University:
Stanford University
Course:
PEDS 282 | Pregnancy, Birth, and Infancy
Academic year:

2023
Views:

370

Pages:

1
Author:

Pierre BERNARD

Pain relief in Labour Psychoprophylaxis Enter labour calmly, look forward to birth, positive attitude from birth partner. Breathing exercises and distraction techniques (music, massage, aromatherapy) Environment in Labour Subdued lighting, room for alternative positions (squatting, all fours, chair), birthing pool Transcutaneous electrical nerve stimulation (TENS) High frequency, low intensity stimulation of dorsal column (T11 à S4) Mother can control current and frequency Stimulation à low freq release of endorphins, high freq closes pain gates Most useful in early labour Complementary Therapy Acupuncture, herbal medicine, guided imagery, naturopathy Systemic opioid analgesia Pethidine (50-150mg im) or diamorphine (5-10mg im) – can also be given IV as PCA Good practice to also prescribe antiemetic. Must have naloxone on standby Inhalation analgesia NO – effective after 5-6 breaths. Self administered though face mask or mouth piece Inhalation should begin as soon as contraction for best effect Pudendal analgesia S2,3,4 crosses sacrospinious ligament behind ischial spine with pudendal artery. Local ananesthesia applied here often used in forceps or ventouse Always aspirate before injection to check not intravascular Lumbar Epidural analgesia Extradural catheter placed, can be topped up if required Woman is immobilised during labour Contraindicated if hypovolaemia Should numb from T10 downwards Spinal analgesia Single injection into subarachnoid space provides block for 2-4 hrs GA Only if – need to delivery baby immediately (eg cord prolapse), maternal coagulopathy mean spinal / epidural not suitable, or if current haemorrhage (epidural & spinal can à hypotension)