PAIN MANAGEMENT DURING BIRTH

PAIN MANAGEMENT DURING BIRTH CHAPTER 20 HYDROTHERAPY IN LABOR Tub bath or Jacuzzi  Decrease in pain and anxiety: may decrease need for pain med  Useful for early labor  Not for prolonged ROM  Monitor water temp to 98.6  SYSTEMIC ANALGESIC CONSIDERATIONS All cross the placenta  Drug action depends on maternal and fetal metabolism and excretion rates  High doses may remain in the fetus for long periods  If given too early, may prolong labor and depress fetus: delay to active labor stage  If given too late, may induce respiratory depression in fetus.  ASSESSMENT CRITERIA FOR SYSTEMIC ANALGESICS Informed choice of patient  Maternal vital signs stable  FHR baseline 110 to 160 with no decels  Good variability  Established contraction pattern  Cervical change and progressive fetal descent  NURSING PROCEDURE Administer per protocol (unusually IVP)  Always look up administration rate, compatibility, dilution etc in med book  Side rails up and assistance to bathroom  Assess FHR  Provide quiet environment  COMMONLY USED NARCOTICS Stadol: 1 to 2 mg IM or IV; antagonist is narcan; may precipitate withdrawal in women with opiate dependency  Nubain  Fentanyl  Demerol: commonly used with narcotic potentiator such as phenergan  REGIONAL AND LOCAL ANALGESIA AND ANESTHESIA Involves temporary loss of sensation by injecting local anesthetic agent into an area in direct contact with nerve tissue  Nursing care:   Anesthesia staff gets informed consent  Establish active labor, stable VS, FHR WNL  Give 500 to 1000ml of IV fluids within 30 minutes of procedure Nursing care continued Void before procedure  Assist with positioning of woman  Monitor vital signs during and after: q 2 min until 10 min after, then q 5-15 until BP stable  Keep on bed rest  Empty bladder every 2 hours  EPIDURAL BLOCK  Advantages: relieves labor discomfort  Woman fully awake; decreased anxiety,  Disadvantages: may slow labor and fetal descent; decreased edibility to push, delay in bladder sensation requiring catheterization Treatment of hypotension event Turn to side or trendelenburg if severe  Iv bolus at rapid rate  Notify anesthesia personnel immediately  Administer vasopressors as ordered: usually ephedrine 5-10 mg IV  Supplemental O2 by mask at 7-10 L/min  OTHER PROCEDURES Spinal block  Prudendal block  Local  General anesthesia 