Good Research Paper About Pain Management For The Obstetric Patient
A registered nurse is a major resource for women during their pregnancy and childbirth. The following discussion is divided into two parts. The first part reviews the pain and discomfort during the four main components of the process during the pregnancy, labor and birth and during the patient’s recovery from giving birth. Part A reviews the causes of pain and discomfort during the process and what interventions can enhance the experience for the mother. Part B discusses the teaching job nurses need to undertake when they help their patients when deciding how they will manage pain during labor and childbirth.
Women around the world use alternative methods for pain relief for many reasons. In some cases traditional practices are passed from generation to generation. Cultures were using alternative pain relief methods before the pharmaceutical companies were started. The economic crisis makes the use of alternative methods in demand because so many people cannot afford costly medicines and therapies. In modern times, patients can choose between both pharmacologic and non-pharmacologic interventions to reduce pain during labor and throughout the duration of the birth. One of the most widely used methods of pharmacological pain intervention is the use of local anaesthesia and epidurals that are given to women to reduce pain during the third phase of labor. Non-pharmacological methods are the alternative strategies like breathing and relaxation exercises, massage and touch and continual support.
If stitches are needed to help the baby leave the womb, then local anaesthesia is applied to the area of the vagina that will be affected. An epidural is another type of anaesthesia, but it is a regional pain reliever to block plain for the mother and is also used for caesarean childbirths to greatly reduce pain. An epidural is a type of spinal anesthesia that allows the woman to stay awake during the childbirth process. The type of pain intervention that puts a woman to sleep is general anaesthesia, but the method is not used very often, only during an emergency. The reason general anesthesia is not used is because the mother and baby can interact immediately after the birth if the mother is awake. Studies show that CSE and EPI are safe, effective techniques for pain reduction during labor and childbirth (Skupski et al., 2009). Nevertheless, women need to know both the advantages and disadvantages of epidural pain relief methods, to help them decide the way they want to manage their pain.
Many choices that do not require medicine for reducing pain are based on common sense and methods that patients feel help them the most. For example, controlling breathing to help a woman manage pain is a natural method. Childbirth classes teach Lamaze to women and their husbands, friends or other person that will help them remember to control their breathing during labor.
Sources of pain during antepartum
Pain during antepartum can be caused by nausea and vomiting that is on-going and can result in dehydration, loss of sleep and weight loss. The causes for nausea and vomiting are not easy to identify and they are different for each woman. A probable cause is the change in the body’s hormones, because estrogens, human chorionic gonadotropin (hCG) and other hormones increase during pregnancy. A sensitive stomach and sensitivity to smells can cause nausea and can lead to vomiting.
Sources of pain during intrapartum
During the intrapartum period the lower back hurts due to lumbar pain and posterior pelvic pain. The lumbar vertebrae are in the very lower back and that is where lumbar pain is felt. The pain might be felt not only in the lower back but down into the legs. The causes are lifting heavy objects, going up the stairs or eve n walking or changing sides in bed may start the pain. The back of the pelvis is where posterior pelvic pain hurts badly and is triggered by twisting around, lifting objects, or motions like climbing in and out of the tub or rising from a low chair. The reason these locations are painful during pregnancy is because the uterus is changing shape and the body’s centre of gravity is changing.
Causes of pain during postpartum
Postpartum pain can be caused because a woman’s body is going though so many changes. Haemorrhoids and constipation cause pain and discomfort and often cause a problem during the postpartum period. The main problems of pain and discomfort can be relieved by rest and taking care of oneself. Other kinds of problems need to be addressed at the doctor’s office such as pain when breathing or vaginal bleeding.
Pain relief for intepartum
The way a woman can find relief for problems during the interpartum period can be with pharmacological methods or alternative, nonpharmacological methods. Lower back pain can be reduced by (1) massage and (2) continual support. Massage can relax muscles that are tense and making pain worse. The advantages of massage include agitation, anxiety and pain reduction. A disadvantage of massage are that it does not work for all women though because some may not feel better during massage or may not be comfortable being massaged in public. No one way to massage can be used as a guideline. Continual support of obstetric patients offers both emotional support and someone to bring ice to chew or to help a woman change her position. The disadvantage of continual support is if the person is more demanding than the patient or is always in the way when nurses are trying to administer to the patient.
The medicine that can be used must be cleared with your health care provider, but most women are able to take acetaminophen (like Tylenol). The usual dose of Tylenol is 650 mg every four hours and can be taken four times in a 24 hour period. The disadvantages are when the writing medicine (such as Advil instead of Tylenol) is taken by mistake and when the guidelines for 650 mg, four times a day are not followed. Other over the counter medicines like nonsteroidial anti-inflammatory drug (like Advil, Motrin or Aleve) should be avoided.
Part B discusses childbirth education and variables that can act as barriers when trying to educate women so they can make better pain intervention decisions during the intrapartum period of the pregnancy.
The best educational plan allows communicating in an organized way the information women need about their health plans and what to expect during the whole childbirth process. The goal of educating obstetric patients is to guide women “through an informed decision-making process” (Lily et al., 2011, p. 11). Childbirth education is an important way to improve the quality of the childbirth experience and help the expectant mother make decisions about the pain interventions she wants to use during labor and delivery (Goldsmith & Wittenberg-Lyles, 2013; Hansford & Forsdike, 2013). The time to share educational information with pregnant patients is during the antepartum period, so they can be prepared for the intrapartum period. Many challenges are faced by nurses when preparing women for childbirth because every woman is from a different background and every woman has unique, individual needs. The special needs of a pregnant patient can be identified during the time the woman’s health history is being taken. If a woman cannot speak English well, that is easy to identify as a potential problem.
Three variables to consider when making lesson plans
Teaching requires communication skills that can adapt to different situations. Language is closely linked with culture so including information on the following situations may help nurses meet the challenge of understanding the reactions of non-English speakers. Nurses need to understand that women speaking different languages are also part of different cultures so their experience of childbirth in a foreign country requires patience and the ability to find alternative ways to communicate with the patient. A language barrier signals to a nurse that their pregnant patient is new to the environment and may be dealing with stresses that negatively affect their anxiety about their pregnancy, such as immigration paperwork or trying to learn English on top of all their other concerns. The reaction of patients who do not speak the language may be due to their confusion or they may be asked to do something that does not fit their religious beliefs. Therefore, nurses need to learn not to label non-English speakers as belligerent, but try to find the core reasons for the reactions but asking for help from, for example, social workers, religious leaders or translators.
Three challenges for teaching are (a) cultural differences; (b) not being able to speak English well and (c) illiteracy are all challenges that need to be overcome so a woman can learn what she needs to know to handle pregnancy, labor, and childbirth while remaining as comfortable as possible. Nurses reported that communicating with patients and their family members is challenging due to cultural differences and health literacy (Goldsmith & Wittenberg, 2013). The woman’s culture influences their family circumstances, and language capabilities. The lesson plan needs to take culture into consideration so the patient can learn strategies to become empowered to make her own choices about pain relief within a culture that is foreign to her.
Non or new English speakers
A woman who is new to the English language needs support to help relieve some of the fear and anxiety she must feel about not understanding everything. Hansfor and Forsdike (2013) developed lesson plans for a course to enhance the learning of women who cannot speak English very well. The lessons total 12-hours of learning and give the women antenatal facts as well as helping them learn English words for talking with health care professionals about pregnancy and labor and about motherhood (Hansfor and Forsdike, 2013).
Language and culture differences
Women who immigrate to foreign countries face many challenges in society when they become pregnant. The society, culture, and language are foreign so asking their nurse questions can be difficult based on all those reasons. The language barrier is a challenge nurses must face when trying to do the best to educate and reduce pain for their pregnant patients. Researchers found that culturally sensitive health support is the right of women when pregnant, during labor and during labor (Benza and Liamputtong, 2014).
Illiteracy is a definite challenge and concern. The problem that arises is the need to find visual and oral teaching methods that will lead to a good understanding of the necessary information by the patients. Women who are illiterate are less knowledgeable about what to expect during pregnancy, during labor and childbirth. The greatest concern is that women who cannot read do not know how to read cannot read the directions and warnings on the medicine they take.
Two non-pharmacological pain interventions
A priority need of women during labor is to be able to rely upon continual nurse, midwife or family support, moving and changing positions and breathing and relaxation techniques (Lily et al. 2011).
Continual support for a woman during labor and childbirth is one of the most important needs of obstetric patients; and may be the most important method for managing pain. A person who is knows the patient and who wants to meet their needs can help them with massage, warm baths, or even aromatherapy.
Continuous support for the obstetric patient from a nurse, nurse midwife or family member is essential. Research shows that when continual support was available the need for “epidural and oxytocin” use was decreased (Welch & Miller 2008, p. 6)
Massage and touch
The core competencies decision support tools for registered nurses includes learning how massage and touch can enhance pain relief by calming a woman during the high stress of labor and childbirth (Lee et al., 2011).
Massage can be applied in many ways, depending on what is the most comforting for the obstetric patient. Back massages with a tennis ball can relive back pain, massage and stroking of the shoulders, feet, face and hands can be effective and effleurage by stroking very lightly the patient’s arm or back in the same rhythm as slow breathing. Lily et al. (2011) include heat and cold applications under the category of massage.
Massage can be used with other alternative strategies like massaging to the rhythm of music or breathing.
The goal of both types of pain relief methods, nonpharmacological and pharmacological is to offer pain relief to obstetric patients, especially when women need it the most during the third stage of labor and during the birthing. Nurses and nurse-midwives are the care-givers who are most involved with women during childbirth and from the beginning as early as prenatal care. Nursing is an opportunity to educate mothers-to-be as well as to make them more comfortable when they are experiences the last phases of the pregnancy. The biggest challenge to overcoming the barriers for women’s decision about their own pain interventions is communication between women and nurses. One of the most effective comfort measures during labor is massage. Education about alternative pain relief methods and good communication with caregivers can help women overcome embarrassment about receiving a massage during labor. Nurses are essential for teaching women the pros and cons of epidural procedures for pain relief. The research on epidural pain relief relies on the abilities of nurses to carry out the necessary measurements during experiments. This research found that there is clearly a need for more research on alternative methods of pain relief.
Benza S and Liamputtong PP. (2014) Pregnancy, childbirth and motherhood: A meta-synthesis of the lived experiences of immigrant women. Midwifery 30: 575-584.
French, K. S. (2015). Transforming Nursing Care Through Health Literacy ACTS. Nursing Clinics of North America, 50, 87-98.
Goldsmith, J. & Wittenberg-Lyles, E. (2013). COMFORT: Evaluating a New Communication Curriculum with Nurse Leaders. Journal of Professional Nursing, 29, 388-394.
Hajiamini, Z., Masoud, S.N., Ebadi, A., Mahboubh, A., Matin, A.A. (2012). Comparing the effects of ice massage and acupressure on labor pain reduction. Complement. Ther. Clin. Pract. 18(3), 169-72. Retrieved from http://www.ctcpjournal.com/article/S1744-3881(12)00041-2/pdf
Hansford, J., & Forsdike, J. (2013). Learning about having a baby in easy English. Pract. Midwife. 16(6), 26-7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23914678
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Madden, K. L., Turnbull, D., Cyna, A. M., et al. (2013) Pain relief for childbirth: The preferences of pregnant women, midwives and obstetricians. Women and Birth 26: 33-40
Pascual-Ramirez, J., Haya, J., Pérez-López. F. R, et al. (2011). Effect of combined spinal–epidural analgesia versus epidural analgesia on labor and delivery duration. International Journal of Gynecology & Obstetrics, 114, 246-250.
Skupski DW, Abramovitz S, Samuels J, et al. (2009) Adverse effects of combined spinal–epidural versus traditional epidural analgesia during labor. International Journal of Gynecology & Obstetrics 106: 242-245.
Welch, L. G. & Miller, L. (2011). Emotional and Educational Components of Pregnancy. Glob. libr. women’s med., Retrieved from http://www.perinatalservicesbc.ca/NR/rdonlyres/578B4507-3801-4553-8D88-7BEE61D1C7FD/0/CoreCompetenciesDST.pdf
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