Info

Medication or Drug Class

Dosage

Description

Rationale

Opioid analgesics; anesthetics

Varies with drug, usually given intravenous push (IVP) or via epidural

Pain relievers

Labor is difficult and prolonged; often back pain is increased owing to the position of the fetus; episiotomy repair, forceps or vacuum extraction requires anesthesia

Oxytocin (Pitocin)

Mix 10 units in 500 mL of IV solution, begin in fusion at 1 mU/min; increase 1- 2 mU/min q 15-30 min until adequate labor is established

Oxytocic

Appropriate to induce labor, or to give the patient a trial labor; should be discontinued upon a definitive diagnosis of CPD, requiring a cesarean section

Independent

Have the laboring woman change positions frequently (approximately every half hour) to encourage movement of the fetal head into a favorable position for delivery. Sitting, squatting, positioning on hands and knees, or side lying (alternating sides) may be used. Avoid supine positioning. To encourage rotation of a fetus from a posterior position, suggest lying on the same side as the fetal limbs, or position the mother on her hands and knees. Pelvic rocking exercises may be helpful. Encourage periods of ambulation, as long as the membranes are not ruptured or the fetal head is well applied to the cervix.

Keeping the bladder and rectum empty allows maximum pelvic space for the descent of the fetal head. Fluid and caloric intake should be attended to during labor. In some delivery settings, however, patients may receive IV solutions for electrolyte, fluid, and/or glucose intake. In other settings, ice chips, clear liquids, or a light diet may be encouraged.

In the second stage of labor, instruct the laboring woman to use her diaphragm and abdominal muscles to bear down during contractions. Help her find a comfortable and effective position for pushing, such as supported squatting, semi-sitting, side lying, or sitting upright in bed or on a chair, birthing stool, or commode. Perineal massage during pushing will help decrease the likelihood of an episiotomy or decrease the degree of episiotomy needed.

Provide encouragement of the patient's coping strategies and assistance with pain management. Nonpharmacologic aids that can be offered include breathing techniques, massage, sacral counter-pressure, rocking chair, application of heat or cold, visualization or relaxation techniques, therapeutic touch, music, showering or bathing, companionship, and encouragement. Provide emotional support; families are often unprepared to deal with an unplanned, unwanted cesarean birth.

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