Nursing Management of Pain During Labor and Birth PDF

Chapter 7 Nursing Management of Pain During Labor and Birth Copyright © 2019, Elsevier Inc. All rights reserved.  Lesson 7.1 Objectives 1. Define each key word listed. 2. List the common types of classes offered to childbearing families. 3. Describe...

Chapter 7 Nursing Management of Pain During Labor and Birth Copyright © 2019, Elsevier Inc. All rights reserved.  Lesson 7.1 Objectives 1. Define each key word listed. 2. List the common types of classes offered to childbearing families. 3. Describe the methods of childbirth preparation. 4. Describe factors that influence a woman’s comfort during labor. 5. Discuss the advantages and limitations of nonpharmacologic methods of pain management during labor. Copyright © 2019, Elsevier Inc. All rights reserved.  Education for Childbearing  Ideally, educational preparation for childbirth begins before conception. Copyright © 2019, Elsevier Inc. All rights reserved.  Types of Classes Available  Gestational diabetes mellitus  Early pregnancy  Exercise for pregnant women  Infant care  Breastfeeding  Sibling  Grandparent  Adolescent childbirth Copyright © 2019, Elsevier Inc. All rights reserved.  Variations of Basic Childbirth Preparation Classes  Refresher  Cesarean birth  Vaginal birth after cesarean  Adolescent Copyright © 2019, Elsevier Inc. All rights reserved.  Content of Childbirth Preparation Classes  Changes of pregnancy  Fetal development  Prenatal care  Hazardous substances to avoid  Nutrition  Common discomforts  Work and benefits of exercise  Coping with labor and delivery Copyright © 2019, Elsevier Inc. All rights reserved.  Childbirth and Pain  How childbirth pain differs from other pain  Part of a normal birth process  Woman has several months to prepare for pain management  Is self-limiting and rapidly declines after birth Copyright © 2019, Elsevier Inc. All rights reserved.  Factors that Influence Labor Pain  Pain threshold  Sources of pain during labor  Central nervous system factors  Gate control theory  Endorphins  Maternal conditions  Cervical readiness  Pelvis  Labor intensity  Fatigue  Fetal presentation and position Copyright © 2019, Elsevier Inc. All rights reserved.  Lesson 7.2 Objectives 6. Explain nonpharmacologic methods of pain management for labor, including the nursing role for each. 7. Discuss the advantages and limitations of pharmacologic methods of pain management. 8. Explain each type of pharmacologic pain management, including the nursing role for each. Copyright © 2019, Elsevier Inc. All rights reserved.  Nonpharmacologic Pain Management  Advantages  Nonpharmacologic methods do not harm the mother or fetus.  They do not slow labor if they provide adequate pain control.  They carry no risk for allergy or adverse drug effects. Copyright © 2019, Elsevier Inc. All rights reserved.  Methods of Childbirth Preparation  Dick-Read method  Bradley method  Lamaze method Copyright © 2019, Elsevier Inc. All rights reserved.  Nonpharmacologic Pain Relief Measures  Relaxation techniques  Skin stimulation  Effleurage  Sacral pressure  Thermal stimulation  Positioning  Diversion and distraction  Breathing Copyright © 2019, Elsevier Inc. All rights reserved.  Breathing  First stage  Slow-paced  Modified-paced  Patterned-paced Constant pattern Stairstep pattern  Second stage  Used when pushing Copyright © 2019, Elsevier Inc. All rights reserved.  How to Recognize and Correct Hyperventilation  Signs and symptoms  Dizziness  Tingling of hands and feet  Cramps and muscle spasms of hands  Numbness around nose and mouth  Blurring of vision  Corrective measures  Breathe slowly, especially when exhaling.  Breathe into cupped hands.  Place a moist washcloth over the mouth and nose while breathing.  Hold breath for a few seconds before exhaling. Copyright © 2019, Elsevier Inc. All rights reserved.  The Nurse’s Role In Nonpharmacologic Techniques  Determine if attended childbirth preparation classes.  Aids in developing appropriate nursing care plan  Identify signs of tension.  Aids in determining appropriate relaxation techniques  Minimize environmental irritants.  Keeping her clean and dry helps her to relax and focus Copyright © 2019, Elsevier Inc. All rights reserved.  Pharmacologic Pain Management  Analgesics  Systemic  Adjunctive drugs to improve effectiveness or counteract side effects  Anesthetics  Regional: loss of sensation  General: loss of consciousness and sensation Copyright © 2019, Elsevier Inc. All rights reserved. Physiology of Relationship of Pregnancy to Analgesia and Anesthesia  Pregnant woman at higher risk for hypoxia  Sluggish GI tract can result in increased risk of vomiting and aspiration.  Aortocaval compression increases risk of hypotension and shock.  Effect on fetus must be considered. Copyright © 2019, Elsevier Inc. All rights reserved.  Pharmacologic Methods (1 of 2)  Advantages  Using medications during labor allows the mother to be more comfortable and relaxed.  Increased relaxation will aid in her ability to work through contractions.  Lessens “stress response,” which, if not controlled, could lead to fetal acidosis. Copyright © 2019, Elsevier Inc. All rights reserved.  Pharmacologic Methods (2 of 2)  Limitations  Important factor to consider—two people, mother and fetus, are being medicated.  Any medication used must be considered for its potential impact on the condition of the fetus.  Can slow labor if given too early Copyright © 2019, Elsevier Inc. All rights reserved.  Analgesics and Adjunctive Drugs  Narcotic (opioid) analgesics  Avoid if birth anticipated within 1 hour  Narcotic antagonist: reverses respiratory depression  Adjunctive drugs: relieves nausea and vomiting Copyright © 2019, Elsevier Inc. All rights reserved. Regional Analgesics and Anesthetics  Regional anesthesia usually involves placement of anesthetic in epidural or subarachnoid space.  The meninges around the spinal cord  Dura mater  Arachnoid mater  Pia mater Copyright © 2019, Elsevier Inc. All rights reserved.  Difference Between Analgesic and Anesthetic  Analgesic blocks pain  Anesthetic blocks both pain and motor responses Copyright © 2019, Elsevier Inc. All rights reserved.  Types of Anesthesia for Childbirth  Anesthetic method  Local infiltration  Pudendal block  Epidural block  Subarachnoid (spinal) block  General anesthesia Copyright © 2019, Elsevier Inc. All rights reserved.  General Anesthesia (1 of 2)  May be necessary in the following circumstances:  Emergency cesarean birth: not enough time to establish a block  Cesarean birth in woman who refuses or has a contraindication to block Copyright © 2019, Elsevier Inc. All rights reserved.  General Anesthesia (2 of 2)  Adverse effects in the mother  Regurgitation with aspiration of gastric contents  Can result in chemical injury to lungs  Adverse effects in the neonate  Respiratory depression  Aggressive resuscitation may be necessary. Copyright © 2019, Elsevier Inc. All rights reserved.  Pharmacologic Techniques  The nurse’s role  Begins at admission  Woman’s preference for pain relief  Keep side rails up.  Provide education regarding procedures and expected effects.  Observe for hypotension and respiratory depression.  Document interventions and assessments. Copyright © 2019, Elsevier Inc. All rights reserved.