 Passenger  Passageway  Powers  Position  Psychologic response

 What is the fetal presentation? › Cephalic (96%) › Breech (3%) › Shoulder (1%)

 We really do not know what causes the primary powers Contraction Frequency, Duration, and Intensity Result in Effacement and Dilatation

 V6hoPkIc

 Pain thresholds are similar in everyone, the perception of pain is not.  Pain is expressed  Sensory  Emotionally  Physiologically

 Pain experienced by mother can result in : › Acidosis of the fetus › Impaired Uterine Contraction

 Position changes › Walking › Rocking › Labor ball  Breathing › May need to breath with mother  Counter-pressure  Application of heat or cold  Showering/Tub  Music  Aromatherapy  Imagery  Focal points  Effleurage  Therapeutic touch  Childbirth Education  Hypnosis  Biofeedback  Empty Bladder regularly

Goal maximum relief with minimal risk to mother and fetus

 Epidural  Spinal/Epidural  Nerve Block  Local  Pudendal  Spinal  Epidural  Combined Spinal/Epidural(CSE)

 Systemic analgesia  IM vs IV  Narcotics Opioid agonist › Demerol, Fentanyl, Morphine  Opioid agonist-antagonist › Stadol, Nubain, Narcan  Epidural

 Opiate antagonist  Works immediately-may need to be repeated  Used to counteract respiratory depression- Neonatal dose available at every delivery  Adult dose: 0.4-2mg IVP  Neonatal dose: 0-1mg/kg of 0.4mg/ml concentration  Do not give to patient with narcotic dependency-triggers immediate withdrawal and possible seizures

MethodEffectsCriteriaCare Local- Lido /Polocaine used with epi Numbs perineum Episiotomy or repair of laceration Normal perineal care PuedendalNumbs lower vaginal/vulva/ perineal area Epis or vacuum delivery anticipated May need more direction in pushing SpinalT-6 to feetC-SectionUterine displacement, VS monitored EpiduralNumbs from T10- S5 Labor /C-sectionMonitoring line, VS, Positioning of pt Intrathecals1.5-3 hoursMultip who is progessing fast Same as Epi/Spinal

Only used in an emergency prior to infant delivery, if patient has contraindications to a Spinal /Epidural, or demands to be put to sleep.

 Maternal position  Uterine Contractions  Blood Pressure  Umbilical Blood Flow Kahn Academy

Continuously or intermittently

 IUPC use  Montevideo Units (MVU) › Subtract baseline pressure from peak pressure for each contraction in a 10 min period is optimal

 Normal FHR Baseline › 10 minute segment with no significant periodic changes or change in baseline of >25 BPM  Variability › Absent › Minimal › Moderate › Marked (pg 421)

 Tachycardia >160 › Can be early sign of fetal hypoxia › Maternal or fetal infection › Maternal hyperthyroidism or fetal anemia › Response to some drugs-cocaine, Meth, terbutaline, Vistaril  Bradycardia <110 › Heart Block › Viral infections such as CMV

 Periodic-with contractions  Episodic-occur without contractions  Acceleration 15 x 15 above baseline  Deceleration › Early › Late › Variable

True knot in cord

 Basic interventions › Oxygen › Reposition › IV fluid bolus  Specific problem › Correct the problem › If can not…..DELIVER BY CESAREAN

 Category I-normal  Category II-requires interventions and close monitoring  Category III-Deliver

 Normal FHR:  FHRV: Moderate (6-25beats)  Accelerations or Early Decelerations: Absent or present  Late or Variable Decelerations: Absent

 FHRV: Absent + Recurrent late decelerations  FHRV: Absent + Recurrent variable decelerations  FHRV: Absent + Bradycardia  Sinusoidal

 Bradycardia without absent FHRV  Tachycardia  FHRV: Minimal or Marked  FHRV: Absent without recurrent decels  Absent accelerations after induced fetal stimulation (this is only diagnostic-not intervention)  Recurrent variable decel + FHRV: Min or moderate  Prolonged decel > 2min but <10 min  Recurrent late decel + FHRV: Moderate  Variable decel with other characteristics: Slow return to baseline, overshoots, or shoulders

 Labor is anxiety provoking  Is the baby going to be ok?  Was this pregnancy planned?  Does the patient have adequate support both at home and in labor?  Will she have help at home when goes home with infant?