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Coping strategies in labour
- 1. COPING STRATEGIES IN LABOUR KARISHMA MOHAMMAD MPT(OBGYN)
- 2. Coping strategies include:- Pharmacological Entonox Pethidine Epidural Paracetamol Meptid Non pharmacological Relaxation Breathing techniques Positioning Pain relief Tens Massage Acupuncture Acupressure Water birth Hypnobirthing Aromatherapy Hydrotherapy
- 3. Role of physiotherapist during labor Relaxation Breathing techniques Positioning Pain relief Massage Other coping strategies (hypnosis, warm water Bath, acupuncture)
- 4. RELAXATION Breathing - Essential to most methods of relaxation; taught concurrently Physiological- Laura Mitchell Method (1963),Jacobson's Touch/massage- Kitzinger (1987) Dissociation and unblocking -Noble (1996) Passive relaxation practiced within pregnancy is replaced by an alert but non-striving state of relaxation in labor [selective dissociation](releasing excess tension) Imagery Hot water bath
- 5. Jacobson used a tenserelease approach that activates both antagonists and agonists maximally. The Mitchell method-Mitchells method activates only antagonists, and moderately. Dissociation and unblocking-Noble says that relaxation is more than rest or stillness; it involves recognizing and releasing excess tension whatever the cause. Touch relaxation-Kitzinger discusses the concept of touch relaxation, where a woman relaxes towards the touch of her partner.
- 6. BREATHING TECHNIQUES Benefits/Purpose of Breathing Techniques Provides Oxygen- to mother, baby, and hard working uterus. Well oxygenated muscles function more effectively and efficiently. Reduces Pain. Relaxation- Rhythmic breathing promotes physical relaxation by reducing muscle tension, and promotes emotional relaxation by reducing anxiety. Distraction- by helping the mother concentrate and focus on breathing instead of her contractions.
- 7. First Stage Labor Slow Breathing (Relaxed Chest Breathing, Abdominal Breathing) Begin by doing one cleansing breath. Light Breathing (Hee Hee Breathing) Begin by doing one cleansing breath. Start your breathing like slow breathing and as the contraction intensifies your breathing becomes quicker and shallower. Patterned Breathing (Hee-Blow Breathing, Lamaze Breathing) Begin by doing one cleansing breath. Breath in quick and shallow breathes. For three exhales make a quick hee noise, one exhale make a slow hoo noise. Variable Breathing ( Transitional Breathing, Take Charge Routine) Begin by doing a cleansing breath. This is just like patterned breathing except that you vary anywhere from one to four hee exhales with one hoo exhale
- 8. Second stage labour Breathing awareness can be used to facilitate pushing. The woman can be trained to breathe in, then slowly out on exertion (e.g. during defecation) so that it will become instinctive to breathe out as she pushes, and to maintain the push at the same time as she breathes in. Each push should last about 5 to 10 seconds, and each contraction may demand three to four pushes. Labor Pant-Blow. This breathing technique is used when it is necessary to keep from pushing.
- 9. Spontaneous Bearing Down (Expulsion Breathing) Breath comfortably until the urge to push becomes irresistible. Next take a deep breath and hold it or slowly release it while bearing down for 5-7 seconds. After bearing down, release any remaining oxygen and breath comfortably the next strong urge- then repeat.
- 10. POSITIONING
- 12. POSITIONING DURING 2ND STAGE OF LABOUR. Commonly used positions are Lithotomy Dorsal (recumbent) Lateral & semirecument
- 13. Massage in labor It is probable that the soothing sensory inputs from stroking, effleurage and kneading activates the gate closing mechanism at spinal level. Area of massage back deep kneading over painful area, double handed kneeding over SI joint., effleurage from sacro coccygeal area, up and over the iliac crest, slow, rhythmical longitudinal stroking, from occiput to coccyx can relieve tension. Abdominal stroking Perineal massage
- 15. Tens in labour:- TENS is a form of non-invasive pain relief TENS has no harmful effects on either the mother or baby TENS does not restrict your ability to move about in labour TENS can be applied at home during early labour Other pain relief options can still be used if TENS does not provide you with adequate pain relief
- 16. Modes of stimulation Two of the TENS parameters are used for labor. These are burst train TENS and brief intense TENS. Burst Train TENS-This is characterized by low- frequency bursts (4 Hz) of higher-frequency stimulation. This type of stimulation has the properties of both conventional TENS and acupuncture-like TENS. Brief Intense TENS This is characterized by a high frequency (100 Hz),a long pulse duration (150s) and the highest intensity that can be tolerated by the patient. It is best used for short periods of time
- 17. Placement of the electrodes During the first stage, labor pain information, when pain is at its most intense, will be entering segments T10L1. The information from the parasympathetic nerves and the pudendal nerve arrives at the spinal segments S2S4. As your labor progresses or if you are experiencing lower back or pelvic pain you can start using the Channel 1 electrodes which are placed either side of the lower spine below the waist
- 18. THANK YOU