Anesthesia in Labor and Delivery

There are five types of anesthesia used in labor and delivery: local anesthesia, pudendal block, lumbar epidural block, subarachnoid (spinal) block, and general anesthesia.

Local Anesthesia:

• It is used for blocking pain during episiotomy
• It is administered just before the birth of the baby
• The anesthetic has no effect on fetus

Pudendal Block:

• It is administered just before the birth of the baby
• The anesthetic is injected into the pudental nerve through a transvaginal route
• It has effect last about 30 minutes
• It blocks the perineal area for episiotomy
• There is no effect on contraction or the fetus

Lumbar Epidural Block:

• The anesthetic relieves pain from contractions and numbs the vagina and perineum
• The anesthetic is injected in epidural space at L3 to L4 and may cause hypotension, so assess the maternal blood pressure
• The anesthetic is administered after labor is established or just before a scheduled casarean birth
• Keep mother in side-lying position or place a rolled blanket beneath the right hip to displace the uterus from the vena cava
• Administer IV fluids if prescribed
• Increase fluids if hypotension occurs

Subarachnoid (spinal) Block:

• The anesthetic is injected into the spinal subarachnoid space at L3 to L5 and administered just before the birth
• It relieves uterine and perineal pain and numbs the vagina, perineum, and lower extremities
• The anesthetic can cause maternal hypotension and postpartum headache
• Keep mother lie flat for 8 to 12 hours following spinal injection
• Administer IV fluids as prescribed

General Anesthesia:

• General anesthesia may be used for some surgical interventions
• It might cause a danger of respiratory depression and vomiting
• The mother is not awake

STAGES OF LABOR – Stage IV

LAST STAGE

• Last stage of labor begins with delivery of placenta and ends with postpartum stabilization
• Duration: usually 1-2 hours after delivery (primipara or multipara)
• Blood pressure returns to the pre-labor level
• Pulse is slightly lower than during labor
• Fundus remains contracted, in the midline, 1-2 fingerbeadths below the umbilicus

Nursing Interventions:

• Maternal assessment every 15 minutes for 1 hours, every 30 minutes for 1 hours, and hourly for 2 hours
• Administer oxytocin product if ordered
• Assess fundus every 15 minutes, if soft, massage with side of hand
• Assess lochia, checking peripad and under lower back
• Assess bladder for distention because full bladder will prevent contractions and increase bleeding
• Assess episiotomy for intactness and possible bleeding

STAGES OF LABOR – Stage III

THIRD STAGE

• Third stage of labor begins with delivery of infant and ends with delivery of placenta
• Duration: up to 20 minutes (primipara or multipara)
• Contractions occur until the placenta is born
• Placental separation and expulsion occur
• Birth of placenta occurs 5-30 minutes after birth the baby

Nursing Interventions:

• Assess maternal signs and uterine status
• Observe for placental separation
• Observe mother for signs of altered LOC or altered respiration (indicate aneurysm or emboli)
• Allow maternal-infant interaction as soon as possible

STAGES OF LABOR – Stage II

SECOND STAGE

• Second stage of labor begins with complete dilation and ends with delivery of infant
• Duration: 30-90 minutes in primipara and 15-20 minutes in multipara
• Cervical dilation complete
• Uterine contractions occur every 2-3 minutes, lasting 60-75 seconds and the intensity is strong
• Increase in bloody show
• Mother feels urge to bear down

Nursing Interventions:

• Assess fetal well-being continuously
• Monitor maternal vital signs
• Encourage pushing
• Encourage deep-full breath (not to hold breath longer than 5 seconds when pushing)
• Commend mother’s effort

STAGES OF LABOR – Stage I

First Stage

The first stage consists of three phases: latent, active, and transition. This stage begins with the first true contraction and ends with complete effacement and dilation to 10 cm.

Latent Phase (Early Labor):

• Duration: 10-12 hours in primipara and 8-10 hours in multipara
• Cervical dilation is 1 to 4 cm
• Uterine contractions occur every 15-30 minutes and are 15-30 seconds in duration and mild intensity
• Mother is talk active
• Encourage mother and partner to participate in care
• Change position and ambulation to comfort mother
• Offer fluids an ice chips
• Inform the progress to mother and partner
• Encourage voiding every 1-2 hours

Active Phase:

• Duration: 2-4 hours in primipara and 2-4 in multipara
• Cervical dilation is 4-7 cm
• Uterine contractions occur every 3-5 minutes and are 30-60 seconds in duration and of moderate intensity
• Mother becomes restless and anxious as contractions become stronger
• Mother may experience feeling of helplessness
• Encourage mother in maintenance of effective breathing
• Provide a quiet environment
• Inform the progress to mother and partner
• Backrubs, sacral pressure, pillow support and position changes to promote comfort
• Offer fluids and ice chips
• Instruct partner in effleurage
• Encourage voiding every 1-2 hours

Transition Phase:

• Duration: 2-4 hours in primipara and 1-2 in multipara
• Cervical dilation is 8-10 cm
• Uterine contractions occur every 2-3 minutes and are 45-90 seconds in duration and strong intensity
• Mother may becomes tired, restless, irritable, and feels out of control
• Encourage rest between contraction
• Inform the progress to mother and partner
• Provide privacy
• Offer fluids and ice chips
• Encourage voiding every 1-2 hours

Special Nursing Interventions First Stage:

• Monitor vital signs
• Monitor fetal heart rate via ultrasound Doppler, fetoscope or electronic fetal monitor
• Assess fetal heart rate before, during and after a contraction (normal FHR is 120-160 beats per minute)
• Monitor uterine contractions by palpating, determining frequency, duration, and intensity of contraction
• Assess status of cervical dilation and effacement
• Assess fetal station presentation and position by Leopold’s maneuver
• Assess the color of the amniotic fluid if the membranes have ruptured because meconium-stained fluid can indicate fetal distress