Pain Management in Pregnancy

Study Notes

Indications of pain:
- Increased blood pressure, tachycardia, hyperventilation
- Nausea and vomiting (N/V)
Non-pharmacological pain relief:
- Lamaze techniques
- Breathing exercises (e.g., paper bag)
- Aromatherapy, music, dim lighting
- Back massage
- Sacral counterpressure (applying pressure to sacral area)
Pharmacological pain relief:
- Sedatives (not typically given during labour unless for complications)
- Neonates: avoid sedatives for 12-24 hours before birth
- Potential risks of sedation: increased risk of nausea and vomiting, risk for aspiration, decreased heart rate, and decreased fetal heart rate
- Risks of opioids: resp-depression
- Analgesics: butorphanol/nalbuphine (pain relief without respiratory depression)
- Anti-emetics necessary if opioids given. Naloxone should be available if opioid use occurs.
- Metoclopramide for nausea & anxiety control
- Epidural block: must be at least 4cm dilated

Unable to bear down: -Nursing interventions: Bolus IV fluids to treat hypotension. Side-lying position with back curved. -Orthostatic hypotension: IV vasopressors (e.g., epinephrine), position laterally, increase IV fluid rate, and initiate supplemental oxygen (O2) -Spinal anesthesia (e.g., for C-section)
- Potential complications: fetal bradycardia, hypotension
Nursing actions: -Vital signs (q10 minutes) -IV fluid bolus -Lateral positioning -Increase IV fluids (if needed)
- Supplemental oxygen (O2)
- Assess contractions and FHR (continuous monitoring)
- HA due to CSF leakage: bed rest, dark room, oral analgesics, caffeine, fluids.