Intrapartum Pain Management PDF

Intrapartum pain experience A subjective experience associated with: Uterine contractions Cervical dilation and effacement Fetal descent during labor and birth  Physiologic responses to pain Increased blood pressure, pulse, respirations, perspirations, pupil diameter, muscle tensi...

Intrapartum pain experience A subjective experience associated with: Uterine contractions Cervical dilation and effacement Fetal descent during labor and birth  Physiologic responses to pain Increased blood pressure, pulse, respirations, perspirations, pupil diameter, muscle tension (facial tension, fisted hands) muscle activity (pacing, turning, twisting) NONVERBAL expressions-withdrawal, hostility, fear and depression VERBAL expression-statements of pain, moaning, groaning  Factors affecting perception of intrapartum pain 1.previous experience with painful stimuli and personal experiences 2. cultural concept of pain, especially during childbirth, and how one should respond 3. rapidly progressive uterine contractions 4. Fear, anxiety and fatigue  Physiologic causes of intrapartum pain 1. Uterine anoxia- due to compressed muscle cells during the contraction 2. Compression of nerve ganglia in the cervix and lower uterine segment during the contraction 3. Stretching of the cervix, and effacement 4. Traction on, strecthing,and displacement of the perineum 5. Pressure on the urethra, bladder and rectum during fetal displaced 6. Distention of the lower uterine segment 7. Stretching of the uterine ligaments  Intrapartum pain management Two goals in intrapartum pain management: A. to provide maximal relief of pain with maximal safety for the mother and fetus B. To facilitate labor and delivery as a positive family experience Nonpharmacological treatment / Pain management 1.prepared childbirth method 🡪 helps client feel more in control and relxed -helping her “work with “the contractions- may shorten labor 2. Hypnosis 🡪 may be helpful with the client 3. Interventions aimed at supporting the client during labor ,it includes: a. providing information about the progress of labor b. reinforcing techniques learned in prepared child birth classes c. directing breathing methods, abdominal lifting, pushing, relieving external pressure, distraction, cutaneous stimulation, and relaxation Pharmacologic management 1. Narcotic analgesic Provide effective pain relief and slight sedation Systemic drug that readily cross the placental barrier🡪 causing DEPPRESSIVE EFFECT on the neonate 2-3 hours after active stage of labor- IM injection FETAL effect would be: LOWERED APGAR SCORE and RESPIRATORY DEPRESSION Narcotic antagonist (ANTIDOTE): NARCON (Naloxone) should be readily available ***Administered if birth is anticipated***  Common drugs Meperidine (Demerol) Morphine Sulfate (Fentanyl) 2. Barbiturates not appropriate to use during active labor🡪 EARLY LABOR due to rapid transfer across placental barrier USED TO INDUCE SLEEP,DEC. ANXIETY,ALLOW REST,AND INHIBIT UTERINE CONTRACTIONS Causes maternal sedation and relaxation MATERNAL SIDE EFFECTS: N/V, hypotension, restlessness and vertigo NEONATAL side effects: CNS depression ,prolonged drowsiness and delayed establishment of feeding Due to poor sucking reflex or poor sucking pressure  Common barbiturates Secobarbital Na (Seconal) Pentobarbital (Nembutal) 3. Tranquilizers These drugs decrease N/V, relieve anxiety and increase sedation Common drugs: Promethazine HCK (Phenergan) Hydroxyzine HCL (Vistaril) Propiomazine (Largon) 4. Agonist/Antagonist Common drugs: Monitor for side effects and CNS depression Nalbuphine (Nubain) (drowsiness,dizziness,HA,ort hostatic hypotension Butorphanol (Stadol) Pentozocine (Talwin) Blocks receptors responsible for respiratory depression, stimulate receptors that blocks painful sensations and decrease maternal N/V 5. Narcotic antagonist (Narcan) Given slowly -reverse CNS depression, as a result of to avoid seizures and opioid administration severe pain  Other drugs during pregnancy Oxytocin(Pitocin)🡪 is a Hormone not a drug -hormone produced by the body-hypothalamus which is released into the bloodstream by the posterior pituitary gland  Uses: Labor induction -to stimulate contractions and induce labor Postpartum hemorrhage - control bleeding and childbirth by stimulating uterine contractions Milk production - stimulate milk productions in breastfeeding mothers  Potential risk and side effects Uterine hyperstimulation- excessive contractions 🡪 fetal distress premature birth Water intoxication- lead to water retention and electrolyte imbalance Postpartum hemorrhage-RARE cases: may cause excessive bleeding after birth Allergic reactions- RARE:in some mothers Nausea/vomiting- common side effects (while labor is induced Headache and dizziness- common side effects  Pre-Administration AssessmentMaternal history: Assess for any contraindications, such as previous uterine rupture, fetal distress, or cesarean section.Fetal assessment: Monitor the fetal heart rate (FHR) to ensure fetal well-being.Cervical assessment: Assess the cervix for readiness to dilate. Maternal vital signs: Take baseline blood pressure, pulse, respiration, and temperature  During Oxytocin Administration. Continuous fetal monitoring: Monitor the FHR for any signs of fetal distress.Contraction monitoring: Assess the frequency, duration, and intensity of uterine contractions. Maternal vital signs: Monitor blood pressure, pulse, respiration, and temperature regularly.Fluid balance: Ensure adequate hydration to prevent hypotension. Pain management: Provide pain relief measures as needed.Titration: Adjust the oxytocin infusion rate as needed to achieve desired contraction patterns. Documentation: Document the start time, rate of infusion, any changes in dosage, and the patient's response.  Methylergonovine maleate is a synthetic ergot alkaloid used primarily to prevent postpartum hemorrhage Action: stimulating uterine contractions. It acts by constricting blood vessels in the uterus and directly stimulating uterine muscle contractions. Indications Prevention of postpartum hemorrhage Hypertension, preeclampsia, coronary artery disease, peripheral vascular Contraindications disease, Raynaud's phenomenon, severe hepatic or renal disease, pregnancy Hypertension, nausea, vomiting, headache, dizziness, chest pain, Side Effects dyspnea, uterine hyperstimulation, pulmonary edema Pre-Administration Assess maternal history: Check for any contraindications, especially cardiovascular conditions. Monitor vital signs: Take baseline blood pressure, pulse, and respirations. Assess uterine tone: Evaluate the uterus for any signs of atony. Prepare for administration: Ensure necessary supplies, such as IV equipment and a syringe. During Administration Administer as ordered: Follow the prescribed route and dosage. Monitor vital signs: Continue to monitor blood pressure, pulse, and respirations frequently. Assess for side effects: Watch for signs of hypertension, nausea, vomiting, or uterine hyperstimulation. Document administration: Record the time, route, dose, and any adverse reactions.  Post-Administration Continue monitoring: Monitor vital signs and uterine tone for several hours. Assess for bleeding: Evaluate the amount and character of lochia. Educate patient: Inform the patient about the importance of rest and avoiding strenuous activity. Report adverse reactions: Notify the healthcare provider of any significant side effects.  Remember: Methylergonovine maleate should be administered under the supervision of a healthcare professional to minimize the risk of adverse effects.  Anesthesia’s for NSVD Epidural: This is the most common method of pain relief during labor. A small catheter is inserted into the lower back and a local anesthetic is injected into the spinal fluid, providing numbness and pain relief in the lower body. Spinal anesthesia: Similar to an epidural, but the anesthetic is injected directly into the spinal fluid, providing more immediate and complete pain relief. This is often used for cesarean sections or forceps/vacuum deliveries. Pudendal block: A local anesthetic is injected into the pudendal nerve, which provides pain relief in the perineum and lower vagina. This is often used for the second stage of labor or for episiotomies. Nitrous oxide: Also known as "laughing gas," this is a gas that can be inhaled to provide pain relief during labor. It has a rapid onset and offset of action, allowing for flexibility in its use. Epidural: This is the most common method of pain relief during labor. A small catheter is inserted into the lower back and a local anesthetic is injected into the spinal fluid, providing numbness and pain relief in the lower body. Spinal anesthesia: Similar to an epidural, but the anesthetic is injected directly into the spinal fluid, providing more immediate and complete pain relief. This is often used for cesarean sections or forceps/vacuum deliveries. Pudendal block: A local anesthetic is injected into the pudendal nerve, which provides pain relief in the perineum and lower vagina. This is often used for the second stage of labor or for episiotomies.  Nitrous oxide: Also known as "laughing gas," this is a gas that can be inhaled to provide pain relief during labor. It has a rapid onset and offset of action, allowing for flexibility in its use.