- The psychological support for preparation of labour during labour pain - Psychological support during labour pain. - The physical care for labour pain.

1. Prepared by: Nabina Bhasima
Bsc.nursing
3rd year
Psychological support and
Physical care for labour pain

2. Overview
- The psychological support for preparation
of labour during labour pain
- Psychological support during labour pain.
- The physical care for labour pain.

3. Psychological support
1. Preparation for
labour
2. Support during
labour

4. 1. Preparation for labour
At some stage in her pregnancy every woman
will realise the inevitability of the delivery of her
baby.
Not every woman will experience labour but the
mother who delivers by planned caesarean
section will also have fears and anxieties and
will wonder just how she will cope with
experience

5. a. Giving information
 Discovering what level of information is
required and meeting the individual woman’s
need present the midwife with a challenge.
 It is best done in an informal, relaxed setting
and on a one-to-one basis.

6. Contd…
 It is more difficult to give information to a
group of woman, since some are likely to
become anxious if too much information is
given.
 The best approach when talking to a group of
women is probably to attempt to meet the
perceive needs of the majority and to offer an
opportunity for further discussion with those
who would like it.

7. Contd…
 The giving of information is
supplemented by handling out leaflets
and recommending books to read.
Some women will wish to attend
additional classes such as those run by
the National Childbirth Trust (NCT).
 Reassuring women that they will be
given appropriate analgesia and telling
them what is available are very
important parts of information given.

8. b. Allaying anxiety
 While every woman is likely to be
apprehensive about some aspect of
pregnancy or labour, many fears will be
unfounded.
 Some women may be anxious at the thought
of being an episiotomy, for example and if
this is no longer routine practice in the local
maternity unit a needless fear may be
allayed.

9. Contd..
 The pregnant woman is often the recipient of
such misinformation just when she is
especially vulnerable.
 Some women unable to resist the temptation
to recount their own horrific experiences to the
innocent primigravida, although of course
women who have experienced childbirth are
often a great source of support and
constructive advice.

10. c. Participation in planning
 Entering hospital for any reason is often
seen as a dehumanising experience.
 The person becomes a ‘patient’ as he or she
enters the building and assumes the sick
role.
 Personal clothing is removed, an identity
band is attached to the wrist and the person
begins to feel helpless.

11. Contd..
 The birth plan is commonly used. This is a
document which the woman compiles
together with the midwife, on which she states
her preferences for care during and after
labour.
 Completing this document a useful
opportunity for discussion of pain relief and
the exchange of information between the
woman and her midwife.

12. Contd..
 Couples who are able to participate in
planning their care in this way will feel that
they matter to the professionals and are
likely to be less apprehensive about the
whole experience of entering hospital.
 The midwife should remember that for
many young couples a hospital associated
with sickness and death and that they may
have had no personal experience of it.

13. d. Meeting staff
 Meeting staff of the labour ward and seeing
the environment will be helpful to many
women.
 If the use of equipment is explained it will
seem less clinical and fearsome.
 The team approach to care is designed to
offer continuity of care and of caregiver to
each woman so that she has the reassuring
experience of meeting familiar people
through out her contact with the maternity

14. Contd..
 The woman is allocated to a team of 6-
12 midwives and will get to know them
during her pregnancy: hopefully the
midwife giving care in labour is therefore
not a stranger.

15. 2. Support during labour
a. The environment
A relaxed, homely atmosphere will help the
woman and her partner feel at ease more
quickly.
The labour room must be furnished in such a
way that an emergency may be dealt with swiftly
and efficiently and for this reason the clinical
aspect can never be removed.

16. Contd..
 Lighting should be versatile.
 The midwife should endeavour to ensure
that there are a few intrusions into the
labour room as possible and should aim
to maintain an unhurried, peaceful
atmosphere.

17. b. A supportive companion
 A supportive companion is a great source
of strength to the woman in labour and
provides the continuity which the staff
cannot always promise.

18. Contd..
 Some men are unwilling companions during
labour and couples should be encouraged to
be honest about this.
 Some women may feel that a female
companion is more appropriate for them.
 Midwife means ‘with woman’ and she aims to
be a supportive companion, working with the
woman and her partner.

19. c. Mobility
 If the woman can be encouraged to be
upright and mobile, labour is likely to
progress more quickly and the woman
will feel more in control, especially if she
is encouraged to change position from
time to time in order to become as
comfortable as possible.

20. d.Giving information
 The couple should be kept fully informed
of progress and all developments during
the course of labour.
 Any treatment or intervention, imminent or
probable, should be anticipated and
explained.
 The prospective parents should be
involved in the decision making and on
procedure should be carried out without

21. e. Relaxation techniques
 If the woman has been in relaxation
techniques she should be reminded of them
and supported as she puts her knowledge into
practice.
 The midwife should be careful to discover just
how the woman has been taught and should
follow the same method.

22. Contd…
 If the woman hasnot attended classes, the
midwife will aim to give her very simple
instructions in breathing techniques.

23. f. Conversation
 When a woman is in labour there are
times to talk and times to be silent.
 A companionable, sympathetic silence is
infinitely preferred by most women in
advanced labour.

24. Contd…
 At this stage a woman is becoming tired
and each contraction requires her
complete concentration and all the
physical and emotional reserves she
can muster.
 She may close her eyes and become
rather distant at this stage.

25. Contd…
 If she is very aware of what is going on in
her body, she is concentrating on the
baby’s progress and her own response
and inconsequential conversation is
inappropriate.
 Conversation over the woman is even
more inappropriate, attention should be
focused on her and her needs throughout
the labour.
 When silence seems appropriate, touch

26. g. Encouragement
 The midwife should aim to encourage the
woman through out her labour.
 Most women will reach a stage when they feel
they cannot continue any longer and will
despair.
 Just a few quiet words of praise after each
contraction or some nonverbal
encouragement will often suffice.

27. Contd…
 The woman who is made to feel she is
coping and progressing very well will usually
respond by continuing to do so.
 The midwife whose communication skills are
well developed and who responds with
warmth and enthusiasm will usually achieve
this.

28. Physical Care
1. Hygiene and comfort
The woman in labour will become very hot and
will perspire profusely so that she will
appreciate the opportunity to have a bath or
shower if she feels able.
A warm bath may be very comforting for the
woman with backache and she may enjoy
soaking herself in deep warm water.

29. Contd…
 If the woman isnot able to get up she will
appreciate frequent sponging, particularly
of her face and neck, with cold water.
 A clean, cool gown will be appreciated
and a fan is comforting.

30. Contd…
 Her mouth will feel much fresher if she
can clean her teeth or have a
mouthwash.
 She may like to have some ice to suck.

31. 2. Position
 Women may need to help to find a
position which is comfortable.
 Leaning forward with the arms resting
on a convenient windowsill, table or
shelf during a contraction may help the
woman to cope with backache.

32. Contd…
 A rocking chair provides a soothing
rhythmic distraction during contractions
and the motion probably encourages
release of endogenous opoids, most
rocking chairs gives good support to the
back.
 Birthing beds and chairs are designed
specifically for women in labour.

33. Contd..
 Ideally they are used for delivery only and the
woman is encouraged to walk about and use
alternatives positions during first stage of
labour.
 She may use any position she finds
comfortable such as squatting, kneeling on all
fours or kneeling upright.

34. Contd…
 Most women prefer such positions if
they have the confidence to try them
and they find that they can cope with the
contractions better than when sitting on
the bed.

35. 3. Physical contact
 The woman may not wish to talk but she
may find physical contact comforting.
 The partner should be encourages to
hold her hand, rub her back, sponge her
face or just cuddle her.

36. Contd..
 Some couples may wish to practise
effleurage, where the partner strokes the
woman’s abdomen and thighs, or similar
techniques.
 Those who are wanting an active birth may
wish to try nipple or clitoral stimulation to
encourage the release of oxytocin from the
pituitary gland and so stimulate uterine
contractions in a natural way.

37. Contd…
 This will also stimulate the production of
endogenous opoids, giving some natural
analgesia.
 The midwife should be sensitive to each
couple’s wishes and should respect
them.

38. Contd..
 Some women become very irritable as
labour progresses and find any touch
annoying and intrusive.
 The midwife should not be afraid to
make sensitive use of physical contact
herself but should learn to recognize
when this becomes irritating and
inappropriate.

39. 4. Care of bladder and bowels
 Care of bowels and bladder is an
important aspect of the mother’s
comfort.

40. References
Book References
 “ B.Ruth,B. Linda”, “Myles textbook for
midwives”, 13th Edition, Churchill
livingstone, page 447- 450
 “Livingstone C.C”, “Aids to obstetrics and
gynaecology”, 4th Edition, Gordon. M.
Stirrat Page no: 242-245
 “Dewhurst”,”Textbook of obstetrics and
gynaecology for postgraduates”, 4th
Edition, C.R Whitfield

41. Net References
https://online.liebertpub.com/doi/abs/10.1089/acm.2
013.0171
https://creativecommons.org/licenses/by/40
https://www.medicalnewstoday.com

42. Thank you