OB: Pain Management during Childbirth

Pain is a ________ experience. It is_______ and personal.

universal, subjective

Excessive catecholamines during labor can reduce blood flow to and from the placenta. What effect does this have on the fetus? AND what effect does this have on contractions?

 

REDUCE BLOOD FLOW TO AND FROM PLACENTA THAT RESTRICTS FETAL OXYGEN SUPPLY

A woman’s pain tolerance is influenced by certain factors. What unfavorable fetal position may prolong labor as well as cause intense back pain during labor.

OP POSITION

 

Adverse effects of excessive pain on the fetus

Excessive pain heightens fear/anxiety, which stimulates the release of
catecholamines

Visceral pain

(1st stage as uterus contracts and cervix dilates, SLOW DULL PAIN)

Somatic pain

(Late 1st stage and 2nd stage as fetus puts pressure on maternal tissues) (QUICK SHARP LOCALIZED)

What PHASE of the First Stage of Labor is the BEST time for the RN to educate the mother on the various pain control methods during labor?

latent phase

Gate control

if you activate nerves in non painful at same time you have pain, it block pain signals from reaching the brain.

Various Nonpharmacologic Techniques:

. Relaxation

. Cutaneous stimulation-MASSAGE

· Hydrotherapy

. Mental stimulation

. Breathing techniques

 

Medications taken during labor are likely to have an effect on the fetus. This could be a ___ or________ effect.

direct or indirect

Direct example

fent given to mom, baby is affected directly

indirect example

epidural, affects mom, doesn’t hurt baby

Ideally, when should analgesics be given during labor in order to avoid slowing progress?

active phase

TRUE OR FALSE: Systemic drugs have effects on multiple systems because they are distributed throughout the body.

TRUE! they have effects on many systems

Notes for Nitrous Oxide “Laughing Gas:”

50% nitrous oxide, 50% oxygen, self-administered

Fentanyl (Sublimaze):

frequent doses,

IV FENT: baby could be born not wanting to breathe (only good for early labor)

Less Nausea, less chance for resp. depression.

Butophanol (Stadol)

mixed opioid agnonist/antagonist

Make sure mom isn’t addicted to opioids

Nalbuphine (Nubain):

(common with fent, both are common in ob to give)

Make sure mom isn’t addicted to opioids.

A woman dependent on opiates (such as heroin) should avoid mixed opioid agonist-antagonist drugs because they can cause __________effects in her and the newborn

adverse

What is the primary side effect of opioids?

Respiratory depression

Why is the timing of the administration of opioids important during labor?

To reduce neonatal resp. depression

Why is a fluid bolus given prior to epidural placement?

To prevent HYPOtension, low BP

Prior to epidural placement, the anesthesiologist injects a ______anesthetic agent into the woman’s back to numb the area.

local

After the woman is numb, the anesthesiologist enters the epidural space with a needle and a catheter is passed through the needle. The catheter allows for a________infusion in order to maintain pain relief during labor.

continuous

Before the full epidural dose is given, a ______dose of the anesthetic is administered to make sure the catheter is in the correct location.

test

If the catheter was placed in the INCORRECT location, what effects will the patient experience?

NUMBESS OF LIPS AND TOUNGE, DIZZINESS, LIGHT HEADEDNESS, TINITUS (RINGING IN EARS), ELVELATED HR  

What vital sign is very important to monitor frequently after epidural placement?

 

BP!

Every 5 minutes! For hypotension

 Assess fetal HR, check leg movement, monitor N/V, pruritus(itching), position change

What can interfere with fetal descent during labor?

FULL BLADDER

THINKING POINT: Once a woman has an epidural, she cannot get out of bed. What nursing care will need provided?

She will need nurses to help flip and turn.

What medication should be at bedside during epidural catheter placement in the event of extreme hypotension? What does this medication do?

IV EPHEDRINE

THINKING POINT: If a mother becomes hypotensive after epidural placement, what changes in the FHR might occur?

LATE DECELERATIONS

TRUE OR FALSE: With this block, the woman loses sensory and motor function below the level of the block. (in subarachnoid)

true: woman loses sensory and motor

Side effect of subarachnoid spinal block

bladder distension

Describe a post-dural puncture headache

Cerebral spinal fluid leaks at site of puncture

How is a post-dural puncture headache treated?

Sitting up and laying down

Notes for Local Infiltration Anesthesia:

Infiltration of the perineum with a local anesthetic

. Done before an episiotomy or laceration repair

Notes for Pudendal Block:

· Anesthetizes the lower vagina and part of the perineum

· Provides anesthesia for episiotomy and vaginal birth, especially one that requires forceps wont block pain from contractions

General Anesthesia, what does it do

 

LOSS OF CONCIOUSNESS, uterine relaxation

Side effects of General Anesthesia

 

- Adverse effects:

. Maternal aspiration of gastric contents

straight to vein but careful with resp. dep, will go to baby , causes urine relaxation

Drugs during gen anesthesia for gastric pH and make secretions less acidic

Citric Acid (Bicitra),

Famotidine (Pepcid),

Rantidine (Zantac)

Drugs for gen anesthesia for gastric empty

Metoclopramide (Reglan)

Gen Anesthesia can cause ____ _____ in neonates

respiratory depression

A woman with a known heroin habit is admitted in early labor. Which drug is
contraindicated with opiate-dependent patients?

A. Nalbuphine (Nubain)

Which patient will most likely have increased anxiety and tension during labor?

D Gravida 3 who has two children younger than 3 years

 

Which method of pain management would be safest for a gravida 3, para 2, admitted at 8 cm cervical dilation?

Breathing and relaxation techniques