A laboring client, gravida 3 para 2, is admitted to the labor unit reporting severe perineal pressure and urgently requesting pain relief. The client's cervix is 10 cm dilated and 100% effaced, with the fetal head at 0 station. Which pain management technique is most appropriate for this client's report of perineal pressure?

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Quizplus · Accepted Answer

11ecbb05_cc0d_0b0e_b433_996d41698c55_MD0009_00 A pudendal nerve block infiltrates local anesthesia (ie, lidocaine) into the areas surrounding the pudendal nerves that innervate the lower vagina, perineum, and vulva. When birth is imminent, a pudendal block provides the best pain relief with the least maternal/newborn side effects and could be administered quickly by the health care provider. It does not relieve contraction pain but does relieve perineal pressure when administered in the late second stage of labor (Option D). In clients without an epidural, pudendal blocks may be used in preparation for forceps-assisted birth or laceration repair. perineal pressure (Option A) An epidural can be administered in the first or early second stage of labor but may not be a feasible option in late second stage when birth is imminent. A multiparous client may give birth before the epidural can be administered or before the epidural takes adequate effect (20-30 minutes). (Option B) Some clients forgo pharmacological pain relief during labor and instead utilize nonpharmacological techniques (eg, hydrotherapy, relaxation breathing). However, this client specifically requests pain relief, and nonpharmacological techniques would likely be ineffective considering birth is imminent. (Option C) IV narcotics cross the placenta and can cause neonatal respiratory depression when administered close to birth. Therefore, these are not generally administered in the second stage of labor. Educational objective: A pudendal nerve block can provide pain relief for clients experiencing perineal pressure in the late second stage of labor. It may also be used in preparation for forceps-assisted birth or laceration repair in clients without an epidural. It does not provide relief of contraction pain.

A Laboring Client, Gravida 3 Para 2, Is Admitted to the Labor