Pain Management During Labor

Non-Pharmacological Pain Relief Interventions

• Effleurage

  • Lightly stroking the abdomen in rhythm with the patient's breathing during contractions.
  • Provides tactile stimulation to distract the brain from pain.

• Sacral Counterpressure

  • Applying counterpressure to the sacrum to relieve pain, especially effective for back labor.
  • Useful for patients experiencing pain in their back.

• Breathing Techniques

  • Example: "Hee hee hoo" breathing.
  • Helps patients focus on something other than pain and ensures proper breathing.
  • Meditative and calming.

Pharmacological Pain Relief Measures

Systemic Relief

• Opioids

  • Strong and effective for pain relief.
  • Consider baby’s exposure as opioids can pass through the circulatory system.
  • Antidote for opioid toxicity: Naloxone.
  • Signs of toxicity: Respiratory changes, level of consciousness changes (10 or less breaths/min as a key indicator).

• Other Medications

  • Antiemetics: To manage nausea.
  • Benzodiazepines: To help with anxiety.

Inhalation

• Nitrous Oxide (Laughing Gas)
  • Delivered via mask.
  • Effects reverse immediately when the patient breathes regular air.
  • Popular in some countries and useful for those avoiding opioids.

Regional Anesthesia

• Epidural

  • Catheter inserted into the epidural space (L3-L4).
  • Provides pain relief from the belly down.
  • Causes weakness and loss of sensation.
  • Important to move and check on the patient frequently.
  • Major side effect: Maternal hypotension; monitor blood pressure and possibly give IV fluids before administration.

• Spinal Block

  • Administered into the cerebrospinal fluid in the subarachnoid space.
  • One-time injection, typically used for C-sections.
  • Provides pain relief from nipples down.
  • Can cause hypotension; monitor blood pressure and intervene with IV fluids or repositioning.

Local Pain Relief

• Local Infiltration

  • Lidocaine used for numbing during procedures like episiotomy or suturing.

• Pudendal Nerve Block

  • Relief for the low vagina, vulva, and perineum areas.
  • Does not affect contraction pain.

Key Points to Remember

• IV Fluids: May be needed to increase blood pressure during epidural or spinal administration.
• Repositioning: May help with hypotension; place patient on their side or use a pillow under the hip.

Conclusion

• Non-pharmacological and pharmacological interventions both have crucial roles in labor pain management.
• Monitor patient closely when administering pharmacological measures to avoid complications.
• Always be attentive to the patient's needs and comfort.

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