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Pain Management for the Obstetric Patient

Part 1
A. Identify and explain two (2) sources of pain for the antepartum patient, intrapartum
patient, and postpartum patient during an uncomplicated pregnancy, labor, and recovery
from the birthing process.
B. Identify one (1) pharmacologic and two (2) non pharmacologic pain management
measures for the intrapartum patient. Explain the benefits and risks of each of these pain
management measures.

A. Identify three (3) variables unique to the pregnant patient that need to be considered
when developing a patient specific pain management teaching plan for the antepartal
patient preparing for labor and birth. Provide an explanation why each of these three (3)
variables needs to be considered when developing a teaching plan for an obstetric patient.
B. Select two (2) non-pharmacologic pain relief options used in the intrapartum period. For
each option, explain three (3) specific points of information related to this pain relief option
that needs to be taught to the patient. Include rationales for each piece of content regarding

why you would need to incorporate this information.

Pain Management for the Obstetric Patient Paper
Part 1a; sources of pain in antepartum, intrapartum and postpartum
The period between when a child is conceived and the period a child is born is referred to
antepartum. During this period, the expectant mother undergoes numerous morphological as well
as physical changes as the child develops. This is why it is important to attend prenatal clinics so
that the nurses can assess these morphological changes to determine if they are normal of putting
the expectant mother at risk. Patient should be taught on ways to maintain physical activeness
and appropriate nutrition. Most health complications experienced by the antepartum patient is

attributable to changes in body hormones, including progesterone levels, estrogen,
gonadotrophin and lactogen. The two main sources of pain are abdominal pain and pelvic pain.
The abdominal pain is due to the stretching of the uterine muscles and expansion of the
ligaments to accommodate the growing fetus. This process is often accompanied by other
physiological disturbances such as nausea and fatigue. The pelvic pain also occurs due to the
enlargement of the abdomen area which causes the pelvic bones adjust accordingly to support the
increase of the growing abdomen (Sandra, Judith, & Jean, 2015).
Intrapartum occurs when one is undergoing labor. This natural process comprises the expulsion
of the fetus, the placenta, and membranes. Sources of pain during this time arise due to the
uterine contractions. The contractions are progressive with the cervix dilation. Picotin and
prostaglandin hormones normally stimulate the pains. The uterine contraction pain and intensity
increases as the baby is about to be expelled. The contractions increase with activities that
increase myometrial such as walking. Initially, the pain occurs in the form of cramping just like
when one is undergoing menstruation and increases with time. The first hours of labor, the
expectant mother is able to control the pains, as they are usually mild. The intrapartum patient
can be taught on effective strategies to manage the pain (Demirel et al., 2013).
Postpartum refers to the period just after birth, mainly the first four hours following birth. This
period is described by excitement and joy, but also pain due to the hemorrhages that may have
occurred during the birth. The main sources of pain are lacerations that could have occurred
during giving birth process. In some cases, the uterine cramping can continue and pain in the
lochia rubra. Pain management during this stage is controlled using narcotics, anti-inflammatory
analgesics that are non-steroidal and where necessary, topical antiseptics could be applied
(Chaillte et al., 2014).

Part 1b; pain management for intrapartum
The pain management in intrapartum can be controlled following pharmacological and non-
pharmacological interventions. Following pharmacological approaches, the nurses can provide
the patient with sedatives to help the patient relax. However, these medications should be used
with caution because the sedative often present adverse effects to the baby and the mother. In
many cases, the use of sedatives makes the mother relax, and feel drowsy. This could present
difficulties in concentrating especially when pushing the baby. The cardiovascular effects are
also associated with alteration of the cardiovascular system. This includes lowering of the heart
rate, which is often linked with difficulties in child’s breathing and even reflexes after birth.
These medications must be avoided and should only be given when necessary and in small
dosages. Additionally, these medications must never be administered to a patient who is about to
deliver (Sandra, Judith, & Jean, 2015).
In the late stage of intrapartum, the best intervention is non-pharmacological intervention. The
nurses must provide the patient with techniques that will enable them cope with pain, fear, and
anxiety that results. One of the techniques that can be applied is controlled breathing technique.
This intervention is important because it relaxes the muscles, which are often tensed. Anxiety
induces endocrinal system, which produces hormones that cause the muscles to become tense.
Tense muscles cause interference with the contractions of the uterine wall, leading to a
complication during delivery. Counseling intervention has also been associated with increased
relaxation of the uterine muscles (Green, 2011).
Nurses should constantly encourage the expectant mother by constantly verbalizing the patient
ability to cope with the pain and the delivery process. If available, the patient can be encouraged
to participate in activities that divert their focus form pain. These include activities such as

walking, massage and the use of the birth ball. The patient should be well educated on about the
gestation period and what to expect during the labor process. This way, the expectant mother
becomes psychologically prepared about the process. Thus, it can face the whole process with
confident. Anxiety is believed to stimulate the endocrinal system where the brain stimulates the
production of the adrenal corticoid hormones, which is often associated with the reduction of
blood flow to important body structures such as the fetus and the placenta. Evidence based
research indicates that an informed patient has less tension which increases blood flow to the
fetus and to the muscles during the uterine contraction process and during delivery (Chaillte et
al., 2014).
Part 2a; variables considered when designing a teaching plan
Nurses are mandated in empowering patients so that they can case manage their healthcare
complications. The process of case management and teaching is challenged by various factors,
including cultural barriers, patient literacy and linguistic barriers are some of the barriers that
affect a successful outcome of a teaching plan. The first key variable that should be assessed is
cultural values and respects. This is because cultural values determine if the patient will follow
the set interventions or cultural aspects interfere with the established interventions. For instance,
in some cultures, the patient is not allowed to take some types of food during pregnancy or even
to carry out vital activities during pregnancy period (Green, 2011).
The patient medical history is important. This is especially valuable in order to understand
previous consumption of medication to avoid adverse interactions. In some cases, the expectant
women can be consuming harmful drugs such as opiods, smoking, and heroin. These drugs are
associated with adverse effects such as Fetal Alcohol Spectrum Disorders, which associated with

numerous neuropathologies. Patients who are addicted should be treated using diazepam and
other necessary support (Sandra, Judith, & Jean, 2015).
The patient medical history is also very important. This involves the history of relatives. This is
because some health complications are inherited and genetic. Other relevant information includes
number abortions, the number sexually transmitted infections (STIs). The number of previous
pregnancies, existing children, and their health status of the children must be recorded. In the
first and the second trimester, pain is an indication of an issue with the physiological process,
and if the pain is very severe, the physician should be consulted. In the last trimester, pain is an
indication of labor. Labor pain varies from person to person and is unique. Mother’s reaction to
pain differs according to the patient physiological preparedness. Patient should be empowered
effectively to ensure that they could manage the disease comfortably and with ease (Martínez
et al., 2012).
The common factors during this process are fear and anxiety experienced by the patients. The
emotional status of the parent determines their ability to cope with anxiety the first time mothers
because of the fear of unknown as well as cultural belief. It is important to understand these
variables because they facilitate in designing of the patient education plan. Additionally,
different stages of labor will require different approach to manage pain. For instance, the first
trimester time pain can be manageable, but in the last trimester, the dilation of the cervix and
contractions of the uterine walls could require non-pharmacological intervention such as breath
relation technique or massage (Demirel et al., 2013).
Part 2b Non-pharmacological pain management
Evidence based research indicates that the best intervention to manage anxiety is through breath
relaxation. Anxiety arises when the patient is inadequately informed about the processes and

physiological activities during the gestation period. Anxiety can also arise due to mixed emotions
of excitement and fear. The interventions should ensure that patient integrity is sustained; this
can be done by drawing curtains when attending to an expectant woman to ensure that privacy is
maintained. The reduction of exposure indicates respect and promotes the patient relationship
with the staff (Chaillte et al., 2014). This mutual relationship makes the patient feel more
comfortable and more relaxed, reducing the rate of anxiety. It is also important to value cultural
beliefs and values give the patient sense of belonging, which empowers the patient to manage
pain. The breath relaxation technique enables the patient cope with anxiety, which helps in
managing pain because it helps relax muscles. This is because tense muscles cause interference
of fetal descent, which is often associated with increased fatigue. The fatigue increases pain
perception negatively affecting patient ability to cope. It also increases mother’s confidence
improving their ability to cope with pains (Demirel et al., 2013).
The use of massage enables pain relief especially during the initial stage of labor. The source of
pain during this stage is due to dilation of the cervix caused by the hypoxia or the contractions of
the uterine muscles. The aim of this intervention is to ensure that patient verbalizes pain relief
indicating that the patient is coping with uterine contractions. It also facilitates the process of
voiding. Full bladder increases pain intensity and discomfort. The massage enables pain
distraction, and can be coupled with other destruction activities such as watching TV, music, or
talking (Chaillte et al., 2014).

Chaillet, N., Belaid, L., Crochetière, C., Roy, L., Gagné, G., & Moutquin, J. et al. (2014).
Nonpharmacologic Approaches for Pain Management During Labor Compared with Usual
Care: A Meta-Analysis. Birth, 41(2), 122-137. doi:10.1111/birt.12103
Demirel, I., Ozer, A., Atilgan, R., Kavak, B., Unlu, S., Bayar, M., & Sapmaz, E. (2013).
Comparison of patient-controlled analgesia versus continuous infusion of tramadol in post-
cesarean section pain management. J Obstet Gynaecol Res, 40(2), 392-398.

Green, C.J. (2011). Maternal newborn: Nursing care plans. Jones and Bartlett Learning.
Martínez, B., Canser, E., Gredilla, E., Alonso, E., & Gilsanz, F. (2012). Management of
Patients with Chronic Pelvic Pain Associated with Endometriosis Refractory to
Conventional Treatment. Pain Practice, 13(1), 53-58.
Sandra, M., Judith A, D., & Jean, W. (2015). CNE SERIES. Pain Management in the Post-
Operative Pediatric Urologic Patient. Urologic Nursing, 35(2).

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