Healthy birth practices as defined by lamaze

Question 1

Neuromatrix

Answer 1

• Expansion of Gate Control Theory
• Both past and present experiences affect pain perception
• Women bring personal neuroreceptors (modifiers) to pain - personal relationships, environment, emotional support, personal coping skills, and other facts

Question 2

Analgesia

Answer 2

• Pain medication intended to relieve some but not all of pain
• Normally given IV but may also be give IM
• Normally narcotics such as Stadol, Nubain, or Fentanyl
• Nitrous oxide being tried in limited areas in US

Question 3

Analgesia Advantages

Answer 3

• Fast acting
• Dose can be repeated
• Does not permanently limit mobility
• Allows mother to rest but she does not have total loss of sensation
• Medication is rapidly metabolized in mom’s body

Question 4

Analgesia Disadvantages

Answer 4

• Requires IV access
• Often makes mom drowsy and not totally aware of surroundings
• Medications that enter mom’s blood stream also enter babies
• If medication is give too close to birth it may cause baby to be lethargic and slow to breathe
• Mom must be monitored for 20-30 min after medication is given

Question 5

Labor Anesthesia - Epidural

Answer 5

• Medication intended to block all pain sensations
• Local anesthetic such as xylocaine and narcotic such as morphine or fentanyl injected into epidural space, test does is given, and then bolus does is given
• Pump is attached so mom receives continuous low dose
• Elevated core temperature but mom appears like she’s cold; be mindful of blankets and temp of room

Question 6

Spinal/epidural intracthecal

Answer 6

• Low dose narcotic is injected into intrathecal space allowing increased freedom of movement often out of bed
• epidural catheter is inserted into epidural space and dosed later if intrathecal dose wears off prior to birth

Question 7

Advantages of epidural anesthesia

Answer 7

• Mom remains awake and alert
• Mom is more comfortable
• Mom can rest
• If cesarean is needed, epidural may be re-does at an increased strength and used for surgery

Question 8

Risks of epidurals

Answer 8

• Potential increased risk of cesarean
• Significant drop in mom’s blood pressure which decreases bloody supply to baby
• Fetal distress
• Accidental injection into a blood vessel during placement which may cause seizures and loss consciousness - 0.12%
• Trauma to blood vessels leading to hemorrhage
• Infection
• Spinal headache as result of puncturing dura - 2%
• Backache - 19%
• Abnormal contractions resulting in need for Pitocin
• Decreased ability to push
• Inadequate pain relief
• Medication interactions
• Fever
• Allergic reactions
• Nausea and vomiting - 30%
• Increased asthma attacks for asthmatic mother
• If cesarean is performed, women with history of herpes have increased recurrences of herpes outbreaks
• Breastfeeding
• Emotional detachment

Question 9

Epidural Preparation and Procedure

Answer 9

• Mom must receive IV fluid bolus prior to placement of epidural
• Multiple monitoring devices must be used
• Mom is placed either on her side or in sitting position and must remain completely still when epidural is paced
• Mom’s back is cleaned with antiseptic solution
• Local numbing agent is place in tissue at injection site
• Epidural catheter is placed
• Bolus dose is given after epidural catheter is secured
• Continuous infusion pump is attached so mother receives continuous low dose
• Mom must then lie on her back for approximately 30 minutes to allow medication to be evenly distributed
• Once medication is evenly distributed she may change positions