Comfort and Labour Support Flashcards
5 effects of RN as labour support
- increased likelihood of spontaneous birth
- decreased analgesia use
- decreased c-section, forceps, vacuum
- decreased incidence of 5 min APGAR
- increased satisfaction with experience
Doula
Not licensed; someone who provides emotional support and comfort measures during labour and delivery
Registered Midwives
Licensed professionals; work as specialists in normal birth and have privileges to do deliveries in the hospital or, if appropriate, in the comfort of the client’s own home
5 categories of labour support
- physical
- emotional
- instructional
- advocacy
- partner/coach care
Pain vs Suffering
Pain: a physical sensation
Suffering: an emotional sensation
The Three R’s
Successful laboring women have these 3 characteristics in common to cope well:
1. Relaxation between contractions
- Rhythm that helps them cope
- Ritual that can be included while going through the rhythm
Mental Activity Comfort Measures
distraction, meditation, non-focussed awareness, imagery, hypnosis
Basic need comfort measures
hygiene, nutrition, hydration
3 examples of massage techniques
- double hip squeeze
- criss cross
- breaking the popsicle
Why is hydrotherapy beneficial during the active stage of labour
Warmth and buoyancy supports uterus
1. reduced surgical birth rates
2. shorter second stage
3. reduced analgesic
4. lower perineal trauma
What position compared to recumbent reduced the duration of labour, risk of c section, less need of epidural, and less chance of NICU?
Walking and upright position
What are the 4 benefits of the birthing ball?
- increases balance
- counter pressure on perineum
- eases back pain
- widens pelvic outlet
What labour activities can occur if a patient has mobility limitations?
The rollover
Q30 min
What are sterile water injections
Pain reduction; 0.1ml of sterile water intradermally in 4 locations lasting 4 hours
What is a consideration of systemic drugs used in pain relief for labour?
Cross placental barrier by simple diffusion
The ideal labor analgesic is
- safe for client and baby
- rapid
- ease of admin
- maternal sense of control
- minimal side effects
- no effect on ambulation, voiding, progress
- effective for all stages
What are the 2 parenteral opioids used for labour pain?
Morphine and Fentanyl
Describe the use of fentanyl vs morphine in labour pain
Morphine: earlier on/if labour is progressing slower (nulliparous) because of longer onset and half life
Fentanyl: given later on/if labour is progressing faster (multipiarous) because shorter onset/half-life
Why is demerol out of favour for pain relief?
Stays in fetal circulation for up to 90 hours
What synergistic medications are necessary to have ordered when using opioid pain relief?
anti-emetics r/t nauseating effects of opioids
Narcan for fetal respiratory depression
What are the advantages of nitrous oxide for pain relief?
(inhaled analgesic)
- rapid effect with patient awake
- no effect on contractions
- minimal neonatal depression
- self adminstaration
Disadvantages of nitrous oxide as pain relief
- decreased effectiveness with prolonged use (only used in later stages of active labour/second stage)
- major risk of general anesthesia if not self administered
- only breath in during contractions; room air when not
Advantages of epidural (4)
- not systemic
- effective for all stages
- increased sense of control
- allow for ambulation, little effect on pushing, less interference with voiding
Epidural side effects/complications (8)
- hypotension
- unanticipated spinal injection
- bladder dysfunction/difficulty ambulating
- inability to push
- shivering
- N/V
- neuro complications
- ineffective block
Why is hypotension the most significant side effect of epidural?
Can cause fetal bradycardia
Contraindications to epidural
§ Patient refusal
§ Significant bleeding or coagulopathy
§ Systemic sepsis
§ Spinal injury / conditions affecting lower spine (relative)
§ Sensitivity to local anesthetics
§ Unavailable personnel / equipment
Define epidural
Anesthetic and/or analgesic injected into epidural space L4-L5 to produce little/no feeling from T4-T10
Usually continuous infusion
Nursing care for epidurals
- baseline vitals and FHR then q5min x 20 after insertion
- IV access with 500-1000ml bolus for hypotension
- attend to client position
- Dermatomes 30-60min (t4-T10)
- Motor function/bromage score q1h
- attention to bladder function
What is a spinal block, advantages, and usual use?
Lock analgesia into spinal canal for quick onset and longer duration
Administered higher for c section and lower for vaginal birth
What is a pudendal block>
Local anesthetic injected into pudendal nerve in vagina near the end of labour and has no effect on fetus/progress of labour
What is local infiltration?
Lidocaine injected into perineum for relief for episiotomy incision or laceratin repair
No effect on client or fetus
4 Major Complications of Pain Relief in Labour
- fetal depression
- uterine relaxation
- vomiting/aspiration
- difficult/failed intubation
