DANGER SIGNS; DURING LABOR AND DELIVERY

High or Low Fetal Heart Rate - normal fetal heart rate ranges only from 120-160 bpm. Lower than120 is termed as
fetal bradycardia, and higher than 160 is 'fetal tachycardia. Both are danger signs. Another important sign is late or
variable deceleration pattern on the fetal monitor.

FETAL DANGER SIGNS:

1. Meconium Staining - in a fetus with a cephalic presentation, meconium staining is a sign of fetal distress. may
indicate fetal hypoxia causing increased motility of the fetus' GIT. In breech presentation, staining may be
normal, but it should still be reported to the physician.

2. Hyperactivity - this may also indicate hypoxia is occurring. Normally, fetus is quiet and barely moving during
labor.

3. Fetal Acidosis -using scalp capillary technique, blood analysis can be made during labor. A pH of below 7.2
indicates acidosis and is a certain sign of fetal distress.

MATERNAL DANGER SIGNS:

1. Rising or Falling Blood Pressure - BP of the mother normally rises slightly in the second stage of labor due to
the pushing efforts. A decrease in BP is also a danger sign for it may indicate an occult intrauterine
hemorrhage.

2. Abnormal Pulse - normal average pulse rate is 70-80 bpm. It normally increases slightly during the second
stage of labor. Tachycardia usually indicates impending shock.

3. Inadequate Prolonged Contractions - when contractions become less frequent, less intense and shorter in
duration, 'this may indicate uterine exhaustion or uterine inertia. It must be corrected or else a CS must be
performed.

4. Pathologic Retraction Ring - can signal impending uttering rupture.

5. Abnormal Lower Abdominal Contour - distended bladder, which can displace uterus and cause uterine atony.
It may also be injured due to the pressure of the fetal head and vice versa.

6. Increasing apprehension.

PAIN RELIEF DURING CHILDBIRTH

ASSESSMENT:
· The sensation of discomfort, is a subjective, personal symptom
· It is unique to each individual
· Pain scale
·Look for objective signs

NURSING DIAGNOSIS
o Pain r/t labor contractions.
o Powerlessness r/t the unexpected duration and intensity of labor.
o Anxiety r/t lack of knowledge about “normal" labor process
o Risk for situational low self-esteem r/t ineffectiveness of prepared childbirth breathing exercises
o Decisional conflict r/t use of analgesia or anesthesia during labor.

PLANNING
o Consider the woman's perceptions about childbirth, her past childbirth experiences (if any), and the amount
and type of childbirth preparation she and her partner made so the expected outcome is realistic.

IMPLEMENTATION
o Keeping a woman and her support person informed about their options and how they differ as labor
progresses is important.
 o Support and encourage a woman to use methods of complementary and alternative therapies for pain
management (ex. Relaxation, prayer, etc.)
o Give pain medications necessary (ex. Analgesia).

EVALUATION
o Client states that pain during labor was within a tolerable level for her. Couple/ client report that they felt
control throughout the labor process Client states that she does not feel intimidated by degree of pain during
labor.

PHYSIOLOGY OF PAIN

PAIN RECEPTORS AND STIMULI

NOCICEPTORS
o are located extensively in the skin and mucosa and less frequently in selected deeper structures, such as
viscera, joints, arterials walls and bile ducts.
o responds to harmful or potentially harmful stimuli that may be chemical, thermal, and mechanical.

CHEMICAL STIMULI FOR PAIN INCLUDES:

a) Histamine: chemical substance in body tissues which in small doses has profound and diverse action on
muscle, blood capillaries and gastric secretions
b) Bradykinin: it has a vasomotor action that increases the permeability of capillary walls &contributes to the
formation of edema.
c) Prostaglandin: apparently involved in normal body functioning and in certain pathological conditions.
d) Acids

PERCEPTION OF PAIN

The amount of discomfort of a woman experience during contractions differs according to her expectations of and
preparation for labor; the length of her labor; the position of her fetus the presence of fear, anxiety, or worry; body
image; self-efficacy; and the availability of support people around her.

Women who believe that they can control their situation (have self- efficacy) are more apt to report a satisfactory birth
experience than those who do not feel in control.

Fetal position is a physical variable that can influence the degree of pain a woman. experiences.

Pain is perceived differently by different individuals because of psychosocial, physiologic, and cultural responses.

The body's ability to produce and maintain endorphins (naturally occurring opiate-like substances) may influence. A
person over all pain threshold and the amount of pain a person perceives at any given time.

COMFORT & PAIN RELIEF MEASURES

PERCEPTION OF PAIN
o Support from a Doula or Coach. A doula is a woman who is experienced in childbirth, but without
professional credentials, who assists women in labor.
o Complementary and Alternative Therapies for pain relief:

1. Nonpharmacologic measures
2. Pharmacologic management

NONPHARMACOLOGIC PAIN MANAGEMENT

Relaxation
o had the woman to find comfortable position during labor.
o Let the woman listen to a soft music(spa music) -Let the woman bring some aroma therapy.

Focusing and Imagery

o Concentrating intently to an object is another method of distraction(focusing) –
o a woman uses a photograph of someone important to her or some image she finds appealing. (imagery)
Prayer
o first measure to relieve stress

Breathing techniques
o They are advantageous because they help to relax a woman's abdomen.

Herbal Preparations
o Several herbal preparations have traditionally been used to reduced-pain(raspberry leaves)

Aromatherapy and essential oils

o is the use of aromatic oils to complement emotional and physical well-being.
o Their use is based on the principle that the sense of smell plays a significant role in overall health.

Heat or cold application

o women who are having back pain may find application of heat to the lower back by a heating pad or a moist
compress comforting.
o Women who become warm from the exertion of labor find a cool washcloth to the forehead comforting.
o Ice chips to suck on to relieve mouth dryness are also refreshing.

Bathing or hydrotherapy
o Standing under a warm shower or soaking in a tub of warm water, jet hydrotherapy tub, or whirlpool is
another way to apply heat to help reduce the pain of labor,(95-100 degrees F) or (35-37.8 degrees celcius) to
prevent hyperthermia.

Therapeutic touch and massage

o therapeutic touch-is the use of touch to comfort and relieve pain(touch therapy)
o increase the release o endorphins
o Effleurage, the technique of gentle abdominal massage is a form of therapeutic touch.

Reflexology
o is the practice of stimulating the hands, feet, and ears as a form of therapy

Crystal or Gemstone therapy

o some gemstone or crystals are thought to have healing powers.
o some woman may bring these into a birthing room to have with them during labor.

Hypnosis
o a woman who wants to use this modality needs to meet with her hypnotherapist during pregnancy

Therapeutic touch and massage

o therapeutic touch-is the use of touch to comfort and relieve pain (touch therapy). increase the release o
endorphins
o Effleurage, the technique of gentle abdominal massage is a form of therapeutic touch.

Yoga and meditation

o Yoga, a term derived from the Sanskrit word “union", describes a series of exercises that were originally
o designed. to bring people to their God. consists of DBE, body postures, and meditation.
o Meditation- is a self- directed practice for relaxing the body and calming the mind.
o Mindfulness- based stress reduction ( MBSR )

Transcendental meditation (TM)

o relieves pain by counteracting on nociceptors

Biofeedback
o is based on the belief that people havecontrol and regulate internal events (heartrate and pain responses)

Transcutaneous electrical nerve stimulation (TENS)

o Acupressure -is the application of pressure or massage at this points. A common point used for a woman in
labor is Co4( Hoku or Hegu point ) located bet. The first finger and thumb on 'he back of the hand.
 o Acupuncture -is based on the concept that illness results from an imbalance of energy. To correct the
imbalance, needles are inserted into the skin at designated susceptible body points ( tsubos )
Intracutaneous Nerve Stimulation( INS)
o is a technique of counterirritation involving the ID injection of sterile water or saline along the borders of the
sacrum to relieve low backpain during labor.

PHARMACOLOGIC PAIN MANAGEMENT

Pharmacologic measures
o Analgesia
o Anesthesia-regional, epidural, spinal, general
o Narcotics