d. Presence or Absence of Certain Obstetrical Deviations or
. The need for induction
in longer, harder labor than
was spontaneous. Problems with the fetus in utero may preclude the patient from
receiving any type of sedation.
e. Patient's Pain Threshold. It is believed that the pain felt may be altered by
the level of available morphine-like hormonal substances in the body called endorphins.
Endorphins are a special protein. They appear to interfere with transmission of pain
producing impulses to the brain or may interfere with the brain's sensitivity to these
impulses. Endorphin levels decrease in the presence of anxiety, tension, fatigue, and
extended negative stimuli.
See figure 4-1 for areas of pain.
Figure 4-1. Areas of pain (continued).