, hypnobirthing, guided meditation) to distract from pain and promote relaxation.

Breathing techniques in labor

Conscious breathing to reduce pain transmission and activate the parasympathetic system; includes cleansing breaths and slow-paced breathing.

Cleansing breath

Deep inhalation through the nose followed by a complete exhale; signals contraction start/end and helps relieve tension.

Slow-paced breathing

Slow, deep breathing (often 4-second inhale, 4-second exhale); promotes relaxation, lowers heart rate, and can enhance endorphin release.

Hyperventilation

Excessive breathing causing CO2 loss and respiratory alkalosis; symptoms include dizziness, tingling, and carpopedal spasm; correct by slower, controlled breathing.

Second-stage pushing: open-glottis vs Valsalva

Physiologic pushing with open-glottis (nondirected) is preferred; Valsalva (closed-glottis) increases intrathoracic pressure and may reduce placental perfusion.

Epidural block (neuraxial anesthesia)

Regional anesthesia by injecting local anesthetic (often with opioid) into the epidural space to provide analgesia for labor and birth; may extend to cesarean birth.

Pudendal block

Localized anesthesia of the lower vagina and perineum for episiotomy or instrumental birth; does not relieve uterine contractions.

Spinal (subarachnoid) block

Intrathecal injection for rapid anesthesia, often used for cesarean birth when an epidural is not in place; provides fast onset but limited duration.

Combined spinal–epidural (CSE) block

Technique combining rapid spinal onsets with an epidural catheter for ongoing analgesia during labor or cesarean birth.

Continuous spinal analgesia

Use of a continuous spinal catheter to maintain ongoing analgesia with lower risk of catheter migration compared to epidurals.

Neuraxial opioid analgesics

Intrathecal or epidural opioids (e.g., morphine, fentanyl, sufentanyl) used with local anesthetics to provide analgesia with less motor block; rapid onset and favorable fetal profiles.

Test dose

Small trial dose (often lidocaine with epinephrine) given before neuraxial administration to detect intravascular or intrathecal placement.

Postdural puncture headache (PDPH)

Headache after dural puncture; treated with epidural blood patch or conservative measures.

Fever with neuraxial anesthesia

75–30% risk of fever with neuraxial anesthesia; usually not infection; monitor for infection signs to avoid unnecessary antibiotics.

Epidural hypotension

Drop in maternal blood pressure after neuraxial block due to sympathetic blockade; managed with IV fluids, lateral positioning, oxygen, and vasopressors as needed.

Sellick’s maneuver (cricoid pressure)

Manual pressure on the cricoid cartilage during induction of general anesthesia to prevent regurgitation of gastric contents.

Nitrous oxide (inhaled analgesia) in labor

50/50 nitrous oxide and oxygen; self-administered by the laboring client to reduce pain and anxiety; rapid onset with minimal systemic absorption.

Systemic opioid analgesics in labor

Opioid medications (e.g., fentanyl, morphine, remifentanil, butorphanol, nalbuphine) given parenterally or via PCA to relieve pain; cross placenta and risk neonatal respiratory depression.

Naloxone (Narcan)

Opioid antagonist used to reverse opioid-induced respiratory depression; may precipitate withdrawal in opiate-dependent clients or newborns.

Adverse effects of neuraxial opioids

Nausea, vomiting, pruritus, delayed respiratory depression in mother or newborn; manage with adjuncts and monitoring.

Indicators of fetal risk with analgesia

Monitoring fetal heart rate and maternal vital signs to detect reduced placental perfusion or fetal hypoxia following analgesia or anesthesia.

Aortocaval compression

Uterus compressing the aorta and inferior vena cava when supine; mitigated by lateral tilt to improve placental perfusion.

Obesity in labor analgesia

Increased dosing uncertainty, airway risk, sleep apnea, GERD risk, and careful monitoring required during analgesia/anesthesia.

Advanced maternal age considerations

Age-related increases in cardiac, vascular, and coagulopathy risks that can affect pain management decisions.

Ongoing nursing assessment in pain management

Pain assessment, fetal status, labor progress, and informed consent; tailor pain management plans to the individual and evolving labor.