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Many women use some type of method to deal with pain during childbirth. The management of labour pain is a primary responsibility of the nurse. It is important for the nurse and the labouring mother to develop mutually acceptable goals for pain relief. The nurse can best facilitate this process by conducting a thorough assessment, implement timely interventions, provide non-pharmacological methods of pain relief alongside or separate from pharmacological methods, and provide comprehensive health teaching regarding post-partum pain.
Pain assessment during labour and delivery focuses on the physiological factors. The nurse must assess for maternal vital signs, degree of pain, fetal heart rate and pattern, and uterine activity before and after administration of medication (Wong, Perry, Hockenberry, Lowdermilk, & Wilson, 2006). It is important to assess which stage of labour the mother is in before administering medication particularly morphine, because if birth occurs within one to four hours of dose, newborn may experience respiratory depression; however, if dose is administered too early on, labour can be prolonged and delayed (Wong et al., 2006). These assessments are made to ensure the health risks to the fetus and the labouring woman are eliminated.
Another important aspect of assessment is cultural factors specific to each patient and the instruments used to analyze the pain intensity level. Labour and delivery is perceived differently by each culture. The cultural assessment should encompass unique care giving behaviours and practices, presence of birth companions and assessment of view of childbirth as a wellness or illness experience (Wong et al, 2006). The patient's culture will also dictate how to express pain and whether pharmacological pain methods will be utilized or if preferences of non-pharmacological methods are in order. Even though pain is a personal experience, it can be analyzed with quantitative pain measure instruments. The Numeric Pain Intensity Scale is ranged from 1(no pain at all) to 10(unbearable pain). The NPIS is used by asking the client to choose a number that best represents the intensity of pain experienced during labour. The McGill questionnaire is composed of descriptive questions asked to the client to evaluate their qualitative pain level. The Visual Analog Scale is composed of pictures with different of state of faces arranging from little pain to worst pain. The VAS is used by asking the client to select a face that also represents the quality of their pain level. (Abushaikha & oweis, 2004) Pain assessment during labour and delivery is important to generate interventions that may possibly decrease the intensity of pain.
Interventions to relieve pain are one of the essential aspects of nursing care that must be considered during a woman's labour. Because of its strong effect on pain management, opioids are one of the most selected drugs administered to patients who are in pain, and thus; it is commonly administered to women experiencing labour pain through IM or IV injections during the first stage of labour. Intravenous administration is preferred to intramuscular because the medications onset of action is faster and more predictable (Wong et al., 2006). IV patient controlled analgesia (PCA) is now available for use during labour. With this method, the women self administers small doses of opioid analgesic by using a pump programmed for dose and frequency (Shorten, Carr, Harmon, Puig, Browne, 2006). According to Wong & Perry (2006, p.448), pharmacological management for pain must be established before pain in a patient reaches its intense severity. Before morphine therapy is initiated to a woman in labour, Lippincott Williams & Wilkins (2008, p. 421) advised that a morphine antagonist be established to encounter any adverse reaction during treatment. Regular patient monitoring of vital signs is a mandatory nursing intervention and must not be neglected during labour and especially after opioid is administered; maternal respirations of fewer than 12 breaths per minute should be notified to the physician immediately. The nurse should encourage voiding every two hours and palpate for bladder distension; bladder distension can inhibit uterine contractions (Wong et al., 2006). All these measures set in place will enhance the effectiveness of opioid therapy during the period of labour and delivery.
Along with pharmacological pain management, Wong & Perry (2006, p. 447), suggested additional and or non-pharmacological pain relief; when done aggressively, it can minimize patient's pain and aid in a satisfactory experience for the patient in labour. For non-pharmacological management of pain, the nurse can assist the labouring mother during deep breathing techniques to reduce anxiety and exhaustion. She can also beckon for a support person to be present during labour; the nurse can also implement the use of proper positioning by using pillows to relieve discomfort and promote circulation for the patient in labour. Effleurage and counter-pressure have been shown relief pain in women during the first stage of labour (Lowdermilk, Perry, 2007). Effleurage is light stroking of the abdomen in rhythm with contraction pain; it is used to distract the women (Lowerdermilk, Perry, 2007). Counter-pressure is steady pressure applied by a support person to the lower back region with the fist of the hand. This technique is used to help women cope with the pain in the lower back (Lowerdermilk, Perry, 2007). Non-pharmacological measures are usually simple, safe and provide the woman with a sense of control over her childbirth.
Women in postpartum may often experience some sort of pain for which the importance of health teaching is significant. Back pain seems to be a common type of pain in postpartum as it is experienced by two thirds of women instantaneously after delivery. (Russell & Reynolds, 1997) Mothers should be taught how to take care of their backs and ways to nurse the baby so that the least amount of pain possible is felt. (Russell & Reynolds, 1997) The nurse should also teach the mother about oral analgesics she may need to take. It's important to inform the mother that if a chronic pain syndrome develops because of continuing symptoms she may require psychological support. (Russell & Reynolds, 1997) It's also vital that postpartum mothers be educated about any side effects they can expect from the pain medications. They should be told that some of the side effects for certain analgesics include constipation, drowsiness, nausea and vomiting, hypothermia, and hypotension. (Wong, Perry, Hockenberry, Lowdermilk, & Wilson, 2006) The teaching should also include the interventions that can be implemented to reduce pain as much as possible.
Some women may experience pain related to perineal lacerations or an episiotomy, hemorrhoids, and breast engorgement (Wong et al., 2006). The nurse can provide health teaching to them so that they understand why this is happening, how long the pain will last, and ways that they can possibly reduce the pain. If a woman has hemorrhoids the nurse should tell her that she probably will feel pain or discomfort especially when defecating, within 6 weeks of delivery. The hemorrhoids should get smaller in size, and a sitz bath can be taken to relieve the pain (Wong et al., 2006). If pain is felt because of breast engorgement the mother can be informed that this is caused by abrupt hormonal changes and an increase in the amount of milk (Wong et al., 2006). Usually this disappears after 24 hours, and the pain can be relieved by placing raw, cold cabbage leaves or ice packs over the breasts or a tight support bra that is well-fitted can be worn (Wong et al., 2006). If the mother has pain related to an episiotomy or perineal lacerations she should be taught that either one of them occurs when the vaginal outlet needs to be enlarged (Wong et al., 2006). The pain can be relieved by using a pillow during sitting, using a side lying position, using ice packs, using a squeeze bottle to cleanse, or having a sitz bath (Wong et al., 2006). Teaching the mother about all the aspects related to the pain she is experiencing will empower her to make the right decisions and therefore possibly reduce her pain.
Many women use some type of method to deal with pain during childbirth. The management of labour pain is a primary responsibility of the nurse. It is important for the nurse and the labouring mother to develop mutually acceptable goals for pain relief. The nurse can best facilitate this process by conducting a thorough assessment, implement timely interventions, provide non-pharmacological methods of pain relief alongside or separate from pharmacological methods, and provide comprehensive health teaching regarding post-partum pain.
Pain assessment during labour and delivery focuses on the physiological factors. The nurse must assess for maternal vital signs, degree of pain, fetal heart rate and pattern, and uterine activity before and after administration of medication (Wong, Perry, Hockenberry, Lowdermilk, & Wilson, 2006). It is important to assess which stage of labour the mother is in before administering medication particularly morphine, because if birth occurs within one to four hours of dose, newborn may experience respiratory depression; however, if dose is administered too early on, labour can be prolonged and delayed (Wong et al., 2006). These assessments are made to ensure the health risks to the fetus and the labouring woman are eliminated.
Another important aspect of assessment is cultural factors specific to each patient and the instruments used to analyze the pain intensity level. Labour and delivery is perceived differently by each culture. The cultural assessment should encompass unique care giving behaviours and practices, presence of birth companions and assessment of view of childbirth as a wellness or illness experience (Wong et al, 2006). The patient's culture will also dictate how to express pain and whether pharmacological pain methods will be utilized or if preferences of non-pharmacological methods are in order. Even though pain is a personal experience, it can be analyzed with quantitative pain measure instruments. The Numeric Pain Intensity Scale is ranged from 1(no pain at all) to 10(unbearable pain). The NPIS is used by asking the client to choose a number that best represents the intensity of pain experienced during labour. The McGill questionnaire is composed of descriptive questions asked to the client to evaluate their qualitative pain level. The Visual Analog Scale is composed of pictures with different of state of faces arranging from little pain to worst pain. The VAS is used by asking the client to select a face that also represents the quality of their pain level. (Abushaikha & oweis, 2004) Pain assessment during labour and delivery is important to generate interventions that may possibly decrease the intensity of pain.
Interventions to relieve pain are one of the essential aspects of nursing care that must be considered during a woman's labour. Because of its strong effect on pain management, opioids are one of the most selected drugs administered to patients who are in pain, and thus; it is commonly administered to women experiencing labour pain through IM or IV injections during the first stage of labour. Intravenous administration is preferred to intramuscular because the medications onset of action is faster and more predictable (Wong et al., 2006). IV patient controlled analgesia (PCA) is now available for use during labour. With this method, the women self administers small doses of opioid analgesic by using a pump programmed for dose and frequency (Shorten, Carr, Harmon, Puig, Browne, 2006). According to Wong & Perry (2006, p.448), pharmacological management for pain must be established before pain in a patient reaches its intense severity. Before morphine therapy is initiated to a woman in labour, Lippincott Williams & Wilkins (2008, p. 421) advised that a morphine antagonist be established to encounter any adverse reaction during treatment. Regular patient monitoring of vital signs is a mandatory nursing intervention and must not be neglected during labour and especially after opioid is administered; maternal respirations of fewer than 12 breaths per minute should be notified to the physician immediately. The nurse should encourage voiding every two hours and palpate for bladder distension; bladder distension can inhibit uterine contractions (Wong et al., 2006). All these measures set in place will enhance the effectiveness of opioid therapy during the period of labour and delivery.
Along with pharmacological pain management, Wong & Perry (2006, p. 447), suggested additional and or non-pharmacological pain relief; when done aggressively, it can minimize patient's pain and aid in a satisfactory experience for the patient in labour. For non-pharmacological management of pain, the nurse can assist the labouring mother during deep breathing techniques to reduce anxiety and exhaustion. She can also beckon for a support person to be present during labour; the nurse can also implement the use of proper positioning by using pillows to relieve discomfort and promote circulation for the patient in labour. Effleurage and counter-pressure have been shown relief pain in women during the first stage of labour (Lowdermilk, Perry, 2007). Effleurage is light stroking of the abdomen in rhythm with contraction pain; it is used to distract the women (Lowerdermilk, Perry, 2007). Counter-pressure is steady pressure applied by a support person to the lower back region with the fist of the hand. This technique is used to help women cope with the pain in the lower back (Lowerdermilk, Perry, 2007). Non-pharmacological measures are usually simple, safe and provide the woman with a sense of control over her childbirth.
Women in postpartum may often experience some sort of pain for which the importance of health teaching is significant. Back pain seems to be a common type of pain in postpartum as it is experienced by two thirds of women instantaneously after delivery. (Russell & Reynolds, 1997) Mothers should be taught how to take care of their backs and ways to nurse the baby so that the least amount of pain possible is felt. (Russell & Reynolds, 1997) The nurse should also teach the mother about oral analgesics she may need to take. It's important to inform the mother that if a chronic pain syndrome develops because of continuing symptoms she may require psychological support. (Russell & Reynolds, 1997) It's also vital that postpartum mothers be educated about any side effects they can expect from the pain medications. They should be told that some of the side effects for certain analgesics include constipation, drowsiness, nausea and vomiting, hypothermia, and hypotension. (Wong, Perry, Hockenberry, Lowdermilk, & Wilson, 2006) The teaching should also include the interventions that can be implemented to reduce pain as much as possible.
Some women may experience pain related to perineal lacerations or an episiotomy, hemorrhoids, and breast engorgement (Wong et al., 2006). The nurse can provide health teaching to them so that they understand why this is happening, how long the pain will last, and ways that they can possibly reduce the pain. If a woman has hemorrhoids the nurse should tell her that she probably will feel pain or discomfort especially when defecating, within 6 weeks of delivery. The hemorrhoids should get smaller in size, and a sitz bath can be taken to relieve the pain (Wong et al., 2006). If pain is felt because of breast engorgement the mother can be informed that this is caused by abrupt hormonal changes and an increase in the amount of milk (Wong et al., 2006). Usually this disappears after 24 hours, and the pain can be relieved by placing raw, cold cabbage leaves or ice packs over the breasts or a tight support bra that is well-fitted can be worn (Wong et al., 2006). If the mother has pain related to an episiotomy or perineal lacerations she should be taught that either one of them occurs when the vaginal outlet needs to be enlarged (Wong et al., 2006). The pain can be relieved by using a pillow during sitting, using a side lying position, using ice packs, using a squeeze bottle to cleanse, or having a sitz bath (Wong et al., 2006). Teaching the mother about all the aspects related to the pain she is experiencing will empower her to make the right decisions and therefore possibly reduce her pain.