Pain Management in Childbirth Flashcards
1
Q
Sources of Pain
A
- Cervical dilation, stretching, contractions
- Uterine ischemia: blood supply decreases during contraction and causes hypoxic uterine muscle
- Pressure and pulling on pelvic structures
- Distension of vagina and perineum with fetal descent
2
Q
What are 4 painful things that contractions do?
A
- Stretching of the cervix
- Movement of ligaments (shortening)
- Buildup of lactic acid over labor makes uterus tender
- Pulling apart of pelvis
3
Q
What is our goal with pain during labor?
A
Cope with but not totally relieve pain
4
Q
Level 1: Non-pharmacologic measures
A
- Social support
- Hydrotherapy
- Ambulation
- Position changes
- Accupuncture/accupressure
- Attention focus/guided imagery
- Therapeutic touch/massage
- Breathing techniques
- Music
- Aromatherapy
5
Q
Gate Control Theory
A
- Local physical stimulation interferes with stimuli reaching the brain by closing the gate at the spinal cord
- Woman has a decrease in her perception of pain
6
Q
Level 2: Systemic Strategies
A
- Oral, IM, IV drugs
- Opioids
- Benzodiazepines
- Barbituates
- Meds dull awareness of pain or pain sensation but don’t remove pain
- Patient will be on falls precaution
7
Q
Level 3: Regional Anesthesia
A
- ## Epidural (labor)Spinal (birth)
- Combined spinal-epidural
- Pudendal block (for lacerations and episiotomy)
- Synergy btw opioid and local anesthetics
8
Q
Contraindications to Epidural
A
- Late phase of labor
- Previous spinal surgery or abnormality
- Anticoagulation therapy or defect
- Known infection
- Existing hypovolemia
9
Q
How epidural works
A
- Uptake occurs by diffusion
- Elimination occurs by vascular absorption by blood vessels
10
Q
Epidural Facts
A
- 50 year old technique used in 60% of current US laboring women
- Tool for back labor and cesarean birth (optional)
- Restricts patient to bed rest
- Usually placed during active labor (after 5 cm dilated)
- May interfere with baby suckling
immediately after birth - Can impact pushing if not light
- Need foley after two hours
11
Q
RN role pre-administration of epidural
A
- Determine that nothing else is working (not coping)
- Have an MD order
- Determine phase of labor
- Patent IV
- Bolus dose of 500-1000 ml fluid
- Stable vital signs
- No allergies to any “caines” ask about dental work
12
Q
Epidural Procedure
A
- Medication administered through a catheter placed outside dura mater in epidural space
- Meds diffuse across to cord and nerve roots for effect
13
Q
RN role during administration of epidural
A
- Position patient/expose back
- Patient must round shoulders over belly
- Support patient throughout procedure
- Partner must leave or be sitting
- Cycle vitals: every minute during admin starting with test dose then Q5 minutes until 20-30 min post procedure
- Watch fetus and mom for signs of maternal hypotension (first clue is N/V)
14
Q
Epidural Test Dose
A
- Small amount of lidocaine with epinephrine given to check placement
- Observe vitals for 5 min
- Note baseline HR and any increase
- Note sudden sensation in buttocks/legs within 3-5 minutes
- Test dose rules out accidental IV or spinal injection
15
Q
Complications of Epidural
A
- N/V (first sign of hypotension)
- Hypotension after med due to vasodilation
- Itching (from duramorph)
- Resp depression
- Inadvertent dural puncture
- Headache
- Hematoma
- IV injection
- Back pain
- Neural trauma
- Infection
