Interventions during labor & birth Flashcards
What is the positioning fro giving an epidural?
“Angry cat position” → have patient sit at edge of bed and lean slightly forward
Safety of epidurals:
Why do we give a fluid bolus?
Give at least 1 L to help decrease side effects of hypotension
may cause ↓ uteroplacental perfusion (watch FHR)
Routine interventions:
What actions are taken if mother’s BP drops?
Anesthesiologist can give ephedrine to reverse hypotension
List 4 pharmacological drugs that can be given during pregnancy for pain relief
Morphine
Nubain
Stadol
Demerol (meperidine)
How do the opioids previously listed help with pain relief during labor?
Aid relaxation & provide pain relief
→ do NOT remove pain entirely
→ wear off relatively quickly
→ may mask changes in fetal heart pattern
→ increases mother’s risk of falls
Why should opioids not be given late in labor?
Risk of respiratory depression in neonate
Name one other pharmacological method used for pain relief
Nitrous oxide → laughing gas
Nitrous oxide
Does not necessarily reduce pain
→ increases relaxation
→ no systemic effects of fetus
→ minimal maternal side effects
→ effects easily reversed by breathing room air
→ increases maternal sense of control over labor
What are some indications of induction
When maternal & fetal conditions warrant delivery
i.e HTN, GDM, preeclampsia, cholestasis, PROM, IUGR, IUFD, oligohydramnios, non-reassuring fetal status
Induction is contraindicated for mothers with
Placenta previa
ACtive HSV
Malpresentation
Prolapsed cord
Previous C section w/ vertical uterine incision
Hx of uterine rupture
List methods of induction & ripening
Cervical ripening agents
Oxytocin infusion
Amniotomy
Mechanical dilatation
Cervical ripening agents
Dinoprostone → cervidil & prepidil
Misoprostol → cytotec
What is the most common cervical ripening agent?
Cervidil → helps dilate opening of cervix
never give to someone who’s had c-section → causes risk of rupture
Amniotomy
Allows presenting part to be better applied to the cervix
stimulates prostaglandin
Amniotomy risks
Infection
Cord prolapse
Rupture of placenta previa
Two types of mechanical Dilatation
Foley bulb
Cook’s balloon catheter
Foley bulb or Cook’s catheter helps
Mechanically dilate the cervix by providing pressure
stimulates release of prostaglandin
Cervix needs to be minimally dilated for insertion
What are the nursing responsibilities with foley bulb or cook’s cath?
Educate the patient
Document time of insertion, removal, or when balloon falls out
Oxytocin infusion
Stimulates uterus to contract
Most effective if cervix is already ripe
Starts slowly; titrate to maternal/ fetal response
Oxytocin infusion risks
Tachysystole (hyperstimulation)
Uterine rupture
Fetal hypoxia
Safe administration of oxytocin
Continuous monitoring (FHR & uterine activity)
Use of checklist
SBAR if complications arise
List the risks of forcep assisted vaginal delivery
- Fetal head or face injuries, brain injury
- 4th degree laceration of perineum
- perineal hematoma, bladder injury
- anal incontinence
List the risks of a vacuum assisted vaginal delivery
- Cephalohematoma
- fetal brain injury
- Fetal death
How many pop-offs are allowed when using vacuum assisted vaginal delivery?
NO MORE than 3
