Coping strategies in labour, Helps to copp up with the pain in the labour, with the relaxation techniqiues mentioned, helps to prevent mother from psychological disorders.

1. COPING STRATEGIES
IN LABOUR
KARISHMA MOHAMMAD
MPT(OBGYN)

2. Coping strategies include:-
 Pharmacological
 Entonox
 Pethidine
 Epidural
 Paracetamol
 Meptid
 Non pharmacological
 Relaxation
 Breathing techniques
 Positioning
 Pain relief
 Tens
 Massage
 Acupuncture
 Acupressure
 Water birth
 Hypnobirthing
 Aromatherapy
 Hydrotherapy

3. Role of physiotherapist during labor
 Relaxation
 Breathing techniques
 Positioning
 Pain relief
 Massage
 Other coping strategies (hypnosis, warm water Bath, acupuncture)

4. RELAXATION
 Breathing - Essential to most methods of relaxation; taught
concurrently
 Physiological- Laura Mitchell Method (1963),Jacobson's
 Touch/massage- Kitzinger (1987)
 Dissociation and unblocking -Noble (1996) Passive
relaxation practiced within pregnancy is replaced by an alert
but “non-striving” state of relaxation in labor [selective
dissociation](releasing excess tension)
 Imagery
 Hot water bath

5.  Jacobson used a tense–release approach that activates
both antagonists and agonists maximally.
 The Mitchell method-Mitchell’s method activates only
antagonists, and moderately.
 Dissociation and unblocking-Noble says that relaxation
is more than rest or stillness; it involves recognizing and
releasing excess tension – whatever the cause.
 Touch relaxation-Kitzinger discusses the concept of
‘touch relaxation’, where a woman relaxes towards the
touch of her partner.

6. BREATHING TECHNIQUES
 Benefits/Purpose of Breathing Techniques
 Provides Oxygen- to mother, baby, and hard working
uterus. Well oxygenated muscles function more effectively
and efficiently.
 Reduces Pain.
 Relaxation- Rhythmic breathing promotes physical
relaxation by reducing muscle tension, and promotes
emotional relaxation by reducing anxiety.
 Distraction- by helping the mother concentrate and focus
on breathing instead of her contractions.

7. First Stage Labor
 Slow Breathing (Relaxed Chest Breathing, Abdominal Breathing) Begin by
doing one cleansing breath.
 Light Breathing (Hee Hee Breathing) Begin by doing one cleansing
breath. Start your breathing like slow breathing and as the contraction
intensifies your breathing becomes quicker and shallower.
 Patterned Breathing (Hee-Blow Breathing, Lamaze Breathing) Begin by
doing one cleansing breath. Breath in quick and shallow breathes. For
three exhales make a quick ‘hee’ noise, one exhale make a slow “hoo’
noise.
 Variable Breathing ( Transitional Breathing, Take Charge Routine) Begin
by doing a cleansing breath. This is just like patterned breathing except
that you vary anywhere from one to four ‘hee’ exhales with one ‘hoo’
exhale

8. Second stage labour
 Breathing awareness can be used to facilitate pushing.
 The woman can be trained to breathe in, then slowly out on
exertion (e.g. during defecation) so that it will become
instinctive to ‘breathe’ out as she pushes, and to maintain the
push at the same time as she breathes in.
 Each push should last about 5 to 10 seconds, and each
contraction may demand three to four pushes.
 Labor Pant-Blow. This breathing technique is used when it is
necessary to keep from pushing.

9.  Spontaneous Bearing Down (Expulsion Breathing) • Breath comfortably
until the urge to push becomes irresistible. Next take a deep breath and
hold it or slowly release it while bearing down for 5-7 seconds. After
bearing down, release any remaining oxygen and breath comfortably
the next strong urge- then repeat.

10. POSITIONING

12. POSITIONING DURING 2ND STAGE OF LABOUR.
 Commonly used positions are
 Lithotomy
 Dorsal (recumbent)
 Lateral & semirecument

13. Massage in labor
 It is probable that the soothing sensory inputs from stroking, effleurage
and kneading activates the gate closing mechanism at spinal level.
 Area of massage back
 deep kneading over painful area,
 double handed kneeding over SI joint.,
 effleurage from sacro coccygeal area, up and over the iliac crest,
 slow, rhythmical longitudinal stroking, from occiput to coccyx can relieve
tension.
 Abdominal stroking
 Perineal massage

15. Tens in labour:-
 TENS is a form of non-invasive pain relief
 TENS has no harmful effects on either the mother or baby
 TENS does not restrict your ability to move about in labour
 TENS can be applied at home during early labour
 Other pain relief options can still be used if TENS does not provide you
with adequate pain relief

16. Modes of stimulation
 Two of the TENS parameters are used for
labor.
 These are burst train TENS and brief intense
TENS.
 Burst Train TENS-This is characterized by low-
frequency bursts (4 Hz) of higher-frequency
stimulation. This type of stimulation has the
properties of both conventional TENS and
acupuncture-like TENS.
 Brief Intense TENS This is characterized by a
high frequency (100 Hz),a long pulse duration
(150s) and the highest intensity that can be
tolerated by the patient. It is best used for
short periods of time

17. Placement of the electrodes
 During the first stage, labor pain information,
when pain is at its most intense, will be
entering segments T10–L1. The information
from the parasympathetic nerves and the
pudendal nerve arrives at the spinal
segments S2–S4.
 As your labor progresses or if you are
experiencing lower back or pelvic pain you
can start using the Channel 1 electrodes
which are placed either side of the lower
spine below the waist

18. THANK YOU