PAIN MANAGEMENT During labor

Outlines:
❖Introduction
❖Factors effecting pain during labor
❖Common pain causes
❖Signs and symptoms during labor
❖Pharmacological management of pain during labor
❖Non pharmacological pain management during labor
❖Conclusion
❖References
 I NT RO DU CT I O N:
❖T h e r e a r e a l o t o f c a u s e s o f p a i n d u r i n g p r e g n a n c y a n d a f t e r p r e g n a n c y t h a t
a r e v e r y c o m m o n a n d c a n b e i n c a p a c i t a t i n g if n o t t r e a t e d a p p r o p r i a t e l y .
❖P a i n d u r i n g l a b o r i s d i ff e r e n t f o r e v e r y w o m a n . It v a r i e s w i d e l y f r o m w o m a n t o
w o m a n a n d e v e n f r o m p r e g n a n c y to p r e g n a n c y . W o m e n e x p e r i e n c e labor p a i n
differently
❖P a i n m a n a g e m e n t t h a t d e fi n e d “ T h e p r o c e s s o f p r o v i d i n g m e d i c a l c a r e t h a t
alleviates o r r e d u c e s pain. Mild to m o d e r a t e p a i n c a n usually b e treated with
analgesic medication.”
❖T h e r e a r e c o m m o n p a i n c o n d i t i o n s t h a t p r e s e n t d u r i n g l a b o r a n d c a n b e
m a n a g e d with pharmacological a n d nonpharmacological treatment options,
for e a c h of the pain conditions during labor .
 Factors effecting pain during labor:
v Labor is considered to be one of the most painful experiences in life.
v Labor pain is an inevitable and intricate part of the childbirth.
v The intensity of the pain experienced during labor affects maternal psychology, labor
progress and fetal well-being.Physiological factors, such as uterine contractions and cervical
dilatation though essential parts of labor, are the major contributors to labor pain.

v Psychological factors, such as stress, anxiety, fear, sense of loss of control and sense of
abandonment also contribute to it. There is a wide spectrum of factors which may influence
labor pain including personal, physical and medical characteristics.
 C O M M O N PAIN C A U S E DU RI NG
P REGNANCY :
❖P a i n d u r i n g l a b o r i s c a u s e d b y c o n t r a c t i o n s o f t h e m u s c l e s o f t h e u t e r u s
and by pressure on the cervix.
❖T h i s p a i n c a n b e f e l t a s s t r o n g c r a m p i n g i n t h e a b d o m e n , g r o i n , a n d b a c k ,
as well as an a c h y feeling. S o m e women’s e x p e r i e n c e pain in their sides
o r thighs a s well.
❖O t h e r c a u s e s o f p a i n d u r i n g l a b o r i n c l u d e p r e s s u r e o n t h e b l a d d e r a n d
bowels b y the baby's h e a d a n d the stretching of the birth canal a n d
vagina.
 S I G N AND S Y M P T O M
DU RI NG L A B O R :
● Persistent lower b a c k pain o r a b d o m i n a l pain, with c r a m p s that feel like p e r i o d pain.
● Painful contractions o r tightenings that m a y b e irregular in strength a n d frequency, a n d
m a y s t o p a n d start.
● Broken waters (ruptured membranes). Your m e m b r a n e s m a y rupture with a gush or a trickle
o f a m n i o t i c fl u i d . A l t h o u g h t h i s c a n h a p p e n l o n g b e f o r e l a b o u r s t a r t s , y o u s h o u l d still c a l l
y o u r m a t e r n i t y unit to let t h e m know.
● A sticky, jelly-like m u c u s d i s c h a r g e , w h i c h m a y b e ti n g e d with b l o o d (bloody show). This is t h e
m u c u s p l u g t h a t b l o c k s t h e c e r v i x d u r i n g p r e g n a n c y . If it c o m e s o u t , l a b o u r c o u l d s t a r t s o o n ,
o r i n a f e w d a y s . It's a s i g n t h a t t h i n g s a r e m o v i n g a l o n g .
● An upset t u m m y or loose bowels.
PHARMACOLOGICAL MANAGEMENT
DURING LABOR
There are five of pharmacological management during labor:

❖ Narcotics analgesic

❖ Spinal block

❖ Epidural anesthesia

❖ Local anesthesia

❖ General anesthesia
 PHARMACOLOGICAL
MANAGEMENT DURING LABOR

■Non-pharmacologic comfort therapies along with

medical interventions may enhance the effectiveness of a
lower dose of medication, which will limit side effects for
the mother and baby.
■ Narcotic Analgesics
■usually given directly into an IV Effects are felt within
two to four minutes. The mother can stand, walk, and
shower during labor. Mother may feel relaxed and
mildly drowsy. Labor may speed up, At other times it
may temporary slow the progress.
 PHARMACOLOGICAL
MANAGEMENT DURING LABOR
■ Local Anesthesia
■ local anesthetic can be inject into the vagina or the area
surrounding it to ease pain.
■usually affect a small area and are especially useful
prior to an episiotomy or the repair of a laceration. It rarely
affects the baby and after it wears off
■ The main limitation is that they do not relieve the pain of
labor contractions.
 PHARMACOLOGICAL
MANAGEMENT DURINGLABOR(cont”)
■ Epiduralanesthesia
■ themost effective method of pain control during labor.
■involves theplacement of a small catheterinto thelower back by
an anesthesiologist. A continuous infusion of medication is
administered through thecatheterto provide a constant level of
anesthesia.
■They may cause themother’s blood pressure to drop, which in turn
may slow thebaby’s heartbeat. Before receiving theepidural, fluids
are given through an IV and themother is positioned on herside to
improve circulation.
■The mother needs to be instructed for the correct position which is to
bend downward and be as much stable as possible, hugging a pillow
could help stabilizing the mother.
 PHARMACOLOGICAL MANAGEMENT
DURING LABOR
■ Spinal Block
■A spinal block is given as an injection into
thelower back. No catheteris required because
the medication is injected into thespinal fluid
■most often used for Cesarean births or procedures
where it is not necessary for themother to help push her
baby out.
■The same position as epidural anesthesia is needed.
■it's important to inform the mother that she will loss
the sensation in her lower abdomen and legs
temporarily.
 PHARMACOLOGICAL MANAGEMENT
DURING LABOR (CONT’)

■ General Anesthesia
■ General anesthetics are medications that cause a loss of
consciousness
■ It can be administered intravenously or inhaled as a gas.

■They are rarely used except for emergency Cesarean

deliveries or in thevery rare case when anatomy of thespine
does not allow for spinal insertion.

■It may cause light headedness and nausea after it wear off.
NON-PHARMACOLOGICAL
MANAGEMENT DURING LABOR:
Maternal Movements and Positional Changes:
Laboring women find some positions and
movements more comfortable than others in
different stages of labor. Many studies suggest
walking or sitting more upright speeds the rate of
labor. Some sample positions include upright,
squatting, side, flat, and hand and knees position.
NON-PHARMACOLOGICAL
MANAGEMENT DURING LABOR:
Patterned Breathing:
Thesebreathing techniques provide comfort and focus while enhancing labor progress. Patterned breathing enhances
oxygen flow to the baby and is also vital to the contracting uterus.
Technique:
This video will show us the benefits of patterned breathing and the techniques.
https://youtu.be/_UNtEozszIo
NON-PHARMACOLOGICAL
MANAGEMENT DURING LABOR
(CONT’):
Touch and Massage:
Touch can convey pain-reducing messages. A hand placed on a painful spot,
a pat of reassurance, stroking the cheek in an affectionate gesture, or a
tight embrace can communicate a message of caring to the laboring
woman.
Relaxation:
Laboring woman can use different relaxation techniques to ease pain. Some
people like music, some like meditation, some like incense. Generally,
relaxation techniques help ease pain in labour.
NON-PHARMACOLOGICAL
MANAGEMENT DURING LABOR (CONT’):
Water immersion:
Most hospitals will have facilities that allow women to have a bath or shower
during the first stage of labour.Many women find that being in a warm bath
is relaxing and helps them to cope with the contractions. They might also find
having a shower can help with any back pain they might be experiencing.
Benefits of water immersion:
There may, however, be some benefits to sitting in a tub of warm
water during the first stage of labor.First, water immersion might
provide some pain relief. Studies have found women who relax in a
warm tub or shallow pool during the early stage of labor tend to use
epidural analgesia slightly less than those who do not.
Second, women who use water immersion tend to have a shorter
length of labor – by about 32 minutes.
Statistics:
Summarization for non-
pharmacological management:
Non-pharmacological methods of labor pain relief are an important part of antenatal education. Most
women are interested in natural techniques before labor.More than half of women use natural methods of
pain relief during labor. In their opinion the most effective are massage, breathing techniques and water
immersion.The intensity of labor pain is reduced by the use of natural techniques.

This video will summarize all the non pharmacological techniques:

https://youtu.be/dRpfPOLMX3Y
Conclusion:
❖ Labour pain management includes a broad range of pharmacologic and no
pharmacologic intervention strategies. Despite the popularity and effectiveness of
pethidine and epidural analgesia it is of great importance to bare in mind the
possible side-effects.

❖ Epidural analgesia is the gold standard of labour pain relief, however water birth
was found to be associated with the highest satisfaction level of the parturient
women.
 R E F E R E N C E S :
_ Elana Pearl Ben-Joseph, M D (June 2018) Pain During Labor and Delivery, Available at:
https://kidshealth.org/en/parents/childbirth-pain.html (Accessed: 15 February 2020).
_Shalini Shah, 1 Esther T. Banh, 1 Katharine Koury, Gaurav Bhatia, Roneeta Nandi, and Padma
Gulur 1 , (2015 Sep 13) Pain Management in Pregnancy: Multimodal Approaches, Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4584042/ (Accessed: 15 February 2020)
_ Pharmacologic Pain Management During Labor. (2014.). Newton-Wellseley Hospital, available at:
https://www.nwh.org/patient-guides-and-forms/maternity-guide/maternity-chapter-3/comfort-measures-during-labo r-and-delivery-
pharmacologic-methods ( accessed: 15 February 2020).
_Eappen S, Robbins D. Nonpharmacological means of pain relief for labor and delivery. Int
Anesthesiol Clin. 2002;40(4):103–114.