RAK College of Nursing

RAK Medical and Health Science University

OBSTETRIC NURSING WRITTEN ASSIGNMENT 1

Names: Maryam saeed hamad 19904016

Suhaila Ali Mohammed 1994076
Noora Jasem Humaid 19904015
Amna Esmaeel Hasan 19904042
Mohamed Adnan Aladawi 19904010
Nouf Obaid 18904039

Submission date: 24/10/2022

Submission to: Dr.Olabisi Fatimo Ibitoye
 Pharmaceutical methods of pain management in labour

LEARNING OUTCOMES
1. introduction
2. Discuss the nurse’s role in supporting pharmaceutical pain relief measures in
labor.
3. Compare the major types of regional analgesia and anesthesia, including the
area affected, advantages, disadvantages, techniques, and nursing implications.
4. Describe the three methods used to provide general anesthesia.
5. Delineate the major complications of general anesthesia.
 Pharmaceutical methods of pain management in labour
When a childbearing woman experiences discomfort during labor and birth, the nurse can assist
her to have a positive birth experience by providing effective comfort measures. Nursing
interventions directed toward pain relief begin with the nonpharmacologic measures , such as
providing information, encouragement, back rubs, and cleanliness. Many women need no
further interventions. For other women, the progression of labor brings increasing levels of pain
that interfere with their ability to cope effectively. For these women, pharmacologic agents
may be used to decrease discomfort, increase relaxation, and reestablish the ability to
participate more actively in the labor and birth experience. In addition to systemic analgesics,
regional nerve blocks (epidural, spinal, and combined epidural-spinal) and local anesthetic
blocks (pudendal and perineal) are available. The methods are not mutually exclusive and may
be used in combination with nonpharmacologic comfort measures.
The nurse should carefully assess the woman before administration of analgesic agents.
Because they are not indicated for women in active labor, the nurse needs to determine the
stage of labor. The nurse should evaluate the woman to determine the frequency, duration,
and intensity of her contractions (Simpson & Creehan, 2008). A vaginal exams performed to
determine if cervical change has occurred. Fetal well-being is established by obtaining
electronic fetal monitoring and ensuring a reactive fetal heart tracing. The nurse should explain
the desired effects of the medication and possible side effects. If the woman is not in active
labor, she can be given the medication and be advised to return home and rest.
Since drowsiness can occur, however, the nurse needs to ensure the woman has a safe form of
transportation home. Nurses need to review the symptoms of active labor and warning signs
and advise the woman to call her healthcare provider.
systemic Analgesia
The goal of systemic analgesia during labor is to provide maximal pain relief with minimal risk
for the woman and fetus. Multiple factors must be considered in the use of analgesic agents:
Effects on the woman, Effects on the fetus, Effects on the labor contractions, Medical status of
the woman, Progress of labor The effects on the mother are of primary importance, because
the well-being of the fetus depends on adequate function of the maternal cardiopulmonary
system. Any alteration of function that disturbs the woman’s homeostatic mechanism affects
the fetal environment. Maintaining the maternal respiratory rate and blood pressure within
normal range is thus of prime importance. All systemic analgesics can cross the placental
barrier by simple diffusion, with some agents crossing more readily than others. Drug action in
the body depends on the rate at which the substance is metabolized by liver enzymes and
excreted by the kidneys. The fetal liver enzymes and renal systems are inadequate to
metabolize analgesic agents, so high doses remain active in fetal circulation for a prolonged
period of time. The percent-age of blood volume flowing to the fetal brain increases during
intrauterine stress, so the hypoxic fetus receives an even larger amount of a depressant drug.
The blood-brain barrier is more per-meable at the time of birth, a factor that also increases the
amount of drug carried to the central nervous system.
Regional anesthesia is the temporary and reversible loss of sensation produced by injecting an
anesthetic agent (called a local anesthetic) into an area that will bring the agent into direct
contact with nervous tissue. Loss of sensation occurs because the local agents stabilize the cell
membrane, which prevents initiation and transmission of nerve impulses. The regional
anesthetic blocks most commonly used in childbearing include epidural, spinal, or combined
epidural-spinal. Epidural blocks may be used for analgesia during labor and vaginal birth and for
anesthesia during cesarean birth. A combined epidural-spinal block may also be used. With this
approach, the epidural is used to provide analgesia for labor, and the spinal provides anesthesia
for birth or analgesia following birth.
An epidural relieves pain associated with the first stage of labor by blocking the sensory nerves
supplying the uterus. Pain associated with the second stage of labor and with birth can be
alleviated with epidural, combined epidural-spinal, and pudendal blocks.
Regional anesthesia carries considerably less risk than general anesthesia. Risk of maternal
death with general anesthesia during a cesarean birth is primarily related to intubation
difficulties and hypovolemia. Other risk factors include obesity, African American race, and
faulty monitoring during general anesthesia.
Until fairly recently, the same anesthetic agents used for regional epidural anesthesia were also
used to produce regional analgesia (pain relief) during labor. This approach was somewhat
problematic because anesthetic agents alter the transmission of impulses to the bladder,
making voiding difficult. The agents also interfere with the woman’s ability to maintain her
blood pressure and move her lower extremities.
The major complications of general anesthesia:-
A primary danger of general anesthesia is fetal depression. Most general anesthetic agents
reach the fetus in about 2 min- utes. The depression of the fetus is directly proportional to the
depth and duration of the anesthesia. The long-term signifi- cance of fetal depression in a
normal birth has not been deter- mined. The poor fetal metabolism of general anesthetic
agents is similar to that of analgesic agents administered during labor. General anesthesia is not
advocated when the fetus is consid- ered to be at high risk, particularly in preterm birth. Most
general anesthetic agents cause some degree of uterine relaxation although the inhalation
agents effect uterine relax- ation to a lesser degree than the IV agents. They may also cause
vomiting and aspiration. Pregnancy results in decreased gastric motility, and the on- set of labor
halts the process almost entirely. Food eaten hours earlier may remain undigested in the
stomach. Even when food and fluids have been withheld, the gastric juice produced dur- ing
fasting is highly acidic and can produce chemical pneu- monitis if aspirated. This pneumonitis is
known as Mendelson syndrome. The signs and symptoms are chest pain, respiratory distress,
cyanosis, fever, and tachycardia. Women undergoing emergency cesarean births appear to be
 at considerable risk for adverse events. The leading cause of maternal deaths in women who
have had general anesthesia is the failure to establish a patent airway.
Contraindications of Analgesics and Anesthetics in Pregnancy

Healthcare professionals have tried to deal with the discussion of Obstetric Analgesia and anesthesia to

healthy women and fetuses in or outside healthcare facilities. The neurobehavioral effect of analgesia and

anesthetics during labor and birth is a crucial issue that should be considered before administering any

pharmacological agents. Pain is an inevitable symptom in women during labor and birth and therefore, the

process of pain relief requires adequate skills in decision-making, close monitoring, and awareness of

potential risks associated with these medications to both the mother and the fetus (Davidson, London, &

Ladewig, 2012). Agents such as anesthesia can cause fetal depression. Inhalation agents can cause uterine

relaxation which can be problematic during child delivery. Additionally, these agents can cause vomiting

and aspiration in the mother. All the health care providers include nurses, labor pharmacists,

obstetricians, anesthesiologists, and pediatricians (Davidson, London,  & Ladewig, 2012). There are

pathophysiological alterations that accompany maternal disorders that have a direct influence on the

choice of medication given to the patient. Research establishes that women who receive general

anesthesia have a reduced capacity to initiate breastfeeding in the postpartum period. Both maternal and

fetal complications go hand in hand and therefore whatever affects the mother negatively will have an

adverse effect on the child.

References

Davidson, M. R., London, M. L., & Ladewig, P. W. (2012). Olds' maternal-newborn nursing and

women's health across the lifespan. Prentice Hall