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Patient will be able to make Assess current knowledge of obstetric pain Allows the nurse to develop an
an informed control individualized
decision regarding pain measures. teaching plan for the patient
control options she would
like
to use.
Assess if patient attended childbirth classes; Provides necessary information so the
if nurse
yes, determine the childbirth techniques can reinforce psychoprophylactic methods
taught. of coping or initiate teaching of
nonpharmacologic
comfort measures that can be
used during stages of labor.
Provide positive reinforcement and Positive reinforcement and encouragement
encouragement provide the patient and support person a
to patient and support persons as they sense of control and self-confidence.
apply nonpharmacologic techniques learned
in
childbirth classes. Assist with techniques as
necessary.
Assess anxiety level and implement Allows for early intervention to decrease
measures to anxiety levels. High levels of anxiety can
reduce anxiety as needed. increase the perception of pain, decrease
ability to tolerate pain, and decrease
comprehension

Patient will express relief
obtained
from labor pain by the use of
childbirth techniques learned
and/or comfort measures/
analgesics/anesthetics given.
Patient will have relaxed
facial expressions
and be able to rest between
uterine contractions.
Provide teaching between uterine
contractions.
Teach patient pain control options available,
giving the pros and cons of each.
Initiate teaching/reinforcing of
nonpharmacologic
comfort measures that can be used during
labor if needed (e.g., use of focal point,
visual
imagery, breathing and relaxation
techniques). Assist with implementation of
these measures as needed.
Provide massage and/or counterpressure
and/or
assist patient to find position of maximum
comfortƜstanding, sitting, squatting,
sidelying,
hands and kneesƜas needed.
If patient is considering an epidural, ensure
that
informed consent is obtained before
administration
of narcotics.
Assess for nonverbal signs of ineffective
coping
with pain and offer pain medications and/or
epidural anesthesia.
of verbal instruction.
The patient is more attentive and can
better
internalize information when not in pain.
Providing information allows the patient to
make informed decisions regarding pain
control.
These nonpharmacologic comfort
measures
work by providing diversion during uterine
contractions. According to the gate
control theory of pain, only a limited
number of sensations can travel along
neural pathways at any one time, so when
activities fill the pathway, pain is being
inhibited.
Changing positions and using
counterpressure
may help alleviate discomfort caused
by pressure of presenting parts on bony
structures, ligaments, or tissues. Massage
helps relieve muscle tension and provide a
diversion to inhibit pain sensations.
The patient will have to wait several hours
to sign an epidural consent if narcotics are
given before the request for an epidural.
Some patients are hesitant to make
requests
even when they would like pharmacologic
interventions. It is common for women in

Administer pain medications as ordered and
assist
with epidural placement.
Provide comfort measures (ice chips,
petroleum
jelly for dry lips, dry linens, etc.).
Keep patient informed of progress made
after
each vaginal examination.
Inform patient when uterine contractions
reach
peak intensity (acme).
Reference: Leifer, Gloria, Maternal Nursing, Copyright © 2008, Nursing Care During Labor and Pain Management, Chapter
8, Elsevier Inc., Amsterdam.
many cultures not to request assistance.
Pharmacologic intervention may be
needed
to alleviate discomfort when
nonpharmacologic
methods of pain control are perceived
to be ineffective.
Enhances patientƞs comfort level.
Progression of effacement, dilatation, and
station encourages the patient that she is
making progress and that the discomfort
will not last forever.
Knowledge that a uterine contraction has
reached peak intensity often promotes
relaxation,
which reduces muscle tension and
pain sensations.