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Pain Control In Labor & Delivery

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Kathleen Ward

on 28 August 2018

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Transcript of Pain Control In Labor & Delivery

Pain Management
Labor & Delivery

Gate Control Theory
FHR 110 – 160
Reactive NST
Accelerations are present with fetal movement
Short term variability present
Long-term variability is average
NO periodic late decelerations or non-periodic decelerations
VS are stable
No Contraindications
Other Medications
Labor Assessment
Contraction pattern
Cervical dilatation
Fetal presenting part
Station of the presenting fetal part
Childbirth Education
Support Person
Cutaneous Stimulation
Other Alternatives
Oral Route~
not used due to poorly absorbed and gastric emptying time prolonged during labor

IV Route
preferred due to prompt, smooth and more predictable action with a smaller dose.

Best that IM medication be given with the onset of a UC, when the blood flow to the uterus and the fetus is normally decreased.
Avoid administering when delivery is anticipated within 2-3 hours

SQ –

routes also available
Analgesic Routes
Narcotic Side Effects for Mom

Nausea/ vomiting
Dizziness/ altered sensorium
Orthostatic hypotension
Delayed stomach emptying

IM or IV Injections
Better pain relief
Lower total dose than IM
Narcotic antagonists to
counteract side effects
in mom/baby
Nubain (reverse itching and nausea
Distribution of Pain
Late Second Stage of Labor
First Stage of Labor
Early Second Stage of Labor
Intradermal injections of 0.1 ml of sterile water
in the treatment of women with back pain
during labor. Sterile water is injected into
four locations on the lower back, two over
each posterior superior iliac spine (PSIS)
and two 3 cm below and 1 cm
medial to the PSIS.

Obtain Baseline info of Mom and Baby
Record Information on FMS and chart
Informed Consent
Preload IV Fluids (dextrose free)
Position mom for procedure

1. Position in a semi-reclining position with lateral tilt
2. Than side lying position - alternate sides
3. Monitor B/P and pulse every 5 minutes for at least 30 min.
4. Then every 30 minutes thereafter
5. Monitor FHT continuously with EFM
6. Interventions for side effects
Pharmacologic Nerve
Block Pathway

Suitable during second and third stages
of labor and for repair of
episiotomy or lacerations.
Use of needle guide (Iowa trumpet) &
Luer-Lok syringe to inject medication.
Thermal stimulation/
Post Procedure
Nursing Care
IV Narcotic Administration
"Administer during a contraction!"
Avoid administering when delivery is anticipated within 2-3 hours
Nursing Management Prior to
Epidural Placement
Kathleen Ward, MSN, RN
Associate Professor of Nursing

Transcutaneous nerve stimulation (TENS) emits low-voltage electrical impulses that very in frequency and intensity. Believed to block nerve pathways. Cochrane research identified a little difference in pain control, but inconsistent.
Ho-Ku Acupressure Point
~Maternal hypotension
~Fetal heart rate changes
associated with impaired
placental perfusion
~Delayed respiratory depression
~Nausea and vomiting

Systemic Drugs for Labor
Opioid analgesics

Observe for respiratory depression in the neonate
Opioid antagonists

Adjunctive drugs


Medications Used
in Labor
Butorphanol Tartrate (Stadol)
Meperidine (Demerol)
Nalbuphrine (Nubaine)
Fentanyl (Sublimaze)
Promethazine (Phenergan)
Hydroxyzine ( Vistaril)
Naloxone (Narcan)

Blood Patch
Pain Management
Physiologic Manifestations:
Increase pulse & respiration
Dilated pupils
Increase B/P
Increase muscle tension
Pain expression depends on culture
Quiet - vocal - wail
Women often tighten skeletal muscles & lie
motionless which leads to muscular tension
Nitrous Oxide
Tasteless/odorless gas
Reduces anxiety & increases feelings of well-being
Nitrous oxide is mixed with oxygen
Best if started 30 sec. before UC starts
Safe for mom & baby
Dizziness or nausea while inhaling
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