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This report describes the background and process for a rigorous project to improve understanding of labor pain and its management, and summarizes the main results and their implications. Labor pain and methods to relieve it are major concerns of childbearing women, with considerable implications for the course, quality, outcome, and cost of intrapartum care. Although these issues affect many women and families and have major consequences for health care systems, both professional and public discourse reveal considerable uncertainty about many questions, including major areas of disagreement. An evidence-based framework, including commissioned papers prepared according to carefully specified scopes and guidelines for systematic review methods, was used to develop more definitive and authoritative answers to many questions in this field. The papers were presented at an invitational symposium jointly sponsored by the Maternity Center Association and the New York Academy of Medicine, were peer-reviewed, and are published in full in this issue of the journal. The results have implications for policy, practice, research, and the education of both health professionals and childbearing women.
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PMID:The nature and management of labor pain: executive summary. 1201 69

Labor pain is often severe, and analgesic medication may not be indicated. In this randomized controlled trial we examined the effects of music on sensation and distress of pain in Thai primiparous women during the active phase of labor. The gate control theory of pain was the theoretical framework for this study. Randomization with a computerized minimization program was used to assign women to a music group (n = 55) or a control group (n = 55). Women in the intervention group listened to soft music without lyrics for 3 hours starting early in the active phase of labor. Dual visual analog scales were used to measure sensation and distress of pain before starting the study and at three hourly posttests. While controlling for pretest scores, one-way repeated measures analysis of covariance indicated that those in the music group had significantly less sensation and distress of pain than did the control group (F (1, 107) = 18.69, p <.001, effect size =.15, and F (1, 107) = 14.87, p <.001, effect size =.12), respectively. Sensation and distress significantly increased across the 3 hours in both groups (p <.001), except for distress in the music group during the first hour. Distress was significantly lower than sensation in both groups (p <.05). In this controlled study, music--a mild to moderate strength intervention--consistently provided significant relief of severe pain across 3 hours of labor and delayed the increase of affective pain for 1 hour. Nurses can provide soft music to laboring women for greater pain relief during the active phase when contractions are strong and women suffer.
Pain Manag Nurs 2003 Jun
PMID:Music reduces sensation and distress of labor pain. 1283 49

Labor pain relief is an important aspect of women's health that has historically been neglected. Epidural analgesia is the only consistently effective method of labor pain relief and has recently undergone substantial improvements to address the concerns of both parturients and obstetric care providers. With increased physician awareness, these recent advances are becoming more widely accepted and routinely available for all laboring parturients. Unfortunately, an increasing number of women are presenting to maternity wards with an absolute contraindication to epidural labor analgesia. The present review will provide an outline of the recent developments in parenteral analgesic options which complement modern epidural analgesic techniques. Protocols for the initiation of "state-of-the-art" parenteral analgesic techniques are provided as a guide to facilitate effective, modern, parenteral labor analgesia.
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PMID:Parenteral opioids for labor analgesia. 1297 43

Labor pain relief (anaesthesia) aims at making the patient comfortable, keep her from pain and stress and at the same time keep the baby from the difficulties caused by the stress of the mother. Our work aimed at introducing the methods of anaesthesia, defining their efficiency, selecting the time and method of anaesthesia in order to improve child birth process or timely intervention. All modern methods of labor pain relief have been established in the clinic: pharmacological, transcutaneous electrical nerve stimulation (TENS), and regional anaesthesia (RA). RA makes 65% of all the pain relief cases, while 20% chooses other types of anaesthesia. Epidural sets of size 18-20 g and spinal syringes of size 25-26 g of Terumo and Braun, as well as 2% lidocaine and fentanyl were used. The statistics of the cases of anaesthesia given in our clinic proves that any method that helps the mother is approved. In 1999 cases of anaesthesia made 6.4%. RA was made only to 5 women. In 2003 82 patients (24%) chose pain relief with different methods. 33 of them (40.2%) chose RA and 49 of them (59.8%)--combined anaesthesia. Spinal anesthesia (SA) in caesarean section was administered to 11 (5%) patients. Total of 200 patients (60%) have been anaesthetized during the years of 2005-2006. 55 caesarean sections (25%) were performed with SA. Exclusive quality of pain relief, absolute relaxation, high assessment of infants by Apgar scale, excellent responses from the patients, absolutely favourable health condition of the woman during the first twenty four hours after the delivery and post operation period make RA an integral part of an obstetrical hospital.
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PMID:[The importance of labor pain relief in the process of childbirth, the regional anaesthesia in caesarean section and in operational gynaecology]. 1705 10

In the first stage of labor, pain is caused by distension of the cervix and low uterine segments in combination with isometric contraction of the uterus. Pain in the second stage of labor is dominated by tissue damage in the pelvis and perineum. Labor pain is due to an activation of nociceptors partly resulting from ischemia. The impulses thus generated are conducted into the spinal cord by afferent C fibers from the cervix and lower uterine segments, and by afferent Adelta and C fibers from the pelvis, pelvic organs and perineum. Labor pain is referred to the dermatomes T(11) and T(12) in the early stage of labor. It spreads to the neighboring dermatomes T(10) and L(1) and eventually involves the dermatomes S(2-4) during the second stage of labor and delivery. As in any other type of pain, labor pain stimulates respiration. This reduces the CO(2) concentration in the blood so that, in pain-free periods, respiratory stimulation is lacking and, in consequence, oxygen concentration in maternal and fetal blood is lowered. Pain-induced sympathetic activation will increase cardiac output in a way that may be deleterious in parturients with heart disease, eclampsia and anemia. Moreover, slowing of gastric emptying may cause nausea and vomiting, and slowing of intestinal propulsive movements may result in ileus and oliguria. An increase in plasma catecholamines and glucocorticoids influences uterine contractions. The amount of beta-endorphin released from the pituitary and placenta into the blood is relatively high but obviously not sufficient to depress pain effectively. Adequate nerve block and epidural anesthesia, as well as measures to relieve anxiety, will help markedly to reduce the risks associated with labor pain.
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PMID:[Labor pain-causes, pathways and issues.]. 1841 27

The main aim was to validate the ratio scale derived from the non-metric continuum of the intensity of the different types of pain using cross-modality matching. Magnitude estimation method and cross-modality matching were used with perceived line lengths. The study was formed by 30 outpatients from various specialty clinics, 30 physicians and 90 nurses. The results were: Cancer Pain, Myocardium Infarct Pain, Renal Colic, Burn Injury Pain, and Childbirth Labor Pain were regarded as the pains of greater intensity; the rank order of pain intensity for the different types of pain, comparing the different psychophysical methods used resulted in levels of significant agreement. The conclusion was that the relation between the magnitude estimates and cross modality matching estimates of the line-lengths is a power function, and the scale for the different types of pain is valid, stable and consistent.
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PMID:Validation of the ratio scale of the differents types of pain. 1883 54

The documentation of pain in the labor and delivery setting is one of the essential tasks of all health care providers who care for women in labor. The Joint Commission standards mandate regular pain assessments, but compliance with this mandate in the highly unique patient population of laboring woman is problematic when using the standard 0 to 10 Numeric Rating Scale. Labor pain is always unique given the various contributing physiologic, emotional, social, and cultural components. This article describes the work of a process improvement group to create an alternative pain assessment tool named the Coping With Labor Algorithm. The group, consisting of nurses and nurse-midwives, used the FOCUS format and Deming's "Plan, Do, Check, and Act" cycle to create a formalized assessment tool for use with laboring women. The Coping With Labor Algorithm is currently in use in the labor unit of a large tertiary care facility, which successfully passed a Joint Commission inspection while using the coping algorithm. The value of the coping algorithm is two-fold: it provides a mechanism for pain documentation, and it provides nursing care suggestions for the laboring woman. This article reports nurses' perceptions of the tool.
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PMID:The coping with labor algorithm: an alternate pain assessment tool for the laboring woman. 2018 29

Pain in labor, like the other kind of pain, start at transduction, transmission and modulation. The original gate-control theory, the gate-control theory Mark II and the neuromatrix theory of pain are proposed to explain the complexity of pain perception and pain relief methods such as internal and external factors. Labor pain is originated from the uterine contraction and cervical dilatation and stretching of the neighbor-pelvic organs during the mechanism of labor. The pain is referred to the dermatomes supplied by the same spinal cord segments which receive input from the uterus, cervix and the neighbor-pelvic organs.
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PMID:Pain in labor. 2121 98

Labour pain is one of the most important factors in shaping women's experiences of birth. Choice around pharmacological relief can be complex. Clinical hypnosis is a non-pharmacological option which a number of women have chosen to use, often paying privately to do so. Self hypnosis allows women the opportunity to take control of this technique. Research findings relating to the therapy vary; some trials have found positive effects by way of a reduction in use of pharmacological pain relief, oxytocin use and shortened first stage of labour. Inclusion of the therapy as a means to invoke relaxation and counter the effects of stress and anxiety alone may be valid reasons for consideration of its use. This article outlines the framework used in clinical hypnosis and discusses some of the issues relating to the evidence base for it.
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PMID:Clinical hypnosis for labour and birth: a consideration. 2378 48

The study of pain goes well beyond the study of anatomy and physiology. To fully understand a phenomenon such as pain, one must consider the realm in which it exists - the conscious mind. This paper aims to explore the concept of the conscious mind and its relevance to the human experience of labour pain. Understanding the interactions between the mind, brain, body, social environment and natural world on the experience of pain enables a more comprehensive conception of labour pain. Reaffirming that pain is an embodied subjective experience is important during this current era in pain science research that seems to lean towards neuroreductionism and conceptualises pain as a pathological by-product of disease. Labour pain, however, is a clear demonstration that pain is not always a signal of bodily disorder. The experience of pain is generated by the brain and is realised through the conscious mind. Thus, the study of pain - particularly complex pains such as labour pain - should focus not just on the physical body and neural processes in the brain but must aim to include, and be capable of capturing, all elements that constitute it; the mind, brain, body and the environment.
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PMID:Labour pain: from the physical brain to the conscious mind. 2395 72


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