2.2 PAIN MANAGEMENT DURING LABOR AND BIRTH
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Questions and Answers

What characteristic differentiates childbirth pain from other types of pain?

  • It has no preparation time.
  • It worsens without intervention.
  • It is self-limiting. (correct)
  • It lasts indefinitely.

    • What source of pain is primarily related to the physical changes during labor?

  • Increased heart rate
  • Emotional stress
  • Maternal fatigue
  • Cervical dilation and stretching (correct)

    • What role do caregiver interventions play in childbirth pain management?

  • They only provide medication options.
  • They increase the duration of labor.
  • They eliminate the need for labor preparation.
  • They can modify the factors affecting pain tolerance. (correct)

    • Which of the following is a common psychosocial factor affecting pain perception during labor?

    <p>Support from family or partners</p> Signup and view all the answers

    How can childbirth preparation classes be beneficial to expectant mothers?

    <p>They provide coping strategies for labor pain.</p> Signup and view all the answers

    What is a common physiological response during contractions that influences pain?

    <p>Reduced uterine blood supply</p> Signup and view all the answers

    Which labor condition can negatively impact fetal presentation and lead to increased pain?

    <p>Fetal occiput posterior position</p> Signup and view all the answers

    What is the significance of understanding variables in childbirth pain for healthcare providers?

    <p>To tailor interventions based on individual pain experiences.</p> Signup and view all the answers

    What is the primary reason for the end of labor pains?

    <p>Birth of the baby.</p> Signup and view all the answers

    Which of the following non-pharmacologic methods involves physical touch to relieve pain during labor?

    <p>Effleurage</p> Signup and view all the answers

    What is a common complication associated with the pharmacologic method of pain relief known as an epidural block?

    <p>Maternal hypotension</p> Signup and view all the answers

    Which of the following techniques is NOT considered a non-pharmacologic method of pain management during labor?

    <p>Pharmacological analgesics</p> Signup and view all the answers

    During which stage of labor is the focus on breathing techniques particularly emphasized according to the outlined methods?

    <p>First stage</p> Signup and view all the answers

    Which pharmacologic method is specifically used to provide loss of sensation for a C-section delivery?

    <p>Subarachnoid Block</p> Signup and view all the answers

    What should be assessed immediately after a woman receives an epidural block?

    <p>Blood pressure</p> Signup and view all the answers

    What is a potential side effect of using narcotic analgesics during labor?

    <p>Delayed infant thermoregulation</p> Signup and view all the answers

    In managing labor pain, which non-pharmacologic method utilizes distraction through a focal point?

    <p>Imagery</p> Signup and view all the answers

    What should be the nurse's response if a woman using breathing techniques during labor experiences dizziness and tingling in her fingers?

    <p>Tell her to exhale slowly into her cupped hands</p> Signup and view all the answers

    Which method should be avoided if the mother is expected to give birth within one hour?

    <p>Narcotic analgesics</p> Signup and view all the answers

    Match the following factors with their corresponding influences on childbirth pain:

    <p>Pain Threshold = Individual pain sensitivity Maternal condition = Cervical dilation and pelvic shape Fetal presentation = Position of the fetus during delivery Caregiver interventions = Methods used to manage pain during labor</p> Signup and view all the answers

    Match the following pain sources with their descriptions during childbirth:

    <p>Dilation of the cervix = Opens to allow passage of the baby Reduced uterine blood supply = Caused by contractions affecting blood flow Pressure of the fetus = Applies force on pelvic structures Stretching of the vagina = Expansion to accommodate the baby’s descent</p> Signup and view all the answers

    Match the types of childbirth classes with their focuses:

    <p>Prepared childbirth classes = Methods to cope with labor Adolescent childbirth classes = Addressing unique concerns of young parents Breastfeeding classes = Techniques for successful breastfeeding Refresher classes = Updating knowledge for experienced parents</p> Signup and view all the answers

    Match the pain characteristics during childbirth with their explanations:

    <p>Self-limiting = Pain resolves after delivery Normal process = Part of the natural childbirth experience Preparation exists = Time to learn coping techniques Lasts for hours = Duration from onset of labor to birth</p> Signup and view all the answers

    Match the following caregiver interventions with their purposes:

    <p>IV lines = Facilitate medication administration Continuous fetal monitoring = Assess fetal heart rate and well-being Amniotomy = Artificially rupture membranes for faster labor Vaginal exams = Monitor progress of labor</p> Signup and view all the answers

    Study Notes

    Pain Management During Labor and Birth

    • Childbirth pain is different from other types of pain.

      • It's part of a normal process.
      • There's time for preparation.
      • It's self-limiting, lasting for hours.
      • Labor pains end with the birth of a baby.

    • Factors that influence pain experiences:

      • Pain threshold: Individual sensitivity to pain.
      • Pain perception: How pain is interpreted.
      • Pain tolerance: Person's ability to cope with pain.

    • Sources of pain during labor:

      • Dilation and stretching of the cervix.
      • Reduced uterine blood supply during contractions.
      • Pressure of the fetus on pelvic structures.
      • Stretching of the vagina and perineum.

    • Physical factors that influence pain:

      • Central Nervous System (CNS) activity.
      • Endorphin levels.
      • Maternal condition (cervix, pelvis, labor intensity, fatigue).
      • Fetal presentation and position (abnormal presentation, fetal occiput posterior).
      • Caregiver interventions (IV lines, continuous fetal monitoring, amniotomy, vaginal exams).
      • Psychosocial and cultural factors.

    Non-Pharmacologic Pain Management

    • Advantages: No harm to mother or fetus, no slowing of labor, no risk of allergy.

    • Limitations: Techniques must be taught and rehearsed, often covered in childbirth preparation classes.

    • Techniques:

      • Relaxation: Adjusting environment, educating about tension signs.
      • Skin stimulation: Effleurage, sacral pressure, thermal stimulation.
      • Positioning: Variety of positions to relieve pressure, support the body.
      • Diversion and distraction: Focal point, imagery, music, TV.
      • Breathing techniques: Cleansing breath, first stage techniques, second stage techniques.

    Pharmacologic Pain Management

    • Physiology of pregnancy and analgesia/anesthesia:

      • Higher risk of hypoxia for the mother.
      • Increased risk of vomiting and aspiration for the mother.
      • Increased risk of hypotension and shock for the mother.
      • Effects on the fetus must be considered.

    • Advantages: More active participation in birth for the mother, helps her relax and work with contractions, decreases stress response.

    • Limitations: Medicating two people (mother and fetus), may slow progress of labor, complications or medications may limit options.

    • Narcotic Analgesics: Frequent small doses, avoid if birth is expected within an hour.

      • Common drugs: Meperidine (Demerol), Fentanyl (Sublimaze), Nalbuphine (Nubain).
      • Safety protocols: Monitor mother and fetus closely.

    • Narcotic Antagonist: Naloxone (Narcan) to reverse respiratory depression.

    • Adjunct drugs (not pain relievers): Benzodiazepines for anxiety and nausea, potential adverse effects on fetus.

    • Anesthetics: Cause loss of sensation, block pain and motor responses.

      • Inhaled (Nitrous Oxide): Via face mask at the peak of contraction, no effect on mother or fetus.

    Regional Anesthetics

    • Epidural Block: Used for vaginal or C-section birth.

      • Combine anesthetic drugs, infused through a catheter.
      • Adverse effects: Maternal hypotension, urinary retention, prolonged second stage of labor.

    • Subarachnoid Block: Used for C-section ONLY, "one-shot" injection with less medication.

      • Loss of all sensation and movement.
      • Adverse effects: Maternal Hypotension, Urinary Retention, Post-spinal headache.

    • Local Block: Used for episiotomy or laceration repair.

      • Injection numbs the area.
      • Pudendal block: Used for vaginal birth, episiotomy, forceps-assisted birth.
      • Adverse effects: Vaginal hematoma, abscess.

    • General Anesthesia: Emergency cesarean delivery when regional block is contraindicated.

      • Adverse maternal effects: Vomiting with aspiration.
      • Adverse fetal effects: Respiratory depression.

    Nursing Role in Pharmacological Pain Management

    • Thorough admission intake: Assess patient's history and preferences.
    • Maintain safety: Monitor mother and fetus closely.
    • Provide education: Explain medication options and potential side effects.
    • Assist the healthcare provider: Prepare for procedures and manage medication administration.
    • Manage medication effects and patient response: Monitor vital signs, provide comfort measures, and manage potential complications.

    The Nature of Pain During Childbirth

    • Childbirth pain is different than other types of pain.
    • It is a normal part of a natural process.
    • It is self-limiting (it stops).
    • It lasts for hours, but ends with the birth of a baby.

    Variables in Childbirth Pain

    • The pain threshold: The amount of pain a person can tolerate.
    • Pain perception: How a person interprets the sensation, often influenced by the amount of knowledge they have concerning labor and childbirth.
    • Pain tolerance: The amount of pain a person is willing to go through before taking action.
    • Pain can also be influenced by physical, maternal, fetal and caregiver factors.

    Sources of Pain During Childbirth

    • Stretching of the cervix.
    • Reduction of uterine blood supply during contractions, resulting in ischemia (lack of blood flow)
    • Pressure of the fetus on pelvic structures.
    • Stretching of the vagina and perineum.

    Non-Pharmacologic Pain Management

    • Advantages: No harm to mother or fetus, no slowing of the labor process, no risk of allergy or adverse reactions.
    • Disadvantages: Require practice and preparation, often covered in childbirth preparation classes.

    Non-Pharmacologic Methods

    • Relaxation: Adjusting the environment to reduce stress and anxiety, educating the mother about signs of tension and how to release it.
    • Skin stimulation: Effleurage (light, circular stroking of the abdomen); Sacral pressure (applying firm pressure to the sacrum); Thermal stimulation (Heat or cold can be applied to the back or abdomen)
    • Positioning: Encourage frequent positions, avoid laying flat on the back, gravity can help the baby descend during labor.
    • Diversion and Distraction: Listening to music, watching TV, imagery, focusing on a specific point in the room.
    • Breathing techniques: Cleansing breaths (deep, slow breaths), First Stage breathing (slow, deep breaths), Second Stage breathing (Short, shallow breaths).

    Nursing Role in Non-Pharmacologic Pain Management

    • Assess the woman's prior knowledge and preparation, and guide and educate her on different techniques.
    • Minimize environmental stimuli to promote relaxation.
    • Assess pain and the effectiveness of pain relief measures.

    Pharmacologic Pain Management

    • Pharmacologic pain management is a more active form of pain management, giving the mother a more active role in the birth process, and it decreases stress response.
    • Disadvantages: Medications can affect both the mother and the fetus, they may slow down the labor process, and can complicate additional interventions.

    Pharmacologic Options

    • Narcotic Analgesics:
      • Meperidine (Demerol)
      • Fentanyl (Sublimaze)
      • Nalbuphine (Nubain)
    • Narcotic Antagonist:
      • Naloxone (Narcan): Reverses respiratory depression in the infant.
    • Benzodiazepines: Relieves anxiety and nausea, can affect fetal heart rate variability, and may delay infant thermoregulation.
    • Anesthetics:
      • Inhaled Nitrous Oxide (Laughing Gas): Given via mask at the peak of contraction.
      • Regional Anesthesia:
        • Epidural Block: Used for vaginal and C-section births.
        • Subarachnoid Block: Used for c-sections only.
      • Local Block: Used for episiotomy or laceration repair.
      • Pudendal Block: Used for vaginal birth, episiotomy, and forceps-assisted births.
    • General Anesthesia: Used for emergency cesarean deliveries and for mothers who have contraindications for regional blocks.

    Nursing Role in Pharmacologic Pain Management

    • Thorough admission intake to assess the woman's medication history.
    • Maintain safety precautions.
    • Provide education about medications.
    • Assist the healthcare provider with administering medication.
    • Manage medication effects and assess patient response.

    Nursing Considerations for Specific Anesthesia Types

    • Epidural Block: Monitor maternal blood pressure for hypotension, assess for urinary retention and monitor labor progress.
    • Subarachnoid Block: Monitor maternal blood pressure for hypotension, and assess urinary retention.
    • Pudendal Block: Assess for vaginal hematoma and abscess.
    • General Anesthesia: Monitor mother for vomiting and aspiration, monitor the infant for respiratory depression.

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    Description

    Explore the unique aspects of childbirth pain and its management. This quiz covers important factors influencing pain experiences during labor, including pain threshold and tolerance, as well as the physical sources of pain. Understand how various elements contribute to the experience of pain in the process of childbirth.

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