Nonpharmacologic

pain management
during labor
By :
Manar Mahmoud 2034847

Afnan jamal 2037701

Rama zurkiyeh 2036314

Insructor: dr. Sumaia Talal

Objective

* At the end of this seminar we will be able to :

- Identify the meaning of nonpharmacologic pain management during labor.

- Explain techniques used to decrease pain during labor.

- Describe nursing interventions for promoting the woman's comfortable and

decrease pain during labor.

- Explain the effect of using these techniques for maternal

Outline:

1-definition

2-principles and techniques

3-nursing experience

4-mothers perception

5-maternal impact

6-neonatel impact
: Introduction

• Labor is the process by which the fetus and the placenta leave the uterus . Delivery
can occur in two ways , vaginally or by a cesarean delivery .

• The experience of child birth is a subjective and multidimensional issue , and each
woman passes through it in a different way . It is one of the most beautiful episodes in
a mother's life , associated with joy , happiness , and celebration : However , a
delivery is also related to negative emotions : fear , anxiety , low sense of security ,
and the expectation of pain ( r / t ) uterine contraction.

* Women often mention , that because of their anxiety they would prefer a caesarean
section rather than a natural delivery

So , we should encourage the mother to give birth naturally and educate her How do
you get through this stage with the least pain and get a positive experience with the
nonpharmacologic measures
Definition

• These measures can increase the production of endogenous endorphins(natural

pain relievers) that bind to receptors in the brain for pain relief

• A decrease in the intensity of discomfort is one of the goals of nursing support

during labor. Nursing measures to decrease pain include the following:

• PSYCHOLOGICAL SUPPORT.

• PHYSICAL CARE.

• PHYSIOLOGICAL SUPPORT (psychophysical methods of coping with pain) .

• ALTERNATIVE METHODS OF PAIN RELIEF .

Pros & cons of non-pharmacological

Interventions

• pros:

1. Non-surgical

2. Enhance women's sense of control over childbirth •

cons:1-Many interventions require special training or prenatal practice

2-Not effective for all mothers

 Support during labor:

• 1-the environment • A relaxed, homely atmosphere will help the women and her
partner feel at ease more quickly. The attitude of the staff is very important, perhaps
more so than the physical details of the environment.The labor room must be
furnished •

2-mobility • If the women can be encouraged to be upright and mobile, labor is likely
to progress more quickly and the woman will feel more in control. And if she
encouraged to change position from time to time in order to become as comfortable
as possible. •

3-relaxation Techniques If the women has been taught relaxation techniques she
should be reminded of them and supported as she puts her knowledge into practice.

4-conversation • When a women is in labor there are times to talk and times to be
silent. At this stage a woman is becoming tired and each contraction requires her
complete concentration and all the physical and emotional reserves. Our duty is to
take her attention.
• Continuous labor support refers to the nonmedical support of the woman in labor
has decreased the use of obstetric interventions. Evidence indicates that continuous
support during labor has a number of measurable positive impacts on key birth
outcomes when compared to intermittent support like; continuous support is
associated with less use of pharmacological techniques, fewer operative deliveries,
and more reports of satisfaction with birth, and moreover, it has clinically
meaningful benefits for women and infant

principles and techniques

1- Hygiene and comfort • The woman in labor will become very hot and will
perspire profusely so that she will appreciate the opportunity to have a bath
or shower if she feels able. A warm bath my be very comforting for the women
with backache and she may enjoy soaking herself in deep warm water. If she
isn't able to get up she will appreciate frequent sponging particularly of her
face and neck, with cold water

2- 2-Position:

Women may need help to find a position which is comfortable. An alternative

position, mybe described as any position other than recumbent, semi-recumbent
or She will have prepared her self during pregnancy by exercising.

setting on the bed ,in active Birth the woman participates fully in her labor, is very
aware of all that is going on within her body and aims to respond to these events
naturally

Care of bladder: By clean after urination every time toprevent infection

 3-Massage • Massage stimulates the body to release endorphins, the natural pain-
killing, mood-lifting chemicals produced in the brain. Endorphins are responsible for
you feel after a bout of laughte. In labor, massage brings the women closer to the
person who's caring for her . This could be the midwife, nurse or birth partner. Touch
can make the women feel better while she is coping with contractions and perhaps
tired or frightened. • •Studies suggest that those mothers who utilize them may have
shorter labors, reduced postpartum depression, shorter hospital stays, and increased
patient satisfaction. Not many potential risks were reported for mother and baby;
thus, it is an excellent method to decrease labor pain
4-Birthing ball: Sitting on the birthing ball keeps the baby properly aligned in the
pelvis and encourage pelvis mobility

Encourages the baby to drop down further (descend) into the pelvis by allowing
gravity to work with the laboring mother.

5- Herbalism

• Several herbal preparations have traditionally been used to reduce pain with
dysmenorrhea or labor, although there is little factual support for their effectiveness.
Examples include raspberry leaves, fennel, and life root. Blue cohosh (squaw root), an
herb that induces uterine contractions, is not recommended because of the risk of
acute toxic effect to the mother or fetus •

From the findings of research, it is difficult to say that the herbs are effective and safe
as the women would like to claim. Some women had experienced complications. Yes
there may be perceived or actual effectiveness in terms of shortening labor, but are
not safe . It is therefore important to scientifically test these drugs if pregnancy is to
be safe. Since the women can not be stopped from taking these herbs as it is engraved
in their culture and some have absolute faith in them.
6-Aromatherapy

• Aromatherapy is the use of aromatic oils to complement emotional and physical

well-being. Their use is based on the principle that the sense of smell plays a
significant role in overall health. When an essential oil is inhaled, its molecules are
transported via the olfactory system to the limbic system in the brain. The brain
responds to particular aromas with emotional responses. When applied externally,
they are absorbed by the skin and then carried throughout the body. The oils used
may be able to penetrate cell walls and transport nutrients or oxygen to the inside of
cells. Jasmine and lavender are oils thought to be responsible for an easier labor.
When a drop of oil, such as lavender, is placed on the skin, a woman is able to taste it
within 15 seconds

• Research showed that aromatherapy massage with Jasmin extract significantly

decreased pain severity in the first stage of labor .Other studies do not support the
effectiveness of inhalation aromatherapy with jasmine extract in reducing labor pain
7-Breathing Technique:

Breathing techniques may help the laboring woman. Encouragerelaxation, provide

distraction, enhance the ability to cope withuterine contractions, and allow the
uterus to function moreefficiently.the nurse should educate the mother the
breathingtechniques to prevent Hyperventilation

A. Bely breathing

In early labor, try belly breathing. As you inhale, expand your belly

outward; as you exhale, relax your belly downward.

1.Put one hand on your belly just below your ribs andthe other

hand on your chest.

2. Take a deep breath in through your nose, and let your belly push

your hand out. Your chest should not move.

3. Breathe out through pursed lips as if you were whistling. Feel the

hand on your belly go in and use it to push all the air out.

4. Do this breathing in between or during contractions. Take your time each bB. Pant-
pant-blow breathing
As your contractions become moreintense,exhale in a "pant-pant blow" pattern,
about6cycles per minute.

1. AS your contraction starts, take a deepbreath in through your nose.

2 * Exhale in 2 short pants followed by onelonger blow. You may have heard
thisdescribed as "hee-hee-hooooo.

3.This breathing in and panting out shouldtake about 10 seconds.

4 Repeat this type of breathing until thecontraction stops

8- Ambulation also aids in fetal descent, increases the frequency and intensity of
contractions, and provides the woman with a sense of control at the first stage of
labor.

9- Music: creates a pleasant and relaxing environment and music transmitted

through earphones can block out disturbing, distracting, or unpleasant sounds.
Carefully chosen music can also reinforce rhythmic breathing patterns, massage
strokes or facilitate focusing one’s attention

10-Hydrotherapy

• Standing under a warm shower or soaking in a tub of warm water, jet hydrotherapy
tub, or whirlpool is another way to apply heat to help reduce the pain of labor. The
temperature of water used should be between (35.0° and 37.8° C) to prevent
hyperthermia.

Soaking in a tub is not usually recommended for women at the beginning of labor
because the heat and relaxations may slow contractions .and not in women whose
membranes have ruptured because of the risk of infection
• Benefits for Mother:

• Warm water is soothing, comforting, relaxing In the later stages of labor, the water
has been shown to increase the women’s energy The effect of buoyancy lessens
mother' boy weight allowing free movement and positioning .

• Benefits for Baby: • Provide an environment similar to the amniotic sac• Eases the
stresser birth
.Contraindications:

1.Maternal fever> 100 4 or suspected maternal

2.infections

3.Amnionitis(uterus infection)

4.Documented non-reassuring FHR

5.Excessive vaginal bleeding

6.Epidural Anesthesia

7.Malpresentation(baby is not facing head-first down the birth canal as birth

approaches)
11-Transcutaneous electrial nerve stimulation (TENS): A small device delivers the
current at or near nerves

it blocks pain signals by stimulating different nerves in your spinal cord. It might also
cause the release of endorphins, which are the body's natural pain relievers

• Overall, there was a slight variation in pain records between TENS and control
groups. The majority of laboring mothers using TENS responded that they would be
willing to use it again in their next pregnancies.
12- Acupuncture:

• The mode of action of this ancient practice, which orginated in china and for east is
not fully understood. It may be related to stimulating the release of endorphin as well
as interruption of the transmission of pain stimuli.

• controlled trials employed found that women who had acupuncture slightly
reduced pain scores and decreased use of the pharmacological methods. The study
also showed that 2 months after birth recollection of labor pain (no significant
differences) , acupuncture as being effective for spent less time in labor, and had less
blood loss. Finally, the study revealed that no serious impacts of acupuncture
treatment
conclusion

• When the mother experiences pain during labor and birth, the nurse can assist her
to have a positive birth experience by providing effective comfort measures. Nursing
interventions directed toward pain relief begin with the nonpharmacologic measures
Effects of massage and acupressure on relieving labor pain, reducing labor time, and
increasing delivery satisfaction

Ilknur Munevver Gönenç, Füsun

Journal of Nursing Research 2020

Purpose:

The aim of this study was to compare the effects of massage and acupressure on labor-related
pain management, duration, and satisfaction with delivery.

Methods:

This randomized controlled trial (n= 120) included three intervention groups (massage only,
acupressure only, and massage+ acupressure) and one control group, in which patients
received no massage or acupressure treatment. A personal information form

three of the interventions were found to be effective in improving satisfaction

Conclusions:

The results of this study indicate that the dual application of massage and acupressure is
relatively more effective than either therapy applied alone and that massage is more effective
than acupressure
 REFERENCES:
● Bonapace, Julie. Accoucher sans stress avec la methodeBonapace.
Montreal, Les Éditions de l’Homme, 2013, 150 pp.

Mass general brigham (newton-wellesley hospital)

https://naitreetgrandir.com/en/pregnancy/childbirth/non-
pharmacological-pain-relief-during-childbirth/#_Toc5356200

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