Nursing 209

N209: Reproductive Health Study Guide

Cesarean Section • Surgical delivery via abdominal and uterine incision • Currently between 30-32% in the U.S. (1:3 deliveries) • Types of incision o Classical: Vertical incision in the anterior uterine wall o Low transverse (Phannenstiel): The most common o Low vertical Vaginal Birth After Cesarean (VBAC) • Also known as TOLAC (trial of labor after cesarean) • Dependent upon the indication for the original cesarean and type of incision • Induction of labor is an option with TOLAC • Risk for uterine rupture Induction of Labor • Unless there is a medical indication, no induction should be scheduled prior to 39 weeks • Best practice protocol requires Bishop Score of 8 or greater • May begin with cervical ripening agents (Cervidil or Prostaglandin Gel) prior to induction • Bishop Score: Evaluates the readiness of the cervix for induction of labor o Uses five measurements: Dilation, effacement, station, consistency, and position o Score of less than 6: Indicates the cervix is unfavorable or “unripe” for induction o Score of 8 or greater: A favorable cervix or “ripe” with a good chance of vaginal delivery

4.6 Labor Medications Systemic Analgesics •

Used during early labor Usually given IV or IM Opiates are first option Does not eliminate labor pain

• • •

Regional Analgesia • Epidural: The most common form of pain relief for labor and delivery in the U.S. o Anesthetic injected into epidural space that alleviates pain in the lower body o

Can be used throughout labor, with the level raised to accommodate a C-section if necessary

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