This is the process where the midwife institute measures to reduce labour pain and ensure a positive childbirth experience for the woman and the family. It can be achieved using pharmacological, nonpharmacological or a combination of both approaches.
Aims
· Assess pain during labour
· Provide pain relief
· Help women to cope with the discomfort of labour
· Ensure satisfying childbirth experience
· Facilitate smooth progress of labour
· Prevent complications
Types
· Pharmacological
· Nonpharmacological
· Combination of both pharmacological and nonpharmacological
Principles of Pain Management
a. Pain assessment is part of vital signs
b. Provide patient and family with adequate information and education on pain management
c. Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
d. Treat each patient as an individual and involve the patient and family in the pain management
e. Employ evidence-based contemporary recommendations for pain management such as:
· Pre-emptive analgesia (analgesic given before a painful stimulus)
· Multi-modal analgesia (using two or more forms of analgesic concurrently)
· Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
· Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management
f. Evaluate the pain management and review decisions per assessment findings
g. Investigate allergies to pain medications and other co-morbidities
h. Employ effective teamwork with doctors and other health team members when managing pain
i. There should be hospital protocol for pain management
j. There should be input and monitoring from hospital management and departmental leadership to achieve effective pain management
k. Guard against dependence or addiction
Requirements
a. Conducive environment
b. A tray containing the following
· Prescribed pain medication
· Syringes
· Needles
· Cotton wool swabs in Gallipot
· Receiver for Used swabs
c. Client’s Maternal and Child Health record book (electronic or manual)
d. Pain assessment tools: Numeric Pain Rating Scale, Visual Analog Scale
e. Conducive environment
f. Sharps container
Steps
1. Establish relationship with the client and significant other based on mutual respect and trust
2. Reassure client and significant other (s) that there are ways to help her cope with pain
3. Encourage support person to remain with woman to provide support where possible
4. Assess client’s knowledge of labour process and her level of anxiety
5. Provide information on pharmacological and nonpharmacological pain management techniques available
6. Counsel the client regarding the risk, side effects and benefits of each
7. Obtain informed consent before administering pharmacologic agents
8. Assess the degree of pain using verbal reports and validated pain assessment tool (pay attention to frequency, intensity and duration of contractions)
9. Assist client to make an informed choice of pain relief options
10. Assess for bladder distention and encourage voiding often (at least every 2 hours)
11. Keep client and significant other informed about the progress of labour
12. Use various nonpharmacological techniques
· Encourage client to change and assume comfortable position
· Teach client to do deep breathing exercises in between contractions
· Encourage client to rest between contractions to reduce fatigue
· Perform sacral massage during contractions or teach and encourage companion to do so
· Use diversional therapy such as:
ü Engage client in conversation of interest and encourage companion to do same if possible
ü Playing client’s preferred music where possible
ü Engage client in preparing of cotton balls
13. Administer prescribed pain medication where necessary
· When administering opioid based medications, cervical dilatation, foetal condition and maternal condition should be assessed first
· Opioid medications should not be given when cervical dilatation is 6cm or more
· Ensure that local anaesthetic agent is given before cutting or suturing episiotomy for pain management (refer procedure for giving and suturing episiotomy)
· Select appropriate steps for pain management of episiotomy (cutting and suturing)
· For IM and IV medications refer procedure manual for administration of medications.
14. Inform obstetrician if client is in intense pain after all the above measures have been used
15. Document all pain relief strategies used in client’s Maternal and Child Health record book
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