Many IBLCE Exam-takers struggle with the pharmacology items on the IBLCE Exam. I’ve never found that too tough, really. But today, it dawned on me that relatively few IBCLCs or IBCLC-candidates have had experience in labor and delivery. Certainly, labor and delivery medications are “fair game” for the exam, so you should have some fundamental knowledge in this area.
So, with my labor and delivery nurse hat on, let me give you some simple things you can do to prepare yourself for the exam.
1. Recognize common reasons why labor and delivery medications are used
I think it’s fair to say that the vast majority of medications given in a labor/delivery unit are given in order to:
- slow contractions if labor begins too early
- start or augment labor contractions if labor doesn’t start, or if it’s stalled
- provide pain relief at the local, regional, or systemic level
- control a problem that is exacerbated by labor (high blood pressure is just one but a very common example)
- strengthen contractions after birth and/or minimize postpartum hemorrhage
- prevent or correct a problem for the baby
Certainly, there can be others. But I’m trying to hit the highlights of drugs that I think you’ll find around the globe. Remember, it’s an international exam.
2. Name specific drugs in each category
If you know why a drug is given, you automatically increase your likelihood of correctly answering a question about it.
Preterm contractions
Different drugs are favored in different locales, and drugs fall in and out of favor in the same locale! By now, I think I’ve given them all! Common drugs to delay or stop labor include magnesium sulfate, terbutaline, and several others.
Starting or enhancing labor contractions …
is accomplished through a synthetic hormone. In the United States, it is manufactured under the brand name of Pitocin.
Pain relief…
is accomplished in different ways.
- Local anesthesia is often given before an episiotomy. Are you familiar with Novocain for dental surgery? If so, you can understand that the “caine” family of drugs can be injected into the perineum before an episiotomy. Pain relief can also be given at the regional level.
- Epidural anesthesia or analgesia is accomplished by using several different drugs, but as far as I can tell, fentanyl is always or nearly always part of that concoction. Spinal analgesia is given in some locales.
- General anesthesia (GA) is also accomplished by using several drugs. These days, GA isn’t used much here in the US. Nitrous oxide, commonly known as “laughing gas” is inhaled, and gives excellent although transient relief. Check here for more details.
Common complications
Conditions such as high blood pressure, or pregnancy-induced hypertension (PIH) can occur. The condition is often controlled by magnesium sulfate, or a commonly-used antihypertensive (labetalol )or others.
Post-delivery contractions
Ideally, contractions spontaneously occur after birth to expel the placenta. But not always. The first and best intervention is to put the baby to breast! This creates more circulating (endogenous) oxytocin. But sometimes, synthetic (exogenous) oxytocin (e.g., Pitocin™) is needed. If the bleeding is really bad, the mother may need methergine.
Medications for babies
Of course, there are “routine” medications like prophylactic antibiotic treatment for the eyes, and Vitamin K to prevent hemorrhage. Other times, however, naloxone (Narcan™) is needed to block the adverse effects of the mother’s pain-relieving drugs.
Other:
I doubt you’ll run into these, but as a labor nurse, I’ve sometimes given medications for anxiety or nausea/vomiting to the laboring woman. Medications are certainly given for other conditions, too.
3. Know the generic name for each labor drug
Drugs that have been around for decades are unlikely to have a trade name. And, remember that on the IBLCE Exam, you will see only the generic names. In the above descriptions, I gave you a few generic names of labor and delivery medications, but you’ll need to know many more.
4. Recognize good distractors
As one who writes practice exams, I’m always looking for distractors. (See the anatomy of an exam item.) The best distractors are “old” drugs (for example, I have not seen meperidine given to labor patients in decades). Similarly spelled drugs also make good distractors. For example, don’t mix up nalbuphine (Nubain™) with naloxone (Narcan™). Totally different.
So how do these labor and delivery medications affect breastfeeding and lactation? Watch for my next post!