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Chapter 7Chapter 7

Nursing Management of Pain During Labor and Birth

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ObjectivesObjectives

Define each key term listed. Describe factors that influence a woman’s

comfort during labor. List the common types of classes offered to

childbearing families. Describe the methods of childbirth

preparation.

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Objectives (continued)Objectives (continued)

Discuss the advantages and limitations of nonpharmacological methods of pain management during labor.

Discuss the advantages and limitations of pharmacological methods of pain management.

Explain nonpharmacological methods of pain management for labor, including the nursing role for each.

Explain each type of pharmacological pain management including the nursing role for each.

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Education for ChildbearingEducation for Childbearing

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Types of Classes AvailableTypes of Classes Available

Gestational diabetes mellitus Early pregnancy Exercise for pregnant women Infant care Breastfeeding Sibling Grandparent Adolescent childbirth

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Variations of Basic Childbirth Preparation Classes

Variations of Basic Childbirth Preparation Classes

Refresher Cesarean birth Vaginal birth after cesarean

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Content of Childbirth Preparation ClassesContent of Childbirth Preparation Classes

Benefits of exercise Pain control methods for labor

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Childbirth and PainChildbirth and Pain

How childbirth pain differs from other pain Part of a normal birth process Woman has several months to prepare for pain

management Is self-limiting and rapidly declines after birth

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Factors that Influence Labor Pain

Factors that Influence Labor Pain

Pain threshold Sources of pain during labor Central nervous systems factors

Gate control theory Endorphins

Maternal conditions Cervical readiness Pelvis Labor intensity Fatigue

Fetal presentation and position

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Nonpharmacological Pain Management

Nonpharmacological Pain Management

Advantages of nonpharmacological methods

Limitations of nonpharmacological methods

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Methods of Childbirth Preparation

Methods of Childbirth Preparation

Dick-Read method Bradley method Lamaze method

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Selected Nonpharmacological Pain Relief Measures

Selected Nonpharmacological Pain Relief Measures

Progressive relaxation

Neuromuscular dissociation

Touch relaxation Relaxation against

pain Effleurage

Sacral pressure Thermal stimulation Positioning Diversion and

distraction Hydrotherapy

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Nonpharmacological Techniques

Nonpharmacological Techniques

Relaxation techniques

Skin stimulation Effleurage Sacral pressure Thermal stimulation Positioning The nurse’s role

Diversion and distraction

Focal point Imagery Music Television

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Skin StimulationSkin Stimulation

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BreathingBreathing

First stage Slow paced Modified paced Patterned paced

Second stage

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How to Recognize and Correct Hyperventilation

How to Recognize and Correct Hyperventilation

Signs and symptoms Dizziness Tingling of hands and

feet Cramps and muscle

spasms of hands Numbness around

nose and mouth Blurring of vision

Corrective measures Breathe slowly, especially

when exhaling Breathe into cupped

hands Place a moist washcloth

over the mouth and nose while breathing

Hold breath for a few seconds before exhaling

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Nursing TipNursing Tip

If a woman is successfully using a safe, nonpharmacological pain control technique, do not interferedo not interfere

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Pharmacological Pain Management

Pharmacological Pain Management

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Physiology of Pregnancy & its Relationship to Analgesia & Anesthesia

Physiology of Pregnancy & its Relationship to Analgesia & Anesthesia

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Pharmacological MethodsPharmacological Methods

Advantages

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Pharmacological Methods Pharmacological Methods

Limitations

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Analgesics and Adjunctive DrugsAnalgesics and Adjunctive Drugs

Narcotic (opioid) analgesics Narcotic antagonist Adjunctive drugs

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Regional Analgesics and Anesthetics

Regional Analgesics and Anesthetics

The meninges around the spinal cord Dura mater Arachnoid mater Pia mater

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Types of Anesthesia for Childbirth

Types of Anesthesia for Childbirth

Anesthetic method Local infiltration Pudendal block Epidural block Subarachnoid (spinal) block General anesthesia

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Epidural Blood PatchEpidural Blood Patch

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General AnesthesiaGeneral Anesthesia

Adverse effects in the mother Adverse effects in the neonate

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Question for ReviewQuestion for Review

What is the most important nursing responsibility after an epidural or spinal block analgesia during labor and delivery?

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ReviewReview

Objectives Key Terms Key Points Online Resources Critical Thinking Questions Review Questions