Prepare by:

Romany Lofty

Objectives:At the end of this presentation the student will be

able to: ○define true labor pain

○recognize the management of labor pain ○manage women how is in labor and has a true pain

Out lines: •definition

•physiology of labor pain •how to mange labor pain

•many methods to mange pain of labor

definitionuterine contractions that result in a change in the cervix and in the birth of an infant.

The pain experienced by the woman in labor is caused by the uterine contractions, the dilatation of the cervix and , in the late first stage and the second stage , by the stretching of the vagina and pelvic .These painful stimuli are said to be transmitted by

thoracic . Lumbar and sacral nerves.

Physiology of pain in labor

The pain pathway or ascending sensory tract originates in the sensory nerve endings at the site of trauma. The impulse travels along the sensory nerves to the dorsal root ganglion of the relevant spinal nerve and into

the posterior horn of the spinal cord . This is known as the first neuron

The second neuron arises in the posterior horn, crosses over within the spinal cord ( the sensory decussation ) and transmits the impulse via the

medulla oblongata , Pons varolii and midbrain to the thalamus . From here it travels a long the third neuron to the sensory

cortex.

As a nurse how to manage pain during labor?

There are a lot of methods in relief pain and comfort during labor

.PSYCHOLOGICAL SUPPORT.PHYSICAL CARE

.PHYSIOLOGICAL SUPPORT (psychophysical methods of coping with pain ).ALTERNATIVE METHODS OF PAIN RELIEF

.PHARMACOLOGICAL METHODS OF PAIN RELIEF

○PSYCHOLOGICAL SUPPORT

Preparation for labor

1-giving information

2-allaying anxiety

3-participation in planning

At some stage in her pregnancy every woman will realise the inevitability of the delivery of her baby. Not every women will experience labor but the mother who delivers by planned caesarean section will also have fears and anxieties and will wonder just how she will cope with the experience.

Ideally. Every pregnant womam should have the opportunity to form a relationship whith one particular midwife so that advice may be given consistently and the women become relaxed and feel able to ask for information freely. In this way each mother is able to obtain as much information .as she wishes.As a nurse you should discover what level of information is required

Some women may be anxious at the thought of being given an episiotomy.Although of course women who have experienced childbirth are often a great source of support and constructive advice.

Entering hospital for any reason is often seen as a dehumanizing experience the birth plan commonly used (couples who are able to participate in planning)

Support during labor

1-the environment

2-mobility

3-relaxation techniques

4-conversation

A relaxed, homely atmosphere will help the women and her partner feel at ease more quickly. The attitude of the staff is very important , perhaps more so than the physical details of the environment. The labor room must be furnished

If the women can be encouraged to be upright and mobile, labor is likely to progress more quickly and the woman will feel more in control. And if she encouraged to change position from time to time in order to become as comfortable as possible.

If the women has been taught relaxation techniques she should be reminded of them and supported as she puts her knowledge into practice.

When a women is in labor there are times to talk and times to be silent. At this stage a woman is becoming tired and each contraction requires her complete concentration and all the physical and emotional reserves. Our duty is to take her

attention.

○PHYSICAL CARE

Hygiene and comfort

position

Care of bladder

The woman in labor will become very hot and will perspire profusely so that she will appreciate the opportunity to have a bath or shower if she feels able . A warm bath my be very comforting for the women with backache and she may enjoy soaking herself in deep warm water.

If she isn't able to get up she will appreciate frequent spongingparticularly of her face and neck , with cold water.

Women may need help to find a position which is comfortable.An alternative position ,my be described as any position other than recumbent , semi-recumbent or setting on the bed, in active Birth the woman participates fully in her labor , is very aware of all that is going on within her body and aims to respond to these events naturallyShe will have prepared herself during pregnancy by exercising.

By clean after urination every time to prevent infection

○PHYSIOLOGICAL SUPPORT (psychophysical methods of coping with pain)

Massage

Transcutaneous electrial nerve stimulation (TENS)

Massage stimulates your body to release endorphins, the natural pain-killing, mood-lifting chemicals produced in the brain. Endorphins are responsible for the high that you feel after exercise, or after a good bout of laughter. In labour, massage brings you closer to the person who’s caring for you. This could be your midwife or your birth partner. Touch can make you feel better while you're coping with contractions and perhaps

tired or frightened .

Doctors and midwives often recommend that patients begin utilizing their transcutaneous electrical nerve stimulation units as soon as the first contractions start and labor begins. You can rent units, borrow machines from hospitals, or purchase your own online or in a brick and mortar supplier: “Cost consideration: to purchase a TENS machine, you’re looking at approximately $200-$300 for a good quality machine. Alternatively, there are now some cheap basic models being made by various manufacturers and

you can now hire them (online too) so you will be spending considerably less”.

The use of water for labor and delivery Water birth is the process of giving birth in a tub of warm water. Some women choose to labor in the water and get out for delivery. Other women decide to stay in the water for the delivery as well. The theory behind water birth is that since the baby has already been in the amniotic fluid sac for nine months, birthing in a similar environment is gentler for the baby and less stressful for the mother.

Midwives ,birthing centers, and a growing number ofobstetricians believe that reducing the stress of labor and delivery will reduce fetal complications. Water birth should always occur under the supervision of a qualified health care provider.

Benefits for Mother:Warm water is soothing, comforting, relaxing.

In the later stages of labor, the water has been shown to increase the woman’s energy.

The effect of buoyancy lessens a mother’s body weight, allowing free movement and new positioning.

Benefits for Baby:Provides an environment similar to the amniotic sac.

Eases the stress of birth, thus increasing reassurance and sense of security.

○ALTERNATIVE METHODS OF PAIN RELIEF

Acupuncture

Herbalism

Many mothers are anxious to avoid pharmacological or invasive methods of pain relief in labor and this contributes to the popularity of complementary methods of

analgesia which are coming into more common use.

The mode of action of this ancient practice, which originated in china and the far east, is not fully understood . It may be related to stimulating the release of endogenous opioids as well as interruption of the transmission of pain stimuli.

Is the forerunner of the modern pharmaceutical industry and uses combinations of natural plant extracts . Herbalists claim that their remedies improve general health and physiological balance , as well as improving strength and stamina.

Aromatherapy

Yoga and medication

This involves the use of aromatic oils, some of which are definitely contraindicated in pregnancy an labor . The essential oils used are concentrated extracts of plants and flowers which are thought to restore balance within the mind and body this substances probably work mainly through the limbic system, that part of the brain where emotion and memory are effected.

Are claimed to have a calming effect, assist the mother in becoming attuned to her body , and give a focus for distraction from pain and tension.

○PHARMACOLOGICAL METHODS OF PAIN RELIEF

1-sedatives and analgesics

2-narcotics *pethidine

3-inhalation analgesia