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Chapter 7

Nursing Management of Pain During
Labor and Birth

Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier

Objectives

Define each key term listed.
Describe factors that influence a woman’s
comfort during labor.
List the common types of classes offered to
childbearing families.
Describe the methods of childbirth
preparation.

Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier

Objectives (continued)

Discuss the advantages and limitations of
nonpharmacological methods of pain management
during labor.
Discuss the advantages and limitations of
pharmacological methods of pain management.
Explain nonpharmacological methods of pain
management for labor, including the nursing role for
each.
Explain each type of pharmacological pain
management including the nursing role for each.
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier

an imprint of Elsevier .Education for Childbearing Elsevier items and derived items © 2007 by Saunders.

an imprint of Elsevier .Types of Classes Available         Gestational diabetes mellitus Early pregnancy Exercise for pregnant women Infant care Breastfeeding Sibling Grandparent Adolescent childbirth Elsevier items and derived items © 2007 by Saunders.

an imprint of Elsevier .Variations of Basic Childbirth Preparation Classes    Refresher Cesarean birth Vaginal birth after cesarean Elsevier items and derived items © 2007 by Saunders.

an imprint of Elsevier .Content of Childbirth Preparation Classes   Benefits of exercise Pain control methods for labor Elsevier items and derived items © 2007 by Saunders.

an imprint of Elsevier .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 Elsevier items and derived items © 2007 by Saunders.

Factors that Influence Labor Pain    Pain threshold Sources of pain during labor Central nervous systems factors Gate control theory  Endorphins   Maternal conditions Cervical readiness  Pelvis  Labor intensity  Fatigue   Fetal presentation and position Elsevier items and derived items © 2007 by Saunders. an imprint of Elsevier .

Nonpharmacological Pain Management   Advantages of nonpharmacological methods Limitations of nonpharmacological methods Elsevier items and derived items © 2007 by Saunders. an imprint of Elsevier .

an imprint of Elsevier .Methods of Childbirth Preparation    Dick-Read method Bradley method Lamaze method Elsevier items and derived items © 2007 by Saunders.

an imprint of Elsevier .Selected Nonpharmacological Pain Relief Measures      Progressive relaxation Neuromuscular dissociation Touch relaxation Relaxation against pain Effleurage      Sacral pressure Thermal stimulation Positioning Diversion and distraction Hydrotherapy Elsevier items and derived items © 2007 by Saunders.

an imprint of Elsevier .Nonpharmacological Techniques        Relaxation techniques Skin stimulation Effleurage Sacral pressure Thermal stimulation Positioning The nurse’s role      Diversion and distraction Focal point Imagery Music Television Elsevier items and derived items © 2007 by Saunders.

Skin Stimulation Elsevier items and derived items © 2007 by Saunders. an imprint of Elsevier .

Breathing  First stage     Slow paced Modified paced Patterned paced Second stage Elsevier items and derived items © 2007 by Saunders. an imprint of Elsevier .

Elsevier items and derived items © 2007 by Saunders. an imprint of Elsevier 16 .

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 Elsevier items and derived items © 2007 by Saunders. an imprint of Elsevier .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.

do not interfere Elsevier items and derived items © 2007 by Saunders. nonpharmacological pain control technique. an imprint of Elsevier .Nursing Tip  If a woman is successfully using a safe.

an imprint of Elsevier .Pharmacological Pain Management Elsevier items and derived items © 2007 by Saunders.

an imprint of Elsevier .Physiology of Pregnancy & its Relationship to Analgesia & Anesthesia Elsevier items and derived items © 2007 by Saunders.

Pharmacological Methods Advantages Elsevier items and derived items © 2007 by Saunders. an imprint of Elsevier .

an imprint of Elsevier .Pharmacological Methods Limitations Elsevier items and derived items © 2007 by Saunders.

Analgesics and Adjunctive Drugs    Narcotic (opioid) analgesics Narcotic antagonist Adjunctive drugs Elsevier items and derived items © 2007 by Saunders. an imprint of Elsevier .

an imprint of Elsevier .Regional Analgesics and Anesthetics  The meninges around the spinal cord    Dura mater Arachnoid mater Pia mater Elsevier items and derived items © 2007 by Saunders.

Types of Anesthesia for Childbirth       Anesthetic method Local infiltration Pudendal block Epidural block Subarachnoid (spinal) block General anesthesia Elsevier items and derived items © 2007 by Saunders. an imprint of Elsevier .

an imprint of Elsevier 26 .Elsevier items and derived items © 2007 by Saunders.

an imprint of Elsevier .Epidural Blood Patch Elsevier items and derived items © 2007 by Saunders.

General Anesthesia   Adverse effects in the mother Adverse effects in the neonate Elsevier items and derived items © 2007 by Saunders. an imprint of Elsevier .

Question for Review  What is the most important nursing responsibility after an epidural or spinal block analgesia during labor and delivery? Elsevier items and derived items © 2007 by Saunders. an imprint of Elsevier .

an imprint of Elsevier .Review       Objectives Key Terms Key Points Online Resources Critical Thinking Questions Review Questions Elsevier items and derived items © 2007 by Saunders.