Giving Birth and Pain Management for Childbirth

Flashcards covering key concepts from lecture notes on giving birth, labor processes, pain management techniques, and obstetric procedures.

What is the average blood loss for a normal spontaneous vaginal delivery (NSVD)?

500mL

How is the frequency of uterine contractions assessed?

From the beginning of one contraction to the beginning of the next.

What are the four 'Ps' that influence the birth process?

Powers, Passenger, Passage, Psyche

Which characteristic of the passenger refers to the orientation of the long axis of the fetus to the mother?

Fetal lie

What is 'lightening' as a premonitory sign of labor?

The descent of the fetal head into the pelvic brim, often experienced as a relief of pressure under the diaphragm.

What is the definition of 'engagement' in the context of the 7 Cardinal Movements of Labor?

Engagement is when the fetal presenting part at its widest diameter reaches the level of the ischial spines of the mother.

What is the longest stage of labor?

The first stage of labor.

What is 'crowning' during the second stage of labor?

Crowning is when the fetal head is low in the pelvis and distends the vulva.

List two signs that suggest placental separation in the third stage of labor.

The uterus has a spherical shape; the uterus rises upward in the abdomen as the placenta descends; the cord extends further from the vagina; a gush of blood appears.

How do true labor contractions differ from false labor contractions?

True labor contractions develop a consistent pattern of increasing frequency, duration, and intensity, and walking tends to increase their strength.

When should a nullipara typically go to the hospital regarding contractions?

When experiencing regular contractions, 5 minutes apart, for 1 hour.

What are the main priorities in nursing care during L&D admission?

Establishing a therapeutic relationship and assessing the status of the mother and fetus.

What are considered major risks associated with spontaneous or artificial rupture of membranes (SROM/AROM)?

Cord prolapse and variable decelerations.

List the top three nursing priorities for the management of a laboring patient after admission.

Fetal oxygenation, maternal discomfort, and maternal injury.

What are the two components involved in childbirth pain?

Physiological and Psychological.

Name one adverse effect of excessive pain during labor.

Increased metabolic rate and O2 demand, decreased blood flow to the uterus and placenta, hyperventilation, or decreased uterine response to oxytocin.

Which type of pain during labor is caused by tissue ischemia, cervical dilation, and pressure on pelvic structures?

Visceral pain.

What is effleurage in the context of nonpharmacological pain management?

A light, stroking massage, often on the abdomen, used for comfort during contractions.

What is a key consideration regarding any drug taken by a pregnant woman during labor?

Any drug taken by the woman may affect her fetus.

What are the common adverse effects of epidural opioids?

Nausea and vomiting, pruritus, and respiratory depression.

What is a potential complication of an epidural block related to dural puncture?

Spinal headache.

Which regional anesthesia technique involves a single dose of local anesthetic and opioid analgesic, resulting in loss of sensory and motor function, often for a cesarean section?

Spinal (Subarachnoid) Block.

What is an advantage of combined spinal-epidural analgesia?

Rapid onset of pain relief without sedation, no motor block (unless combined with epidural anesthesia), or no sympathetic block with typical hypotension (unless combined with epidural).

What is Naloxone (Narcan) and how is it used in labor pain management?

An opioid antagonist that reverses opioid-induced respiratory depression, though it has a shorter half-life than most opioids it reverses. It can also be given in small doses for pruritus.

What are the two main nursing priorities for an emergency birth in any setting?

Prevent or reduce injury to mom and baby, and maintain the infant's airway and temperature after birth.

What are the risks associated with an amniotomy?

Prolapsed cord, infection, and abruptio placentae.

What is the primary indication for an external or internal version procedure?

Malpresentation of the fetus.

List one maternal and one fetal risk associated with operative delivery (e.g., forceps or vacuum).

Maternal: Laceration or episiotomy, hematoma formation. Fetal: Ecchymoses, facial or scalp lacerations, facial nerve injury, cephalohematoma, intracranial hemorrhage, chignon.

What are some methods to prevent an episiotomy?

Proper positioning, laboring down, and perineal massage.

What is a primary indication for the induction or augmentation of labor?

Fetal compromise, SROM or PROM without contractions, postterm pregnancy, chorioamnionitis, placental dysfunction, IUFD, or maternal conditions worsening with continuation of pregnancy.

What are the signs of uterine tachysystole?

Contraction duration longer than 90-120 seconds, contractions less than 2 minutes apart or relaxation of less than 30 seconds between contractions, uterine resting tone greater than 20 mmHg or peak pressure greater than 90 mmHg during the first stage of labor with IUPC, or MVUs greater than 400.

List three indications for a cesarean section.

Dystocia, Cephalopelvic Disproportion (CPD), maternal disease requiring prompt delivery, active genital HSV lesion at birth, history of certain prior uterine surgeries, persistent Non-Reassuring Fetal Heart Tones (NRFHT), prolapsed umbilical cord, fetal malpresentation, placenta previa, or abruptio placentae.