A nurse is caring for a client who is in active labor and requests pain medication.

Which of the following factors should the nurse consider when choosing a pharmacological pain management method? (Select all that apply.)

These are the factors that the nurse should consider when choosing a pharmacological pain management method for a client who is in active labor.

• the client’s preference and birth plan should be respected and supported by the nurse.The client may have specific wishes or expectations about the type and timing of pain medication, and the nurse should discuss these with the client and provide information and education as needed.
• the stage and duration of labor affect the type and effectiveness of pharmacological pain management methods.For example, parenteral opioids provide pain relief that is superior to nitrous oxide but inferior to regional anesthesia.However, opioids may cause adverse effects such as nausea, vomiting, sedation and respiratory depression in both the mother and the fetus.Therefore, opioids are usually given in early labor and avoided in late labor or close to delivery.Regional anesthesia, such as epidural or spinal anesthesia, provides the most effective pain relief but may also have some drawbacks such as hypotension, pruritus, urinary retention and prolonged second stage of labor.Therefore, regional anesthesia may not be suitable for clients who have contraindications or who are in advanced labor.
• the fetal heart rate and position may influence the choice of pharmacological pain management method.For example, regional anesthesia may cause maternal hypotension, which can reduce uteroplacental blood flow and cause fetal bradycardia.Therefore, regional anesthesia should be used with caution in clients who have fetal distress or nonreassuring fetal heart rate patterns.Additionally, some fetal positions, such as occiput posterior or transverse lie, may cause more severe back pain that may not be relieved by regional anesthesia alone.In such cases, other methods such as sterile water injections or pudendal block may be helpful.

Acupressure is an example of gate control theory of pain, which describes how non-painful sensations can override and reduce painful sensations.Acupressure involves applying pressure to specific points on the body to stimulate large-diameter nerve fibers that can block the transmission of pain signals from smaller-diameter nerve fibers.