OB quiz 3 Flashcards
Pain and discomfort experienced during labor have two neurologic origins:
Visceral and somatic
Visceral
From cervical changes, distention of lower uterine segment, and uterine ischemia.
Referred pain
Originated in uterus radiates to abdominal wall, lumbosacral area of back, iliac crest, gluteal area, and down thighs
Somatic pain
Intense, sharp, burning, well localized
Emotional expressions of suffering often seen
- Increased anxiety
- Crying, groaning, gesturing, writhing
- Cultural expression of pain varies
Factors influencing pain response
Physiologic factors, culture, anxiety, previous experience, gate-control theory of pain, comfort, support, environment
A Doula
Someone who stays with you during labor, that is trained to support the mom. (Doesn’t mean you don’t have a support person). They are not a nurse/midwife.
Breathing techniques
Very controlled, deep breath in through your nose, then slowly out of your mouth like blowing out a candle.
Effleurage
A light touch
counter pressure
fist/tennis balls pressing into pt’s back.
Relaxing and breathing techniques
- Acupressure and acupuncture
- Application of heat and cold
- touch and massage
- Hypnosis
- Biofeedback (doing a great job!)
- Aromatherapy
- Intradermal block
Systemic analgesia
- Opioid (narcotic) agonist analgesics
- Opioid agonist-antagonist analgesics
- Opioid antagonists
Pudendal nerve block
Take a giant needle, insert into pudendal nerve (which innervates the uterus). Very painful, but was very effective. Pt died before from one because her BP went too low.
Disadvantages of a spinal anesthesia
- Marked hypotension
- Impaired placental perfusion
- Ineffective breathing patterns
Effects of epidural block on neonate
Little or no lasting effects on the neonate
Nitrous oxide for analgesia
Self-administered via face mask
General anesthesia
- Used rarely for vaginal births
- Used infrequently for elective cesarean section
- May be necessary if indications necessitate a rapid birth
A woman is in labor if…
There is cervical change and regular contractions.
Latent phase
Up to 3 cm of dilation
Active phase
4-7 cm of dilation
Transition
8-10 cm of dilation
True Labor
contractions are regular
Emergency Medical Treatment and Active Labor Act (EMTALA)
Cannot turn away people in imminent labor or if they’re in active labor. If they are not in labor yet, can send them to another hospital.
Fist stage of labor- Assessment
- Determination of true or false labor by:
- Contractions (put monitor on)
- Fetus (Check heart tones, check for accelerations/decelerations, look at variability)
- Cervix (check for ruptured membranes)
- Prenatal data
- Interview
- Psychosocial factors
- Women with a history of sexual abuse
- Stress in labor
- Cultural factors
- Vital signs
Assessment of uterine contractions
- Frequency- beginning of one contraction to another
- Intensity-how high it goes on the strip
- Duration-swoop upward to swoop downward its about a minute long
- Resting tone-stright flat line when at rest
- Cervical effacement, dilation,
- Fetal descent: -5 to +5
Assessment-Laboratory & Diagnostic tests
- Analysis of urine specimen
- Blood tests
- Assessment of amniotic membranes and fluid.
Plan of care and interventions
- General hygiene
- Nutrient and Fluid intake
- Elimination- I & Os, straight cath
- Ambulation & Positioning
Second stage of labor
- 50 min for nulliparous
- 30 min for multiparas
Second stage of labor-Latent
Relatively calm with passive descent of baby through birth canal
Second stage of labor-Descent
Active pushing and urges to bear down
Second stage of labor-Transition
Presenting part is on perineum, and bearing-down efforts are most effective from promoting birth
Vertex presentation
Birth of head
Birth of shoulders
Birth of body & extremities
Third stage of labor
Placental separation and expulsion
Placental separation & expulsion
- Firmly contracting fundus
- Change in shape of uterus
- Sudden gush of dark blood from introits
- Apparent lengthening of umbilical cord
- Vaginal fullness
- Provider examines placenta and membranes for intactness
Number one goal in 4th stage of labor
Make sure baby is breathing.
