Chapter 12:

Pain Management Pamela Dennis RNC-OB MSN Chapter 12

Pain During Labor and Birth :

Pain During Labor and Birth Perception of pain Threshold remarkably similar in all, regardless of gender,
social, ethnic, or cultural differences Differences play definite role in person’s perception of and
behavioral responses to pain

PowerPoint Presentation:
Fig. 16-1. Discomfort during labor. A, Distribution of labor pain during first stage. B, Distribution of labor
pain during later phase of first stage and early phase of second stage. C, Distribution of labor pain
during later phase of second stage and during birth. ( Gray shading indicates areas of mild discomfort;
light-colored shading indicates areas of moderate discomfort; dark-colored shading indicates areas of
intense discomfort.)

Non-pharmacologic Management of Pain:

Non-pharmacologic Management of Pain Nonpharmacologic measures often simple, safe, and
inexpensive Provide sense of control over childbirth and measures best for woman Methods require
practice for best results Try variety of methods and seek alternatives, including pharmacologic methods,
if measure used is not effective

Non-pharmacologic Management of Pain :

Non-pharmacologic Management of Pain Childbirth preparation methods Dick-Read method Lamaze
method Bradley method HypnoBirthing Birthing from within Childbirth and Postpartum Professional
Association

Non-pharmacologic Management of Pain :

Non-pharmacologic Management of Pain Relaxing and breathing techniques Relaxation Imagery and
visualization Music Touch and massage Conscious breathing Energy work Effleurage and
counterpressure Water therapy (hydrotherapy)

Non-pharmacologic Management of Pain:

Non-pharmacologic Management of Pain Relaxing and breathing techniques Transcutaneous electrical
nerve stimulation Acupressure and acupuncture Applications of heat and cold Hypnosis Biofeedback
Aromatherapy Intradermal water block

PowerPoint Presentation:
Fig. 16-7. Intradermal injections of 0.1 ml of sterile water in the treatment of women with back pain
during labor. Sterile water is injected into four locations on the lower back, two over each posterior
superior iliac spine (PSIS) and two 3 cm below and 1 cm medial to the PSIS. The injections should raise
a bleb on the skin. Simultaneous injections administered by two clinicians decreases the pain of the
injections.

Pharmacologic Management of Discomfort :

Pharmacologic Management of Discomfort Sedatives (Barbiturates) Analgesia and anesthesia Local
Anesthesia Regional Anesthesia Systemic analgesia Opioid (narcotic) agonist analgesics Opioid
(narcotic) agonist–antagonist analgesics Opioid (narcotic) antagonists

Pharmacologic Management of Discomfort:

Pharmacologic Management of Discomfort Nerve block analgesia and anesthesia Local perineal
infiltration anesthesia Pudendal nerve block Spinal anesthesia (block) Disadvantages Marked
hypotension Impaired placental perfusion Ineffective breathing patterns Headache Autologous epidural
blood patch

PowerPoint Presentation:
Fig. 16-8. Pain pathways and sites of pharmacologic nerve blocks. A, Pudendal block; suitable during
second and third stages of labor and for repair of episiotomy. B, Epidural block; suitable during all
stages of labor and for repair of episiotomy.

PowerPoint Presentation:
Fig. 16-9. Pudendal block. Use of needle guide (“Iowa trumpet”) and Luer-Lok syringe to inject
medication.
Pharmacologic Management of Pain:
Pharmacologic Management of Pain Nerve block analgesia and anesthesia Epidural
anesthesia/analgesia Lumbar epidural anesthesia/analgesia Caudal epidural block Walking epidural
analgesia Epidural and intrathecal opioids

Pharmacologic Management of Pain :

Pharmacologic Management of Pain Nerve block analgesia and anesthesia Epidural
anesthesia/analgesia Contraindications to epidural blocks Maternal refusal or inability to cooperate
Maternal cardiac conditions Antepartum hemorrhage Anticoagulant therapy or bleeding disorder
Infection at injection site Allergy to anesthetic drug

Pharmacologic Management of Pain:

Pharmacologic Management of Pain Nerve block analgesia and anesthesia Epidural
anesthesia/analgesia Effects of epidural block on neonate Paracervical (uterosacral) nerve block Nitrous
oxide for analgesia

PowerPoint Presentation:
Fig. 16-10. A, Membranes and spaces of spinal cord and levels of sacral, lumbar, and thoracic nerves.
B, Cross section of vertebra and spinal cord.

PowerPoint Presentation:
Fig. 16-10. C, Levels of anesthesia necessary for cesarean and vaginal births.

Pharmacologic Management of Pain :

Pharmacologic Management of Pain General anesthesia Used rarely for vaginal births Infrequently for
elective cesarean section May be necessary if indications necessitate a rapid birth

PowerPoint Presentation:
Fig. 16-13. Technique of applying pressure on cricoid cartilage to occlude esophagus to prevent
pulmonary aspiration of gastric contents during induction of general anesthesia.

Nursing Care Management :

Nursing Care Management Plan of care and implementation Nonpharmacologic interventions Informed
consent Timing of administration Preparation for procedures

Nursing Care Management :

Nursing Care Management Plan of care and implementation Administration of medication Intravenous
route Intramuscular route Spinal nerve block Signs of potential problems Safety and general care
Anesthesia in obese woman

Nursing Care Management :

Nursing Care Management Plan of care and implementation Maternal hypothermia after analgesia and
anesthesia Defined as core body temperature of less than 35° C Caused by effects of analgesia and
anesthesia May result in cardiovascular, pulmonary, circulatory, hematologic, neurologic, or renal
complications
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