Ch 15 Pain management during childbirth

Ch 15 Pain management during childbirth


Chapter 15 Pain management during childbirth. It is a unique nature of pain during birth. It differed from any other types of pain. It is part of a normal process, preparation
time exists. it is self-limiting, labor pain is not constant,
but intermittent. Sometimes you don’t’ have a lot f time between
but it does give some time of a break. Labor ends with the birth of a baby. Adverse Effects of Excessive pain. It can have some physiologic effects. Fear and anxiety, especially if the yare going
in after they have had a bad experience before . It increases maternal metabolic and respiratory
rate. Once again it is like that fight or flight
phenomenon will kick in. And Physiologic effects can happen to their
body as well. WE talked about hyperventilation already. Variables in Childbirth pain, physical factors. Sources: Tissue ischemia
Cervical dilation Pressure and pulling on pelvic structures
Distention of the vagina and perineum Tolerance: Labor intensity
Cervical readiness Fetal position
Pelvic readiness Fatigue and hunger can play a factor and
Caregiver interventions can play a role in it as well. Variable ins Childbirth pain: psychosocial
factors. Culture definitely plays a part. Lots of cultures out there are very stoic
and don’t show a whole lot of pain. Anxiety and fear we talked about already,
previous experiences. Did they prepare? Some times taking classes ahead of time just
helps them deal with what is going to happen. And do they have that good support? Some non pharmacologic pain management Advantages:Does
not slow labor No side effects or risk of allergy
Some pharmacologic methods may not eliminate labor pain. May be the only realistic option in advanced,
rapid labor So a lot of times if it is going that quickly
they are not going to have a chance to use anything. So sometimes the nonpharmacologic methods
will be more effective . Gate control is explained on the slide. An example of this would be massage or water
therapy. This makes the person concentrate on the massage
or water therapy which lessens the pain sensation. Can also use a visual focal point as well. You are directing the pain away by focusing
on something else besides the pain Other ways to prepare for that pain management
there is childbirth ed classes. Ideal time: before labor
Support person- learns specific measures to help and encourage
Nurse teaches and reinforces as well, best done during the latent phase and not trying
to do it after that if the y don’t have on board to help the m relax. Application of techniques they can use relaxation,
cutaneous stimulation, hydrotherapy, mental stimulation, and breathing exercises. Pharmacologic pain management . Most of the
meds can have some effect on the fetus. Some more so than others .It is never unsafe
like we are going to cause undo harm to them but sometimes the baby doesn’t tolerate them
well. Maternal physiologic alterations as well,
it can effect the course of the labor.Some pain meds taken at certain times will slow
down the labor. Can be complications. A lot of side effects of epidurals, the number
1 is hypotension. If moms blood pressure is low, its going to
effect that baby as well. Also interactions with other substances whether
it is something we are giving them or she could have possibly be taking on her own. Analgesics. Systemic drugs, a couple of examples would
be Demerol, stadol, and nubain, Side effects they can slow labor if given in latent phase-
before 4 cm. You will see it being used but there is always
tha risk. maternal—resp. depression, nausea, vomiting,
drowsiness fetal/neonatal—resp. depression, lethargy,
hypotonia-must monitor newborn carefully if mom has just received those meds. Regional pain mangement can be a nepidural
block. Relief from pain from contractions and birth. Relief of pain from contr. and birth
Used during 1st and 2nd stage of labor, for C/S
Adverse effects: HYPOTENSION, decreased urge to push, Can make pushing phase a lot longer. risk of dural puncture (can cause spinal and
spinal headache), urinary retention Be sure to keep mom off back, also expect
an IV bolus prior to mom receiving (help prevent hypotension). Other things the ycan do. The ycan do a local . They have have a local
infiltration in the perineum for episitomy or repairs of lacerations. Pudendal block is used in 2nd stage of labor
for episiotomy, foreceps, repairs, does not block contraction pain, only blocks perineal
pain. Regation pain management:INtrathceal Opiod
Analgesics. Intarthecal is a lot like the epidural. Just depends which space it is going into. Usual they give smaller doses and it is not
a continuous. To where epidurals are continuous medication
, this is where they it is usually just like an injection. So a lot of times what they will do is start
someone with an intrathecal and then they will keep a catheter in place so once they
want the epidural, they can hook up the medication up to that .It is a much smaller dose. Woman can usually feel contractions but not
nearly as much. Rapid onset of pain relief without sedation. They can ambulate during labor. Once again it depends on how sensitive that
each woman is and some protocols don’t want the woman out of bed. But it doesn’t numb you like the epidural
will. There is no sympathetic block. I has limited duration of action, usually
about 2 hours is how long they last and it is inadequate pain relief for late labor and
the birth itself. It can help to get through certain careas
though. ˜Parenteral analgesia (opioid analgesics):
Demerol, Stadol, Nubain (Nalbuphine) Opioid antagonists: Narcan. Baby might have to have narcan if mom received
any of these medications too close to delivery. Adjunctive drugs; Phenergan, Vistril.IT means
they help the pain meds work better and help alleviate some of the side effects .Sedatives
are sometimes given during early labor if mom really needs the sleep. Anesthetics 2 types. They are a general and regional .Rarely used
Uses: Emergency C/S refusal of spinal anesthesia for a C/S. They
don’t give her too many options for this anymore because the general anesthesia goes directly
to baby so truly when they are doing a c-section, the doctors are literally standing over mom
ready to start because that anesthesia they are cutting because that anesthesia will go
to baby and can cause a lot of respiratory depression. They just don’t tend to use that very much
anymore. Sometimes they do have to use the if they
have to manually remove the placenta if it doesn’t come out on its own. They may use a regional for that .

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