Pharmacological Pain Management in Labor Flashcards
What does PAIN stand for in labor?
P- Purposeful
A- Anticipated
I- Intermittent
N- Normal
What will happen physiologically to a woman who is experiencing excessive labor pain?
increase in metabolic rate and increase in the demand for oxygen, increase in cortisol and glucagon, and a release of catecholamines
What does increasing catecholamines do when a woman is in labor?
inhibits the uterine response to oxytocin
What can unrelieved pain during labor lead to?
PTSD and PPD
What are the 4 main sources of pain during labor?
tissue ischemia, cervical dilation, pressure/pulling on pelvic structures, distention of the vagina/perineum
(burning, tearing, splitting-somatic pain)
What is visceral pain during labor?
cramp-like or throbbing feeling that results from the contraction of the uterus and originates in the uterus and cervix
What caused somatic pain in labor?
skin and deep tissue pain that results from the distention of the vagina, perineum, pelvic floor, and stretching of ligaments in the pelvis, and is normally sharp and localize
(rectal pressure may also occur)
What are some factors that influence pain?
intensity of labor, fetal position and size, characteristics of pelvis, fatigue, medical interventions, culture, anxiety and fear, previous experiences with pain, support system, and preparation for childbirth
What scale is used to determine pain during labor?
PQRSTU
What is a downside of administration of certain pain medications that are given during labor?
may slow down labor or increase the length of the 2nd stage
What are the different types of regional pain management?
regional anesthesia, pudendal block, local infiltration anesthesia, epidural block, combined spinal-epidural, subarachnoid block/spinal
What is the advantage of regional pain management during labor?
the woman participates in her birth experience, may have good pain control, no loss of consciousness, can interact with her partner and infant, and she retains her airway reflex
What is the difference between analgesia and anesthesia?
analgesia is utilized for pain relief
anesthesia will cause a loss of sensation locally, regionally, or generally
When would a pudendal nerve block be used?
second stage of labor
Why is a pudendal block not used much anymore?
increases the risk of infection and puts the mother at risk for urinary retention
When is local infiltration anesthesia used for a woman?
When prepping for/repairing an episiotomy or when repairing a laceration
Where will local infiltration anesthesia be injected?
perineum
What are the advantages of using a Q pump for pain management during labor?
it will only numb a targeted site, it is a small disposable pump, it will continuously deliver medication, pump is connected to a catheter which can be removed at home, faster recovery for patient, better pain relief without side effects of narcotics
What are the side effects of the Q pump?
increase in pain, fever, chills, sweats, bowel/bladder changes, difficulty breathing, redness/warmth/discharge/excessive bleeding from catheter site, pain/swelling/large bruises around catheter site, dizziness/lightheadedness, numbess/tingling around site, drowsiness, confusion
Who administers an epidural block?
anasthesiologist
Is an epidural block a sterile or clean procedure?
sterile
What sensations will a patient still feel after administration of an epidural?
touch and pressure, but not cold or cramping
Is an epidural usually administered by itself?
no. It is usually in combination with analgesics