Nursing Care for Labor Pain

Labor refers to a series of progressive contractions of the uterus that result in dilation and thinning of the cervix. This allows the fetus to descend from the uterus, through the birth canal, and into the extrauterine environment. As the nurse, you’ll collaborate with the registered nurse, or RN, to manage your patient’s pain during the labor process.

Now, pain during labor is expected and time-limited but can still cause anxiety, leading to a stress response that can have an adverse effect on the progression of labor and on the fetus. Excessive pain can heighten the mother’s fear and anxiety, causing the release of cortisol and catecholamines like epinephrine and norepinephrine. When these act on alpha receptors, the uterine blood vessels and muscles constrict, reducing uterine blood flow, reducing the fetal oxygen supply, and potentially leading to fetal hypoxia. Labor also increases the mother’s metabolic rate and demand for oxygen, making the hypoxia worse.

Finally, after labor, poorly managed pain can make it difficult for the mother to interact with the newborn due to post-labor fatigue and exhaustion.

Now, management of labor pain can include nonpharmacologic and pharmacologic methods. Non-pharmacologic methods begin with prenatal education, like offering realistic information on pain and expectations. This can reduce anxiety and allow the mother and partner o rehearse for labor and develop the necessary skills to cope with labor pain.

Other specific nonpharmacologic methods include cognitive processes and cutaneous techniques. Cognitive processes include continuous labor support, where the presence of a support person provides emotional and physical support during labor; music therapy, which can increase pain tolerance and serve as a distraction from pain guided imagery where the patient focuses on a pleasant mental scene or experience; and breathing techniques that can be done either during or between contractions and include taking a deep breath through the nose then gently exhaling through pursed lips.

On the other hand, cutaneous techniques can be used to modulate the intensity of pain by helping to block pain impulses and stimulating the release of endorphins. These include back, shoulder, or sacral massage; the use of a birthing ball, which can be used to rock or gently bounce on to decrease perineal pain; and hydrotherapy which uses warmth and buoyancy to promote relaxation and increase pain tolerance.

Moving on, there are four types of pharmacologic methods to keep in mind. First, there are systemic analgesics, which can include IV administration of full opioid agonists like fentanyl and remifentanil; or partial opioid agonists like nalbuphine. Next, there’s neuraxial or regional analgesia, which involves either an epidural or spinal administration of a local anesthetic and an opioid medication; sometimes it can be a combination of epidural and spinal administration. Another type of regional analgesia is a pudendal block, which involves injecting a local anesthetic just below the ischial spine through the vaginal wall. Next, there’s intermittent inhalation of nitrous oxide which provides pain relief, but the patient remains conscious. The final method is general anesthesia where the patient is fully unconscious, so the most common scenario for its use is during cesarean delivery.