Maternity Chapter 14

A nurse is caring for a client who has been administered an epidural block. Which should the nurse assess next? uterine contractions pulse temperature respiratory rate

D Explanation: The nurse must monitor for respiratory depression. Monitoring the client's respiratory rate will be the best indicator of respiratory depression.

As a woman enters the second stage of labor, her membranes spontaneously rupture. When this occurs, what would the nurse do next? Ask her to bear down with the next contraction. Assess fetal heart rate for fetal safety. Test a sample of amniotic fluid for protein. Elevate her hips to prevent cord prolapse.

B Rupture of the membranes may lead to a prolapsed cord. Assessment of FHR detects this

A client has just received combined spinal epidural. Which nursing assessment should be performed first? Assess pain level using a pain scale. Assess vital signs. Assess for spontaneous rupture of membranes. Assess for fetal tachycardia. Assess for progress in labor.

B The most common side effect of spinal and epidural anesthesia is hypotension, which can lead to fetal bradycardia, decelerations, or fetal distress. Although each is important, assessment of vital signs should be performed first.

A client in labor has administered an epidural anesthesia. Which assessment findings should the nurse prioritize? maternal hypertension and fetal bradycardia maternal hypotension and fetal tachycardia maternal hypotension and fetal bradycardia maternal hypertension and fetal tachycardia

C Explanation: Epidural anesthesia conveys the risk of hypotension, especially if the client has not received an adequate amount of fluid before the procedure is performed. A sudden drop in maternal blood pressure can cause uterine hypoperfusion, which may result in fetal bradycardia. The other choices are not an adverse effect of epidural anesthesia.

A gravida 1 client is admitted in the active phase of stage 1 labor with the fetus in the LOA position. The nurse anticipates noting which finding when the membranes rupture? Bloody fluid Cloudy white fluid Greenish fluid Clear to straw-colored fluid

D The infant is in the correct position, and the client has been in labor. Expectation would be for normal amniotic fluid presentation of clear to straw-colored fluid. If there is blood, then the uterus is bleeding and there is an extreme emergency. If the fluid is greenish, there is meconium in the fluid. Cloudy, white fluid may indicate an infection is present.

The nursing instructor is preparing a class discussing the role of the nurse during the labor and birthing process. Which intervention should the instructor point out has the greatest effect on relieving anxiety for the client? Continuous labor support Massage therapy Pharmacologic pain management Prenatal classes

A Continuous labor support by a caring nurse or doula can help decrease a woman's anxiety during labor. Anxiety causes the release of catecholamines, which slow down the labor process. The continuous support helps keep the woman focused on what is important as well as provide necessary guidance and education as needed. The massage therapy, prenatal classes, and pharmacologic pain management are all tools that the nurse can use to help the woman.

If a fetus were not receiving enough oxygen during labor because of uteroplacental insufficiency, which pattern would the nurse anticipate seeing on the monitor? fetal heart rate declining late with contractions and remaining depressed a shallow deceleration occurring with the beginning of contractions fetal baseline rate increasing at least 5 mm Hg with contractions variable decelerations, too unpredictable to count

A Lack of blood supply to the fetus because of poor placental filling prevents the fetal heart rate from recovering immediately following a contraction.

When assessing fetal heart rate patterns, which finding would alert the nurse to a possible problem? prolonged decelerations variable decelerations accelerations early decelerations

A Prolonged decelerations are associated with prolonged cord compression, placental abruption (abruptio placentae), cord prolapse, supine maternal position, maternal seizures, regional anesthesia, or uterine rupture. Variable decelerations are the most common deceleration pattern found. They are usually transient and correctable. Early decelerations are thought to be the result of fetal head compression. They are not indicative of fetal distress and do not require intervention. Fetal accelerations are transitory increases in FHR and provide evidence of fetal well-being.

A woman in early labor is using a variety of techniques to cope with her pain. When the nurse enters the room she notes that the woman is making light, circling movements with her fingertips across her abdomen. What technique is she using? abdominal imagery pain pathway blockage effleurage massage

C Effleurage is a form of touch that involves light circular fingertip movements on the abdomen and is a technique the woman can use in early labor. The theory is that light touch stimulates the nerve pathways to the brain and keeps them busy, thereby blocking the pain sensation.

The nurse is admitting a client in early labor and notes: FHR 120 bpm, blood pressure 126/84 mm Hg, temperature 98.8°F (37.1°C), contractions every 4 to 5 minutes lasting 30 seconds, and greenish-color fluid in the vaginal vault. Which finding should the nurse prioritize? Possible maternal infection Fetal heart rate Green-colored fluid in the vagina Irregular contractions

C Green-tinted fluid with ROM is indicative of meconium in the amniotic sac, or the infant having a bowel movement in utero. Infection would be shown by pus or cloudy fluid and possibly an elevated temperature. The FHR is within normal range. Irregular contractions are expected at this stage of labor.

A client and her husband have prepared for a natural birth; however, as the client progresses to 8 cm dilation, she can no longer endure the pain and begs the nurse for an epidural. What is the nurse's best response? Gently remind the client of her goal of a natural birth and encourage and help her. Ask the husband to gently remind her of their goal of natural birth and to encourage and help her. Suggest a less extreme alternative such as a sedative. Support the client's decision and call the provider.

D Pain is subjective and its level is only what the client experiences. The nurse should support the desire of the client. Sedatives would be counterproductive as they may slow the labor process. It would be inappropriate to negate her feelings and remind her of earlier goals; that is the job of the support person and should be left up him or her to decide what to say and when to say it.

The pregnant client is planning to hire a doula for support during labor. What statement by the client requires follow-up by the nurse? My doula will provide me with massage and encouragement in labor. My doula will help me with contractions so I will not need any pain relief in labor. My doula will come to my home in early labor and stay with me once I am admitted to the hospital. My doula will be able to support both me and my partner during the labor and birth.

B A doula is a professional support person who can provide continuous support in the prenatal, labor, and postpartum periods for both the client and partner. The doula will provide support for nonpharmacologic pain relief, such as massage. Doula care is associated with less intervention and pharmacologic pain relief in labor but is not a guarantee that pharmacologic pain relief will not be needed; this misconception should be addressed with the client.

The nurse is assisting a client through labor, monitoring her closely now that she has received an epidural. Which finding should the nurse prioritize to the anesthesiologist? Inability to push Urinary retention Dry, cracked lips Rapid progress of labor

A If the client is not able to push, her epidural dose may need to be adjusted to decrease the impact on the sensory system. Dry lips indicate that she may need fluids, so the nurse should give her some ice chips or a drink of water. Urinary retention and rapidly progressing labor should be directly reported to the obstetrician, not the anesthesiologist.

The nurse is caring for a client who has been in labor for the past 8 hours. The nurse determines that the client has transitioned into the second stage of labor based on which sign? The urge to push occurs. Emotions are calm and happy. Frequency of contractions are 5 to 6 minutes. Fetus is at -1 station.

A Second stage of labor is the pushing stage; this is typically identified by the woman's urge to push or a feeling of needing to have a bowel movement. In the second stage the cervix can be 10 cm, dilated 100% and effaced. The station is usually 0 to +2. The emotional state may be altered due to pain and pressure. Contraction frequency is variable and not clearly indicative of a particular stage. The fetus can be at stage -1 for any length of time.

The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next? administration of oxygen by mask application of vibroacoustic stimulation tactile stimulation fetal scalp stimulation

A The client should be administered oxygen by mask because the abnormal FHR pattern could be due to inadequate oxygen reserves in the fetus. Because the client is in preterm labor, it is not advisable to apply vibroacoustic stimulation, tactile stimulation, or fetal scalp stimulation.

The nurse is admitting a client who is in early labor. After determining that the birth is not imminent, which assessment should the nurse perform next? Fetal status Maternal obstetrical history Maternal status Risk factors

A The woman may present to the birthing suite at any phase of the first stage of labor. Therefore, it is important to assess birth imminence, fetal status, risk factors, and maternal status immediately. If birth is not imminent and the fetal and maternal conditions are stable, perform additional data collection, including the full admission health history, a complete maternal physical assessment, the status of labor and any labor, birth, and cultural preferences the woman may have.

The nurse is monitoring a laboring client with continuous fetal monitoring and notes a decrease in FHR with variable deceleration to 75 bpm. Which intervention should the nurse prioritize? Change the position of the client. Administer oxygen. Notify the primary care provider. Increase her IV fluids.

A Variable decelerations often indicate a type of cord compression. The initial response is to change the position and try to release the cord compression. If this does not work, apply oxygen while using the call light to alert others. If this continues, her fluid status needs to be assessed before increasing her IV rate.

Which nursing action prevents a complication associated with the lithotomy position for the birth of the fetus? Rubbing the client's legs Placing a wedge under the hips Massaging the client's lower back Providing a paper bag

B Due to the lithotomy position, the nursing action of placing a wedge under the hips is correct to avoid supine hypotension. Rubbing the legs or massaging the back can relax the client between intense contractions but those actions do not prevent a complication. Providing a paper bag prevents hyperventilation typically caused by pattern breathing.

The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this as which form of therapy? acupuncture acupressure effleurage biofeedback

B Acupressure is the application of pressure or massage at designated susceptible body points. A common point used for a woman in labor is Co4, which is located between the first finger and thumb on the back of the hand. Women may report their contractions feel lighter when a support person holds and squeezes their hand because the support person is accidentally triggering this point. Acupuncture involves insertion of needles into the same body points. Effleurage, the technique of gentle abdominal massage often taught with Lamaze in preparation for birth classes, is a classic example of therapeutic touch. Biofeedback is based on the belief that people have control and can regulate internal events such as heart rate and pain responses.

All pain management modalities can slow labor if given too early except: opioids acupuncture hydrotherapy epidural anesthesia

B Acupuncture can be used to augment labor. Epidural anesthesia and opioids such as meperidine and butorphanol can slow labor progress if given too early.

The postpartum nurse is providing care for a client who has just given birth and had epidural anesthesia. Her vital signs are stable, her pain is a 3 on a scale of 0 to 10, and she states that she is tired. The feeling in the client's legs has returned, but she cannot lift her knees, and she has not been out of the bed. What is the most appropriate nursing diagnosis to include in the plan of care at this time? Acute Pain Risk for Injury Disturbed Sleep Pattern Activity Intolerance

B Because the client had epidural anesthesia, cannot lift her legs, and has not been out of the bed since the epidural, she is at risk for injury. The nurse should take all measures to make her safe because walking may be difficult for her at first. There is not enough substantial evidence to support the other nursing diagnoses at this time.

The nurse is monitoring the electronic fetal heart rate monitor and notes the following: variable V-shaped decelerations in the fetal heart rate (FH)R lasting about 30 seconds, accelerations of about 5 beats/min before and after each deceleration, no overshoot, and baseline FHR within normal limits. Which response should the nurse prioritize? Start an oxytocic infusion and decrease the rate of IV fluids. Help the woman change positions. Discontinue supplemental oxygen. Encourage pushing with contractions during second stage of labor.

B The electronic fetal heart rate monitor reading is associated with cord compression. Changing to a different position is a first intervention to determine if this will improve the oxygen to the fetus. Supplemental oxygen should be maintained until the mother is stable. Pharmacologic interventions are premature. The nurse should modify pushing in the second stage of labor to improve fetal oxygenation.

A labor nurse is caring for a client who is 7 cm dilated, 100% effaced, at a +1 station, and has a face presentation on examination. The nurse knows that teaching was understood when the birth partner makes which statement? "Our baby will come out with the back of the head first." "Our baby will come out face first." "Our baby will come out facing the hip." "Our baby will come out with the buttocks first."

B The fetal presentation pertains to the part of the fetus that comes through the cervix and the birth canal first. A face presentation indicates that the face presents first. The face is a large part of the head, so caution must be used.

The health care provider is evaluating a high-risk woman for a continuous internal monitoring. Which criterion would need to be met for this type of monitoring? insertion by any staff rupture of membranes cervical dilation of 1 cm the presenting fetal part not visible

B The insertion of the spiral electrode should be inserted only by a skilled practitioner. Ruptured membranes, cervical dilation of at least 2 cm, and the presenting fetal part low enough to allow placement of the scalp electrode are all necessary.

A client in labor has requested the administration of opioids to reduce pain. At 2 cm cervical dilation (dilatation), she says that she is managing the pain well at this point but does not want it to get ahead of her. What should the nurse do? Explain to the client that opioids should only be administered an hour or less before birth. Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor. Agree with the client, and administer the drug immediately to keep the pain manageable. Refuse to administer opioids because they can develop dependency in the client and the fetus.

B The timing of administration of opioids in labor is especially important as, if given too early (before 3 cm cervical dilatation), they tend to slow labor. If given close to birth, because the fetal liver takes 2 to 3 hours to activate a drug, the effect will not be registered in the fetus for 2 to 3 hours after maternal administration. For this reason, opioids are preferably given when the mother is more than 3 hours away from birth. This allows the peak action of the drug in the fetus to have passed by the time of birth.

The nurse instructs the client about skin massage and the gate control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods? The gating mechanism opens so all the stimuli pass through to the brain. The gating mechanism is located at the pain site. These methods are a technique to prevent the painful stimuli from entering the brain. Pain perception is decreased if anxiety is present.

C Gate-control diverts the pain stimuli from the pain site by replacing with a comfort stimuli in a new location. Gate control does not need to be applied directly to the site of the pain. Anxiety heightens the painful feelings. Gating blocks the flow of painful stimuli to the sensory centers in the brain.

To assess the frequency of a woman's labor contractions, the nurse would time: the end of one contraction to the beginning of the next. how many contractions occur in 5 minutes. the beginning of one contraction to the beginning of the next. the interval between the acme of two consecutive contractions.

C Measuring from the beginning of one contraction to the next marks the time between contractions.

How does a woman who feels in control of the situation during labor influence her pain? Decreased feeling of control helps during the third stage. There is no association between the two factors. Feelings of control are inversely related to the client's report of pain. Feeling in control shortens the overall length of labor.

C Studies reveal that women who feel in control of their situation are apt to report less pain than those who feel they have no control.

The nurse is reviewing the uterine contraction pattern and identifies the peak intensity, documenting this as which phase of the contraction? decrement diastole acme increment

C The acme is the peak intensity of a contraction. The increment refers to the building up of the contraction. The decrement refers to the letting down of the contraction. Diastole refers to the relaxation phase of a contraction.

The nurse is monitoring a client who just received IV sedation. Which instruction should the nurse prioritize with the client and her partner? Ambulate within 15 minutes to prevent spinal headache. Sit on the edge of the bed with her feet dangling before ambulating. Ambulate only with assistance from the nurse or caregiver. Remain in bed for at least 30 minutes.

C The client may have decreased sensory ability from the medication. She needs assistance to ambulate for safety. She will be largely unable to move, so she should remain in bed unless absolutely necessary.

Which primary symptom does the nurse identify as a potentially fatal complication of epidural or intrathecal anesthesia? Staggering gait Decreased level of consciousness Difficulty breathing Intense pain

C Total spinal blockade occurs when an inadvertent injection of a local anesthetic is placed into the intrathecal or epidural space. The resulting effect is that the anesthetic travels too high in the body causing paralysis of the respiratory muscles. Difficulty breathing is a sign. A decreased level of consciousness will occur later. A staggering gait or intense pain is not a primary symptom.

While assessing the progress of the labor, the nurse explains that the fetal heart rate variability is moderate. Which explanation is best to use with the parents? FHR fluctuation range is undetectable. FHR fluctuates over 25 beats per minute. FHR fluctuates from 6 to 25 beats per minute. FHR fluctuates less than 5 beats per minute.

C Variability is described in four categories: absent, fluctuations range undetectable; minimal, fluctuations range observed at <5 beats per minute; moderate (normal), fluctuation range from 6 to 25 beats per minute; and marked, fluctuation range >25 beats per minute.

Touch and massage can be helpful during labor. Which touch and massage methods are used in labor? Select all that apply. patterned breathing counterpressure effleurage water therapy

C D Effleurage, a form of touch that involves light circular fingertip movements on the abdomen, is a technique the client can use in early labor. Light touch stimulates the nerve pathways to the brain and keeps them busy, thereby blocking the pain sensation. If the client is experiencing intense back labor, it is often helpful for the partner to give the client a massage over the lower back or to use the fists or palms of the hands to apply counterpressure.

The laboring client who is at 3 cm dilation (dilatation) and 25% effaced is asking for a narcotic for pain relief. The nurse explains this usually is not administered prior to the establishment of the active phase. What is the appropriate rationale for this practice? This can lead to maternal hypertension. This would cause fetal depression in utero. The effects would wear off before birth. This may prolong labor and increase complications.

D Administration of pharmacologic agents such as narcotics too early in labor can stall the labor and lengthen the entire labor. The client should be offered nonpharmacologic options at this point until she is in active labor.

The nurse is reviewing the medication administration record (MAR) of a client at 39 weeks' gestation and notes that she is ordered an opioid for pain relief. Which is an assessment priority after administering? Assess maternal blood pressure. Assess for dry mouth. Assess for constipation. Assess fetal heart rate.

D After administering an opioid to a laboring mother, the priority is to assess the impact on the fetus. Opioid administration can cross the placental barrier and affect fetal heart rate and variability. After birth, there may be a decrease in alertness of the neonate. Maternal factors of decreased blood pressure, constipation, and dry mouth are of a lower priority.

The nurse is monitoring a client who is in the second stage of labor, at +2 station, and anticipating birth within the hour. The client is now reporting the epidural has stopped working and is begging for something for pain. Which action should the nurse prioritize? Give the meperidine because she needs pain relief now. Call the primary care provider, and obtain a reduced dose of meperidine. Call the anesthetist from the nurse's station to retry the epidural. Encourage her through the contractions, explaining why she cannot receive any pain medication.

D At this point, any medication would be contraindicated as it would pass to the fetus and may cause respiratory depression. The nurse will have to work with the mother through the contractions and pushing. The client has progressed too far to retry the epidural medication. No meperidine should be given due to the risk to the fetus.

The nurse is preparing a young couple for the upcoming birth of their child, and the mother expresses concern for needing pain medications and the effects on the fetus. When counseling the couple about pain relief, the nurse would incorporate which information in the teaching about measures to help to decrease the requests for pain medication? A quick epidural can replace the need for pain medication. Sitting in a hot tub helps decrease the need for pain medication. Lying on an ice pack can help decrease the need for pain medication. Continuous support through the labor process helps decrease the need for pain medication.

D Continuous labor support involves offering a sustained presence to the laboring woman. A support person can assist and provide aid with acupressure, massage, music therapy, or therapeutic touch. Research has validated the value of continuous labor support versus intermittent support in terms of lower operative deliveries, cesarean births, and request for pain medication.

Early in labor, a pregnant client asks why contractions hurt so much. Which answer should the nurse provide? release of endorphins in response to the uterine contractions blocking of nerve transmission via mechanical irritation of nerve fibers distraction of the brain cortex by other stimuli occuring in the body lack of oxygen to the muscle fibers of the uterus due to compression of blood vessels

D During contractions, blood vessels constrict, reducing the blood supply to uterine and cervical cells, resulting in anoxia to muscle fibers. This anoxia can cause pain in the same way blockage of the cardiac arteries causes the pain of a heart attack. Endorphins are naturally occurring opiate-like substances that reduce pain, not cause it. Distraction and mechanical irritation of nerve fibers are also methods of reducing pain, not causes of pain.

The nurse's note (above) was documented by the client's labor nurse minutes after epidural initiation. What action should the nurse take first? Administer oxygen at 8 to 10 liters per minute. Offer IV ondansetron. Initiate 500 ml IV fluid bolus. Assess blood pressure.

D Hypotension is a common side effect after epidural block and can cause nausea, dizziness, and lightheadedness. The nurse should first reassess the blood pressure to determine if hypotension is the cause of these symptoms. The hypotension may be treated with an IV fluid bolus or with an antihypotensive agent such as ephedrine. Oxygen may also be used to treat a client with hypotension, after assessment of vital signs. Treating the hypotension may reverse the nausea; an IV antiemetic may be indicated only if the nausea persists.

A client has presented in the early phase of labor, experiencing abdominal pain and signs of growing anxiety about the pain. Which pain management technique should the nurse prioritize at this stage? Immersing the client in warm water in a pool or hot tub Administering a sedative such as secobarbital or pentobarbital Administering an opioid such as meperidine or fentanyl Practicing effleurage on the abdomen

D In early labor, the less medication use the better; allow use of nonpharmacologic management and control the pain with effleurage. Sitting in a warm pool of water is relaxing and may lessen the pain, but it does not control the pain. Sedatives are not indicated as they may slow the birthing process. Opioids should be limited as they too may slow the progression of labor.

A woman states that she does not want any medication for pain relief during labor. Her primary care provider has approved this for her. What the nurse's best response to her concerning this choice? "Let me get you something for relaxation if you don't want anything for pain." "Your health care provider is a man and has never been in labor; he may be underestimating the pain you will have." "That's wonderful. Medication during labor is not good for the baby." "I respect your preference, whether it is to have medication or not."

D Individualizing care to meet a woman's specific needs is a nursing responsibility.

The nurse is assessing a client in labor for pain and notes she is currently not doing well handling the increased pain. Which opioid can the nurse offer to the client to assist with pain control? thiopental secobarbital hydroxyzine hydrochloride meperidine

D Meperidine is an opioid that is commonly used during labor and birth. Secobarbital and thiopental are barbiturates. Hydroxyzine hydrochloride is a tranquilizer which can be used to supplement the opioid or reduce anxiety.

A nurse is monitoring a female client with an epidural block. Which complication would be the most important for the nurse to monitor in the client? postdural puncture (spinal) headache accidental intrathecal block a failed block respiratory depression

D Respiratory depression is a complication of epidural anesthesia and should be closely monitored in laboring clients. A failed block, accidental intrathecal block, and a postdural puncture (spinal) headache are all side effects of a spinal epidural block.

The student nurse is preparing to assess the fetal heart rate (FHR) and has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's: right upper quadrant. right lower quadrant. left upper quadrant. left lower quadrant.

D The best position to auscultate fetal heart tones in on the fetus back. In this position, the best place for the FHR monitor is on the left lower quadrant.

Which nursing action is essential if the laboring client has the urge to push but she is not fully dilated? Assist the client to a Fowler position. Have the client divert the energy to squeezing a hand. Have the client lightly push to meet the need. Have the client pant and blow through the contraction.

D The essential nursing action does not allow the client to push. The action is to have the client pant at the beginning of the contraction and then have the client blow through the peak of the contraction. Pushing efforts before the cervix is fully dilated may result in cervical lacerations or cause edema of the cervix, slowing delivery of the fetus. No pushing should be accomplished at this time. It is difficult to divert energy but not push. Assuming a Fowler position places weight on the perineum.

If the monitor pattern of uteroplacental insufficiency were present, which action would the nurse do first? Administer oxygen at 3 to 4 L by nasal cannula. Ask her to pant with the next contraction. Help the woman to sit up in a semi-Fowler's position. Turn her or ask her to turn to her side.

D The most common cause of uteroplacental insufficiency is compression of the vena cava; turning the woman to her side removes the compression.

The registered nurse has identified that the client's labor progress has slowed. Which nursing intervention, done by the LPN, is completed first? Assess the strength of contraction Assess the client's psyche Assess the fetal heart rate Assess if the bladder is distended

D The nurse must consider causes impeding fetal descent. A full bladder may slow fetal descent. Encourage the client to void at least every 2 hours. Assessment of the fetal heart rate, contraction strength, and psyche is important to note but is not directly related to impeding the fetal descent.

A multigravida client admitted in active labor has progressed well and the client and fetus have remained in good condition. Which action should the nurse prioritize if the client suddenly shouts out, "The baby is coming!"? Contact the primary care provider. Auscultate the fetal heart tones. Time the contractions. Inspect the perineum.

D The nurse needs to determine if birth is imminent by assessing the perineum and be prepared for birth. Once the nurse assesses the coming labor, she can then assess the heart sounds, contraction rate, and contact the primary care provider—if there is time.

A client in active labor is given spinal anesthesia. Which information would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia? excessive contractions of the uterus increased frequency of micturition passage of the drug to the fetus headache following anesthesia

D The nurse should inform the client and her family about the possibility of headache after spinal anesthesia. The drug is retained in the mother's body and not passed to the fetus. There may be uterine atony, and not excessive uterine contractions, following spinal anesthesia. Spinal anesthesia may lead to bladder atony, and not an increased frequency of micturition.

There has been much research done on pain and the perception of pain. What is the result of research done on levels of satisfaction with the control of labor pain? Women report higher levels of satisfaction when regional anesthetics are used to control pain. Women report higher levels of satisfaction when the primary care provider makes the decision on what type of pain control to use. Women report higher levels of satisfaction when different types of relaxation techniques are used to control pain. Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience.

D Women identify being involved in their pain management and adequate control of their pain as important factors in their overall labor experience. Women often report that it is not the amount of pain they have during labor that contributes to a satisfactory birth experience but rather how their pain is managed.