The document discusses various methods for managing pain during labor, including both non-pharmacological and pharmacological approaches. It defines true labor pain as being caused by uterine contractions and cervical dilation. Non-pharmacological methods discussed include psychological support, physical comfort measures, relaxation techniques like massage and TENS, and alternative therapies such as water birth, acupuncture, herbalism, and aromatherapy. Pharmacological approaches outlined are sedative/analgesics, narcotic drugs like pethidine, and inhalation analgesia. The document provides details on the physiology of labor pain and recommendations for nurses on supporting women throughout the different stages of labor.

1. Prepare by:
Romany Lofty

2. At the end of this presentation the student will be
able to :
○define true labor pain
○recognize the management of labor pain
○manage women how is in labor and has a true pain

3. •definition
•physiology of labor pain
•how to mange labor pain
•many methods to mange pain of
labor

4. uterine contractions that result
in a change in the cervix and in
the birth of an infant.

5. The pain experienced by the woman in labor is caused
by the uterine contractions, the dilatation of the
cervix and , in the late first stage and the second
stage , by the stretching of the vagina and pelvic .
These painful stimuli are said to be transmitted by
thoracic . Lumbar and sacral nerves .
Physiology of pain in labor
The pain pathway or ascending sensory tract originates in the sensory
nerve endings at the site of trauma. The impulse travels along the sensory
nerves to the dorsal root ganglion of the relevant spinal nerve and into
the posterior horn of the spinal cord .
This is known as the first neuron
The second neuron arises in the posterior horn, crosses over within the
spinal cord ( the sensory decussation ) and transmits the impulse via the
medulla oblongata , Pons varolii and midbrain to the thalamus .
From here it travels a long the third neuron to the sensory
cortex .

6. As a nurse how to manage pain during labor ?
There are a lot of methods in relief pain and comfort
during labor
.PSYCHOLOGICAL SUPPORT
.PHYSICAL CARE
.PHYSIOLOGICAL SUPPORT (psychophysical methods of coping with pain )
.ALTERNATIVE METHODS OF PAIN RELIEF
.PHARMACOLOGICAL METHODS OF PAIN RELIEF

7. ○PSYCHOLOGICAL SUPPORT
Preparation for labor
1-giving information
2-allaying anxiety
3-participation in planning
At some stage in her pregnancy every woman will realise the inevitability of the delivery of
her baby. Not every women will experience labor but the mother who delivers by planned
caesarean section will also have fears and anxieties and will wonder just how she will cope
with the experience.
Ideally. Every pregnant womam should have the opportunity to form a relationship whith one
particular midwife so that advice may be given consistently and the women become relaxed
and feel able to ask for information freely. In this way each mother is able to obtain as much
information .as she wishes.
As a nurse you should discover what level of information is required
Some women may be anxious at the thought of being given an episiotomy.
Although of course women who have experienced childbirth are often a great source of
support and constructive advice.
Entering hospital for any reason is often seen as a dehumanizing experience
the birth plan commonly used (couples who are able to participate in planning)

8. Support during labor
1-the environment
2-mobility
3-relaxation techniques
4-conversation
A relaxed, homely atmosphere will help the women and her partner feel at ease more
quickly. The attitude of the staff is very important , perhaps more so than the physical
details of the environment.
The labor room must be furnished
If the women can be encouraged to be upright and mobile, labor is likely to progress
more quickly and the woman will feel more in control. And if she encouraged to
change position from time to time in order to become as comfortable as possible.
If the women has been taught relaxation techniques she should be reminded of
them and supported as she puts her knowledge into practice.
When a women is in labor there are times to talk and times to be silent. At this
stage a woman is becoming tired and each contraction requires her complete
concentration and all the physical and emotional reserves. Our duty is to take her
attention .

9. ○PHYSICAL CARE
Hygiene and comfort
position
Care of bladder
The woman in labor will become very hot and will perspire profusely so that she will appreciate
the opportunity to have a bath or shower if she feels able . A warm bath my be very comforting
for the women with backache and she may enjoy soaking herself in deep warm water .
If she isn't able to get up she will appreciate frequent sponging
particularly of her face and neck , with cold water.
Women may need help to find a position which is comfortable.
An alternative position ,my be described as any position other than recumbent , semi-recumbent or
setting on the bed, in active Birth the woman participates fully in her labor , is very aware of all that is
going on within her body and aims to respond to these events naturally
She will have prepared herself during pregnancy by exercising.
By clean after urination every time to prevent infection

10. ○PHYSIOLOGICAL SUPPORT (psychophysical methods of coping with pain)
Massage
Transcutaneous electrial
nerve stimulation (TENS)
Massage stimulates your body to release endorphins,
the natural pain-killing, mood-lifting chemicals
produced in the brain. Endorphins are responsible for
the high that you feel after exercise, or after a good
bout of laughter.
In labour, massage brings you closer to the person
who’s caring for you. This could be your midwife or
your birth partner. Touch can make you feel better
while you're coping with contractions and perhaps
tired or frightened.
Doctors and midwives often recommend that patients begin utilizing their transcutaneous electrical nerve
stimulation units as soon as the first contractions start and labor begins. You can rent units, borrow
machines from hospitals, or purchase your own online or in a brick and mortar supplier: “Cost
consideration: to purchase a TENS machine, you’re looking at approximately $200-$300 for a good quality
machine. Alternatively, there are now some cheap basic models being made by various manufacturers
and you can now hire them (online too) so you will be spending considerably less.”

11. The use of water for labor and delivery
Water birth is the process of giving
birth in a tub of warm water. Some
women choose to labor in the
water and get out for delivery.
Other women decide to stay in the
water for the delivery as well. The
theory behind water birth is that
since the baby has already been in
the amniotic fluid sac for nine
months, birthing in a similar
environment is gentler for the baby
and less stressful for the mother.
Midwives, birthing centers, and a
growing number
ofobstetricians believe that
reducing the stress of labor and
delivery will reduce fetal
complications. Water birth should
always occur under the supervision
of a qualified health care provider.
Benefits for Mother:
Warm water is soothing, comforting, relaxing.
In the later stages of labor, the water has
been shown to increase the woman’s energy.
The effect of buoyancy lessens a mother’s
body weight, allowing free movement and
new positioning.
Benefits for Baby:
Provides an environment similar to the
amniotic sac.
Eases the stress of birth, thus
increasing reassurance and sense of
security.

12. Acupuncture
Herbalism
Many mothers are anxious to avoid pharmacological or invasive methods of pain
relief in labor and this contributes to the popularity of complementary methods of
analgesia which are coming into more common use .
The mode of action of this ancient practice, which originated in china and the far east, is not
fully understood . It may be related to stimulating the release of endogenous opioids as well
as interruption of the transmission of pain stimuli.
Is the forerunner of the modern
pharmaceutical industry and uses
combinations of natural plant extracts .
Herbalists claim that their remedies
improve general health and physiological
balance , as well as improving strength
and stamina.

13. Aromatherapy
Yoga and medication
This involves the use of aromatic
oils, some of which are definitely
contraindicated in pregnancy an
labor . The essential oils used are
concentrated extracts of plants and
flowers which are thought to restore
balance within the mind and body
this substances probably work
mainly through the limbic system,
that part of the brain where emotion
and memory are effected.
Are claimed to have a calming
effect, assist the mother in
becoming attuned to her body ,
and give a focus for distraction
from pain and tension.

14. 1-sedatives and analgesics
2-narcotics
*pethidine
3-inhalation analgesia