Pain Management of Obstetric Patients DEALING WITH BIRTH PAINS

Causes and Management Intervention

Two Sources of Pain

Pain is classified into nociceptive or neuropathic (ICEA, 2014). Nociceptive pain develops from tissue, muscle or bones. It is dull, aching, burning, stretching or beating. It crosses through mylenated nerve fibers. Neuropathic pain, on the other hand, emanates from the nerves when some damage has been inflicted on them (ICEA, 2014). It may be chronic when it is numbing, tingling or burning. Over-stimulation of the nerve fibers can damage them as in a burned-out state (ICEA),

The three stages of the birth process are antepartum or before birth, intrapartum or during delivery, and postpartum or following childbirth or delivery (ICEA, 2014).

Antepartum -- These are visceral and somatic or perineal (ICEA, 2014). Visceral pain emanates from the internal organs located in the abdominal and pelvic cavities and spreads and referred to nerve pathways. This occurs in the first stage of labor. During this stage, sporadic uterine contractions begin and become regular, more frequent, more intense and longer. The uterine muscles expand and then relax alternately. The cervix opens and small blood vessels at the walls of the vagina and cervix break. This inflammatory response creates much pain but is considered normal. Somatic pain is a sharp sensation from the connective tissue, muscle, bone and skin. This occurs during the second stage of labor, when the ligaments stretch and the cartilage and bones relax. The pain sensation runs through the pudendal and perinatal nerve pathways of the lower sacral part (ICEA).

Intrapartum -- Sources of pain may be emotional, functional or physiological (Limaz, 2010). Emotional sources of pain often come from a lack of knowledge, experience or preparation for the event. Functional sources of pain include the stretching of the uterus, contractions, the coming out of the fetus, sleeping position and some birth procedures. And physiological causes include the incorrect position of the baby and other conditions co-occurring with childbirth (Limaz).

Postpartum -- afterpains or cramping is often experienced after delivery, most intense in the second and third days when breastfeeding or taking prescribed medicine for the contraction pain (NWH, 2014). This problem is most common after the birth or a second or third baby. Uterine contracting may also cause pain until the uterus returns to its normal pre-pregnancy size. Pain may also be caused by a laceration or tear caused by an episiotomy, which is a surgical incision made on the vaginal opening to hasten childbirth. The tissues surrounding the vagina may swell because of a deep tear but this is normal and will eventually resolve. And hemorrhoids may develop and cause pain and pressure around the rectum. Hemorrhoids usually emerge during late pregnancy or labor and made worse by constipation after childbirth. They may also swell and become painful, itchy or bleed (NWH).

Labor and birth pains are all physical in nature (ICEA, 2014). They may be mental or psychological too, such as fear, anxiety and panic. These result fro the linkage among the endocrine, nervous and reproductive systems. It may also result from a lack of preparation for the event as discussed earlier and in a latter part of the paper. Furthermore, pain is also experienced in a cultural, spiritual, developmental or environmental way. All these possible sources must be examined seriously when planning a pain management program (ICEA).

The sensation or experience of pain originates from the brain, specifically the cortex, the neurotransmitters and the hormones, which are involved in the pain mechanism (ICEA, 2014). They all contribute to the perception of pain and its memory. Meanwhile, brain regions within the amygdale, hippocampus, and the limbic system contribute to the development of anxiety, fear and panic. Psychological reactions develop from the fear of the unknown, especially when accompanied by a sensation of pain. These reactions arise when a woman reaches the edge or threshold of pain and no pain relief measure is introduced.

B. Pharmacological and Non-Pharmacological Treatments for Intrapartum Patients

Pharmacological -- (Benefits) Analgesia in childbirth has been shown by scientific investigations to provide pain relief when administered early in labor and without adverse consequence (Landau, 2009). These studies also showed that large doses of diluted local anesthesia with opioids may prove more effective then epidural analgeaia alone (Landau).

(Risks) Analgesia may also be used in the late stages of labor as a pudendal block and relieve pain in the vaginal and perineal areas (Schrock, 2012). But because it is administered close to delivery, there is only slight systemic absorption. Large doses may be needed to bring about the desired effect but risks like local anesthetic toxicity,...

Immersion in water -- (Benefit) when performed in the first stage of labor, it substantially reduces pain perception and thus the need for any analgesia.
(Risk) A 2004 study, however, found that this approach decreased the time of delivery and the overall labor progress (Schrock).

This method is commonly used in the second stage of labor (Schibed, 2009). Its benefits and risks both require further review and research. But currently, they both promise potential benefits to women in labor. The general concept is that water birth meets the requirements of natural birth. The mother achieves a feeling of privacy and possession of her body. She moves with complete freedom and unfettered by technology and the fears and confusion it creates (Schibed).

2. Mindfulness Meditation (Benefits) -- a method of imagining pain as something controllable and in reducing stress and anxiety (Hughes, 2009). It uses the cognitive therapy in controlling these experiences and the recurrence of depression. At the same time, it allows the mother more attention for the newborn (Hughes).

(Risks) Nine recent studies on psychosocial approaches on childbirth pains showed that they reduce depression but only in the short-term (Dennis and Hodnet, 2007 as qtd in Hughes, 2009). Moreover, these approaches do not seem to assert beneficial effects on mother and child relationships and the development of the child itself (Hughes).

A. Teaching Plan

A. 3 Variables to Consider

The best way to prepare women for pregnancy, labor and childbirth is to educate and train them or to prepare them for the event (Ekuba et al., 2011). What to impart to them almost entirely depends on their individual or group circumstances. A study ranked certain variables to determine the ones, which should receive highest considerations.

1. Education -- Studies showed that educational status was the greatest factor for achieving awareness on birth preparedness (Ekabua et al., 2011). The more education women usually live in urban areas where conveniences for childbirth can be found (Ekabua et al.)

2. Behavior or Attitude -- Preparedness for birth and its possible adverse consequences depends on individual intention and appropriate behavior or character (Ekabua et al., 2011). Education, marital status or parity cannot assure attendance of clinical visits (Ekabua, et al.).

3. Distance -- Transportation is a necessary part of birth preparedness. In rural or Distant areas, roads are poor or non=existent (Ekabua et al., 2011). Otherwise, the transportation system is not too dependable, especially when rushing pregnant women to hospitals (Ekabua et al.).

A recent study conducted on all three variables showed that despite a high awareness of the concept of birth preparedness, the awareness of danger signals of pregnancy was low (Ekabua et al., 2011). The level of education, marital status and parity did not insure attendance of at least four clinical visits necessary with a health professional. The volunteers' knowledge of available community resources was also quite low. The study thus recommended the integration of birth preparedness and complication readiness into the maternal and child health services of each State. This will incline women to become more aware of the danger signals of pregnancy and childbirth and locate a skilled health professional at the time of need. It also recommended a sort of emergency response system in the community from which emergency funds, transport and blood donations may be obtained. These resources must be installed and disseminated to the public (Ekabua et al.).

B. 2 non-Pharmacological Options for Intrapartum Patient

1. Acupuncture -- this is generally safe and effective when used in pregnancy and childbirth, basically derived from traditional Chinese medicine (Schibed, 2009). Besides its traditional uses, which are already widely known, it is valued for its safety and effectiveness in treating the pains of pregnant women and those giving birth. It has thus become part of the service regimen of obstetricians and midwives (Schibed).

Tthis method is primarily used to deal with morning sickness, probable miscarriage or a breech position (Schibed, 2009). A) In childbirth, it focuses on cervical opening in case of prolonged labor and also as pain management. b) many studies revealed that the inclusion of this methods in dealing with the pains of pregnancy and children carried no risks. c) Health professionals, however, strongly recommend that this method be acquired only from trained and qualified persons.

2. Intradermal Injections of Water or IDI -- this is a recourse by women in labor the relief of backache, which 30% of surveyed women in labor suffered from (Schibed, 2009). a) it is simple and easy to learn and apply. It uses…