Responding to Pain Management During Labor- Balancing Pharmacological and Non-Pharmacological Interventions

Responding to student 1

Hello,

Thank you for sharing your post. The evidence-based nursing procedures proposed are well-aligned with the Quality and Safety Education for Nurses (QSEN) competency of Patient-Centered Care. Through this approach, professionals can ensure that the care that is rendered to patients is in agreement with the particular personal values, priorities, and preferences of the patients. Within the domain of medical procedures and childbirth, these interventions put the patients in control of pain management by putting them in power. For instance, discussing pain management options with the patient before administering medication ensures that the patient’s preferences are considered, fostering a collaborative approach to care. Additionally, providing non-pharmacological interventions such as positioning and breathing exercises acknowledges the holistic needs of the patient beyond just medication (Becker et al., 2017).

By adhering to the standards of Patient care, the nurses are able to amplify the birth experience, create satisfaction for their patients, and finally contribute to the good health of the mother and the child. (Parkies et al., 2024) It calls for professionals to involve patients individually and actively in decision-making, thus showing care for patients, which forms the most critical part of the QSEN competency of patient-centered care. However, the principles of patient-centeredness can play a key role in improving the childbirth experience, facilitating patient engagement, and eventually resulting in positive health outcomes for both mother and baby. (Engle et al., 2021) This correlation also shows the necessity of respecting differences between patients and seeking collaboration with patients in their treatment planning, which corresponds with the essence of the QSEN competence of Patient-Centered Care.

References

Becker, W. C., Dorflinger, L., Edmond, S. N., Islam, L., Heapy, A. A., & Fraenkel, L. (2017). Barriers and facilitators to use of non-pharmacological treatments in chronic pain. BMC Family Practice, 18(1). https://doi.org/10.1186/s12875-017-0608-2

Engle, R. L., Mohr, D. C., Holmes, S. K., Seibert, M. N., Afable, M., Leyson, J., & Meterko, M. (2021). Evidence-based Practice and Patient-centered Care: Doing Both Well. Health Care Management Review, 46(3), 174–184. https://doi.org/10.1097/HMR.0000000000000254

Parkies, L., Murray, D., & Okafor, U. (2024). Pharmacological labor pain interventions: South African midwives’ perspective. BMC Nursing (Online), 23(1). https://doi.org/10.1186/s12912-024-01844-w

Responding to Student 2

Hello,

Great work. The nursing interventions as outlined in your case study span the Quality and Safety Education for Nurses (QSEN) category of Patient-Centered Care. (Boswell et al., 2021). This competency highlights the priority of readiness for variation with respect to patients’ preferences, needs, and values, which is shown by the use of the combination of pharmacologic and non-pharmacologic comfort methods during labor and childbirth.

By offering options such as using a doula or coach for emotional and physical support and implementing sensory stimulating strategies like aromatherapy and breathing techniques, nurses prioritize the patient’s comfort and well-being. (Bellini et al., 2023). Additionally, educating patients on these techniques and their potential benefits demonstrates a commitment to empowering patients to actively participate in their care decisions. Fundamentally, including both drug and non-drug therapies that account for the specific requirements of the person, nurses are implementing principled personalized care to ensure positive childbirth and healthier mothers and babies.

References

Bellini, E., Macchi, A., Setola, N., & Lindahl, G. (2023). Sensory Design in the Birth Environment: Learning from Existing Case Studies. Buildings, 13(3), 604. https://doi.org/10.3390/buildings13030604

Boswell, C., Sanchez, L., & Powers, R. (2021). QSEN competencies. Nursing Management, 52(4), 49–53. https://doi.org/10.1097/01.numa.0000733664.57667.9f

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Question

Reply 1- Pharmacological vs. Non-Pharmacological Interventions

During labor and childbirth, the mother experiences great pain, and it is the role of the nurse to provide strategies for pain management, either pharmacological or non-pharmacological. Pharmacological interventions include using medication to reduce the pain, and non-pharmacological interventions are any other methods that do not use medications (Thomson et al., 2019). The type of intervention that is used depends on factors such as the health of the mother, the most effective practices, and cultural considerations depending on the mother.

Responding to Pain Management During Labor- Balancing Pharmacological and Non-Pharmacological Interventions

Pain Management During Labor and Birth

The pharmacological interventions that are used to manage pain during delivery include narcotic analgesics, spinal block anesthesia, epidural anesthesia, and local anesthesia (Zuarez-Easton et al., 2023). The main aim of using these medications is to reduce or prevent the pain of the mother and also reduce cases negatively affecting the fetus, exertion from pushing, and contractions. In addition, the advantages of these medications are that they help the mother to relax and take her focus away from the pain. However, it is critical to communicate with the patient before giving the medication to ensure that she understands alternative options and the potential side effects that they can have. This communication is for the purpose of ensuring there is active participation from the patient and that any decisions made are informed. On the other hand, the most commonly used non-pharmacological strategies to manage pain during labor and childbirth are using a doula, the therapeutic touch, hydrotherapy, aromatherapy, breathing exercises, and using a birthing ball (Matabane et al., 2024). The specific strategy to be used depends on how effective it is, its appropriateness, and the circumstances of the process of labor and birth.

Classifications of Pain Relief Drugs during Labor and Birth and Their Side Effects

The different medications that are used for pain management in labor and delivery belong to different classes. Two of the most common medication classes are anesthetics and analgesics. According to Yang et al. (2020), anesthetics work by numbing the sensation of pain by acting on the peripheral nervous system by impacting how the brain responds to sensory stimulation. Since there is no responsiveness, the patient is in anesthesia. A main example of such medication is epidural anesthesia, which is injected into the epidural area. However, even though the medication is effective, it can have some effects on the mother and her fetus, such as the development of hypoglycemia and the fetus being in distress. Analgesics are also medications used to manage pain during labor and birth (Gido et al., 2021). The use of this medication depends on how severe the pain of the mother is. A major example of analgesics is opioids, which can help reduce pain without affecting the mobility of a patient. However, similar to anesthetics, analgesics also can impact the mother and the fetus, leading to issues such as depression.

Non-Pharmacological Nursing Interventions to provide Comfort during Labor and Birth

There are different ways in which nurses can give comfort to mothers when they are in labor and delivery. One such strategy is to place the mother in a good position, which helps reduce distress, reduce pain, and reduce the length of labor. This should be done by putting the expectant mother in a comfortable position while giving birth. Another intervention is helping an expectant mother with breathing exercises (Issac et al., 2023). If the mother has no previous training and experience with breathing exercises to use during labor, the nurse can help direct her on how to breathe to be able to relax and guide the patient in the whole process.

Reply 2- Nonpharmacologic methods of pain management aim at promoting comfort, and reducing anxiety, fear, tand ension to manage pain while pharmacological pain management involves the use of analgesics (Institute, 2019l).

Non Pharmacological methods of pain management during labor and delivery sometimes involve the use of of a doula or a coach who is a person experienced in childbirth, labor and delivery as well as postpartum support, this person provides emotional and physical support (Silbert-Flagg, 2022b). The Gate-Control Theory of Pain is a concept that is used to explain how distraction can be a great tool to manage pain as this theory suggests that the brain can only receive limited sensory perceptions at a time ,hence, implementing sensory stimulating strategies like aromatherapy, breathing techniques, Imagery , music and cutaneous stimulation techniques like back rubs ,walking, application of heat or cold will alleviate pain by sending more signals to the brain that will subsequently block some pain signals (Institute, 2019l).

Pharmacological methods uses drugs like opioid analgesics which include medication like meperidine hydrochloride, fentanyl, butorphanol and nalbuphine (Institute, 2019l). Opioid analgesics relieve pain by causing central nervous system depression, however the timing for giving opioids is important as it might cause respiratory depression of a new born child if given close to birth, they might also increase nausea and vomiting. Sedatives are also another class of drugs that are used to relieve anxiety and help with sleep, examples of sedatives used include Phenobarbitals, they are known to cause respiratory depression hence they are not given if birth is expected within the next 12 to 24 hours (Institute, 2019l).

The nurse can help the patient by implanting alternative therapies like using the birthing ball, ambulation, and relaxation during labor and birth. The nurse can also explain to the patient how these nonpharmacological techniques will help with their pain during labor and delivery (Silbert-Flagg, 2022b)

Responding to Pain Management During Labor- Balancing Pharmacological and Non-Pharmacological Interventions