#5 Pain Management during labor

• Pain felt during labor includes visceral pain from uterine contractions and cervical dilation, typically felt in the lower back and abdomen during the first stage of labor.
• Somatic pain arises from fetal head pressure and the stretching of pelvic muscles and perineal tissue.
• Pain perception is influenced by factors such as time, comfort level, anxiety, physiological factors, cultural background, support availability, environment, and prior experiences.
• Positive coping mechanisms during labor include moaning, rhythmic movements or breathing, and relaxing between contractions.
• Negative coping mechanisms during labor include difficulty relaxing, increased agitation, and crying.

Nonpharmacological Pain Management

• Environmental adjustments can aid in pain management, including modifications to lighting, noise levels, room temperature, visitors, music, and aromatherapy.
• Support systems are crucial, including ambulation, massage, position changes, visualization techniques, and heat or cold therapy.
• Relaxation and breathing techniques such as yoga, meditation, the Bradley method (natural with partner support), Lamaze (controlled breathing and relaxation), hypnosis, biofeedback, water therapy, and acupuncture can be beneficial.
• Touch and massage techniques include effleurage (light fingertip massage) and counterpressure (firm pressure using full hands).

Pharmacological Pain Management

• Opioid analgesics like morphine and Stadol offer rapid pain relief, but they can affect the fetus, potentially causing variability; these are not appropriate within one hour of birth and pose a significant fall risk to the mother.
• Opioid agonists can lead to fetal effects, such as decreased heart rate variability, and maternal effects, including nausea, vomiting, and respiratory depression; nursing interventions include assessments, antiemetics, and safety measures.
• Opioid agonist-antagonists have a lower risk of respiratory depression.
• Always keep naloxone nearby to reverse toxicity if necessary.
• Common medications include Nalbuphine (IV) and Remifentanil (PCA).
• Nitrous oxide, when mixed with oxygen, can be inhaled in low concentrations during the first and second stages of labor, self-administered at the start of a contraction with a short half-life of 30 seconds; prolonged use can cause nausea, and its effectiveness may decrease as labor progresses.
• General anesthesia is reserved for emergencies when spinal anesthesia is unsuccessful; it is rarely used in uncomplicated births, requiring premedication with a clear oral antacid; due to the risk of neonatal narcosis, the baby should be delivered quickly; risks include allergic reaction, sore throat, damage to the throat, teeth, or vocal cords, lung infection, awareness during surgery, stroke, myocardial infarction, postpartum hemorrhage, and aspiration.
• Local anesthesia: Perineal infiltration involves injecting anesthesia into the perineal tissue before an episiotomy, while a pudendal nerve block involves a longer needle injected higher up.

Regional Anesthesia and Analgesia

• Spinal or intrathecal blocks involve opioids, local anesthetics, or a combination injected into the subarachnoid space, commonly using Fentanyl, morphine, lidocaine, or bupivacaine, often used during C-sections.
• Spinal or intrathecal blocks offer a quick onset and last 90-120 minutes but cannot be titrated, presenting fewer effects than general anesthesia, and typically require the patient to remain bed bound; the anesthesia provider is responsible for obtaining consent, not the nurse.
• Epidural anesthesia is another option for regional anesthesia.