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Pain Control In Labor & Delivery

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Kathleen Ward

on 30 June 2016

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Transcript of Pain Control In Labor & Delivery

Pain Management
During
Labor & Delivery

Maternal
Nonpharmacological
Gate Control Theory
Fetal
FHR 110 – 160
Reactive NST
Accelerations are present with fetal movement
Short term variability present
Long-term variability is average
NO periodic late decelerations or non-periodic decelerations
VS are stable
No Contraindications
Women is willing
Labor Assessment
Contraction pattern
Cervical dilatation
Fetal presenting part
Station of the presenting fetal part
Childbirth Education
Classes
Support Person
Cutaneous Stimulation
(effleurage)
Other Alternatives
TENS
Morphine
Demerol ~ Meperidine
Stadol ~ Butorphanol Tartrate
Nubain ~ Nalbuphine
Sublimaze ~ Fentanyl
Promethazine ~ Phenergan
Hydroxyzine ~ Vistaril
Naloxone ~ Narcan
Pharmacological Management
of Labor
Oral Route~
not used due to poorly absorbed and gastric emptying time prolonged during labor

IV Route
~preferred due to prompt, smooth and more predictable action with a smaller dose.

IM
~ Best that IM medication be given with the onset of a UC, when the blood flow to the uterus and the fetus is normally decreased (Wylie, 2005)
Avoid administering when delivery is anticipated within 2-3 hours

SQ –
routes also available
Analgesic Routes
In order of potency
Stadol
potency 7x MS; 30-40x Demerol

Dose 1-2 mg


Morphine

Morphine 2.5-15 mg/kg in 4-5 ml sterile water over 4-5 min


Nubain
Not > 20

mg

Demerol

Demerol infusion 1 mg/ml or mg/ml slow injection; 1/10 potency of MS 15-35 mg/hr infusion
SYSTEMIC PAIN RELIEF
Narcotic Side Effects for Mom

Nausea/ vomiting
Dizziness/ altered sensorium
Orthostatic hypotension
Delayed stomach emptying

IM or IV Injections
PCA
Better pain relief
Lower total dose than IM
Narcotic antagonists to
counteract side effects
in mom/baby
Narcan
Nubain (reverse itching and nausea
Blood Patch
Distribution of Pain
Late Second Stage of Labor
First Stage of Labor
Early Second Stage of Labor
Interdermal
Injections
Intradermal injections of 0.1 ml of sterile water
in the treatment of women with back pain
during labor. Sterile water is injected into
four locations on the lower back, two over
each posterior superior iliac spine (PSIS)
and two 3 cm below and 1 cm
medial to the PSIS.
Spinal/Epidural
Epidural

Obtain Baseline info of Mom and Baby
Record Information on FMS and chart
Informed Consent
Preload IV Fluids (dextrose free)
Position mom for procedure

1. Position in a semi-reclining position with lateral tilt
2. Than side lying position - alternate sides
3. Monitor B/P and pulse every 5 minutes for at least 30 min.
4. Then every 30 minutes thereafter
5. Monitor FHT continuously with EFM
6. Interventions for side effects
Pharmacologic Nerve
Block Pathway

Suitable during second and third stages
of labor and for repair of
episiotomy or lacerations.
Use of needle guide (Iowa trumpet) &
Luer-Lok syringe to inject medication.
Nursing Actions
Thermal stimulation/
Hydrotherapy
Post Procedure
IV Narcotic Administration
Administer during a contraction
Avoid administering when delivery is anticipated within 2-3 hours
Nursing Management Prior to Epidural Placement
Kathleen Ward, MSN, RN
Associate Professor of Nursing

Doula
Transcutaneous nerve stimulation (TENS) emits low-voltage electrical impulses that very in frequency and intensity. Believed to block nerve pathways. Cochrane research identified a little difference in pain control, but inconsistent.
Ho-Ku Acupressure Point
Full transcript