PAIN MANAGEMENT

DURING SECOND
STAGE OF LABOR

SELECTION OF TOPIC

16700

Data kelahiran

16600
16500
16400
16300
16200
16100

16540
2012

16602
2103

16298
2014

WHAT IS LABOR?
Stages in labor

Definition

Clinical Manifestation

From onset of labor

to full dilation of the

cervix (about 10cm)
has 2 phases, latent
and active.

First stage

Hypertonic dysfunction /
hypotonic dysfunction.
Prolong latent stage.
Dystocia;
o Martenal Haemorrhage.
o Fetal Brachial plexus
injury.
o Fx clavicle.
o C-spine.
o Asphyxia to the infant.
Chorioamnionitis.

The second stage of

labor begins from full
cervical dilation to
delivery of the fetus.

Fetal distress.
Fetal hypoxia.
Fetal acidemia.
Maternal distress.

Begins after delivery

of the infant and
ends with delivery of
the placenta.

Postpartum haemorrhage.
Retained placenta.
Inversion of the uterus.
Obstetric shock.

Second stage

Third stage

Effacement : Ripening of
the cervix The cervix
become softening and
thinning.
Dilation: Opening of the
cervix.
Increase in vaginal
discharge bloody show.
Rupture of membranes.
Contraction of the
uterus.

Complication might be happen

WHAT IS PAIN MANAGEMENT?

The management of labor pain is a major

goal of intrapartum care. There are two
general approaches: pharmacologic and
nonpharmacologic (Lowe, 2002).

Most women use nonpharmacologic

approaches for managing labor pain, with or
without pharmacologic approaches
(Kozhimannil et al. 2003).

OBJECTIVE AND PURPOSE

At the end of this session the student will be

able to;
Define

second stage of labor.

State the factors predisposing pain in second
stage labor.
Explain the clinical manifestation of pain in
second stage of labor.
Improve the quality of nursing care in managing
the mother with labor pain during labor.

HYPOTESIS.

For most women;

The

process of giving birth is the most intense

physical feeling.

labor

pain should not necessarily be treated

with medications.

Non-medical

method are safer than medical

methods in treating labor pain.

CASE STUDY-BIODATA.

Mother - 29 years old;

G2P1.
EDD

18/08/2015.
Body weight 58kg.
Height is 150cm.
Diagnosed having anemia at 36/52 of gestation.
Blood pressure 110/70mmhg.
Hb: 10.6gm%.

CASE STUDY HISTORY.

Refer by Patient Assessment Centre (PAC) @

4.30am with complaint of labor pain and
leaking liquor with show since 12.30am.
On admission vital sign;
BP

134/84mmHg.
PR 84/min.
Temp. 37 celcius .

Presented with uterus contraction 3:10 (2530).

The cardiotocograph reading is reactive and
no fetal distress is detected.

Vagina examination;
Os:

5cm.
Cx: 0.5cm/soft.
Membrane absent.
St: -2.

Mother is bearing down and restless during

contraction .
Analgesic given using epidural method.

CASE STUDY EPIDURAL EFFECT.

Mother;
Mother

feel better after

epidural given.
Vital sign are normal.
No complaint of SOB or
headache.

Child;
No fetal distress.
APGAR Score 9/10 in
One minute.

LITERATURE REVIEW.

Study by Mugambe and friends, are using

descriptive study included 151 women, 18
years or older, attending the antenatal clinic.

Most of the women (99.3%) believed that the

staff had an important role to play in helping
to relieve labor pain.
(Mugambe, Nel, Heimstra & Steinberg, 2014)

In other studiesCraig, Grant, Tao, McIntire &

Leveno (2015), observational study carried
out a total of 66 pregnant women received
inhaled nitrous oxide and oxygen during
labor on request and after prior assessment
of suitability.

There was no difference in degree of motor

blockade, incidence of operative delivery,
visual analog scores, or neonatal outcomes
between the two groups.
(Grant, Tao, McIntire & Leveno, 2015)

In other studies, (Dammer et.al (2014),

observational study carried out between
April and September 2013, a total of 66
pregnant women received inhaled nitrous
oxide and oxygen during labour on request
and after prior assessment of suitability.

A statistically significant reduction of pain

was achieved with nitrous oxide and oxygen.

The inhaled analgesia was mostly used by

women who refused epidural analgesia.
(Dammer et al, 2014).

Anim-Somuah, Smyth & Jones (2011), which

is the method of the studies collected from
the Cochrane Pregnancy and Childbirth
Group's Trials Register (31 March 2011) and
randomised controlled trials.

Epidural analgesia was found to offer better

pain relief in reducing pain during labour.
(Anim-Somuah, Smyth & Jones (2011).

RECOMMENDATION.

Delivery facilities must offer every woman

privacy and allow her to be accompanied by
husband, friend, mother, or relative.

Psychosocial support, education,

communication, choice of position, and
pharmacological methods appropriately
used.

Monitoring of the fetal heart beat must be

continued during the second stage to allow
early detection of bradycardia.

Women should not be forced or encouraged

to push until they feel an urge to push.

Provision of critical skills for second stage

management needs to be supported by
policies as well as training, simulations
(drills), and linkage with a functioning
referral system.

Thank you