Pharmacologic and non-pharmacologic pain management for the laboring patient in obstetrics.

Conceiving a child can be a wonderful experience. Mothers may enjoy every moment of the experience from the time that the physician or midwife diagnoses pregnancy to the time that they have to push the baby's head out of the birth canal. Many mothers can appreciate that feeling of fetal kicking for the first time in their pregnancy as well as the moving around and turning back and forth that they also experience. Even though most mothers love the feeling of being pregnant, the laboring segment of pregnancy brings with it pain. There are treatment options to manage pain during laboring. Therapeutic treatment of pain for the laboring patient include opioid analgesics, epidural block, and alternative therapies that do not include medication efforts to relieve pain.

When used effectively, opioid analgesics can be a good choice for pain management of the laboring mother. Activation of neurons that descend to the spinal cord takes place when using an opioid analgesic. Intermittent doses are administered early in the laboring process to hopefully ensure that the patient gets pain relief before having to push the fetus out of the birth canal. Opioid analgesics contain the ability to reduce pain by either inducing sedation or by creating an analgesic; however, it is not certain which effect will actually take place (London, Ladewig, Davidson, Ball, Binder, & Cowen, 2014). Some common analgesics that are used for the laboring patient include butorphanol, nalbuphine, meperidine, and fentanyl. All of these medications are classified as opioid agonist antagonists. The action of these medications includes binding to opiate receptors and changing the perception of and response to painful stimuli while producing central nervous system depression that is generalized (Florence & Palmer, 2003). Some side effects of these medications include sedation, dizziness, and respiratory depression. The effects of these medications would need to be monitored closely in order to ensure the safety of the patient.

Another therapeutic measure of pain management for the laboring patient would be to administer a lumbar epidural block. With this treatment, an anesthetic is introduced and injected in the epidural space. This medication provides relief to the patient while laboring and during birth. With this treatment, the laboring mother is able to remain fully conscious and to actively participate in the birthing of the fetus (London et al, 2014). Two common medications that are used for the epidural block are bupivacaine and ropivacaine. These medications are classified as epidural local anesthetics. Bupivacaine and ropivacaine act effectively by inhibiting conduction and initiation of sensory nerve impulses. Also, the entry of sodium and exiting of potassium in neurons help to stop the transmission of pain receptors (Heesen, Van de Velde, Klohr, Lehberger, Rossaint & Straube, 2014). An adverse effect of receiving epidural treatment is maternal hypotension. Laboring patients can experience a drop in blood pressure and therefore a bolus of intravenous fluid should be given before administration to prevent this adverse event from occurring.

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Of course there are some pain management methods that do not include medication that can be used to manage the pain of the laboring patient. Relaxation is an important factor while experiencing labor. If relaxed, the patient can reduce the amount of anxiety, tension, and stress that is experienced throughout the process of labor. Relaxation can promote natural endorphins that would block pain receptors and reduce the amount of pain that is experienced. Relaxation can be promoted by use of water therapy that takes away some of the discomfort and feelings of pressure. Wireless external fetal monitors are safe for use during water therapy in order to continue fetal monitoring. Guided imagery is another tactic to attempt to distract the patient from the painful effects of labor. Thinking of a favorite vacation spot or picturing one's self on a crisp and clean sand beach may help to take the focus off of the actual pain that the laboring patient experiences. Tactile stimulation may also be effective in pain management. A therapeutic touch called effleurage involves gentle stroking that may alleviate some discomfort by keeping the sensory nerves busy so that not all pain signals are transmitted. Acupuncture and acupressure can also be used to block the pain signals from coming in contact with the brain (Weatherspoon, 2011).

Opioid analgesics, epidural blocks, and alternative therapies are all options to be considered in the therapeutic treatment of pain for laboring patients. Pain management is an important factor when treating patients because pain causes stress and discomfort for the patient and this may lead to some distress of the fetus. Not all pain management options will work for every laboring patient. With many options of therapy available to choose from, pain management for the laboring patient can be very effective and provide a more comfortable environment for birth (Sanders & Lamb, 2014).

References

Florence, D., & Palmer, D. (2003). Therapeutic choices for the discomforts of labor. Journal of Perinatal & Neonatal Nursing, 17(4), 238-251.

Heesen, M., Van de Velde, M., Klohr, S., Lehberger, J., Rossaint, R., & Straube, S. (2014). Meta-analysis of the success of block following combined spinal-epidural vs epidural analgesia during labour. Anesthesia, 69(1), 64-71.

London, M. L., Ladewig, P A., Davidson, M. R., Ball, J. W., Binder, R. C., Cowen, K. J. (2014). Maternal and child nursing care. Upper Saddle River, NJ: Pearson Education

Sanders, R., & Lamb, K. (2014). An exploration of the benefits and drawbacks of intrapartum pain management strategies. British Journal of Midwifery, 22(9), 642-649.

Weatherspoon, D. (2011). Current Practices in Easing Discomfort from Labor and Delivery: Alternative and Medical Practices. International Journal of Childbirth Education, 26(4), 44-48.

Edwin Pouncival Smith, BS, RMA, RN/B.S.N. Candidate, South University (Dec. 2015), Experienced Clinical & Administrative Medical Assisting Faculty Member, Basic Life Support Certified Professional

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