The nurse is teaching a pregnant client about fetal kick counts.
Which statement made by the client indicates a need for further instruction?

Choice A rationale:

Hispanic women: While Hispanic cultures often emphasize strength and resilience, their expression of pain during labor can vary significantly. Some may vocalize their pain while others may remain more stoic. It's important to avoid generalizations and assess each individual's preferences and needs.

Choice B rationale:

Chinese women: In traditional Chinese culture, stoicism in the face of pain is often valued. This may be rooted in Confucianism, which emphasizes self-control and endurance. Women may be less likely to express their pain during labor to avoid appearing weak or losing face. They may also believe that vocalizing pain could negatively impact the birthing process. However, as labor progresses, they may become more vocal and request pain relief.

Choice C rationale:

Caucasian/European women: Caucasian women exhibit diverse responses to labor pain, influenced by personal experiences, cultural beliefs, and social expectations. Some may express their pain openly, while others may prefer to manage it quietly. It's crucial to avoid stereotyping and provide individualized care.

Choice D rationale:

African-American women: African-American women often express their pain during labor more openly than some other cultural groups. This may be due to historical experiences of racism and discrimination in healthcare, leading to a distrust of medical professionals and a greater reliance on self-advocacy. They may also have a stronger sense of community and support networks that encourage open expression of pain.

Rationale for Choice A:

Encouraging the woman to rest between contractions can promote relaxation and help conserve energy, but it does not directly address the mechanisms of pain transmission as explained by the gate-control theory. Rest can have indirect benefits for pain management, but it does not directly interfere with pain signals in the same way that massage does.

Rationale for Choice B:

Administering prescribed medication can effectively block pain signals, but it does not rely on the principles of the gatecontrol theory. Medications typically work through pharmacological mechanisms that target pain receptors or neurotransmitters, rather than by competing with pain signals at the spinal cord level.

Rationale for Choice D:

Changing the woman's position can sometimes alleviate discomfort by shifting pressure or encouraging fetal movement, but it does not directly apply the gate-control theory either. Position changes can offer some physical relief, but they do not directly modulate the transmission of pain signals.

Rationale for Choice C:

Massaging the woman's back directly aligns with the gate-control theory of pain management. This theory proposes that nonpainful sensory input can effectively compete with pain signals, preventing them from reaching the brain. The following mechanisms explain how massage applies this theory:

Stimulation of non-painful nerve fibers: Massage activates large-diameter nerve fibers that transmit touch, pressure, and vibration sensations. These signals travel faster than pain signals and can effectively "close the gate" at the spinal cord, preventing pain signals from ascending to the brain.

Release of endorphins: Massage can stimulate the release of endorphins, the body's natural pain relievers. Endorphins bind to opioid receptors in the brain and spinal cord, reducing the perception of pain.

Reduction of muscle tension: Labor pain often involves muscle tension and spasms. Massage can help relax tense muscles, which can indirectly reduce pain by decreasing muscle ischemia and the release of pain-provoking substances.

Promotion of relaxation and distraction: Massage can induce a state of relaxation and provide a distraction from pain. This psychological effect can further contribute to pain relief by reducing anxiety and focusing attention on pleasant sensations.

Conclusion:

Massage offers a non-pharmacological, evidence-based approach to pain management that directly aligns with the gate-control theory. By stimulating non-painful sensory input, promoting relaxation, and releasing endorphins, massage effectively interrupts pain signals and provides significant relief for women in labor.