part 1 - Comprehensive Overview of Labor and Delivery Pain Management in Obstetrics

normal contractions are

- coordinated

- involuntary

- intermittent

contraction cycle

- increment

- acme

- decrement

- interval

increment

increasing strength

acme

peak; greatest strength

decrement

decreasing strength

interval

elapsed time from beginning of one contraction until the beginning of the next contraction; minutes

cycle & pattern

- frequency

- duration

- intensity

frequency

beginning of 1 uterine contraction to beginning of the next

duration

beginning of a uterine contraction to the end of that same contraction

intensity

strength of contraction (mild, moderate, strong) & its assessed by palpation

uterine body

- upper 2/3 of uterus contracts actively to push fetus down

- lower 1/3 remains less active to promote downward passage of fetus

cervical changes

effacement & dilation

effacement

thinning & shortening of the cervix

dilation

opening of the cervix

components of birth process

- powers

- passage

- passenger

- psyche

powers

- uterine contractions

- maternal pushing efforts

passage

- consists of maternal bony pelvis & soft tissues

- pelvic brim divides bony pelvis into: false pelvis & true pelvis

true pelvis

- inlet (upper pelvic opening)

- midpelvis (pelvic cavity)

- outlet (lower pelvic opening)

passenger

- the fetus

- anatomic & positional variables influence labor

fetal lie

orientation of the long axis of the fetus to the long axis of the woman

- longitudinal

- transverse

- oblique

attitude

relation of fetal body parts to one another

- flexion

- extension

presentation

- cephalic

- breech

- shoulder

fetal part that enters the pelvis is termed the "presenting part"

fetal head

- bones

- sutures

- fontanels

molding of the head

occurs with normal vaginal deliveries causing misshapen or elongated scalp

as uterus contracts

blood flow is diminished

oblique lie

lying at an angle to the mother and converts to transverse or horizontal during labor

cephalic presentation

fetal head enters pelvis

breech presentation

fetal buttocks or legs enter pelvis 1st

shoulder presentation

baby is in transverse or horizontal position at delivery, must be turned

position

- describes location of a fixed reference pt on presenting part in relation to 4 quadrants of maternal pelvis

position abbreviations

indicates relationship between the fetal presenting part & maternal pelvis

(i.e. ROA, LOA)

- 1st letter: Right (R) or Left (L)

- 2nd letter: Occiput (O), Mentum (M), Sacrum (S)

- 3rd letter: Anterior (A), Posterior (P), Transverse (T)

fetal compass rose

psyche

- anxiety

- culture & expectations

- birth as an experience

- support

psyche: anxiety

- catecholamines are released in response to anxiety & fear

- inhibits uterine contractions & blood flow to the placenta

psyche: culture

assess personal values & expectations

psyche: birth as an experience

physical & emotional experience that forever changes a woman & her family

psyche: support

continuous support has a positive effect on labor

true labor: contractions

- usually have a consistent pattern of increasing frequency, intensity, & duration

- contractions tend to increase with walking

- contractions typically begin in lower back & gradually sweep around to lower abdomen

true labor: discomfort

- may persist as back pain in some women

- discomfort often resembles menstrual cramps during early labor

true labor: cervix

- includes progressive effacement & dilation (most important characteristic)

false labor: contractions

- inconsistent in frequency, duration, & intensity

- contractions do not change or may decrease w/ activity

false labor: discomfort

- felt in the abdomen & groin

- discomfort may be more annoying than truly painful