Pre-eminent

signs of
Labor
TRUE vs FALSE LABOR

GROUP 1
BSN A-2-8
 MEMBERS
ADVINCULA
SANDRA
BARRIDO
KENNETH
BORJA
GABRIELLE

ALCANTARA BASILIO CABARLE

PERRIEL AINA ROSSELE

BALLORAN BELEN CASTOR

ABEGAIL CAMILLE MIKE

CALANTOG
RIGIL
 Case presentation:
Maria is a 34-year-old G1P0 38 4/7 weeks AOG, she came into the clinic this morning for
abdominal pain. During interview she said that she feels like she is having uterine contractions
but is unsure if it is really happening. She also said that she feels it whenever she is moving
around the house but goes away when she is at rest. She has been feeling this since last night. She
denies bloody show and ruptured bag of water.

The nurse did an internal examination, it reveals the following findings:

Cervical os: closed

Effacement: 0
Station: Floating
Membranes: Intact

She was ordered by her doctor to go home, ambulate for 30 minutes every 4 hours during day
time and come back if the contractions become more regular. Maria went home.
The next morning, Maria went back to the clinic to report that she is having uterine contractions
every 4 to 5 minutes, lasting for about 1 minute. She also reported bloody show and a sudden gush of
fluid from her vaginal area while in the vehicle going to the clinic.

The nurse did an IE and it reveals:

Cervical os: 5 cms

Effacement: 80%
Station = +3
Membranes: Spontaneous rupture

She is hooked to the fetal monitor and her initial NST shows:
The doctor ordered the following:

Please admit to labor room

Start NPO

IV Fluids:
PNSS 1 L to run for 100 ml/hour
Side drip, D5NR 1L + 10 units syntocinon 10 units at 8 drops per minute to titrate accordingly

Medications:
Buscopan 20 mg IV every 2 hours to complete 3 doses

Hooked to fetal monitor

Sterile gloves for internal examination
Please refer to anesthesiologist for epidural anesthesia as planned
Please refer pediatrician of this admission
 A.
Describe the result
of Non-Stressed
Test?
-Barrido and Belen
-The NST result of patient Maria shows that it is a ‘reactive NST’. This is because the fetal
heart rate increases at least 15 beats per minute over the baseline (between 110 and 160
beats per minute), lasting at least 15 seconds, after movement within the time period.
The upper strip signifies heart rate; the lower strip indicates uterine activity.
-

Baseline fetal heart rate on this strip is between

120 beats/minute wherein it shows fetal heart
rate acceleration in response to fetal movement.
There is much variation in the FHR, it’s down to
110 then to 150, its bouncing back and forth a
lot, which can either be bad or good result
because it can either indicate that the mother is
going to deliver the baby already, or it could be
a bad sign.
Results:
Baseline fetal heart rate is 120-150 bpm.
2 contractions in a 10 minute period, mild.
- There are 2 contractions in a 10 minute period. The strength is only mild since the peak is only
about 40-50.
Variability is marked.
- As we can see in the given result, the amplitude range is greater than 25, so we can say that is
has a marked variability.
 (+) Accelerations.
- In the upper panel of the strip where the FHR is seen, we can see that there are accelerations
present because there is an increase of greater than 15bpm.
Result shows a reactive NST.
- It is a reactive NST since baseline FHR is within normal range, variability is marked wherein
there are fluctuations in FHR, and accelerations are present wherein there is a short term rises in
the FHR.
A nonstress test is a screening test used in pregnancy to assess fetal status by means of the fetal heart rate and its
responsiveness. A cardiotocograph is used to monitor the fetal heart rate and presence or absence of uterine
contractions. The test is typically termed "reactive" or "nonreactive". The normal range for baseline FHR is
defined by NICHD as 110 to 160 beats per minute. A change in baseline FHR is said to occur when the change
persists for 10 minutes or longer. A baseline of less than 110 bpm is defined as bradycardia.
A nonstress test also involves application of the fetal monitor to record the fetal heart rate. The mother is
instructed to push a marker button when she feels the fetus move wherein this marker button indicates movement
as it occurred in relationship to the fetal heart rate. With sufficient placental functioning, the fetus should
demonstrate an acceleration in heart rate with movement, in the same way that the adult experiences increased
heart rate with exercises. A lack of fetal heart rate acceleration indicates the need for further testing.
Non-stress test is used to screen the high-risk pregnancy where the placental compromise is anticipated to include
post-term pregnancy, pregnancy induced hypertension, gestational diabetes, intrauterine growth retardation, and
maternal complaints of decreased fetal movement.
B.

Create drug study

for this case?
-Calantog and Castor
  BUSCOPAN
DRUG ORDER DOSE AND FREQUENCY MECHANISM OF ACTION INDICATION CONTRAINDICATIONS ADVERSE EFFECT NURSING
RESPONSIBILITY/PRECAUTIO
NS
Generic Name: Oral: 10 - 20mg 3 to 4 times The mechanism of action of Used for the symptomatic Not advised for patients who Anticholinergic effects may be 1. Take this drug 30
a dayIV Buscopan is that it blocks the treatment of pain, abdominal have demonstrated prior observed such as : minutes to 1 hour
 Butylscopolamine muscarinic receptors found and menstrual cramping. hypersensitivity to Hyoscine- before meals
/ Hyoscine-N-   on the smooth muscle walls N-butylbromide or any other Immune system 2. Do not give the tablet
butylbromide which means its blocks the   component of the product; disorders: Anaphylactic shock version for patients who
Adults and children over 6 action of acetylcholine on the myasthenia gravis, including fatal outcome, have dysphagia
Brand Name: years: 1-2 sugar coated receptors found within the Used for spasmodic activity mechanical stenosis in the anaphylactic reactions, dyspnea, (difficulty in swallowing)
tablets 3-5 times daily smooth muscle of the in the digestive system as gastrointestinal tract, skin reactions (e.g., urticaria, rash, 3. Do crush the tablet
 Buscopan gastrointestinal and urinary well as female genital paralytical or obstructive ileus, erythema, pruritus) and other 4. Buscopan will
  tract and thus reduces the organs, especially the megacolon. hypersensitivity. potentiate the effect of
spasms and contractions. cervico-uterine plexus and alcohol and other CNS
Classification:
This relaxes the muscle and thus aiding cervical dilatation Tablet: In case of rare depressants.
 
thus reduced the pain from hereditary conditions that may Cardiac disorders: Tachycardia. 5. Do not take antacids
 antispasmodic
the cramps and spasms.   be incompatible with an and antidiarrheal 2 to 3
(spasmolytic) and Injectin: 20 - 40mg up to
excipient of the product, the hours prior to taking this
anticholinergic  every 2 hrs minutes.
use of the product is Gastrointestinal disorders: Dry drug.
Maximum daily dose of
contraindicated. mouth. 6. It is not necessary to
Route: 100mg
take the medication if
you are not in pain.
 Oral – Tablets   7. Avoid driving or
Injection: untreated narrow Skin and subcutaneous tissue
 Parenteral – operating machinery
angle glaucoma, hypertrophy disorders: Dyshidrosis.
Intravenous, Adults and adolescents over after parenteral dose.
of the prostate with urinary
intramuscular or 12 years: 1-2 ampoules
retention, tachycardia. Renal and urinary
subcutaneous  
injection  
disorders: Urinary retention.
By intramuscular injection,
Pregnancy Category: C   Hyoscine-N-butylbromide
(BUSCOPAN) ampoules are
  Injection: Eye disorders,
contraindicated: in patients
Accommodation disorders,
being treated with
mydriasis, increased intraocular
anticoagulant drugs since
pressure.
intramuscular haematoma
may occur.

Vascular disorders: Blood pressure

.
decreased, dizziness, flushing.
  D5NR (Dextrose 5% in Water)
DRUG ORDER DOSE AND MECHANISM OF INDICATION CONTRAINDICATIONS ADVERSE EFFECT NURSING
FREQUENCY ACTION RESPONSIBILITY/PRECAUTIONS
Generic Name Intravenous- Dextrose in Dextrose (antidote) is used for;  Solutions Side effects of dextrose  
1000ml drops at intravenous fluids containing dextrose (antidote) include:  Use aseptic techniques to
 Dextrose 8 per minute undergoes   may be keep the dextrose and
(Antidote) oxidation to carbon contraindicated in  Possibility of instruments free from
  dioxide and water,  Acute alcohol patients with known intracellular lactic infection.
and quickly intoxication allergy to acid production in  
Brand Name: provides fluid and   corn or corn the setting of  Double check to ensure IV
calories.  Sulfonylurea overdose products. ischemic brain fluids is within its expiration
 N/A     cells date.
     Insulin overdose,  Patients having  
  intracranial or  high blood sugar  Monitor blood glucose
Classification: Glucose is readily  High blood potassium intraspinal (hyperglycemia) levels to evaluate the
converted into fat in (hyperkalemia), hemorrhage effectiveness of the drug.
 Nonpyrogenic the body which can      Low blood  
 Parenteral be used as a  Insulin induced  Severely potassium  Solution containing acetate
fluid source of energy as hypoglycemia in dehydrated (hypokalemia) should be used with caution
 Electrolyte required. pediatric patients.   as excess administration
 Nutrient  Anuric  Fluid retention may result in metabolic
replenisher     (edema) alkalosis.
 Isotonic then  Hepatic coma
hypotonic It works by quickly  High or low blood  
increasing the volume
Route: amount of glucose (hyper/hypovolemi  If an adverse reaction does
in your blood. a) occur, discontinue the
 Parenteral - infusion, evaluate the
Intravenous  Dehydration patient, institute appropriate
  therapeutic
countermeasures
Pregnancy
Category: A

 
  SYNTOCINON
DRUG ORDER DOSE AND MECHANISM OF INDICATION CONTRAINDICATIONS ADVERSE EFFECT NURSING
FREQUENCY ACTION RESPONSIBILITY/PRECA
UTIONS
Generic Name Injection: 10 units/mL Oxytocin increases the Causes potent and  Patients that is Maternal 1. All patients receiving
sodium permeability of selective stimulation of hypersensitive to oxytocin IV must be
 oxytocin   uterine myofibrils, uterine and mammary drug CNS: subarachnoid under continuous
(synthetic indirectly stimulating gland smooth muscle.  Vaginal delivery hemorrhage, observation by
injection) To induce or stimulate contraction of the uterine isn't advised seizures, coma. trained personnel
labor smooth muscle. The Antepartum: Induction of (placenta previa, who have a thorough
Brand Name: uterus responds to labour for medical vasa previa, CV: arrhythmias, knowledge of the
Adults: Initially, 0.5 to 1 oxytocin more readily in reasons (e.g., post invasive cervical HTN, PVCs, drug.
 Syntocinon milliunit/minute IV the presence of high maturity, pre-mature carcinoma, hypotension, 2. Discontinue oxytocin
infusion. Increase rate estrogen concentrations rupture of the genital herpes), tachycardia. infusion immediately
Classification: by 1 to 2 and with the increased membranes, pre- when if uterine
milliunits/minute at 30- to duration of pregnancy. eclampsia); cephalopelvic GI: nausea, vomiting. hyperactivity or fetal
 Therapeutic 60-minute intervals until Augmentation of labour disproportion is distress occurs.
class:Oxytocics normal contraction in selected cases of present, or when GU: abruptio 3. Monitor fluid intake
Pharmacologic pattern is established. uterine inertia. delivery requires placentae, tetanic and output.
class: Decrease rate when conversion, as in uterine contractions, 4. Monitor and record
Exogenous labor is firmly postpartum
transverse lie. uterine contractions,
hormones established. Rates Postpartum: Caesarean  hemorrhage, uterine
Fetal distress HR, BP, intrauterine
exceeding 9 to 10 section following delivery when delivery rupture, impaired pressure, fetal HR,
Route: milliunits/minute are of the infant; Prevention isn't imminent, in uterine blood flow, and character of
rarely required. and treatment of prematurity, in pelvic hematoma, blood loss at least
 Parenteral -
postpartum increased uterine
other obstetric every 15 minutes.
Intravenous and  
haemorrhage associated emergencies, and motility. 5. Instruct patient to
Intramascular
with uterine atony. in patients with promptly report
To reduce postpartum .
Pregnancy Category: A bleeding after expulsion severe toxemia or adverse reactions.
hypertonic uterine
of placenta
  patterns.
DRUG ORDER DOSE AND MECHANISM OF INDICATION CONTRAINDICATIONS ADVERSE EFFECT NURSING
FREQUENCY ACTION RESPONSIBILITY/PRE
CAUTIONS
 Adults: 10 to 40 units in  Patients with Hematologic:
1,000 mL of lactated invasive cervical
Ringer solution, or NSS cancer and in afibrinogenemia,
IV infused at rate those with possibly related to
needed to sustain previous cervical postpartum bleeding,
uterine contraction and or uterine pelvic hematoma.
control uterine atony. surgery
Also, may give 10 units (including Other: anaphylaxis,
IM after delivery of cesarean death from oxytocin-
placenta. section), grand induced water
multiparity, intoxication,
uterine sepsis, hypersensitivity
traumatic reactions.
delivery, or
overdistended
uterus.
 May cause Fetal
antidiuretic effect
CNS: infant brain
and risk of
damage, seizures.
severe water
intoxication,
CV: bradycardia,
seizures, or
arrhythmias, PVCs.
death.
EENT: neonatal retinal
hemorrhage.

Hepatic: neonatal
jaundice.

Other: low Apgar scores

at 5 minutes, death.
C.
Explain why the physician
ordered Maria to go home at first
and then ordered to admit her
next day?
-Alcantara and Cabarle
 Why did the physician ordered Maria to go home at first?

Maria states “ I feel like I am having uterine contractions but am unsure if it is really
happening and I feel it whenever I am moving around the house but goes away when
I am at rest.

The result of Maria's first internal examination:

Cervical os: closed
Effacement: 0
Station: Floating
Membranes: Intact
The physician ordered Maria to go home because based on the verbalization of the
client regarding her uterine contraction and her first internal examination results show
that Maria was experiencing the signs of false labor, such as having uterine
contractions but is unsure if it is really happening and she feels it whenever she is
moving around but goes away when she is at rest. The physician ordered Maria to
ambulate for 3 minutes every 4 hours during daytime and come back if the
contractions become more regular.
Maria will be admitted to the hospital if her cervix is past six centimeters, her water is broken or if
she have special circumstances (as determined by her doctor or midwife). Additionally, some
hospitals will admit her if Maria is dilated four or five centimeters and are having regular, strong
contractions.

Some contractions that occur during the final weeks of pregnancy are not a sign of labor. This is
typically referred to as "false labor”, also known as Braxton Hicks contractions. They soften and
thin the cervix to help the body get ready for labor and delivery. False labor is characterized by
contractions that come and go with no pattern or consistency, they also stop with walking or
resting or with changes in position, they are usually weak and don’t get stronger, or start strong
and get weaker and the pain is only felt in the front.
 Why did the physician admit maria the next day?
The next morning, maria went back to the clinic.
Maria reported that " I am having uterine contractions every 4 to 5 minutes that last
for about 1 minute and there is a bloody show and a sudden gush of fluid from my
vaginal area"

The result of Maria's second Cervical

internal examination:
os: 5 cms
Effacement: 80%
Station = +3
Membranes: Spontaneous rupture
The physician ordered Maria to admit in the labor room because she was experiencing the
signs of true labor, such as uterine contractions every 4-5 min. lasting for about 1 min., she had
a bloody show and a sudden gush of fluid from her vaginal area. She’s in active labor, her
cervix dilation is 5 cm, 80% effaced, +3 fetal station, and her membranes are spontaneously
ruptured.
 True Labor vs. False Labor
TRUE LABOR
Contractions occur in a regular pattern
Contractions seem to start in lower back the travel to
lower abdomen
Contractions not stopped by controlled breathing,
sedation
Cervix softens, effaces, and dilates
Contractions come closer together, stronger, tend to last
longer
Contractions get stronger with ambulation
Fetus continues descent into pelvis
FALSE LABOR
Contractions rarely follow a pattern
Contractions may be felt in back, but often noticed in
the fundus
Contractions eventually stop with relaxation
intervention
Cervix may soften, but little or no change in
effacement or dilation
Contraction vary in length and intensity
Contractions frequently stop with ambulation
or position change
No significant change in fetal position
•True labor contractions will be 2-3 minutes apart for an hour or more.

Dealing with false labor. If you are experiencing false labor, there are a few methods
to use to ease the discomfort, such as:
•Get up and walk around the room
•Drink a glass of warm milk or cool juice
•Listen to soothing music
•Change the position you’re in by lying down or just sitting for a period of time
•Take a warm, not hot, shower
•Take deep breaths to relax your muscles
•Sit in a rocking chair or use a birthing ball to move your body to-and-fro
•Place a warm water bottle against your stomach
It’s possible you still won’t be sure if you’re experiencing true labor even after
becoming familiar with the signs of labor. In some cases, women have painful
contractions for days with no cervical changes. Other pregnant women may feel only
a backache or a little pressure.

If you are bleeding or are fewer than 36 weeks pregnant and experiencing consistent
contractions, you should visit your doctor immediately or call 9-1-1 to be taken to
the nearest hospital.
D.

Explain the result of

internal examination?
-Basilio and Borja
Interpretation of Results of both First Internal Examination and the
Internal Examination the patient had the next morning.

Cervical OS: closed Cervical OS: 5 cms

The Cervical OS of Patient Maria is 5cm
In the first internal examination of
already at this stage the cervical dilation of the
the patient the result revealed that the
patient is as big as a lime slice. Which is the
patient’s Cervical OS is closed which
same on the third image in the photo. This also
means she is not yet in the first stage
states that patient Maria is at the First Stage
of labor.
Active Phase of labor. In this stage and phase
the contractions begin to get longer, stronger,
and closer together. The active stage of labor is
characterized more by the rate of regular
cervical dilation per hour
Interpretation of Results of both First Internal Examination and the
Internal Examination the patient had the next morning.

Effacement: 0 Effacement: 80%

While in the second internal exam of patient

The first internal exam of patient
Maria her cervical effacement is still
zero which means she is not in labor
yet.
Maria the next day, the Cervical Effacement of
patient Maria is 80% already meaning, as her
cervix reaches 80 percent effacement, it is almost
short enough to allow her baby through the
uterus, assuming it is accompanied by dilation. It
also means that the patient is 20 % away from
being fully effaced at 100%, which is when she is
ready to deliver her baby. A patient may reach 80
percent effacement or higher during the early
stage of labor, or this may happen once you reach
active labor.
Interpretation of Results of both First Internal Examination and the
Internal Examination the patient had the next morning.

Station: Floating Station = +3

In the first internal exam of the patient
the result showed that the fetal station While the fetal station of the patient is +3 which
is floating which means the means the baby is already within the birth canal.
“presenting” or most palpable (able to
feel) part of the baby is above the
woman's ischial spines. Sometimes a
doctor can't feel the presenting part.
This station is known as the
“floating.” zero station. The baby's
head is known to be “engaged,” or
aligned with the ischial spines.
Interpretation of Results of both First Internal Examination and the
Internal Examination the patient had the next morning.

Membranes: Intact
In the first internal examination of
patient Maria, the result showed
that her membranes is still intact
which means her water didn't break
yet during that time.
Membranes: Spontaneous
rupture
While in the next internal examination of the
patient the result shows: membranes: spontaneous
rupture. When a hole or tear forms in the sac, it's
called a rupture of the membranes. Most women
describe this by saying their "water broke." Your
membranes can break by themselves. This is called
a spontaneous rupture of the membranes. It most
often happens after active labor has started. Which
is also the same case for patient Maria and it also
means that she’s not in labor yet.
 Spontaneous rupture of the membranes
Sometimes it can be hard to tell if your membranes have ruptured. As you get closer
to your due date, your uterus puts more pressure on your bladder. A strong Braxton
Hicks contraction or sneeze can cause some urine to leak. You might mistake this for
a rupture of the membranes.
If you are lying down when your membranes break, you are more likely to feel a
gush of liquid. If the membranes break when you are standing up, you are more
likely to feel just a trickle. That's because the baby's head gets pushed down against
the cervix and acts like a cork when you stand.
E.

Why does the doctor ordred

to use sterile gloves during
internal examination?
-Advincula and Balloran
 Sterile processes are necessary for patient care activities in order to keep the
environment free of germs and to avoid infection. Donning sterile gloves is a major
component of preventing and minimizing infection during operations or invasive
procedures.
 What are sterile gloves?
Sterile gloves are a type of disposable glove that are devoid of any germs and free
from all microorganisms. They aid in the prevention of wound infections and limit
the danger of blood and bodily fluid pathogen exposure for healthcare
professionals.

What are the benefits of gloves?

Sterile gloves are most commonly worn for a reduction in the transmission of
microorganisms between health-care workers and patients, and vice versa. Sterile latex
free surgical gloves help in minimizing the risk of cross contamination and are
instrumental in wound and surgical site hygiene.
 Communicable Disease Prevention?
Sterile latex gloves are used for the prevention of spreading communicable diseases
such as hepatitis B, Hepatitis C, HIV, and AIDS. Gloves are an important part of
infection control. Proper hand protection prevents you from making contact with
bodily fluids, blood, and potentially infectious materials which can spread disease.

Infection Control
Sterile nitrile gloves also contribute to infection control by limiting the transmission of
microorganisms between health care workers and patients. They are used as a barrier
from potential pathogenic microorganisms including bacteria and viruses.
 When to Wear Sterile Gloves
When coming into touch with a sterile spot, tissue, or bodily cavity, sterile medical
gloves must be used. They are required for just about any surgical intervention and
invasive contact with the human body. Because skin cannot be sanitized, surgical
staff must wear disposable sterile gloves.

Double-Gloving
Wearing two pairs of sterile latex surgical gloves during invasive medical procedures,
also known as "double gloving," is a technique used by healthcare providers to reduce
their danger of bloodborne pathogen exposure. The glove underneath the top glove
acts as an extra layer of protection when the glove integrity is breached during an
invasive surgery or medical procedure. Double gloving has been shown to lessen the
risk of exposure and has become standard practice.
 Sterile Glove Safety
The following precautions must be considered before purchasing and wearing sterile
latex free gloves. This will ensure your personal protection and patient safety meet
the highest standards.
1. Choose tight-fitting gloves. Picking up objects, such as surgical instruments,
should be easy. These gloves come in multiple sizes. Make sure you choose the size
that is right for your hand fit.
2. Always wash hands before putting on sterile gloves and immediately after their
removal. Wearing sterile gloves does not replace protective handwashing. Gloves are
not a substitute for good hand hygiene.
3. Make sure all tools and supplies are ready before donning gloves.
4. Practice latex allergy precautions by asking the patient ahead of time if they are
allergic or choose another type of latex free sterile gloves to use devoid of latex
proteins.
 The glove pyramid
To aid decision making on when to
wear (and not wear) gloves Gloves
must be worn according to
STANDARD and CONTACT
PRECAUTIONS. The pyramid
details some clinical examples in
which gloves are not indicated,
and others in which examination
or sterile gloves are indicated.
Hand hygiene should be performed
when appropriate regardless of
indications for glove use.e
F.

What is an epidural
anesthesia?
-Advincula and Balloran
DEpidural is a kind of anesthesia. This is a
medicine that blocks pain. It can be used for labor
and delivery. It's also used for some kinds of
surgery. For an epidural, anesthetic is injected into
the lower spine. This is done by an anesthesiologist.
Or it may be done by a nurse anesthetist (CRNA).
Epidural anesthesia is an effective form of
childbirth pain relief. Epidural anesthesia is the
injection of a numbing medicine into the space
around the spinal nerves in the lower back. It numbs
the area above and below the point of injection and
allows you to remain awake during the delivery. It
can be used for either a vaginal birth or a cesarean
delivery (C-section). An anesthesia specialist
administers epidural anesthesia
 How pain is blocked
The spinal cord is the main path for pain signals. These signals travel from nerves
through the spinal cord to your brain. The brain registers them as pain. The epidural
blocks the nerves that enter your lower spine.

Numbing your lower body

Anesthetic is injected through the skin of your back into the part of the spinal canal
called the epidural space. This blocks nerves below the point where it's injected. It
can reduce pain or block most feeling. You are awake. And you still have feeling in
your upper body.
 Epidural Placement for Labor
Epidural anesthesia involves putting a sterile guide needle and a small tube
(epidural catheter) into the space around the spinal cord (epidural space). The
epidural catheter is placed at or below the waist.
The guide needle is inserted and removed, while the catheter remains in place.
The catheter is taped in place up the center of your back and at the top of your
shoulder.
Medicine is injected into the catheter to numb your body below the insertion site.
This will help relieve pain during labor and birth.
 How an epidural is given
Epidural anesthesia involves the insertion of a sterile guide needle and a small tube
(epidural catheter) into the space around your spinal cord (epidural space). The epidural
catheter is placed at or below the waist. The doctor first uses a local anesthetic to numb the
area where the needle will be inserted. Then the guide needle is inserted and removed,
while the catheter remains in place. The catheter is taped in place up the center of your
back with the end taped in place on top of your shoulder.
An anesthetic medicine is injected into the catheter to numb your body above and
below the point of injection, as needed. The amount of discomfort or pain that you have
depends on the amount of anesthetic used. Less anesthetic (often called alight epidural)
will allow you to be more active in your labor and feel enough to push effectively. With
higher levels of anesthetic, you will feel little or no pain from your contractions. You may
be required to remain in bed when an epidural is used. You will also have a tube placed in
a vein (intravenous, or IV tube) and a fetal monitor.
Before delivery, the epidural medicine dose can be decreased so that you can push more
effectively while remaining relatively comfortable. The epidural catheter can also be
used to numb the area between the vagina and anus (perineum) just before delivery.
Because the amount of medicine given at one time is small, epidural anesthesia wears
off during labor unless additional medicine is given. So the use of epidural infusion
pumps is common. With an infusion pump, the epidural medicine is given continuously
in small amounts so that you don't have to worry that the pain relief will wear off during
your delivery.
In addition to more constant pain relief, another benefit of having an infusion pump is
that it allows you to have more control of your belly and leg muscles.
 Side effects
The most common side effect from epidural anesthesia is lowering of the mother's
blood pressure. Less common side effects may include severe headache after delivery,
difficulty urinating or walking after delivery, and fever. A rare side effect is seizure.
Because an epidural can decrease your ability to push, a forceps or vacuum delivery
may sometimes be needed.

After delivery
The epidural catheter may be removed right after delivery, or it may be left in place for several
hours to a day and used to give you pain-relieving medicine. This is usually done after a
cesarean delivery. If you are planning to have a tubal ligation before you leave the hospital (to
prevent future pregnancy), the catheter may be left in place.
The effects of the epidural usually wear off within 2 hours after the epidural medicine is
stopped. After the epidural wears off, you may have some hip or back pain from childbirth.
You may have a small bruise and the skin may be sore where the epidural was put in your
back. This will probably get better in 1 or 2 days.
RISK AND POSSIBLE COMPLICATION
A sudden drop in blood pressure, which may cause
the baby's heart rate to drop temporarily

Severe headache after birth

Soreness of the back for several days

Dizziness, seizures, breathing problems, allergic reaction to the

anesthetic, nerve damage, or paralysis (all very rare)
When to seek medical care
Follow your healthcare provider's care instructions after the procedure.
Call your provider right away if you have any of the following:
Signs of infection at the epidural site, such as redness, swelling, warmth, or drainage

Fever over 100.4°F (38°C) or higher, or as advised by your healthcare provider

Chills
Shortness of breath or trouble breathing

Numbness or weakness your legs that doesn’t go away

Severe headache

Trouble controlling your bladder

Pain that isn’t relieved by pain medicine

Other Recovery Instructions – Including Limits to Activities
Although you do not need to rest in the sense of remaining still after you have regained feeling to your limbs, you should avoid some activities
right after the epidural.

Driving
Do not drive within 12 hours of receiving your epidural injection.

Heat
Do not apply heat right to the injection site for at least three days following the epidural. This includes steam rooms, saunas, and hot packs, but
your regular shower is safe.

Normal Daily Activities

Wait a full 24 hours after the injection to get back to your full range of daily activities.

Take It Easy But Move Around

 You should not be afraid just to rest and remain mostly still as you recover from the epidural, but you do want to move around every once in a
while. This is as simple as taking a short walk when you feel able.

Medicines, Eating, and Drinking

 After the procedure, you can eat, drink, and take your medications as normal.

Swimming and Baths

Wait until the day after your epidural to take a bath, swim, or go in a hot tub.
Flyer or a pamphlet:
True and False labor.
 References
https://www.rxlist.com/normal-saline-drug.htm#description
https://www.scribd.com/doc/109761163/PNSS-drug-study
https://www.drugs.com/mtm/normal-saline-flush.html
https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/017521s068lbl.pdf
https://www.rxlist.com/consumer_dextrose/drugs-condition.htm
https://www.rnpedia.com/nursing-notes/fundamentals-in-nursing-notes/d5w-dextrose-5-water-iv-fluid/
https://www.summahealth.org/medicalservices/womens/aboutourservices/maternity-services/pregnancy-
overview/true-labor-false-labor
https://www.whattoexpect.com/pregnancy/symptoms-and-solutions/dilation-and-effacement.aspx
https://www.healthline.com/health/pregnancy/cervix-dilation-chart#stage-1
https://www.verywellfamily.com/your-babys-station-2759017
https://www.uofmhealth.org/health-library/tn7466
https://www.uofmhealth.org/health-library/zm2624#zm2624-sec
https://newyorkspinespecialist.com/how-long-should-you-rest-after-an-epidural/
https://en.wikipedia.org/wiki/Nonstress_test#:~:text=A%20nonstress%20test%20(NST)%20is,or%20absence%20of
%20uterine%20contractions.
Thank
You !
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