tissue ischemia
during contractions, blood supply to uterus is diminished esp during acne
sources of child birth pain
tissue ischemia, cervical dilation, pressure and pulling on pelvic structures, distention of the vagina and perineum
factors influencing perception and tolerance of pain
intensity of labor, fetal position and size, characteristics of the pelvis, fatigue, intervention of caregivers
psychological factors that influence perception and tolerance of pain
anxiety and fear, previous experiences with pain, childbirth preparation, support system
hyperventilation
respiratory alkalosis caused by blowing off too much CO2 causing dizziness, tingling fingers, stiff mouth
regional anesthesia
provide pain relief without loss of consciousness. examples are pudendal block, spinal, epidural, combo spinal epidural
pudendal (saddle) block
given in second stage (pushing) to numb perineum and vagina. does not relieve uterine pain or contractions, can be used for pain relief with perineal repair and is safe
epidural block
popular regional block for relief of pain in labor and birth. local anesthetic is injected into the epidural space, given after labor is established or before a CS, stop infusion at end of 1st stage to increase effectiveness of pushing.
epidural space
outside the dura mater, between the dura and spinal cord
adverse effects of epidural block
maternal hypotension, bladder distention, prolonged second stage, migration of the epidural catheter, fever, metal taste in mouth and ringing in ears indicates med in blood stream
adverse effects of epidural opioids
nausea and vomiting, pruritus, respiratory depression
epidural concerns
check BP every 5-15 minutes, regional blocks often result in increased chance of forceps or vacuum delivery, after delivery a spinal headache is possible
what is the treatment for spinal headache?
blood patch
IV opioids onset, peak, duration
onset: 5 minutes
peak: 30 minutes
duration: 1 hr
IM opioids onset, peak, duration
onset: 30 minutes,
peak: 1-3 hrs
duration: 4-6 hrs
before any pain medication or regional anesthesia.....
do cervical exam
preferred meds for labor
stadol ( 1-2 mg O 2-4 hrs)
nubain ( 10-20 mg)
inhalants
nitrous oxide is the most common inhalation agent used for labor management. must be self administered with oxygen at a concentration no greater than 50%. the woman MUST hold the mask herself
side effects of inhalants
dizziness, N/V and dysphoria
induction or augmentation
stimulation of uterine contractions, all time high in the US, induction for convince has led to rising C/S rates, should only be initiated when the benefits of birth outweigh the risk of being pregnant.
reasons for induction
post term gestation, prolonged ROM< gestational hypertension/diabetes, renal disease, chorioamniotiis, dystocia, intrauterine fetal demise, isoimmunization, diabetes
pitocin (oxytocin)
utertonic agent used for induction and augmentation, produced naturally by the posterior pituitary response varies widely among women, high risk drug
what is the most important intervention concerning pitocin?
time and length of contractions with EFM
goal contraction pattern for using pitocin
duration of 40-90 seconds, frequency of 2-3 minutes, dilation= 1 cm/hr
uterine tetany
contractions too close together which can cause fetal distress. contractions are tetany if they are q 2 minutes.
what happens if tetany occurs when using pitocin?
turn off pitocin and restart per protocol once the tetany is resolved
episiotomy
midline or mediolateral
indications for cesarean
dysfunctional labor pattern, cephalo pelvic disproportion, fetal distress, malpresentations (breech, shoulder), multifetal pregnancy, active genital herpes, hypertensive disorder, diabetes, placenta previa, umbilical cord prolapse
cesarean section care pre op
full physical assessment- determine last meal/drink, desire NPO prior to surgery due to anesthesia, notify anesthesia if PO intake
post op cesarean care
bubble- he
psychosocial assessment cesarean section
feelings of loss, fears for self and abby, expectations missed.