Pain Management During Labor PDF

Field of Nursing Science Maternal and Newborn Health Nursing Pain Management during Labor Dr : Shimaa Badawy Date : 30/ 11/2024 Outlines Introduction Definition of labor pain Causes of labor pain Pathway of pain Sign and Symptom Outlines Factors that affect the re...

Field of Nursing Science Maternal and Newborn Health Nursing Pain Management during Labor Dr : Shimaa Badawy Date : 30/ 11/2024 Outlines Introduction Definition of labor pain Causes of labor pain Pathway of pain Sign and Symptom Outlines Factors that affect the response and perceptions of labor pain Management  o Pharmacological methods  o Non-Pharmacological methods Nursing role Introduction Laboring woman can be reassured that labor pain lasts for only admit duration, approximately12 h and when delivery occur, the pain will be gone this will help the women to cope with discomfort. Additionally pain and child birth are both so bound up together in cultural expectation and personal beliefs that is difficult to lay down rules on clinical practices to deal with them. Definition Defines pain as an unpleasant sensory and emotional experience associated with uterine contraction and begins with delivery of the fetus Causes of labor pain: 1) Causes of the first stage of labor. Uterine contractions and dilatation of cervix. 2) Causes of the second stage of labor. Uterine contractions and dilatation of vagina and stretching of vulva and perineum by the presenting part. Characteristic of pain: 1) Burning 2) Aching 3) Throbbing 4) Sharps and cramps Signs and Symptoms: 1) Increase of blood pressure 2) Decrease of pulse 3) Change of skin color (pallor color) 4) Crying 5) Anxious 6) Diaphoresis 7) Restlessness 8) Excessive muscular excitability  Factors that affect the response and perceptions of labor pain  Age Culture. The meaning of the pain Attention Anxiety Fatigue Coping style Social and family support  I- Non- pharmacological methods Non pharmacological methods for relief of discomfort are taught many different types of child birth preparation classes or has read various Labor Pain book and magazines on the subject, the nurse can teach techniques to relief of discomfort during labor.  Advantages of Non pharmacological methods: 1) Reduce of maternal mortality rate of women. 2) Reduce the fetal death during prenatal period 28 weeks of gestation. 3) Prevent undesirable side effect of pharmacological management. 4) Providing natural methods for women to promote normal labor. 5) Promote relaxation and reduce stress. 6) Promote strengthen of muscles.  1) Lamaze breathing technique: This technique involve 8 pattern of controlled chest, nose and breathing. A - Slow Inhale through the nose and exhale through the mouth or nose 6 or 9 times / min  1) Lamaze breathing technique: B- Accelerated – decelerated: Inhale through the nose and exhale through the mouth as contraction becomes more intense. 2) Relaxation: Use in focus attention by choosing some fixable object in labor room fociseal in object to reduce perception. This technique with feed back relax help women to verbalize word (relax) when onset contraction.  3) Aromatherapy: - Aromatherapy helps in reduce stress therapy allowing pain to be better, tolerated, some suggestions aromatherapy also promote stress reduction. - Essential oils of rose, lavender, neroli, clary - saga and other are place in baths on labor mother's skin.  4) Acupuncture or acupressure: - An acupressure is a similar alterative to acupuncture pressure applied with fingers or small beads at acupuncture point. - Both have shown to lead to lower use of pharmacological pain relief. - Acupuncture has been shown to increase relaxation in labor women.  5) Effleurage method: Definition it is type of massage using pressure applied over a wide area of the body. How to works: A- Light effleurage promote relaxation, alleviation of pain and encourage sleep.  5) Effleurage method: B- Deep effleurage: improves circulation, while stretching and relaxation tens. How to do it: Perform in circle motion with the hands relaxed palms on the body always keep easing pressure on the return movement  6) Immersion hydrotherapy: Soaking in warm water sufficient to cover the mother is belly is available upon request and by physician order. A portable soft - sided inflatable labor pool can be brought into your private room. A private room allows a sense of safety and comfort ad you relax in warm water. Experience buoyancy and freedom of movement as the mother spend her labor in the comfort of the labor pool  7) Massage and touch: Woman suffering from back ache or pain during labor may find appropriate massage. perform circular massage over lumbosacral area reducing friction with the use of aclum powder of body lotion. Some women may find it comfortable to have abdominal massage.  8) Yoga: Using a serious of deep breathing technique , body stretching postures and medication to promote relaxation , slow respiration rate , low blood pressure , improve physical lightness , reduce stress and anxiety.it may help labor pain by helping the body and possibly release endorphin  9) Music therapy: Studies have shown the effect of listening to music on reducing labor pain. When women listen to music she fells relaxation in muscle and decrease pressure. So the pain is reduced  10) Applying hot and cold: Heat: is typically applied to women back, lower abdomen, groin and for perineum Heat sources include: Hot water bottle , Heated back filled shock, Warm compresses, Bathing in water - In addition used for pain relief Pain, muscle spam and increase contraction  10) Applying hot and cold: Cold: is usually applied to the women back, chest and face during labor Cold sources include: A bag of surgical gloves filled with cold water , Frozen gel neck, Cold shower, Ice in wash clothes. II- Pharmacological methods A- Analgesics  1) Pethidine A synthetic drug - it is an analgesic and antispasmodic. The best analgesic duty dose is 50 to 100 mg intramuscular. action lasts 2 h so contraindicated if delivery is expected to occur within 2h because it depress the fetal respiratory center , the anti date is naloxon which injected into the umbilical vein im or subcutaneous  2) Morphine dose is 10 to 15 mg I'm, action lasts 4 H. IT Depress the fetal respiratory center. It is not used during labor unless the fetus is dead. B- Tranquilizers  1) Valiam It can be used in the first stage of labor. Dose is 5 to 10 mg everything 4h. It may cause fetal hypotonia and hypothermia. Not recommended in the preterm labor because of the risk of, hyperbilrubinemia and jaundice in newborn C- Inhalation analgesia  1) Mixture oxide and oxygen: A special machine delivers the mixture of nitrogen oxide 50% and oxygen 50% to produce analgesia. Patient inhales the mixture once she feels that a contraction is coming on. a face mask or a mouth piece is used. it is relatively safe for the mother and fetus. However, inhalation analgesia should not be used for more than 3h. Other wise we get depression of fetal respiratory center D- Anesthesia  1) General anesthesia: Mixture oxide and oxygen is a safe aesthetic. As it produce little muscular relaxation. It is not suitable for reduction of inverted uterus, in this case it is combine with halo thane, 5%.  2) Spinal anesthesia: It is difficult to perform in pregnancy due to enlargement of the abdomen and may cause hypertension and spinal shock. The anesthetic drug is injected in to the subarachnoid space it produce relief of pain for 1 to 4 h.  3) Epidural anesthesia:: Labor route: the anesthetic drug combine with short acting narcotics like fentanyl is injected into the epidural space between 3 and 4 lumber vertebrae