NM 704 Mod 6 Exam 3 *MINE notes only
transcutaneous electric nerve stimulation (TENS) ✔✔- less likely to report severe
pain
- provides temporary relief
- best if started early in labor
touch & massage ✔✔- reduces pain intensity during 1st stage
- firm counter pressure on back is effective
- only effective if woman is comfortable with touch
application of heat ✔✔- can cx increased circulation to affected tissue -->
decreasing pain
application of cold ✔✔- has a numbing effect
contraindications for application of heat & cold ✔✔- epidural
- fever
- raynauds
- sickle cell
epidurals mode of action ✔✔- needle placed into epidural space --> area that
surrounds spinal cord & contains nerve roots
,- numbing med is then given thru catheter --> effectively blocking all nerves in
epidural space from site of insertion down --> no longer able to transmit sensory
or motor signals
- sensory & motor nerve blockage occurs --> cxing effective pain relief --> but also
impacts mobility
- individualized effectiveness
epidural benefits ✔✔- provide the most effective pain relief in labor
- generally considered safe
- adverse effects --> are rare
- woman generally more satisfied with experience with epidural pain relief than
with other types of meds
epidural contraindications ✔✔- woman's refusal/ unwillingness/ inability to
cooperate with placement
- infection at placement site
- blood clotting d/o
- sepsis
- hemodynamic instability
- heparin therapy, low platelet count, or spinal cord neurological disease
epidurals poss complications ✔✔- cx drop in maternal b/p --> d/t veins & arteries
dilating --> leading to decrease in blood flow to placenta --> resulting in drop of
, FHR --> usually resolves on own --> give IV bolus prior to epidural placement to
prevent hypotension in mom
- itching, n/v, fever, back pain, resp depression, longer pushing time
- spinal HA --> rare --> may occur if anesthesiologist puts needle in a little too far
- abscess or spinal cord injury --> very rare
epidural effect on progress of 2nd stage labor ✔✔- cxes longer stage
- ability for mom to feel the "ejection reflex" is inhibited
epidural effect on rates of oxytocin augmentation ✔✔- interferes with natural
release of hormone @ end of labor
- can cx decrease ability of uterus to contract efficiently --> leading to need for IV
med augmentation
epidural effects on operative vag births ✔✔- increased
- d/t inability to feel "ejection reflex" --> leading to episiotomy, forceps, vacuum
extraction
epidural effects on c/s rates ✔✔- no clear answer on impact --> some evidence
shows relationship while some does not
epidural effect on 1st stage length ✔✔- conflicting evidence --> some studies
report may increase length of this stage, while others show no correlation
transcutaneous electric nerve stimulation (TENS) ✔✔- less likely to report severe
pain
- provides temporary relief
- best if started early in labor
touch & massage ✔✔- reduces pain intensity during 1st stage
- firm counter pressure on back is effective
- only effective if woman is comfortable with touch
application of heat ✔✔- can cx increased circulation to affected tissue -->
decreasing pain
application of cold ✔✔- has a numbing effect
contraindications for application of heat & cold ✔✔- epidural
- fever
- raynauds
- sickle cell
epidurals mode of action ✔✔- needle placed into epidural space --> area that
surrounds spinal cord & contains nerve roots
,- numbing med is then given thru catheter --> effectively blocking all nerves in
epidural space from site of insertion down --> no longer able to transmit sensory
or motor signals
- sensory & motor nerve blockage occurs --> cxing effective pain relief --> but also
impacts mobility
- individualized effectiveness
epidural benefits ✔✔- provide the most effective pain relief in labor
- generally considered safe
- adverse effects --> are rare
- woman generally more satisfied with experience with epidural pain relief than
with other types of meds
epidural contraindications ✔✔- woman's refusal/ unwillingness/ inability to
cooperate with placement
- infection at placement site
- blood clotting d/o
- sepsis
- hemodynamic instability
- heparin therapy, low platelet count, or spinal cord neurological disease
epidurals poss complications ✔✔- cx drop in maternal b/p --> d/t veins & arteries
dilating --> leading to decrease in blood flow to placenta --> resulting in drop of
, FHR --> usually resolves on own --> give IV bolus prior to epidural placement to
prevent hypotension in mom
- itching, n/v, fever, back pain, resp depression, longer pushing time
- spinal HA --> rare --> may occur if anesthesiologist puts needle in a little too far
- abscess or spinal cord injury --> very rare
epidural effect on progress of 2nd stage labor ✔✔- cxes longer stage
- ability for mom to feel the "ejection reflex" is inhibited
epidural effect on rates of oxytocin augmentation ✔✔- interferes with natural
release of hormone @ end of labor
- can cx decrease ability of uterus to contract efficiently --> leading to need for IV
med augmentation
epidural effects on operative vag births ✔✔- increased
- d/t inability to feel "ejection reflex" --> leading to episiotomy, forceps, vacuum
extraction
epidural effects on c/s rates ✔✔- no clear answer on impact --> some evidence
shows relationship while some does not
epidural effect on 1st stage length ✔✔- conflicting evidence --> some studies
report may increase length of this stage, while others show no correlation
