Comprehensive Fetal Heart Rate and Labor Support Strategies for Nursing and Birth Professionals

What is the fetal heart rate baseline indicating tachycardia?

A fetal heart rate baseline of 175 bpm for 15 minutes.

What nursing intervention should be taken for a tachycardic fetal heart rate?

Administer antipyretics to the mother and increase maternal hydration with IV fluids.

What defines a prolonged deceleration in fetal heart rate?

A decrease of ≥15 bpm lasting 2-10 minutes, returning to baseline.

What happens if a prolonged deceleration lasts ≥10 minutes?

It is classified as a new baseline bradycardia.

What are some causes of prolonged deceleration?

Maternal hypotension, cord compression/prolapse, uterine tachysystole, prolonged maternal position, rapid descent of the fetus.

What is the treatment for prolonged deceleration?

Immediate intrauterine resuscitation including repositioning the mother, stopping oxytocin, giving IV fluids, and applying oxygen.

What is the definition of baseline bradycardia in fetal heart rate?

A fetal heart rate drops below 110 bpm for ≥10 minutes.

What are the urgent interventions for baseline bradycardia?

Same as prolonged decelerations: reposition, fluids, oxygen, stop oxytocin, and prepare for delivery if necessary.

What is the difference between pain and suffering in labor?

Pain is a physical sensation, while suffering is an emotional state of distress.

What are the goals of pain management in labor and delivery?

To alleviate pain and prevent it from causing suffering.

What are some non-pharmacological methods for pain management during labor?

Continuous labor support, hydrotherapy, ambulation, breathing techniques, and mindfulness.

What is the role of continuous labor support?

To help the laboring client feel secure, comfortable, and informed during childbirth.

Who can provide continuous labor support?

Doulas, trained labor support specialists, partners, nurses, midwives, and family members.

What is the definition of a doula?

A trained professional who provides continuous physical, emotional, and informational support during and after birth.

What distinguishes midwives from doulas?

Midwives are licensed health professionals specializing in pregnancy and birth, while doulas focus on non-clinical care.

What is the Indigenous Birth Support Worker Program?

A program aimed at supporting Indigenous clients in labor, addressing reproductive injustices faced by Indigenous women.

What is the significance of Truth & Reconciliation Day?

It honors residential school survivors and recognizes the resilience of Indigenous cultures.

What does the Cree concept of Wahkohtowin emphasize?

Kinship and interconnectedness.

What is the importance of pain assessment for clients admitted for labor?

Every client must have a pain assessment to tailor pain management strategies.

What are some emotional responses that can lead to suffering during labor?

Panic, fear, sadness, feeling overwhelmed, and helplessness.

What is the recommended approach before offering pharmacological pain management?

Try non-pharmacological options first, as they are simple, safe, and inexpensive.

How does distraction help in pain management during labor?

It shifts the focus away from pain to something the client can control.

What is the role of mindfulness in preparing for birth?

To help the laboring individual focus on one contraction at a time.

What should clients do to prepare their body for labor?

Eat healthy, sleep, exercise, and stay relaxed.

What is the significance of creating a birth plan?

It helps clients feel safe and prepared for the birth process.

What is the practice of birth alerts in Saskatchewan?

A practice where social workers or health care providers place alerts on the files of expectant mothers, often leading to newborns being seized after birth.

What percentage of birth alerts issued in Saskatchewan in 2020 involved Indigenous women?

74% (56 out of 76 birth alerts).

When were birth alerts officially ended in Saskatchewan?

In 2021.

What is the goal of developing prenatal case teams for vulnerable women?

To build trust and support during pregnancy instead of punitive surveillance.

What is the role of a Registered Nurse (RN) in labor support?

To assess and manage physiological and psychological processes, provide comfort measures, emotional support, and coordinate care.

What are the benefits of continuous labor support according to research?

Shorter labors, less use of analgesia, fewer operative births, and higher likelihood of breastfeeding.

What does Wahkohtowin emphasize in the context of labor support?

It emphasizes kinship, respect, and reciprocal responsibility in supporting someone in labor.

What is the aim of the Lamaze Method in childbirth?

To provide distraction and teach various breathing techniques to manage pain.

What is the focus of the Bradley Method in childbirth?

To minimize the perception of pain and emphasize natural, unmedicated labor with partner involvement.

What is hydrotherapy in the context of labor?

Using water for comfort and pain relief during labor, effective when the mother is in active labor.

What are the recommended positions for labor according to current practices?

Frequent position changes including sitting, walking, kneeling, standing, and using birthing balls.

What are the effects of heat therapy during labor?

Promotes relaxation, reduces pain perception, and can be applied safely with precautions.

What is effleurage in labor support?

A gentle massage technique using light, rhythmic stroking to provide comfort during contractions.

How does the environment impact labor?

A calm, supportive environment promotes relaxation and better labor progress, while chaotic spaces can amplify stress.

What is the purpose of using breathing techniques during labor?

To promote relaxation and pain relief through distraction.

What is the significance of the Association of Women's Health, Obstetric and Neonatal Nurses' position statement?

It emphasizes the importance of nursing support for laboring women to improve birth outcomes.

What are some common applications of cold therapy during labor?

Ice-filled surgical gloves, frozen gel packs, and cold washcloths to provide numbing sensation and pain relief.

What is the recommended water temperature for hydrotherapy during labor?

Should not exceed body temperature to avoid risks.

What is the goal of using ambulation and position changes during labor?

To reduce labor length, facilitate fetal positioning, and promote comfort.

What is the impact of therapeutic touch and massage during labor?

It promotes muscle relaxation, improves circulation, and provides emotional comfort.

What is the role of the partner in the Bradley Method?

To act as a coach, reminding the birthing person to relax and providing support.

What are the risks associated with hydrotherapy during labor?

Hyperthermia leading to fetal tachycardia and risk of unplanned underwater birth.

What is the significance of timely and accurate documentation in nursing care during labor?

It ensures coordinated care and effective communication among the healthcare team.

What is the purpose of using hot and cold applications during labor?

To provide comfort and pain relief with minimal side effects.

What is the Double Hip Squeeze technique used for?

It provides counter pressure to ease discomfort during labor.

What are the key elements of a supportive environment for labor?

Dim lights, peaceful surroundings, privacy, temperature control, soothing music, personalization, and safety.

What are the Three R's of comfort measures for childbirth according to Penny Simkin?

Relaxation, Rhythm, and Ritual.

How does relaxation help during labor?

It conserves energy and reduces tension between contractions.

What role does rhythm play in coping with labor?

Finding a rhythmic pattern (like breathing or swaying) provides consistency and predictability.

What is the significance of ritual in labor coping strategies?

Repeating a rhythmic activity builds a sense of control and stability.

What are some additional comfort measures during labor?

Massage, hydrotherapy, heat/cold application, and changing positions.

What is the goal of pharmacologic pain relief in labor?

To provide maximum pain relief with minimal risk to mother and baby.

What are the ideal characteristics of labor pain relief methods?

Safe for both mother and baby, rapid and effective, easy to administer, preserves maternal control, minimal side effects, and effective in both stages of labor.

What are the types of pharmacologic pain relief options available during labor?

Systemic analgesia, inhaled analgesics, and regional/local anesthesia.

What are systemic analgesics and give examples?

Medications like morphine and fentanyl that affect the entire body and can cross the placenta.

What is the effect of nitrous oxide as an inhaled analgesic?

It has a rapid onset and offset, is self-administered, and has minimal neonatal effects.

What is the purpose of regional/local anesthesia during labor?

To provide loss of sensation in a targeted area, such as with epidurals.

What are the potential side effects of systemic analgesics given near birth?

They may cause respiratory depression in the newborn and affect breastfeeding ability.

What is the purpose of using synergistic medications with opioids?

They reduce nausea and vomiting, which are common side effects of opioids, and decrease anxiety.

What is general anesthesia used for in labor?

Reserved for emergencies when there is no time for spinal/epidural anesthesia.

What are the risks associated with general anesthesia during labor?

It can cause fetal depression, increased risk of bleeding, and complications with intubation.

What should be remembered about all systemic drugs in labor?

They cross the placenta and can affect the fetus.

What is a key implication for practice when administering opioids in labor?

Opioids should be given so that birth occurs 1-4 hours after administration to reduce respiratory depression risk in newborns.

What is the primary component of Nitrous Oxide used in labor?

50% Nitrous Oxide and 50% Oxygen

What is a key benefit of using Nitrous Oxide during labor?

It provides rapid effect while allowing the mother to remain awake and alert.

What is a major risk associated with Nitrous Oxide if not self-administered?

Inadvertent general anesthesia.

What is the main route of administration for Nitrous Oxide?

Inhaled via mask during contractions.

What are common side effects of Nitrous Oxide?

Dizziness, confusion, nausea, vomiting, and tingling in the face.

What is the most common form of regional pain relief during labor?

Epidural Block.

What is the difference between an Epidural and a Spinal Block?

An Epidural allows for ongoing pain relief via a catheter, while a Spinal Block is a one-time injection providing immediate but short-term relief.

What are the typical drugs used in a standard Epidural?

Local anesthetic (lidocaine, bupivacaine) combined with an opioid (morphine or fentanyl).

What is a common complication of an Epidural?

Low blood pressure (hypotension).

What is the purpose of a Pudendal Block?

To numb the perineal area, often used for episiotomy or repair.

What is the expected onset time for a Spinal Block?

Immediate, within seconds to minutes.

What is a key distinction between systemic and regional analgesia?

Regional analgesia targets a specific area, while systemic analgesia affects the entire body.

What is a 'walking epidural'?

A Combined Spinal-Epidural (CSE) that allows for more mobility while providing pain relief.

What is a potential side effect of a Spinal Block?

Post Dural Puncture Headache due to CSF leakage.

What is the typical duration of pain relief from a Spinal Block?

1.5 to 3 hours.

What is the role of the anesthesiologist in administering a Spinal Block?

To ensure the injection is correctly placed in the subarachnoid space.

What is the Bromage Test used for?

To assess motor function after an Epidural.

What are contraindications for Epidural analgesia?

Patient refusal, localized infection, significant bleeding, systemic sepsis, and spinal injury.

What is the expected position for a patient receiving an Epidural?

The patient must sit in a C-curve position.

What should be monitored after administering an Epidural?

Blood pressure, pulse, and sensory level.

What is the purpose of the Combined Spinal-Epidural (CSE) technique?

To provide rapid pain relief with ongoing control through an epidural catheter.

What is a common nursing intervention before administering an Epidural?

Establish IV access and possibly administer a fluid bolus.

What is the expected effect of an Epidural on labor progression?

It may prolong the second stage of labor.

What is the risk associated with a 'wet tap' during anesthesia procedures?

It can lead to a spinal headache due to CSF leakage.

What should be assessed to determine the sensory level of an Epidural?

Check dermatomes for sensitivity to temperature changes.

What is the effect of a Pudendal Block on labor progress?

It has no effect on fetal heart rate or progress of labor.

What is the main advantage of using a Combined Spinal-Epidural (CSE)?

Higher vaginal delivery rates and greater control over body sensations.

What is a significant concern when using a walking epidural?

Safety during ambulation, as patients may require assistance.

What is the expected outcome of a successful Epidural?

Significant pain relief in the lower body while the patient remains awake.

What should be done if a patient reports itching after an Epidural?

Monitor for potential allergic reactions and manage symptoms.

What is the typical patient experience during the administration of Nitrous Oxide?

The mother self-administers the gas, which helps manage pain during contractions.

What is the primary goal of pharmacologic pain relief during labor?

To provide effective pain management while allowing the mother to participate in the birthing process.