Pain Management During Labor- Maternal (OB) Nursing
A review for nursing students about the pain management techniques involved during the laboring process. There is also a brief description of the types of pain, sources of pain, and influences on pain during childbirth.
Once you review the information in this post, be sure to download this PDF cheat sheet that includes all the important information.
Also, be sure to check out these other Maternal (OB) Nursing study guides (downloadable PDF cheat sheets also available):
- Changes in Pregnancy
- Stages of Labor
- Fetal Monitoring During Labor
- Pregnancy Complications
- Nursing Care of Postpartum Mother
- Labor and Delivery Complications
- Postpartum Complications
Types of pain during childbirth:
- Visceral- slow and deep, poorly localized; dominates stage 1 of the birthing process
- Somatic- fast and slow, precisely localized; end of stage 1 and beginning of stage 2
Sources of pain during childbirth
- Tissue ischemia– blood supply to the uterus is decreased
- Cervical dilation– stretching is painful!
- Pressure and pulling on pelvic structures
- Distention of the vagina and perineum- burning, tearing, splitting
Influences on pain during childbirth:
- Intensity of labor- short and intense is usually severely painful
- Cervical readiness- longer labor and greater fatigue if cervix is not ready
- Fetal position- occiput posterior fetal position is unfavorable
- Characteristics of the pelvis- size and shape
- Fatigue- influences ability to tolerate pain
- Intervention by caregivers- IV line causes pain, fetal monitoring equipment, induction or augmentation
- Culture- how the mother perceives, interprets, and responds
- Anxiety and fear- magnify sensitivity to pain
- Previous experiences with pain
- Preparation of childbirth- preexisting expectations
- Support system
Pain Management Techniques:
| Regional | Mother remains awake and is able to participate in her birth experience. Limitations include: -Maternal hypotension (administer IV fluids, IV ephedrine to combat hypotension) -Fetal heart rate changes -Respiratory depression -Nausea/vomiting -Pruritus Spinal block: Inserted in subarachnoid lumbar Relieves uterine and perineal pain Spinal headache may occur (instruct mother to stay supine) Decreased BP Epidural block Threaded at L3-L4 Can be used for vaginal and c-section births Decreased BP |
| Opioid analgesics | Demerol Fentanyl Stadol Nubain Observe for respiratory depression in the neonate |
| Pudenal block | Numbs the lower vagina and part of the perineum Used for vaginal birth or episiotomy |
| General anesthesia | Used for emergency c-sections or women who refuse or are not a candidate for regional anesthesia Mother is at risk for aspiration of gastric contents -NPO, restrict fluids Mother and baby are also at risk for respiratory depression Wedge is placed under mother to avoid vena cava compression |
| Nonpharmalogical techniques | Relaxation Massage Hydrotherapy Mental stimulation Breathing techniques -Slow paced breathing -Pattern-paced breathing |
I hope this was helpful!
As always, feel free to contact me if you have any questions or just want to chat.
Happy Nursing!