Admission of a woman in Labour VK EDITED.pptx

admission of a woman in labour

1. PHYSIOLOGY AND MANAGEMENT OF PAIN IN LABOUR

2. Learning Objectives Describe the sources of in labour Describe the physiology of pain in labour Describe the effects of pain in labour Explain the ways in which women express and communicate their pain in labour Explain factors that influence women’s response to pain Discuss the midwives role in pain assessment during labour

3. Genesis 3: 16

4. Introduction Labour is an emotional experience and involves both physiological and psychological mechanisms. The pain of labour is severe but despite this its memory diminishes with time . Pain relief in labour is complex and often challenging without regional analgesia. Effective management of labour pain plays a role in a woman's satisfaction with childbirth The experience of labour is complex and subjective. Several factors affect a woman's perception of labour making each experience unique.

5. Introduction The memory of this pain however is short lived In a study that was done on parturients who experienced severe pain in labour , 90 % found the experience satisfactory three months later 2 . This short term memory may be related to the positive outcome that often occurs at the end of labour

6. Sources of pain Labour pain has two components : visceral pain which occurs during the early first stage and the second stage of childbirth, somatic pain which occurs during the late first stage and the second stage. The pain of labour in the first stage is mediated by T10 to L1 spinal segments, whereas that in the second stage is carried by T12 to L1, and S2 to S4 spinal segments.

7. Sources of pain 1. Visceral Pain Caused by cervical dilatation and effacement Uterine contractions The changes in the cervix and uterine ischemia causes discomfort called visceral pain Pain occurs with uterine contractions and relived after a contraction The pain is felt in lower abdomen, radiates to lumber area of the back and down the thighs Visceral pain occurs when there is activity in the uterus or cervix

8. Sources of pain Visceral Pain Uterine ischemia also causes visceral pain During the contraction there is reduced blood supply to myometrium causing ischemia, hypoxia and fatigue and pain The pain sensation are dull, diffuse, persistent and aching The pain is transmitted through myelinated fibers and travels more rapidly and perceived as sharp and localized.

9. Sources of pain 2. Somatic Pain or Perineal Pain This pain is caused by traction or the pull exerted on the uterine ligaments Pressure exerted by the presenting part on the perineum, bladder, bowels and other pelvic organs and tissues Pain may be localized, cramping, tearing or bursiting like in nature due to distension and lacerations of the cervix , vaginal and perineal tissues Pain may be referred and discomforts may be felt in the thighs and flanks

10. ROLE OF MIDWIFE Education Support Respect and autonomy Good assessment Good communication

11. Sources of pain Usually begins during the transition phase when descent is very fast This pain gives the feeling of bearing down and sensation may be overpowering Somatic pain travels via pudendal nerves through the dorsal root of the 2 nd , 3 rd and 4 th sacral nerves. Pain is experienced with the contraction intensity of 15 to 20 mmHg above the resting tone of 25 mmHg

12. FACTORS INFLUENCING RESPONSE TO PAIN Previous childbirth experience Level of anxiety and responses to stress Significance of pregnancy Education and preparedness for birth Presence of support person (birth companion) Perceived support from health care personnel Feelings passed to the woman from mother or others Fatigue Feelings of self worth and femininity

13. PAIN PERCEPTION Different people perceive pain differently Never compare peoples experiences for purposes of controlling pain Low threshold- feeling pain even with little pain stimuli High threshold- pain felt after a large stimuli of pain

14. EFFECTS OF LABOUR PAIN Increased activity in the sympathetic nervous system leading to changes in Blood pressure Pulse rate Respirations Nausea and vomiting Affective changes eg Crying - groaning – anxiety- gesturing and hand clenching and wringing

15. Management of pain in labour Non pharmacological factors Pharmacological factors