Comfort measures during labor

3 Pain origins

• Somatic (intense, sharp, well localized)

• Visceral (from distention, stretching)

• Referred (radiates)

Lamaze Method of childbirth preparation

Method of building a mothers confidence in her ability to give birth. Usually drug free, encourages breathing and movement

Hypnobirthing

Method of pain management involving visualisation, relaxation, and deep breathing

Non-pharmacological comfort strategies

• Relaxation

• Imagery and visualisation

• Music

• Touch and massage

• Energy work

• Conscious breathing

• Effleurage and counter-pressure

• Hydrotherapy

• Transcutaneous electrical nerve stimulation (TENS)

• Acupressure and acupuncture

• Heat and cold application

• Aromatherapy

• Intradermal sterile water block

• Position changes and movement

Pharmacological comfort strategies

• Sedatives

• Analgesia and anesthesia

• Nitrous oxide

• Epidural

• Pudental injection

• Spinal block

What do sedatives do?

Relieve anxiety and induce sleep

What does analgesia do?

Alleviate sensation of pain or raise threshold for pain perception WITHOUT LOC

What does anesthetic do?

Abolishes pain perception by interrupting nerve impulses to the brain. Can cause LOC

What route is preferred for Opioids?

IV is preferred over IM

What are opioid effects on the fetus?

The fetus may be born sleepy with slow respirations

Where is epidural injected?

Between 4th and 5th lumbar

What position should mom be in to receive an epidural?

Sat on edge of bed (preferred) or side lying

What has to be monitored closely after an epidural is given?

Respirations

How often should vital signs be done after epidural administration?

At least every 3-5 mins for first 15 mins

What should the nurse do if moms BP is low before an epidural?

Administer IV fluids (1500mL ringers lactate)

What should the nurse do if mom is itching after an opioid administration?

Give benadryl

What are the risks of an epidural?

• Increases risk of instrument use during birth

• Longer 2nd stage of birth

• Increases risk for augmentation with oxytocin

• Weakened contractions

When is a pudental used?

• 2nd stage of labor

• Episiotomy

What is a spinal block?

Anesthetic injected into subarachnoid space. Mixes with CSF

When is spinal block used?

C-sections

What are the risks of a spinal block?

• Hypotension

• Post-dural puncture headache

• CSF leak

What should always be on hand when there are meds administered during labor?

Narcan and oxygen