Comfort and Support During Labour Flashcards
What are doulas?
Trained labour support and someone who provides emotional support/comfort measure during labour/delivery. Not licensed HCP and their focus is non-clinical care
What are indigenous birth support workers?
Arises out of 2017 regarding tubal ligation experiences of Indg women. Says there must be Indg birth support worker every shift (priority is Indg women in labour but can help any pregnant women in need)
What is a registered midwife?
Work as specialists in normal birth/have privileges to do deliveries at home or in hospital. They are licensed professionals and nurses can work alongside them in hospitals.
Goals of supportive care?
Provide safe environment for labouring client/baby, empower client/respect choices, promote client’s coping, offer assurance/info, cultural care, support/involve client and family
What factors affect pain perception?
Knowledge/childbirth prep, past experiences, responses of others, physical/emotional state, and effectiveness of pain management
5 categories of labour support?
Physical, emotional, instructional/info, advocacy, and partner/coach care
Pain vs suffering?
Pain is physical sensation whereas suffering is emotional reaction (exhaustion, feel unsupported, helpless, out of control, panicked)
What is childbirth prep?
Have they taken any prenatal classes, previous experiences, stories of others, what is their birth plan (values)
3 Rs of comfort measures Penny Simkin?
- Relaxation- able to relax during/between contractions
- Rhythm- use of rhythm characteristics for coping (like swaying)
- Ritual- find/use rituals (repeated use of rhythmic activities with every contraction)
Slow paced breathing vs light breathing?
SPB- slowly inhale through nose/exhale through pursed lips, rate (5-12 breath/minute)
LB- breathe in/out of mouth, used when clients are struggling, silent in/audible out, rate (30-60 breath/minute)
Massage techniques?
Double hip squeeze provide counter pressure than can be helpful during contractions. Back/hand massage can help.
What is hydrotherapy? benefits and risks
Use of water for active labour (shower or tub). Water temp shouldn’t exceed body temperature.
B- reduce pain, relive anxiety, promote sense of control, take weight off (buoyancy)
R- hyperthermia, hypothermia, change in client HR, fetal tachycardia
Positionin in labour?
Certain positions promote circulation/relaxation/relieve discomfort/labour contractions. Changing positions facilitates labour/fetal descent.
T or F: ambulation (walking upright) during 1st stage of labour improves birth outcomes
True
What is birthing/peanut ball used for?
Increase balance in pregnancy, provides counter pressure on perineum, widens pelvic outlet to maximum
What enviorment should be present for birth?
Dim lights, peaceful surroundings, provide privacy, cool from for labouring client, music can be relaxing, and have safety
What is TENS?
Transcutaneous electrical nerve stimulation. Machine used during labour to assist body to produce its own natural pain relief using electrodes over nerve pathways
What is sterile water injections?
Inject 0.1 mL of SW into 4 locations in the back to reduce pain
T or F: all systemic drugs used in labour for pain cross placental barrier by simple diffusion
True
Ideal labour analgesic characteristics?
Safe for client/fetus, minimal SE, effective for all labour stages, no effect of ambulation/voiding/labour progress, and rapid effect
Systemic analgesia of morphine and fentanyl?
M give 2-5 mg IV q4hr or 5-10 mg IM q4hr, and its given during the 1st stage. Fentanyl give 50-100ug IV q1hr. Fentanyl is short acting and has less impact on fetus, and is usually given during the 2nd stage. These narcotics can cause respiratory depression on the fetus
What is nitrous oxide?
An inhaled analgesic that has rapid effect, no effect on contractions/mobility, minimal fetus depression, and self administration (during contractions). Disadvantage- less effective/more variable pain relief than epidural, requires active use through labour
What is an epidural?
Type of regional analgesic that’s injected into epidural space that produces little/no feeling from uterus downwards (pt controlled epidural is most common). It is safe for mom/baby, provides pain relief for all stages, increased sense of control for client, and are still able to maintain ambulation
Epidural SE?
Hypotension for the pregnant client, which can lead to fetal bradycardia indirectly. Also spinal headaches, bladder dysfunction, difficulty ambulating, reduced ability to push/inability, N/V (rare), itch/tremor, neuro complications, and failed block (sometimes it doesn’t work)
Contraindications to epidural?
Pt refusal, significant bleeding, systemic sepsis, spinal injury/conditions affecting low spine, sensitivity to local anesthetics, and unavailable personnel/equipment
What is a walking epidural?
Allows for ambulation/mobility which enhances labour progress. It increase control over body and is designed to provide pain relief while still being aware of contractions/pressure.
Nursing care for epidurals?
Take baseline Vs/FHR, get IV access for bolus in case of hypotension, support pt/person for insertion, BP/HR q5minx20 after insertion with continuous RN presence, change position (roll in bed), assess sensory level 30-60 min with ice (start below umbilicus), assess motor function q4hr (bromage scoring), and void prior to insertion
What is a spinal block?
Local anesthetic injected into spinal canal in subarachnoid space. It’s quick acting and has a longer duration. During 1st age (T10-L1 affected) and during 2nd stage (S2-S4 affected)
What is a pudendal block?
Local anesthetic injected into pudendal nerve to lower vagina/perineum. This blocks local nerves only. Usually used near end of labour to provide relief during pushing. It has no effect on fetus/labour progression
What is local infiltration?
Local anesthesia like lidocaine is injected into the perineum to provide pain relief for episiotomies/laceration repairs. Has no effect on labour/PP client or fetus
What is general anesthesia used for?
Used in emergent situations and has higher risks. It works the quickest
Complications of general anesthesia?
- Fetal depression-causes resp depression
- Uterine relaxation
- Vomit/aspiration- stomach may not be emptied prior to anesthesia, anesthetic agents may cause V/A
- Difficult or failed intubation
