DR WAN ZAHANIM WAN YUSOFF O&G HRPZ II KB

Kesakitan semasa dalam proses kelahiran tidak dapat di gambarkan oleh mana-mana ibu. Kesakitan akibat kontraksi uterus merupakan satu petanda bahawa ibu itu akan bersalin dan ini membolehkan seseorang ibu itu mendapat khidmat seorang bidan untuk menyambut kelahiran bayinya dengan selamat

Oleh kerana kesakitan kontraksi semasa proses kelahiran adalah petanda awal bersalin dan ianya akan berterusan sehingga bayi dilahirkan , adalah wajar ubat untuk menghilangkan kesakitan diberi kepada ibu tanpa sebarang kesan sampingan pada ibu mahupun bayi.

There are three main causes of pain during childbirth: emotional, functional, and physiological.

Emotional sources of pain can be: fear, the unknown, lack of education, etc Functional sources of pain can be: cervical dilatation, contractions, descent of the baby, position, procedures, etc. Physiological sources of pain: derivations from "normal"

Assessment hanya dapat dilakukan ke atas ibu sahaja dan bukannya ke atas pandangan dari pakar Obstetrik, pakar Bius atau suami pesakit. Oleh itu ianya amat susah dilakukan kerana semasa kelahiran , selain dari merasa sakit ibu juga dalam ketakutan atas keselamatan anak dan dirinya sendiri dan ianya amat subjektif dan berbeza dari seorang ibu dengan ibu yang lain

Kesakitan semasa 1st stage visceral disebabkan oleh dilatation of cervix Kesakitan semasa 2nd stage somatik disebabkan oleh trauma pada tisu vaginal dan perineal

1ST STAGE OF LABOUR Transmission of the pain of the 1st stage of labour occurs in sympathetic nerve fibres that enter the neuraxis at the 10th, 11th, 12th and 1st lumbar spinal levels

2ND STAGE OF LABOUR Pain impulses enter the neuraxis at the 2nd to 5th sacral segments The afferent sensory neural pathways can be effectively inactivated with a block of pain and sympathetic afferents from T10 S5

Sejak berzaman di Babylon, Egypt, China dan Palestine pukau diikuti dengan penggunaan ubat lali seterusnya dengan mengalih kesakitan kepada perkara lain - muntah

Umum Kebanyakan ibu-ibu tidak ingin mengambil sebarang ubat untuk menghilangkan sakit bersalin atas sebab-sebab tersendiri Ingin merasa kesakitan bersalin Takut sebarang kesan sampingan pada diri sendiri atau bayi Kelahiran yang cepat

Posisi yang paling selesa dan memberi sokongan fisikal Mengurut dan sentuhan kasih Beri semangat Relax dan bernafas dengan betul

Self-help The following techniques can help you to be more relaxed in labour, which can help you to cope with the pain. Learn about labour. This can make you feel more in control and less frightened about what's going to happen. Read books such as The Pregnancy Book, which your midwife can give you; talk to your midwife or doctor and go to antenatal classes.

Learn how to relax and stay calm. Breathe deeply. Keep moving. Your position can make a difference. Try kneeling, walking around or rocking backwards and forwards. Bring a partner, mother or mother in law. If you don't have anyone, don't worry. Your midwife will give you all the support you need. Ask your partner to massage you (although you may find that you don't want to be touched). Have a bath.

Hydrotherapy (being in water) Water can help you relax and make the contractions seem less painful. Ask if you can have a bath or use a birth pool. The water will be kept at a comfortable temperature, but it won't be above 37C. Your temperature will be monitored.

Alternative methods of pain relief Some mothers want to avoid the above methods of pain relief and choose acupuncture, aromatherapy, homeopathy, hypnosis, massage and reflexology. Most of these techniques don't provide very effective pain relief. If you'd like to use any of these methods, its important to discuss it with your midwife or doctor and let the hospital know beforehand. Most hospitals don't offer them for pain relief during labour. If you want to try an alternative technique, make sure that the practitioner is properly trained and experienced. For advice, contact the Institute for Complementary Medicine

Easing Discomforts Following are some ways to ease discomfort you may feel during labor: Do relaxation and breathing techniques taught in childbirth class. Have your partner massage or firmly press on your lower back. Change positions often. Take a shower or bath, if permitted. Place an ice pack on your back. Use tennis balls for massage. When contractions are closer together and stronger, rest in between and take slow, deep breaths. If you become warm or perspire, soothe yourself with cool, moist cloths.

Finger pressure Sama dengan akupuntur Cuma menggunakan jari untuk menekan pada point jarum

34 minggu ke atas Mengurangkan risiko episiotomy dan koyak semasa bersalin 2 ibu jari- rythmic u shape- 5 minutes alternate day Relax dan contract

Berdiri, bertinggung, berpeluk dan menyandar

Bertinggung adalah terbaik

Education of birthing process breathing exercise Psychoprophylaxis minimizing pain not eliminating pain and the success depends on - mothers willingness to attempt - her determination to succeed - normal labour

Cara pernafasan Relax semasa mengandung, bersalin dan selepas bersalin Pergerakan secara rythmicalmenggerakkan punggung semasa kontraksi, menggerakkan jari, menggosok perut, menghentak kaki, menyanyi, meraung serta membilang Imagery Panas dan sejuk Musik Mengurut

This can be achieved because both excitatory and inhibitory impulses affect the conscious perception of pain

TENS transcutaneous electrical nerve stimulation By bombarding the dorsal column with innocuous stimuli, inhibiting pain

Entonox ( 50% nitrous oxide: 50% O2) the most rapidly acting analgesic Its effectiveness can be enhanced by supplementing intermittent self administered entonox with continuous nasal supplement

Opioids eg pethidine and nubain and for heart disease - morphine Side effects to mother include nausea, vomiting, sedative effect and also aspiration Neonatal effect include reduced apgar score, respiratory depression, reversed by naloxone

Lumbar Epidural Caudal anaesthesia Double catheter technique Spinal/saddle block PCA Intratecal opioids Paracervical block Pudendal block Local block

Hypotension Pain Effect on labour Fetal heart rate abnormality Neonatal effects of local anestetics Backache Neurological sequelae, seizures, total spinal Toxicity of local anestetic Space occupying lesions hematoma formation

Ianya biasa diberi kepada ibu-ibu yang akan bersalin dengan cara instrumental forceps/vacuum Ianya diberi dengan menggunakan jarum yang khas pada pudendal nerve iaitu berdekatan dengan ischial spine

Sebanyak 10 cc lignocaine 2% disuntik pada saraf pudendal iaitu 5 cc setiap satu. Komplikasi yang teruk adalah sekiranya ubat lignocaine tercucuk ke dalam salur darah dan ianya dapat diatasi sekiranya sebelum ubat di suntik, ianya ditarik dahulu.

Ianya paling kerap diamalkan dimana-mana dewan bersalin Ini kerana ia perlu semasa hendak melakukan episiotomy Ubat lignocaine 2% disuntik di kawasan episiotomi hendak dibuat.

Pain relief in labour General - flexibility and choice are important Non pharmacological methods - education, preparation classes etc. - Psychoprophylaxis - TENS

Entonox - rapid effect - Limited use in late labour Systemic analgesic - timing and dosage vary - Pethidine ( naloxone should be available for babies ) - nubain

Regional ( epidural ) anestetic and trained support staff should be available constantly Preferred method with 1. Vaginal breech 2. Multiple pregnancy 3. Preterm/low birthweight baby 4. Hypertension/pre eclampsia 5. Many medical problems 6. Prolonged labour

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Contraindication Maternal wishes Clotting disorder Certain cardiac problems: aortic stenosis, pulmonary hypertension, right to left shunt Side effect to fetus include depressant effect

Opiates mempunyai kesan sampingan terhadap ibu aspiration dan pada bayirespiratory depression. Ianya lebih kepada sedation daripada analgesic Kesakitan semasa bersalin mempunyai komponen psychologi dan penggunaan method psychologi amat membantu

Epidural amat perlu untuk indikasi atas pilihan ibu terutama dalam kes-kes prolonged labour, kembar dan songsang Epidural mungkin akan memanjangkan 2nd stage dan meningkatkan instrumentasi Terdapat beberapa kontraindikasi bagi epidural anestesia termasuklah coagulopathy, perdarahan yang teruk dan memerlukan kelahiran yang cepat

Komplikasi yang penting dalam epidural adalah hypotensi dan ianya dapat dikurangkan dengan penggunaan konsentrasi rendah local anestetik, avoiding the supine position dan pre loading dengan crystalloids

KACIH

TIMA