Labor and Delivery and Pain Management Options

Introduction to Labor and Delivery

• Women’s Satisfaction in Childbirth
  • Highly satisfied women report feelings of:
  • Personal accomplishment
  • Increased self-esteem
  • Greater self-confidence
  • Success as a couple (Nichols and Zwelling, p. 703)

Supporting Women During Labor

• Women with satisfying birth experiences felt well supported during labor and delivery and had fond memories of their nurses (Nichols and Zwelling, p. 703).

Signs Preceding Labor

• Signs do not indicate labor has started. Definition of labor:
  • Labor is characterized by: Strong and painful contractions with cervical change.
• Common signs include:
  • Lightening
  • Increased urinary frequency
  • Backache
  • Stronger Braxton Hicks contractions
  • Flu-like symptoms or fatigue
  • Surge of energy (nesting behavior)
  • Slight weight loss
  • Bloody show
  • Cervical ripening
  • Loss of mucous plug

Key Terms

• Group Beta Strep (GBS):
  • Recommendations:
  • All women should be tested (vaginal and rectal swab) at 34-37 weeks.
  • If positive, women are treated during labor unless cesarean section is planned with intact membranes.

Causes of Labor

• Theories and the 5 Ps of Labor:
  1. The Passenger: Fetus and placenta.
  2. The Passage: Birth canal and bony pelvis.
  3. The Powers: Contractions.
  4. Position: Maternal position during labor.
  5. The Psyche: Psychological response to labor.

The Passenger (Fetus)

• Sutures and Fontanelles:
  • Allow molding of the fetal head (examples include caput succedaneum and cephalohematoma).
  • Serve as landmarks to assess fetal attitude and position.
• Fetal Presentation:
  • The part of the fetal body entering the pelvis first:
  • Cephalic (95%)
  • Breech (3%)
  • Shoulder (2%)
• Fetal Attitude:
  • Relationship of fetal parts to itself:
  • Vertex (flexed)
  • Military (extended)
  • Brow or Face (extended)
• Fetal Lie:
  • Relation of fetal spine to maternal spine.
  • Options: Vertical (cephalic or breech) or horizontal/transverse.

Fetal Position

• Relation of the presenting part to maternal pelvis:
  • Occiput Anterior (OA): Optimal position for labor.
  • Occiput Posterior (OP): Causes prolonged labor and back labor.
  • Occiput Transverse (OT): Can cause arrest of descent at the ischial spines.

The Passageway

• Bony pelvis:
  • Hormone relaxin softens joints.
  • Four types: gynecoid, android, anthropoid, platypelloid.
• Soft tissues:
  • Cervix, vagina, perineum, influenced by estradiol, progesterone, relaxin, and prostaglandins for increased size and elasticity.

Maternal Positioning

• Affects:
  • Maternal and uteroplacental perfusion.
  • Perception of pain.
  • Changes fetal position and rotation in the pelvis.
  • Nurses play a significant role in managing positions during labor.

Complications from Poor Positioning

• Supine Hypotension:
  • Caused by aortocaval compression leading to maternal hypotension and fetal distress.
  • Other effects include:
  • Narrower birth canal
  • Loss of pelvic mobility
  • Slower progress and greater discomfort during labor.

Psychosocial Effects of Labor

• Psychological Factors:
  • Increased pain, birth trauma, prolonged labor, and low Apgar scores can result from poor psychological support.

True vs. False Labor

• True Labor:
  • Regular contractions that increase in intensity.
  • Lasting cervical change observed.
• False Labor:
  • Irregular contractions, do not result in cervical change, stops with rest.
• Indicators for Hospital Visit:
  • Contractions every 5 minutes for nulliparous women, or every 10 minutes for multiparous women.
  • Membranes ruptured.
  • Fetal movements decrease.

Stages and Phases of Labor

1. First Stage: Ends with 10cm dilation; sensations dictate when to push, possibly requiring labor down approach.
2. Second Stage: Active pushing; time varies based on parity.
3. Third Stage: Delivery of the placenta; assessed by signs such as cord lengthening.

Nursing Interventions for Labor Stages

• Stage 1 in Nursing:
  • Admission procedures, education, and comfort measures.
• Stage 2:
  • Emotional support, open-glottis pushing.
• Stage 3:
  • Assess placenta, monitor for complications, and promote bonding.

Pain Management Approaches

• Continuous Support: Significantly contributes to shorter labor and improved satisfaction.
• Non-Pharmacologic Comfort Measures:
  • Techniques include counterpressure, massage, heat/cold therapy, acupressure, and aromatherapy.
• Medications:
  • Opioids (IM/IV) for pain relief, pros and cons associated with speed and effectiveness.
  • Analgesia options like nitrous oxide and regional blocks (epidural).

Complications with Anesthesia

• Maternal hypotension, spinal headache, hematomas, and potential respiratory suppression in neonates.
• General Anesthesia: Used only in emergencies with significant maternal risks due to pregnancy physiology.

Importance of Labor Support

• Key Elements for Pain Relief:
  • Comfort measures, position changes, emotional support, and breathing techniques are essential to enhance the labor experience.
• Tools in Labor:
  • Familiarity with supportive tools enhances positive experiences for mothers during childbirth.