OB Discomfort
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| 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
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| 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
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| Where does tissue ischemia during childbirth originate? | the blood supply to the uterus decreases during contractions which leads to tissue hypoxia and anaerobic metabolic
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| 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
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| 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).
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| What are cutaneous stimulation techniques for pain management? | *Self massage. *Massage by others. *Counterpressure. *Touch-by-holding. *Thermal stimulation
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| What are mental stimulation techniques for pain management? | *Imagery *Focal point
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| What is first stage breathing? | *Slow-Paced. *Modified-Paced. *Combined Slow and Modified Pace. *Patterned-Paced. *Breathing to prevent pushing
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| 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
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| 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
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| When is pain medication ideally given? | when labor is well established
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| During labor, what can limit the choices of analgesia or anesthesia? | Complications during pregnancy
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| What popular block that provides analgesia and anesthesia for labor and birth without sedation of the woman and fetus? | Epidural
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| 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
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| 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
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| What analgesia involves opioids being injected into subarachnoid space? | Intrathecal Opioid Analgesics and Subarachoid (Spinal) Block
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| 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
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| What are the disadvantages of Intrathecal Opioid Analgesics? | *Limited duration. *Inadequate pain relief for late labor and birth
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| What may be combined with an epidural block for pain control? | Intrathecal Opioids Analgesics
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| What are the adverse effects of Intrathecal Opioids? | *Nausea, vomiting. *Pruritis. *Delayed maternal respiratory depression
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| 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
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| What are the contraindications of Subarachoid (Spinal) Block? | *Uncorrected hypovolemia. *Infection in the area of insertion. *Systemic Infection. *Allergy
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| What are the adverse effects of Subarachoid (Spinal) Blocks? | *Maternal Hypotension. *Urinary Retention. *Spinal Headache (postdural puncture HA)
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| What is the Tx of a Subarachnoid (Spinal) Block? | *Bedrest with IV hydration. *Caffeine. *Blood patch
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| 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
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| Who are narcotic antagonists most often given to following pregnancy? | The newborn
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| Why is general anesthesia not preferred for childbirth, and who is it not recommended for? | Produces loss of sensation & consciousness, uncomplicated vaginal birth
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| 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
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