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Pain relief in labour
It is not possible to assess how much pain a person is feeling because pain cannot be measured. Pain leads to physical and emotional exhaustion and lessen the woman’s confidence. The pain threshold varies from one individual to another so the woman in labour must be relieved from pain and baby’s safety must be ensured.
· Fear and Anxiety: Heighten the individual’s response topain. E.g. fear of unknown, previous bad experiences etc.
· Personality; Plays a part in the woman’s response to pain. Atense and anxious woman will respond poorly to pain and cope less.
· Fatigue: A woman who is fatigued will tolerate pain less: prolonged labour.
· Culture & social Factors: Also play a part while someculture encourage sloicism others encourage expression of feelings.
· Expectations: A woman who is realistic in her expectation iswell equipped and will cope better with labour pain.
Pain in labour is caused by uterine contractions, dilatation of the cervix and stretching of the vagina and the pelvic floor muscles to accommodate the presenting part (In late 1st and 2nd stage). The pains are said to be transmitted by the thoracic, lumber and sacral nerves.
1. Psychological method: This is the most important aspect ofpain relief, because a woman who is already apprehensive with labour pain will relax if she is admitted into a clean, well organized, calm and reassuring environment. The midwife must be sympathetic and understanding. These will alley her fears, relax more and be able to cope with the pain. The personality of the Midwife should reflex kindness, interest in the patient with kind words and deeds. These include:
· giving of information: as necessary
· Allaying of anxiety
· Participating in Planning and care.
· Giving of physical care.
Support during labour: Massage the back during contractions. Provide hygiene and comfort positioning Bladder and bowel care. Feeding;
It is not possible to classify accurately the action of groups of drugs. A small dose of narcotic would act as sedative, while a large dose of tranqullizer would act s hypotic. Since drugs are used for various reasons the Midwife must know the reason for administration of a drug that is to relief pain,alley apprehension, and induce sleep.
The Midwife must have a good knowledge and understanding of the principle underlying the administration of various drugs, and the main action of the drug she administers. Success and safety of drugs depend on:
The choice of the appropriate drug or combination of drugs,
Proper timing, and
Checking the dose.
These are drugs that are supposed to relief pain without rendering the patient unconscious. Examples are panadol, Aspirin fortral etc.
Narcotics: Allay anxiety and induce sleep – strong analgesicwith some sedative effect e.g. pethidine, morphine, pethilorfan, fortal, tramal
Hypnotics: Induce sleep, anti convulsant – chlorahydrate,welldone, Diazeperin, omnopon, paraldehyde
Tranquillisers: Calm patient: Phenegan
Sedatives: Induce sleep – Barbiturate groups.
Refers to any of various mixtures of phenothiazine derivatives and Pethidine for intravenous administratin. E.g. chlorpromazine (Largactil) 50mg. Promethazine (Phenergen) 50mg. Pethidine 100mg.Mixed and given slowly intravenously until a state of sedative, tranquility and analgesia (ataralgesic) is produced.
Use: In the treatment of pre eclampsia and eclampsia, for forceps and breech deliveries and caesarean section.
It is permitted by Midwife Board) It is used on healthy women in late first stage of labour or in 2nd stage of labour. They are volatile agents which are excreted fairly quickly from the body. They include Entonox: Pre mixed nitrous oxide 50% and Oxgyen 50%.
A blue liquid evaporates easily into the air to form a non-inflammable vapour. It is an anaesthetic agent with analgesic action. The anaesthetic effect depends on the concentration. It is administered in Emotril Automatic inhaler apparatus.
Anaesthesia means absence of sensation and free from pain or reversible depression of all the senses.
Types of anaesthesia are:
Regional anaesthesia(e.g epidural block, spinal anaesthesia, pudendal block), and Local anaesthesia(e.g. lignocan).
Technique whereby local anaesthetic solution is injected into the subarachnoid space i.e. into the CSF.
Pudendal block – Local anaesthetic solution is injected adjacentto the pudendal nerves just below the ischial spines where they supply pelvic floor, vulva and perineum.
Paracervical block: These cases the paracervical plexus are blocked. It is used in prolonged labour – 10mls of 1% lignofcaine solution is injected into the lateral fornices of the vagina. It reduces pain and backache in the last 2-3hrs. There is risk of bradycardia – fetal death may occur due to spasm of uterine vessels.
10mls of 0.5% Lignocain is infiltrated into the perineum for episiotomy. The technique used will depend on the type of episiotomy.
The process of labour and child birth bring about the event that the woman has been anticipating throughout her pregnancy. The forces of labour are referred to as “4P’s”. They are the P assage, Passenger, Power, and the Psyche.
These important factors must work together for labour to progress normally. An alteration in any one or a combination of the factors can alter the outcome of labour.
The length of labour varies widely and is influenced by parity, birth interval, psychological state (psyche), presentation, position, pelvic shape and size and character of uterine contractions. Sound knowledge of physiology of labour aids the midwife in the course of her managing her patient.
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