Pain Management for the Obstetric Patient

Sources of pain for the antepartum patient, intra-partum patient, and postpartum patient during an uncomplicated pregnancy, labor, and recovery from the birthing process.

Antepartum period starts when the woman’s pregnancy is diagnosed and ends just before delivery of a baby. During the prenatal period, an expectant mother experiences different body and hormonal changes. Usually, these changes come at different stages of the pregnancy. It is common for antepartum patients to experience pains during uncomplicated pregnancy. There is a varied spectrum of conditions, which can occur with pain during pregnancy. A common thing during pregnancy is headache. Most expectant women experience tension headache usually because of reluctance to take analgesics during pregnancy. It is common for headaches to be on and off, recurring with different levels of pain. Headaches persist during the first trimester. Expectant women experience back pains. Statistics indicates that close to 50% of expectant women suffer from back pains during pregnancy (Danakas, 2007). Different factors contribute to back pains in women, the major one being an increase in weight. However, severe back pains can occur because of multi-parity, pre-existing problems and increased age. Severe back pains scientifically occur due to neuronal and endocrine mechanisms. Pain can be dull, stabbing, burning, or accompanied with root compression.

Normal pregnancy can also present pains due to nerve entrapment. Almost half of nerve entrapment patients experience pain during pregnancy (Lang, 1999). Expectant mothers also experience abdominal pain, which is related to physical existence of an expanding uterus and dislodgment of abdominal pain. During pregnancy, expectant women experience softening and stretching of ligaments of the symphysis pubis. According to medical practitioners, this may lead to suprapubic pain and hence severe abdominal pains. In uncomplicated pregnancy, other various factors and conditions can contribute to pains. For instance, sickle crisis and pulmonary embolism cause pain in pregnant women. In addition, doctors agree that the trauma is also a significant cause of pain. Expectant women living in environments with domestic violence can also report severe experiences of pain (Danakas, 2007).

An intra-partum patient is the one who is in the birth process. During the act of birth, women experience various pains. Common pain for intra-partum patient is labor. Regular uterine contractions, contraction and expansion of the cervix, and descent of the bestowing part characterize normal labor. Labor pains encompass the period from the start of consistent contractions to impulsive vaginal expulsion of the baby. For intra-partum patients, pains begin with uterine contractions. Contractions start in two pacemakers near the utero tubal junctions and only one is operative in each contraction, which spreads like a wave over the whole uterus. The pain occurs from a resilient and continued deed of the muscle of the uterine fundus, which rises as labor progresses (Lang, 1999). The frequency of the uterine shrinkages is about 3 minutes with at least a minute between shrinkages. Cervical dilatation, which causes labor pains in intra-partum patients, occurs from above downwards, being accompanied by thinning. Severe pains occur due to coordinated contraction and retraction of the upper segment. Labor for expectant women takes place in different stages. The initial stage of the birth process has the expectant mother experiencing discomposure during contractions. However, there will be no pain between the contractions. According to nurses, women having the fetus positioned in the next end will experience back pain from the uninterrupted contractions. According to practitioners, as labor progresses and pain gets strong and tenacious, expectant mothers experience exhaustion and are disheartened, often facing trouble managing contractions.

One pharmacologic and two non-pharmacologic pain management measures for the intra-partum patient.

For expectant women, alleviation of pain is imperative. During pregnancy and childbirth, an expectant woman has goals set for her and with it comes significant pain. Pain management has several approaches. This section explores two pain management techniques, in particular pharmacologic and non-pharmacologic pain management. For intra-partum patients, recommended pain management is non-pharmacologic. In most cases, non-pharmacologic approaches are often simple and safe, have few side effects, and are inexpensive and applicable throughout labor. More so, measures give the expectant mother a sense of power over her childbirth. The expectant mother is responsible for decisions made during childbirth. Most non-pharmacologic methods require practice for the best results (Lang, 1999).

Breathing and Relaxation Techniques. Evidence suggests that relaxation improves labor pain management. Ideally, relaxation works well with such activities as walking, slow dancing, rocking, and position changes. These activities help the baby rotate through the pelvis while rhythmic motion stimulates mechanoreceptors in the brain. In turn, this will decrease pain insight in expectant women (Danakas, 2007). During labor, a nurse can help the expectant woman by offering a serene and stress-free setting. It is important to provide cues as required and identify signs of tension. Another relation technique is imagery and visualization, which are imperative in preparation for birth. These approaches help in providing an expectant mother with a sense of well-being during pregnancy, assist in expansion of the cervix, and reduce pain experienced during the childbirth process. Examples include imagining a walk through a restful garden or breathing in light, energy, and a healing color. Diverse skills taught in childbirth classes supplement relaxation during pregnancy and labor. Breathing techniques provide distraction, hence reducing the impression of agony and aiding a pregnant woman in having proper control during contractions. Nurses agree that breathing activities promote relaxation of the abdominal muscles, hence increasing abdominal cavity. In addition, this will lessen the uneasiness brought about by contact between the uterus and stomach wall throughout contractions. Further during the childbirth process, breathing techniques will increase abdominal pressure, which helps with expelling the fetus (Lang, 1999). Nurses advise on breathing techniques as they help relax the pudenda muscles to prevent precipitation of the fetal head. During contractions, various breathing techniques are applicable such as paced breathing and simple breathing patterns.

Water Therapy. Another non-pharmacologic measures that promote comfort and relaxation during labor include bathing, showering, and jet hydrotherapy. Nurses employ water therapy to reduce the risk of prolonged labor. Nurses usually introduce this technique when the expectant woman is in active labor. Other benefits derived from water therapy include enhancing impulsive fetal rotation to the occiput forward position due to increased resilience. The main benefit of water therapy is pain relief and relaxation, especially when the expectant mother is close to giving up during labor (James, 2011). Doctors advise this technique for repeated births with occasional breaks as they are more effective compared to long births. Recommended water temperatures for the therapy should range from 35 to 37. The notable disadvantage of water technique is the risk of infections. However, hydrotherapy also offers benefits such as reduced back pains.

Another available approach to pain management is pharmacologic measures. These approaches should be implemented before pain becomes so severe that catecholamines increase and the expectant mother experiences pro-longed labor. Mainly, pharmacologic measures come in handy as labor becomes more dynamic and uneasiness and agony deepen.

Sedatives. These aim to relieve anxiety and induce sleep to expectant women during labor. Sedatives are most efficient when expectant women experience a prolonged latent phase of labor and the nurse sees the need to reduce anxiety levels. Despite their positive effect on an expectant mother during labor, sedatives can cause undesirable side effects, including respiratory and vaso-meter depression. These side effects have high chances of affecting the mother and the newborn (Lang, 1999).

Identify three (3) variables unique to the pregnant patient that need to be considered when developing a patient specific pain management teaching plan for the ante-partum patient preparing for labor and birth.

When it comes to development of a patient specific pain management teaching plan, it is essential for a nurse to handle every pregnancy case individually. Requirements for individual women clearly vary depending on various individual levels. For instance, basic information regarding pregnancy and birth may be a review for some women, but may be altogether new to others (James, 2011).

Parity is an essential variable when preparing a patient specific pain management teaching plan. Parity implies previous experiences of the expectant mother and previous problems and issues experienced during pregnancy (Danakas, 2007). Different persons have varied experiences of the childbirth, hence ensuring the need to cater for these differences in the teaching plan. Including parity in the plan helps the nurse to understand proper methods of pain management to administer during each phase of pregnancy and childbirth. Previous experiences equally help in understanding the source of pain during the process as pain cases vary from one individual to another. Childbirth and pregnancy experiences also vary from one mother to another. Ante-partum patients should provide nurses with all relevant information concerning their prior experiences. For instance, if one pain management measure worked for the patient in her first or prior pregnancies, then the nurse should be aware of that. This can be helpful in determining pain management for the current pregnancy and avoiding errors during the process.

Educational level is a major variable, which will influence the teaching plan. On the one hand, pregnancy and childbirth process can be new to some ante-partum patients. On the other hand, not every woman is well-informed when it comes to the procreative method and family planning. Take, for instance, an adolescent mother (Lang, 1999). She maybe too young to understand changes occurring with her. Thus, it is significant for every patient to avail information about education level. It is clear that different persons have different levels of education and knowledge concerning reproduction. When nurses consider education level as a variable in the teaching plan, the focus is on the knowledge about reproduction and family planning. There is minimal awareness on reproduction and family, hence making it necessary to educate the expectant mother. Once all these aspects are understood, the expectant woman can plan and understand various pain management tools available (Danakas, 2007).

Another notable variable is culture/religion and philosophy concerning varied methods and steps of childbirth. People come from different cultures and religions; hence, there is a need to incorporate this information in the teaching plan. Some women may find it uncomfortable with available pain management plans. Having this knowledge will enlighten a concerned nurse on necessary individual approaches to pain management (James, 2011). Cultures vary and some may affect the expectant mother either positively or negatively. The plan for pain management should give room for cultural and religious practices regarding pregnancy and childbirth.

Non-pharmacologic discomfort reprieve options used in the intra-partum period.

Non-pharmacologic pain measures aim to reduce anxiety, fear, and tension, which are the main factors behind pain during labor. Sensory stimulation strategies are non-pharmacologic pain relief measures (Danakas, 2007). These mainly help to promote relaxation and pain relief during labor. Most sensory stimulation techniques are a part of education expectant mothers receive in the course of their pregnancy. They comprise imagery, music, aromatherapy, use of focal points, and breathing techniques. It is necessary for expectant mothers to understand various ways in which these techniques help with pain relief.

Another non-pharmacologic pain relief technique is maternal position changes, which also promotes relaxation. Some of the positions include squatting, kneeling, semi-sitting, kneeling, and rocking back and forth. Expectant mothers need to understand that position changes only help with pain relief for short periods, hence explaining the need for constant changes (James, 2011). Depending on the level of pain, different positions will apply. Mainly, position changes affect the uterus and position of the baby in order to avoid the supine hypotension syndrome.

References

Danakas, G. T. (2007). Practical guide to the care of the gynecologic/obstetric patient (2nd ed.). Philadelphia, PA: Mosby/Elsevier.

James, D. K. (2011). High-risk pregnancy management options (4th ed.). St. Louis, MO: Saunders/Elsevier.

Lang, J. D. (1999). Pain management. Philadelphia, PA: W.B. Saunders.