Tanta University.

Faculty of Nursing.
Maternal and Neonatal Health Nursing Department.
3rd year, 1st semester, 2023-2024.

Prepared by: -
1- Ahmed Atef Abdullah Ahmed 2- Ahmed AbdELHameed ELsayed Wafa
3- Ahmed AbdELRahman zakiEldin 4- Ahmed AbdELAalim Ebrahim ELgaria
5- Ahmed Metwaly Hassan Metwaly 6- Amira Abd ELWhab Mohammed
7- Amira Eid Elmaddawy 8- Amira Mohammed Ahmed
9- Amira Mohammed Esmail 10- Amira Mohammed Ramdan
11- Amira Mohammed Riyad Bardan 12- Amira Mohammed Saeed
13- Amira Mohammed Shaaban 14- Amira Mohammed Abdullah
15- Amira Mahmoud Elsayed Nassar 16- Amira Mosaad Mosaad Elzarka
17- Amira Mostafa Sallam 18- Eman Osama Shama
19- Eman Reda Abd ElSabry
Under supervision of: -
Assisst. Prof. Dr/ Ghada Abd El-Salam Belal.
Dr/ Shaimaa Mohamed Hashem.
Dr/ Eman Ahmed El-Kholy.
Dr/ Doaa Samir El-Khawaga.
Assisst. Lecturer/ Eman Abd El-Karim Ellpody.
Demonestrator/ Asmaa El-Saied Salama.
Demonestrator/Sara Ayman Salem.

Group ( 2 )

1
 ‫الرؤية‬
‫‪ -‬الريادة والتميز فى إستثمار المعرفة فى التمريض وتحقيق التنمية المستدامة‪.‬‬

‫الرساله‬

‫‪ -‬تسعى كلية التمريض – جامعة طنطا إلى بناء بيئة أكاديمية فاعلة تؤدى الى تخريج كوادر مهنية متميزة‬
‫فى علوم التمريض قادرة على المنافسة فى سوق العمل على المستوى المحلى واإلقليمى ومواكبة‬
‫التطورات العالمية وتساهم فى تقديم الخدمات الصحية للمجتمع ودفع مسيرة البحث العلمى التطبيقى‬
‫المبتكر فى إطار قيم وتقاليد المجتمع وذلك من خالل برامج تعليمية حديثة وفق معايير أكاديمية معتمدة‪.‬‬

‫‪2‬‬
 ‫رؤية ورسالة قسم تمريض صحة االم وحديثى الوالدة للعام الجامعي‬
‫‪2024-2023‬‬
‫رؤية القسم‬
‫التطلع إلى أن يكون قسم تمريض صحة األم وحديثى الوالدة من االقسام العلمية المتميزة على مستوي‬
‫الكلية من خالل إعداد ممرض وممرضه متميزين قادرين على المنافسة الفعالة في عصر تكنولوجيا‬
‫المعلومات‪.‬‬
‫رسالة القسم‬
‫يسعي قسم تمريض صحة األم وحديثى الوالدة الي إكساب الطالب المعلومات والمهارات واالتجاهات‬
‫اإليجابية الالزمة والتي تمكنهم من تقديم رعاية تمريضية متطورة في مجال صحة المرأة وحديثي الوالدة‬
‫وبذلك يساهم في تطوير مهنة التمريض وخدمة المجتمع وتنمية البيئة كما أن القسم يساعد على تنمية‬
‫وتشجيع القدرات التعليمية والبحثية المبنية على األدلة والبراهين لدي الطالب وأعضاء هيئة التدريس بما‬
‫يتواكب مع احتياجات المجتمع‪.‬‬
‫أهداف القسم‬

‫‪ ‬يهدف القسم إلى تقديم برامج تعليمية من شأنها إعداد كوادرمن الطالب قادرة على تقديم رعاية‬
‫تمريضية شاملة للمرأة بمختلف المراحل العمرية وعلى جميع مستويات الصحة والمرض مبنية‬
‫على تحليل وتحديد اإلحتياجات الجسمانية والنفسية والبيئية للمرأة واألسرة والمجتمع وذلك‬
‫باستخدام المعلومات والتقنية الحديثة وتطبيق نظريات وأبحاث علوم التمريض والعلوم األساسية‬
‫واالجتماعية واإلنسانية كأساس للممارسة التمريضية المهنية‪.‬‬
‫تتلخص أهداف القسم فيما يلي‪- :‬‬ ‫‪‬‬

‫‪3‬‬
‫دراسة الجوانب الجسدية والنفسية واالجتماعية المؤثرة في حياة المرأة من خالل‪:‬‬
‫‪-‬‬
‫‪ ‬دراسة محتوي التشريح للجهاز التناسلي الداخلي والخارجي وعلم وظائف األعضاء‪.‬‬
‫‪ ‬دراسة الحالة الصحية للمرأة خالل فترات اإلنجاب والتي تشتمل على الحمل‪ ،‬الوالدة‪ ،‬النفاس‬
‫واألمراض النسائية ورعاية حديثي الوالدة ويتم التركيز على الرعاية الصحية من خالل تطبيق‬
‫العملية التمريضية‪.‬‬
‫‪ ‬دراسة الجهاز التناسلي والرعاية الطبية للسيدة وأمراض النساء الشائعة من حيث األسباب وطرق‬
‫العدوى واإلنتشار‪ ،‬األعراض‪ ،‬العالج والمضاعفات‪.‬‬
‫‪ ‬دراسة كل ما هو جديد فى تمريض أمراض النساء والتوليد وتطبيقه عند الحاجة إليه‪.‬‬
‫‪ ‬اإلرتقاء بصحة األم والجنين أثناء الحمل وتقديم العناية التمريضة الكاملة لهم خالل مراحل الحمل‬
‫المختلفة‪.‬‬
‫‪ ‬إعطاء التثقيف الصحي الشامل للمقبلين على الزواج‪.‬‬
‫‪ ‬تقديم العناية التمريضية الشاملة لألم والجنين أثناء الوالدة‪.‬‬
‫‪ ‬تقييم اإلحتياجات األساسية والضرورية لألم أثناء فترة النفاس وإعطاء الرعاية التمريضية لها‪.‬‬
‫‪ ‬تقديم المشورة الصحية للسيدات عن وسائل تنظيم األسرة‪.‬‬
‫تطبييق نتائج األبحاث التمريضية القائمة على الدليل التى تساعد فى تخفيف مضايقات‬ ‫‪‬‬
‫السيدات خالل الفترة ما حول سن اإلياس‪.‬‬

‫رئيس القسم‬
‫أ‪.‬د‪/‬منال جاهين‬

‫‪4‬‬
Objectives :-

General objectives:

At the end of this seminar, the student will be able to:

● Describe pain management during labor.

Specific objectives:

At the end of the seminar, the student will be able to:

● Define childbirth preparation classes.

● Enumerate methods of childbirth preparation classes.
● Discuss benefits of childbirth preparation classes.
● Define pain and pain management.
● Discuss sources of pain during labor.
● know factors that affect pain intensity during labor
● Discuss assessment of pain during labor.
● Discuss methods of pain management and nursing role.

5
Out Lines:-
 Introduction.
 Definition of childbirth.
 Definition of childbirth preparation.
 Childbirth education classes:-
 Definition of childbirth education classes
 Types of childbirth education classes.
 Childbirth preparation classes:-
 Definition of childbirth preparation classes.
 Methods of childbirth preparation classes.
 Benefits of childbirth preparation classes.
 Pain management during labor:-
 Definition of pain
 Definition of pain management during labor
 Sources of labor pain.
 Factors affecting labor pain intensity.
 Assessment of labor pain.
 Pain management during labor:-
 Pharmacological methods of pain management.
 Non-pharmacological methods of pain management.

6
Introduction:
A woman's childbirth experience is vitally important, and her birthing
memories endure. Major factors that influence the quality of this
experience include personal expectations, the quality and amount of
support she receives, the quality of the caregiver-patient relationship
(e.g., communication, continuity of care, empathy, and respect), her
involvement in decision making, her clinical risk, and outcome.

Although women have always prepared for childbirth, the process

has become more formal. The development of structured educational
programs in preparation for childbirth came about when birth moved
from the home to the hospital. Birth became a medical event; mothers,
sisters, and other lay women knowledgeable about birth were no longer
in attendance, and cultural and family rituals associated with birthing
were lost. In the early years of formal childbirth education, the focus was
on the basic anatomy, the physiology of labor and birth, and simple
strategies (typically relaxation and breathing) to cope with the pain of
contractions. We now know more about the role of pain, the hormonal
physiology, the wide and ever increasing number of ways that women
can find comfort and the importance of continuous emotional and
physical support during labor and birth.

7
Definition of childbirth:-

Childbirth, also known as delivery, is the ending of pregnancy where one or

more babies leave the uterus by passing through the vagina or by Caesarean section.
Definition of childbirth preparation:-
Childbirth preparation defined as is an educational approach to labor and
delivery as well as a way of providing information and support to women for
facilitating childbirth and enhancing the ability of an individual to develop and
perform the role of parent. Or It is physical and psychological preparation for
women/couple and environment to facilitate childbirth with minimal pain or
without pain and complications. It is called also natural, educated, or
cooperative childbirth.

Definition of childbirth education classes:-

The childbirth education classes are a routine service in the developed countries, in
order to provide women with the knowledge, skills, and attitudes to prepare them for
pregnancy, labor and delivery, early postpartum days and parenting as well as inform the
parents about the healthy development of the baby.
This service is provided to parents free of charge in some university hospitals, in
nursing schools of universities, in private hospitals and in the maternity centers of the
Ministry of Health.

https://motherbabysupport.net/parent-support/childbirth-education-group/

8
Types of childbirth education classes:-
1. Preconception classes.
2. Early pregnancy classes.
3. Exercise classes.
4. Childbirth preparation classes.
5. Cesarean birth preparation classes.
6. Breast feeding classes.
7. Parenting classes.
8. Classes for fathers.
9. Postpartum classes.

Childbirth preparation classes:

Definition of childbirth preparation classes:

Childbirth preparation classes focus mainly on providing information about the

process of labor, management of pain, emotional issues during labor,
postpartum period, and the early weeks of motherhood. In addition, these
courses include opportunities for social support

Methods of the childbirth preparation classes:-

1- Dick- Read method:

He described a cycle of "fear- tension- Pain" in which fear of the unknown

intensifies muscular tension which in turn increases the perception of pain. Thus;
the Dick-Read focuses on the importance of giving the mother adequate
information prenatally to reduce her fear of the unknown and thus minimize muscle
tension.

2- Bradley method: (also called Husband Coached Birth):

He believed that the father is the most effective person for labor support. This
method was the first to include the father as a support person for "husband-
coached childbirth". Thus, the training techniques are directed toward the coach,

9
not only the mother. The coach is educated in massage, comfort techniques to use
on the mother throughout the labor and birth process.

3- Lamaze method:

It was developed slightly later, focuses on the idea that pain and uterine
contraction are separate phenomena that became linked in the human mind.
The Lamaze method is directed toward reducing the negative preconceptions which
woman have about labor through education and the formation of new conditioned
reflexes in response to uterine contraction. He selected breathing and active
relaxation techniques, which are practiced until they are accomplished with ease.
4- -Hypnobirthing method:

This method teaches relaxation and self-hypnosis techniques. The instructors have
gone through extensive training. The goal is to teach women how to painkilling to
achieve a natural and fear-free childbirth.

Benefits of the childbirth preparation classes: -

1- Increased confidence for labor and birth among women who attended
parental classes.
2- Decreased need for analgesic medication in labor.
3- Pain management with breathing and relaxation technique.
4- Calm the women and relief her stress and anxiety that come from not
knowing what expect once labor begin in a prenatal education course.
5- Increase rate of vaginal labor.
6- Improve mother child relationship, because of this relationship forms the
basis for child's future social, emotional development.
7- They build supportive relationship between couples.

10
Definition of pain:
Pain is subjective unpleasant sensation associated with actual or potential tissue
damage. It is considered the fifth vital signs.

Definition of pain management during labor:

Methods and techniques used to manage pain of labor and to provide comfort, either
with pharmacological or non-pharmacological methods.

Sources of pain during labor:

A. Visceral Discomfort (Abdominal or Internal Organs):

This occurs most often during the first stage of labor. It results from uterine
contractions. Discomfort is felt in the lower abdomen, lumbar region, and thighs.
The woman will be free of pain between contractions.
B. Somatic Pain (Perineal Discomfort):

The greatest discomfort is felt during the second stage of labor. This is when the
cervix is completely dilated. Discomfort is due to the stretching of the vagina and
the perineum as the presenting part moves through the birth canal.

Factors that affect pain intensity during labor:

A- Physiological factors: Such as

1. Cervical changes:

Cervical changes that occur before labor (softening, some effacement, and
dilatation) will influence the number of contractions needed to complete
effacement, and dilatation.

11
 2. Woman's pelvic anatomy itself:

If the woman's pelvic anatomy is large, it may be easily expandable and if it is

small, more stretching and increased intra-abdominal pressure may be required.

3. Fetal head size:

 A large head would require more pressure and more time to descend and
deliver.
 A small head may pass through the pelvis with a minimal amount of
stretching.

4. Strength, frequency, and duration of uterine contractions:

 Extremely strong contractions may cause significant discomfort to the woman.

 Contractions occurring every two to three minutes may cause the woman to be
fatigued and less tolerable of the discomfort.

 Contractions continually lasting sixty to ninety seconds require a great deal of

tolerance by the woman.

B-Psychological factors: Such as:

 Women history with pain.

 Level of fear and anxiety.

 Feeling of isolation and loneliness.

 Expectation to labor pain.

 Women's pain threshold can influence personal pain perception.

C-Socio-cultural background:

 Some culture encourages loud vigorous expression of pain, where others value
self-control.

12
D- Environmental factors:

 Woman using homelike birthing environments have often reported less use of
pharmaceutical agents during the childbirth experience than for similar women
in traditional hospital environment.
Pain assessment during labor
1. Assess if the pain is true or false labor pain:-
2. Assess the characteristics of labor pain (PQRST technique):
 Precipitated (triggered) and palliated (relieved) factors.
 Quality of pain (cramping, tightening, sharp, stabbing, aching).
 Region: site of pain (abdomen–groin–back).
 Site of radiation.
 Severity (intensity) of pain.
 Timing (frequency and duration of pain).
3. Assess woman’s blood pressure, pulse and respirations.
As anxiety and pain increase, the patient's blood pressure, pulse, and respiration
increase .
4. Assess woman’s posture:-The woman may become stiff and tense up. This is
an indication that the woman is not tolerating well. Her legs and arms may be loose
and relaxed; this indicates that the woman is effectively dilating with contraction.
Commonly used pain rating scale
The most common tool to assess the severity of pain is pain rating scale.
1. Visual Analogue Scales – are useful in assessing the intensity of pain. This scale
includes a horizontal 10 cm line, with ends indicating the extremes of pain.
The person is asked to place a mark indicating where the current pain lies on the
line. To score the results, a ruler is placed along the line and the distance the person
marked the line from the bottom extreme is measured and reported in cms.

13
2. 10 Numeric Pain Intensity Scale – is used for children, elderly and visually or
cognitively impaired patient.
The person will be asked to rate the pain from 0-10 with 0 signifying no pain and
10 signifying the worst pain.
3. Simple Descriptive Pain Intensity Scale -
The patient may be asked to rate the pain on a verbal scale (e.g., none, slight,
moderate, severe, or very severe)
4. Faces pain rating scale – is a useful for children and for woman with language
problems or low literacy. This tool presents a series of cartoon-like faces ranging
from a happy to a crying face. The person experiencing pain is asked to point to the
face that best represents how he/she feels faces pain rating scale.

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.istockphoto

Pain management during labor:-

1. Non-pharmacologic measure.
2. Pharmacologic measures.
Types of non-pharmacologic measures:
A) Cutaneous stimulation: - It is defined as stimulation of skin for the purpose
of relieving pain, it includes:-

14
1) Application of heat and cold:-
It is believe that ice and heat stimulate the non-pain receptors which help to
relieve pain. Neither heat nor cold therapy should be applied to areas with impaired
circulation

https://www.google.com.eg/search?q=application+of+heat+and+cold+in+labor+pain

2) Hydrotherapy:-
Is a measure that may involve showering or soaking in regular tub.When
showering is the selected method of hydrotherapy, the women's tends or sits in a
shower chair in warm shower and allows the water to gently fall over abdomen and
back. If the tub is chosen, the woman immerses herself in warm water for
relaxation and relief of discomfort.

https://www.google.com.eg/search?q=hydrotherapy+in+management+of+labor+pain

15
3) Reflexology:-

It is a field of therapy that uses specific touch techniques to stimulate

"reflex points and areas" on the feet, hands and ears. Reflexologists believe that
each of these points corresponds to a specific part of the body. The point that
corresponds to the uterus is located on the inside of the ankle about halfway
between the ankle bone and the heel.

https://thefootroom.co.uk/2019/01/24/reflexology/

16
4) Acupuncture Acupressure&:-
- Is an ancient Chinese system involving the stimulation of certain specific
points on the body to enhance the flow of vital energy.
- Acupuncture points can be stimulated by the insertion and withdrawing of
needles, the application of heat, massage, laser, electrical stimulation or a
combination of these methods.
- Spleen 6 (SP6) and large intestine 4 (LI4) are the most commonly used acupoints
for labor pain.

https://www.google.com.eg/search?q= =ssl#tbm=isch&q=acupuncture+in+labor.

5) Transcutaneous nerve stimulation "TENS":-

It involves the use of two pairs of electrodes attached to the woman's back to block the
never pathway between the uterus and spinal cord which reducing the perception of pain.

17
 https://www.google.com.eg/transcutaneous+electrical+nerve+stimulation+in+labor

5) Massage:-
It involves the manipulation of the soft tissues of the body to reduce stress
and tension, improve circulation, decrease pain and promote comfort. It include
6) Therapeutic touch:-
The nurse places hands on the client’s body or less than 1 inch above client's
body. It probably works to relieve pain by increasing endorphins it is also a form of
distraction of attention.

7) Effleurage:-
It is a light massage of abdomen during contraction which not involve
pressure women perform effleurage by using both hands in a circular motion to
decrease the ability of the nerve fibers at the site of pain to transmit impulses.
Effleurage can be used in the latent phase of labor but become less effective during
the active phase

http://img.tfd.com/mk/E/X2604-E-13.png

B)Ambulation and position changes:-

The women should be allowed to walk if she isn't in active labor or if there are no
contraindications.

1) Sitting position:-

18
 https://www.amazon.com/Comfortable-Upright-Birth-Support-C-U-B/dp/B017HQ5BSK

2) Walking:-

https://anniegroves.wordpress.com/tag/labor-and-delivery/
3) Leaning forward on chair or birth ball

https://www.care.com/c/stories/4955/how-a-birthing-ball-helps-with-pregnancy-lab/

4) Lunging

19
 https://www.thebump.com/a/birthing-positions

5) Flexing and extending women's legs

https://www.motherandbaby.co.uk/pregnancy-and-birth/birth/labour-and-birth/preparing-for-labour-exercises

6) Squatting

https://www.thebump.com/a/birthing-positions

7) Get on hand or knee

20
 https://www.motherandbaby.co.uk/pregnancy-and-birth/birth/labour-and-birth/preparing-for-labour-exercises

8) Lying

https://www.healthguide911.com/2016/06/comfort-positions-during-labor.html

C-Cognitive behavior stimulation (Relaxation technique):

Involve the learning of activities that deeply relax the body and mind. Relaxation
distracts the client, lessens the effects of stress from pain, increases pain tolerance,
increases the effectiveness of other pain relief measures and increases perception of
pain control. It include:-
A. Breathing technique :
a-Slow paced breathing (slow, chest breathing):
It can be used in early labor (3-4 cm cervical dilatation). The breathing pattern is a
deep, slow, chest or abdominal pattern. It should be half the normal breathing rate (6 to

21
 9 breaths/ minute). It is generally best to breathe in through the nose and breathe out
either through the nose or the mouth.
b- Modified –paced breathing (Accelerated panting)
It can be used when the cervix is 4-7 cm dilated. The woman's respiratory rate
increase, but it doesn't exceed twice her normal rate. Inhalation or exhalation should
occur every 4 second.
c- Patterned paced breathing (pant- blow breathing)
It can be used when the cervix is 7-10 cm dilated. This is very shallow patterns
that minimize diaphragm and chest movement at a rate of one breath per second. While
exhaling, the woman make a sound of "he" , with every fifth exhalation instead of "he"
the woman makes a short shallow " puff" just sufficient to make a candle flame flicker.
This pattern helps the woman concentrate on the breathing rather than on the strong
contractions.
B. Focusing: It refers to concentrating on an object as a method of distraction. Woman
can use a photograph of someone important to her and concentrating on it during
contractions.
C. Yoga: It's a series of exercises that were originally designed to bring people who
practice it closer to their God. It consists of deep breathing exercise, body postures to
strength muscle and mind focusing to relax the body. It reduce labor pain through relax
the body and releasing endorphins.
D. Meditation – Is a process whereby the client empties the mind of all sensory data, and
typically, concentrates on a single object, word or idea. This activity produces a deeply
relaxed state in which O2 consumption decreases, muscles relax, and endorphins are
produced.
E. Guided Imagery: It involves a temporary shift away from reality activities. Woman
learns to create the images that she wants during the childbirth experience include: a

22
pleasant scene, picture or a place where she felt most relaxed or safe for example imagine
that she is walking on the beach.
F. Distraction – Involves the redirection of the client’s attention away from the pain
and into something that the client finds more pleasant.
g. Aromatherapy is the use of plant-derived aromatic essentials oils to promote the
sense of physical and psychological wellbeing. The most common essential oils that are
used in labor are lavender, chamomile, mandarin, clary sage, ginger, jasmine, lemon, and
peppermint. It can be used in bath water, soaking compress, applied on the skin, or kept
available in small vials to open and smell.
h. Herbal preparation include; valerian, passionflower chamomile tea, raspberry leaf
tea (women freeze it in ice cubes to suck on), which are thought to relieve labor pain.
j. Virtual Reality The woman wears a pair of goggles with a screen that creates a
sensation of being transported into lifelike three-dimensional world and novel
environments. VR is hypothesized to reduce labor pain through preoccupying the
woman's brain through the overflow of information presented by the virtual environment.

Pharmacological measures for pain management:

1-Analgesia.

Drugs that relieve pain without loss of consciousness usually given during the 1 st stage of
labor. Analgesic drugs include the following:
-Systemic route:
a) Systemic analgesia: use of one or more drugs which are administered orally,
intramuscularly (IM), or intravenously (IV) that become distributed throughout
the body via the circulatory system. The most commonly used analgesics

23
 during the first stage of labor are barbiturates, benzodiazepines, opioids
(narcotics),
b) Non steroidal anti-inflammatory drugs (nsaids) – act on peripheral nerve
endings and minimize pain by interfering with prostaglandin synthesis. It is the
treatment of choice for mild pain and continues to be effective when combined
with narcotics for moderate to severe pain.
Examples: Aspirin –ketolac.
-local route:
a) Epidural analgesia/ anesthesia (block): it is the most effective method of pain relief
in labor. It includes an injection of either local anesthetic agent and opioids analgesic or
both into the epidural space (just outside the dura mater). It is usually delayed until the
woman's cervix dilated 3 to 5 cm.
b) Spinal anesthetics: it is difficult to perform in pregnancy due to enlargement of the
abdomen and may cause hypotension and spinal shock. it provides relief of pain for 1
to 3 hours, it's injected into the subarachnoid space.

24
 https://qph.cf2.quoracdn.net/main-qimg-8a3325d8a22e416f6c286c46531e6e10-lq

C) Combined spinal-epidural anesthetics: the spinal anesthesia leads to rapid relief

of pain, and the epidural anesthesia allows repeated administration of the anesthesia
drug through the epidural catheter to maintain relief of pain.

D) Pudendal nerve block:

Is a safe, simple, and effective pain relieve method in the late second stage of labor
during vaginal birth. It is achieved by injecting a local analgesia around the pudendal
nerve near each ischial spine. It provides analgesia to the lower part of the vagina, vulva,
and perineum, but doesn’t relieve the pain of uterine contractions.
the pudendal nerve, derived from the second, third, and fourth sacral nerve roots,
supplies the vulva and perineum.

https://o.quizlet.com/2x7MIlSKvC6BmtUf8
E) Local perineal infiltration: the injection of a local anesthetic such as lidocaine into
the superficial perineal nerves to numb the perineal area. This technique is done just
before performing an episiotomy or suturing a laceration.

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 https://dm3omg1n1n7zx.cloudfront.net/rcni/static/journals/ns/30/24/ns.30.24.36.s45/graphic/ns_v30_n24_45_0002.jpg

F) Inhalation analgesia is the most commonly used labor analgesic in many

countries as nitrous oxide gas (laughing gas). It is administered in 50:50 mix with
oxygen using a blender device and a mask held by the woman in any stage of labor.
The woman places the mask over her mouth and nose as soon as a uterine
contraction began then remove between it

https://www.apsf.org/wp-content/uploads/newsletters/2020/3502/nitrous-oxide-for-labor.jpg

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Nursing role in pain management:

1- Greet woman respectively and with kindness.

2- Assessment of pain including the intensity, duration, quality, aggravating and

relieving factors.

3- Tell the woman about all available non-pharmacological measures which can be
used to relieve her pain.

4- Help woman to choose the best non-pharmacological measures.

5- Explain to the woman the chosen measure, apply it to her or assist her to apply it.

6- Reassessment of pain, evaluating the effect of the chosen measure, if pain

continues inform doctor to use one of pharmacological measures.

References:-
1. Erkal Y., Dereli S., & Aslantekin F. Prenatal attachment and social
support in risky pregnancies, Turkey Clinics J Health Sci., 2019; 163-9.
2. Haseeb F. Basic Obstetric . 8th ed., Cairo, University book center com .,2019
; 149-51.
3. Picker T ., Brook P., Connel J . Oxford Hand book of pain management, 4th
ed.,USA.,Elsevier com .,2020; 30-57.
4. Pillirtteri A. Maternal and Child Health Nursing : Care of Childbearing and
Childrearing Family. 7th ed ., New York, Lippincot Williams and Wilkins
Com.,2019;155-59.

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 5. Casanova R . Backmann and Ling’s Obstetrics and Gynecology. 8th ed.,
China , Wolter Kluwer ,2019.100-10.
6. Definition of childbirth retrieved from:
https://en.wikipedia.org/wiki/Childbirth available at 2/10/2023 at 10.30 pm.

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