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Maternal responses: during
labor: with each contraction, 300-500 mls of blood forced into maternal
circulation → ↑ cardiac out put which ↑ with pain and
anxiety. In supine position, cardiac
output ↓, HR ↑, stroke volume↓. Best to assume side-lying
position. BP ↑ during contractions and pushing.
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Respiratory: anxiety & pain → hyperventilation
& respiratory alkalosis; muscular activity → mild metabolic
acidosis. Acid-base balance - norm /p
24 hrs
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Renal & GI – ↑ in
pressure and edema to bladder can lead to over distension; ↑ in renin
& angiotension help control
uteroplacental blood flow. GI – gastric emptying delayed → risk of
aspiration if general anesthesia necessary
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Immune/blood – WBCs inc to
25,000 – 30,000. Blood glucose ↓ (energy during contractions), insulin
requirements drop
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Pain – gate-control theory:
mechanism aloows ↑ or↓ in
impulses to CNS. Pain can be reduced through tactile stimulation such as back
rubs, sacral pressure, effleurage; and
CNS-controlled activities such as suggestion, distractions, &
conditioning.
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Pain varies: 1st stage:
stretching, pressure, hypoxia of muscles during contraction; 2nd
stage – hypoxia to uterine muscles, stretching of vagina & perineum and
pressure on adjoining . Figure 15 – 16, p 328.
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What about fetal response?
Heart rate changes in response to intracranial pressure from maternal
contractions; fetal blood pressure protects fetus during contractions; fetus
responds to light, sound, & touch, beg 37 wks
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