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
Anxiety: Heighten the individual’s response topain. E.g. fear of unknown,
previous bad experiences etc.
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.
& social Factors: Also play a part while someculture encourage
sloicism others encourage expression of feelings.
who is realistic in her expectation iswell equipped and will cope better with
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.
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.
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:
choice of the appropriate drug or combination of drugs,
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.
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.
the treatment of pre eclampsia and eclampsia, for forceps and breech deliveries
and caesarean section.
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.
means absence of sensation and free from pain or reversible depression of all
anaesthesia(e.g epidural block, spinal anaesthesia, pudendal block), and Local
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.
0.5% Lignocain is infiltrated into the perineum for episiotomy. The technique
used will depend on the type of episiotomy.
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.
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
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.