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Many women experience back pain during labor. For some women, the pain is
continuous and unyielding. Pain during labor can be expected, but anesthesia is not
the only method of pain management. Especially during an OOH birth, it is important
clients have reminders of frequent position changes, have a strong set of hands
available for physical comfort and be surrounded by supportive friends and/or family
members. It is important to remember that even though many of us have doula
backgrounds, we are not the doula when we are the midwife. Our priorities are safe
birth and good outcomes for mothers and babies. We can make suggestions to help
with pain management. We are not the primary support person. Some women have
support during labor, others do not have that luxury and have people present at the
birth who are ill-equipped to attend a birth.
2. Assessment
i. Risk Factors:
a. Mother is obese and does not exercise
b. Mother is sedentary for most of day. She sits at a desk all day.
c. She lacks a healthy, balanced diet and eats mostly processed sugar foods,
contributing to her obesity
d. She refuses to get off the bed during labor
e. She has low physical stamina and little flexibility in her joints
f. She has done nothing to prepare physically for the birth
g. She has very little support
h. Her first child was born OP after 42 hours of labor
i. GD- onset at 24 weeks
3. Management Plan
a. Tylenol
b. Glass of wine
c. Hot packs
d. IV (LR) for hydration
ii. Complementary measures to consider:
a. Labor tub
b. Shower with jets pointing to sacral region
c. Rolling pin/tennis balls to press into the back
d. Massage low back area
e. Stretching out hip-flexors
f. Position changes- all 4s, side-lying, lunging, climbing stairs, knee-press
position, leaning over birth-ball, slow-dancing with partner.
g. Infusion of lavender essential oils to promote relaxation
h. Music in the room to relax/distract
i. Epsom salt bath
j. Guided mediation and progressive relaxation exercises
k. Walking
iii. Considerations:
a. Must keep mother hydrated
b. Must remember that as much as possible, we are aiming for a positive
birth memory for the mother
c. Aiming to help the baby turn to reduce the risk of OP delivery, long 2 nd
stage and possible lacerations
d. Aiming for high Apgar scores for baby to assure immediate skin to skin
contact and early breastfeeding
a. Show client ad family poster of fetal positioning and the etiology of the
sacral pain.
b. Show passage of baby through the pelvis with a model pelvis and newborn
to help client understand the 3 Ps-passenger, power, passage
c. Teach partner how to do hip-squeeze and counter pressure
d. Explain why position change is important
e. Stay positive and complementary
v. Follow-Up:
a. Head to toe examination, examine clients back and ask about any current
back pain she may be experiencing. Check Homans sign.
b. Examine perineum to check that laceration from 2nd degree tear healing
well.
c. Check BS (blood sugars) and vital signs
d. Ask how she is doing, discuss breastfeeding, the postpartum period, her
nutrition, and how she is doing in general
e. Recommend physical therapy twice a week to help with existing back pain
and stiffness
f. Recommend follow-up care with GP to monitor BS
g. Recommend nutritionist to help with nutrition counseling and education
h. Recommend a mommy group to seek support from other moms
References
Simkin, P. (2013). The birth partner: A complete guide to childbirth for all dads and all other
labor companions.
Boston, MA: Harvard Common Press.
Simkin, P. , Whalley, J., & Keppler, A. (2001). Pregnancy, childbirth and the newborn- the
complete guide to childbirth. New York, NY: Simon & Schuster.