Intrapartum: Labor

Support
2016

Brooke Flinders, MSN, RN, CNM

Wise Words
Birth is not only about making
babies. Birth is about making
mothers- strong, competent,
capable mothers, who trust
themselves and know their inner
strength

B. Rothman (From Advanced Labor

Techniques CAPP Manual)
Brooke Flinders, MSN, RN, CNM

Complement Partners
Support
Build on anything that seems to be
working already
Fosters a meaningful experience
for the new family
Can help you out when youre
trying to multi-task

Brooke Flinders, MSN, RN, CNM

Labor Support Theories

Lots of theorists/ approaches to
labor support: Bradley method,
Lamaze, etc., etc.
Good to examine any hang-ups
you have so that you can put them
aside

Brooke Flinders, MSN, RN, CNM

Doulas are Your Friends!

Doulas focus on the woman and

dont need to be overwhelmed by

policies, procedures, and
documentation!
Doulas are not meant to take the
place of a nurse or midwife; they
have NO medical training.
Doulas have great bags of tricks
Brooke Flinders, MSN, RN, CNM

Doulas are Your Friends!

If your patient invited/hired her,
you might as well get along, or it
could be a long, long, long labor :)
Doulas vary greatly in experience
and qualifications- dont need a
degree to be supportive

Brooke Flinders, MSN, RN, CNM

Techniques May Seem Strange,

but Can Work Anyway

Need to explore what makes you

feel uncomfortable r/t childbirth
and sexuality
Will be faced with a variety of
family units: friends, extended
family, boyfriends, lesbian/gay
couples

Brooke Flinders, MSN, RN, CNM

Techniques May Seem Strange,

but Can Work Anyway

Will be faced with situations

that may make you squirm
The goal of labor support is to
help a woman have the birth
that she wants- shell always
remember it.
Brooke Flinders, MSN, RN, CNM

Examples of
Support/Techniques
Hypnobirthing
Superficial Heat
Superficial Cold
Hydrotherapy
Soothing Touch/ Effleurage
Massage
Therapeutic Touch
Brooke Flinders, MSN, RN, CNM

More Techniques
Acupressure
Aroma Therapy
Birthing Ball
Intradermal Injections
Position Changes

Brooke Flinders, MSN, RN, CNM

Pharmacologic Pain Relief

Goal is to provide maximum

pain relief with minimum risk
to mother and fetus

Brooke Flinders, MSN, RN, CNM

Pharmacologic Pain Relief

Goal is impacted by following
factors

All systemic drugs used in labor for

pain relief cross placental barrier by
simple diffusion
Drug action in body depends on rate
at which substance is metabolized by
liver
Fetus has inadequate ability to
metabolize analgesic agent
Brooke Flinders, MSN, RN, CNM

Timing of Medication
After complete assessment, an
analgesia agent is generally
administered when cervical change
has occurred - pain medication
given too early may prolong labor
and depress fetus

Brooke Flinders, MSN, RN, CNM

Nursing Management
Nubain and Stadol may cause fetal
respiratory depression at birth if
given too late in labor, but are good
options in earlier active phase
Maternal and fetal vital signs must
be stable before systemic drugs
may be administered (Baby should
be reactive)
Brooke Flinders, MSN, RN, CNM

Nursing Management
Assess mother and fetus and

evaluate contraction pattern before

administering prescribed
medications
If narcotics are used too late in
labor and the infant experiences
respiratory problems, Narcan can
be used to reverse the effects
Nubain 5/5q 4
Stadol 1-2q3-4
Brooke Flinders, MSN, RN, CNM

Epidurals
Injection of anesthetic agent into

epidural space
Produces little or no feeling to area
from uterus downward
Pushing during second stage of
labor may be impaired due to lack
of sensation
Hypotension is most common side
effect
Brooke Flinders, MSN, RN, CNM

Epidurals
May preload with crystalloid

solution bolus (LR)

Woman may need urinary
catheterization due to loss of
bladder sensation
Assess sensation motor control
and orthostatic blood pressure

Brooke Flinders, MSN, RN, CNM

Continuous Epidural
Infusions
Provide good analgesia
Produce less nausea and provide
greater ability to cough
May produce breakthrough pain,
sedation, respiratory depression
Itching and hypotension are side
effects

Brooke Flinders, MSN, RN, CNM

Spinals
Local anesthetic agent injected
directly into spinal canal
Level of anesthesia dependent
upon level of administration
May be administered higher for
cesarean birth or lower for vaginal
birth

Brooke Flinders, MSN, RN, CNM

Pudendal Block
Local anesthesia injected directly into

pudendal nerve, which produces

anesthesia to lower vagina, vulva,
perineum
Only produces pain relief at end of labor
Has no effect on fetus or progress of
labor
May cause hematoma, perforation of
rectum, trauma to sciatic nerve

Brooke Flinders, MSN, RN, CNM

Local
Local anesthesia injected into

perineum prior to episiotomy

Provides pain relief only for
episiotomy incision
There is no effect on maternal or
fetal vital signs
Requires large amounts of local
anesthetic agents
Brooke Flinders, MSN, RN, CNM

Complications
Regional anesthesia administered per
spinal or epidural route can cause:

Maternal hypotension from hypovolemia or

effects of anesthesia - treat with bolus of
crystalloid IV fluid and notify anesthetist
Bladder distension
Inability to push during second stage of
labor
Severe headache with spinal anesthesia

Brooke Flinders, MSN, RN, CNM

Complications
Elevated

temperature with
epidural anesthesia
Possible neurologic damage

Brooke Flinders, MSN, RN, CNM

Nursing Care for Clients with

General Anesthesia
Nurse should

Assess when mother ate or drank last

Administer prescribed premedication such
as antacid
Place wedge under mother's right hip to
displace uterus and prevent vena cava
compression
Provide oxygen prior to start of surgery

Brooke Flinders, MSN, RN, CNM

Nursing Care for Clients with

General Anesthesia
Ensure

IV access is established
Assist anesthesiologist by
applying cricoid pressure during
placement of endotracheal tube

Brooke Flinders, MSN, RN, CNM

Complications/
Considerations
Fetal depression
If mother receives general anesthesia, infant
may have respiratory depression
Method not advocated when infant is
considered high risk

Uterine relaxation: Most general

anesthetic agents cause some uterine
relaxation
Emesis/ Aspiration
Brooke Flinders, MSN, RN, CNM

Coordination of the Health Care

Team and Family Members
Anticipate need for any ancillary staff!!
Remember that if you dont get them

there, YOU may be the only one there to

resuscitate baby, deal with a sick Mom,
etc.
Follow hospital policies r/t visitors and
reasonable numbers of guests for
birth. Try to accommodate familys
requests- it is their birth!!
Brooke Flinders, MSN, RN, CNM