Pain Managment for the Obstetric Patient
Part one (1) looks at the causes and management interventions of discomfort and pain during pregnancy, labor, birth and recovery from birth. Part two (2) is a component of a teaching plan the registered nurse would use to assist an antenatal patient make an informed decision regarding pain relief measures to be used during labor and birth.
Part 1
•A. Identify and explain two (2) sources of pain for the antepartum patient, intrapartum patient, and postpartum patient during an uncomplicated pregnancy, labor, and recovery from the birthing process. .
•B. Identify one (1) pharmacologic and two (2) non pharmacologic pain management measures for the intrapartum patient. Explain the benefits and risks of each of these pain management measures. .
Part 2
In order for the woman to make an informed decision regarding pain relief measures to be used in the intrapartum period, the information needs to be provided in the antepartum period.
Before finalizing a teaching plan for the pregnant woman, her history needs to be assessed to determine any variables that may affect the content of the teaching plan. For example, are there any language variables/barriers that will affect care provided during labor and birth?
•A. Identify three (3) variables unique to the pregnant patient that need to be considered when developing a patient specific pain management teaching plan for the antepartal patient preparing for labor and birth. Provide an explanation why each of these three (3) variables needs to be considered when developing a teaching plan for an obstetric patient. .
•B. Select two (2) non-pharmacologic pain relief options used in the intrapartum period. For each option, explain three (3) specific points of information related to this pain relief option that needs to be taught to the patient. Include rationales for each piece of content regarding why you would need to incorporate this information. .
Pain management for the obstetric patient
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Introduction
Pain is an unpleasant experience that has the potential to cause tissue damage and is manifested through emotional and sensory experiences. As such, pain therapy is recommended to relieve pain and increase comfort through pharmacological and non pharmacologic management strategies. Experiences of pain are not the same and individual tolerance to pain as well as coping techniques have a direct impact on how people deal with the experience. Women in labor experience pain in different forms and a single pain reliving method can be used, but one can also rely on multiple pain management strategies. As such, understanding the sources of pain for the antepartum patient, intrapartum patient is important. This essay will also highlight on the pain management strategies for intrapartum patient and the risks and benefits for each strategy. It will also focus on a teaching plan intrapartum patient to facilitate pain management.
PART 1
Sources of pain for the antepartum patient, intrapartum patient, and postpartum patient
Obstetric disorders are some of the major causes of pain for antepartum patient, intrapartum patient, and postpartum patients. However, back pain can often affect women because of hormonal, mechanical psychosocial as well as circulatory factors. Changes in the pelvic region causes back pain during and after child birth, and this may persist, given that the pelvic as well as lumbar region may also be affected following back pain (Beckmann, 2010). However, in postpartum the pain tends to diminish, but if not managed properly it can persist. Even though, back pain can occur at any time, for antepartum patient, intrapartum patients the risk is higher, even for those with no prior history of back pain before the pregnancy.
Pelvic pressure is another source of pain that typically occurs at the third trimester, but expecting women can also experience the pressure anytime during the pregnancy. The growing baby pump puts pressure on the pelvic area, affecting the bones, muscles and joints in the area. Even though, it may appear normal, if the pelvic pain persists the patients should consult the obstetrician. Other functional sources are also closely related to pelvic pressure, and hence the patient should be advised on the best lying positions during pregnancy labor and postpartum.
Pharmacologic and non pharmacologic pain management measures
Pharmacologic
Medical management of pain should ideally be at a minimal level, and use of non pharmacological therapies should also be used. Non- opioid drugs including sedatives are used to relive pain.
Benefit
The patients are likely to be satisfied with the option if there are no side effects including feelings of nausea or getting sick.
Risks
There is a potential harm to a mother and fetus from long term use of medication.
In any case evaluation of the impact of the pharmacological option to cause harm is not a straight forward matter especially when there is likelihood of congenital defects. Even with no adverse effect on feta; organ development, the pharmacological option might negatively affect the physiology of pregnancy, for drugs like NSAIDs which may cause delay n onset of labor.
Non pharmacologic
One of the most common strategies for pain management is the breathing techniques to improve relaxation
Benefits
The technique has the potential to reduce anxiety and stress and hence improves relaxation with patterned breathing and relaxation exercises used concurrently for enhanced relaxation. The technique is also potentially beneficial in stabilizing the blood pressure and slowing the heartbeat. At the same time, breathing techniques facilitate full oxygen exchange allowing women to relax better.
Risks
Breathing techniques are sensory stimulation methods that may not necessarily work, and there are no measures to assess their impact. Shallow breathing also limits the techniques and may increase anxiety rather meaning they may be at times ineffective in reducing stress levels.
Massage
Massage is also undertaken to ensure relaxation, improve mobility and blood circulation
Benefits
The relaxation techniques are adapted depending on the pregnancy condition, and the approach takes into account the lying position and back pain complications (Field, 2010). The technique is associated with improved oxygenation of muscles and reduced muscle tension, meaning that the technique can compliment medication for those suffering from back pain.
Risks
Side lying to facilitate the process may not occur for long times because of uncomfortable stretching which may increase the risk of complications o the mother and the fetus.
Sometimes, the therapist may fail to identify all the sore spots, aggravating the sores, meaning that the patient does not get relief from the massage experience.
PART 2
Considering variables in a teaching plan Patient perception
Patient perceptions about the interventions are important indicators on whether there is a need to ...