Chapter 15: Pain Management During Childbirth

Question 1

Agonist

Answer 1

Causing a physiologic effect

Question 2

Analgesia

Answer 2

Relief of pain without loss of consciousness

Question 3

Anesthesia

Answer 3

Loss of sensation, with or without loss of consciousness

Question 4

Antagonist

Answer 4

Blocking effect of the drug

Question 5

Cleansing breath

Answer 5

Deep breath taken at the beginning and end of each contraction

Question 6

Endorphin

Answer 6

Natural substance similar to morphine

Question 7

Habituation

Answer 7

Reduced effectiveness of a pain management method after prolonged use

Question 8

Paced breathing

Answer 8

Learned breathing techniques used during labor

Question 9

Sellick maneuver

Answer 9

Blocking the esophagus by pressing the trachea against it

Question 10

Valsalva maneuver

Answer 10

Holding the breath while pushing against a closed glottis

Question 11

What is the difference between pain threshhold and pain tolerance? What factors can influence a woman’s pain tolerance during labor, positively or negatively?

Answer 11

Pain threshhold is the minimum stimulus that a person perceives as painful; it is relatively constant under different conditions. Pain tolerance is the maximum amount of pain that a person is willing to endure; it may change with the circumstances. Factors influencing pain tolerance during labor include intensity of labor, readiness of the cervix to dilate with the force of contractions, fetal position, pelvic size and shape, maternal fatigue and hunger, or interventions of caregivers (a positive or negative influence).

Question 12

How can excessive maternal pain reduce fetal oxygenation?

Answer 12

Excess maternal pain can result in fear and anxiety, which stimulate the mother’s sympathetic nervous system to release substances that simultaneously cause vasoconstriction and pooling of blood in the mother’s vascular system, plus a higher uterine muscle tone with reduction of effective contractions. The net effect is that blood flow to and from the placenta falls and labor contractions are less effective, thus prolonging labor.

Question 13

How is labor affected when the fetus is in an occiput posterior (OP) position?

Answer 13

The fetal occiput is pushed against the woman’s sacral promontory with each contraction, causing intense back pain. In addition, the fetus must usually rotate into the occiput anterior position to be born, so labor is often longer.

Question 14

What are key features of each type of breathing technique and variations of each type that the woman may choose:

a. Cleansing breath:
b. Slow-paced breathing:
c. Modified paced breathing:
d. Patterned paced breathing:

Answer 14

a. Cleansing breath: The cleansing breath releases tension, provides oxygen, clears the mind to focus on relaxing, signals the labor partner of contraction’s beginning or end; may be taken in any way comfortable.
b. Slow-paced breathing: Enhances relaxation and allows the woman to concentrate on relaxation and allows the woman to concentrate on relaxation rather than number of breaths; she may se nose, mouth, or combination breathing.
c. Modified paced breathing: Uses shallow but rapid breathing, and may be combined with slow-paced breathing.
d. Patterned paced breathing: Focus on pattern of breathing interferes with pain impulse transmission; some may make a special sound (‘hee’ ‘hoo’); the woman may vary number of breaths before blowing.

Question 15

Which breathing technique can help a woman avoid pushing too early?

Answer 15

Blowing prevents glottis closure and breath-holding.

Question 16

Describe hyperventilation and nursing interventions to help a woman correct the problem.

Answer 16

Rapid deep breathing results in loss of carbon dioxide, eventually resulting in respiratory alkalosis. The woman feels dizzy or lightheaded, with numbness and tingling of fingers and lips; tetany, stiffness of the face and lips, or carpopedal spasm may occur. Breathing into a paper bag or cupped hands causes rebreathing of carbon dioxide and correction of alkalosis.

Question 17

Compare and contrast open glottis pushing with closed glottis pushing.

Answer 17

Traditional closed-glottis pushing may result in impaired blood flow to the uterus, is fatiguing for the woman, and has not proven to significantly shorten second stage. Open-glottis pushing improves maternal-fetal oxygenation and is more physiologic, but the second stage may be longer.

Question 18

What is the purpose of giving a test dose before performing an epidural block? What would be signs of problems after the test dose, and what causes these signs?

Answer 18

The test dose is given to identify inadvertent dural or intravascular puncture before injection of the full dose of the anesthetic drug. Evidence of these problems includes rapid and intense motor and sensory block (subdural or subarachnoid injection) or numbness of the tongue and lips, lightheadedness, dizziness, and tinnitus (intravascular injection).

Question 19

In which regional anesthesia method is it desirable to obtain cerebrospinal fluid (CSF)? Why?

Answer 19

The subarachnoid block (SAB) punctures the dura and arachnoid membranes, entering the space that contains cerebrospinal fluid. Appearance of a few drops of CSF confirms the correct location for injection of the anesthetic drug for this block.

Question 20

If an infant receives nalaxone (Narcan), why should the nurse continue to monitor the infant for respiratory depression?

Answer 20

The duration of action for nalaxone is shorter than for most of the opioids it reverses. Respiratory depression could recur until effects of the opioid drug have abated.

Question 21

What are methods to relieve the pain of a spinal headache?

Answer 21

Bed rest with oral or IV hydration; blood patch