Comfort and Pain Management During Labor and Delivery

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Labor is one of the most intense experiences that a mother would have to encounter before she could glimpse her angel. The pain may seep through her bones, but all of these would be forgotten the moment she touches her infant. These are the moments that show that pain could be conquered ultimately by love.

Etiology and Physiology of Pain

  • Pain is a basic protective mechanism that alerts a person that something threatening is happening somewhere in the body.
  • Involuntary muscles do not normally cause pain when contracting, which is why uterine contractions are unique.
  • Blood vessels constrict during contractions, reducing the blood supply to uterine and cervical cells resulting to anoxia of the muscle fibers.
  • The anoxia causes the pain just like what happens in a heart attack.
  • Ischemia to the cells increases as labor progresses, and anoxia also increases leading to intense pain.
  • Another explanation for the pain is the stretching of the cervix and perineum.
  • The moment that the stretching of the cervix is complete, the woman would feel the strong urge to push, and the pain disappears as the woman pushes.
  • The pressure of the fetal presenting parts to the tissues also contributes to the discomfort that the woman is feeling.
  • Cultural differences also determine the way a woman may perceive the pain.
  • Pain sensations start in nociceptors which are stimulated by mechanical, chemical, or thermal stimuli.
  • As they are stimulated, chemical mediators help transmit the pain impulse along myelinated and unmyelinated fibers to the spinal cord.
  • Neurotransmitters assist the pain impulse across the synapse between the peripheral and the spinal nerve.
  • The pain impulse ascends the spinal cord to the brain cortex where it would be interpreted as pain.
  • The Melzack-Wall gate control theory of pain proposes that pain can be halted at three points: the peripheral end terminals, the synapse points, or at the point where the impulse is interpreted as pain.
  • The major action of pain medications is to block the spinal cord neurotransmitters to halt the pain impulse from crossing towards the spinal nerve.

Comfort Measures

Relaxation

  • Relaxation is mostly taught in preparing for childbirth classes.
  • Relaxing keeps the abdominal wall from becoming tense and allows the uterus to rise during contractions without pressing against the abdominal wall.
  • As the woman focuses on relaxing, it will also serve as a distraction technique because it distracts her from the pain she is feeling.
  • Advise the woman to find her position of comfort during labor as it will greatly help her to relax.
  • Another way for the woman to relax is to listen to her favorite music or do aromatherapy while inside her birthing room.

Focusing and Imagery

  • Focusing is concentrating intently on an object that will serve as the distraction.
  • It also keeps the sensory input from reaching the cortex of the brain, thus avoiding pain.
  • A photograph would be used by the woman and she concentrates on it during contractions.
  • Avoid disturbing the woman by asking questions while she is focusing because it would break her concentration.

Prayer

  • There are women who find prayers comforting whenever they are in a stressful situation.
  • Worship objects such as Bibles, rosaries, and crosses could give comfort to a woman during labor.
  • Be careful in changing the sheets because the worship objects might be thrown away; these are sacred to the woman.

Breathing Techniques

  • Most preparing for childbirth classes also teach breathing techniques or patterns.
  • Breathing techniques help relax the woman’s abdomen during contractions.
  • It can be considered as a distraction technique because the woman concentrates on slow-paced breathing instead of minding the pain.
  • Breathing techniques are best taught to the woman before labor, but if she is not familiar with it, she can still be coached even while she is in labor.

Herbal Preparations

  • There may be little evidence that shows the effectiveness of herbal medicines against pain during labor, but it is still widely used by some women.
  • Raspberry leaves, life root, and fennel are some of the examples of these herbs.

Heat or Cold Application

  • Women who are experiencing back pain during labor will find heat application to their lower backs soothing.
  • After labor, a cool cloth to the forehead could also soothe the woman from too much exertion.
  • Ice chips also help relieve the dryness of the woman’s mouth during labor.

Therapeutic Touch and Massage

  • Therapeutic touch is the use of touch to comfort and relieve pain.
  • According to its philosophy, the body contains energy fields.
  • If the energy fields are plentiful, it results to good health.
  • If the energy fields are few, it results to ill health.
  • Therapeutic touch redirects the energy fields that lead to pain through the laying of hands.
  • The release of endorphins is increased as touch or massage is applied, leading to decrease in pain.
  • Effleurage is a form of therapeutic touch taught at Lamaze classes and is especially helpful during the first and second stages of labor.

Pharmacologic Measures

Narcotic Analgesics

  • Narcotics have potent analgesic effects but are used cautiously because they can cause fetal CNS depression.
  • Women in preterm labor should not have any narcotics as pharmacologic measure because of the lung immaturity of the fetus.
  • Meperidine is an advantageous drug during labor because of its sedative and antispasmodic effects which relieve pain and helps relax the cervix.
  • Meperidine is given 3 hours before birth to allow the peak action of the drug in the fetus to pass by the time of birth.

Regional Anesthesia

  • Regional anesthesia involves the injection of a local anesthetic to block specific nerve pathways.
  • Research has proven that some effects of the anesthesia to the fetus result to fetal heart rate decelerations and symptoms of flaccidity, bradycardia, and hypotension in the newborn.
  • Regional anesthesia allows the woman to stay awake and aware of the happenings during birth.
  • It also helps prevent postpartum hemorrhage as it does not depress the uterine tone, so the uterus remains capable of contraction after birth.

Local Anesthesia

  • Local anesthesia reduces the ability of local nerve fibers to conduct pain.
  • Local infiltration uses the injection of a local anesthetic into the superficial nerves of the perineum.
  • The effect lasts for 1 hour, which allows for a pain-free birth and suturing of episiotomy.
  • The pudendal nerve block is the injection of an anesthetic near the right and left pudendal nerve at the level of the ischial spine.
  • This anesthetic provides pain relief after 2 to 10 minutes for 1 hour.
  • FHR and the maternal blood pressure should be checked immediately after injection to detect maternal hypotension.

The types of pain relief during labor and birth vary widely, and it is up to the woman if she would want to employ these measures during the right time. Proper education and information from the healthcare providers is a must so that the couple could make the right decision when it comes to the procedures and measures that they would want during labor and birth.

Practice Quiz: Labor & Delivery Pain Management


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1. Why are uterine contractions considered as unique to the human body?

A. They progress as time stretches by.
B. They cannot be relieved by any intervention.
C. The involuntary muscles do not usually have pain upon contraction.
D. The tissues surrounding the area are compressed with contractions.

2. What contributes mostly to the pain during birth?

A. The stretching of the perineal tissue.
B. The constriction of the blood vessels.
C. The anoxia to the cells.
D. The pressure of the fetal presenting part against the tissues.

3. Which of the following is not a nonpharmacologic measure?

A. Breathing techniques
B. Pudendal nerve block
C. Focusing and imagery
D. Relaxation

4. Which of the following is most helpful during the first and second stages of labor?

A. Prayers
B. Massage
C. Breathing techniques
D. Yoga

5. What is the effect of Meperidine (demerol) to the fetus?

A. Respiratory depression
B. CNS depression
C. The fetus becomes small for its gestational age.
D. Fetal hypotension

Answers and Rationale

1. Answer: C. The involuntary muscles do not usually have pain upon contraction.

Involuntary muscles such as the heart and stomach do not suffer pain during contraction of the muscles.

2. Answer: A. The stretching of the perineal tissue.

A, because the perineal tissue is stretched widely during birth which gives great pain to the woman.

3. Answer: B. Pudendal nerve block

B, pudendal nerve block is a pharmacologic measure used to relieve pain during labor and birth.

4. Answer: B. Massage

B, massage helps relieve pain through the release of endorphins by touch.

5. Answer: A. Respiratory depression

A, meperidine can cross the placenta and can cause respiratory depression to the fetus.

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