Labor Management
Labor Management
Part 2: Objective information:Fetal heart tones are 130, with minimal variabilityVaginal exam is 4 cm/90%effaced/ -1 stationShe is complaining of pain – 8/10 on a numerical scale.An IV has been started with an 18 gauge catheter with 1 liter of Lactated Ringers at 150 ml per hr in left forearm.
How can you provide non pharmacological comfort to this patient?What are the pharmacological methods to use?Without prenatal records or history GBS is unknown. What must you provide?Contractions are 5 minutes apart and you receive an order to augment labor – what non pharmacological methods can you employ (or ask the MD to provide?)Pitocin is ordered, please include at what rate you will start Pitocin, and how often you titrate. What equipment is needed to hang and run Pitocin IV?
SAMPLE ANSWER
Labor Management
The pain of labor is a phenomenon that is recognized universally and is brought about by the contractions of the uterus. Both pharmacotherapy and non-pharmacotherapy options can be considered to help the laboring woman to cope with the pain as well as build confidence in the process (Dhakal, Shah, and Singh, 2017). The non-pharmacological technique that would be employed for this patient involves Breathing techniques and massage which have been established as useful in pain management but also helps in increasing the likelihood of continuing breastfeeding (Adams, et al. 2015). The pharmacological method that would be used includes the administration of pain killers to help manage the pain that the laboring woman is in.
Labor Management
The GBS of the patient is not known because the medical history of the patient is unknown. Therefore, it is necessary to take samples of the laboring woman and carry out tests such as the VDRL, serology, blood group, urinalysis among other basic tests. It is important to also provide information such as the fetal NST and also any decelerations or any tachycardia or bradycardia.
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With contractions about five minutes apart, the non-pharmacological option that would be used is the Lamaze technique. This is a technique that is used in the labor process and it involves exercises and breathing control to give pain relief without drugs (Parthasarathy, and Doula, 2018). The main aim of the process is to help the mother’s confidence to improve and also reassure them that they are capable of going through the natural process. This psycho-prophylactic method helps the woman to gain a better understanding of how to cope with the pain of childbirth and most importantly, facilitates labor and promotes comfort. The main strategies involved include relaxation techniques, as well as movement and massage.
Pitocin, synthetic oxytocin, is a natural hormone that helps your uterus contract during labor and has been recommended for this patient. The use, in this case, is to augment labor because the contractions are not moving fast enough and therefore, present the risk of infection and other problems. 10 to 40 units of Pitocin will be added to 1,000 mL of a non-hydrating diluent and run at a necessary rate
References
Adams, J., Frawley, J., Steel, A., Broom, A., & Sibbritt, D. (2015). Use of pharmacological and
non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women. Midwifery, 31(4), 458-463. Doi: 10.1016/j.midw.2014.12.012
Dhakal, A., Shah, S., & Singh, B. (2017). Assessment of knowledge on non-pharmacological
methods of pain relief during labour among nurses working in maternity and children hospital, Nepal. Journal of Chitwan Medical College, 7(3), 25-28. Doi: 10.3126/jcmc.v7i3.23691
Parthasarathy, S., & Doula, P. (2018). Beyond Lamaze: Are We Missing the Key to Unlock
Women’s Potential? The Journal of Perinatal Education, 27(1). Doi: 10.1891/1058-1243.27.1.6
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