C-Sections and VBACs – Past, Present, and Future

C-Sections and VBACs – Past, Present, and Future
Presentation by:
Russell S. Kirby, PhD, MS, FACE

Professor and Vice Chair
Department of Maternal and Child Health
School of Public Health
University of Alabama at Birmingham

Objectives

* Identify trends in Cesarean delivery and VBAC
* Discuss the clinical and public health significance of recent trends
* Describe evidence-based practice and its role in clinical decision making
* Review several recent influential publications and their impact
* Speculate on the future of obstetrics and labor/delivery management


Percent of Live Births
Total C- Section
Rate
Primary C-Section
Rate
VBAC Rate
Trends
Risk Factors Associated with Cesarean Delivery
BMI Cesarean Vaginal
Clinical Documentation of Previous Cesarean Section
Operative Vaginal vs. C-Section Rates
The Realistic Evidence-Based Rating Scale
The Practice of Evidence-based Practice
How Do We Practice EBP?
Quality of Evidence
Commentary on Elective Cesareans

C-Sections and VBACs – Past, Present, and Future.ppt

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Cesarean Section in Nulliparous Women

Cesarean Section in Nulliparous Women
Presentation by:
Noelle Lefitz, RN, BSN, SNM
Nicole Carlson, RN, BSN, SNM
Nancy K. Lowe, CNM, PhD, FACNM, FAAN

Background

C-section rate for low-risk (full-term, singleton, vertex) nulliparous women:
Risks of Cesarean Section
Long term Maternal Risks
More Risks of C-Section
Aim of Study
Review of Literature
Characteristics of nulliparous women associated with CDD
BMI
Advanced Maternal Age
Epidural
Occiput Posterior (OP) Presentation
Anxiety
Continuous Labor Support
Decreased Hydration in Labor
Induction of Labor
Low Bishop Score/Unengaged Vertex Presentation
Diagnostic decision-making practices around dystocia
The Definition of Dystocia
Recommendations: SOGC (& ACOG)
Elective Induction
Questioning the Definition
CNMs: The Protective Effect from Cesarean Birth
Study Design
Variables Examined
Results
Conclusions
Pain Control
The OHSU CNMs

Cesarean Section in Nulliparous Women.ppt

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Pain Perception, Management And Assessment

Pain Perception, Management And Assessment
Amy C. Chavarria, RN, MSN, MBA, HCM, CCE


THE PAIN PROCESS

Mechanical
Chemical
Thermal

Pain receptors are stimulated
NOCICEPTORS
Spinal Cord
Brain


STRUCTURES RELATED TO PAIN PROCESS
Physiologic Pain
Neuropathic Pain
Four Processes Involved in Nociception

* Transduction
* Transmission
* Perception
* Modulation

Pain Theories
III. Pattern (Summation) Theory
IV. Endorphin/Enkephalin Theory
Gate Control Theory
CHARACTERISTICS OF PAIN
PAIN SCALES
Adult and Older Adult
FACTORS AFFECTING PAIN PERCEPTION/RESPONSE
MANIFESTATIONS OF PAIN
ASSESS THE PATIENT’S PAIN

Develop Nursing
Diagnosis
Develop a Nursing
Care Plan
Implement
Plan of Care
BEHAVIORAL RESPONSES
Pain Assessment
OTHER FACTORS

Causative Factors
Relieving Factors
Pain-related
Problems
Activities for daily living
Treatment Plan
COGNITIVE THERAPY
Mind Interventions
GUIDED IMAGERY
HEAT AND COLD APPLICATION
Spiritual
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)
TENS ELECTRODE APPLICATION
SAFETY ISSUES
Implementation of Therapy
Maintenance of Therapy
Nonpharmacologic Invasive Techniques
Pharmacologic Interventions for Pain
Opioids (Narcotics)
Nonopioids/NSAIDS
Coanalgesic Drugs
WHO Ladder Step
Approach for Cancer Pain Control
Rational Polypharmacy
Oral Administration
Transmucosa/Transnasal and Transdermal Administration
Medication Administration
Subcutaneous Infusion Placement
Medication Administration
PATIENT CONTROLLED ANALGESIC (PCA)
Barriers to Effective Pain Management
DOCUMENTATION OF PAIN MANAGEMENT THERAPY
Pain is known as the 5th vital sign.
Specificity Theory
Clinical application of gate control theory:
Pain intensity and much more topcis are covered in this 143 slides presentation.

PAIN PERCEPTION, MANAGEMENT AND ASSESSMENT.ppt

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