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PAIN RELIEF AND COMFORT IN LABOR

Subject: Obstetric and Gynecological nursing

Submitted to: Respected Mrs. Himani (Msc Nsg) Obstetrics and Gynecology Lecturer Shri Sukhmani College of nursing, Dera Bassi

Submitted by: Talwinder Kaur Msc Nsg 1st yr

PAIN
Pain is sensation of discomfort resulting from stimulation of specialized nerve endings. During labor, pain sensation is relayed to the spinal cord from T10, L1, S1-S4. These sensory fibers make synaptic connections in dorsal horn of spinal cord with cells that provide axons that make up the spinothalamic tract.

PAIN OF LABOUR
STAGE I:- Stretching shearing distortion of uterine tissue. Simultaneously there is dilatation of the lower uterine segment and cervix. During the 1st stage - pain is referred to the low back region STAGE II:- caused by distortion & stretching of the pelvic structures in addition to pain of uterine contraction. Pain is referred to :-lower abdomen / pelvic regions -thighs -low back region STAGE III:- It is usually well tolerated with spontaneous placental delivery.

TYPES OF PAIN RELIEF IN LABOR

1. Non-pharmacological:
Continuous labor Support Hydrotherapy Ambulation and position Acupuncture and acupressure Attention focusing and imaginary Therapeutic touch and massage Breathing techniques

2. Pharmacological:
Analgesic drugs and Narcotics Regional Anesthesia

Non-pharmacological: 1. Continuous labor support

Involves offering a sustained presence to the laboring woman by: Providing emotional support Comfort measures Advocacy Information and advices Support for the partner Support can be provided by: Woman's family A midwife A nurse Any one close to the woman

Roles of companion Assist the woman to ambulate Repositioning the client Use breathing technique Aid with the use of acupressure Massage Music therapy Therapeutic douche Help in the birth plan

2. Hydrotherapy
Advantages of warm water: Release muscle tension Soothing stimulation of nerves in the skin Promote vasodilatation Reversal of sympathetic nervous response Reduction in catecholamine

3. Ambulation and position

Maternal position in labor has consequences for both maternal comfort and fetal well-being. The dorsal supine position with the gravid uterus resting on the aorta and inferior vena cava can cause decreased cardiac output and relative placental hypoperfusion. Changing position every 30 min. Sitting, walking, kneeling, standing, lying down, getting on hands and knees.

4. Acupuncture and Acupressure

Acupuncture involves stimulating key trigger points with needles. The purpose of acupuncture is to restore qi( channels of energy) , thus diminishing pain. Acupressure involves the application of affirm finger or massage at the same trigger points to reduce the pain sensation. Holding and squeezing the hand of the woman in labor may trigger the point most commonly used. Some acupressure points are found along the spine, neck, shoulder, toes, and soles of the feet.

5. Attention focusing and imaginary

Uses many of the senses and the mind to focus on stimuli. The woman focus on tactile tactile stimuli e.g. touch, massage, or stroking, May focus on auditory stimuli e.g. music and verbal encouragement. Visual stimuli Breathing, relaxation, positive thinking, and positive visualisation.

6.

Therapeutic touch and massage

Massage works as a form of pain relief by increasing the production of endorphins in the body which reduce the transmission of signals between nerve cells and thus lower the perception of pain. Massage of the neck, shoulder, back, thighs, feet, and hands.

7. Breathing techniques
The woman concentrate on slow-paced rhythmic breathing. Verbal commands from her partner supply an ongoing auditory stimulus to her brain.

Pharmacological:
Analgesic drugs and Narcotics Regional Anesthesia

1. Analgesic Drugs and Narcotics

An analgesic that is appropriate during one phase of labor may be entirely inappropriate at another time. Narcotics are best avoided until the active phase of labor is reached (i.e. 4 cm of dilation in the primi gravida and 5 cm in the multipara).

Side effect of parenteral narcotics: It cross the placenta and may depress the fetus. Loss of either reactivity (acceleration above baseline) or short-term variability in the fetal heart rate tracing. Respiratory depression Decreased alertness Inhibit sucking Delay in effective feeding.

Analgesic Drugs o A narcotic antagonist, preferably naloxone hydrochloride (Narcan), in both the adult (0.4 mg intravenously or intramuscularly) and neonatal (0.1 mg per kg) doses, should be readily available when these drugs are in use.

2. Regional Anesthesia
Many experts consider regional anesthesia the preferred method for vaginal delivery. If there is any concern about interpreting the fetal monitor tracing a regional anesthetic is preferred over parenteral

Methods of regional analgesia The available methods include: epidural spinal caudal paracervical pudendal block