Chapter 27The Comfort and Support in Labor

Factors influencing women`s perceptions and experience of labor

Biological factorsPsychological factorsSocial factorsSpiritual factorsCultural factorsEducational factorsTypes of support: One to one support midwife to women support The language of child birthUnderstanding childbirth processesMobility and position Culture, movement and position

Types of support: One to one support Much midwifery and medical research has indicated that the one-to-one support by a midwife in labour reduces the need for analgesia and improves the birth experience of the mother. It also shortens the length of the labour. This is reaffirmed in the Modernizing Maternity Care document (MCWP 2006), which concludes that maternity services should develop the capacity for every woman to have a designated midwife to provide care in established labour for 100% of the time

The language of child birth

The terms ′pain′ and ′labour′ are suggestive of difficulty and trouble.

′The skill of watching what you are saying is essential′ (Robertson

2003, p 63), when dealing with women during childbirth. A huge

difference is made if sensitivity is used when explanations are

provided or when information is given, to women. A lot of the

terminology is medical, masculine and negative (Robertson 2003).

The midwife is now able to rely on research, evidence and her/his

decision-making skills to provide care.

The relationship between the woman and the midwife is important

and can also impact on how the woman perceives the pain of labour

Understanding childbirth processes

for midwifery purposes to explain what occurs during labour. The discomfort of

labour is caused by the descent of the fetal head further into the pelvis. It is also

caused by pressure on the cervix and the stretching of the vaginal walls and pelvic

floor muscles, as descent of the presenting part occurs.

It is therefore not suitable to use pain-relieving measures used in other medical

circumstances, as the purpose is not to stop or impair the birth process (or

contractions), but to let the labour progress normally, with the descent of the

presenting part and with the rotation of this. The reactions of the woman to labour

and to the discomfort of this varies greatly. So then must the response of the

midwife. Answers and solutions are needed to support and enable the woman to

cope with the birthing process.

Mobility and position

Mobility during labour improves both the woman's experience and the

outcome of labour. The uterine action is more effective, labour is

shortened, there is a reduced need for pharmacological analgesia and

oxytocin augmentation. The risk of fetal compromise is lowered.

It is documented that recumbent positions result in supine hypotension,

diminished uterine activity and a reduction in the dimensions of the pelvic

outlet (Walsh 2000). Women who take up an erect position during labour

experience less pain, have significantly less perineal trauma and have

fewer episiotomies. Restriction of movement can actually compromise

labour

The birth planThe document that describe the women request during all the stagesThis plan could be adjusted or change depend upon the progress and the situationHow women control the pain during labor?Pain control during labor should be woman centeredThe pain is the empowerment during laborThe ability to control pain and tolerate vary from woman to womenWomen experience, attitude and culture affect on the issueMidwife role is to encourageSelf control is the most importantWomen need to understand that labor and control pain are challenge (relaxation, deep breathing

The physiology of pain Pain stimulus and pain sensationPain is caused by stimulus pain receptors effectPain can be increase or decreased affect by sensory factorsFor example fear and anxiety increase the pain in some casesPainful stimulus affect on other organ such as heart beat, bp, sweating (sympathetic nervous system effect )

Pain transmissionPain pathway originates in the sensory nerve ending at the site of traumaThe impulse travels along the sensory nerve into the nerve rooting in the spinal cordThe labor pain can be classified as acute pain as differ than chronic pain receptors or nerve fibersPain can be recognized by sensory function for example one receptor for each sensation (heat, cold, pressure ect.)

Method of controlling pain Natural non pharmacologicalPharmacologicalnon pharmacological Homeopathy (see chapter 50)Prepared from plan and still widely used in many country Different from country to countryHas positive and negative effectHydrotherapyImmersion in water during labor as a tool of analgesia and pain reliefThis method relieve muscle spasm and increase gravity and enhance laborAdvantage natural process as no oxytocin less augmentationno medical intervention,decrease labor time and decrease the use of pain releif

Music therapy This type of therapy used to provide relaxation tech.Used in early stageUsed as type of supportTENSThis is transcutaneous electrical nerve stimulation Use as pain relief by It is a tool that produce electrical charge across the skin which :prevent pain signal go to uterus ,cervix and vaginastimulating the natural production of endorphin and enkephalinsDecrease the incoming pain stimuli

Contraindication of TENS Risk of affecting fetal monitoringSkin allergiesNot preferred by the motherIn proper skill of applicationsNot controlling the painPharmacological Methods Of Pain Control1.Opiate drug (pethidine)It is the most systemic narcotic analegesiaRoute IMDose 50-150mg Action 20 min.2.Diamorphine: provide effect for up to 4 hr. in labor less use than pethidine3.MeptazinolDose 100-150, active 4hr.

Midwifery careObserve VS and drug effectMonitor fetal Side effect of drugInhalation analgesia EntonoxGas mixed consist of 50% oxygen and 50% nitroxide Consider the most inhalation drug of use that affect CNS receptors Regional [epidural analgesia]Sensory nerve blocking via spinal cord ProcedurePositioncomplication

ProcedureDone by specialist anesthetist Done under aseptic techniquecomplicationsDural punctureConsequent headacheRespiratory arrestFetal compromiseLoss of bladder sensation Neural damage