Care Lecture 16: Labor Pain

gate control theory

theory that explains how the nervous system blocks or allows pain signals to pass to the brain

activate nerves in a non-painful way at same time you're experiencing pain --> blocks the pain signal from reaching your brain

what does the gate control theory state?

-abdomen

-hips

-back area

-legs/thighs

-perineum

what are some of the sites of labor pain?

-physiologic response

-previous experience

-culture

-anxiety/fear

-support

-environment

-preparation

the pain response is based on what factors?

-establish rapport

-educate/answer questions

-let them know what to expect

-teach relaxation techniques

-advocate

what are the cognitive strategies with childbirth education regarding labor pain?

-ambulation

-position changes/rocking

-backrubs/counterpressure

-warm blankets

-hot/cold packs

-hydrotherapy (shower/whirlpool)

-birthing ball

-TENS

what are the care management comfort strategies regarding labor pain?

helps with the pain and engages the fetus

what is the benefit of ambulation/position changes/rocking regarding labor pain?

closes the gate theory --> ↓ pain

what is the benefit of backrubs/counterpressure regarding labor pain?

many places do not allow you to enter a whirlpool if your amniotic bag of fluid has ruptured since this ↑ risk of infection

what is something to keep in mind regarding hydrotherapy for some patients with labor pain?

can help open up the pelvis to engage the fetus down

what is the benefit of the birthing ball regarding labor pain?

-patterned, paced breathing

-essential oils/aromatherapy

-music

-imagery

-focal points

what are some sensory strategies that can help with labor pain?

-big, deep, long cleansing breaths

-slow-paced breath (to prevent hyperventilation)

-modified pace breathing

what are some examples of patterned, paced breathing that a nurse might instruct her patient to do when experiencing labor pain?

help through a contractions

big, deep, and long cleansing breaths are especially helpful regarding what type of labor pain?

-fentanyl

-stadol

**IV pushes

what are the two most common IV medications used for labor pain?

at the IV port nearest the IV insertion site

where are IV meds administered when they're being given for labor pain?

-given in small doses

-give during a contraction

WHEN and in what dose are IV meds administered when they're being given for labor pain?

to ↓ exposure to the fetus = due to constricted blood flow during contractions

why should IV meds being given for labor pain be administered during a contraction?

neonate is at risk for respiratory depression

if IV meds for labor pain are given too close to delivery, what can result?

8-9 cm or further --> can lead to respiratory depression in fetus

what dilation level should the nurse STOP administering IVP (IV push) medications? why?

nitrous oxide

what is a medication that can be inhaled to decrease labor pain?

-spinal

-epidural

what are the two regional medications that can be used for labor pain?

spinal

a one-time injection of a medication usually that is used for C-sections

epidural

a continuous drip of medication into the spinal region; good for the laboring process since it is usually a long process

pudendal block

a nerve block that we usually see right in the perineum

-prior to delivery

-right after delivery when provider needs to do repairs on a tear

when is a pudendal block usually given?

right when the patient walks in

when must a consent for an epidural be received?

-hematocrit

-hemoglobin

-platelets

what labs should be obtained in a woman who has an epidural?

pre-hydrate (bolus of IV fluid) before epidural --> 500-1,000 mL of fluid bolus

what is important to do regarding epidurals and hydration?

epidural relaxes our arteries and veins

↓

leads to a ↓ BP

↓

a ↓ BP leads to ↓ perfusion in the mother and fetus

↓

hydrate to ↑ or maintain perfusion

why is it important to hydrate prior to the administration of an epidural?

be in fetal curled up position to open up the spinal cord more

what position should the woman be in when receiving an epidural and why?

before, during and after placement

(fetal monitoring)

when should fetal monitoring be done for a woman with an epidural?

before, during, & after epidural placement

(pain and discomfort)

when should pain and discomfort be assessed for a woman with an epidural?

within 10-15 minutes of placement

how long does it usually take for an epidural to take effect?

q5 min until stable then q15-30min as ordered

how often should vital signs be taken in a woman with an epidural?

monitor continuously

how often should O2 saturation be monitored in a woman with an epidural?

continue to monitor for hypotension

following the epidural catheter placement, what should the nurse continue to monitor for?

-lateral positioning

-↑ IV fluids

-O2/mask @ 10 Liters/min

-vasopressor per protocol

what are some nursing interventions for hypotension?

this will increase placental perfusion

why is it helpful to position a patient on her side when she is experiencing hypotension following an epidural?

minimize pushing down on vena cava --> can cause perfusion issues

why is it important that a woman NOT be lying on her back following an epidural?

every 30 - 60 min

how often should a woman's position be changed after receiving an epidural?