Currently there are many different types and methods of pain relief. The doctor chooses one or several options depending on the woman’s wishes (if they discussed this in advance), depending on the condition of the woman in labor and the condition of the child at the time of birth.
Anesthetics
For pain relief during labor in modern anesthesiology, various medicinal substances. Premedication is carried out during the preparation process. Premedication includes the prescription of sedatives, analgesics, anticholinergics and other drugs. The use of these drugs is intended to reduce the negative impact on the body emotional stress, prevent possible side effects associated with anesthesia, facilitates anesthesia (it is possible to reduce the concentration or dose of the drug used, the excitation phase is less pronounced, etc.) Anesthesia is carried out using various medications. Medicines can be administered intramuscularly, intravenously or inhalation. All anesthetics act primarily on the central nervous system. Drugs acting on the central nervous system include: analgesics, tranquilizers, narcotic analgesics, etc. The proposed list of drugs is far from complete, but in my opinion it gives an idea of the drugs and their effects.
Propanidid(sombrevin, epanthol; agent for intravenous anesthesia) - when administered intravenously, it quickly binds to plasma proteins, quickly decomposes into inactive metabolites, and is not detected in the blood 25 minutes after administration. The narcotic effect occurs immediately after the administration of sombrevin, after 20-40 seconds. The surgical stage of anesthesia lasts 3-5 minutes. Propanidide causes a more pronounced hypnotic effect than an analgesic one. Sombrevin penetrates the placental barrier, but after 15 minutes it decomposes into inactive components. There is evidence that sombrevin can lead to respiratory depression, acidosis in the fetus, and cause allergic reactions in the mother.
Ketamine hydrochloride(calypsol, ketalar; analgesic) - half-life is about 2 hours. After intravenous administration the narcotic effect occurs within 30 seconds and lasts 10 minutes; after intramuscular injection- after 5 minutes and lasts 15 minutes. Has a strong analgesic effect, does not relax skeletal muscles and does not inhibit muscle reflexes. respiratory tract. In pregnant women, it increases the tone of the uterus. Ketamine penetrates the placental barrier and in doses of more than 1.2 mg/kg of the birthing woman’s body weight causes depression of vital signs. important functions fetal body. There is evidence that sombrevin and ketalar also have an effect on the body’s immunological system. Thus, when sombrevin is administered, the number of T- and B-lymphocytes decreases by 15 and 4%, while when ketalar is administered, they increase by 10 and 6%, respectively, which suggests that ketalar is less dangerous in pregnant women with allergic diseases, with blood loss and immune system deficiency. This is important, since during pregnancy there is a shift in immune system mother's body, which consists in a decrease in cellular and humoral immunity, in addition, a number of immunological systems are directly related to perinatal damage central nervous system fetus
Barbiturates(sodium thiopental, hexenal; drugs for non-inhalation anesthesia) - after intravenous administration, 65-70% of the dose of barbiturates binds to plasma proteins, and the remaining free fraction has a narcotic effect. The narcotic effect of barbiturates is based on inhibition of the cerebral cortex and blockade of synapses. Barbiturates are weak acids, having a low molecular weight, penetrate the placental barrier, and the degree of depression in the fetus is directly proportional to the concentration of the anesthetic in the mother’s blood.
Diazepam(relanium, seduxen; tranquilizers) - sedatives that relieve irritability, nervousness, and stress. At oral administration absorbed in an amount of about 75%, the maximum level in plasma occurs after 1-1.5 hours. In the liver, 98-99% of diazepam is metabolized into the enterohepatic circulation. The half-life in the blood plasma of women is 1-3 days, in newborns - 30 hours. In the fetal blood, the highest concentration is created 5 minutes after intravenous administration. In the umbilical cord blood of a newborn, the concentration of diazepam is equal to its concentration in venous blood mother when administered in a dose exceeding 10 mg or more. At the same time, the concentration of diazepam in the brain is low. In this case, apnea in newborns, hypotension, hypothermia, and sometimes signs of neurological depression are common. Diazepam is able to accelerate the dilation of the cervix and helps relieve anxiety in a number of women in labor.
Promedol(narcotic analgesic) is easily absorbed by any route of administration. Maximum concentration in plasma is determined after 1-2 hours. The mechanism of action of promedol is based on interaction with opiate receptors. It has an analgesic, sedative effect, and depresses the respiratory center. After parenteral administration the analgesic effect occurs within 10 minutes and lasts 2-4 hours. Promedol has an antispasmodic effect and promotes dilatation of the cervix. Easily penetrates the placenta. 2 minutes after intravenous and somewhat later after intramuscular administration, a concentration appears in the umbilical cord blood approximately equal to that in the maternal blood plasma, but there may be significant fluctuations in individual fetuses depending on their intrauterine state. The more time passes from the moment of administration of the drug, the higher its concentration in the blood of the newborn. The maximum concentration of promedol and its toxic metabolite in the blood plasma of a newborn was observed 2-3 hours after its administration to the mother. The half-life of promedol elimination from the body of a newborn is approximately 23 hours, and in the mother - 3 hours. Promedol is generally considered safe for mother and baby. However, in some cases, the drug can cause depression in the newborn due to the fact that it has an inhibitory effect on the processes of glycolysis and the respiratory center. Promedol, like all morphine-like drugs, has a number of disadvantages, the main of which is that in effective doses(more than 40 mg) it depresses breathing and causes severe drug dependence, can cause a state of stupor, nausea, vomiting, smooth muscle atony, constipation, depression, decreased blood pressure. Promedol can cause respiratory depression and drowsiness in a child. After birth, breathing is restored, but children do not immediately latch onto the breast.
Described side effects inherent in almost all potent analgesics, with the exception of pentazocine (Lexir, Fortral). For pain relief, non-narcotic analgesics (baralgin, analgin...) are usually not used, since they depress labor.
Promedol(narcotic analgesic) is used in most Moscow clinics as an anesthetic. Promedol has an analgesic and antispasmodic effect (helps accelerate the opening of the pharynx). An injection of promedol is administered into the buttock or thigh. Promedol manifests itself in different ways. For some, it has a calming effect, relaxes, and causes drowsiness, although consciousness is completely preserved. For someone else, some women lose control of themselves, experience a state of intoxication, and may feel nauseous and stagger.
Pentazocine(lexir, fortral; narcotic analgesic) - indicated for pain relief during labor. It has a stimulating effect on hemodynamics and respiration, and also has a birth-stimulating effect. Does not have a pronounced sedative effect. This drug is considered to be non-narcotic, incapable of causing addiction, that is, an analgesic without a psychometic effect.
Diprivan(propofol) is a new ultra-short-acting intravenous anesthetic. Diprivan quickly induces sleep, maintains the inclusion of consciousness throughout the infusion (infusion) of the drug with a rapid restoration of consciousness after stopping the infusion, and has fewer side effects compared to other intravenous anesthetics. However, a number of publications indicate possible undesirable manifestations of diprivan during anesthesia, including a deterioration of certain parameters of central hemodynamics, although data on this issue are extremely contradictory. From a pharmacological point of view, diprivan is not an anesthetic, but a hypnotic.
Nitrous oxide(a means for inhalation anesthesia) - is one of the components general anesthesia during caesarean section. The drug is insoluble in lipids. It is absorbed very quickly (2-3 minutes) and excreted unchanged by the lungs. 5-10 minutes after the start of inhalation, tissue saturation with anesthetic reaches its maximum. In 5-6 minutes it is completely eliminated from the blood. Relatively weak anesthetic with high degree safety when mixed with oxygen. It affects only the central nervous system, does not depress respiration, cardiovascular system, does not provide negative influence on the liver, kidneys, metabolism, contractile activity of the uterus. It quickly penetrates the placenta, after 2-19 minutes the concentration of nitrous oxide in the blood of the umbilical cord vein is 80% of the level in the mother's blood. Long-term inhalation of nitrous oxide sometimes results in the birth of a baby with low Apgar scores.
Nitrous oxide is given through a special apparatus using a mask. The woman in labor is introduced to the technique of using nitrous oxide; in the future, she puts on a mask herself and inhales nitrous oxide with oxygen during contractions. During pauses between contractions, the mask is removed. Nitrous oxide mixed with oxygen significantly reduces pain without completely eliminating it and causes euphoria. It is used at the end of the first stage of labor. The effect of the gas appears after half a minute, so at the beginning of the contraction you need to take several deep breaths. The gas dulls the pain; when inhaling it, the woman feels dizzy or nauseous. Nitrous oxide is usually given in combination with narcotic analgesics.
Relaxers(ditylin, listenol, myorelaxin; muscle relaxants) - are slowly and incompletely absorbed into the digestive tract. Do not penetrate the placenta. Causes persistent muscle relaxation. These relaxants do not affect the condition of the newborn, but in some newborns with impaired feto-placental permeability, some authors note a low Apgar score.
The use of drugs for the treatment of pain and anxiety in women in labor involves the use of anesthetics and analgesics, both narcotic and non-narcotic, and their combination with sedatives and neuroleptics.
General anesthesia
Most often, general anesthesia is used for childbirth by caesarean section. General anesthesia affects not only the woman in labor, but also the child.
Neuroleptanalgesia method
The method of neuroleptanalgesia, which provides a kind of mental peace, satisfactory analgesia, accompanied by stabilization of hemodynamic parameters and the absence of a significant effect on the nature of labor, has become quite widespread for pain relief.
Fentanyl is injected intramuscularly. The greatest effect is achieved when combined with droperidol. If necessary, a repeat dose is administered after 3 to 4 hours.
Neuroleptanalgesia is not recommended for use if the patient has severe hypertension (increased arterial pressure), increased tone bronchioles You need to be prepared for the possibility of drug-induced depression in the newborn. Narcotic analgesics have a depressive effect on the respiratory function of the newborn.
Ataralgesia method
Another common method of labor pain relief. The ataralgesia method is a combination of analgesics with diazepam, seduxen and other benzodiazepam derivatives. Benzodiazepane derivatives are among the safest tranquilizers; their combination with analgesics is especially indicated for severe fear, anxiety and mental stress. The combination of dipyridole with seduxen has a beneficial effect on the course of labor, shortening the total duration and period of cervical dilatation.
However, there is an effect on the condition of the newborn, in the form of lethargy, low indicators according to the Apgar scale, low neuroreflex activity.
Epidural analgesia method
This method has been studied quite thoroughly. The beneficial effect of epidural analgesia is important during pregnancy and childbirth, complicated by gestosis, nephropathy, late toxicosis, in the analgesia of labor in the breech presentation of the fetus, it has a beneficial effect on the course of premature birth, shortening the period of cervical dilatation and lengthening the period of expulsion, which contributes to a smoother advancement of the head. At the same time, under the influence of epidural analgesia, the muscles of the perineum relax and the pressure on the fetal head decreases. It is indicated for congenital and acquired heart defects, chronic diseases of the lungs and kidneys, edema, myopia (myopia) and damage to the retina.
At the same time, epidural analgesia may cause a decrease in uterine activity. There was also an increase in the duration of labor and a decrease in uterine activity in the second stage of labor during epidural analgesia, which contributed to an increase in the number of surgical deliveries (forceps, Caesarean section). A negative hemodynamic effect is also known. In addition, hypotension is noted Bladder, increased temperature (hyperthermia).
Currently used for epidural analgesia various drugs(local anesthetics, narcotic and non-narcotic analgesics, diazepam, ketamine). Lidocaine is the most widely used drug in pregnant women. Lidocaine is metabolized in the liver. Cumulation (accumulation) of the drug often occurs, which subsequently manifests itself as neuro- and cardiotoxicity in relation to the mother and fetus.
Epidural analgesia provides long-lasting and highly effective pain relief from the onset of labor until birth, but can cause serious complications.
The principle of epidural analgesia in labor is that the anesthetic is injected into the epidural space and blocks the subdural nerves in the T10 to L1 segments. It is effective when contractions cause severe back pain and position changes do not help or are difficult. Its time should be calculated so that the effect of the anesthetic ceases by the second stage of labor, otherwise labor may slow down and the risk of episiotomy and forceps may increase. Anesthesia should be stopped when pushing occurs. This period requires “personal” participation from the woman. Anesthesia is not stopped in the second stage of labor (pushing period), if necessary special indications, for example, myopia.
Standard technique for epidural analgesia in labor
IN obstetric practice Combined subdural-epidural anesthesia and analgesia are used. The epidural space is punctured with an epidural needle, through which a needle is then inserted to puncture the subdural space. After removal of the subdural needle, the epidural space is catheterized. The main application of the method is the administration of narcotic analgesics for effective pain relief from contractions, followed by the use of continuous infusion epidural analgesia from the end of the first stage of labor.
An epidural takes about 20 minutes to administer. The woman is asked to curl up with her knees touching her chin. The puncture is performed in a lateral or sitting position. Many anesthesiologists use a sitting position for puncture, since in this position it is easier to identify middle line back, which often causes certain difficulties due to swelling subcutaneous tissue lumbar region and sacrum. The back is treated with an anesthetic solution. After local anesthesia the skin is pierced with a thick needle to facilitate subsequent needle insertion for epidural analgesia. The epidural needle is slowly advanced into the interspinous junction (the doctor inserts a hollow needle into intervertebral disc). A syringe is attached to it. Anesthesiologist administers anesthetic syringe in the lower back. The medicine is delivered through a tube inside the needle as needed. The needle is not removed, which allows you to administer an additional dose if necessary. The effect of the anesthetic wears off after 2 hours. It may be accompanied by some difficulty in movement and trembling in the hands. Some women feel weakness and headache, as well as heaviness in the legs, which sometimes lasts for several hours, itchy skin, urinary retention.
Like all methods of anesthesia, such anesthesia has a number of side effects and complications. Epidural anesthesia with concentrated solutions of local anesthetics can increase the duration of the first and second stages of labor, and then there is a need for oxytocin (oxytocin increases uterine contractility) or surgical delivery.
Side effects such as respiratory depression, lower back pain, temporary numbness of the limbs, headache, dizziness, nausea, vomiting, itching, depression. You should immediately report any unpleasant sensations to your doctor! The most dangerous complication is inflammation of the peridural space, which can appear on days 7-8. This happens when the rules of asepsis and antiseptics are poorly observed. Another complication is hypotension (low blood pressure). It occurs as a result of an overdose of the drug; to prevent this from happening, the woman in labor is given medications that increase vascular tone.
A competent and highly qualified doctor, understanding the seriousness of the entire procedure, will explain to the woman all the pros and cons and will not perform epidural anesthesia unless absolutely necessary, simply because he was asked. Most anesthesiologists discuss with women the effectiveness and benefits of this method for both mother and baby and the risks possible complications. After which the woman signs papers stating that she is familiar with all the pros and cons and agrees to this procedure. (“It is a natural sense of self-protection for the anesthesiologist to want written consent; the obstetrician should note in her notes that the woman agrees to the epidural, and the anesthesiologist would be wise to simply sign the note.”) Take your time during a normal pregnancy and during normally developing labor, do an epidural.
It’s a different matter when this is the only way to relieve pain during childbirth and carry it out safely. Then try, after talking with your doctor, to be as favorable as possible about this procedure! A positive attitude is 90% of success! In the process of choosing, you can doubt, think about, weigh, choose what is best for you now, BUT, when you have made a decision, follow only it! Vanity and tossing around in the mind will only ruin things.
Women who are subsequently dissatisfied with epidural analgesia during labor usually come to the maternity hospital with a strong attitude towards this method of pain relief and agree to have it only when there is time for detailed explanations not anymore. One should adhere to the tactic of “explain, but not persuade.” This means that, while explaining to a woman all the advantages of spinal methods of pain relief, one should not insist on their choice. This is due to the fact that when analyzing complications, it very often turns out in retrospect that most of the troubles occur in those women who categorically refused epidural anesthesia or analgesia, but succumbed to the doctor’s persuasion. Apparently, there is something more serious than our ideas about clinical physiology spinal methods of pain relief. Of course, the ideal time to discuss the role of spinal pain management with expectant parents is before birth."
Fear of childbirth (especially the first in life) is a standard phenomenon. But, as a rule, they are afraid not of the birth itself, but of the pain that the girl experiences at this time. Yes, labor takes place different people differently. Some say that everything is almost painless, while others say that the pain is simply unbearable. Here, a lot depends on the characteristics of the mother’s body. In this article we will look in detail at pain relief during childbirth, its types, indications and contraindications. The information will be useful for those who are planning to give birth to a child, but are afraid of pain and do not know what pain relief methods exist today.Basic methods of pain relief during childbirth
In modern obstetric practice there are several effective ways pain relief. On this moment Epidural anesthesia during childbirth is considered optimal, allowing to completely eliminate pain in the first stage of labor - when the cervix opens. In most cases, this is the moment that is most painful for a woman. And often the longest. Epidural anesthesia during natural childbirth makes the process painless. The essence of the procedure is that the solution local anesthetic inserted into the space above the shell spinal cord. After the injection, within a couple of minutes the entire lower part of the body becomes insensitive. The signal from the brain is blocked and the woman does not experience pain. The advantage of epidural anesthesia is that, unlike general anesthesia the woman remains conscious.
2. Inhalation anesthesia during childbirth
Less radical, but also not as effective, is inhalation anesthesia. It is a general anesthesia using nitrous oxide, which is supplied to the lungs of the woman in labor through a special mask. This type of anesthesia is used in the first stage of labor, just like the previous method.
3. Local anesthesia during childbirth
Its essence boils down to the fact that only certain areas of the body are anesthetized. Thus, the woman in labor remains conscious throughout the entire period of labor.
4. Narcotic analgesics during childbirth
These drugs can be administered either intramuscularly or intravenously. Under their influence, sensitivity to pain during childbirth is reduced, and the woman in labor can relax more between contractions.
This is far from full list methods of pain relief during natural childbirth without cesarean section. However, obstetricians and gynecologists recognize them as the most rational and safe for mother and child. In any case, the method of pain relief is prescribed individually in each case by the attending physician.
Methods of pain relief during cesarean section birth
A caesarean section during childbirth is often necessary. IN in this case Several types of pain relief are used. And in some cases, the woman in labor can choose which method to use. However, obstetrics and gynecology specialists strongly recommend two types:
· Epidural anesthesia;
· General anesthesia.
What determines the choice of pain relief during childbirth?
It is impossible to answer unequivocally which anesthesia is better for caesarean section. There are three main factors depending on which you should choose the method of pain relief:
1. Psychological preparedness for surgery. A woman can choose whether she prefers to sleep during labor or remain awake to see her newborn baby right away.
2. Level of equipment of the maternity hospital, where the operations will be performed. It may be that the selected maternity hospital is not equipped necessary equipment for performing certain types of anesthesia.
3. Qualification of specialists giving birth. First of all, this concerns the anesthesiologist and whether he can really perform any of the methods of pain relief equally well.
Let's look at both types of anesthesia in more detail and decide which anesthesia is better for a caesarean section.
Anesthesia is performed using three components: “preliminary anesthesia”, insertion of a tube through the trachea and supply of anesthetic gas with oxygen, and administration of a muscle relaxant. Only after all three steps have been completed can the operation begin.
The advantage of general anesthesia is that the woman in labor sleeps soundly during all stages of the operation and does not feel pain. In addition, there are almost no contraindications to it. But at the same time, quite serious side effects and complications can occur.
Complications from general anesthesia during childbirth
· Headaches, dizziness, nausea and unpleasant muscle weakness.
· Allergic reactions, respiratory tract infection, pneumonia in especially critical cases.
Among other things, general anesthesia can affect the child:
Drowsiness and general weakness;
· Temporary breathing problems;
· Perinatal encephalopathy.
Similar Negative consequences are not common, but can occur. But before you give up general anesthesia, please note that today effective techniques, helping the child to tolerate the effects of anesthesia normally.
The principle of implementation is practically no different from that described above, so we will not describe it in detail again. Let's dwell on the unmentioned details. Preparation for anesthesia begins on average half an hour before the operation. After the anesthesia takes effect, specialists proceed directly to performing a cesarean section.
Despite the fact that epidural anesthesia is considered one of the most gentle and safe methods pain relief, contraindications for its implementation everything is just like that:
· The presence of skin inflammations or pustules that are located within a radius of 10 cm from the puncture site;
· Problems with blood clotting;
· Allergic reactions to some of the drugs used;
· Diseases of the spine and osteochondrosis, which are accompanied by severe pain;
· Incorrect position of the fetus;
· Too much narrow pelvis or high fetal weight.
Side effects are also possible. However, if we are talking about caesarean section, then with epidural anesthesia their risk is significantly higher, with anesthesia with natural childbirth. The fact is that more drugs are administered during surgery. Including narcotic substances, including fentanyl.
However, if the anesthesiologist is experienced and highly qualified, then complications in most cases are minimized. However, even in this case, certain discomfort after execution operations can take place.
Consequences of epidural anesthesia
· Trembling legs, headaches and back pain. Often, all these consequences completely disappear a few hours after the operation, but in rare cases the headache lasts for several days, and sometimes even up to several months.
· Problems with urination. A rare side effect is allergies. And almost always specialists have everything they need to eliminate such effects.
· Nerve or spinal cord injury. An extremely rare phenomenon that occurs only during the work of an unprofessional or inexperienced anesthesiologist.
It should also be remembered that with epidural anesthesia, a woman’s legs will go numb. This frightens many and causes severe discomfort.
Indications for anesthesia during childbirth
Both in the case of natural childbirth and birth by cesarean section, there are a number of indications for anesthesia:
· Severe pain during labor in a woman in labor. On average, about 25% of women in labor experience significant pain when anesthesia is urgently needed. About 65% experience moderate pain, and approximately 10% experience only minor pain painful sensations;
· Too much big size the fetus, since its release can cause serious pain;
· Labor takes too long;
· Weak labor;
· ALWAYS during a caesarean section;
· With fetal hypoxia. In this case, anesthesia is one of the most effective methods to reduce the risk of its manifestation;
· Necessity surgical intervention during the birth process. In this case, intravenous anesthesia is mainly used.
Pain relief with promedol during childbirth
Pain relief during childbirth with promedol is one of the most popular methods. However, it should be remembered that promedol is a narcotic substance. Promedol is injected into a vein or muscle. In most cases, the injection allows you to take a break from pain for half an hour to two hours. Sometimes I even manage to sleep normally. It all depends on the body’s reaction to the effects of the drug. Therefore, some women in labor sleep soundly until the baby is born, while others only have time to take a short nap. The upper limit of the drug's effect sometimes reaches two hours from the moment of birth.
The injection is not performed after the cervix is dilated more than 8 cm, since the baby must take the first breath independently. Accordingly, he must be cheerful, which is impossible if he is also affected by the drug. It is also not recommended to use promedol before the cervix is dilated to at least 4 centimeters. If the injection is given before the cervix dilates, it may become main reason birth weakness. In addition to the direct analgesic effect, promedol can be used to treat various pathologies of labor. It should be remembered that the drug may have a number of contraindications:
· individual intolerance;
· if there is depression of the respiratory center;
presence of a blood clotting disorder;
simultaneously with taking MAO inhibitors for the treatment of central nervous system diseases;
· high blood pressure;
· depression of the nervous system;
heart rhythm disturbances.
Promedol during childbirth can cause complications for the child and mother:
· Nausea and vomiting;
· Weakness;
Confusion;
· Weakening of body reflexes;
· Respiratory dysfunction in a child.
In this regard, it is necessary to weigh the pros and cons of using promedol before making a choice in favor of the drug.
Modern methods and the methods of labor anesthesia, as you may have already understood, are different. However, there is not always an urgent need drug pain relief childbirth In some cases, it is quite enough to perform some exposure without drugs to ensure a reduction in pain in the woman in labor. Let's look at the main ones.
Types of natural pain relief during childbirth
1. Pain-relieving massage. In the process of performing a massage, a specialist acts on the surface of the body and nerves, while causing minor pain. At the same time, attention is diverted from labor pain. In most cases, the massage consists of stroking the back and collar area.
2. Relaxation. It is not always necessary to even require the intervention of a specialist to relieve the pain. There are a number of relaxation techniques that can reduce pain levels and provide good rest in between.
3. Hydrotherapy. Childbirth in water, during which pain is noticeably reduced, and the birth itself occurs much faster. You can use either a shower or a bath during contractions.
4. Electroanalgesia. In this case it is used electricity, which affects key biological active points and allows you to better tolerate labor pain.
5. Fitball. The fitball makes it easier to endure contractions; you can sit or lie on it.
Additional types of anesthesia
Spinal anesthesia– a single injection using a local anesthetic. The duration of action is from 1 to 4 hours, depending on the chosen anesthetic and the characteristics of the mother’s body;
Combined technique- combines best sides spinal and epidural anesthesia. This method prescribed by an anesthesiologist;
Regional anesthesia– anesthesia of individual areas. One of the most effective, safe and comfortable ways.
Every woman in labor has the right to choose the method of pain relief that is most suitable for her. However, the final decision is made together with the attending physician. To achieve the desired result and complete pain relief, you need to choose different methods in each specific case. Otherwise, there may be negative consequences for the mother and child, as well as pain. Therefore, no matter what kind of birth is coming, the approach to choosing a pain reliever should be responsible and balanced.
Lecture No. 16 (04/15/14)
Pain relief during labor: modern principles and methods.
Pain relief for childbirth – a set of measures aimed at the prevention and treatment of disorders of uterine contractility, correction of the threatening condition of the intrauterine fetus and elimination of severe discomfort in women in labor.
Excessive labor pain can disrupt normal labor birth act, contribute to fatigue during childbirth, the development of weakness and incoordination of labor. At the same time, complete analgesia is achieved and labor weakens or stops. Therefore, it is acceptable for a woman to maintain moderate levels of physical overstrain. Such an interpretation of the significance of labor pain is consistent with its modern understanding as a negative biological need that forms a functional system that ensures the process of childbirth.
Pain response levels:
Level 1 – fabric
Level 2 – segmental
Level 3 – NS, subbuttal area
Level 4 – CNS, cerebral cortex
A painful birth is more likely in the following cases:
Dysmenorrhea, painful menstruation before giving birth
At the birth of a large baby
First birth
Long lasting labor
Premature birth
Use of oxytocin during childbirth
After expiration of amniotic fluid
In case of insufficiency of ………………………… of a woman in labor
The main causes of pain during childbirth are:
Opening of the cervix, rich in nerve receptors of the highly sensitive peritoneum.
Uterine sprain
Excitation of vascular receptor fields
Myometrial contraction
Labor pain relief should be started under the following conditions:
Established labor activity
Development of regular contractions
Opening of the cervix by 3-4 cm
Severe pain and restless behavior of the woman in labor
No obstetric contraindications
Requirements for obstetric drugs:
Pain relief must be long-term
Should be carried out in the first and second stages of labor
It should be easily interrupted - it is impossible for light obstetric anesthesia to turn into deep anesthesia, when the muscles relax, gas exchange between the mother and the fetus worsens
During the operation, a deeper anesthesia is given, but also taking into account the interests of both the mother and the fetus, so as not to cause drug-induced depression.
Group of pain relief methods:
Agents that have an effect on the cortex, hence the subcortex: magnesium sulfate, morphine and its derivatives, scopolamine, hydrochloride, chloroform, nitrous oxide, GHB, Viadrin, hypnosis, CiPPOR, electroanalgesia.
Agents acting on the subcortex: veronal, pyramidon, medinal, periakton, amitaoiatria.
Spinal block: lumbar, sacral, invertebral, epidural, caudal - widely performed abroad, but the percentage increases surgical interventions, since it is paid.
Local anesthesia (infiltration, conduction).
When conducting analgesia during labor, it should be remembered that the placenta does not interfere with the passage of analgesics. The fetal respiratory center is sensitive to sedatives and analgesics, so the use of these drugs leads to respiratory depression in newborns.
General anesthesia:
In obstetrics they are used only in emergency cases, as anesthetics penetrate the placenta and depress the central nervous system of the fetus.
Inhalation anesthesia:
Nitrous oxide– used in the 1st and 2nd stages of labor. It does not prolong labor time or suppress contractions. A mixture of nitrous oxide and oxygen in equal proportions provides sufficient analgesia, the patient breathes this mixture between pushes during the second stage of labor.
Cyclopropane– used only shortly before resolution – depresses the fetal central nervous system.
Halothane– used to achieve maximum relaxation of the uterine muscles (internal rotation, bringing down the fetus by the leg, reversing the inversion of the uterus).
Atonic bleeding may develop, so the administration of the anesthetic should be short-term.
Analgesia and sedative therapy during childbirth:
Meneredine and Promethazine– the joint of a narcotic analgesic tranquilizer effectively relieves pain during childbirth. Menedine 50-100 mg with Promethazine 25 mg can be administered every 3-4 hours. The effect occurs after 45 minutes.
Butorphanol and Narbuphine– synthetic narcotic analgesics are used intravenously. The fetal respiratory center is less depressed.
Morphine– a strong narcotic analgesic, and is rarely used during the active phase of labor. Usually prescribed IM 10-15 mg to patients with frequent, painful, ineffective contractions during discoordinated labor.
Naloxone– an antagonist of narcotic analgesics, normalizes the breathing of a newborn.
Barbiturates (Sodium Thiopental, Hexenal, drugs for non-inhalation anesthesia) - after intravenous administration of 65-70% of the dose, barbiturates bind to plasma proteins, the remaining free fraction has a narcotic effect. The narcotic effect of barbiturates is based on inhibition of the cerebral cortex and blockade, and the degree of fetal depression is directly proportional to the concentration of the mother’s blood.
Ataralgesia:
This is a combination of analgesics with diazepam, seduxen and other benzodiazepam derivatives. Benzodiazepine derivatives are among the safest tranquilizers; their combination with analgesics is especially indicated for severe fear, anxiety and mental stress. The combination of roperidol with seduxen has a beneficial effect on the course of labor, shortening the total duration of the period of cervical dilatation. However, there is an effect on the condition of the newborn, in the form of lethargy, low scores on the Aprgar scale, and low neuroreflex activity.
Conduction anesthesia:
* Nerve pathways– complete pain relief is achieved by blocking fibers of the 9th and 12th thoracic nerves, parasympathetic and sensory fibers, and sacral nerves.
* Paracervical blockade– effective for pain relief during contractions, including the second stage of labor. 5-10 ml of a 1% lidocaine solution is injected into the paracervical area at 3 and 9 o'clock or into the uterosacral area at 4 and 8 o'clock on both sides of the cervix. The effect occurs within 1-2 hours.
* Pudendal nerve block- Pudendal anesthesia.
* Spinal anesthesia– contraindications: bleeding, severe hypertension, disorders of the blood coagulation system.
* Epidural anesthesia.
Physiological methods of SIPPOR:
Systematic monitoring of a pregnant woman for timely detection of pathology and taking appropriate measures.
It is correct to formulate the dominant attitude towards the act of childbirth as a physiological process in order to relieve a woman of the feeling of fear that childbirth is painful.
Familiarization with the process of the birth act in order to eliminate surprises, alarming orientations.
Teaching a pregnant woman correct, reasonable behavior, performing pain relief techniques - which are a technique for toning the cortex.
SIPPOR has two links:
Women's consultation
Hospital (maternity hospital)
The effects of medications on the fetus:
Oxytocin overdose– increased uterine tone, persistent disruption of uteroplacental perfusion – development of hypoxia.
Beta blockers and sedatives – decreased heart rate variability.
Epidural anesthesia– decreased maternal blood pressure, decreased maternal blood flow – fetal hypoxia.
Sedatives– decreased fetal activity and CTG reactivity.
Alternative methods of labor pain relief include:
Changing body position:
Standing or walking
Squatting
Squatting with support
Hanging on your partner
The presence of a loved one can help:
Reducing the duration of labor
Reduce the need for painkillers
Reducing the number of surgical interventions
Reducing the number of newborns with low body weight on the Apgar scale
Reducing negative perceptions of the birth process
Pain relief during childbirth helps a woman more easily cope with the birth of her baby. Advances in anesthetic techniques are minimizing the risk. Let's take a closer look at the methods of anesthesia during childbirth, find out which types are preferable, and how to relieve pain during childbirth without drugs.
Is there pain relief during childbirth?
Childbirth without pain recently seemed impossible. However, the development of medicine allows a pregnant woman to become a mother almost painlessly. At the same time, conditions of maximum comfort are created, which minimize the development of stressful conditions and eliminate fear. Completely stopped pain syndrome, and along with it, fear disappears on a subconscious level.
It is worth noting that pain relief during childbirth is sometimes a prerequisite. Childbirth is not possible without anesthesia if there is chronic diseases. Thus, doctors alleviate the suffering of a woman in labor and completely relieve emotional stress. All this has a positive effect on speed recovery period and its duration.
Pain relief during childbirth - pros and cons
Not all pregnant women choose an easy, pain-free birth. Many people speak out against anesthesia during this period. Their concerns are related to negative impact on the fetus of the anesthetic component. In addition, such pregnant women are confident that a baby born with pain relief will adapt worse to new conditions environment. However, modern pain management techniques completely eliminate the presence of these factors.
Recent studies in the field of obstetrics have proven that proper pain management during timely childbirth, compliance with dosages, minimizes the development of complications. When talking about pain relief during childbirth, doctors name the following positive aspects:
- reduction of pain syndrome;
- eliminating stress;
- prevention .
But like any medical procedure, an anesthetic injection during childbirth has disadvantages:
- development of an allergic reaction;
- weakening of labor.
Types of pain relief during childbirth
Methods of pain relief during childbirth, depending on the means and methods used, are usually divided into:
- non-drug methods;
- medicinal;
- regional anesthesia.
The choice of anesthesia technique is determined by the condition of the fetus and the pregnant woman. Doctors take into account the possibility of using anesthesia, paying attention to:
- gestational age;
- number of fruits;
- no contraindications for a pregnant woman.
Non-drug methods of labor pain relief
Non-drug pain relief during childbirth completely eliminates the use of drugs. At the same time, doctors use various psychological techniques, physical procedures, etc. In this way, it is possible to distract the woman as much as possible from the pain factor, to reduce the suffering associated with the process of expulsion of the fetus. Among the common techniques:
- Psychoprophylaxis– conducting courses in which a pregnant woman is introduced to the peculiarities of the birth process, taught how to relax, breathe, and push correctly.
- Massage of the lumbar and sacral area– reduces pain, makes it easier to endure the period of cervical dilatation.
- Breathing technique– helps to relax and not feel pain so intensely.
- Acupuncture– installation of special needles in the prenatal period helps relieve physical stress and prepare the pregnant woman for childbirth.
- Warm baths– reduce the tone of the uterine muscles, accelerate the process of dilatation, and reduce pain.
Medicinal methods of pain relief during childbirth
As the name implies, these methods of anesthesia involve the use of drugs. Analgesic for labor pain relief is selected individually. It should be taken into account that such drugs are able to penetrate the placental barrier, so their use can be limited - at a certain period of labor and in the dosage prescribed by the doctor. According to the method of administering the anesthetic, it is customary to distinguish:
- Intravenous anesthesia. It involves the introduction of a drug directly into the general bloodstream, leading to a complete loss of consciousness. The patient falls asleep, and sensitivity is eliminated.
- Epidural anesthesia. Involves administering the drug to the spinal cord area. As a result, the transmission of nerve impulses from the lower parts of the body is blocked.
- Inhalation anesthesia. The anesthetic is administered through the respiratory tract.
Drug pain relief during labor has a positive effect on the woman’s subsequent rehabilitation. Future mom does not experience fear or emotional stress associated with the upcoming birth. Modern principles of pain relief during childbirth have many advantages, including:
- full control of the delivery process;
- no side effects;
- minimal impact on the fetus.
Modern methods of labor pain relief
Modern labor anesthesia completely eliminates the development of complications associated with the use of medications during delivery. At the same time, the effect of anesthetic drugs on the fetus itself is minimized. It helps give birth healthy child, accelerates recovery processes female body V postpartum period. Among the common, widely used modern techniques pain relief:
- Pudendal block (injection of anesthetic into the area of the pudendal nerve);
- injection of drugs into tissues birth canal(reduces sensitivity, reduces pain when the baby passes through the birth canal).
Pain relief during childbirth - epidural anesthesia
Epidural pain relief during childbirth is widespread due to its high efficiency and lack of effect on the baby. At the same time, it is possible to provide the mother in labor with maximum comfort. Medicine injected into the area between the 3rd and 4th lumbar vertebrae. Stopping the transmission of nerve impulses eliminates the feeling of pain. The woman herself is conscious and can hear the first cry of her baby, as with natural childbirth.
However, this pain relief during childbirth has its drawbacks. Among the main ones:
- incorrect behavior of a woman in labor who does not feel well during contractions;
- prolongation of the period of expulsion of the fetus;
- the risk of developing acute hypoxia in the baby due to a strong decrease in blood pressure in the mother.
Intravenous pain relief during childbirth
Painkillers during childbirth are rarely administered intravenously. This is due to a high risk of complications. After using most anesthetics, there is a decrease in activity and the development of lethargy, which negatively affects the process of delivery. In addition, there is a possibility of a decrease in the tone of muscle structures, which has a bad effect on the process of expulsion of the fetus: they become weakly expressed, have a short duration and intensity.
Natural pain relief during childbirth
When thinking about how to relieve pain during childbirth, women often come across natural anesthesia methods. These methods absolutely exclude the use of drugs and are safe for the baby and mother. Their action is aimed at relaxation. Among them:
- use of music therapy;
- massage of the lumbar region;
- physical activity.
How to prepare for childbirth without pain?
Considering methods of pain relief during childbirth, it must be said that effective method is self-relaxation. Having mastered these skills, a woman will be able to alleviate her condition during childbirth. You need to learn this in advance, while still carrying a baby. In order to control your body you need to:
- Take a horizontal position.
- Breathing should be slow and concentrated.
- Raise one leg, then the other, feeling the tension.
- Make a fist with one hand, then the other.
When you feel tension, you need to fix the muscles for 5-10 seconds, then relax. This is done with each part of the body, gradually using the muscles of the back, legs, abdomen, arms, and pelvis. These methods of pain relief during childbirth will help the mother in labor to completely relax during the period between contractions, take a break and continue the process. The delivery itself will be less painful, and complications such as rupture of the vagina and perineum will be avoided.
It is clear that during childbirth the baby must somehow leave the mother's womb. The uterus contracts, and the baby gradually comes out through the dilated cervix and vagina. Pain during childbirth can occur due to stretching of the cervix, vagina, perineum, compression and rupture of soft tissues. Some women in labor suffer so much that their heart function and breathing may be impaired. In addition, prolonged pain often leads to premature fatigue, cessation of uterine contractions, and hypoxia (lack of oxygen) of the fetus.
The question of whether it is necessary to resort to pain relief during labor is something that every woman must decide for herself. Modern methods of anesthesia (medicinal anesthesia, epidural anesthesia, etc.) are considered quite safe for both mother and child, and make the process of giving birth more comfortable.
However, many experts are against labor pain relief. First, there is a risk (albeit small) of side effects. Secondly, the natural course of labor is disrupted (the administration of drugs can slow down or weaken labor).
On the other hand, everyone’s pain sensitivity threshold is different. Under the influence of “uncontrollable” prolonged pain, some women in labor may experience increased blood pressure, increased heart rate, and weakness in labor. This is harmful to the health of mother and child. In such cases, it is wiser to resort to anesthesia rather than suffer from unbearable pain.
However, it is best to prepare for childbirth in advance. With the help of so-called psychoprophylactic preparation, you can increase the threshold of pain sensitivity and ease the course of childbirth. It is believed that a woman who is psychologically ready for childbirth, has a good understanding of all stages of the birth process, knows how to breathe correctly, knows methods of self-relief of pain and is focused on results can easily do without pain relief. In such cases, childbirth is associated not with “torment”, but with the expectation of a miracle, great happiness - a quick meeting with the most beloved and wonderful person you have been waiting for for so long.
There are several ways to reduce pain during childbirth.
Psychological preparation
The pain of childbirth is aggravated by ignorance. So learn more about the birth process. You can obtain relevant information from pregnancy schools, antenatal clinics or from specialized literature. Women who are psychologically ready for childbirth find it much easier to give birth.
Water birth
A warm bath relaxes, distracts, has a good effect on labor and even improves blood supply to the fetus. Stay in warm water can significantly reduce the pain of a woman in labor during the first stage of labor, when the cervix dilates. However, before you fill your bathtub, seriously consider the pros and cons of this type of birth.
Reflexology
Some clinics use acupuncture for pain relief. It relieves pain during labor and normalizes labor. In Russia, this method is not yet very popular, most likely due to the lack of professional acupuncturists.
Drug pain relief
They tried to anesthetize childbirth many years ago. For this purpose, narcotic drugs were used, such as morphine, opium tincture, and nitrous oxide. The main disadvantage of these methods was negative impact narcotic painkillers on the fetus. In particular, they can cause weakened breathing in an infant.
In modern obstetrics, the most commonly used narcotic analgesic is promedol. It has a good analgesic effect and has less effect on the child than other drugs.
Often, due to painful long-term contractions, women in labor undergo sleepless night. Accumulated fatigue can interfere at the most crucial moment. In such cases, sleep-inducing medications are prescribed.
Before giving a woman painkillers, be sure to consult with an obstetrician-gynecologist or anesthesiologist.
Epidural anesthesia
This is a relatively new method of pain relief. The doctor places a thin needle between the vertebrae and injects an anesthetic substance under the dura mater of the spinal cord. Painkillers are used in this case local action: lidocaine, marcaine, ropelocaine and others. After administration of the drug, all sensitivity below the level of its administration is temporarily blocked.
Epidural pain relief has its downsides. On the one hand, good pain relief is provided, but on the other hand, the woman cannot push effectively. Therefore, immediately before the baby is born, epidural anesthesia is suspended. In addition, in rare cases, epidural anesthesia can cause headaches and back pain, which haunt a woman for quite some time. long time after childbirth.
Sometimes epidural pain relief is necessary medical indications, for example, in case of abnormal position of the fetus, the birth of twins, as well as in case of some complications of pregnancy or childbirth.
Loading...