Intrapartum Pain Experience

NCM2107-CareoftheMother,Child &Adolescent(WellClients)

Preparedby:
RitaE.PenasoMAN,RN
Lecturer
Overview of Pain
• Intrapartum pain is a subjective experience of physical
sensations associated with uterine contractions, cervical
dilation and effacement, and fetal descent during labor and
birth.
• Physiologic responses to pain may include increased blood
pressure, pulse , respirations, perspirations, pupil diameter,
muscle tension (e.g. facial tension or fisted hands) or
muscle activity (e.g. pacing, turning, or twisting).
• Nonverbal expressions of pain may include withdrawal,
hostility, fear, or depression.
• Verbal expression of pain may include statements of pain,
moaning, and groaning.

7/18/2021 Rita E. Penaso MAN, RN

Factors affecting perception of intrapartum pain

1. Previous experience with painful stimuli

and personal expectations of the birth
experience
2. Cultural concept of pain, specifically
during childbirth, and how one should
respond
3. Rapidly progressive uterine contractions
4. Fear, anxiety, and fatigue

7/18/2021 Rita E. Penaso MAN, RN

Physiologic causes of intrapartum pain

• Uterine anoxia due to compressed • Distention of the lower uterine

muscle cells during the contraction segment
• Compression of the nerve ganglia in • Stretching of the uterine ligaments
the cervix and lower uterine
segment during the contraction
• Stretching of the cervix during
dilation and effacement
• Traction on, stretching, and
displacement of the perineum
• Pressure on the urethra, bladder,
and rectum during fetal descent

7/18/2021 Rita E. Penaso MAN, RN

Intrapartum pain management
• A. OVERVIEW
1) The two goals of intrapartum pain management are:
(a) To provide maximal relief of pain with maximal safety for the mother and fetus
(b) To facilitate labor and delivery as a positive family experience
2) Pain relief may be achieved by using prepared childbirth methods (e.g. Lamaze), analgesics, or regional
anesthetics.
3) Intervention for pain relief during labor depends on the following factors :
(a) Gestational age of the fetus
(b) Frequency, duration, and intensity of the contraction
(c) Labor progress
(d) Maternal response to pain and labor
(e) Allergies and sensitivities to analgesics and anesthetics

7/18/2021 Rita E. Penaso MAN, RN

Nonpharmacologic pain management
1. Prepared childbirth methods can help the c) Directing breathing methods, abdominal
client feel more in control and relaxed, lifting, pushing, relieving external pressure,
helping her “work with” the contractions; distraction, cutaneous stimulation, and
it may shorten labor relaxation.
2. Hypnosis may be useful in some clients.
3. Interventions aimed at supporting the
client during labor may be helpful. These
include:
a) Providing information about the progress
of labor
b) Reinforcing techniques learned in
prepared childbirth classes.

7/18/2021 Rita E. Penaso MAN, RN

Pharmacologic pain management
1. Narcotic analgesics provide effective pain
relief and slight sedation
a) Narcotic analgesics are systemic drugs
that really cross the placental barrier,
with depressive effects on the neonate
occurring 2 to 3 hours after intramuscular
injection.
b) Maternal side effects include nausea,
vomiting, mild respiratory depression,
and transient mental impairment.
c) Fetal effects are reduced fetal heart rate
(FHR) and decreased variability, neonatal
effects are lowered Apgar score and
respiratory depression.
7/18/2021 Rita E. Penaso MAN, RN
d) Narcotic antagonists (i.e. naloxone
(Narcan) must be readily available in case of
respiratory depression in the mother or
newborn.
e) The decision to administer a narcotic
analgesic is based on the results of a vaginal
examination; if birth is anticipated within 2
to3 hours, the risk of neonatal narcosis may
preclude the use of analgesics.
f) The dosage is kept to the smallest effective
dose.
Pharmacologic pain management

2. Barbiturates d. The rapid transfer of barbiturates across the

a) These drugs cause maternal sedation and placental barriers and the lack of an
relaxation antagonist to counteract their effects make
them generally inappropriate to use during
b) Maternal side effects of barbiturates active labor
include nausea, vomiting, hypotension,
restlessness, and vertigo.
c) Neonatal side effects of barbiturates
include central nervous system
depression, prolonged drowsiness, and
delayed establishment of feeding (e.g.
due to a poor sucking reflex or a poor
sucking pressure).

7/18/2021 Rita E. Penaso MAN, RN

Pharmacologic pain management
3. Tranquilizers d) Fetal effects associated with tranquilizers
a) These drugs decrease the anxiety and include tachycardia and the loss of normal
apprehension associated with pain and beat-to-beat variability on electronic fetal
sometimes relieve the nausea associated heart monitoring.
with narcotic analgesics. e) Newborn effects associated with
tranquilizers include hypotonia, hypothermia,
b) Tranquilizers potentiate active sedative
generalized drowsiness, and a reluctance to
and analgesic effects, decreasing the
feed for the first few days.
dosage of analgesic and sedative drugs
needed to produce the desired effect.
c) Maternal side effect associated with
tranquilizers include hypotension (which,
in turn, decreases fetoplacental
circulation), drowsiness, and dizziness.

7/18/2021 Rita E. Penaso MAN, RN

Pharmacologic pain management
4. Regional anesthesia (conduction
anesthesia)
a) Types of regional anesthesia include
spinal block, epidural, paracervical,
pudendal block, and local infiltration.
b) These blocks provide pain relief with
injected anesthetic agents at sensory
serve pathways.
c) Adverse reactions may include maternal
hypotension, allergic or toxic reaction,
respiratory paralysis, and partial or total
anesthetic failure.
7/18/2021 Rita E. Penaso MAN, RN
d) Nursing responsibilities during
administration of regional anesthesia include:
(1) Assisting the anesthesiologist as
requested
(2) Establishing a reliable intravenous line
(3) Being prepared with medication and
equipment for emergency situations if
they arise
5. General anesthesia (inhalant [ e.g. nitrous
oxide and halothane] and intravenous [e.g.
Pentothal]) usually is used during childbirth
only if an emergency cesarean section
becomes necessary.
This Photo by Unknown Author is licensed under CC BY-SA

7/18/2021 Rita E. Penaso MAN, RN