Labor and Del questions.

**canoehead, BSN, RN** · Dec 8, 2003

Anxiety about what? The labor? We'd give more education, breathing techniques, try for 1-1 staffing, encourage family members to stay with mom. For beeralized anxiety disorder we'd have all of the above plus the patient's established meds. I would expect the MD to have worked out a plan for management with the patient so she doesn't come in already worried that there is not going to be help for her when she needs it.

What's MPV? Sinus tach with no symptoms would be untreated. We could bring down the rate if the patient got symptomatic but I would expect that patient to be shipped elsewhere if problems were expected.

DoctorRN · Dec 8, 2003

Originally posted by FutureRNTerri
Hi,

What is the protocol for a mother in Labor who has excessive anxiety? Would narcs be used? Benzos? or does the epidural reduce anxiety?

How often do you run across this situation?

I also have a question about tachycardia. I have been diagnosed with gestational sinus tachycardia. I also have MVP. Resting BPM is about 120. I am concerned about during delivery. How is this situation handled? My OB looks at me like I am crazy when I express my concerns.

Thanks

Benzos would not be the drug of choice due to sedative effects on the baby. Epidural doesn't do much to reduce anxiety.

I can't say as I have ever heard of Gestational sinus tachycardia and a web search doesn't pull anything. There is also no mention in Danforth's obstetrics.

Are you anemic is that why you have tachycardia?

Do you have an arrythmia associated with your mitral valve prolapse? Have you been evaluated by a cardiologist? Have you had your thyroid checked out?

In 10 years in L&D I can say that I saw plenty of people who were anxious and a few who were severely anxious. Don't recall having a protocol for severe anxiety though.

Dayray, RN · Dec 8, 2003

In my mind the intervention would depend on the patient and what the anxiety was being caused by.

If the patient is anxious because they are in pain then I would help them with relaxation techniques and/or give them pain meds.

But many times pain isn't the biggest problem. Allot of times people are just scared. Thats when a soft voice and gentle explanations of "what to expect" and the reasons for interventions help allot.

It is also important to remember that patients experience loss of control during pregnancy and especially during labor. So if there is time (and there usually is) I explain options and let the patient make choices. Reassurance that you are going to do your best to take care of them and establishing trust help to allow the patient to regain control of there anxiety or accept direction from you.

I don't think that meds would be the best choice for anxiety in labor. Everyone is scared in labor and they use coping mechanisms to control the fear. I direct my efforts at identifying the patients coping mechanisms and reinforcing them.

These situation comes up often and I personal like them. lol I guess that sounds kind of sadistic so ill rephrase it. I like helping people overcome or deal with the anxiety. I find it challenging and rewarding.

As for the second question :

it is normal to have a 15- 20 bpm increase in early pregnancy and it may or may not continue threw out your pregnancy. I'm not sure if this is what your Ob is calling gestational sinus tach but if it is, it isn't really a diagnosis but a description of a normal physiologic change in pregnancy. that may be why he doesn't see it as a problem.

I think you are right to have concern about the MPV. Most times it doesn't cause a problem but sometimes it can depending on severity. If you don't feel your OB is addressing your concerns I would get a new one. There may be nothing special done for your MPV during labor and it might not be a cause for concern. However your OB should defiantly consider MPV and at least consider its potential risks. If you don't think he has get rid of him.

RENAISSANCE RN · Dec 8, 2003

Hi,

My thryroid is normal .5 tsh ( lower end of the spectrum). The OB said that this is ok. My MVP has been reevaluated by an echo last week. ( I am awaiting the results). I had a 24 hour holter ( awaiting the results). MY in office Ekg showed Sinus Tach. Resting BPm are about 110-120 ( activity) 130-150. My blood tests showed slight anemia ( 37.1) - OB does not feel that this is the cause of the tach. ( He suspects that it is just brought on by pregnancy). tach - not MVP.

So I guess this is just a waiting game. I know that this is probably benign. I think I may add a cardiologist to the mix, this may calm my fears, I think I just don't feel confident in the OB alone. I have never had a condtion like this before.

I appreciate all of your help.