QuestionShe was in a LOT, asynetic position ( at a +2 station). at 35 weeks I was 3cm 80% effaced. at admittance (10pm) I was 3cm 95% (5 weeks of bed rest); 1:10 5-6 100% 0 station; 3:34 6-7 100% +1; 4:54 7 100% +1; 5:56 8-9 +1 +2; 6:05 complete Drugs: 2306 Clindamycin 900mg; 0045 Phengram 25 mg; 0122 & 0124 stadol 1 mg iv & 1 mg im; 0334 stadol ? 1mg; 0414 pit drip started; 0454 pit upped to 2; upped to 4 at 0536; 0652 Clindamycin 900mg; 0711 1 l warm lr; 903 pit off.
The dr said they routinely give 2 mg right off the bat and then again 1 more every hour. Can you tell me where I can find the ACOG guidelines for that?
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Followup To
Question -
I was given stadol 2 mg ( 1 IV, 1 IM) at 1:30 am (was at 5-6cm after 1 hour of contractions)(according to manf. this is the max dosage for a 4 hour time frame). I had an unusual reaction the nurse noted it in my chart. It put me in a black out. Apparently my labor started to slow was at 6-7 at 3:30 - was given more stadol and then pitocin at 4:15 without being checked again. Was complete by 6am. My daughter became stuck LOT I believe (looking out right hip). I was told (later)that I had a primary arrest of labor. My dr told me that "it is good to sleep through active labor".
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Followup To
Question -
If given a pain medication and the patient has an adverse reaction to it - do you give them more? and do you go over the maximum dosage that the manufacurer gives?
Answer -
Common sense dictates that if I give a medication to a patient and there is an adverse reaction, and I am sure that it is due to the medication, I would stop the medication and find an alternative. There is a term called "minimal lethal dose", which is the dose at which there can be death from the drug. We try to give dosages well below this limit. Which medication during labor are you referring to?
Answer -
We usually give Stadol 2mg every 4 hours to "take the edge off the labor pains. Sometimes, I will give 1mg every 2 hours if the labor is progressing rapidly. However, if there appears to be secondary arrest of dilatation or cephalopelvic disproportion (stuck baby) we often recommend an epidural anesthesia because it will numb you from the waist down, whereas Stadol only takes away some of the discomfort. Stadol will not cause the type of reacion you described and it would be nice to know exactly what the nurse documented on the chart as to the reaction you had. I doubt that the Stadol had any role in your arrest of labor.
AnswerYou can try ACOG.org to find out the ACOG standars for managment of labor and delivery. HOwever, there is no "cookbook" style manual for the use of drugs during labor. Some practitioners use 2mg of Stadol and some use 1mg of Stadol at various times during the process. It is up to the individual.
