Providing Comfort During Labor & Birth
Providing Comfort
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Concerns about the discomfort and pain involved in labor and birth dominate
the thoughts of childbirth.
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Use neutral terms-contraction instead of pain

Pharmacologic agents pose risks for both mother (hypotension) and fetus
(bradycardia).
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Experience of Pain During Childbirth
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Etiology of Pain:

During contractions, blood vessels constrict, reducing the blood supply to
uterine and cervical cells, resulting in anoxia to muscle fibers. Anoxia causes
pain.

Stretching of cervix and perineum

Pressure of fetal presenting part on tissues, organs.
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Physiology of Pain:
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Basic protective mechanism that alerts a person that something is happening.
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Perception of Pain:
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Pain is perceived differently

Body produces endorphins (naturally opiate like substances)
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Factors Influencing Pain Perception:
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Fetal position, fear, anxiety, worry, expectation of pain, body image, and selfefficacy.
Pain Relief Measures
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Empowering women and their partners with information so they can decide
how to best relieve pain during labor.
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Support From a Coach

Emotional involvement of husband

May need someone else to coach
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Alternative Therapies For Pain Relief

Based on gate control theory concept that distraction can be effective in
preventing the brain from processing pain sensations coming into the cortex.
Alternative Therapies For Pain Relief
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Relaxation

Focusing and Imagery
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Breathing Techniques
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Herbal Preparations-raspberry leaves, fennel, life root. Blue cohosh toxic.
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Aromatherapy and Essential Oils-Lavender and Jasmine

Heat and Cold Applications
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Bathing or Hydrotherapy
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Therapeutic Touch and Massage
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Yoga
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Reflexology-pressure to hands, feet, and ears.

Crystal or Gemstone Therapy-specific positioning to be effective.
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Hypnosis
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Biofeedback
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Transcutaneous Electrical Nerve Stimulation-TENS T10-L1
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Acupressure and Acupuncture
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Intracutaneous Nerve Stimulation-injection of sterile water or saline along
borders of sacrum.
Pharmacologic Pain Relief

Analgesia-reduces or decreases awareness of pain.
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Anesthesia-causes partial or complete loss of sensation.

Ask about allergies to medications.
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Virtually all medications cross the placenta.
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No aspirin for pain.
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Goals:
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Relax the woman and relieve her discomfort, yet have minimal systemic effects
on her uterine contractions, her pushing effort, or the fetus.

Medications with a molecular weight > 1000 cross the placenta poorly those
with a molecular weight < 600 cross very readily.

Narcotic Analgesics

Potent analgesic effects-causes fetal CNS depression.

Intrathecal Narcotics:

Injection into the spinal cord. (Morphine)

Catheter is introduced into the subarachnoid space of the spinal cord.
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Takes effect in 15 to 30 min. and lasts 4 to 7 hours.

May need pudental block in late labor.
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Additional Drugs:
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Tranquilizers (vistaril, phenergan)
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Regional Anesthesia:

Injection of a local anesthetic to block specific nerve pathways. (Marcaine,
Nesacaine)

Block sodium and potassium transport in the nerve membrane.
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Allow the woman to be completely awake and aware of what is happening.
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May or may not be aware of contractions.
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Helps prevent postpartal hemorrhage.
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Epidural Anesthesia (Peridural Blocks):
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Anesthetic agent placed just inside the ligamentum flavum in the epidural
space. Level L4-5, L3-4 or L1-2
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Blocks spinal nerve roots in the space and sympathetic nerve fibers with them.
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Blocks pain for labor and birth.
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CSF is not entered with epidural. No HA.
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Spinal headache due to leakage of CSF or instillation of air into CSF.
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Concerns:
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Hypotension
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Keep on side afterwards
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Tends to prolong second stage of labor.
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Technique for Administration:
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Lumbar epidural anesthesia done at 5 to 6 cm dilated.
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Pt. lies on side or sits upright.
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Clean lumbar area with antiseptic solution.
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Local anesthetic injected into skin at L3-4
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3 to 5” needle is passed into epidural space.
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Catheter is passed through needle into space and needle is withdrawn and
catheter is taped into place.
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Test with a local anesthetic solution through cathether, wait 5 min. check legs
for flushing, and warmness, evidence that it is in place.
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Produces anesthesia up to level of the umbilicus in 10 to 15 min, lasts 40 min
to 2 hours.
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Monitor VS temp will increase.
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Bladder will fill without woman knowing so void q 2 hours. I&O
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PCEA
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Combined Spinal Epidural Technique
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Anesthesiologist administers-inserts epidural needle then a fine spinal needle
into CSF. A narcotic agonist (fentanyl) is added to CSF and needle is
withdrawn.
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Immediate pain relief

Spinal (Subarachnoid) Anesthesia:

Used less frequently today.

Local anesthetic agent (Marcaine or Naropin) is injected using lumbar
puncture technique into subarachnoid space (CSF) L3-4 interspace. Rises to
T10.

IV of LR solution for hydration.
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Spinal headache due to leakage of CSF or instillation of air into CSF.
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Have woman lie flat and give analgesic.
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Medication for Pain Relief During Birth
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Natural pressure anesthesia.
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Local Anesthetics
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Local infiltration:
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Injection of anesthetic into superficial nerves of the perineum (Lidocaine).
Along borders of vulva.
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Lasts 1 hour
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Pudendal Nerve Block:
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Injection of local anesthetic near the right and left pudendal nerves at the
level of the ischial spine.
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Injection made through vagina
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Relives pain in 2 to 10 min., lasts for 1 hour
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General Anesthesia
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Never preferred due to dangers of hypoxia and inhalation of vomitus.

Pentothal plus 6 other drugs available.
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Endotracheal tube.
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Infant may need resuscitation.
Comfort During Labor
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Reduce Anxiety With Explanations of Labor Process:
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Clear understanding of what to expect.
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Do not know or may not remember.
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Provide Comfort Measures:
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Reposition or walk
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Ice chips, wet cloth
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Change pads frequently
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Clean gown, shower
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Pharmacologic pain relief