Pain Management in Labour
and Delivery
!! REMEMBER: HER PAIN IS REAL!!
Under-treatment of pain for those with dependence is more of a trigger than giving
opiates.
Ask and assess level of pain. Honour her choices.
Pain Management Options
- Support by caregivers, family, friends, doulas (professional labour support)
- Comfort measures in labour (e.g., dim
lights, back massage, change of position, walking, music, ice chips,
showers, etc.)
- Opioid analgesia (fentanyl,
meperidine, morphine) - variety of routes can be
used
- Epidural anaesthesia usually works well
for substance-dependent women and may be preferred
- !! Mixed agonists-antagonists are
CONTRAINDICATED for acute pain management of opiate-dependent patients eg. nalbuphine (Nubain), pentazocine (Taiwin), butorphanol (Stadol)
In Labour
- If on methadone, maintain patient on
regular dose
- If in withdrawal from opiates, treat
appropriately (see opiates
section)
- If analgesia required, use any option
above and recognize that cross-tolerance to opiates may require increased
dosing
- Many substance-using women have a lower
pain threshold
- Fetal heart tones may have minimal
variability with opiate, alcohol or sedative use; assess further for fetal compromise
- Consider consulting anaesthesia and
paediatrics
Postpartum
- Treat pain with ibuprofen and/or narcotics
(e.g., acetaminophen & codeine, oxycodone,
or hydromorphone - give a 3-5 day quantity); re-evaluate
long-term use of analgesics
- Consider patient-controlled analgesia (PCA) or patient-controlled epidural anaesthesia (PCEA), if available, after caesarean section
Factors That May Affect a Woman's
Perception of Pain
|
Personal |
Hospital |
|
o Past
negative experience e.g., history of sexual abuse o Occiput posterior (OP) labour o Cultural
perspective o Fear o Anxieties
and apprehension o Tolerance o Partner
issues |
o Lack
of support o Unwanted
support o Loss
of control o Hypervigilence o Heightened
vulnerability o Lack
of privacy |