LABOR PAIN MANAGEMENT

BY
TIYAS K

DEPARTMENT OF CHILD & MATERNITY NURSING,

AIRLANGGA UNIVERSITY, 2014

DEFINITION
Pain:
An unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or
described in terms of such damage (International
Association for the Study of Pain (IASP), 1980)
Labor pain:
Pain as a result of childbearing process (uterine
contraction, cervical softening, effacement, and dilatation,
the descent of presenting part into the pelvis, and
psychological condition of mother)

LABOR PAIN
Physical factors:
Muscle cramps and straining
Medical tests and procedures (pelvic
exams, shots, IVs, catheterization, and so
forth)
Descent of the baby

LABOR PAIN
Psychological factors:
Fear of pain
Fear of the unknown
Anxiety
Self-doubt
Lack of education
Exhaustion
Dehydration
Hunger
(Source: The American College of Obstetrics and
Gynecology, 2009)

CAUSES
First stage: uterine contractions and
dilatation of the lower uterine segment and
cervix to allow passage of the fetus.
Second stage: greater pressure of the
presenting part on pain-sensitive pelvic
structures and distension of surrounding
structures.

PATHWAYS
Uterus and cervix: mainly via A-delta and C
fibers passing in the sympathetic nerves to the
sympathetic chain; referred to the T10L1
dermatomes.
Vagina and pelvic outlet: via A-delta and C fibers
passing in the parasympathetic bundle in the
pudendal nerves; referred to the S2S4
dermatomes.
Other: contributions from the ilioinguinal,
genitofemoral, and perforating branch of the
posterior coetaneous nerve of the thigh; somatic
pain experienced in the L2S5 dermatomes.

PAIN REGION
Labor contractions are felt:
in the back, legs,
lower abdomen
accompanied by menstrual-like or
gastrointestinal cramping sensations,
spreading to the perineum and thighs
(Lowe 2000, ACOG, 2000).

CONSEQUENCES OF LABOR PAIN

Respiratory:
hyperventilation, leading to hypocapnia and
respiratory acidosis.
Cardiovascular:
increases cardiac output and blood pressure via
sympathetic activity; Increased venous return
Neuroendocrine:
increases maternal catecholamine secretion with risk
of uteroplacental constriction.

CONSEQUENCES OF LABOR PAIN

Gastrointestinal:
delayed emptying and increased acid secretion
Psychological:
long-term emotional stress, with potential
adverse consequences on maternal mental
health and family relationships.

BENEFITS
Indicates to the mother and those
assisting labor/delivery that contractions
are occurring.
May have positive connotations regarding
childbirth, related to societal/cultural
influences.
May indicate problems (e.g. uterine
rupture, placental abruption).

PAIN THEORY
Specificity theory
This theory proposed that a specific system of
nerves carry messages from pain receptors in the
skin to a pain centre in the brain and that the
intensity of the pain is correlated to the amount of
tissue damage
Pattern theory
The most important feature of pain is the amount of
stimulation (tissue damage, injury)

Gate control theory

Stimulation in
C fiber(pain
fiber) open the
gate, causing
pain

Gate control theory

Stimulation in
A fiber
(sensory
nerves) close
the gate,
causing pain
reduced

Natural Labor Pain management

Counter Pressure
Environmental Conditions
Breathing Techniques
Water
Birthing Aids
Vocalization
Visualization
Emotional Support

Counter Pressure
an effective labor pain management
strategy for back labor or other areaspecific discomfort. It is performed by
applying pressure, usually significant
pressure, to an area of discomfort

Water
Laboring women can get in the shower
and direct the water stream to specific
areas of discomfort. Using a labor tub
decreases the pressure on the mother's
body, alleviating pressure and making her
more buoyant. This can enhance her
relaxation and facilitate comfortable
birthing positions

Breathing Techniques
Lamaze
controlling deep breath and muscle
relaxation
Bradley
controlling deep breath with aid from
husband

Vocalization
A birthing woman may choose to moan
with her contractions. She may choose to
softly sing, chant, or grunt. She needs to
follow her body and know that whatever
sounds she makes are good sounds, are
natural sounds

Visualization
Mental imagery / guided imagery
Laboring women may visualize their cervix
opening, their baby descending the birth
path, or their breath as it enters and exits
the body. These techniques are
particularly effective when paired with a
imagery relaxation script, either read by a
birth companion or in audio form

Other non Pharmacology Technique

Effleurage Method
Hypnosis
Acupressure
Aroma therapy

Pharmacology Technique
Pain relief with a narcotic such as meperidine,
plus one of the tranquilizer drugs such as
promethazine, is usually appropriate.
PUDENDAL BLOCK
PARACERVICAL BLOCK
SPINAL (SUBARACHNOID) BLOCK.
EPIDURAL ANALGESIA.
COMBINED SPINAL-EPIDURAL
TECHNIQUES.
General anesthesia

Analgesia & Anesthesia

Pudendal block

Subarachnoid block

Epidural anesthesia

References
Lowe N. The nature of labor pain. Am J Obstet Gynecol
2000; 186:S1624.
J. Edmond Charlton, Core Curriculum for Professional
Education in Pain, IASP Press, Seattle, 2005.
F. Gary Cunningham...[et al.]. 22nd ed. Williams
obstetrics 2005
Smith CA, Collins CT, Cyna AM, Crowther CA.
Complementary and alternative therapies for pain
management in labor. Cochrane Database of Systematic
Reviews 2006
Youngkin, Marcia Szmania Davis.3rd ed Women's
health: a primary care clinical guide 2004

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