Discuss pharmacological versus non-pharmacological nursing interventions used for pain management during labor and birth.
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Discuss pharmacological versus non-pharmacological nursing interventions used for pain management during labor and birth.
List two different classifications of drugs used for pain relief during labor and birth, and include potential side effects of the drugs on the fetus.
Describe two nursing interventions by the nurse to provide comfort during labor and birth that could be considered as non-pharmacological and the expected outcomes.
Nonpharmacologic Pain Management During Labor
Birthing Ball.
Patterned Breathing.
Beverages.
Movement and Position Changes.
Superficial Heat and Cold.
Counter-Pressure.
Touch and Massage.
Aromatherapy.
Pharmacological treatment
Typical opioid (narcotic) medications used for pain relief at the UI Hospitals & Clinics include fentanyl, Nubain (nalbuphine), morphine, and Stadol (butorphanol).
Narcotic Analgesics
Narcotic analgesics are usually given directly into an IV (intravenous catheter). Effects are felt within two to four minutes and are often described as “taking the sting off ” of pain. Narcotic analgesics don’t require you to limit movement. you’ll stand, walk, and shower during labor. you may feel relaxed and mildly drowsy. Labor may speed up, especially if there has been slow progress due to tension and fear. At other times, narcotic analgesics may cause a brief lived slowing of progress. Doses is additionally repeated every number of hours and so the results on the baby, like respiratory depression, are generally minimal.
Local Anesthesia
Your physician or midwife can inject a district anesthetic on site or the globe surrounding it to ease pain. These numbing medications usually affect alittle area and are especially useful before an episiotomy or the repair of a laceration. It rarely affects the baby and after it wears off, there are usually no lingering effects. the foremost limitation is that they’re doing not relieve the pain of labor contractions.
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Non-pharmacologic comfort therapies along with medical interventions may enhance the effectiveness of a lower dose of medication, which may limit side effects for you and your baby.
Narcotic Analgesics
Narcotic analgesics are usually given directly into an IV (intravenous catheter). Effects are felt within two to four minutes and are often described as “taking the sting off ” of pain. Narcotic analgesics don’t require you to limit movement. you’ll stand, walk, and shower during labor. you’ll feel relaxed and mildly drowsy. Labor may speed up, especially if there has been slow progress due to tension and fear. At other times, narcotic analgesics may cause a short slowing of progress. Doses is additionally repeated every few hours and thus the consequences on the baby, like respiratory depression, are generally minimal.Local Anesthesia
Your physician or midwife can inject a region anesthetic into site or the realm surrounding it to ease pain. These numbing medications usually affect atiny low area and are especially useful before an episiotomy or the repair of a laceration. It rarely affects the baby and after it wears off, there are usually no lingering effects. the foremost limitation is that they’re doing not relieve the pain of labor contractions.
Epidural Anesthesia
Epidural anesthesia is that the only method of pain control during labor. regional anesthesia involves the position of alittle catheter into the lower back by an anesthesiologist. never-ending infusion of medication is run through the catheter to provide a unbroken level of anesthesia.
Many types of medication can ease pain during labor and delivery. Epidural and spinal blocks are common choices — but you have other options, too. Work together with your health care team to make the best decision for you and your baby.
Use this guide to search out out more about specific medications used during labor and delivery.
Epidural block
Description
An epidural block could also be a regional pain-blocking procedure which can be used during labor. An epidural block uses one or more pain medications called anesthetics injected via a catheter into atiny low space outside the neural structure within the lower back (epidural space). this allows for repeated or continuous administration of medicines. you’ll be a test dose to make sure the epidural is positioned correctly. It takes about one to fifteen minutes for the medication to want effect, depending on the type of anesthetic used. Your health care provider will seek advice from you the foremost effective time to request an epidural during labor. you’d possibly not be able to have an epidural if you have got got had surgery in your lower back, have low blood-clotting factors, have an infection in your lower back or are on certain blood thinners.
Cons
You could experience an inadequate or failed epidural. An epidural might decrease your physical phenomenon, which could slow the baby’s rate. you’ll develop a fever or itchiness or experience postpartum soreness in your back. Rarely, you’d possibly develop a nasty headache. whether or not you have a combined spinal-epidural block, sometimes called a walking epidural, you will probably not be able to walk during labor.
Spinal block
Description
A spinal block is sometimes accustomed block pain during a C-section. However, round spinal block could also be used as a regional analgesic if delivery is predicted in a very very short time or if forceps or vacuum extraction is required and there is enough time for the procedure. During a spinal block, the medication is injected into the fluid below the anatomical structure within the lower back and takes effect right away. A spinal block is typically combined with an epidural block during labor (combined spinal-epidural block).
Cons
A spinal block might decrease your pressure, which can slow the baby’s pulse. you will develop a fever or itchiness or experience postpartum soreness in your back. Rarely, you’d possibly develop a foul headache.
Opioids
Description
Various opioids are often used to lessen pain during labor. they’ll be injected into a muscle or given through an intravenous (IV) catheter.
Cons
Opioids don’t completely eliminate hurting and typically don’t work for pain experienced during delivery. They commonly cause nausea, vomiting and drowsiness. These medications can affect your newborn’s breathing and cause your baby to be drowsy, which could interfere with initial breast-feeding.
and breathing and cause your baby to be drowsy, which could interfere with initial breast-feeding.
Local anesthetic injection
Description
A local anesthetic could be wont to quickly numb the perineal area if you would like an incision to increase the opening of the (episiotomy) or repair a tear after delivery. The medication is injected into the world round the nerves that carry feeling to the labor organ , vulva and perineum.
Cons
Local anesthetics don’t relieve the pain of contractions. An allergic reaction is possible. Rarely, injecting local anesthetics into a vein might produce a toxic reaction, affecting your central systema nervosum or heart.
Pudendal block
Description
A regional anesthesia could be used shortly before delivery to dam pain between the (perineum). It also can be wont to relieve pain during the repair of a tear after delivery. The anesthetic is injected into the perineal wall near the pudendal nerve and takes effect in 10 to twenty minutes.
Cons
A pudendal block might not work or might affect only one side of the perineum. An allergic reaction is possible. Rarely, a regional anesthesia can cause an infection at the injection site, and injecting the medication into a vein might affect your central systema nervosum or heart.
Nitrous oxide
Description
Nitrous oxide — an odorless, tasteless gas — is an inhalation analgesic that can be used during labor. You administer the anesthetic gas employing a hand-held mask . Nitrous oxide takes effect within a moment .
Cons
Nitrous oxide doesn’t eliminate pain. To experience relief, you will need to time inhalation of laughing gas in order that it occurs about 30 seconds before you expect each contraction. You might experience nausea, vomiting, dizziness and drowsiness.
Opioids can affect your baby’s breathing and heart rate for a short time. Your baby could also be drowsy, which may make it harder for your baby to breastfeed within the first few hours after birth.
Nursing interventions
These interventions can include bed rest/recumbent position, electronic fetal monitoring (EFM), limited oral intake during labor, frequent vaginal exams, inductions/augmentations, amniotomy, regional anesthesia, catheterization, ineffective pushing, episiotomy, instrumental vaginal birth, and cesarean surgery.
