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? help OP rotate, shorten labor, widen pelvic outletEpidural Anesthesia: The Bad, part 2⚫Unable to void; may need catheter⚫“Spotty” blocks⚫Mild itching⚫May ↓ neonate’s ability to breastfeed⚫Maternal fever → blood cultures/antibiotics in neonate103104105106107108
19Epidural Anesthesia: The Ugly (Contraindications)⚫Bleeding disorders or anticoagulant use⚫Mother low volume (PIH)⚫Thrombocytopenia⚫Infections near site (i.e., herpes)Tattoos are NOT a contraindicationMore Active Phase Info⚫Check maternal VS hourly; T every 4 hours, unless ROM (hourly, with pulse)⚫Check FHT every 30 minutes in low-risk; every 15 minutes high-risk⚫Note uterine contraction pattern every 30 minutesTransition Phase ⚫Patient dilates from 8-10 cm⚫Contractions strong and close together: every 1 ½ -2 minutes, lasting 60 seconds or more⚫Short phase⚫Nullipara: no >2 hours⚫Multipara: no >1 hour⚫Descent progressive⚫Nullipara: 1 cm/hour⚫Multipara: 2 cm/hourTransition Phase, cont’d…⚫Breathing patterns: pant-blow during contractions & rhythmic chest breathing in-between ⚫Head descends; urge to push⚫Patient irritable, discouraged, over-whelmed⚫Give specific instructions⚫Remind her that baby is almost here⚫Encourage her⚫Remain with herTransition Phase, cont’d…⚫Physical sensations: N/V, belching, chills, trembling, sweating, difficulty relaxing⚫Special considerations:⚫Hyperventilation: tingling, dizzy, light-headed⚫Rebreathe exhaled air between contractions⚫Back labor: small of back, difficult to relax, increase in tension⚫Warm or cold compresses⚫Counterpressure to small of back⚫Increase in bloody showTransition Phase, cont’d…⚫Check maternal VS every 30 minutes⚫Check FHT every 30 minutes low-risk; every 15 minutes high-risk109110111112113114
20Second Stage of Labor⚫Nullipara: 48-174 minutes, 66 average⚫Multipara: 6-66 minutes, 24 average⚫“precip. packs”⚫Prolonged second stage = >2 hours⚫Pushing sensation: pressure of fetal head on sacral & obturator nerves⚫Woman feels relieved; birth near & actively involved⚫Some fight pushing; fear, loss of controlSecond Stage of Labor, cont’d…⚫Coach efforts: open glottis pushing⚫Physical sensations: vaginal fullness, rectal pressure, burning, stretching⚫Instruct to stop pushing at birth of head; use pant-blowSecond Stage of Labor, cont’d…⚫Check maternal VS every 15 minutes⚫Check FHT every 5-15 minutes (most RNs check after each contraction)⚫Check delivery equipment; O2, suction, Code Pink Team/Code Pink Box, turn on warmerSecond Stage: Crowning“Ring of Fire” sensationEpisiotomies not performed until this point.Cardinal Movements (Mechanisms) of Labor⚫Engagement⚫Descent⚫Flexion⚫Internal rotation⚫Extension⚫External rotation/restitution⚫External rotation/shoulder rotation⚫Expulsion 115116117118119120