A nurse is assisting a client who is in active labor and plans to use hypnosis as a nonpharmacologic method of pain relief.

Which of the following actions should the nurse take to facilitate this method?

These are the factors that the nurse should consider when choosing a pharmacological pain management method for a client who is in active labor.

• the client’s preference and birth plan should be respected and supported by the nurse.The client may have specific wishes or expectations about the type and timing of pain medication, and the nurse should discuss these with the client and provide information and education as needed.
• the stage and duration of labor affect the type and effectiveness of pharmacological pain management methods.For example, parenteral opioids provide pain relief that is superior to nitrous oxide but inferior to regional anesthesia.However, opioids may cause adverse effects such as nausea, vomiting, sedation and respiratory depression in both the mother and the fetus.Therefore, opioids are usually given in early labor and avoided in late labor or close to delivery.Regional anesthesia, such as epidural or spinal anesthesia, provides the most effective pain relief but may also have some drawbacks such as hypotension, pruritus, urinary retention and prolonged second stage of labor.Therefore, regional anesthesia may not be suitable for clients who have contraindications or who are in advanced labor.
• the fetal heart rate and position may influence the choice of pharmacological pain management method.For example, regional anesthesia may cause maternal hypotension, which can reduce uteroplacental blood flow and cause fetal bradycardia.Therefore, regional anesthesia should be used with caution in clients who have fetal distress or nonreassuring fetal heart rate patterns.Additionally, some fetal positions, such as occiput posterior or transverse lie, may cause more severe back pain that may not be relieved by regional anesthesia alone.In such cases, other methods such as sterile water injections or pudendal block may be helpful.

The stage and phase of labor and the fetal heart rate and pattern are important factors that the nurse should consider when choosing a systemic analgesic for a client who is in active labor.Systemic analgesics can cross the placenta and affect the fetus, so the nurse should monitor the fetal heart rate and pattern for any signs of distress or changes.The stage and phase of labor can influence the timing and effectiveness of systemic analgesics, as well as the risk of adverse effects on the mother and the fetus.For example, systemic analgesics given too early in labor may prolong labor, whereas systemic analgesics given too late in labor may cause respiratory depression in the newborn.

Normal ranges for maternal vital signs are: blood pressure 110/60 to 140/90 mm Hg, pulse 60 to 100 beats per minute, respiratory rate 12 to 20 breaths per minute, and temperature 36.5 to 37.5°C (97.7 to 99.5°F).

Normal ranges for fetal heart