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NSG 3332OB High Risk Lecture Ch 7.
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NSG 3332OB High Risk Lecture Ch 7.
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MATERNAL INFANT CH 16-The Nursing Role in ProvidingComfort During Labor
2020 National Health Goals Related to Pain Relief During Labor
o Reduce the maternal mortality rate to no more than 11.4 deaths per 100,000 live births
from a baseline of 12.7 per 100,000.
o Reduce the fetal/newborn death rate during the perinatal period (28 weeks of gestation to
7 days after birth) to no more than 5.9 per 1,000 live births from a baseline of 6.6 per 1,000
live births.
How can nurses help achieve these goals?
o By educating women about the advantages of preparing for CB, helping them to use
breathing patterns or other complementary and alternative therapies and techniques
during labor so they need a minimum of analgesia and anesthesia, and conscientiously
monitoring women who do receive analgesia and anesthesia.
o Book starts out with a perfect scenario about the expectations of a couple coming in for
their first labor.
o Remember, it is the ENTIRE FAMILY’s experience; it is not just a patient’s…it is a family
centered event that affects everyone.
o Theories, according to your book to use more neutral terms, like contractions, instead of
saying labor pains because it reminds them of the pain associated with labor. However,
there is pain involved. Fear and tension magnify the pain. So, getting a woman using
alternative therapies and getting the support person involved leads to a more successful
and positive birth experience.
Assessing Pain and Pain Relief During Labor and Birth
o Listen carefully to not only what a woman says but also how she rates her discomfort level
on a pain assessment scale.
o Look for subtle signs such as facial tenseness, flushing or paleness, hands clenched in fists,
rapid breathing, or rapid pulse rate.
o When assessing pain, listen for verbal cues but also observe non-verbal cues – very
important. This can be applied to all patients you care for
o Pain can lead to a sense of powerlessness, anxiety r/t lack of knowledge, inability to actively
listen to the education receiving having to do repetitive teaching, lead to low self- esteem,
and decisional conflict (which can also be r/t analgesia and anesthesia provided
o POC must be individualized – it is HER perception of pain for a multitude of reasons. Make
her interventions and goals individualized
o Risks involved in using pharmacologic interventions, must weigh benefits/risks – risk to
mom and fetus
o Example – hypotension which affects both mom and fetus
,MATERNAL INFANT CH 16-The Nursing Role in Providing
Comfort During Labor
o The type of pharmacologic measures poses concerns in how it affects the family/support
person
o Informed education on non-pharmacologic measures important – breathing, birthing ball,
ambulating, relaxation measures (story of use of breathing/coaching)
o In the overall outcome, how did she and support person/family think their birth experience
was?
Experiences of Pain During Labor and Birth
o Informed education on non-pharmacologic measures important – breathing, birthing ball,
ambulating, relaxation measures (story of use of breathing/coaching)
o In the overall outcome, how did she and support person/family think their birth experience
was?
o REMEMBER – the laboring woman who has a support person whose role is to be actively
involved in the care will have a POSITIVE influence on total experience but also on pain
relief/management
Etiology
o Uterine ctx blood vessels constrict reduces blood supply to uterine and cervical cells anoxia
to muscle fibers pain (in the same way blockage of cardiac arteries cause pain of an MI)
o Think about a time you were exercising and your muscles cramped up muscles were not
getting O2 they needed for a variety of reasons
o So, as labor progresses and ctxs increase in intensity anoxia increases pain intensifies
o Pain also results from stretching of the cervix and perineum this is just like intestinal pain
when increased amounts of gas stretches the intestine
o At the end of the transitional phase (woman is completely dilated) and she feels she has to
push pain often disappears as long as she is pushing until the fetal presenting part causes a
final stretching of the perineum
o Pain also comes from pressure of the fetus/presenting part on tissues, including pressures
on surrounding organs (bladder, urethra and lower colon)
o Cultural perceptions of pain serve as a large role and must never be discounted
Physiology
o Melzack-Wall gate theory proposes pain can be halted at 3 points the peripheral end
terminals; the synapse points in the dorsal horn of the spinal cord; and the point at
which the impulse is interpreted as pain in the brain cortex
, MATERNAL INFANT CH 16-The Nursing Role in Providing
Comfort During Labor
o Pain in peripheral terminals is automatically reduced by the production of endorphins and
encephalins. These are naturally occurring opiates that limit transmission of pain from the
end terminals. Then, you can reduce pain more at these end points by mechanically
irritating nerve fibers through an action like rubbing the skin b/c this blocks nerve
transmission (example – having the support person apply steady/massaging pressure points
if she is c/o LBP
o Major way to block spinal cord neurotransmitters, i.e. never allowing the pain impulse to
cross a spinal nerve, is by administration of pain medications.
o Also, the brain cortex can be distracted from sensing impulses as pain by such techniques
as imagery, thought stopping, and aromatherapy and yoga.
o Anesthetic pain relief measures for the first stage of labor designed to stop pain at lower
sensory sites, NOT the upper motor sites, so strong ctxs can continue AND we need her to
be able to effectively push when she gets to 2nd stage
Perception
o Influencing factors (anxiety, worry, body image, self-efficacy, availability of support people
o Expectations and preparation for labor
Comfort and Pain Relief
Support from doula or coach
o Some partners are unable to provide the role of coach d/t their emotional role i.e. too
involved in birth.
o Having an effective doula can increase a woman’s self esteem, speed the labor process, and
improve breastfeeding success as well as decrease rates of oxytocin augmentation, epidural
anesthesia, C/S birth and postpartum complications (2013).
o An effective coach can also provide that b/c some women cannot afford cost of doula.
Please don’t get idea a woman who can’t have a doula will not have these successes. It is
about having a supportive and active coach.
Alternative therapies
o Non-pharmacologic measures and are based on gate control theory (we also discussed this
in chapter 14 – page 314 excellent discussion/examples) that DISTRACTION can be effective
at preventing the brain from processing pain sensations coming into the cortex
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