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Unit 5: Birth

Chapter 25: Pain Management During Labor

Focus Your Study

Focus Your Study

Pain relief during labor may be enhanced by nonpharmacologic methods and administration of analgesic agents and regional anesthesia blocks. The nurse can offer alternative comfort measures, avoid offering pain medication to women who do not desire pain medication, provide the woman who does desire pain medication with the opportunity to explore available options, and provide education and reassurance to the expectant woman and her support person. The goal of pharmacologic analgesia during labor is to provide maximal pain relief with minimal risk for the woman and fetus. The optimal time for administering analgesia is determined after a complete assessment of vital factors, including maternal, fetal, and labor assessments and the woman's perception of her pain level and her need and desire for pain medication. Two common analgesic agents are butorphanol (Stadol) and nalbuphine (Nubain). Opiate antagonists, such as naloxone (Narcan), counteract the respiratory depressant effect of the opiate narcotics by acting at specific receptor sites in the central nervous system. Sedatives, including barbiturates, benzodiazepines, and H1- receptor antagonists, are primarily used in latent or early labor to promote rest and allow the woman to sleep. Regional anesthesia is achieved by injecting local anesthetic agents into an area that will bring the agent into direct contact with nerve tissue. Methods most commonly used in childbearing include lumbar epidural, spinal block, combined spinal-epidural block, pudendal block, and local infiltration. Three types of local anesthetic agents used in regional blocks are amides, esters, and opiates. The amides are absorbed quickly and can be found in maternal blood within minutes after administration. The esters are metabolized more rapidly and have only limited placental transfer. Opiates act on specific opiate receptors in the spinal cord and have a greater analgesic effect when combined with a low dose of local anesthetic. Possible maternal complications of regional anesthesia, although rare, include systemic toxicity, convulsions, and sudden cardiovascular collapse. Agents in use for epidural and spinal routes include the opioids morphine and fentanyl. Adverse reactions of the woman to local anesthetic agents range from mild symptoms, such as palpitations, to cardiovascular collapse. The newer amides, including ropivacaine and levobupivacaine, are longer acting and have fewer side effects. Pudendal blocks provide perineal anesthesia during the second stage of labor, birth, episiotomies, or laceration repair. General anesthesia can be achieved by intravenous injection, inhalation of anesthetic agents, or a combination of both methods.

The goal of general anesthesia is to provide maximal pain relief with minimal side effects to the woman and her fetus. Complications of general anesthesia include fetal depression, uterine relaxation, vomiting, and aspiration. The choice of analgesia and anesthesia for the high-risk woman and fetus requires careful evaluation.

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