Maternity Nursing Q 66
A primigravida patient is admitted to the labor delivery area. Assessment reveals that she is in the early part of the first stage of labor. Her pain is likely to be most intense:
A. Around the pelvic girdle
B. Around the pelvic girdle and in the upper arms
C. Around the pelvic girdle and at the perineum
D. At the perineum
Correct Answer: A. Around the pelvic girdle
During most of the first stage of labor, pain centers around the pelvic girdle. During the late part of this stage and the early part of the second stage, pain spreads to the upper legs and perineum. The pain of early labor is referred to T10-T12 dermatomes such that the pain is felt in the lower abdomen, sacrum, and back. This pain is dull in character and is not always sensitive to opioid drugs.
Option B: Upper arm pain is not common during any stage of labor. With each uterine contraction, pressure is transmitted to the cervix causing stretching and distension and activating excitatory nociceptive afferents.
Option C: Pain arises due to afferents that innervate the vaginal surface of the cervix, perineum, and vagina and occurs as a result of stretching, distention, ischemia, and injury of the pelvic floor, perineum, and vagina.
Option D: During the late part of the second stage and childbirth, intense pain occurs at the perineum. Somatic pain occurs closer to delivery, is sharp in character and easily localized to the vagina, perineum, and rectum. It radiates to the adjacent dermatomes T10 and L1 and compared to visceral pain, is more resistant to opioid drugs.