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OB Tutoring
Labor & Delivery
| Term | Definition |
|---|---|
| 5 P’s of Labor | Power: refers to uterine contractions and pushing efforts Passageway: refers to the anatomy of the patient’s bony pelvis and soft tissues Passenger: refers to the fetus Psyche: refers to patient’s state of mind Position: refers to patient position |
| 5 P’s of Labor | These factors influence labor & birth and play a significant role in the progression & outcome of labor |
| 5 P’s of Labor (Power) | Refers to the forces that drive labor (uterine contractions & maternal pushing efforts) - Can augment “Power” with Oxytocin (Pitocin) - RN can also coach to push WITH contractions |
| 5 P’s of Labor (Power) | Primary Power: Uterine Contractions - Occurs in the upper uterus and applies pressure to the fetus. This pressure allows the cervix to dilate and efface (allowing for passage of the fetus). - Strength/Duration/Frequency of Contractions Affect Power |
| 5 P’s of Labor (Power) | Secondary Power: Pushing Efforts - This occurs when the cervix is dilated completely. |
| 5 P’s of Labor (Passageway) | Refers to the birth canal (pelvis, cervix & vagina) - Different types of pelvis (android, anthropoid, gynecoid, platypelloid); gynecoid is preferred for vaginal birth - not important for this class |
| 5 P’s of Labor (Passageway) | - Ability of the soft tissue to stretch - Prior gynecological surgeries can form scar tissue causing issues for fetal passage - Pelvic floor muscles help orient and turn the fetus through the cardinal movements of delivery |
| 5 P’s of Labor (Passageway) | Soft tissue can also affect the “passageway” Stations - Zero Station: presenting part at ischial spines - (-) station: presenting part above the ischial spine - (+) station: presenting part below ischial spines |
| 5 P’s of Labor (Passenger) | Refers to the baby and its position in the womb. Fetal Lie: Orientation of the Fetal Spine Relative to Maternal Spine |
| 5 P’s of Labor (Passenger) | Fetal Lie: - Longitudinal: Fetal head or fetal buttocks enter pelvis first - Transverse: Head to tailbone axis is at 90 degree angle to mother - Oblique: Any angle between longitudinal and transverse |
| 5 P’s of Labor (Passenger) | Fetal Head - Largest part of the infant Fetal Positions - Cardinal Movements (See Second Stage of Labor) |
| 5 P’s of Labor (Passenger) | Fetal Presentation: Part of the Fetus Closest to Birth Canal - Cephalic: Head first - Breech: Butt or feet first - Shoulder: Transverse lie |
| 5 P’s of Labor (Passenger) | Fetal Attitude - Vertex: Full Head Flexion - Sinciput: Moderate Head Flexion - Brow: Partial Head Extension - Face: Poor Head Flexion. Complete Extension |
| 5 P’s of Labor (Psyche) | Refers to the emotional and psychological wellbeing of the mother during labor. Psyche can slow down labor: - Anxiety - Stress - Fear - Pain Tolerance Relaxation can augment labor. |
| 5 P’s of Labor (Position) | - Refers to the position of the mother during labor. - Positioning significantly improves the process of labor, it can facilitate the descent of the baby (gravity), enhance comfort during labor, expand the pelvic dimensions (squatting). |
| 5 P’s of Labor (Position) | - Contractions are most effective in an upright position, discourage lying on back. - Lithotomy position is only done for the provider |
| Signs of Impending Labor | - Contractions become regular - Presence of bloody show - Descent of the fetus into the birth canal (lightening), may occur about two weeks before labor for a primigravida - Nesting impulse: overwhelming desire to get your home ready for your new baby. |
| Signs of Impending Labor | - GI distress (heartburn, nausea, diarrhea) - Weight loss of 1 to 3 lb just before onset of labor - Labor is confirmed by cervical change (dilation and effacement). |
| True Labor | comprises processes that result in the expulsion of the products of conception by the mother. It begins with contractions that cause progressive cervical changes of dilation and effacement and ends with the placental delivery. |
| True Labor | - Contractions may persist as back pain or menstrual-like cramps, beginning in the lower back and gradually sweeping around to the lower abdomen. - Contractions tend to increase with walking. |
| True Labor | Contractions become stronger, regular and get closer together - 4-6 minutes apart lasting 30-60 seconds True labor follows a specific sequence of events called the Cardinal Movements of Labor. |
| True Labor | - True labor is confirmed by cervical change (dilation and effacement) |
| False Labor | consists of contractions without cervical dilation or effacement. It can mimic true, early labor. |
| False Labor | - Contractions are inconsistent or weak in frequency, duration, and intensity. - Contractions may stop or slow down with activity/changing positions. |
| False Labor | - Discomfort is felt in the abdomen and groin and may be more annoying than painful. - The cervix does not significantly change in effacement or dilation. |
| Contraction Time | True Labor: regular, getting closer together, usually 4-6min apart, lasting 30-60sec False Labor: irregular, not occurring close together |
| Contraction Strength | True Labor: become stronger with time, vaginal pressure is usually felt False Labor: frequently weak, not getting stronger with time or alternating (strong followed by weak) |
| Contraction Discomfort | True Labor: starts in the back and radiates around toward the front of the abdomen False Labor: usually felt in the front of the abdomen |
| Any change in activity | True Labor: contractions continue no matter what positional change is made False Labor: contractions may stop or slow down with walking or making a position change |
| Stay or go hospital? | True Labor: stay home until contractions are 5 mins apart, last 45-60secs, strong enough you can't converse, then go hospital or birthing center False Labor: drink fluids and walk to see if any change in intensity of contractions, if diminish stay home |
| True vs. False Labor Assessment | - Contraction Frequency, Duration, Intensity, Length - Cervical Effacement and Dilation - Fetal Station - Are membranes intact or ruptured? |
| True vs. False Nursing Management | - Rest/Sleep - Relax in a warm bath or receive back rub - Distraction Activities - Education on signs or symptoms of true/false labor (educate both mom & partner) |
| True vs. False Nursing Management | - Walk for 1-2 hours - If there are no cervical changes, then we may decide to discharge them back home. |
| Stages & Phases of Labor | First Stage: Dilation and effacement of the cervix. - Latent phase: 0 to 6 cm dilation - Active phase: 6 to 10 cm dilation - Transition phase: 8 to 10 cm dilation |
| Stages & Phases of Labor | - Second Stage: Complete dilation to the birth of the baby. - Third Stage: Birth of the baby to delivery of the placenta. - Fourth Stage: Delivery of the placenta to four hours postpartum or the patient is clinically stable. |
| Stages of Labor (First Stage) | First Stage: Dilation and effacement of the cervix. This stage is the longest, lasting 8-12 hours. It begins with regular contractions that cause cervical dilation and effacement. |
| Stages of Labor (First Stage) | Latent Phase: 0 to 6 cm dilation (40% effaced). - This is the longest-lasting phase of labor, characterized by a period of excitement. - Contractions feel like menstrual cramps and are mild to palpation. |
| Stages of Labor (First Stage) | Active Phase: 6 to 10 cm dilation (50-100% effaced). - The patient may become more focused, anxious, or restless. - Contractions become more regular and painful and are moderately strong to palpation. |
| Stages of Labor (First Stage) | Transition Phase: 8 to 10 cm dilation (part of the active phase). - Contractions are strong and close together. - The patient may feel out of control, irritable, or dependent. - This is the shortest-lasting phase of labor |
| Stages of Labor (Second Stage) | This stage may last 20 minutes to 2 hours. - Pushing starts with the cervix completely dilated and ends with the birth of the baby. - Pushing may be delayed until the patient feels the urge to push. |
| Stages of Labor (Second Stage) | - As the fetus descends through the birth canal, the fetal head rotates for optimal delivery |
| Stages of Labor (Second Stage) | - *Cardinal Movements: Engagement, Descent, Flexion, Internal Rotation, Extension, External Rotation (Restitution), Expulsion* KNOW ORDER!!! |
| Stages of Labor (Second Stage): Cardinal Movements 1 | Engagement: The fetal head reaches the level of the ischial spines. (0 Station) Descent: The fetus moves past the ischial spines. (+1 Station) Flexion: Fetal chin touches chest in response to pressure from maternal tissue. |
| Stages of Labor (Second Stage): Cardinal Movements 2 | Internal Rotation: Fetal head rotates Extension: The fetal chin comes off the chest and the neck arches as the head is born. |
| Stages of Labor (Second Stage): Cardinal Movements 3 | External Rotation (Restitution): The fetal head is born and rotates again as the shoulders move into position for birth. Expulsion: The body of the fetus is born |
| Stages of Labor (Third Stage) | This stage is complete within approximately 5 to 30 minutes. - Begins with the birth of the baby and ends with the delivery of the placenta. - The uterus contracts to deliver the placenta. |
| Stages of Labor (Third Stage) | Signs of placental separation include: - Lengthening of the umbilical cord - A gush of blood - The client reports a need to push |
| Stages of Labor (Third Stage) | - After the delivery of the placenta, the uterus continues to contract to "pinch" or close the open blood vessels in the decidua to prevent maternal hemorrhage. |
| Stages of Labor (Third Stage) | - Failure to contract is called uterine atony and is a primary cause of postpartum hemorrhage. - Massage the Fundus with Uterine Atony! |
| Stages of Labor (Fourth Stage) | Begins with the delivery of the placenta and ends after 4 hours or when the patient becomes clinically stable. - Pain medication should be administered as needed, and the nurse should assist with skin-to-skin contact and initiating breastfeeding. |
| Stages of Labor (Fourth Stage) | - The nurse should assess uterine position, vaginal bleeding (lochia), and vital signs. - This is done every 15 min for the first hour, then every 30 min for one hour, then q4h unless the RN assesses the need for more frequent monitoring |
| Stages of Labor (Fourth Stage) | - The nurse should encourage urination when the client feels the urge to urinate |
| Stages of Labor (Fourth Stage) | Normal Uterine Involution Occurs Predictably: - 1 hour after delivery, the fundus is at the umbilicus, it descends 1 fingerbreadth/postpartum day until it becomes a pelvic organ again at day 10 and can no longer be felt via the abdomen. |
| Rupture of Membranes (ROM) | - Spontaneous or mechanical breaking of the amniotic sac that surrounds the fetus and amniotic fluid. - Think of this as an umbrella term. |
| Preterm Rupture of Membranes (PROM) | - When the amniotic sac breaks before labor begins at or after 37 weeks. - If the rupture occurs at or after 37 weeks of gestation (to term), the risk of infection and fetal distress is lower, and labor may be induced or allowed to progress naturally. |
| Preterm Premature Rupture of Membranes (PPROM) | - When PROM occurs before 37 weeks of pregnancy - most common identifiable cause of preterm delivery |
| Preterm Premature Rupture of Membranes (PPROM) | If the rupture occurs before 37 weeks of gestation like in PPROM, further evaluation and management are needed to determine the best course of action, which may include expectant management, antibiotics, or delivery. |
| Artificial Rupture of Membranes (AROM) or Amniotomy | ROM using an Amnihook (Cervix MUST be Dilated) |
| Assessment of Rupture of Membranes (ROM): COAT | COAT: Color, Odor, Amount, Time of Rupture. |
| Assessment of Rupture of Membranes (ROM): COAT | Color: color of fluid (e.g., clear, straw-colored, thick greenish, bloody, etc.). - Odor: should not have an odor; if it does, describe the odor. - Amount: how much was seen (e.g., wet panties, a puddle, etc.). |
| Assessment of Rupture of Membranes (ROM): COAT | - Time: what time and day did the mother notice ROM (this is important to determine how many hours have passed before the 24-hour mark after ROM; time will affect the plan of care for her labor and delivery). |
| Assessment of Rupture of Membranes (ROM) | - Sterile Speculum Exam: direct observation of fluid coming out of the cervical os (opening of the cervix) - Nitrazine Test: pH test to determine alkalinity of amniotic fluid - Goal pH: 7.0-7.4 (normal vaginal secretions pH 3.8-4) |
| Assessment of Rupture of Membranes (ROM) | - Ferning Test: A microscopic examination of dried fluid to observe the characteristic fern-like pattern of amniotic fluid. |
| Assessment of Rupture of Membranes (ROM) | - Fetal Fibronectin Test: assessment of vaginal fluid to assess for fetal fibronectin in amniotic fluid; it determines the risk of onset of preterm delivery within 4 days |
| Assessment of Rupture of Membranes (ROM) | - Fetal fibronectin is a protein made during pregnancy. It's found between the lining of your uterus and the amniotic sac that's protecting your baby. Fetal fibronectin works as a glue to hold the amniotic sac to the uterine lining. |
| Assessment of Rupture of Membranes (ROM): Advanced Diagnostic Tests | - Amniotic Fluid Index (AFI): Ultrasound assessment of the amniotic fluid volume to determine if it's normal or reduced. - Placental Alpha Microglobulin-1 (PAMG-1) Test: A specific test for PAMG-1, a protein marker of amniotic fluid |
| Assessment of Rupture of Membranes (ROM): Advanced Diagnostic Tests | - Amnisure Test: A rapid, point-of-care test that detects placental alpha microglobulin-1 (PAMG-1), a protein marker of amniotic fluid. |
| Rupture of Membranes (ROM) Associated Risks | PROM - Risk for infection - Cord prolapse - Cord compression - Variable deceleration - Placental abruption - Chorioamnionitis |
| Rupture of Membranes (ROM) Associated Risks | PPROM - Infection - Prolapse - Fetal malpresentation - Precipitous labor |
| Rupture of Membranes (ROM) Causes | PROM - Spontaneous or Mechanical ROM PPROM - Must not have any causative risk factors - Previous PPROM - Infections of the genital tract - Vaginal bleeding during pregnancy - Smoking |
| Rupture of Membranes (ROM) Management | PROM - Deliver |
| Rupture of Membranes (ROM) Management | PPROM - Give antibiotics if there is an infectious process that caused PPROM - Monitor mom for infection, uterine contractions |
| Rupture of Membranes (ROM) Management | PPROM - If labor does not occur within 48 hours discharge home with instructions about when to come back in (Handled on a case-by-case basis) |
| Rupture of Membranes (ROM) Management | PPROM - Give corticosteroids to promote fetal lung maturity in gestation under 34 weeks. - Tocolytics to delay labor - give full course of steroids over 48 hours |
| Fetal Monitoring Characteristics | - A baseline heart rate is assessed over 2 minutes in a 10-minute period and is normally between 110 and 160 bpm. - Variability is the irregular fluctuations in the baseline fetal heart rate. |
| Fetal Monitoring Characteristics | - Moderate variability has an amplitude of 6 to 25 bpm and is assessed over a 10-minute period. - Accelerations are an increase in baseline of at least 15 beats and lasting at least 15 seconds in a term fetus. |
| Fetal Monitoring Characteristics | - Decelerations are decreases in the fetal heart rate from baseline. |
| Fetal Monitoring Characteristics: VEAL CHOP | VEAL = CHOP Variable decelerations Early decelerations Accelerations Late decelerations Cord compression Head compression Okay/O2 sufficient Placental insufficiency |
| VEAL CHOP Management (MINE) | Maternal repositioning Identify labor progress No interventions Execute interventions |
| VEAL CHOP Management LIONS mnemonic order | Left lying position IV fluids Oxygen (8-10L by nonrebreather mask)/Discontinue Oxytocin Notify HCP Surgery Prep (C-section) |
| Variable Decelerations = Cord Compression | From umbilical cord compression (V shape on monitoring) - Unrelated pattern of FHR & contractions - Pattern may be U or V or W shaped - Transitory acceleration precedes or follows the decel - FHR may ↓ to less than 100 bpm; then return to baseline |
| What Can Cause Cord Compression | Slowing of FHR w/ a contraction or in-between one (contraction) - Fetus wrapped in cord/rolling on cord, pulling on cord = decreased circulation to baby |
| Variable Decelerations = Cord Compression: Nursing Interventions (in order) 1 | - Maternal position change (knee-to-chest, trendelenburg, semi-fowlers) *DO THIS FIRST* - Discontinuing oxytocin infusion. - Administering oxygen 8 to 10 L by non-rebreather mask (Never by NC) - Notifying the provider (MD/CNM) |
| Variable Decelerations = Cord Compression: Nursing Interventions (in order) 2 | - Assist with vaginal or speculum exam to assess for cord prolapse. - Assist with Amnioinfusion if ordered. - Assisting with birth if the pattern is not corrected (vaginal or C/S if not corrected) |
| Early Decelerations = Head Compression | Benign changes caused by head compression during uterine contractions. - Can stimulate the vagus nerve (when pressure is bending the fetus’ neck during uterine contraction), causing a temporary slowing of the FHR |
| Early Decelerations = Head Compression | Clinical Significance: Normal Pattern; not associated with fetal hypoxemia or low APGAR scores Fetal Monitoring: "Bowel shaped", mirrors the contraction |
| Early Decelerations = Head Compression: Nursing Interventions | *None except PREPARE for delivery and document* - Vaginal exam (assess the degree of fetal head descent & labor progression) - Encourage mom to push if 10cm dilated, 100% effaced |
| Early Decelerations = Head Compression: Nursing Interventions | - Fundal pressure (can mimic head compression or exacerbate early decelerations) - Placement of internal mode of monitoring (can provide a more accurate read of the FHR; requires rupture membranes and cervical dilation; i.e. fetal scalp electrodes) |
| Early Decelerations = Head Compression: Nursing Interventions | - Descent of the fetal presenting part (seen during the vaginal exam; directly related to the likelihood of experiencing early decelerations as the head engages in the pelvis) |
| Accelerations = O2 Sufficient/Okay | Normal pattern and signifies fetal well-being. Can be periodic or episodic. “Okay” Presence is highly predictive of acid-base balance (ie. Absence of fetal metabolic acidemia) |
| Accelerations = O2 Sufficient/Okay: Causes | - Spontaneous fetal movement - Vaginal exam - Electrode application - Fetal scalp stimulation - Fetal reaction to external sounds - Breech presentation |
| Accelerations = O2 Sufficient/Okay: Causes | - Occiput posterior presentation - Uterine contraction - Fundal pressure - Abdominal palpation. |
| Accelerations = O2 Sufficient/Okay: Nursing Interventions | none is needed, just documentation |
| Late Decelerations = Placental Insufficiency | Caused by uteroplacental insufficiency. - Placental Abruption - Mom Using Drugs - Trauma (Ex. MVA) - Injury to Placenta |
| Late Decelerations = Placental Insufficiency | An abnormal pattern is closely associated with fetal hypoxemia, low APGAR scores, and fetal academia, an ominous sign especially if associated with fetal tachycardia and loss of variability. |
| Late Decelerations = Placental Insufficiency: Nursing interventions | - Maternal position change to lateral. *DO THIS FIRST* - Correcting maternal hypotension by elevating legs. (trendelenburg) - Increasing IV rate of maintenance IV solution. - Palpating the uterus to assess for tachysystole (excessive use of pitocin) |
| Late Decelerations = Placental Insufficiency: Nursing interventions | - Discontinuing oxytocin if infusing. - Oxygen is administered at 8-10 L/min using a non-rebreather mask. - Never give NC - Notifying the provider (MD/CNM) |
| Late Decelerations = Placental Insufficiency: Nursing interventions | - Internal monitoring is considered for a more accurate fetal and uterine assessment. - Assisting with birth if the pattern is not corrected (vaginal or C/S if not corrected) |
| Sinusoidal Pattern | Sinusoidal Pattern: associated with fetal anemia reflecting the fetus’ attempt to compensate for reduced O2 carrying capacity of its blood |
| Pain Relief in Labor | Pain is what the patient says it is. Many factors play a role in pain tolerance, including fear, previous experience with labor pain, support system, and fatigue. |
| Manifestations of pain in Labor | pain in the abdomen, lower back, or thighs with contractions. Continuous pain in the lower back may occur if the fetus is in an occiput-posterior position. Continuous abdominal pain may indicate a placental abruption. |
| Pain Relief in Labor: Non-pharmacological management | - Focused breathing. - Hypnotherapy. - Position changes. - Cutaneous stimulation. - Aromatherapy. - Music. - Sacral counter pressure. |
| Pain Relief in Labor: Non-pharmacological management | - Document patients comfort level before, during and after assisting with comfort measures & education done - Dimming lights and reducing noise. - Verbal encouragement. |
| Pain Relief in Labor (Pharmacological): Rule of Thumb | - Use the smallest dose possible to achieve the anticipated effect - It has been shown that control of administration by the woman leads to increased satisfaction & lower amounts of meds used. |
| Pain Relief in Labor (Pharmacological): Rule of Thumb | - Some are excreted in breast milk - What happens to the mom happens to the fetus - ALL meds cross the placental border and can affect the fetus |
| Pain Relief in Labor (Pharmacological): Opioids | Opioids: Considerations for use patient selection is important, Dosing and administration can be challenging, and Long-term use can lead to dependence |
| Pain Relief in Labor (Pharmacological): Opioids | Morphine 2–5 mg IV; May be given IV or epidurally - Rapidly crosses the placenta, causes a decrease in FHR variability - Can cause maternal and neonatal CNS depression - Decreases uterine contractions |
| Pain Relief in Labor (Pharmacological): Opioids | Meperidine (Demerol) 25–75 mg IV; May be given IV, intrathecally, or epidurally - Maximal fetal uptake 2–3 hr after administration - Can cause CNS depression - Decreased fetal variability |
| Pain Relief in Labor (Pharmacological): Opioids | Fentanyl (Sublimaze) 50–100 mcg IV; Is given IV or epidurally - Can cause maternal hypotension, maternal and fetal respiratory depression - Rapidly crosses placenta |
| Pain Relief in Labor (Pharmacological): Mixed Opioid Agonist/Antagonist | Mixed Opioid Agonist/Antagonist: - Should not be used in patients who are dependent on opioids because may cause withdrawal. - Less risk of respiratory depression than opioids. |
| Pain Relief in Labor (Pharmacological): Mixed Opioid Agonist/Antagonist | Butorphanol (Stadol) 1–2 mg IV q2-4 hrs - Is rapidly transferred across the placenta - Causes neonatal respiratory depression |
| Pain Relief in Labor (Pharmacological): Mixed Opioid Agonist/Antagonist | Nalbuphine (Nubain) 10–20 mg IV - Causes less maternal nausea and vomiting - Causes decreased FHR variability, fetal bradycardia, and respiratory depression |
| Pain Relief in Labor (Pharmacological): Nitrous Oxide | - Self-administered before the start of contractions - Side effects include nausea and vomiting, dizziness, and dysphoria - No FHR abnormalities have been attributed to its use. |
| Pain Relief in Labor (Pharmacological): Antiemetics | Hydroxyzine (Vistaril) 50–100 mg IM. - Does not relieve pain but reduces anxiety and potentiates opioid analgesic effects; cannot be given IV. - Is used to decrease nausea and vomiting |
| Pain Relief in Labor (Pharmacological): Antiemetics | Promethazine (Phenergan) 25–50 mg IV or IM. - Is used for antiemetic effects when combined with opioids. - Causes sedation and reduces apprehension. - May contribute to maternal hypotension and neonatal depression |
| Pain Relief in Labor (Pharmacological): Antiemetics | Prochlorperazine (Compazine) 5–10 mg IV or IM. - Frequently given with morphine sulfate for sleep during the prolonged latent phase; counteracts the nausea that opioids can produce |
| Pain Relief in Labor (Pharmacological): Benzodiazepines | Benzodiazepines are used for minor tranquilizing and sedative effects. Midazolam (Versed) 1–5 mg IV - Is not used for analgesia but amnesia effect - Is used as an adjunct for anesthesia - Is excreted in breast milk |
| Pain Relief in Labor (Pharmacological): Benzodiazepines | Diazepam (Valium) 2–5 mg IV - Is given to enhance the pain relief of opioids and cause sedation - May be used to stop eclamptic seizures - Decreases nausea and vomiting - Can cause newborn depression; therefore, the lowest possible dose should be used |
| Pain Relief in Labor (Pharmacological): Regional Anesthesia | - Provides pain relief without loss of consciousness. - It involves the use of local anesthetic agents, with or without added opioids, to bring about pain relief or numbness through the drug’s effects on the spinal cord and nerve roots. |
| Pain Relief in Labor (Pharmacological): Regional Anesthesia | - The routes for regional pain relief include Epidural Block, CSE, Local Infiltration, Pudendal Block, and Intrathecal (Spinal) Analgesia/Anesthesia. - General anesthesia is generally only used for emergency delivery. |
| Pain Relief in Labor (Pharmacological): Regional Anesthesia | - Partial or complete loss of pain sensation below the T8 to T10 level of the spinal cord. |
| Pain Relief in Labor (Pharmacological): Regional Anesthesia | Epidural - A type of regional anesthesia used to numb an area of the body, often the lower half, to relieve pain |
| Pain Relief in Labor (Pharmacological): Regional Anesthesia | - Epidural Complications: N/V, Hypotension, Fever, Pruritis, Maternal Fever, Allergic Reaction, Respiratory Depression, etc. |
| Pain Relief in Labor (Pharmacological): Regional Anesthesia | -Epidural C/I: Hx Spinal Surgery/Abnormalities, Coagulation Defects, Cardiac Disease, Obesity, Infections, Hypovolemia, Patients using Anticoagulation Therapy |
| Pain Relief in Labor (Pharmacological): Regional Anesthesia | Combined Spinal Epidural Block (CSE) - Could be PCEA (Patient Controlled Epidural Analgesia) - Complications: Maternal Hypotension, Post-Dural Puncture Headache, Inadequate or Failed Block, Maternal Fever, Pruritis, etc. |
| Pain Relief in Labor (Pharmacological): Regional Anesthesia | Combined Spinal Epidural Block (CSE) - Maternal Motor Function Remains Active (can bear down during second stage of labor, reflexes are not lost) - Rapid Onset of Pain Relief (3-5 minutes, lasts up to 3 hours) |
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