Chapter 7

Nursing Management of Pain During

Labor and Birth

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Objectives

Define each key term listed.

Describe factors that influence a womans
comfort during labor.
List the common types of classes offered to
childbearing families.
Describe the methods of childbirth
preparation.

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

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.
Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Education for Childbearing

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Types of Classes Available

Gestational diabetes mellitus

Early pregnancy
Exercise for pregnant women
Infant care
Breastfeeding
Sibling
Grandparent
Adolescent childbirth
Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Variations of Basic Childbirth

Preparation Classes

Refresher
Cesarean birth
Vaginal birth after cesarean

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Content of Childbirth
Preparation Classes

Benefits of exercise
Pain control methods for labor

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Childbirth 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

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

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

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Nonpharmacological Pain
Management

Advantages of nonpharmacological
methods
Limitations of nonpharmacological methods

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Methods of Childbirth
Preparation

Dick-Read method
Bradley method
Lamaze method

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Selected Nonpharmacological
Pain Relief Measures

Progressive
relaxation
Neuromuscular
dissociation
Touch relaxation
Relaxation against
pain
Effleurage

Sacral pressure
Thermal stimulation
Positioning
Diversion and
distraction
Hydrotherapy

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Nonpharmacological
Techniques

Relaxation
techniques
Skin stimulation
Effleurage
Sacral pressure
Thermal stimulation
Positioning
The nurses role

Diversion and
distraction
Focal point
Imagery
Music
Television

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Skin Stimulation

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Breathing

First stage

Slow paced
Modified paced
Patterned paced

Second stage

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

16

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

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Nursing Tip

If a woman is successfully using a safe,

nonpharmacological pain control technique,
do not interfere

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Pharmacological Pain
Management

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Physiology of Pregnancy & its

Relationship to Analgesia & Anesthesia

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Pharmacological Methods
Advantages

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Pharmacological Methods
Limitations

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Analgesics and Adjunctive Drugs

Narcotic (opioid) analgesics

Narcotic antagonist
Adjunctive drugs

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Regional Analgesics
and Anesthetics

The meninges around the spinal cord

Dura mater
Arachnoid mater
Pia mater

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Types of Anesthesia
for Childbirth

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

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

26

Epidural Blood Patch

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

General Anesthesia

Adverse effects in the mother

Adverse effects in the neonate

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Question for Review

What is the most important nursing

responsibility after an epidural or spinal
block analgesia during labor and delivery?

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier

Review

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

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier