DRUGS FOR PAIN CONTROL DURING LABOR:

4 STAGES IN LABOR
AND DELIVERY:

1.Dilating stage
2.Pelvic stage
3.Placental separation and expulsion
4.Early postpartum
1. DILATING STAGE

 cervical effacement and dilation occur; the cervix thins and

becomes fully dilated at 10 cm.

3 phases in dilating stage categorized by cervical dilation:

1)Latent phase – 0-4 cm
2)Active phase – 4-7 cm
3)Transition phase – 8-10cm
2. PELVIC STAGE
 begins with complete cervical dilation and ends with delivery of
the newborn.
3. PLACENTAL SEPARATION AND EXPULSION
 The placenta separates from the uterine wall and is delivered.

4. EARLY POSTPARTUM
 the first 4 hours after the delivery of the placenta and is a period of
physiologic, stabilization of mother and initiation.
ALTERNATIVE AND COMPLEMENTARY DRUGS:
 Use of herbal supplements, especially in the late
pregnancy to stimulate labor.
Analgesia and Sedation:
Systematic drugs used during labor:
 sedative hyprotics
 opioid agonist
 mixed opioid agonist-antagonist
SEDATIVE - Tranquilizer drugs-these drugs may also be administered to minimize
maternal anxiety and fear although they promote rest and relaxation, they do not provide
pain relief.
Example: barbiturates or hyprotics
HYDROXYZINE - given alone during early labor or in combination
SEDATION - Hyponotics
Pentobarbital- short acting barbiturate and sedation for latent
phase of labor.
Side Effect: bradycardia, hypertension, syncope, anxiety,
confusion, and hallucination.
PROMETHAZINE - A phenothiazine antitasmine and
antiemetic often given with opioids as an adjunct to increase
sedation and reduce nausea, and vomiting in labor.
S.E.- Blurred vision, CNS depression, orthastatic
hypotension
HYDROXYZINE - Anxiolytic antiemetic antihistamine used as a preoperative and
postoperative adjunct therapy to reduce opioid dosage, treat anxiety and control
emesis in labor.
S.E. - CNS depression
Narcotic agonists
FENTANYL CITRATE - a synthetic opiate that is 100 times as potent as morphine.
used as pain relief as adjunct to regional anesthesia.
S.E.- constipation, nausea, vomiting, dyspenea, confusion dizziness, fatigue,
headache, CNS depression. ( contraindicated in patient in severe asthma)
MORPHINE - an opioid that binds to CNS opiate receptors and inhibits ascending
pain pathways, used for adjunct to regional anesthesia for pain delivery.
S.E. CNS depression, constipation, hypotension
MIXED OPIOD AGONIST-ANATGONIST
 Butorphanol tartrate- used for relief of moderate
to severe pain. Used in pregnancy> 37 weeks
with no fetal distress.
S.E.- CNS depression, hypotension, constipation
 Nalbuphine hydrochloride- surgical anesthesia
supplement. used as adjunct to anesthesia
S.E. – respiratory depression, constipation,
hypotension
 POSTPARTUM PARINEAL WOUNDS AND HEMORROIDS
Benzocaine, aerosol wound and 20% - a local anesthesia that inhibits
impulses from sensory nerves by decreasing permeability of the cell
membrane to sodium ions, it is hydrolyzed in plasma and liver by
cholinesterase and is eliminated as metabolism urine.
S.E.- Rash, itching, redness
Witch hazel or pramoxine premedicated pads- is one of the safest and
most natural postpartum vaginal care option for local irritation and
discomfort of hemorrhoids and episotomies.
S.E.- local irritation
. Hydrocortison tissue- act as an anti inflammatory
agent to relieve pain and itching from irritated
tissue.
. Dibucaine ointment- topical anesthetic with the
same action as benzocaine. Do not use near eyes
or over denuded surfaces or blistered areas or if
rectal bleeding is represent.
 NURSING PROCESS PAIN CONTROL DRUGS
• ANESTHETIC USE IN OBSTETRIC
• Local Anesthesia-women receiving parental analgesic for
labor and delivery may require more focused anesthesia
for episiotomies and repair of perineal lacretions.
• Regional anesthesia- this anesthesia may be
administered as a single dose or as a combined spinal-
epidural block.
• General Anesthesia-although rarely used may be
necessary for emergency deliveries, when spinal or
epidural anesthesia is contraindicated.
REGIONAL ANESTHESIA
REGIONAL ANESTHESIA
 DRUGS THAT ENHANCE UTERINE MUSCLE CONTRACTILITY
-Uterotropic drugs insert enhance uterine contractility by stimulating the
smooth muscle of the uterus.
PROTOTYPE DRUG CHART
Oxytocin
- IV oxytocin can also be used for labor argumentative,stimulation of effective uterine
contraction once labor has begun
OTHER DRUGS THAT ENHANCE UTERINE CONTRACTION:
• Ergot alkaloids also called ergotism- one of the large group
of alkaloids derived from fungi act by direct smooth
muscle cell receptor stimulation.
S.E.- uterine cramping, nausea and vomiting, dizziness,
hypertension with IV administration, sweating, chest
pain,dyspenea,itching and sudden severe head ache.
SIGN: Pain in the arms,legs and lower back,numbeness,cold
hands and feet muscular weaknesses, diarrhea ,hallucination,
seizures and blood hypercoagulability.
DRUG USED DURING THE POSTPARTUM PERIOD
• Puerperium- the period from delivery until 6 weeks
postpartum,the mothers body physically recovers from antepartal
and intrapartal stressors and returns to its pregnant state.
• Pain relief for uterine contraction
- After birth pain may occur during the first few days
postpartum,when uterine tissue experience ischema during
contraction particularly in multi parous patient and when
breastfeeding.
• Pain relief for perineal wounds and hemorroids
-pregnancy and the delivery process increase pressure to the
perineal soft tissue causing it to become echymotic or edomatous.
IMMUNIZATION
Rhg(D) IMMUNE GLOBIN
- Is routinely administered to women with fetal blood mixing
such as after absorption or with threatened abortion at any
stage of gestation with continuation of the pregnancy,
obstetric manipulation or trauma or ectopic pregnancy.
- S.E. Hypotension, chills, dizziness, fever, headache, rash,
abdominal pain, diahrea.
RUBELLA VACCINE
-Maternal rubella,also called German measles
- is a potentially devasting infection for the
fetus,depending on gestational age.
S.E.- are generally mild and temporary,burning or
stinging at the injection site is caused by acidic Ph of
the vaccine.
 POSTPARTUM DEPRESSION

 I s intense feeling of sadness, anxiety or preventing patients

from performing their daily task and occurring 1-3 weeks
after child birth, but may occur up to a year after giving
birth, related to change in hormone levels.