Pain relief in labor is complex and often challenging. Effective management of labor pain plays a relatively major role in a woman's satisfaction with childbirth. Labor contractions usually cause discomfort or a dull ache in the back and lower abdomen, along with pressure in the pelvis. Contractions move in a wave-like motion from the top of the uterus to the bottom. Some women describe contractions as strong menstrual cramps. support measure during childbirth Reduction of fear and anxiety by providing information and support. Facilitation of appropriate rest, sleep and for ambulation. Provision of a labor companion. If you are an expectant mother, you should talk with your obstetrician and your anesthesiologist to develop a plan on Pain management during labor and delivery that ensures the safest possible pregnancy, childbirth, and recovery.

1. PHARMACOLOGICAL
& NON-PHARMACOLOGICAL
PAIN MANAGEMENT
DURING
LABOUR & DELIVERY
MS. MUNEESWARI JEYACHANDRAN, MSC (N), MBA, PH.D. (N) SCHOLAR.

2. ♦ Labor is an emotional experience and involves both physiological and psychological
mechanisms.
♦ The experience of childbirth 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 such as fear, anxiety, low sense of
security, and the expectation of pain.
♦ Pain relief in labor is complex and often challenging.
♦ Effective management of labor pain plays a relatively major role in a woman's satisfaction with
childbirth.
INTRODUCTION

3. COURSE OUTLINE
By the end of this health education session, the participants will be able to know :
♠ What is labor Vs Labor and delivery?
♠ How do you differentiate labor pain from general pain?
♠ What is the purpose of pain in labor
♠ How to manage your labor pain in a successful way?
♠ Why do you need pain relief during labor and delivery?
♠ Do your reproductive rights get support from your health care providers?
♠ Do you identify with self help during labor?
♠ Do you know your support measure during labor?
♠ Why birth companion support is important during labor?
♠ How can I handle my labor pain?
♠ What is the benefits of Non-pharmacological methods of pain relief during childbirth?
 Why are positions so essential in labor and delivery?
 How does the birthing ball help ease labor pain?
 How do you do Breathing technique for painless labor and delivery?
 How are massage techniques beneficial for painless labor?
 How do relaxation techniques aid in labor pain relief?
♠ What are the pharmacological pain management available during childbirth?

4. Labor is defined as the process by which the fetus is expelled from
the uterus. More specifically, labor requires regular, effective
contractions that lead to dilation and effacement of the cervix.
Labor
Labor and delivery are the process by which a baby is born,
from the body's preparations to when the baby and the placenta
leave the womb.
What is Labor Vs Labor & delivery?
Labor And Delivery

5. How do you Differentiate Labor Pain from General Pain ?
Pain is a common labor symptom and located in the abdomen, back, pelvic floor, perineum,
or other locations.
Pain describes as "an unpleasant sensory and emotional experience associated with actual or potential
tissue damage, or described in terms of such damage"
-The International Society for the Study of Pain
Pain
Labor Pain
Labor contractions usually cause discomfort or a dull ache in the back and lower abdomen, along with pressure in the pelvis.
Contractions move in a wave-like motion from the top of the uterus to the bottom.
Some women describe contractions as strong menstrual cramps.
Pain is a general term that describes ”uncomfortable sensations” in the body.

6. Physiologic drivers of labor pain
♦ Uterine contractions.
♦ Cervical dilation.
♦ Pressure on cervix from the fetus.
What Is The Purpose Of Pain In Labor?

7. How to manage your labor pain
in a successful way?
Successful control of pain in labor requires
active management of the entire process.

8. Why do you need pain relief during labor and delivery ?
♠ To Cope with labor and delivery.
♠ To Decrease the intensity of pain during labor and delivery.
♠ Ability to change birthing positions.
♠ To enhance comfort and reduce apprehension
♠ An increased ability to function in personal and professional relationships.
♠ To Improve sense of overall well-being.

9. Do Your reproductive rights get support from your health care
providers ?
7). Choice
of labor
and birth
position
Health care providers support women’s sexual and reproductive rights through advocacy for women’s access to:
1) Prenatal and parenting education 2). Privacy 3) Hydration & nourishment
during labor
4). Labor companions.
5). Non Pharmacological pain relief
for labor and delivery.
6). Pharmacological pain relief

10. Helping yourself to stay comfortable
Do You Identify with self-help during labor ?
Before you go into
labor, think about what
you will do.
Learn and practice
relaxation and breathing
techniques.
Keep moving around and have a
birth partner or someone to support
you and massage you.
Having confidence
in your body
will also help.

11. Do you Know your Support Measures During Labor?
♠ Encouragement & facilitation of position changes and mobility.
♠ Reduction of fear and anxiety by providing information and support.
♠ Facilitation of appropriate rest, sleep and for ambulation.
♠ Provision of a labor companion.
♠ Listen to her complaints, and ensure hydration & breathing techniques.

12. ♠ Encourage slow to fasten abdominal breathing into abdomen as progress of labor.
♠ Help to change comfortable positions
♠ Play favorite music from the playlist or watch the movie from hospital TV.
♠ Remind them why she is doing this and encourage for each stage of labor.
♠ Offer her a cool drink, ice chips to avoid dryness during labor.
♠ Give other supporters a shoulder rub.
♠ Knead her buttocks or apply pressure to her sacrum
♠ Apply warm cloths to her perineum
♠ Hold her hand and onto her toes.
♠ Massage her hands and feet
♠ Make long, firm strokes down her whole body
♠ Stroke down her thighs to her feet
♠ Apply cold or warm packs to the sacrum or neck
Shoulder Rub

13. Why Birth Companion Support is important during Labor ?
Provide physical contact & encouragement to the woman is
beneficial to mothers and their babies.
Reduces the length of labor, the use of medication for pain relief,
the cesarean rate, and the use of oxytocin.
Who can be a birth companion?
 Mother’s partner/spouse/husband.
 Mother’s Mom
 A family member or relative.
 Friend.
 Doula (nonmedical trained personnel who
support the woman during labor).

14. Alter thoughts & Focus concentration
Non-Pharmacological
Pain Management
How can
I
handle my
labor pain?
There are
2
General
approaches
for
Pain Management
during labor & delivery
Pharmacological
Pain Management
Eliminating or decreasing the physical
sensation of labor pain.
Largely directed at increased comfort, enabling
the laboring woman to cope with the pain and
preventing suffering

15. For women who birth without medical interventions, there may be many benefits, including:
♠ Less pain after birth
♠ Faster recovery from birth
♠ Less chance of a Cesarean section
♠ Increase in self-esteem as a result of the birth
WHAT IS THE BENEFITS OF NON-PHARMACOLOGICAL PAIN MANAGEMENT
DURING CHILDBIRTH ?
♠ More bonding with the baby
♠ A calmer, more settled baby
♠ Less likelihood of depression after the birth
♠ Potential for easier breastfeeding

16. Why are Positions so essential in labor and delivery?
Benefits of different positions during labor
Moving around, staying upright, and changing position can helps:
 To ease the pain.
 Increase cope up during labor.
 Feel in control of labo
 Increase the chances of a shorter labor.
 Push the baby downwards.
 Find the best position for giving birth.
Sitting Position
Rocking/ slow dancing
Sitting upright on
Birthing ball
Sitting backward on a chair
Hands and knees
Sitting forward lean
Standing forward lean
Birth balls kneel
Lying on side
Sitting position with bed bar
Abdominal lifting

17.  Place a yoga mat on the floor and keep the birthing ball.
 Assist the mother to sit over the ball comfortably.
 Try variety of comfortable position on birthing ball to relieve labor pain and speedup the labor.
 Hold the mother and started initially with breathing techniques for 1 to 10 counts after that for and through movement.
 Provide birthing ball for 15 minutes in the cervical dilatation of 2cm, 4cm & 6cm.
Contraindications
The birthing ball should not be used in the following conditions:
 Mother with rupture of membrane
 Mother who underwent previous caesarean section
 Mother with burns or infections.
Benefits of use of birthing ball
The general benefits include:
 Release of muscular tension
 Promote circulation of blood.
 Relieves pain improves general health.
 Promotes comfort
Benefits in labor includes
 Reduces labor pain
 Induces labor
 Improves coping
 Promotes good contractions & cervical dilatation
 Aids in progress of labor with reducing the duration of labor.
How does the Birthing Ball help ease labor pain?

18. How do you do Breathing Techniques for painless labor and delivery?
Expulsion
breathing
THE DIFFERENT BREATHING TECHNIQUES
The organizing
Breath
Slow breathing Light Accelerated
breathing
Variable or transition
breathing
 Inhale deeply
and exhale with
a big sigh.
 This will
increase focus
and release
tension.
Inhale slow
through the nose
and exhale
through mouth.
This Helps
manage
contraction pain
 Hee-Hee-who or
Pant-pant-blow
 Breathe in lightly,
taking shallow
inhalations, and
breathe out with
long, relaxing
exhalations.
 This technique is guided
by the contraction.
 Speeds up and lightens
the breathing as
comfortable until no
longer resist the urge to
push.
 Then takes a deep
breath, leans forward,
and breathes out with a
moan or grunt.
 Taking rapid,
shallow breaths
through the
mouth at a rate
of about one
breath per
second.

19. How are Massage Techniques beneficial for painless labor?
Benefits of massage
 Helps to alleviate muscular tension in the extremity.
 Helps to increase oxytocin
 Increase the release of endorphins from pituitary gland.
 Act as natural pain killers.
 Give soothing effect on mother’s nervous system.
 Reduce anxiety, depression, and stress during labor
Hand and Foot Massage
Long Strokes Sacral Counter pressure
Two-Person Grounding Stroke
Shoulder Massage

20. ♠ Drink plenty of plain water 6-8 glass during the labor.
♠ Take warm water bath in early stage of labor.
♠ Rub ice on Maternity Acupressure points to relieve or reduce labor pain.
♠ Apply cool cloths to the forehead, back of the neck, wrists, and low back.
♠ Apply friction massage using cold moist wash- cloths wrapped around the hands.
♠ Use frozen juice cans or a frozen rolling pin to roll over soft tissue of the body.
♠ Spray water on the back or belly with a hand-held shower.
How does hydrotherapy influence your painless labor and delivery?

21. HOT WATER BAG APPLICATION
 Hot water temperature is 104-110°F
 Place the mother in a left lateral position.
 Apply the hot water bag over the sacral for 20 minutes with one-hour interval.
 Change the position of the bag is necessary.
MUSIC THERAPY
 Music therapy can relax, soothe, decrease pain and provide distraction. By stimulating the release of endorphins music enhances one’s
sense of well-being and decrease the need for pain medication.
DISTRACTION TECHNIQUES
 Reading favorite book.
 watch favorite film, web series, song videos etc.
 Low lighting can enhance a calm mood and promote relaxation.
DIM LIGHTING ROOM
How do Relaxation Techniques aid in labor pain relief?

22. Many types of medications can ease pain during labor and delivery.
♠ An odorless, tasteless gas- is a pain reliever.
♠ Using a hand-held face mask.
♠ Takes effect within a minute
PROS CONS
 Used on and off or continuously during
labor
X Doesn't eliminate pain
 Can control the amount you use X For relief, it's necessary to breathe in the nitrous
oxide about 30 seconds before each contraction
 Able to walk during labor X May cause nausea, vomiting, dizziness and
drowsiness.
PHARMACOLOGICAL PAIN MANAGEMENT IN LABOR
1. NITROUS OXIDE

23. 2. OPIOID DRUG – INJ. PETHIDINE
How is pethidine given during labor?
Standard dose is 50-100mg, together with an anti-emetic (Inj. Primperan) agent, into your upper thigh area.
What is pethidine?
It is both an (analgesic) painkiller and an antispasmodic, so may help you feel relaxed as well as reducing labor pain.
How long does pethidine last?
 Takes about 20 minutes to work and one injection of Pethidine can last between two and four hours
When can I use pethidine?
 Usually given in the 1st stage of labour, cervix is opening up from being tightly closed to fully dilated.
 (Beneficial - very early stages of labor).
 Prior injection, assess cervix dilation by vaginal examination.
What happened to you after pethidine?
 It will help you to relax and lessens the pain.
 You can also use Entonox (Gas & Air) with this.
Is my baby affected with this medication ?
 As Pethidine is an opiate it will cross the placenta and a small amount will
pass through to your baby.
 If cervix is 7-8 cm dilated, Pethidine does cross the placenta, cause
respiratory depression (reduced breathing) and low APGAR score at birth.
 A reversal drug (Antidote – Inj. Narcan) for your baby would then be required.
 Resuscitation of baby will be done by Neonatologist and nursing team.

24. LOCAL ANESTHESIA
 Inject medication into
the area around the
nerves that carry feeling
to vagina, vulva,
& perineum.
 Administer Medication
just before delivery to
relieve pain during
childbirth.
 Use Local anesthesia is
during episiotomy where
tissues need to be
repaired after childbirth.
Pudendal block
 Reduce smooth
muscle spasm.
 Accelerating cervical
dilatation without
major side effects.
 Reduce duration of
first stage of labor.
 Administer IV with
normal saline or IM
route.
BUSCOPAN PERFALGAN
 Help in relieving labor pain during
first stage of labor
 Has positive influence on bearing
down & progress of labor.
 Administer as IV medication.

25. Epidural analgesia
Possible side effects and complications of epidural analgesia include:
After epidural insertion, blood
pressure may drop, cause
fainting and feel nauseated, treat
with intravenous fluid.
Causes some muscle weakness in
the legs, so, women who have had
an epidural analgesia may be
confined to bed.
The lack of sensation in the lower
body means that you will not be able
to tell when you need to urinate.
Urinary catheter insertion useful.
 Give medication through a tube placed in the lower back by anesthetist.
 Use a combination of analgesics and anesthetics during labor and vaginal delivery.
Will I be able to move or feel anything after receiving an epidural?
 Can move with an epidural, but you may not be able to walk.
 Make you more comfortable, still aware of your contractions.
 May feel labor progresses.
How is an epidural given?
Soreness
Headache

26. Thanks to the miracles of modern medicine.
If you are an expectant mother,
you should talk with your obstetrician and your anesthesiologist to
develop a plan on
Pain management during labor and delivery
that ensures the safest possible pregnancy, childbirth, and recovery.

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practice, 24(3), e12642.
2) Chaillet, N., Belaid, L., Crochetiere, C., Roy, L., Gagné, G. P., Moutquin, J. M., ... & Bonapace, J. (2014). Nonpharmacologic
approaches for pain management during labor compared with usual care: a meta‐analysis. Birth, 41(2), 122-137.
3) Landau, R. (2009). Pain management during labor. F1000 Medicine Reports, 1.
4) Smith, A., LaFlamme, E., & Komanecky, C. (2021). Pain management in labor. American Family Physician, 103(6), 355-364.
5) Taavoni, S., Abdolahian, S., Haghani, H., & Neysani, L. (2011). Effect of birth ball usage on pain in the active phase of labor: a
randomized controlled trial. Journal of midwifery & women's health, 56(2), 137-140.
NET REFERENCE
1) www. Mayoclinic.org
2) www.ncbi.nlm.nih.gov
REFERENCES