New way to assess pain in laboring women

  1. I came across a very interesting article in the current issue of Nursing for Women's Health. The article featured The University of Utah Hospital and a new way to assess pain - developed specifically in relationship to laboring women.

    They have developed a "Coping with Labor Algorithm"

    We all know that JCHAO mandates an adequate pain assessment, but how many of your patients look at you like you are crazy when they are in pain and trying to deal with UC's and you want them to rate their pain on a scale of 0-10? This new method really makes sense and the article states it is JCHAO compliant as well. It involves asking the question "how are you coping with your labor?" and looking at physical and emotional ques as well. This seems a much more effective method than charting pain 10/10 on a primip that is still smiling and giggling! (you all know exactly what I mean!)

    Have any of you heard of this, or better yet, use it in practice? I think it is a great idea and have emailed the University of Utah Hospital to get more specific information on implementing a trial on my unit using the algorithm.

    Curious to hear your thoughts! :typing
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    About LaborLovinRN

    Joined: Aug '08; Posts: 18; Likes: 33
    Labor and Delivery RNC
    Specialty: L&D, OR, Med/Surg


  3. by   SmilingBluEyes
    I have always done it this way. Numbers are so hard to tell. I can formulate a number via Wong scale, if pressed. But I usually just chart coping mechanisms, interventions and how effective they are. That is how I have always done it, rather than bug laboring women with the 1-10 question. I only use this scale when they can't express their pain in ANY other way.

    So the above makes perfect sense to me!
  4. by   paintedbison
    Sounds good to me. Rating pain in labor is kind of a weird idea to me anyways. Like, usually if someone is hurting at a ten, you should definitely be trying to alleviate pain. But, not everyone hurting at a ten in labor wants pain meds...
  5. by   cmonkey
    I don't recall getting the 10/10 question with DD, but it wouldn't have been particularly useful. I mean, no ctx = no pain, and ctxs were worse when I was in the wrong position. Once I found a good one, they were totally bearable. With my son, I yapped between ctx until the last 20 minutes.

    I like the idea of just asking how the woman feels she is coping. And I don't think laboring women should EVER be asked if they're "ready for their drugs now" or the like. She knows if she can take it, let her decide.
  6. by   L&DWannabe
    I had my baby boy back in June- and I wanted a natural childbirth. For me, it was essential NOT to refer to what I was feeling as pain. So in the middle of my concentration- my nurse comes in and asks me to rate my pain on a scale of 1-10. Well- thanks for the help! haha. Obviously, labor HURTS. But I didn't care- and didn't want to be reminded of it every 15 minutes. The question, how are you coping would be much more appropriate- even if you can rate that. Because I had to give her an 8 on the pain scale- but if she would have asked how I was coping I would have told her a "1"- being the best.
    I think it's great that they are looking at labor and delivery as a different "pain" than a medical problem. Unlike other reasons for being in the hospital, pain is actually normal and a sign that things are progressing well- and shouldn't be treated as something you want to avoid unless the mother feels that way.
  7. by   MIcrunchyRN
    Quote from paintedbison
    Sounds good to me. Rating pain in labor is kind of a weird idea to me anyways. Like, usually if someone is hurting at a ten, you should definitely be trying to alleviate pain. But, not everyone hurting at a ten in labor wants pain meds...

    My nurse when I was in labor knew I didn't want pain meds yet kept asking me my pain level... DUH Pain is expected!

    I knew she had to chart something... and I knew if I said too high a number she was obligated to ask me (per hospital protocol)... so I lied.. told her a 2... She eventually got the hint and quit asking me.
  8. by   fertile_myrtle
    I rarely use negative words during a labor. I NEVER use the word pain. I don't even like the word "contraction" really.
  9. by   L&DWannabe
    I found the word 'intensity" to work the best for me.

    Fertile- what would you say instead of contraction?
  10. by   fertile_myrtle
    Well, I guess when I am interacting with my patients, I don't find the need to actually say the word "contraction." When I am talking with them, I make sure to tell them that every sensation she is feeling is normal and good. I tell her that her body is doing the job it was perfectly designed to do. I tell her to release her face, her neck, her shoulders,... all the way down to her fingers... release her muscles to be open and loose.... relax her mouth.

    I rarely (I'd like to say never) find it necessary to use the word contraction while I am managing a labor patient.

    Things are different with an induction of course or with a PTL.

    This is just me... I'm one of those "different" nurses...
  11. by   fertile_myrtle
    When I am charting my pain assesment I use a "nurses note" and describe what is occuring for labor/pain management. In my notes I can use those words... but not to my patient.

    Women need to be reminded that birth is normal. I make it one of my priorities to reinforce that.
  12. by   fertile_myrtle
    Now I'm just rambling... but I also want to add that there is a difference between pain and suffering. I think it is possible for a woman to feel pain during contx or during labor, but she may not be suffering. It is pain with a purpose and that is a world of difference for some folks.