Non-Pharmacologic Pain
Management During Labor
Authored by: Karina Schaub, RNC, MN
Objectives
• Identify several non-pharmacologic ways to help
patients cope with labor pain
• Know the contraindications for certain methods of
pain relief
• Identify several ways nurses can show support for
the pt and their support people
Physiologic Responses to Pain
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Release of Catecholamines
BP
HR
RR
Tension
Information to Discuss Upon
Admission
• Review Birth Plan
• Discuss pain relief options and coping
mechanisms
• Advise support person
• Discuss FHM standards
Empowering Women to
Give Birth
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Motivation
Encouragement
Position changes
Offer advice to support person
Physical Presence
Fetal Monitoring Standards
per ACOG
• Low risk patients:
– 20 minute strip initially
– Active Labor: during and 30 seconds after a
contraction Q 30 min
– 2nd Stage: during and 30 seconds after a
contraction Q 15 min
** Always follow your hospital’s protocol
Fetal Monitoring Standards
per ACOG
• High risk patients:
– 20 minute strip initially
– Active Labor: during and 30 seconds after a
contraction Q 15 min
– 2nd Stage: during and 30 seconds after a
contraction Q 15 min
** Always follow your hospital’s protocol
National Organization Support
Association of Women’s Health, Obstetric,
and Neonatal Nurses (AWHONN)
American College of Obstetricians and
Gynecologists (ACOG)
Research Study Support
“The presence of a doula during labor…
Lower use of analgesia,
Lower C/S rate,
Increased maternal satisfaction.”
(Berghella, et al, 2008)
Personal Needs
• Nutrition
– Water
– Ice chips
– 120 cal/hr
• Elimination
Non-Pharmacologic Coping
Mechanisms
Walking
Swaying
Rocking Chair
Birthing Ball
Changing Positions
Squatting Bar
Tub
Rebozo
Distractors
Focal Point
Visualization
Music
Aromatherapy
Heat/Cold
Massage
Acupressure
Hypnobirthing
Movement
• Walking
• Swaying
• Hands & Knees
Using Props
• Rocking Chair
• Birthing Ball
Using Props
• Squatting Bar
– Put bed into chair position
– Squat holding the bar
– Pull on sheet
Using Props
• Rebozo
– Support with rebozo under arms to
relax neck, shoulders, and back
– Passive Movement Relaxation
Hydrotherapy
“Liquid Epidural”
– Less pain
– Less muscle tension
– Reduces effect of
gravity on mother
Hydrotherapy
Contraindications:
 Maternal fever> 100.4 or suspected maternal
infections
 Amnionitis
 Documented non-reassuring FHR
 Condition requiring continuous EFM
 Excessive vaginal bleeding
 Epidural Anesthesia
 Malpresentation
 Other conditions at discretion of HCP
Hydrotherapy
• Water temp mildly warm
• Push fluids
• Offer towel to drape over pt for privacy
Hydrotherapy
• Decreases pain sensation
• Less use of IM/IV/epidural analgesia
• Fewer instrumental deliveries
• Decreased incidence of cesarean sections
• Decreased incidence of perineal trauma
• Increased maternal satisfaction
(Berghella, et al, 2008)
Does bath water enter vagina?
• Research Study:
Tampon placed in vagina before entering the water
Potassium iodide solution placed in tub water
No tampons reacted to the iodide until they were
removed
Conclusion: Bath water does NOT enter the vagina
(Siegel, 1990)
Hydrotherapy after SROM
– No differences in
maternal or neonatal infections, asphyxia
or resp problems.
• Waldenstrom. et al, 1992
- Pre-labor SROM – No
differences in maternal or neonatal
infection rate.
• Erolsspm. et al, 1996
Perineal Massage
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Starting at 34 wks
Almond oil 5-10 min daily
Perineal Massage 2nd stage
Warm pack 2nd stage
(Berghella, et al, 2008)
Sterile Water Papules
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Injection of Sterile Water in 4 areas
Burns x 30-90 seconds
Back pain relieved in 2-3 minutes
Pain relief x 2-3 hours
May be repeated
** Note – does not relieve contraction pain
Sterile Water Papules
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MD, CNM, RN
Best to have 2 people inject at the same time
Tuberculin syringes, 0.3 ml of Sterile Water
Locate injection site over sacrum (4 injections)
Sterile Water Papules
• Cleanse area with alcohol
• Inject 0.15 ml of the Sterile Water
intradermally in each site
• Watch for a wheal to form
Using the Senses
• Focal Point (sight)
– Spot on the wall
– Calming photo
• Music (sound)
– CD’s, IPOD, Headphones
– Activates the right brain
Using the Senses
• Aromatherapy (smell)
– Clary Sage: Anxiety, Fatigue, Stress
– Jasmine: Confidence, Fatigue, Stress
– Lavender: Anxiety, Irritability, Stress
– Peppermint: Fatigue, Relaxes urinary meatus
– Rose: Anxiety, Stress
Using the Senses
• Heat/Cold (touch)
– Cool cloth
– Fan
– Warm tub
• Massage (touch)
– Back
– Feet
– Tennis Ball
Mind over Matter
• Distractors
– TV
– Children playing
– Cleaning
• Visualization
– Visualize a favorite place where you can think
of smells, sounds, feelings…
Breathing Rhythm in Labor
• Breathing patterns
– Slow deep breaths 1st Stage
– Feeling pushy but can’t push yet?
• Pant – short quick breaths out
Acupressure
• For Nausea/Vomiting
– Inner Gate or Neiguan P6 Pressure Point
Acupressure
• Pain relief during labor
– Hegu li-4 pressure point
Hand Reflexology
• Pressure on the balls of the hand and
finger tips
• Can use in both hands
Acupressure
• Cervical Dilation
– Sanyinjiao SP-6
Hypnobirthing
• Childbirth method using mind/body and
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meditation science
Deep relaxation
Eliminate Fear, Tension, and Pain
Techniques improve immune and nervous
system function in preparation for birth:
– Teaches to recognize and release fears in labor
– Teaches to extend natural labor pain management
Conclusion
• Combine different techniques based on
your assessment of pt’s needs
• Provide rationale behind the various
methods of pain relief
• Let the pt and family know that you are
there for them
Questions
?
References
Berghella, V., Baxter, J., & Chauhan, S. (2008). Evidence-based labor and delivery management. American Journal of Obstetrics and
Gynecology. 445-454. Retrieved February 1, 2011 from www.AJOG.org.
Birthing Ball. [Online Image] Retrieved June 23, 2009 from http://www.birthease.co.uk/birthease_shop/Shop-Products/Birth-BirthingBall/Birth-Birthing-Ball-Large-Image.jpg.
Buckle, J. (2000). Aromatherapy for Health Professionals.
Cervical Dilation Acupressure. [Online Image] Retrieved June 22, 2009 from http://acupuncture.rhizome.net.nz/acupressure/images/sp6_2.gif.
Childbirth Instructor Magazine. (1997). The Moaning Option. 2nd Quarter
Dougans, I. (2003). Reflexology: The Complete Illustrated Guide to Therapeutic Foot Massage for Health and Well-being.
Intradermal Injection. [Online Image] Retrieved June 23, 2009 from http://www.hivandhepatitis.com/0_images_2008/tb_hosp2.gif
Jonquil, S. (1997). Midwifery Today. Sterile Water Blocks for Back Pain in Labor.
Kunz, K. & Kunz, B. (2003). Reflexology: Health at your fingertips. 120-121.
Labor Bathtub. [Online Image] Retrieved June 23, 2009 from http://www.discoversanmiguel.com/images2010/Twin-Cities-LaborTub.jpg
References Cont’d
Labor Squatting Bar. [Online Image] Retrieved June 23, 2009 from
http://www.google.com/imgres?imgurl=http://www.wpahs.org/womenshealth/clinical/services/images/OBtour_25_001.jpg&i
mgrefurl=http://crispy-not-crunchy.blogspot.com/2009/08/littlests-birthstory.html&usg=__8786P5Mwt3BMFqt3IBMMGJwmpiU=&h=188&w=240&sz=38&hl=en&start=7&itbs=1&tbnid=UM0y
N02DhWKrGM:&tbnh=86&tbnw=110&prev=/images%3Fq%3Dlabor%2Bsquatting%2Bbar%26hl%3Den%26sa%3DN%26
gbv%3D2%26ndsp%3D20%26tbs%3Disch:1
Mongan, Marie. (2006). Hypnobirthing: The Mongan Method.
Pfeil, Aerlyn, CPM. (2007). Sterile Water Papules for Back Labor Relief.
Sterile Water Papule Injection Sites. [Online Image] Retrieved May 3, 2009 from
http://www.scielo.br/img/revistas/rba/v56n5/en_12f1.gif.
Tisserand, R. (1977). Healing Arts Press. Art of Aromatherapy.
Trolle, B., Moller, M., Kronberg, H. & Thomsen, S. (1991). American Journal of Obstetrics and Gynecology. The Effects of
Sterile Water Blocks on Low Back labor Pain.