Pain management
- Breathing techniques, position changes, guided imagery, massage
- Nitrous oxide- allows pt to be more relaxed
- Doesnt cross placenta and gets out of system as soon as take a breath of room
air
- IV pain management- once every 2-4 hrs, does cross placenta and affect baby
- Teach to time out carefully- don’t give close to delivery
- If delivery progresses too fast, you can give narcan to baby or to mom right
before delivery
- Contractions feel shorter, but still feel pain at peak of contraction
- Epidural
- Teach: anesthesia comes in and gets consent, on a pump, does not cross
placenta, nreve block for pain
- Still feels ferguson’s reflex - pressure in vagina and have urge to push
- Lose feeling- can’t get up in bed
- Make sure pt stays in bed- foley usually inserted
- PCA pump given so pt can give themselves a bolus
- Numbs abdomen
- Pudendal block
- Good for a pts that progressed in labor and its too late to give epidural
- Only for 10 cm and pushing and is not tolerating well
- Numbs perineal
Labor- strong painful contractions WITH CERVICAL CHANGE
Inductions- cervix must be ripe FIRST before you start adding contractions
- Manual/mechanical dilation with cervical balloon- inflates balloon to 60-80cc- insert
catheter into cervix and inflate
- Acts as baby’s head-puts pressure on cervix
- Check q 4 hrs - pull on balloon
- Balloon usually slips out when about 4 cm- theeeennn we can start pitocin
- Cytotec- PO, PV- low doses to irritate and ripen the crevix
- Harder to manage if baby doesn’t tolerate bc the pill is alr ini body- cannot be
taken out
- Cervidil- med on a string thru vagina and sits on cervix and releases protiglandins to
help ripen cervix
- Stays in for 12 hrs
- If baby doesn’t tolerate, can always take the string out
Bishop score- the higher the score, the more favorable the cervix for vag delivery
- Initial vag exam
- How far along they are dilated, effacement of cervix, baby’s station in cervix
- Higher the score, less we have to do to induce her
Pitocin management
- My job as nurse to manage pit
- Makes contractions stronger and closer together and more frequently
, - Make sure things are done safely and not in the expense of putting the baby in distress
- If baby is not tolerated- stop pit or turn down
Therapeutic Communication with fetal loss- encourage them to talk about it when they are
ready, encourage them to talk about it with family members and siblings at home
Rupture of membranes at home (ROM)- ask COAT- color, odor, amount, time
- Should be clear and odorless
- If green or really dark- bby passed first meconium- notify NICU to make sure that
everything is ready in case any suctioning needs to be done
- amount - it can be a slow trickle or a lot
- Time is important to prevent infx
Betamethasone- steroid given to moms if we think the baby will deliver early
- Used for PROM -premature rupture of membranes
- Used for fetal lung maturity
- Given in 2 doses 24 hrs apart- most beneficial if delivery 48 hrs after first dose
- Not beneficial to give if there is an infx or sepsis— at this point you want to deliver and
deal with the immature lungs bc baby will be more sick if you wait
Emergency situations-
- Cord prolapse- cord comes out before baby’s head is delivered-TRUE EMERGENCY
- Go to operating room and deliver baby NOW via C/S not vaginally
- Called rodeo delivery bc fingers need to be in vag and holding head while going
to the operating room- keep hand there until feel baby leave abdomen during C/S
- Risk: Polyhydramnios, Amniotomy (AROM), or if baby’s head is not engaged
- Uterine Rupture-
- More at risk if you have a previous uterine scar- previous C/S
- Uterine incision can rupture again
- S/S: loss of fetal station (baby is just floating around in mom’s abdomen- very
very painful), immediate stop of contractions bc uterus is no longer intact, sever
abd. pain
- Run to OR and get baby out via C/S
- Abnormal placental placement-
- Placenta Previa- placenta attached over cervix- implanted really low in uterus
- Seen early in pregnancy
- Complaints of bright red vag bleeding
- **bright red vaginal painless bleeding**
- Cannot delivery vaginally- must be C/S* - massive hemorrhage for mom
and baby
- Pelvic rest for entire pregnancy- no sex, no vaginal exams
- Long stressful pregnancy bc it is normal to bleed throughout pregnancy
- Abnormal placental attachment
- Placental abruption - premature detachement from uterine wall
- Risk factor: HTN, trauma, MVA,
- S/S: very rigid, firm abdomen, very painful, occult bleeding (blood gettting pulled
and trapped behind placenta)
- Breathing techniques, position changes, guided imagery, massage
- Nitrous oxide- allows pt to be more relaxed
- Doesnt cross placenta and gets out of system as soon as take a breath of room
air
- IV pain management- once every 2-4 hrs, does cross placenta and affect baby
- Teach to time out carefully- don’t give close to delivery
- If delivery progresses too fast, you can give narcan to baby or to mom right
before delivery
- Contractions feel shorter, but still feel pain at peak of contraction
- Epidural
- Teach: anesthesia comes in and gets consent, on a pump, does not cross
placenta, nreve block for pain
- Still feels ferguson’s reflex - pressure in vagina and have urge to push
- Lose feeling- can’t get up in bed
- Make sure pt stays in bed- foley usually inserted
- PCA pump given so pt can give themselves a bolus
- Numbs abdomen
- Pudendal block
- Good for a pts that progressed in labor and its too late to give epidural
- Only for 10 cm and pushing and is not tolerating well
- Numbs perineal
Labor- strong painful contractions WITH CERVICAL CHANGE
Inductions- cervix must be ripe FIRST before you start adding contractions
- Manual/mechanical dilation with cervical balloon- inflates balloon to 60-80cc- insert
catheter into cervix and inflate
- Acts as baby’s head-puts pressure on cervix
- Check q 4 hrs - pull on balloon
- Balloon usually slips out when about 4 cm- theeeennn we can start pitocin
- Cytotec- PO, PV- low doses to irritate and ripen the crevix
- Harder to manage if baby doesn’t tolerate bc the pill is alr ini body- cannot be
taken out
- Cervidil- med on a string thru vagina and sits on cervix and releases protiglandins to
help ripen cervix
- Stays in for 12 hrs
- If baby doesn’t tolerate, can always take the string out
Bishop score- the higher the score, the more favorable the cervix for vag delivery
- Initial vag exam
- How far along they are dilated, effacement of cervix, baby’s station in cervix
- Higher the score, less we have to do to induce her
Pitocin management
- My job as nurse to manage pit
- Makes contractions stronger and closer together and more frequently
, - Make sure things are done safely and not in the expense of putting the baby in distress
- If baby is not tolerated- stop pit or turn down
Therapeutic Communication with fetal loss- encourage them to talk about it when they are
ready, encourage them to talk about it with family members and siblings at home
Rupture of membranes at home (ROM)- ask COAT- color, odor, amount, time
- Should be clear and odorless
- If green or really dark- bby passed first meconium- notify NICU to make sure that
everything is ready in case any suctioning needs to be done
- amount - it can be a slow trickle or a lot
- Time is important to prevent infx
Betamethasone- steroid given to moms if we think the baby will deliver early
- Used for PROM -premature rupture of membranes
- Used for fetal lung maturity
- Given in 2 doses 24 hrs apart- most beneficial if delivery 48 hrs after first dose
- Not beneficial to give if there is an infx or sepsis— at this point you want to deliver and
deal with the immature lungs bc baby will be more sick if you wait
Emergency situations-
- Cord prolapse- cord comes out before baby’s head is delivered-TRUE EMERGENCY
- Go to operating room and deliver baby NOW via C/S not vaginally
- Called rodeo delivery bc fingers need to be in vag and holding head while going
to the operating room- keep hand there until feel baby leave abdomen during C/S
- Risk: Polyhydramnios, Amniotomy (AROM), or if baby’s head is not engaged
- Uterine Rupture-
- More at risk if you have a previous uterine scar- previous C/S
- Uterine incision can rupture again
- S/S: loss of fetal station (baby is just floating around in mom’s abdomen- very
very painful), immediate stop of contractions bc uterus is no longer intact, sever
abd. pain
- Run to OR and get baby out via C/S
- Abnormal placental placement-
- Placenta Previa- placenta attached over cervix- implanted really low in uterus
- Seen early in pregnancy
- Complaints of bright red vag bleeding
- **bright red vaginal painless bleeding**
- Cannot delivery vaginally- must be C/S* - massive hemorrhage for mom
and baby
- Pelvic rest for entire pregnancy- no sex, no vaginal exams
- Long stressful pregnancy bc it is normal to bleed throughout pregnancy
- Abnormal placental attachment
- Placental abruption - premature detachement from uterine wall
- Risk factor: HTN, trauma, MVA,
- S/S: very rigid, firm abdomen, very painful, occult bleeding (blood gettting pulled
and trapped behind placenta)
