Nursing Management of Pain During Labor and Birth

Overview

  • Focus on nursing management of pain for intrapartum patients and their families.

Student Learning Outcomes

  • Assist in the coordination of care for intrapartum patients and their families. (CSLO 6)

  • Determine collaborative relationships needed to provide and improve care for intrapartum patients and their families. (CSLO 5)

  • Apply clinical judgment to ensure quality outcomes when caring for intrapartum patients and their families. (CSLO 4)

  • Practice effective communication skills to promote safety and support decision-making when caring for intrapartum patients and their families. (CSLO 3)

  • Demonstrate caring behaviors when providing nursing care to intrapartum patients and their families. (CSLO 2)

  • Use patient-centered nursing care for intrapartum patients and their families. (CSLO 1)

Types of Classes Available

  • Gestational Diabetes Mellitus

  • Early Pregnancy

  • Exercise for Pregnant Women

  • Infant Care

  • Breastfeeding

  • Sibling and Grandparent classes

  • Adolescent Childbirth

  • Variation of Basic Childbirth Preparation

    • Refresher classes

    • Cesarean birth

    • Vaginal birth after cesarean

    • Adolescent classes

Content of Childbirth Preparation Classes

  • Changes of pregnancy

  • Fetal development

  • Prenatal care

  • Hazardous substances to avoid

  • Nutrition

  • Common discomforts during pregnancy

  • Work benefits of exercise

  • Coping mechanisms for labor and delivery

Understanding Pain in Childbirth

How Childbirth Pain Differs from Other Pain

  • Part of a normal birth process.

  • Women have several months to prepare for pain management.

  • Self-limiting; pain rapidly declines after birth.

  • Cultural perceptions influence views on childbirth pain.

Methods of Childbirth Preparation

  • Hypnobirthing: Uses relaxation techniques to reduce pain perception.

  • Bradley Method: Focuses on partner-supported natural childbirth.

  • Lamaze Method: Incorporates breathing techniques and relaxation strategies.

Factors that Influence Labor and Pain

  • Pain Threshold and Tolerance: Variation among individuals.

  • Sources of Pain During Labor:

    • Maternal conditions (cervical readiness, pelvis, labor intensity, fatigue).

    • Fetal presentation and position.

    • Central Nervous System factors.

    • Gate Control Theory: Explains how non-pain stimuli influence pain perception.

    • Endorphins: Body's natural pain relievers.

Nursing Tips

  • If a woman is successfully using a safe, nonpharmacological pain control technique, do not interfere.

Nonpharmacological Pain Management

Advantages

  • Do not harm mother or fetus.

  • Do not slow labor if providing adequate pain control.

  • Carry no risk for allergy or adverse drug effects.

Limitations

  • Participation in childbirth classes may be required.

  • Most effective when practiced prior to delivery.

  • May not eliminate all pain.

Selected Nonpharmacological Pain Relief Measures

  • Relaxation Techniques: Help to reduce stress and anxiety.

  • Gate Control Theory Techniques:

    • Skin stimulation (e.g., effleurage, sacral pressure).

    • Thermal Stimulation: Hot and cold packs for skin stimulation.

    • Positioning: Adjusting positions can help alleviate pain.

    • Diversion and Distraction: Activities to take focus off pain.

    • Breathing: Controlled breathing can aid in managing contractions.

Recognizing and Correcting Hyperventilation

Signs and Symptoms

  • Dizziness

  • Tingling of hands and feet

  • Cramps and muscle spasms of hands

  • Numbness around nose and mouth

  • Blurring of vision

Corrective Measures

  • Breathe slowly, especially during exhalation.

  • Breathe into cupped hands to regulate breathing.

  • Use a moist washcloth over the mouth and nose when breathing.

  • Hold breath briefly before exhaling.

The Nurse’s Role in Pain Management

  • Begins at admission to the labor unit.

  • Assess patient’s preference for pain relief options.

  • Keep side rails up for safety.

  • Provide education regarding procedures and their expected effects.

  • Observe patient for hypotension and risks of hypoxia for both mother and fetus.

  • Monitor for nausea and vomiting (N & V).

Pharmacological Techniques for Pain Management

Advantages

  • Medications during labor can enhance comfort and relaxation.

  • Increased relaxation may facilitate participation in care.

Limitations

  • Consider potential effects of medications on the fetus.

Types of Pharmacological Techniques

  • Systemic Drugs: Provide analgesia without loss of consciousness.

  • Analgesics: Improve effectiveness and counteract side effects.

  • Adjunctive Drugs: Assist pain relief, can cause loss of sensation in specific areas.

  • Anesthetics: Induce loss of sensation, especially pain, while maintaining consciousness.

Considerations during Pharmacological Pain Management

  • Pregnant women are at higher risk for hypoxia and complications.

  • Slow gastrointestinal tract increases vomiting and aspiration risks.

  • Aortocaval Compression: May lead to hypotension and shock;

  • Influence on fetus must be assessed during pain management.

Specific Drugs for Pain Relief

  • Analgesics:

    • Avoid if delivery expected within 1 hour to minimize respiratory depression risk in newborns.

    • Examples include:

    • Fentanyl (Sublimaze): Opioid agonist-antagonist.

    • Butorphanol (Stadol): Narcotic analgesic; caution with drug-dependent mothers.

    • Narcotic Antagonist (Naloxone): Reverses respiratory depression in newborn.

  • Nausea-relieving Adjunctive Drugs: Used to manage side effects from pain relief medications.

Nitrous Oxide in Pain Management

  • Inhaled gas controlled by the client.

  • Reduces awareness of pain but may cause nausea.

  • Generally has no negative effects on mother or fetus.

Types of Anesthesia for Childbirth

  • Local Infiltration: Often used for episiotomy.

  • Pudendal Block: Does not affect contraction pains.

  • Epidural Block: Provides regional anesthesia without loss of consciousness.

  • Subarachnoid (Spinal) Block: Used in specific cases like cesarean births.

  • General Anesthesia: Rarely used due to associated risks.

Limitations and Adverse Effects of Anesthesia

Limitations for Epidural

  • Contraindicated in cases of abnormal blood clotting, infections, or hypovolemia.

Adverse Effects

  • Maternal hypotension, urinary retention, and risk of prolonged labor due to diminished urge to push.

Monitoring and Responsibilities During Epidural Placement

  • Monitor blood pressure initially every 5 minutes, then less frequently as stable.

  • Administer IV fluids (500-1000 mL) prior to epidural placement.

  • Monitor for fetal hypoxia and urinary retention (every 2 hours).

  • Not safe for patients with platelet counts under 100,000.

Epidural Blood Patch for Spinal Headaches

  • In case of a spinal headache, anesthesiologist or CRNA can perform a blood patch to alleviate symptoms.

General Anesthesia Risks

Adverse Effects on Mother

  • Risk of regurgitation leading to aspiration of gastric contents, causing chemical lung injury.

Adverse Effects on Neonate

  • Potential for respiratory depression requiring aggressive resuscitation.

Review Question

  • What is the most important nursing responsibility after administering epidural or spinal block analgesia during labor and delivery?