Working With Pain in Labour

Question 1

Pain can increase levels of catecholamines, what can this cause?

Answer 1

Increased cardiac output/HR
Raised blood pressure
Hyperventilation
Decreased uterine blood flow
Decreased uterine contractions
Nausea and vomiting
Delayed bladder emptying

Question 2

What are some pain behaviours?

Answer 2

Facial expressions
Verbalisations, vocalisations
Body movements
Mood changes
Changes in activity patterns

Question 3

What can pain perception be affected by?

Answer 3

Past experiences
Cultural learning
Mood and attention

Question 4

What is meant by gate control?

Answer 4

When the signal travelling to the spinal cord reaches a certain level of intensity, the ‘gate’ opens. Once the gate is open, the signal can travel to the the brain where it is processed, and the individual proceeds to feel pain. Simply stated when the gate closes, the brain does not receive the info that is coming from the periphery to the spinal cord.

Question 5

What is meant by visceral pain?

Answer 5

Pain related to the inetrnal organs that is perceived in the midline of the body

Question 6

What is meant by somatic pain?

Answer 6

Pain that occurs in tissues such as the muscles, skin or joints

Question 7

What is visceral pain caused by in labour?

Answer 7

The uterine contractions, the dilation of the cervix and by the stretching of the vagina and pelvic floor.

Question 8

What is the body of the uterus served by? (in terms of nerves)

Answer 8

Served by autonomic nerves originating in thoracic 11 and 12 and lumbar 1 verterbrae.

Question 9

What is Gate control theory in labour by Dekker 2018 and some examples?

Answer 9

If nerves are activated in a non- painful way, at the same time that pain is experienced, this activation blocks the pain signals from reaching the brain e.g.
Massage
TENS machine
Hydrotherapy

Question 10

What is meant by working with pain and what did Leap 2016 find about continuity of carer in relation?

Answer 10

The working with pain approach is based on the principle that pain is one aspect of the physiology of normal labour
Women who had continuity of carer required less pain relief.

Question 11

What are some examples of working with pain using psychology, positions and natural therapies

Answer 11

Breathing/ hypnobirthing
Active labour/ positions
Water
Massage
Aromatherapy
Acupuncture
TENS
Sterile water injections
Ice packs.

Question 12

How can maternal position help with pain?

Answer 12

Changing maternal position and movement potentially reduces sources of pain.
Women wont generally put themselves into an uncomfortable position.
Women experience sig less pain when in vertical position.

Question 13

What are 3 methods of pahrmalogical pain relief?

Answer 13

Inhalation
Opiods
Epidural

Question 14

What are advantages of entonox- nitrous oxide and O2

Answer 14

Maternally administerred- effective if used appropriately
Odourless and colourless
Used in waterbirths

Question 15

What are disadvantages of entonox- nitrous oxide and O2

Answer 15

Vitamin B12 deficiency with overuse-24hrs
Administration may impact on effectiveness
Nausea

Question 16

What are advantages of diamorphine hydrochloride

Answer 16

Provides superior analgesia than pethidine
Evidence would suggest that it is best given IV
Given by IM injection usually with an anti-emetic
There is a reported lower incidence of vomiting
Psychological benefits are more intense
Use has increased greatly
APGAR’s of the neonate appear to be better than those whose mothers have had pethdine

Question 17

What are disadvantages of diamorphine hydrochloride

Answer 17

Pain at injection site
Dizziness
Sleepy
Suppressed respiratory system/ gastric emptying

Question 18

What are advantages of pethidine hydrochloride

Answer 18

Give some analgesia after 10 mins and is at max effectiveness after 1 hours

Question 19

What are disadvantages of pethidine hydrochloride

Answer 19

The half-life of pethidine is 3hrs in the mother and 21hrs in the neonate
Can cross the placental barrier and effect the fetus
In comparison with other opioids more women receiving pethidine experienced adverse effects including drowsiness and nausea

Question 20

What is the administration of pethidine?

Answer 20

Can be prescribed 4-6 hourly
Use of Nalocone as antidote
Given by IM injection usually with an anti-emetic

Question 21

What are the advantages of mepazinol-meptid?

Answer 21

Fewer side effects
It does not cause respiratory suppression in the neonate
Similar analgesic effect to pethidine

Question 22

What are the disadvantages of mepazinol-meptid?

Answer 22

Side effects nausea and vomiting
Not commonly used in some trusts

Question 23

What are some side effects of paracetamol/

Answer 23

Rashes, blood disorders, liver damage with overuse

Question 24

What are some side effects of co-codomal? (not to be used with paracetamol0

Answer 24

Constipation

Question 25

Where is epidural usuallu sited?

Answer 25

Around L3-4 (spinal cord finishes around L1-2, so risk of nerve damage is low)

Question 26

Can epidurals increase risk of instrumental or CS?

Answer 26

Evidence that they increase the risk of instrumental births but not overall CS rate