1. Describe the degrees of perineal lacerations, comfort measures to help, and what to avoid
with 3rd and 4th degree lacerations.
a. First degree –
... [Show More] extends through skin (not muscle)
b. Second degree – extends through the muscle of perineal body
c. Third degree – extends through the anal sphincter muscle
d. Fourth degree – extends and involves anterior rectal wall
Assess episiotomy or laceration repair for erythema and pain. Promotes measures to help
soften the client’s stools.
Apply ice/cold packs to the perineum for the first 24hours to reduce edema and provide
anesthetic effect.
Heat therapies (hot packs), moist heat, and sitz baths can be used to increase circulation
and promote healing
and comfort.
Encourage sitz baths at a hot or cool temperature for at least 20 min for at least twice a
day. Administer analgesics, such as nonopioids (acetaminophen), nonsteroidal antiinflammatories
(ibuprofen), and
opioids (codeine, hydrocodone) for pain and discomfort.
Opioid analgesia can be administered via a patient-controlled analgesia (PCS) pump after
cesarean birth.
Continuous epidural infusions can also be used for pain control after cesarean birth.
Apply topical anesthetics (benzocaine spray) to the client’s perineal area as needed or
witch hazel compressed or
hemorrhoidal creams to the rectal area for hemorrhoids.
Educate the client about proper cleansing to prevent infection.
2. Know the 7 cardinal movements in labor, in order, and what describe what happens with
each one.
1. Engagement – Biparietal diameter of the fetal head passes the pelvic inlet
Occurs earlier in first babies; as firm abdominal muscles guide the fetus into
position, 3-4 weeks before labor
Occurs after labor is established in multiparous due to relaxes abdominal
muscles
2. Descent – progress of presenting part through the pelvis, due to
Direct pressure exerted by amniotic fluid
Direct pressure exerted by fundus on the fetus
In second stage, force of the mother pushing
Measured by the station
Accelerates in the active phase of labor, or when water breaks
3. Flexion – Descending head meets resistance from the cervix/pelvic, and flexes chin to
chest
Creates a smaller diameter moving through pelvis
4. Internal rotation -Fetal head enters pelvis in transverse position because pelvis is wider
side to side
Pelvic outlet is widest from front to back
So fetus must turn in order to exit
Rotation begins at ischial spines but is not complete until head reaches
lower pelvis
Back of head (occiput) rotates to front of mother’s pelvis, and face rotates
posteriorly to mothers
back
5. Extension -Fetal head touches down on perineum and is pushed to the front by the
perineum
Occiput passes under symphysis pubis first
Head emerges by extension of neck
Face delivers
Chin delivers
6. Restitution and external rotation
Restitution
After the head is out it rotates to a transverse position (same position it entered
the pelvis)
Restitution is a 45 degree turn that realigns the head with back and shoulders
External rotation
Occurs as shoulders engage and descend
»Anterior shoulder descends first; rotates to midline and delivers under pubic
arch
»Posterior shoulder moves over perineum
7. Expulsion (birth)
Following the delivery of the head and shoulders, we lift the fetus up toward the
mother’s front
When the baby completely emerges, the birth is complete, and
Second stage of labor ends
3. What is station?
Relation is the presenting part of the fetus to the maternal ischial spines, measures the
degree of descent of the fetus
0 = level of spines
- = above spines
+ = below spines, +4 - +5 birth
4. Bishop score?
5. What is betamethasone for?
Promote fetal lung maturation if early delivery is anticipated (cesarean birth) and
surfactant production.
Stimulates fetal surfactant production.
Recommended for moms at risk for preterm birth, administered between 24- and 34-
weeks’ gestation. Benefits 24 hours after administered:
Respiratory Distress Syndrome (RDS) decreased
Intraventricular hemorrhage decreased
Necrotizing enterocolitis decreased
6. Name 4 tocolytics (meds for preterm labor) and one side effect for each one.
Tocolytics – buy time to give glucocorticoids (betamethasone)
Magnesium sulfate – relaxes smooth muscles
Terbutaline – relaxes smooth muscles
Indomethacin – blocks prostaglandins
Nifedipine – inhibits calcium in smooth muscles
7. What would you do for infection or fever in labor?
Treated with combination broad spectrum antibiotics.
Assess/monitor the infants heart rate.
8. Name 3 types of pain management for labor, and the one main complication of each one.
(Hint: opioid, epidural, and )
Sedatives – reduce anxiety, induce rest, latent phase
Barbiturates like phenobarbital – sleep in latent labor
Analgesia – alleviate the sensation of pain only, with no loss of consciousness or effects
on reflexes and muscle tine
Mostly opioids, usually given IV push
Cannot use NSAIDS in late pregnancy or labor – may close ductus arteriosus or
stop contractions
Anesthesia – causes analgesia, amnesia, relaxation, and decreased reflexes
Partial: local or regional (ex. Epidural) – no loss of consciousness, or
Complete general – unconscious
IV or IM opioids – respiratory depressants in mom and newborn
Opioid agonist analgesic
»Meperidine, fentanyl, morphine, or remifentanil
»Can inhibit contractions, so not given before 4 cm dilation, active phase
+More respiratory depression with meperidine (maternal and neonate)
Opioid agonist – antagonist analgesics
»Butorphanol (stadol) or nalbuphine (Nubain)
+Less respiratory depression
+DO NOT give agonist-antagonist meds to an opioid dependent person
– precipitates
withdrawal symptoms (maternal and neonate)
Opioid antagonist – reversal agents – always have available if opioids are used.
»Naloxone (Narcan)
+Cannot reverse non-opioid like alcohol, diazepam, phenobarbital, or
meperidine
Regional anesthesia: Spinal
Contains a local anesthesia and may add an opioid agonist analgesic (Fentanyl)
Medication(s) injected into subarachnoid space (where spinal fluid/cord are)
Medications mix with cerebral spinal fluid
Typically used in cesarean births
Fast, deep anesthesia, no movement
Regional anesthesia: Epidural
Injection of local anesthetic (bupivacaine), an opioid analgesic (fentanyl) or both
Medications are injected between the 4th and 5th lumbar vertebrae
Most effective pharmacologic pain relief for labor
Used by most women in the USA
Epidural and Intrathecal (spinal): Opioids
Use fentanyl, sufentanyl, or preservative free morphine
Used for postoperative pain
»Typically ambulate sooner, facilitates peristalsis, bladder emptying, and clot
prevention
»Cause nausea, itching, respiratory depression, other opioid side effects
Side effects/complications of Epidural and Spinal Anesthesia
1. Hypotension
Then poor placental perfusion
Longer 2nd stage of labor, more oxytocin, forceps, or vacuum
Pruritus (itching) if opioid
Urinary retention, need [Show Less]