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68wm6 p2 OB Discomfo

OB Discomfort

How does childbirth pain differ from other pain? *It is part of a normal body process. *Woman has several months to prepare for pain management. *Pain is self-limiting and rapidly declines after birth. *Pain of labor ends with the birth of a baby
What are the four sources of childbirth pain? *Dilation and stretching of the cervix and lower uterus. *Tissue ischemia *Pressure and pulling on pelvic structures *Stretching of the vagina and perineum
Where does tissue ischemia during childbirth originate? the blood supply to the uterus decreases during contractions which leads to tissue hypoxia and anaerobic metabolic
What are the effects of excessive catecholamines during childbirth? *Reduced blood flow to and from the placenta. *Reduced effectiveness of uterine contractions.  *Lessens the pleasure of this life event
What happens if the fetus occiput is posterior during childbirth? When the fetus is occiput posterior, each contraction pushes the fetus against the mother's sacrum resulting in persistent poorly relieved back pain (often referred to as back labor).
What are cutaneous stimulation techniques for pain management? *Self massage. *Massage by others. *Counterpressure. *Touch-by-holding. *Thermal stimulation
What are mental stimulation techniques for pain management? *Imagery *Focal point
What is first stage breathing? *Slow-Paced. *Modified-Paced. *Combined Slow and Modified Pace. *Patterned-Paced. *Breathing to prevent pushing
What is second stage breathing? *Goal is to assist mother to respond to urge *Lengthy pushing at this stage results in maternal fatigue *Open-glottis pushing or limited breath holding to under 8 seconds promotes the best fetal oxygenation
What can prolongued breath holding (greater than 8 sec) cause? recurrent increases in intrathoracic pressure with a resulting fall in cardiac output and blood pressure
When is pain medication ideally given? when labor is well established
During labor, what can limit the choices of analgesia or anesthesia? Complications during pregnancy
What popular block that provides analgesia and anesthesia for labor and birth without sedation of the woman and fetus? Epidural
What are three Epidural Block Contraindications? *Coagulation defects. *Uncorrected hypovolemia. *Infection in the area of insertion. *Severe systemic infection. *Allergy. *Fetal condition that demands immediate birth
What are the adverse effects of epidurals? *Maternal hypotension *Prolonged second stage of labor *Maternal fever *Delayed maternal respiratory depression *Nausea and vomiting *Catheter migration *Cesarean births
What analgesia involves opioids being injected into subarachnoid space? Intrathecal Opioid Analgesics and Subarachoid (Spinal) Block
What are the advantages of Intrathecal Opioid Analgesics? *Woman can feel her contractions without the pain *Rapid onset without sedation *No motor block *No sympathetic block
What are the disadvantages of Intrathecal Opioid Analgesics? *Limited duration. *Inadequate pain relief for late labor and birth
What may be combined with an epidural block for pain control? Intrathecal Opioids Analgesics
What are the adverse effects of Intrathecal Opioids? *Nausea, vomiting. *Pruritis. *Delayed maternal respiratory depression
What is the effect of a subarachnoid (spinal) block? Woman loses both sensory and motor function below the level of the block with relief of pain from contractions
What are the contraindications of Subarachoid (Spinal) Block? *Uncorrected hypovolemia. *Infection in the area of insertion. *Systemic Infection. *Allergy
What are the adverse effects of Subarachoid (Spinal) Blocks? *Maternal Hypotension. *Urinary Retention. *Spinal Headache (postdural puncture HA)
What is the Tx of a Subarachnoid (Spinal) Block? *Bedrest with IV hydration. *Caffeine. *Blood patch
What is a blood patch? blood (10-15cc) is withdrawn from a vein in the woman and injected into the epidural space in the area of the puncture
Who are narcotic antagonists most often given to following pregnancy? The newborn
Why is general anesthesia not preferred for childbirth, and who is it not recommended for? Produces loss of sensation & consciousness, uncomplicated vaginal birth
What are the adverse effects of general anesthesia? *Maternal aspiration. *Respiratory depression in both mother and fetus.  *Possible hemorrhage since general anesthesia yields uterine smooth muscle relaxation
Created by: Shanejqb