SANMARCOS ANGELA C.

BSN III

She walks in the halls with her sister and mother. She returns hourly for a 15 minute ftal
monitor check and vital sign check. After the third hour, her contractions are 4-5 minutes
apart, lasting 50-60 seconds, and are of moderate intensity.
She is examined and found to be: 6 cm dilated and 100 % effaced and at-1 station.
During the contractions, she can no longer talk and she needs to use her special
breathing with her sister that she learned in her childbirth education clas. She is
experiencing low back pain during each contraction and has decided to stop ambulating
for now and asks if she can have something for the pain

3. What medication and dosage are safe to administer at this time and
explain why?
- An epidural block can be given. Block installation is often painless, though
numbing the skin beforehand may cause some discomfort. Small tubes (epidural
catheters) placed in the low back allow a pump to drip pain medicine into the lower
body. It takes up to 15 minutes for the medication to take effect, depending on the type
of anesthetic used. The optimum moment to request an epidural during labor will be
discussed with you by your healthcare practitioner; it may be as soon as your labor
begins or as it progresses. If you have had significant lower back surgery, have low
blood clotting factors, have an infection in your lower
back, or are on specific blood thinners, you might not be
able to get an epidural.

Pros
An epidural eases most pain in the lower body without slowing labor
much. You remain awake and alert, but you still feel pressure and
some stretching during delivery. The epidural's effect on the baby is
minimal to none. A combined spinal-epidural block relieves pain
faster than a regular epidural and might use less medication.

Cons
In a few instances, epidurals might not provide enough pain relief. An epidural can decrease blood
pressure. There's a small risk that the drop in blood pressure could slow the baby's heart rate. Other
possible side effects include fever, itchiness or back soreness after giving birth. A bad headache is a rare
side effect.

Some women with an epidural can't walk during labor.

4. What stage of labor and phase is she now in
- She’s on Stage 1 of labor in active phase due to the contraction every 4-5mins
that lasts 60secs every contract.

5. Would this be a good time for her to have an epidural? Why and
why not?
- The health care providers wait to administer epidurals until the cervix has dilated to
4 or 5 centimeters, first time mothers were randomly assigned to receive the pain relief
“early” (at less than 4 to 5 centimeters dilated) or “late” (they waited until they were at
least 4 to 5 centimeters dilated.

But based on other references, it depends on the hospitals, if the patient asks for pain
relief they will give it immediately. There is some previous evidence that suggested
early epidurals could prolong labor and increase C-section rates.