METHODS OF PAIN CONTROL

DURING LABOR AND

DELIVERY
 Birth

Ddedakacs uTxra: satanjvels gagimravleb da

gagiZneleb orsulobas, tanjviT Sob Svilebs

biblia,dabadeba,Tavi 111,16

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 What is pain?
The way pain is experienced is a reflection of
the individuals emotional, cognitive, social and
cultural circumstances

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 Pain during delivery

• Most severe pain for women

• A side effect of a normal process of labor
• Varies among the parturients
• Originates from diferent sites

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The pain during the first stage of delivery P

• Pain occurs during contractions

• Pain is visceral or cramp-like.
• Pain originates in the uterus and cervix
• Pain is produced by distention of uterine and cervical
mechanoreceptors
• Pain is produced by ischemia of uterine and cervical
tissue
• The pain signal enters the spinal cord.

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 The pain during the second stage of
delivery

• Pain is somatic
• Pain occurs from distention:
Vagina
Perineum
Pelvic floor
Pelvic ligaments
• The pain signal is transmitted to the spinal cord
• Pain is more severe and combinated.

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 Adverse consequences of labor
pain
• Hyperventilation

• Neurohumoral effects

• Psychological effects

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 Defending mechanisms

• mSobiarobis procesSi matulobs opioiduri peptidebis

raodenoba, rac xels uwyobs :

E endogenuri analgeziis ganviTarebas

“tkivilis hormonis” inhibirebas

tkivilis zRurblis amaRlebas

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 The management of labor pain
Two general approaches

1. Pharmacological

2. nonpharmacological

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 The primary goal of
nonpharmacological approaches
• Not to make the pain disappear

• Help the woman to cope with labor pain

• Prevent suffering

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 Nonpharmacologic techniques

• Birth environment
• Water immersion
• Intradermal water blocks
• Maternal movement and positioning
• Touch and massage
• Acupuncture and acupressure
• Hypnosis
• Relaxation and breathing
• Aromatherapy
• Music and audioanalgesia

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 Birth environment

• Comfort aids and places to walk, bath and rest

• The ideal environment for a nonpharmacologic

approach fosters a sense of comfort and privacy

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 Water immersion
• Immersion in warm water deep enough to
cover the woman’s abdomen

• Enhance relaxation and reduce labor pain

• Didn’t increase the risk of maternal or

neonatal infection

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 Intradermal water blocks
• intracutaneous sterile water injections may
reduce the perception of severe low back
pain in laboring women without side-effects
on the fetus or mother.

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Maternal movement and positioning
• The use of upright positions is associated
with less painful labor
Standing
Walking
Kneeling

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 Touch and massage
• Touching can communicate such possitive
messages as:
Caring
Concern
Reassurance
Love
• Massage enhanced relaxation and reduce pain

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 Acupuncture and acupressure
• Acupuncture-placement of needles at
specific points on the body.

• Acupressure-pressure with fingers or small

beads at acupuncture points.

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 Hypnosis

• Hypnosis used for childbirth is almost always

self-hypnosis.
• Common hypnotic pain relief techniques are:
“Glove anesthesia”
“Time distortion”
“Imaginative transformation”

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 Relaxation and breathing

• Relaxation and breathing

may contribute more to a
woman's ability to cope with
labor pain than to actually
reduce the pain

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 Aromatherapy
• The science of using highly
concentrated essential oils or
essences distilled from plants in
order to utilize their therapeutic
properties

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 Music and audio analgesia
• Audio analgesia –the use of auditory
stimulation ,such as music, white noise or
environmental sounds to decrease pain
perception
• Listening to music reduced pain intensity
levels and opioid requirements

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 recommendation

• offering women nonpharmacological methods to help them cope

with pain (grade1B)
• all nonpharmacological methods have few, if any serious side
effects and require few safety precautions
• nonpharmacological methods help women to maintain or restore
a sense of personal control over the birth process
• nonpharmacological techniques can be combined or used
sequentially to increase the total effect
• nonpharmacological methods are generally inexpensive

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 pharmacological methods
• pharmacological approaches are directed at
elimination of the physical sensation of labor
pain
Inhalation analgesia
Parenteral opioids
Regional analgesia

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 Inhalation analgesia
Inhalation analgesia with nitric oxide is:
• Inexpensive
• Easy to administer
• Safe for mother and fetus\neonate
• The analgesic effect is better than that
produced by opioids,but less than with
epidural analgesia

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 Parenteral opioids
• Exert their effects in the maternal brain.
• Crosses the placenta and affects the fetus:
• Fetal heart rate changes
• Central nervous system depression
• Slowing of respiratory rate
• Changes in muscle tone
• Long-term neonatal effects

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 Systemic opioids
Compared to epidural analgesia:
• Less changes in pain score
• More sedative effects
• Shorter duration of labor,
• less oxytocin augmentation
• Fewer instrumental deliveries

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 Epidural analgesia(1)

A central nerve block technique acheved

by injection of a local anaesthetic close to
the nerves that transmit pain
• Ep.analg.technique photo
 Epidural analgesia(2)

• The only consistently effective means of

relieving the pain of labor and delivery.
• Provide safe and effective labor analgesia
• May reverse the untoward physiological
consequences of labor pain

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 Epidural analgesia(3)
Epidural analgesia is associated with:
• Increased risk of instrumental vaginal
delivery
• Longer second stage of labor
• Increased oxytocin requirement
• Likelihood of maternal fever
• unlikely to increase the risk of caesarean
section

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 Epidural analgesia(4)

• Eepiduraluri analgeziis gamoyenebiT

mSobiaroba fiziologiuridan gadadis
paTologiurSi

• Eepiduraluri analgezia nayofis rutinuli

monitoringis Cvenebaa

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 Which one?

• The battle between nonpharmacologic and

pharmacological treatment must be decided by women
• The women should be involved in the decision-making
process regarding all aspects of the childbirth, including
pain relief, to increase maternal satisfaction.
• The women must be educated and informed about all
pain relief techniques during pregnancy, prior to the
onset of labor and make her own free choice

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