Chapter 17

Question 1

Pain is what?

Answer 1

A highly individualized phenomena with sensory and emotional components

Question 2

There two types of pain what are the names?

Answer 2

Somatic
Visceral

Question 3

What is somatic pain?

Answer 3

Comes from the skin, muscles and soft tissue

Question 4

What’s visceral pain?

Answer 4

Comes from the internal organs

Question 5

What does visceral pain mean in labor and deliver terms?

What about in visceral labor pain occur?

Answer 5

It’s vague, not localized
It often feels like a deep sqeeuze, pressure or aching

( contraction pain!!)

During the early first stage and second stage of childbirth, this pressure allows the cervix to dilate

Question 6

What does somatic pain mean in labor and delivery and when does it occur?

Answer 6

Shape pain in the vagina, rectum and premium

Closer to delivery

Question 7

Can we control visceral pain?
And how?

Answer 7

Yes
Giving medications like epideral

Question 8

Why is somatic pain harder to aid the pain?

Answer 8

The pressure feeling, we kinda want you to have it so you can push

Question 9

What are some factors that influence pain?

Answer 9

Physiologic factors ( tolerance )

Culture
Anxiety
Previous experience
Gate control theory of pain
Comfort
Support
Environment

Question 10

What is the gate control theory ?

How does it affect labor?

Answer 10

Pain goes up to your spinal cord and delivers it to the brain

We block the gate by epidural so we don’t feel the pain or like distraction

Question 11

What type of breathing technique do we recommend patients?

Answer 11

Lamas breathing!!

Question 12

What are some nonoharmacologic pain management?

Answer 12

Acupressure
Water therapy
Aromatherapy
Music
Hypnosis
Relaxing and breathing techniques
Touch and massage

Question 13

Why do you want to practice breathing techniques before going into the labor?

Answer 13

Cause it’s hard to just teach you in the moment

Question 14

What is effleurage and counter pressure??

Answer 14

Circle massage & counter pressure onto the back to help

Question 15

Notes
It is unacceptable for woman in labor to endure severe pain when safe and effective relied measures are available !!

Question 16

What does sedatives pharmacological medications mean?

Usually given when?

Answer 16

Relieve anxiety and induce sleep

Prolonged early phase of labor when we need mom to sleep in order to get strength back

Question 17

What are some examples of sedatives?

Answer 17

Barbiturates
Phenothiazines
Benzodiazepines

Question 18

What is anesthesia?

Answer 18

Encompasses analgesia, amnesia relaxation and reflex actvity

( overall term )

Question 19

What is analgesia?

Answer 19

The alleviation of the sensation of pain or easing of the threshold for pain perception without loss of consciousness

( epidural )

( we didn’t knock you out )

Question 20

The type of analgesic or anesthetic chosen is determined by what? (2)

Answer 20

Stage of labor of the women and by the method of birth plan

Question 21

What is systemic analgesia?

Answer 21

Opioids readily cross the placenta ; effects on the fetus and newborn can be profound there analgesic effect in labor is limited

Opioids!!!

Question 22

It’s super important to know that if we are going to get systemic analgesia, like opioids, what do we need to know about the baby?

How does this affect labor?

Answer 22

It’s also gonna get it cause it crosses the placenta

So if it’s gonna make mom relax, it’s also gonna make baby relax and not wanna be pushed out

Question 23

So since opioids can cross the placenta, when can you give and not give?

Answer 23

Early stage ( contraction pain )

Not later stage ( like actual pushing labor )

Question 24

We want to be careful with opioids so we want to have what on hand?

Answer 24

Narcan at bed side!!

Question 25

What is nerve block analgesia and anesthesia?

Example of this is?

Answer 25

Used to produce sensory blockage and various degrees of motor block age over a specific region of the body

Epidural

Question 26

We have to be very careful with epidural, it can give her a spinal headache so what do we give?

But when do you give this ___or when can you give it to her?

Answer 26

Blood patch

After baby is born

Question 27

What’s the most common thing we use for labor?

What does it really do?

Why don’t we medicate the mom when they are feeling the pressure??

Answer 27

Epidural anesthesia or analgesia
Taking the visceral pain away
( when she gets ready to push, she’ll feel the pressure )

Because we want them to push!!

Question 28

What is a combined spinal epidural?

Answer 28

Walking epidural !!!

Like you can move compared to like a normal epidural which numbs your leg

Question 29

What is epidural or spinal opioids?

Answer 29

Just like the immediate relief into your spine of like FET.

Question 30

We want to be careful with opioids and epidurals because mom can go into?

Answer 30

A hypotensive state and that effects baby circulation and health

Question 31

So before giving an epidural and opioids, we give them a what?

If it still drops with this what do we do?

Answer 31

Bolus 500 cc of fluid up to 1000cc

Give them another Bolus

Question 32

Notes
Contraindications

Maternal hypotension
Maternal coagulopathy
Infection at the site
Increased intracranial pressure
Allergies to the anesthetic drug
Some types of maternal cardiac condition

Question 33

What do anesthesia do before giving epidural ?

And why do they do this?

Answer 33

They check there platelets counts

To see if they can clot because they will bleed a lot from the site

Question 34

Notes

Epidural block effects on newborn
- no evidence that is has a significant effect on the child’s later mental and neurologic development

Question 35

What is nitrous oxide for analgesia?

Answer 35

Breathing this in to help pain !!

(50% or less )

Question 36

Notes
General anesthesia
- rarely used
- the woman should be premeditated with clear oral antacid to neutralize the acidic contents of the stomach

Because the risk for neonatal necrosis

Question 37

Notes

Just asking pain scale
Assess and evaluate