[Chapter 16, The Nursing Role in Providing Comfort During Labor and Birth]

Experiences of Pain and During Labor/Birth:

1. Etiology
2. Physiology
3. Perception

1.) Etiology - Causes can be doubts, there is more to our body that isn't explored
yet.
A. Anoxia - Absence of oxygen
B. Stretching of the cervix and perineum - pain possibly results from stretching
C. Pressure of the fetal presenting part on tissues - additional discomfort in
labor may stem from the pressure presenting part

2.) Physiology: Pain can be halted in three points

>The peripheral end terminals
>The synapse ponitin the dorsal horn of the spinal cord
>The point at which the impulse is interpreted as par in the brian cortex

3.) Perception - The amount of discomfort a woman experiences during contractions

differs according to:
A. Her expectations and preparation for labor;
B. the length of her labor;
C. the position of her self-efficacy
D. the availability of support people around her
*SPOKEN: The views/lifestyle/supprt system available will greatly influence the
primigravida mother on whether
she is able to handle or face difficulties in A, B, C or D.

===End of V1====
[Comfort and nonpharmacologic pain relief measures.]

1. Support from a doula or a coach

2. Complementary and alternative therapies

1.) Support from a doula or a coach:

A doula is a woman who is experienced in childbirth, but without the professional
credentials, who guides and assists women in
labor.
*SPOKEN: It matters when a doula is able to encourage the woman going into labor

2.) Complementary and alternative therapies

A. Relaxation - Keeps abdominal wall from becoming tense, allowing uterus to rise
with cnntraction w/o pressing on abdominal wall
B. Focusing and imagery - Concentrating intensely on an object/another distraction
C. Spirituality - If prayer makes the patient feel eased, then let the patient get
ample time in doing so
D. Breathing techniques - They are advantageous because they help relax a woman's
abdomen
E. Herbal Preparations - Women can use these to strengthen uterine contractions
(some herbs are not recommended (ex. black hush))
F. Aromatheraphy and essential oils - Use of aromatic oils in order to complement
emotional/physical well being
G. Heat or Cold application - Has always been used for pain (but be careful para
dili ma paso)
H. Bathing or hydrotherapy - Another way to reduce pain
I. Therapeutic touch and massage - Laying hands to redirect the energy causing the
pain (effleurage = gentle abdominal massage)
J. Yoga and meditation - A term derived from a sansrkit word that means "union"
originally designed to bring people closer to their God
K. Reflexology - The practice of stimulating the hands/feet/ears as a form of
therapy
L. Hypnosis - She is conditioned to hypnotic suggestion, so that she will
experience reduced pain during labor
M. Biofeedback - based on the belief that people have control and can regulate
internal events such as heart rate or pain responses
N. Transcutaneous electrical nerve stimulation (TENS) - Ipikit ang rods(?)
O. Intracutaneous nerve stimulation - Injecting via IV in order to relieve low back
pain during labor
P. Acupuncture and Acupressure - based on the concept that illness results from the
imbalance of energy, to correct the balance,
needles are inserted into the skin at designated body points
===End of V2===

[Pharmacologic measures for pain relief during Labor]

1.) Goals
+ Labor must relax the woman and relieve her discomfort, yet have minimal systemic
effects
on her uterine contractions, her pushing effort or her fetus

2.) Preparation for medication administration

+ NEVER give a drug during labor unless you KNOW it is safe for both clients:
a. the mother
b. the fetus

3. Narcotics Analgesics
+ Narcotics may be given during labor because of their potent analgesic effect, but
all drugs in this
category cause fetal CNS depression to some extent; so they are used cautiously

A. Intrathecal Narcotics:
+ Intrathecal Injection refers to the injection into the spinal cord.
+ With intrathecal narcotic injection, a catheter is introduced into the spinal
canal (te sbarachnoid space), and a narcotic
such as morphine or fentanyl citrate is injected into the canal by way of the
catheter