What part in the contraction pattern do you administer narcotics to mom?

Well, ?. Think about your question.

I would think it would be the conclusion bc the fetus is not under any stress....

This is a bizzare question. Does it really matter when you administer it?

This is a question my teacher asked on a test and I saw on a practice NCLEX test.

What do you think the answer is?

It sounds like a theoretical, test question :)

I can see 2 schools of thought:

Between contractions, the baby's HR has a chance to "normalize" because he is not experiencing the stress and oxygen deprivation of a contraction. Some may say that this is the optimal time to introduce a medication which may affect the baby's heart rate, hemodynamics and physiological status.

At the peak of a contraction, the baby may be experiencing stress, but on the other hand, this time of relative reduced blood flow may actually decrease the amount of medication that reaches the baby's circulation.

In reality, by the time a narcotic is administered and circulates thru mother's bloodstream, thru the placenta and reaches the baby's circulation, there will probably be no correlation at all to the timing of a contraction, so what difference does it make?

Ideally, it's best not to give narcotics if delivery is anticipated prior to the time that the respiratory depression of the newborn will have "worn off." But even that is open to best judgement. If the mom is in such pain that she is unable to participate in a controlled delivery, a dose of narcotics may be the lesser of two evils.

In the AWHONN book, it says to admin narcs during the contraction to minimize the amount that reaches the fetus if your doing IVP. I start to give my narcs the beginning of the contraction and have it administered by the end. Our hospital policy is no narcs after 7cm dilated.

I have always done this DURING the contraction, SLOWLY. For the reasons AWHONN states.

7cm can be SO arbitrary. MANY primips will be HOURS before they deliver when still at 7.....even multips can take time.......I go more with 8 or even 9 in primips and maybe 6-7 in multips. But babies come when they want. Some faster than others. Narcs are not 100% safe and I tell my patients this.

The difficulty I have is my Pitocin is in the lowest port so just b/c I begin my IVP with a CTX, how much gets in during that point...and even if it gets into the bloodstream, you cannot assess how fast the patient will metabolize it, so who know how much is getting to the baby and at what point...and we have to push narcs over 10 minutes so there is NO way to be that exact every 2-4 minutes while pushing meds.