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17.1 Nonpharmacological Pain Management

The laboring person has many options for nonpharmacologic methods to control pain, fear, and anxiety in labor. These methods focus on the physiologic, psychologic, and social aspects of labor. When the laboring person is relaxed, fewer stress hormones are released into the body, and the person experiences less pain. Some of these relaxation techniques, such as biofeedback and hypnosis, should be practiced during pregnancy to prepare for labor. Other techniques, such as massage, position changes, and acupressure, can be used for the first time in labor. Having a support person, such as a doula, partner, or nurse, can facilitate relaxation, create a better birth environment, and increase the satisfaction of birth. The nurse will take vital signs, assess pain, and evaluate FHR before and after interventions.

17.2 Pharmacological Pain Management

The laboring person has many options for pharmacologic pain control. Some of these medications are used for early or latent labor, while others are used for more intense active labor. The nurse provides options for pain relief and explains the pros and cons of each medication to the patient and support person. Each medication comes with benefits and side effects. The nurse is responsible for knowing these side effects and being diligent in monitoring the laboring person. Naloxone is readily available for the laboring person and newborn when opioids are in use. Vital signs and FHR are assessed prior to administration of opiates. Pain level is assessed before and after administration to check effectiveness.

17.3 Anesthesia

Anesthesia in childbirth is available for laboring people who choose this route for managing labor pain. Epidural anesthesia is the most commonly used anesthesia in labor. The nurse has the responsibility of monitoring the laboring person and fetus before, during, and after epidural anesthesia use. Spinal and general anesthesia are reserved for use during cesarean birth or other surgical procedures. These types of anesthesia have rapid onset but also are related to side effects for the laboring person and fetus. The nurse educates the laboring person on the use, advantages, and disadvantages of each type of anesthesia. The nurse also monitors for the effectiveness and side effects related to anesthesia in childbirth.

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