Maternity Chapter 7

Childbirth prep classes

Exercise

Gestational diabetes classes

Sibling classes

Grandparents classes

Breastfeeding

Infant care

VBAC classes

Childbirth pain is part of a normal birth process. The mother has several months to prepare for pain management. Is self limiting and rapidly declines after birth.

Pain Threshold

Sources of pain during labor

CNS factors ( gate control theory, endorphins)

Maternal conditions (cervical readiness, pelvis, labor intensity, fatigue)

Fetal presentation/ position

Do not harm the mother or fetus. They also do not slow labor if the provide adequate pain control. They also do not carry any risks for allergy or adverse effects.

Dick- Read method

Bradley method

Lamaze method

Dilation/stretching of cervix

Reduced uterine blood supply during contractions

Pressure if the fetus on pelvic structures

Stretching of the vagina/ perineum

Natural body substances similar to morphine.

Explains how pain impulses reach the brain for interpretation.

Dick-Read was an English physician who introduced the concept of a fear-tension pain cycle during labor. Believed that fear of childbirth contributed to tension which resulted in pain.

Originally called “husband coached childbirth” and was the first to method to include the father as an integral part of labor.

Aka psycho prophylactic method: it is the basis of most childbirth prep classes in the U.S. It uses mental techniques that that condition women to respond to contractions with relaxation instead of tension.

Relaxation techniques

Skin stimulation

Positioning

Diversion/distraction

Breathing

Several variations of massage are often used during labor including:

Effleurage

Sacral pressure

Thermal stimulation

Muscle fatigue and strain. In addition position changes can also promote the normal mechanisms of labor.

Focal point changes

Imagery

Music

Television

Most effective if practiced before labor. Should not be used until they are needed

Deep inspiration and expiration similar to a deep sigh. Help the mother to relax and focus.

Slow- paced breathing

Modified- paced breathing

Patterned- paced breathing

Woman begins with slow paced breathing. Starts the pattern with a cleansing breath, then breathes slowly, as during sleep. A cleansing breath ends the contraction. Exact rate is not important, but about 6-9 breaths per minute is average.

This pattern begins and ends with a cleansing breath. During the contraction the woman breathes more rapidly and shallowly. The rate should be no more than twice her usual rate.

This technique is more difficult to teach the unprepared laboring woman because it requires her to focus on the pattern. Begins with a cleansing breath which is followed by rapid breaths punctuated with an intermittent slight blow aka plant blow or hee hoo.

When it is time to push, the woman takes a cleansing breath, then takes another deep breath and pushed down while exhaling to a count of 10.

Analgesics and Anesthetics

Systemic drugs that reduce pain without loss of consciousness.

Cause a loss of sensation, especially of pain.

Regional: loss of sensation

General: loss of consciousness and sensation

Anesthesiologists and Certified registered nurse anesthetist

Meperidine (Demerol): given by IV or intramuscular

Fetanyl (Sublimaze): rapid onset and short duration of action, often used with an epidural. Can cause respiratory depression.

Nalbuphine (Nubain): reduce pain and is thought to cause less respiratory depression than meperidine. Should not be used in women who are drug addicts.

Naloxone (Narcan): acts within minutes to help resuscitate a newborn who has respiratory depression because of narcotic sedation of the mother during labor. Duration of action 1-2 hours

All Benzodiazepines: reduce anxiety, nausea and vomiting, may delay achievement of thermoregulation in newborn.

Nitrous oxide: uses a mask controlled by woman. Decreases awareness of pain. Causes nausea and vomiting.

Woman is in sitting or side lying position, her back is relatively straight, rather than sharply curved forward to avoid compressing the tiny epidural space, which is about 1mm (thickness of a dime). The physician or nurse anesthetist penetrates the epidural space with a large needle, and a fine catheter is threaded into the epidural space through the bore of the needle.

Positioning is similar to that for the epidural block except the her back is curled around her uterus in a C shape. The dura is punctured with a thin spinal needle.

A postspinal headache can sometimes occur most likely due to spinal fluid loss. This is performed by the nurse anesthetist or anesthesiologist and provides dramatic relief. Woman’s blood is withdrawn from her vein/injected into the epidural space in the area of the subarachnoid puncture.

Used for vaginal births, although it has become less common as the popularity of the epidural block has increased. Provided adequate anesthesia for an episiotomy and for most low forceps births.