Chapter 17 Flashcards
(37 cards)
unique nature of pain during birth
- Childbirth is a “normal” process
- Has months to prepare for labor
- Pain has a foreseeable end
- Pain is intermittent (with contraction, have it then goes away)
- Pain ends with birth of baby
pain during labor and birth
-Neurologic origins
-Perception of pain
-Expression of pain
-Factors that influence pain response (tolerating pain - how much pain someone is willing to induce; support? prepared? what methods individual wants)
peoples response in labor - blood pressure increase, n/v, can hyperventilate which increases pain level
Neurologic origins
1st stage visceral pain 2nd stage somatic pain
Physiologic Factors
dilation and effacement (thinning of cervix) - allow baby to leave uterus
pressure and pulling on pelvic structures
distention of the vagina and perineum
contractions - stop blood flow
fatigue - the more tired you are the less you can handle pain
support and help of caregivers
fetal position - face presentation can cause more pain
other factors
- culture
- anxiety - if pt is nervous and they don’t know whats going to happen, muscles will tense
- pervious experience - will affect ability to cope
- gate-control theory of pain - paplov’s, distract brain will decrease pain level
- comfort - position mom wants to be in will diminish pain
- support
- environment - comfortable? can see more around?
nonpharmacologic pain management advantages
no side effects to the fetus, risk for sedation decreases, don’t slow down labor
nonpharmacologic pain management limitations
if doesn’t work then between a rock and hard place if only method for pain, have to be educated before labor
childbirth preparation methods
if know whats going on makes everything better; education and participatory guidance are very important
relaxation
teach constant relaxation - how to relax complete body, think of some place you really enjoy, relax every body part complete, teach how to relax towards the touch
effeurage
rubbing abdomen as during breathing techniques
counterpressure
turn on side, push away from lower spine as counterpressure of the back of the head
breathing techniques
will speed up as contractions become more intense, swallow breaths, breathe above diagram
music
releases endorphines, so makes you happy
nonpharmacologic methods
HYDROTHERAPHY NERVE STIMULATIO/ACUPRESSURE HEAT AND COLD TOUCH HYPNOSIS BIOFEEDBACK AROMATHERAPY WATER BLOCK
Criteria for pain relief
- must be as safe as possible for mom/baby
- must relieve pain
- must not interfere with labor progress
pharmacologic pain relief
- if drug passes placenta will have some effect on baby
- epidural can compromise mom bp and then endanger fetus blood flow
- no pain relief until active stage of labor, if given too early then can stop labor
- some meds might not be okay depeds on mom and baby
opioid agonists drugs
Dilaudid (takes effect 10-15 min), Demerol (IV push, given over morphine but high rate of respiratory depression), Fentanyl (Sublimaze) (short acting), Sufenta
opioid agonists
reduces proceptions of pain w/o sedation, higher level of people vomiting, given IV some IM, usually if birth in 4 hours don’t give IV meds, watch respiratory rate in mom
opioid (narcotic) agonist
stadol, nubain – act to depress pain at certain receptor sites
opioid (narcotic) antagonists
narcan - give to newborn after delivery or to mom in labor
nerve block analgesia and anesthesia
- Local Perineal Infiltration
- Pudendal Block
- Epidurals
- Spinal (subarchnoid block)
- Combined Epidural/Intrathecal(spinal)
- General anesthesia/Nitrous Oxide (malpractice in the US, have to get baby out in 5 minutes)
local perineal infiltration
- Usually xylocain 1%
- Numbs perineum for repair of episiotomy
- No relief of contraction pain
- Fan like multiple injections
- Post delivery: ice to perineum (24hrs.) to decrease edema, hematoma formation then sitz baths
not to give relief from pushing or contractions, done for repair of epistotomy
pudendal block
- Numbs the lower vagina/perineum for vaginal birth
- No relief of contraction pain, done just before delivery for vacuum and forceps delivery
- Transvaginally inject the pudendal nerve through the vagina using a trumpet needle guide
- Usually xylocaine 1%
- not for relief of contraction for 2nd pushing stage
Epidural
- Pain relief for both contractions and delivery
- Type of regional anesthesia
- Usually a local anesthetic and an opioid analgesic are used together
- Injected into epidural space between the dura and the spinal canal,usally L3-L4 for vaginals and T4-T6 c-sections. Can reposition for c-sec. if it’s not expected
- most common in US
- epidural space- negative pressure space
- want mom laying straight or have hot spots where it goes to the side
- does not get rid of al sensations of done correctly
- have to have time for it to take affect
- watch for oxygenation so mom has pulse ox