The laboring patient brought a written birth plan indicating that she wanted to avoid pain medications and an epidural
She is now at 6 cm and states, "I can't stand this anymore! I need something for pain! How will an epidural affect my baby?" The best response by the nurse is: 1. "The narcotic in the epidural will make both you and the baby sleepy."
2. "It is unlikely that an epidural will decrease your baby's heart rate."
3. "Epidurals tend to cause low blood pressure in babies after birth."
4. "I can't get you an epidural, because of your birth plan."
2
Rationale 1: It is rare for sedation to occur from absorption of the medications of a continuous epidural.
Rationale 2: If the mother becomes hypotensive, the fetal heart rate can become bradycardic. IV hydration prior to the epidural and positioning the mother with a lateral tilt would help prevent this problem.
Rationale 3: Mothers can experience hypotension after the epidural is administered, but babies do not develop hypotension after birth as a result of a labor epidural.
Rationale 4: A birth plan is what the patient hopes for prior to the onset of labor, but it can be modified at any time.
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