Pain Management During Childbirth [RECORDED LECTURE] — Transcript

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1. 0:01Today we are going to discuss pain
2. 0:03management during labor. Childirth pain
3. 0:06signals that the time of birth is near.
4. 0:10Pain is a subjective and individual
5. 0:13experience and each client's response to
6. 0:16the pain of labor is unique. Safety for
7. 0:19the mother and fetus must be the nurse's
8. 0:22primary consideration when planning pain
9. 0:25management measures.
10. 0:28At the completion of this lesson, we
11. 0:31should be able to examine factors that
12. 0:33influence pain during labor
13. 0:37and compare nonfarmacological
14. 0:41and pharmacological
15. 0:43nursing interventions that assist with
16. 0:45labor.
17. 0:50There are many factors that influence
18. 0:52pain.
19. 0:54There are three basic types of pain in
20. 0:57childbirth.
21. 0:58The first type of pain is associated
22. 1:02with muscle contractions as the cervix
23. 1:05is opening or dilating.
24. 1:08The second type of sensation is a
25. 1:10feeling of intense pressure as the baby
26. 1:13gets lower and pushes on the muscles in
27. 1:16the pelvis.
28. 1:18The third type of pain is a feeling of
29. 1:20burning or stretching as the vagina and
30. 1:23skin stretch.
31. 1:26Some physical factors that affect pain
32. 1:29sensation are cervical readiness, fetal
33. 1:32position, fatigue, and nursing
34. 1:36interventions.
35. 1:38Psychosocial factors include culture,
36. 1:41previous experience,
37. 1:44childbirth preparation, and the client's
38. 1:47personal support system.
39. 1:51The fear, tension, pain cycle developed
40. 1:54in the 1920s to describe how fear causes
41. 1:58increased pain during childbirth.
42. 2:02As fear and anxiety increase, muscle
43. 2:06tension increases and pain increases.
44. 2:10To help reduce pain during labor, the
45. 2:14nurse can reduce fear by educating the
46. 2:17client about what is happening and
47. 2:20reducing tension by promoting
48. 2:22relaxation.
49. 2:27There are many non-farmacological
50. 2:30pain management techniques that help
51. 2:32reduce anxiety, fear, and tension, which
52. 2:36are major contributing factors to pain
53. 2:39in labor.
54. 2:41Child birth education, which are classes
55. 2:44that clients take during pregnancy to
56. 2:47learn about labor, patterned breathing
57. 2:50techniques, and newborn care. Some other
58. 2:53relaxation techniques include aroma
59. 2:56therapy, music, low lighting, active
60. 3:00birthing positions, and hydrotherapy.
61. 3:04Ephilage is a technique that uses light,
62. 3:09gentle, circular stroking of the abdomen
63. 3:13in rhythm with breathing during
64. 3:15contractions.
65. 3:17Using sacral counter pressure by placing
66. 3:21the heel of your hand to apply
67. 3:24consistent pressure to the sacrum to
68. 3:27counteract lower back pain.
69. 3:33Pharmacological pain management includes
70. 3:36analesia and anesthesia.
71. 3:39Pain medication alleviates pain
72. 3:42sensations or raises the threshold for
73. 3:45pain perception.
74. 3:47Analesia provides pain relief while
75. 3:51still allowing the client to sense
76. 3:54contractions.
77. 3:56Anesthesia
78. 3:58eliminates pain perceptions by
79. 4:01interrupting the nerve impulses to the
80. 4:04brain.
81. 4:07Opioid analesics act in the central
82. 4:11nervous system to decrease the
83. 4:14perception of pain without the loss of
84. 4:17consciousness.
85. 4:19The most common opioid anesic used is
86. 4:23fentinyl. The client can receive opioids
87. 4:27via IM or IV
88. 4:31during the early part of active labor.
89. 4:34But the intravenous route is recommended
90. 4:37because the action is quicker.
91. 4:40Nurses need to educate their clients
92. 4:42that opioid use can cause drowsiness. It
93. 4:46is important to instruct clients to call
94. 4:48for help with ambulation.
95. 4:51Opioid use can have adverse effects
96. 4:54causing decreased fetal heart rate
97. 4:56variability,
98. 4:58nausea and vomiting, sedation, or
99. 5:02neonatal respiratory distress if given
100. 5:05too close to delivery.
101. 5:08Prior to administering opioid analesics,
102. 5:11the nurse must verify labor is well
103. 5:13established. When administering
104. 5:16oberoids, the nurse must monitor
105. 5:19maternal vital signs, contraction
106. 5:22pattern, and fetal well-being.
107. 5:25Be prepared to administer anti-imetics
108. 5:28as prescribed for nausea and vomiting.
109. 5:30And assess for adverse reactions, and be
110. 5:33prepared to administer Narcan for
111. 5:36respiratory distress.
112. 5:42An epidural block consists of a local
113. 5:44anesthetic
114. 5:46bivocaine
115. 5:48along with an analesic morphine or
116. 5:51fentanyl injected into the epidural
117. 5:54space at the level of the fourth or
118. 5:57fifth vertebrae.
119. 5:59This eliminates pain from the level of
120. 6:01the umbilicus to the thighs, relieving
121. 6:05the discomfort of uterine contractions,
122. 6:08fetal descent and stretching of the
123. 6:10paranium. However, this might not remove
124. 6:13pressure sensations. It is administered
125. 6:16when the client is in active labor and
126. 6:19dilated to at least 4 cm. Continuous
127. 6:23infusion or intermittent injections can
128. 6:25be administered through an inddwelling
129. 6:29epidural catheter.
130. 6:31An epidural block can cause fetal brada
131. 6:34cardia, maternal itching and maternal
132. 6:37hypotension.
133. 6:40Maternal hypotension is the most common
134. 6:42adverse effect on an epidural block. The
135. 6:46labor nurse must be prepared to
136. 6:48administer ephedrin to increase the
137. 6:51blood pressure. Position the client on
138. 6:54her left lateral side. Increase the IV
139. 6:57fluid and give oxygen. Sometimes
140. 7:01multiple doses of ephedrin are
141. 7:03necessary.
142. 7:05Prior to a client receiving an epidural
143. 7:08block, the nurse will administer a bolus
144. 7:10of IV fluid to help prevent the expected
145. 7:14maternal hypotension.
146. 7:16The labor nurse will also assess
147. 7:18maternal vital signs, contractions, and
148. 7:22fetal heart rate patterns as well as
149. 7:24placing the client in a left sideline
150. 7:27position to promote circulation and
151. 7:29oxygenation. The nurse will also insert
152. 7:32a foley catheter and provide client
153. 7:35safety.
154. 7:38A spinal anesthesia block consists of a
155. 7:42local anesthetic vuvocaine injected
156. 7:46below the spinal column directly into
157. 7:49the spinal fluid often in combination
158. 7:52with an analesic such as fentinyl. The
159. 7:55spinal block eliminates all sensations
160. 8:00from the level of the nipples to the
161. 8:02feet. It is commonly used for a
162. 8:06sensorian birth. A low spinal block can
163. 8:10be used for a vaginal birth but is not
164. 8:12used for labor. A spinal block is
165. 8:15administered in the late second stage or
166. 8:18before a cacaian birth.
167. 8:21Maternal hypotension is the most common
168. 8:23adverse effect associated with a spinal
169. 8:26block. Other potential adverse effects
170. 8:29include fetal brada cardia, bladder and
171. 8:32uterine atne after birth and a potential
172. 8:35headache from spinal fluid leak at the
173. 8:37puncture site.
174. 8:39For a client who receives a spinal
175. 8:41block, the nurses will monitor maternal
176. 8:44vital signs, manage maternal
177. 8:46hypotension,
178. 8:48assess level of anesthesia, numbness,
179. 8:51provide client safety, and perform
180. 8:55interventions to manage a spinal
181. 8:57headache
182. 8:59if one develops.
183. 9:02Best nursing actions and management of
184. 9:04postpartum spinal headache is to keep
185. 9:07the client supine
186. 9:09in a dark room. Give po analesics,
187. 9:14caffeine and fluids.
188. 9:22General anesthesia
189. 9:24is rarely used for vaginal and cacaian
190. 9:27births when there are no complications.
191. 9:31General anesthesia is used when there is
192. 9:33a delivery complication,
193. 9:36emergency or if a client has a counter
194. 9:39indication to nerve block anesthesia.
195. 9:43General anesthesia produces
196. 9:45unconsciousness.
197. 9:48Nursing actions include monitoring
198. 9:50maternal vital signs, ensuring client
199. 9:53has been NPO, applying SEDDS to prevent
200. 9:56DVTs,
201. 9:58and assess the client post delivery for
202. 10:01decreased uterine tone called uterine
203. 10:04atne, which is the primary cause of
204. 10:07postpartum hemorrhage. It is extremely
205. 10:09important to facilitate bonding between
206. 10:12mom and the newborn as soon as possible.
207. 10:19In summary, there are many factors
208. 10:22affecting pain during labor, including
209. 10:24uterine contractions, cervical dilation,
210. 10:27and pressure from the fetus. Management
211. 10:30of labor pain is a major goal of
212. 10:33intraartum nursing care. Two approaches
213. 10:36to manage labor pain include
214. 10:38non-farmacologic
215. 10:40and pharmacologic.
216. 10:42There are a variety of non-farmacologic
217. 10:44methods of pain management during labor
218. 10:47that evidence-based research prove are
219. 10:49very effective. The most common
220. 10:52pharmacological methods of pain
221. 10:54management include opioids, epidural and
222. 10:57spinal nerve blocks, and general
223. 10:59anesthesia when necessary.