Labor pain relief drugs really bring relief to the woman in labor. However, it should be remembered that they are prescribed strictly according to indications, since they act in a complex way on the whole body, and not only mothers, but also the child, have side effects, and in some cases complications can also result. This is why expectant mothers should not rely on a miraculous injection or a magic pill. Fortunately, today there are many opportunities for obtaining information on how to make the birth of a baby as comfortable as possible for both him and the mother: teaching aids and courses for pregnant women talk about methods of effective self-help in childbirth, one of the most effective methods among which is massage during childbirth. Thanks to him, you can significantly reduce pain... And all this - without the use of medications and medical interventions!
Why is there pain during labor?
- pain is provoked by intense contractions of the muscles of the uterus,
- stretching the birth canal and perineum,
- muscle spasms,
- compression of large vessels in the area small pelvis,
- individual characteristics, such as the structure of the pelvic organs or low pain threshold women, when it is very painful even with minor exposure.
- psychological reasons: fear of childbirth, expectation of something unpleasant and unknown, general tension.
It is important for every woman preparing to become a mother to remember: there is no such thing as childbirth. constant pain... And in fights, and in attempts discomfort increase gradually, and also gradually subside, alternating with periods of rest. And correctly carried out in the right time massage during childbirth will completely reduce pain to a minimum.
How does massage work during childbirth?
Massage during childbirth has a beneficial effect on the entire nervous system, and through it - on the entire body of a woman: it allows you to relax, remove nervous tension and muscle fatigue, distract from painful sensations and even anesthetize contractions. The mechanism of such a beneficial effect of massage during childbirth is rather complicated.
Its first stage is the excitation of skin receptors in the massaged area. Then the impulse is transmitted throughout the central nervous system, in which a favorable response is formed. Massage during childbirth activates the production of natural stimulants - hormones and enzymes, which play the role of natural adaptogens that contribute to the body's rapid adaptation to a stressful situation.
In addition, massage helps to increase blood circulation and better oxygenation of tissues and organs of both the woman herself (which also has an analgesic effect on childbirth) and the fetus, which prevents the development of oxygen starvation.
7 types of massage during childbirth
Both the woman in labor and her assistant (husband, mother or midwife) who is present during childbirth can do anesthetic massage during childbirth.
Follow these simple rules:
- Massage for childbirth can be done with dry hands (the main thing is that they are warm, since the feeling of cold can provoke reflexive muscle spasm) or with the help of special creams and gels that improve gliding on the skin and may contain components that relieve pain in the composition. Do not be discouraged if you forget your massage cream during your hospital appointment. You can always ask the midwife for some petroleum jelly.
- It is possible to use aromatic essential oils- they contribute to deeper relaxation. But at the same time, you should find out in advance whether the expectant mother has allergic reactions to them and whether they cause an increase blood pressure.
Which labor massage is right for you?
1. Acupressure massage during childbirth
Until the contractions are in full force, you can limit yourself point massage during childbirth. It is useful for the expectant mother to remember where the two important points, which in childbirth will need to be influenced. The first is located on back side hand in the groove between the thumb and forefinger (it is clearly visible if the fingers are wide apart). The second is on inside shins four fingers above the ankle (this is the area of the ankle where the bones protrude from the outside and from the inside). Press on these points continuously, with the finger perpendicular to the surface of the body. Movements should be short, pulsating, and last no longer than a minute. Then you should take a break for a couple of minutes and continue the impact in a given rhythm. It is clear that such a massage during childbirth can be done by both the woman in labor and her assistant. Correct impact on hotspots contribute to the strengthening and pain relief of contractions, the cervix opens faster, and all this happens without an increase in pain.
2. Stroking the abdomen during the contraction
At the beginning of each contraction, you can gently stroke your lower abdomen. To do this, place your palms on the lower part of it and lightly massage the abdomen with your fingertips from the center to the sides and back. At the moment of intensification of the contraction, the intensity of pressure can be increased, but only slightly. If the assistant does the massage during childbirth, then it will be more convenient for him to sit behind her.
3. Massage of the sacrum during childbirth
Women who are familiar menstrual pain, it is often noted that the sensations in the first stage of labor are similar to those that arise in " critical days»: Aches in the lower abdomen and aches the lower back. In this case, massage in the sacrum area (this is the area that is located just below the lower back) helps a lot. What is remarkable about this area? The secret of the pain relieving effect of childbirth when exposed to it is simple. The fact is that the sacral nerve plexus is located here, which is associated with the pelvic organs and is responsible for their innervation. When this zone is stimulated, the transmission of a nerve impulse to the uterus and other organs is blocked, thus, it is possible to reduce pain.
Massage of the sacral region can be done with one hand, or both at once, with the pads or knuckles, the base or edge of the palm, fist or hand massager. The main thing is that the impact is intense enough: pressure, active rubbing, patting and tapping are permissible. If desired, you can cover not only the sacrum, but also a wider area around it.
A powerful, pain-relieving effect can be achieved by pressing on the dimples above the buttocks - the exit site of the sacral nerve - which provide noticeable relief.
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4. Massage the ilium during contractions
This method is based on the principle of transferring the source of pain. Similar to how we three temples, to relieve a headache, during contractions, you can rub and massage the ilia of the pelvis, which are located below the waist on both sides of the abdomen. They need to be stimulated both at the same time, using active rubbing. This type of massage during childbirth can be combined with the stroking of the lower abdomen already described above (in this case, the movements of the hands should go from the iliac bones to the center and back), as well as with the movements of the hands along the groin fold from the ilium to the perineum - this improves blood circulation in the uterus ...
5. Massage of the buttocks during childbirth
Important reflex zones are also located in the buttocks - at the exit site sciatic nerve... To find them, you need to mark an imaginary center on each buttock (as a rule, there is a small fossa, with pressure on which mild pain may occur). Rolling or pressing the center of the buttocks with your fists thumbs helps to relax the pelvic floor muscles - this is a great way to distract a woman from labor pains.
6. Massage the thighs during contractions
Palm rub inner surface thighs is an excellent pain relieving trick. To do this, you need to lie on your side and, firmly pressing your palm to the skin of the inner surface of the thigh, stroke it from groin to knee and back. As the intensity of the contraction increases, the pressure on the thigh should also increase.
7. Massage between contractions
In the period between contractions, it is not recommended to touch the skin of the abdomen, as this is fraught with too intense an extraordinary contraction. However, massage is very useful here too! Assistant can knead a woman neck-collar area, upper part back, do general light a relaxing full body massage so that the woman in labor can calm down and rejuvenate before the next contraction. It is important to remember that lying on your back is undesirable, since the inferior vena cava can be pinched and blood circulation in the pelvic organs is impaired.
Pain relief with massage: alone or with an assistant?
The choice of positions for massage during childbirth depends on the individual characteristics of each expectant mother: the body itself tells how it is more convenient for it to sit during the massage: on its side, standing on all fours, lying or sitting on a fitball, in a knee-elbow position - it all depends only on you.
If you have an assistant, then the choice of possible poses will be wider. For example, postures in which a woman in labor, standing on her knees or on straightened legs, seems to hang on her assistant, holding his neck with her hands, the lower back relaxes well, and the partner can additionally massage her sacrum. The convenience of giving birth with an assistant lies in the fact that in this case it is possible to combine different types of massage during childbirth, for example, a woman strokes her abdomen and rubs the ilium, while the partner acts on the sacrum.
However, the absence of an assistant does not mean at all that the pain-relieving massage should be abandoned. After all, only a woman herself can know what kind of impact and on which zone she needs at the moment. So listen to your body and, focusing on your feelings, you will probably be able to choose the types of massage that are most effective for you and help yourself to endure the period of contractions easier.
When shouldn't you massage?
Despite the fact that anesthetic massage during childbirth is indicated for almost all women, it is worth discussing separately possible obstacles to its implementation. Directly during childbirth, a woman can be extremely unpleasant to any touch. In this case, the massage will have to be abandoned.
Deviations from the normal course of labor (for example, weak labor, stopping the movement of the fetus through the birth canal, acute fetal hypoxia, bleeding, etc.) become a serious contraindication. You will have to give up massage during childbirth during the installation of CTG sensors, as well as in the second stage of labor, when attempts begin.
Natalia Gouda
Obstetrician-gynecologist, head of the observational department of the maternity hospital, Mytishchi
Magazine "9 months"
№01 2006
For pain relief of childbirth, use as non-drug methods(they do not need syringes, medications, doctors), and medication, which can only be carried out with the help of a specialist.
How will doctors help?
General anesthesia. When using these types of anesthesia, pain sensitivity of all parts of the body is lost. Along with the loss of pain sensitivity during general anesthesia, medications also affect consciousness.
Endotracheal anesthesia. General anesthesia is performed with artificial ventilation lungs. The method provides a long lasting effect. In this case, a whole combination of drugs is used, and the actual anesthetic enters the lungs through the trachea. Such anesthesia is used to carry out caesarean section, often in case of emergency.
Inhalation (mask) anesthesia. One form of pain relief is an inhalation anesthetic, nitrous oxide, which the woman in labor inhales through a mask that resembles a respirator. The mask is used during the first stage of labor, when the cervix dilates.
Local anesthesia. When applying local anesthesia only certain parts of the body are deprived of pain sensitivity.
Epidural anesthesia. One of the forms of local anesthesia, which is provided by the introduction of a local anesthetic solution into the space above the hard membrane of the spinal cord. These days, this type of anesthesia is widely used during childbirth. After the injection, the lower body becomes insensitive. The nerves that send pain signals to the brain from the uterus and cervix pass through the lower spine, where the anesthetic is injected. During the action of this kind of pain relief, the woman is fully conscious and can talk to others.
Local anesthesia. This method, which desensitizes any part of the skin, is often used after childbirth to relieve pain during soft tissue suturing. In this case, the anesthetic is injected directly instead of the intervention.
Intravenous anesthesia. A drug (anesthetic) is injected into a vein. At the same time, the woman falls asleep for a short time (10-20 minutes). It is used when performing short-term surgical interventions during childbirth, for example, with the release of the retained parts of the placenta, with the imposition of obstetric forceps.
The use of narcotic analgesics. Narcotic analgesics are administered intramuscularly or intravenously, while pain sensitivity decreases during childbirth, the woman gets the opportunity to fully relax in the intervals between contractions.
Medical indications for pain relief
very painful contractions, restless behavior of a woman (it should be borne in mind that, according to statistics, 10% of women in labor experience mild pain, which does not require treatment, 65% - moderate pain and 25% - strong pain syndrome, which requires the use of medicines);
large fruit;
long-term childbirth;
premature birth;
weakness generic activity(shortening and weakening of contractions, slowing down the dilatation of the cervix, rhodostimulation with oxytocin in order to increase contractions);
caesarean section operation;
multiple pregnancy;
hypoxia (oxygen deficiency) of the fetus - with the use of anesthesia, the likelihood of its occurrence decreases;
the need for surgical interventions during childbirth - the application of forceps, manual removal of the placenta. In these situations, intravenous anesthesia is often used. The same method is used immediately after childbirth at the time of recovery. birth canal.
Anesthesia without medication
Anesthetic massage is an effect on certain points at which nerves exit onto the surface of the body. Exposure to these nerves causes some soreness and thus distracts from labor pain. Classic relaxing massage - stroking the back, neck area. This massage is used both during contractions and in between.
Without exception, all expectant mothers experience some anxiety in anticipation of childbirth. One of the reasons for such anxiety is the well-known idea of \ u200b \ u200bthe pain of contractions. Can pain be affected? And is the woman herself able to make her childbirth as easy and painless as possible? In this section, we will tell you in detail about all the methods of pain relief, their pros and cons.
Relaxation - Relaxation techniques that help you tolerate contractions more easily and get adequate rest in between.
Rational Breathing - There are several breathing techniques that can help you withstand contractions more easily. With the skillful use of the correct type of breathing during a contraction, we achieve a slight, pleasant dizziness. It is at this moment that the release of endorphins occurs (these hormones in a large number produced during childbirth; endorphins have an analgesic and tonic effect and are released into the blood during a contraction).
Active behavior during childbirth is good if the expectant mother knows that during normal, uncomplicated childbirth, you can take different poses and choose the most comfortable one, in which it is the given woman in labor that is easier to tolerate. Active behavior also means movement, walking, swaying, bending and various postures designed to relieve the spine. Change of position is the first and most natural desire for any discomfort.
Hydrotherapy is the use of water to relieve contractions. V different situations during contractions, one way or another, you can use the bath or shower.
Electroanalgesia - use electric current to influence biologically active points, which also helps to endure labor pain.
The right to choose
To use non-drug methods of pain relief, you need to know about these methods and have practical skills. A course of psycho-preventive preparation for childbirth can be taken at an antenatal clinic or at a school for pregnant women, where you will be taught correct breathing during childbirth, shown rational postures, and help you master relaxation methods.
Posture, breathing, pain-relieving massage, hydrotherapy during normal labor can be used almost without restriction. In the maternity hospital, you need to consult a doctor about this. In some situations (with breech presentation of the fetus, with premature birth) the doctor may restrict the freedom of movement of the woman in labor and strongly recommend expectant mother lie. But the skills of breathing, relaxation will be useful to you in any case.
The doctor will definitely prescribe medication methods if there are medical indications, depending on the condition of the woman in labor and the child at the time of delivery.
When using drug anesthesia, the anesthesiologist preliminarily conducts a conversation with the woman, talking about the essence of the method that is planned to be applied, as well as about its possible negative consequences... After that, the woman signs a consent to the use of one or another method of pain relief. I must say that in emergency situations when the life of a woman or child is threatened serious danger, this procedure is neglected.
Separately, it should be said about the contract for childbirth. When concluding an agreement, which indicates that one or another method of drug pain relief will be used at the request of the woman, drug pain relief is used when the woman in labor asks. In these cases, epidural anesthesia is more commonly used.
If in a situation with the presence of medical indications and with a contract for childbirth, everything is more or less clear, then in other cases, the use of medication methods at the request of a woman is a controversial issue and in each medical institution solved in different ways.
The issue of pain relief during childbirth is always relevant for expectant mothers and is resolved each time on an individual basis, depending on many factors.
As the due date approaches, each expectant mother, one way or another, thinks about the upcoming difficulties that are associated with the birth of a child. We are talking about severe pains that invariably accompany the birth process. Of course, each person is different, and for some women, pain during birth is a completely bearable, albeit unpleasant sensation, while for others it is a source of incredible torment.
It has been proven that in most cases, a woman experiencing severe pain for a long time, at the decisive moment, may simply not be ready to give birth to a child. naturally, the body is exhausted, and the woman in labor simply does not have the strength to push. To prevent this from happening, pain relievers are used during childbirth.
Pain relief during childbirth can be used for a variety of reasons:
- As we have already said, the task of pain relief is the comfort of the woman and her readiness for the birth of a child. In a quarter of women in labor, the pain threshold is so low that, while experiencing pain during labor, some simply experience a feeling of panic, may perform inappropriate actions, and do not listen to the doctor's instructions. In this case, the pain reliever used during childbirth is designed to eliminate the woman's restless behavior.
- Painful sensations are also relieved if a too large baby or twins are expected, and even during prolonged, or, conversely, premature, or "rapid" childbirth.
- It happens that during the labor process, emergency surgery is required, for example, the application of forceps, or the removal of the placenta. In such cases, special drugs are also used, usually intravenous.
- The use of an anesthetic is considered effective if there is a risk of fetal hypoxia, or the expectant mother has weak labor. Here the effect is directed a little in the other direction, and not to relieve pain. With hypoxia, for example, the use of such drugs reduces the risk of oxygen starvation in the baby.
As for the risks associated with the use of drugs that relieve discomfort, then, contrary to the popular belief that this can have a detrimental effect on the health of the child, doctors think differently. As we have already said, the issue is resolved individually each time, and the effect is, of course, primarily aimed at bringing benefit, not harm. Of course, each drug has its own list of contraindications, but we will talk about this a little lower when we analyze which ones exist. modern methods pain relief during childbirth.
Types of pain relief during childbirth
Pain relief during childbirth can be completely different, from the use of drugs, to methods explaining how to pain relief during childbirth on your own. We will start, perhaps, with pain relief in labor in modern conditions, that is, those methods, the main principle of which is this or that introduction of medications into the body.
Pain relief during labor
Medicines to reduce pain during labor may be ingested in different ways, from inhalations and compresses, to their introduction intramuscularly and intravenously. Let's take a closer look at what and how childbirth is anesthetized.
Inhalation
For such labor pain relief, a mixture of nitrous oxide and oxygen is used. This combination gives a fairly high efficiency and is used during cervical dilatation. The description of this method, by the way, gives an answer to the question "Do labor pain relief in the first period?" The advantage of this method is that the woman herself determines the degree of pain and takes a breath as needed.
Intravenous pain relief
What is injected into a vein during childbirth for pain relief? Most often, these drugs, designed to provide pain relief during childbirth, are various analgesics. By the way, they enter the body not only, but also intramuscularly, and with the help of special compresses. This method of facilitating the prenatal period is aimed at ensuring that a woman can fully rest between contractions and gain the strength that will be needed during attempts.
Sometimes the doctor, when deciding what kind of pain relief to use during childbirth, opts for such a drug as promedol. Although promedol belongs to narcotic drugs, it has been proven that its one-time use will not harm either the mother or the child. This medication is not used on last stage labor, otherwise this method can affect the baby's respiratory activity, in other words, it will be difficult for him to take the first breath.
Often, and especially during the birth of the first baby, a situation arises that labor activity is significantly delayed. In such cases, in order to give the expectant mother a rest, doctors put her to sleep. 
Epidural anesthesia
Here, pain reliever during childbirth is injected into the back (spine) using a catheter. This method provides almost complete elimination of pain symptoms, but it must be remembered that along with the pain, the ability to move independently for some time may disappear. It depends on the dosage of the drug being administered, sometimes a woman can fully stand on her feet. The downside is the fact that while using this method, the woman in labor loses the ability to fully push. Therefore, shortly before the onset of attempts, the administration of the drug is suspended.
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Are unique. The severity of pain that a mother feels during the process of giving birth differs in different women... It depends on many factors, such as the size and position of the fetus, the strength of the contractions, and pain tolerance. Some women may need to use proper breathing and relaxation techniques to relieve pain, while others may need anesthesia during childbirth.
During labor, pain can be relieved by different kinds anesthesia. The most commonly used anesthesia are epidural and spinal anesthesia, but there are other options for pain relief. Before giving birth, a woman needs to carefully ask her doctors about possible elimination or relief of pain in order to make the best choice for herself and her baby.
What are the indications for pain relief in natural childbirth?
A woman's desire is a sufficient indication for pain relief during childbirth. Sometimes analgesia is indicated for expectant mothers who have certain risk factors, even in the absence of such a desire. These situations are known to gynecologists, who in such cases refer women to an anesthesiologist for consultation.
What types of anesthesia can be used for vaginal delivery?
As already indicated, any childbirth, if the woman wishes, can be anesthetized. However, there are contraindications to many methods.
During natural childbirth There are two main types of pain relievers used:
- Analgesics are drugs that help relieve pain. These drugs include opioids (such as fentanyl or morphine). While they can relieve pain, they cannot completely rid the woman in labor. In addition, they also reduce anxiety and help the woman to relax. Analgesics should not be given just before the baby is born, as they can slow down his reflexes and breathing.
- Anesthetics are agents that block most sensations, including pain. Depending on how the anesthetics are used, local, regional and general anesthesia are distinguished.
Benefits and Potential Consequences of Using Anesthesia During Labor
|
Name of the method of pain relief |
Action and possible benefits |
Potential risk to the mother |
Potential risk to the child |
|
Analgesics (common pain relievers, including opioids) |
May relieve pain, reduce anxiety, and help relax during labor. Do not block all sensations. Do not lead to loss of consciousness. Does not slow down labor and does not affect contractions. |
Does not completely eliminate pain. May cause drowsiness or difficulty concentrating. May weaken memories of childbirth. May cause nausea, vomiting, and itching. May lower blood pressure or slow breathing. May cause allergic reactions and breathing difficulties. |
When administered just before childbirth: May cause drowsiness, making it difficult to breastfeed immediately after birth. May slow down breathing and impair reflexes. May disrupt the thermoregulation of the child. |
|
Blocks most sensations below the waist. It takes 10-20 minutes to start the action. It can be used throughout the entire period of labor. The drug can be injected through the catheter several times, which allows you to reduce or increase the dose as needed. |
Numbness can complicate pushing and urination problems (bladder catheterization may be necessary). If the numbness spreads to chest, it can make breathing difficult. If the needle breaks hard meninges, a woman may develop headache lasting several days. Blood pressure may drop. You may experience slight dizziness or nausea, tinnitus. If the needle hits a nerve during epidural catheterization, the woman may feel an electrical shock in one leg. If the drug passes into a vein, it may cause dizziness and seizures (in rare cases). Although rare, there is a risk of allergic reactions, damage to blood vessels, development infectious process or swelling in the epidural space. If childbirth when used for pain relief spinal anesthesia progress slowly, drugs may end too quickly. |
A decrease in mother's blood pressure can cause a slowdown in the baby's heart rate and breathing. |
|
|
Spinal anesthesia |
Blocks most of the sensations below the ribcage. The action starts immediately and lasts 1-2 hours. With the introduction of stronger drugs, it can be used to relieve pain during a caesarean section. |
||
|
Pudendal block |
It is used to numb the perineum, usually before an episiotomy. |
Anesthetizes only the perineal area, does not affect the pain of contractions. Rarely causes any negative effects on the mother or child. |
|
|
General anesthesia |
Can be started very quickly and cause immediate loss of consciousness. Blocks almost all sensations, including pain. Used only when needed (for example, for an immediate caesarean section) |
A woman will not remember events when she is unconscious. The woman will be drowsy for a certain amount of time. The patient may experience nausea or vomiting. |
May make the baby drowsy, making it difficult breast-feeding immediately after childbirth. May decrease the blood supply to the baby. |
Is delivery possible without anesthesia?
Should you give birth with anesthesia?
Every woman during pregnancy begins to think about whether it is worth using anesthesia during childbirth. Many of them think that natural childbirth is the only correct way, however, they often change their minds during very painful contractions. But there are safe and effective methods of pain relief that will help expectant mothers to focus on attempts, and not on the pain of moving the child along the birth canal. Every woman should remember that the decision to administer anesthesia during childbirth belongs only to her.
Taras Nevelichuk, anesthesiologist, specially for the site site
Useful video
Any woman. As precisely physiological process childbirth has certain characteristics and is accompanied by a number of specific manifestations. One of the most famous manifestations of the act of birth is pain. It is the pain syndrome that accompanies every childbirth that is the subject of numerous discussions, both by pregnant women themselves and by doctors, since given characteristic the generic act seems to be the most powerfully emotionally colored and deeply affecting the psyche.
Any pain has a very specific effect on the human psyche, causing him deep emotional experiences and creating a stable memory of an event or factor accompanied by pain syndrome. Since pain accompanies almost the entire labor act, which normally can last from 8 to 18 hours, any woman remembers this process for her entire life. Pain during childbirth has a bright emotional coloring, which, depending on the individual psychological characteristics personality, as well as the specific circumstances that surround the generic act, can be tolerated easily or, on the contrary, very difficult.
Women for whom the pain of childbirth was tolerated relatively easily or, in the terminology of the women in labor, was “tolerable”, have absolutely no idea what other women experienced and felt, who, by the will of circumstances, felt terrible, unbearable pain.
Based on the experienced sensory experience, two radical positions arise in relation to pain relief in childbirth - some women believe that it is better to "be patient" for the sake of healthy baby, and the latter are ready for any drug, even very "harmful" for the child, which will relieve them of hellish, intolerable torment. Of course, both positions are radical and therefore cannot be true. The truth lies just somewhere in the area of the classical "golden mean". Consider the various aspects related to pain relief in labor, relying primarily on common sense and on the data of serious reliable research.
Labor pain relief - definition, essence and general characteristics of medical manipulation
Pain relief during childbirth is a medical manipulation that allows you to provide a woman in labor with the most comfortable conditions, thereby minimizing stress, eliminating inevitable fear and not creating a negative image of the birth act in the future. Relief of the pain syndrome and the removal of the associated strong, subconscious fear, effectively prevents violations of labor in many impressionable women who have a pronounced emotional perception of reality.Labor pain relief is based on the use of various medication and non-medication techniques that reduce the level of mental anxiety, relieve tension and arrest the conduction of a pain impulse. For pain relief during labor, the full range of currently available drugs and non-drug techniques cannot be used, since many of them simultaneously with analgesia (pain relief) cause complete loss of sensitivity and muscle relaxation. A woman in labor should maintain sensitivity, and the muscles should not relax, as this will lead to a halt in labor and the need to use stimulants.
All currently used methods of pain relief in childbirth are not ideal, since each method has pros and cons, and therefore, in a particular case, the method of relieving the pain of the labor act must be selected individually, taking into account the psychological and physical condition women, as well as the obstetric situation (position, fetal weight, pelvic width, repeated or first births, etc.). The choice of the method of labor pain relief that is optimal for each particular woman is carried out jointly by an obstetrician-gynecologist and an anesthesiologist. Efficiency different methods labor pain relief is not the same, so for best effect you can use combinations of them.
Pain relief in childbirth in the presence of severe chronic diseases in a woman is not just a desirable, but a necessary procedure, since it relieves her suffering, relieves emotional stress and fear for her own health and the life of the child. Pain relief during labor does not just relieve pain, but at the same time interrupts the functioning of adrenaline stimulation that occurs with any pain syndrome. Stopping the production of adrenaline allows you to reduce the load on the heart of a woman in labor, expand blood vessels and, thus, to ensure good placental blood flow, which means better nutrition and oxygen delivery for the baby. Effective relief of pain in childbirth can reduce the energy consumption of a woman's body and her stress respiratory system, as well as reduce the amount of oxygen it needs and, thereby, prevent fetal hypoxia.
However, not all women need labor pain relief, since they normally tolerate this physiological act. But one should not draw the opposite conclusion that everyone can "endure". In other words, labor pain relief is a medical manipulation that must be performed and used when necessary. In this case, in each case, the doctor decides which method to apply.
Pain relief during childbirth - pros and cons (should pain relief during childbirth?)
Unfortunately, at present, the issue of pain relief in childbirth is causing the division of society into two radical opposing camps. Adherents of natural childbirth believe that pain relief is unacceptable, and even if the pain is unbearable, you need, figuratively speaking, to grit your teeth and endure, sacrificing yourself to the future baby. Women with the described position are representatives of one radical part of the population. Representatives of another part of women who adhere to the opposite, but equally radical position, which can be conditionally designated as an "adept" of pain relief in childbirth, are very fiercely opposed to them. The adherents of anesthesia believe that this medical manipulation is necessary for all women, regardless of the risks, the condition of the child, the obstetric position and other objective indicators of a particular situation. Both radical-minded camps are fiercely arguing with each other, trying to prove their absolute innocence, justifying possible complications pain and pain relief with the most incredible arguments. However, no radical position is correct, since neither the consequences of severe pain nor the possible side effects of various methods of pain relief can be ignored.It should be recognized that labor pain relief is an effective medical manipulation that allows you to reduce pain syndrome, relieve stress associated with it and prevent fetal hypoxia. Thus, the benefits of pain relief are evident. But, like any other medical manipulation, labor pain relief can provoke a number of side effects on the part of the mother and baby. These side effects are usually transient, that is, temporary, but their presence has a very unpleasant effect on the psyche of a woman. That is, pain relief is efficient procedure, which has possible side effects, so you cannot use it the way you want. It is necessary to anesthetize childbirth only when a specific situation requires it, and not according to instructions or some standard averaged for all.
Therefore, the solution to the question "Whether to do labor pain relief?" must be taken separately for each specific situation, based on the condition of the woman and the fetus, the presence of concomitant pathology and the course of labor. That is, anesthesia must be performed if a woman does not tolerate labor pains well, or the child suffers from hypoxia, since in such a situation it is beneficial medical manipulation far exceeds possible risks side effects. If childbirth proceeds normally, the woman calmly tolerates contractions, and the child does not suffer from hypoxia, then anesthesia can be dispensed with, since additional risks in the form of possible side effects from manipulation are not justified. In other words, to make a decision on pain relief during labor, you need to take into account the possible risks from not using this manipulation and from its use. Then the risks are compared, and an option is selected in which the probability of cumulative adverse consequences (psychological, physical, emotional, etc.) for the fetus and the woman will be minimal.
Thus, the issue of pain relief in childbirth cannot be approached from the standpoint of faith, trying to attribute this manipulation to the camp, figuratively speaking, unconditionally "positive" or "negative". Indeed, in one situation, anesthesia will become positive and the right decision, and in the other - no, because there is no indication for this. Therefore, whether to do anesthesia, it is necessary to decide when the labor begins, and the doctor will be able to assess specific situation and a woman in labor, and make a balanced, healthy, meaningful, and not emotional decision. And an attempt to decide in advance, before the onset of childbirth, how to relate to pain relief - positively or negatively, is a reflection of the emotional perception of reality and youthful maximalism, when the world is presented in black and white, and all events and actions are either unconditionally good or such certainly bad. In reality, this does not happen, so labor pain relief can be both a blessing and a disaster, like any other medicine. If a medicine is used as directed, then it is beneficial, and if it is used without indications, then it can cause serious harm to health. The same can be fully attributed to labor pain relief.
Therefore, we can make a simple conclusion that pain relief during childbirth is necessary when there are indications for this on the part of a woman or a child. If there are no such indications, then there is no need to anesthetize the labor. In other words, the position on pain relief in each specific case should be rational, based on taking into account the risks and condition of the woman in labor and the child, and not on an emotional attitude to this manipulation.
Indications for the use of labor pain relief
Currently, labor pain relief is indicated in the following cases: - Hypertension in a woman in labor;
- Increased pressure in a woman during childbirth;
- Childbirth against the background of preeclampsia or preeclampsia;
- Severe diseases of the cardiovascular and respiratory system;
- Heavy somatic diseases in a woman, for example, diabetes mellitus, etc.;
- Dystocia of the cervix;
- Discoordination of labor;
- Severe pain in childbirth, felt by a woman as unbearable (individual pain intolerance);
- Expressed fear, emotional and mental stress in a woman;
- Childbirth large fruit;
- Breech presentation of the fetus;
- The young age of the woman in labor.
Methods (methods) of labor pain relief
The whole set of methods of labor pain relief is divided into three large groups:1. Non-drug methods;
2. Medication methods;
3. Regional analgesia (epidural anesthesia).
Non-drug methods of pain relief include a variety of psychological techniques, physical therapy, proper deep breathing, and other methods based on distraction from pain.
Medicinal methods of labor pain relief, as the name implies, are based on the use of various drugs that have the ability to reduce or stop pain.
Regional anesthesia, in principle, can be attributed to medical methods, since it is produced with the help of modern powerful anesthetic drugs that are injected into the space between the third and fourth lumbar vertebrae. Regional anesthesia is the most effective method of pain relief during labor and is therefore widely used today.
Methods of labor pain relief: medication and non-medication - video
Non-drug (natural) labor pain relief
The safest, but also the least effective ways labor pain relief are non-drug, which include a combination of different methods based on distraction from pain, the ability to relax, create a pleasant atmosphere, etc. Currently, the following non-drug methods of labor pain relief are used: - Psychoprophylaxis before childbirth (attending special courses where a woman gets acquainted with the course of childbirth, learns to breathe correctly, relax, push, etc.);
- Lumbar and sacral divisions spine;
- Correct deep breathing;
- Hypnosis;
- Acupuncture (acupuncture). The needles are placed on the following points - on the abdomen (VC4 - guan-yuan), hand (C14 - hegu) and lower leg (E36 - tszu-san-li and R6 - san-yin-jiao), in the lower third of the lower leg;
- Percutaneous electroneurostimulation;
- Electroanalgesia;
- Warm baths.
The most common ways non-drug pain relief childbirth are massage of the lower back and sacrum, being in the water during contractions, correct breathing and the ability to relax. All of these methods can be used by the woman in labor on her own, without the help of a doctor or midwife.
Anesthetic massage and birth positions - video
Pain relief during labor
Medical methods of labor pain relief are highly effective, but their use is limited by the condition of the woman and possible consequences for the fetus. All analgesics currently used can cross the placenta, and therefore can be used to relieve pain during labor. limited quantity(dosages) and in strictly defined phases of the labor act. The entire set of drug methods for pain relief in childbirth, depending on the method of application of the drugs, can be divided into the following types: - Intravenous or intramuscular injection drugs that relieve pain and relieve anxiety (for example, Promedol, Fentanyl, Tramadol, Butorphanol, Nalbuphine, Ketamine, Trioxazine, Elenium, Seduxen, etc.);
- Inhalation of drugs (for example, nitrous oxide, Trilene, Methoxyflurane);
- The introduction of local anesthetics in the area of the pudendal nerve (pudendal blockade) or in the tissue of the birth canal (for example, Novocaine, Lidocaine, etc.).
V last years there is a tendency to replace narcotic analgesics with non-narcotic ones, such as Tramadol, Butorphanol, Nalbuphine, Ketamine, etc. Non-narcotic opioids synthesized in recent years have a good analgesic effect and, at the same time, induce less pronounced biological reactions.
Inhalation anesthetics have a number of advantages over other drugs, since they do not affect the contractile activity of the uterus, do not penetrate the placenta, do not disturb sensitivity, allow a woman to fully participate in the labor act and independently resort to the next dose of laughing gas when she deems it necessary. Currently for inhalation anesthesia in childbirth, nitrous oxide (N 2 O, "laughing gas") is most commonly used. The effect occurs within a few minutes after inhalation of the gas, and after the cessation of the drug supply, its complete elimination occurs within 3 - 5 minutes. The midwife can train the woman to inhale nitrous oxide on her own as needed. For example, breathe during a fight and do not use gas in between. The undoubted advantage of nitrous oxide is its ability to be used for pain relief during the expulsion of the fetus, that is, the actual birth of the child. Recall that narcotic and non-narcotic analgesics cannot be used during the expulsion of the fetus, since this can negatively affect its condition.
During the expulsion period, especially during childbirth with a large fetus, anesthesia with local anesthetics (Novocaine, Lidocaine, Bupivacaine, etc.) can be used, which are injected into the pudendal nerve, perineum and vaginal tissue located next to the cervix.
Medical methods of pain relief are now widely used in obstetric practice most maternity hospitals in the CIS countries and are quite effective.
General application scheme medications for labor pain relief can be described as follows:
1.
At the very beginning of labor, it is useful to introduce tranquilizers (for example, Elenium, Seduxen, Diazepam, etc.), which relieve fear and reduce the expressed emotional coloring of pain;
2.
With the opening of the cervix by 3 - 4 cm and the appearance of painful contractions, narcotic (Promedol, Fentanyl, etc.) and non-narcotic (Tramadol, Butorphanol, Nalbufin, Ketamine, etc.) opioid pain medications in combination with antispasmodics (No-shpa, Papaverine, etc.). It is during this period that non-drug methods of labor pain relief can be very effective;
3.
When the cervix is dilated by 3 - 4 cm, instead of the introduction of painkillers and antispasmodic drugs, you can use nitrous oxide, teaching the woman in childbirth to inhale the gas on her own as needed;
4.
Two hours before the alleged expulsion of the fetus, the administration of anesthetic narcotic and non-narcotic drugs should be discontinued. Either nitrous oxide or local anesthetics in the pudendal nerve (pudendal block) can be used to relieve pain in the second stage of labor.
Epidural pain relief during labor (epidural anesthesia)
Regional analgesia (epidural anesthesia) has become more widespread in recent years due to its high efficiency, availability and harmlessness to the fetus. These methods allow providing maximum comfort to a woman with minimal impact on the fetus and the course of labor. The essence of regional methods of labor pain relief is the introduction of local anesthetics (Bupivacaine, Ropivacaine, Lidocaine) in the area between two adjacent vertebrae (third and fourth) lumbar(epidural space). As a result, the transmission of the pain impulse along the nerve branches is stopped, and the woman does not feel pain. Drugs are injected into that department spinal column where is missing spinal cord, so there is no need to be afraid of damaging it. Epidural anesthesia has the following effects on the course of labor:
- Does not increase the need for emergency cesarean delivery;
- Increases the frequency of applying a vacuum extractor or obstetric forceps due to improper behavior of the woman in labor, who does not feel well when and how to push;
- The period of fetal expulsion with epidural anesthesia is somewhat longer than without labor pain relief;
- May cause acute fetal hypoxia due to a sharp decline pressure of a woman in labor, which is stopped by sublingual application of a nitroglycerin spray. Hypoxia can last for a maximum of 10 minutes.
Currently, there are the following indications for epidural anesthesia during labor:
- Gestosis;
- Premature birth;
- The young age of the woman in labor;
- Severe somatic pathology (for example, diabetes, arterial hypertension, etc.);
- Low pain threshold for women.
Painkillers for epidural anesthesia (as well as narcotic analgesics) can be started not earlier than the cervical dilatation by 3-4 cm.However, the catheter is inserted into the epidural space in advance, when the woman's contractions are still rare and not painful, and the woman can lie down in the fetal position 20 - 30 minutes without moving.
Drugs for labor pain relief can be given as a continuous infusion (like a drip) or fractionally (bolus). With constant infusion, a certain number of drops of the drug are delivered to the epidural space within an hour, which ensures effective relief of pain. With fractional administration, the drugs are injected in a certain amount at clearly defined intervals.
The following local anesthetics are used for epidural anesthesia:
- Bupivacaine is injected fractionally in 5-10 ml 0.125-0.375% solution after 90-120 minutes, and infusion - 0.0625-0.25% solution in 8-12 ml / h;
- Lidocaine is injected fractionally at 5-10 ml of 0.75-1.5% solution after 60-90 minutes, and infusion - 0.5-1.0% solution at 8-15 ml / h;
- Ropivacaine is injected fractionally at 5-10 ml of 0.2% solution after 90 minutes, and infusion - 0.2% solution at 10-12 ml / h.
If, for some reason, local anesthetics cannot be used for epidural anesthesia (for example, a woman is allergic to drugs of this group, or she suffers from heart defects, etc.), then they are replaced with narcotic analgesics - Morphine or Trimeperidine. These narcotic analgesics are also fractionally or infusion injected into the epidural space and effectively relieve pain. Unfortunately, narcotic analgesics can provoke unpleasant side effects such as nausea, itching of the skin and vomiting, which, however, are well controlled by the administration of special drugs.
It is now common practice to use a mixture of narcotic analgesic and local anesthetic to produce epidural anesthesia during labor. This combination can significantly reduce the dosage of each drug and relieve pain with maximum possible effectiveness... A low dose of narcotic analgesic and local anesthetic reduces the risk of lowering blood pressure and developing toxic side effects.
If an emergency caesarean section is needed, epidural anesthesia can be enhanced by the introduction of a larger dose of anesthetic, which is very convenient for both the doctor and the woman in labor herself, who will remain conscious and will see her baby immediately after being removed from the uterus.
Today, epidural anesthesia in many maternity hospitals is considered standard procedure obstetric benefits, available and not contraindicated for most women.
Means (drugs) for labor pain relief
Currently used for pain relief in childbirth medications from the following pharmacological groups: 1. Narcotic analgesics (Promedol, Fentanyl, etc.);
2. Non-narcotic analgesics (Tramadol, Butorphanol, Nalbuphin, Ketamine, Pentazocine, etc.);
3. Nitrous oxide (laughing gas);
4. Local anesthetics(Ropivacaine, Bupivacaine, Lidocaine) - used for epidural anesthesia or injection into the pudendal nerve area;
5. Tranquilizers (Diazepam, Relanium, Seduxen, etc.) - are used to relieve anxiety, fear and reduce the emotional color of pain. Introduced at the very beginning of labor;
6. Antispasmodics (No-shpa, Papaverine, etc.) are used to accelerate the dilatation of the cervix. They are introduced after the opening of the uterine pharynx by 3 - 4 cm.
The best analgesic effect is achieved with epidural anesthesia and intravenous administration narcotic analgesics in combination with antispasmodics or tranquilizers.
Promedol for pain relief during childbirth
Promedol is a narcotic analgesic that is currently widely used for pain relief in childbirth in most specialized institutions in the CIS countries. As a rule, Promedol is administered in combination with antispasmodics, has a pronounced analgesic effect and significantly shortens the duration of cervical dilatation. This drug affordable and highly effective.Promedol is injected intramuscularly and takes effect after 10-15 minutes. Moreover, the duration of the analgesic effect of one dose of Promedol is from 2 to 4 hours, depending on the individual sensitivity of the woman. However, the drug perfectly penetrates the placenta to the fetus, therefore, when using Promedol, it is imperative to monitor the child's condition by CTG. But Promedol is relatively safe for the fetus, since it does not cause any irreversible damage or damage to it. Under the influence of the drug, the child may be born lethargic and drowsy, it will be difficult to breastfeed and will not immediately breathe. However, all these short-term disturbances are functional, and therefore will quickly pass, after which the child's condition is completely normalized.
If epidural analgesia is unavailable, Promedol is practically the only available and effective analgesic that relieves pain in childbirth. In addition, with stimulated labor, which accounts for up to 80% of their the total in the CIS countries, Promedol is literally a "life-saving" drug for a woman, since in such cases the contractions are extremely painful.
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