Objectives for Topic 4.

2
Understand why labor is painful
Physical & psychological responses to pain in labor
Treatment of pain in labor (non-pharmacological and
pharmalogical)
Risks of pharmacological treatments
What causes pain in labor
Pain is a result of constriction of blood vessels during
a contraction which results in anoxia to muscle fibers
 Stretching of the cervix and perineum
Pressure of the fetus on tissues & surrounding organs
Pain in Labor
Every women has a different perception of the pain of
labor – what is this dependent on?

Extreme fear can cause the woman to be so tense that

pain is perceived worse than it would be if she were
more relaxed
 Pain in Labor
Pain can be managed by:
 Non-pharmacological and pharmacological methods

Pharmacological:
 Analgesia and anesthesia both increase the risk of maternal and fetal mortality
related to birth
 Narcotics can lead to depressed fetal respirations
 Anesthesia is not without risk for anyone

*It is important that the nurse not assume the mother needs medication just
because she is vocal in labour. To offer medication at the wrong time can
imply the mother is not doing a good job
NON –Pharmacological Pain
Management in Labour
Doula or support person
What could a mom use non-pharmacologically to
reduce pain in labor?
Water immersion, changing position, shower, slow
breathing, walking, music, massage, therapeutic
touch, heat and cold compress
Pharmacological Pain
Management
Pain Management:
analgesia (narcotics)
epidural (not always 100% effective)
spinal
Narcotics-Analgesia
Can be given IM, IV, SC, epidural or spinal
Narcotics do cross the placental barrier
Because the fetal liver does not metabolize the drug as
quickly the effect will not be seen in the fetus for 2-3
hours after maternal administration
If delivery is imminent, within 2-3 hours, narcotics may
not be administered to the woman
Epidural Anesthesia
Placed in the epidural space of the spinal cord
Can cause hypotension, prolonged second stage of labour.
IV Bolus is given prior to epidural being administered to reduce
the incidence of hypotension.
Can be “topped up”
Assessment prior to administration?

What are our interventions if hypotension occurs after an epidural?

Spinal Anesthesia
Placed into the subarachnoid space of the spinal cord
Used for C-sections, emergency situations
Can cause hypotension, spinal headache, puritis
Spinal headache is caused by leakage of the CSF/possible
injection of air into site.
Assessment prior to administration?
Regional Anesthesia

F
Pudendal Nerve Block
Injection of anesthetic into pudendal nerves
Can be used for forceps deliveries, episiotomy or tear
repair
This is injection is done through the vagina
Provides pain relief to the perineal area
Risks of Pharmacological Pain Management
What are the risks of analgesia or anesthesia?
CNS depression of newborn/fetus
Respiratory depression (mother and fetus)
Hypotension (mother) – increase iv, lay on left side,
raise legs
Risk for infection
Prolonged second stage
Spinal headaches  may need spinal tap