Comfort and Labour Support

Question 1

5 effects of RN as labour support

Answer 1

1. increased likelihood of spontaneous birth
2. decreased analgesia use
3. decreased c-section, forceps, vacuum
4. decreased incidence of 5 min APGAR
5. increased satisfaction with experience

Question 2

Doula

Answer 2

Not licensed; someone who provides emotional support and comfort measures during labour and delivery

Question 3

Registered Midwives

Answer 3

Licensed professionals; work as specialists in normal birth and have privileges to do deliveries in the hospital or, if appropriate, in the comfort of the client’s own home

Question 4

5 categories of labour support

Answer 4

1. physical
2. emotional
3. instructional
4. advocacy
5. partner/coach care

Question 5

Pain vs Suffering

Answer 5

Pain: a physical sensation

Suffering: an emotional sensation

Question 6

The Three R’s

Answer 6

Successful laboring women have these 3 characteristics in common to cope well:
1. Relaxation between contractions

2. Rhythm that helps them cope
3. Ritual that can be included while going through the rhythm

Question 7

Mental Activity Comfort Measures

Answer 7

distraction, meditation, non-focussed awareness, imagery, hypnosis

Question 8

Basic need comfort measures

Answer 8

hygiene, nutrition, hydration

Question 9

3 examples of massage techniques

Answer 9

1. double hip squeeze
2. criss cross
3. breaking the popsicle

Question 10

Why is hydrotherapy beneficial during the active stage of labour

Answer 10

Warmth and buoyancy supports uterus
1. reduced surgical birth rates
2. shorter second stage
3. reduced analgesic
4. lower perineal trauma

Question 11

What position compared to recumbent reduced the duration of labour, risk of c section, less need of epidural, and less chance of NICU?

Answer 11

Walking and upright position

Question 12

What are the 4 benefits of the birthing ball?

Answer 12

1. increases balance
2. counter pressure on perineum
3. eases back pain
4. widens pelvic outlet

Question 13

What labour activities can occur if a patient has mobility limitations?

Answer 13

The rollover
Q30 min

Question 14

What are sterile water injections

Answer 14

Pain reduction; 0.1ml of sterile water intradermally in 4 locations lasting 4 hours

Question 15

What is a consideration of systemic drugs used in pain relief for labour?

Answer 15

Cross placental barrier by simple diffusion

Question 16

The ideal labor analgesic is

Answer 16

1. safe for client and baby
2. rapid
3. ease of admin
4. maternal sense of control
5. minimal side effects
6. no effect on ambulation, voiding, progress
7. effective for all stages

Question 17

What are the 2 parenteral opioids used for labour pain?

Answer 17

Morphine and Fentanyl

Question 18

Describe the use of fentanyl vs morphine in labour pain

Answer 18

Morphine: earlier on/if labour is progressing slower (nulliparous) because of longer onset and half life

Fentanyl: given later on/if labour is progressing faster (multipiarous) because shorter onset/half-life

Question 19

Why is demerol out of favour for pain relief?

Answer 19

Stays in fetal circulation for up to 90 hours

Question 20

What synergistic medications are necessary to have ordered when using opioid pain relief?

Answer 20

anti-emetics r/t nauseating effects of opioids

Narcan for fetal respiratory depression

Question 21

What are the advantages of nitrous oxide for pain relief?

Answer 21

(inhaled analgesic)

• rapid effect with patient awake
• no effect on contractions
• minimal neonatal depression
• self adminstaration

Question 22

Disadvantages of nitrous oxide as pain relief

Answer 22

• decreased effectiveness with prolonged use (only used in later stages of active labour/second stage)
• major risk of general anesthesia if not self administered
• only breath in during contractions; room air when not

Question 23

Advantages of epidural (4)

Answer 23

1. not systemic
2. effective for all stages
3. increased sense of control
4. allow for ambulation, little effect on pushing, less interference with voiding

Question 24

Epidural side effects/complications (8)

Answer 24

1. hypotension
2. unanticipated spinal injection
3. bladder dysfunction/difficulty ambulating
4. inability to push
5. shivering
6. N/V
7. neuro complications
8. ineffective block

Question 25

Why is hypotension the most significant side effect of epidural?

Answer 25

Can cause fetal bradycardia

Question 26

Contraindications to epidural

Answer 26

§ Patient refusal § Significant bleeding or coagulopathy § Systemic sepsis § Spinal injury / conditions affecting lower spine (relative) § Sensitivity to local anesthetics § Unavailable personnel / equipment

Question 27

Define epidural

Answer 27

Anesthetic and/or analgesic injected into epidural space L4-L5 to produce little/no feeling from T4-T10 Usually continuous infusion

Question 28

Nursing care for epidurals

Answer 28

1. baseline vitals and FHR then q5min x 20 after insertion 2. IV access with 500-1000ml bolus for hypotension 3. attend to client position 4. Dermatomes 30-60min (t4-T10) 5. Motor function/bromage score q1h 6. attention to bladder function

Question 29

What is a spinal block, advantages, and usual use?

Answer 29

Lock analgesia into spinal canal for quick onset and longer duration Administered higher for c section and lower for vaginal birth

Question 30

What is a pudendal block>

Answer 30

Local anesthetic injected into pudendal nerve in vagina near the end of labour and has no effect on fetus/progress of labour

Question 31

What is local infiltration?

Answer 31

Lidocaine injected into perineum for relief for episiotomy incision or laceratin repair No effect on client or fetus

Question 32

4 Major Complications of Pain Relief in Labour

Answer 32

1. fetal depression 2. uterine relaxation 3. vomiting/aspiration 4. difficult/failed intubation