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