Labor, Delivery, Postpartum

Question 1

Uterine contractions produce progressive cervical effacement (thinning of uterus) and dilation.
 Pain and discomfort increases.
 Uterine contraction, cervical dilation and effacement,
hypoxia of the contracting myometrium, and perineal pressure from the presenting part.

Answer 1

First stage of labor

Question 2

Pain perception

Answer 2

Woman’s past experience with pain.
 Anticipation of pain.
 Fear and anxiety.
 Knowledge deficit of the labor and delivery process.
 Involvement of support persons.

Question 3

Nonpharmacological Measures for Pain Relief during delivery, labor, postpartum give 3

Answer 3

 Ambulation
 Effleurage and counterpressure.
 Touch and massage.
 Changing positions and rocking.
 Engaging support persons.
 Breathing and relaxation techniques.
 Transcutaneous electrical nerve stimulation.
 Application of heat and cold.
 Aromatherapy
 Hydrotherapy (warm water baths or showers).

Question 4

Sedative drugs

Answer 4

Secobarbital – A sedative-hypnotic; through oral
 Pentobarbital – through IV
 Hydroxyzine – through IM

Question 5

Drugs interfere with pain impulses at the subcortical level of the brain.
 High doses of opioids are required for effective labor analgesia when administered parenterally.

Answer 5

Narcotics (opiods) agonists

Question 6

Narcotic drugs

Answer 6

Meperidine (Demerol) – most commonly prescribed.
 Fentanyl – through IV
 Morphine Sulfate – less frequently used.

Question 7

Drugs exert their effects at more than one site and are often an agonist at one site and an antagonist at another.

Answer 7

Opiods with mixed narcotic agonist - antagonistic effect

Question 8

Examples for Opiods mixed with narcotic agonist

Answer 8

Butorphanol Tartrate and Nalbuphine
o Additional doses do not increase the degree of
maternal or neonatal respiratory depression, so there is less respiratory depression with these drugs than with opioids.

Question 9

Adverse effects of opiods

Answer 9

Results in analgesia, sedation, euphoria, decreased gastrointestinal (GI) motility, respiratory depression, and physiologic dependence.

Parenterally administered side effects:
 Nausea, vomiting, sedation, orthostatic hypertension, pruritus, and maternal and neonatal respiratory depression.

Question 10

Types of Pain Experienced in Childbirth

Answer 10

Visceral and somatic pain

Question 11

from the cervix and uterus is carried by sympathetic fibers and enters the neuraxis at the thoracic (T10 – T12) and lumbar (L1) spinal levels, and early labor pain is transmitted to T11 and T12 with later progression to T10 and L1.

Answer 11

Visceral pain

Question 12

 Is caused by pressure of the presenting part and by stretching of the perineum and vagina. This is the pain of the transition phase and the second stage of labor, and it is transmitted to the sacral (S2 – S4) areas by the pudendal nerve.

Answer 12

Somatic pain

Question 13

Achieves pain relief during labor and delivery without loss of consciousness.
 Injected local anesthetic agents temporarily block conduction of painful impulses along sensory nerve pathways to the brain.
 Allows the patient to experience labor and childbirth with relief from discomfort in the blocked area while maintaining consciousness.

Answer 13

Regional anesthesia

Question 14

Types of Regional Anesthesia:

Answer 14

 Prudendal Block – pain relief for the birth.
 Epidural Anesthesia – pain relief during labor.
 Combined Epidural / Spinal Anesthesia
 Spinal Block

Question 15

– Used for cesarean birth.

Answer 15

Spinal Subarachnoid Block

Question 16

 Without anesthetic agent.
 Allows woman to sense contractions without feeling
 Retains ability to voluntarily bear down during second stage of labor.

Answer 16

Epidural and Intrathecal Opioids

Question 17

Rarely given for vaginal birth.
 Sometimesusedinemergencycesareanbirthswhen
the woman is not a good candidate for spinal block.
 Relieves pain through loss of consciousness.
 Woman is at risk of regurgitation and aspiration of
gastric contents.
 Causes uterus to relax postpartum.

Answer 17

General anesthesia

Question 18

Drugs that Enhance Uterine Muscle Contractility


Answer 18

Uterotropic drugs enhance uterine contractility by stimulating the smooth muscle of the uterus.
 Oxytocin
 The ergot alkaloids
 IV oxytocin

Question 19

Stimulation of effective uterine contractions once labor has begun.
 It facilitates smooth-muscle contraction in the uterus of a patient already in labor bur experiencing inadequate uterine contractility.

Answer 19

Labor augmentation

Question 20

uterine inactivity or hypotonic contractions, may be more responsive to oxytocin that patients who has not begun labor, therefore a lower starting dose will be needed.

Answer 20

Uterine inertia

Question 21

Act by direct smooth muscle-cell receptor
 Not used during labor because they can cause sustained uterine contractions, which would result in fetal hypoxia and could rupture the uterus.
 Promote sustained contractions and to prevent or control postpartum hemorrhage and to promote uterine involution.

Answer 21

Ergot alkaloids