Maternity Nursing: Intrapartum Q 31

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A laboring client is to have a pudendal block. The nurse plans to tell the client that once the block is working, she:

  

     A. Will not feel the episiotomy

     B. May lose bladder sensation

     C. May lose the ability to push

     D. Will no longer feel contractions

    

    

Correct Answer: C. May lose the ability to push

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A pudendal block is a local anesthetic injection given as a treatment for pain in the second stage of labor (pushing) just before the delivery of the baby. It is administered through the vaginal wall and into the pudendal nerve in the pelvis, providing anesthesia to the perineum. The numbing effect of the pudendal block may cause the woman to lose the ability to push that is why it is not given when the baby’s head is too far down in the vagina.

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Option A: A pudendal nerve block targets the pudendal nerve trunk as it enters the lesser sciatic foramen, about 1 cm inferior and medial to the attachment of the sacrospinous ligament to the ischial spine. Here, the nerve is medial to the internal pudendal vessels. This nerve is accessed by 2 approaches, transvaginal and transcutaneous (or perineal).

Option B: Bladder sensation is not lost. The sensory and motor innervation of the perineum is derived from the pudendal nerve, which is composed of the anterior primary divisions of the second, third, and fourth sacral nerves.

Option D: Pudendal block does not abolish the pain of uterine contractions and cervical dilatation; this sensation is transmitted by the sympathetic fibers derived from the spinal levels of T10-L2.

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