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
T10–L1 dermatomes.
• Vagina and pelvic outlet: via A-delta and C
fibers passing in the parasympathetic
bundle in the pudendal nerves; referred to
the S2–S4 dermatomes.
• Other: contributions from the ilioinguinal,
genitofemoral, and perforating branch of
the posterior coetaneous nerve of the
thigh; somatic pain experienced in the L2–
S5 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
Aβ 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 area-
specific 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:S16–24.
• 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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