The article describes possible types of labor pain relief, their advantages and disadvantages, and also identifies probable complications after anesthesia in mother and child.
Pain relief during childbirth - important process. It happens that the course and even the outcome of childbirth depends on the type of anesthesia.
“Switching off” or reducing pain helps relieve the condition of the mother during natural delivery, as well as performing a cesarean section, both under general and regional anesthesia. However, at the same time, the use of anesthesia can negatively affect the health of the mother and child.
For pain relief during natural childbirth, the following can be used:
At caesarean section Anesthesia may be used:
Spinal anesthesia is often mistakenly called epidural. However, it is important to understand that, despite the similar action and the same puncture site, these are two completely different types anesthesia, which have a number of fundamental differences:
Thus, each of these types of pain relief has its own advantages and disadvantages, but there is no need to say that any of them is safer. The most important thing is that anesthesia is performed by an experienced anesthesiologist who can competently prepare the patient for the upcoming birth.
Indications for epidural anesthesia:
IMPORTANT: Some clinics practice the use of epidural anesthesia without indications. To make a woman feel comfortable and confident during childbirth, pain relief is given at her request.
Large fetus - indication for epidural anesthesia
Epidural anesthesia is performed as follows:
IMPORTANT: During the puncture, the woman must remain motionless. Both the quality of anesthesia and the likelihood of complications after it depend on this.
The catheter tube is inserted into the narrow epidural space, which is located near the spinal canal. The supply of an anesthetic solution blocks pain, since the nerves responsible for its transmission are temporarily “turned off”.
IMPORTANT: If during the administration of the drug a woman feels any unusual changes in her condition (dry mouth, numbness, attacks of nausea, dizziness), she must immediately inform the doctor. You should also warn about a contraction if it begins during a puncture or administration of an anesthetic.
Like any medical intervention, epidural anesthesia can cause complications, including:
Complication after epidural anesthesia during childbirth - headache
Each woman must independently decide whether she needs pain relief during childbirth, if there are no direct indications for this. Undoubtedly "advantages" of childbirth with anesthesia can be considered:
Possible negative consequences of an epidural for a woman in labor:
An increase in temperature is one of the possible negative consequences after epidural anesthesia. An epidural anesthesia may also have an effect on a child. negative influence. Infants born under anesthesia may experience:
There is no clear answer to the question about the need to use epidural anesthesia during childbirth. In each individual case expectant mother should discuss with your doctor possible consequences in case of refusal (or consent) from anesthesia and make a decision.
Epidural anesthesia must be done if there are direct links to this medical indications or the woman in labor cannot bear the pain.
A woman who is confident in her abilities and has no direct contraindications to using anesthesia can manage without anesthesia. natural birth without the use of anesthesia.
Severe headache and back pain - frequent consequences epidural anesthesia. These unpleasant sensations can occur for a long time after childbirth. They appear as a result of an accidental puncture meninges at the moment of needle insertion.
IMPORTANT: Accidental damage to the meninges occurs in 3 cases out of 100. Subsequently, more than half of the affected women experience months of headaches and back pain.
To stop these pains, in most cases, repeated drug intervention is necessary.
Epidural anesthesia during free childbirth is done by agreement with the doctor. The cost of services and medications spent during the process of delivery using epidural anesthesia may depend on the specifics of the mother's health insurance.
Svetlana, 25 years old: I was going to give birth without pain relief. But something went wrong in the process. I panicked when the contractions turned into some kind of cramps. The neck opened very slowly, and the pain was unreal. The doctor, looking at my suffering, offered me an epidural. I agreed, which I have never regretted. The pain after the puncture subsided, I was able to calm down, relax and concentrate. I gave birth to my son easily, and neither I nor the child had any negative consequences.
Olga, 28 years old: She gave birth with epidural anesthesia. 3 weeks after giving birth, pain began to appear in my back. After each “shot”, movements are immediately constrained. It becomes impossible to turn or straighten up. The pain intensifies and repeats 5–10 times a day. I can’t bear it anymore, and I’m afraid to go to the doctor. It would be better if I gave birth myself, especially since I had no indication for an epidural.
Kira, 33 years old: It’s been 3.5 years since giving birth with epidural anesthesia, and my legs still hurt. Even at night I sometimes wake up with severe pain in my legs and back. I can no longer walk for a long time because of this. Life has turned into a nightmare.
In practice, I have encountered the fact that patients often confuse spinal and epidural anesthesia, misinterpret general anesthesia, and are very frightened and distrustful.
Spinal and epidural anesthesia suggest the introduction local anesthetic in close proximity to the spinal cord. Although these types of anesthesia are fundamentally similar, each of them has its own anatomical, physiological and clinical features.
The spinal cord is in the center spinal column and is surrounded by cerebrospinal fluid; and all this, in turn, is surrounded by the dura mater, then T.M.O. (pia dura). Hence, epidural - on top of the dura mater, subdural - under the T.M.O.
Spinal anesthesia - the fastest in terms of execution technique. An injection is made into the spine at the lumbar level with a long and thin needle. The thickness of the needle is slightly larger than a hair, so the puncture is almost painless (all painful sensations when punctured only with skin). The needle passes almost to the spinal cord (behind the T.M.O.). The doctor determines the correct placement of the needle by the appearance of a drop of cerebrospinal fluid from the needle.
” The drug is administered once. The needle is removed. Since the local anesthetic reaches the spinal cord directly, clinical sensations develop within 1-2 minutes.
You must definitely talk about them to your anesthesiologist, since the anesthesiologist will determine the level of anesthesia that has developed, its depth, and possible complications that may develop.
- warmth that appears in the buttocks and thighs and gradually decreases towards the feet;
- heaviness in the legs;
- "goosebumps";
- tingling;
- There may be general weakness, dizziness, nausea and vomiting - there is no need to be afraid of this.
Such sensations arise due to a decrease in blood pressure (BP), as all the vessels in the lower part of the body relax and dilate.
Spinal anesthesia blocks all types of sensation. Depending on the drug, it lasts from 30 minutes to 3 hours. It cannot be extended!
There are certain conditions that must be met to reduce the risk of complications. The simplest and most important thing is a horizontal position without a pillow until sensitivity returns and with a pillow for 12 hours.
Why? - since there is a puncture of the T.M.O., the cerebrospinal fluid vertical position may leak and, as a result, headaches occur that are difficult to treat.
Obstetric anesthesiologists and neuraxial pain management techniques are often blamed for any neurological symptoms that occur in postpartum period. However, it should be remembered that both pregnancy and the process of childbirth themselves can cause neurological disorders. Nerves can be damaged by the descending fetal head or during the application of obstetric forceps. Neurological disorders can also be caused by long, protracted labor. The use of retractors during caesarean section can also lead to neurological complications.
Epidural anesthesia - more complex and time-consuming to complete. Can be performed as a treatment for incoordination labor activity, and for pain relief during the 1st stage of labor, cesarean section, and for postoperative pain relief.
” With epidural anesthesia, the drug is injected into the space surrounding the nerves exiting the spinal cord, so options range from pain relief with mild motor blockade to deep anesthesia with complete motor blockade.
Epidural anesthesia is technically more difficult than spinal anesthesia. First, the skin is anesthetized, then the doctor, working with a long and thick needle, approaches the space where the nerves go and inserts a catheter through the needle, through which the drug is delivered. In this case, the drug can be administered for as long as desired (maximum permissible 7 days).
The sensations develop within 5-20 minutes and are completely similar to the spinal anesthesia clinic. The difference is that with spinal anesthesia there is no sensitivity at all, while epidural anesthesia only relieves pain impulses at a certain specified level. At the same time, a woman may feel touching, stretching, pressure - this is the norm.
” With spinal and epidural anesthesia, the woman remains conscious (including); He hears everything, sees his anesthesiologist and can communicate with him. After extraction, they will immediately show the baby to her, give her a kiss, and put her to her breast.
The most scary word- general anesthesia. It is performed during a caesarean section only in conditions life-threatening mother or child.
” All drugs are administered intravenously. There is an instant loss of consciousness. The woman sees nothing, hears nothing, feels nothing. Used for general anesthesia narcotic analgesics. At intravenous administration they reach the fetus very quickly, so obstetricians work quickly.
After the operation, if everything is in order, the mother will see the baby only in her room, after 2 hours. One of the discussed issues among patients is indications and contraindications. We sorted out the testimony.
Refusal of the woman in labor
. Absence necessary conditions and equipment
. Severe hypovolemia and a real risk of massive bleeding (placental abruption, uterine rupture, hypotonic bleeding)
. Coagulopathy (blood clotting disorder)
. Signs of aorto-caval compression (to avoid them, the woman is turned on the table on her left side, while the vessels are released from the pressure of the pregnant uterus)
. Treatment with anticoagulants
. Sepsis
. Skin infection at the puncture site
. Increased intracranial pressure
. Allergy to anesthetics
. AV block and other heart problems
. Significant fetal distress (umbilical cord prolapse, bradycardia)
. Exacerbation of herpes infection
The urgency of the situation and the lack of time to prepare the woman in labor and perform manipulations
. Presence of fetal malformations, antenatal fetal death
. Emotional instability of the mother in labor
. Some heart diseases
. Existing Opportunity expanding the scope of the operation
. Peripheral neuropathy
. Mental illness
. Low level intelligence (oligophrenia)
. Treatment with heparin
. Surgical team disagreement
. Spinal deformity
. Previously suffered spinal injuries.
The question everyone asks is How do anesthesia and drugs affect the fetus?
NO way - if it is spinal or epidural anesthesia.
INFLUENCE - if it is general anesthesia.
Drugs for spinal and epidural anesthesia (lidocaine, bupivacaine, ropivacaine) are used all over the world, and nothing better has yet been invented. When introduced, they decompose “there.” They have a large molecule, and they enter the mother’s blood in extremely small quantities. If the placenta is mature and normal (by 32-40 weeks of pregnancy), then it will not miss the drug. In other cases, only a few molecules that are not destroyed in the blood will enter the fetal bloodstream. BUT,. . . By the time the drug reaches the baby’s blood, the woman will become a mother. Simply put, the drug does not have time to reach the child.
At general anesthesia everything is different and depends on the speed of the obstetricians’ work - “the faster, the better.” The narcotic analgesics used in their entirety penetrate through the placenta to the fetus and, accordingly, cause the same effects as in a woman. This is depression of consciousness, breathing, and heartbeat. Newborn babies often sleep and breathe poorly...they are under anesthesia. But...and these drugs are different. Their use depends on the source specific situation, reasons for surgical delivery. Fentanyl, promedol, morphine opiates penetrate everywhere, oppressing everything. Ketamine is a synthetic drug. The only drug that causes reverse reactions. It raises blood pressure and stimulates the respiratory and cardiovascular centers. Although the baby will sleep, breathing and heartbeat will not be significantly disturbed. It should be remembered that for each drug there are clear and strict indications! The use of any drug depends on the specific situation, complexity, severity of the mother and baby.
In conclusion, I want to say that with any type of anesthesia, mutual understanding between the doctor and the patient is very important, how much trust you have in the doctor. This determines how quickly, painlessly and effectively the anesthesia will take place. First of all, calm down, ask the doctor everything that interests you. The doctor must tell you about the entire anesthesia process.
I am an anesthesiologist, before the operation I try to tell everything about anesthesia, and during the process I talk through what I will do and how. During the operation I try to talk with women and hold their hands. The entire anesthesia process goes more smoothly if the woman herself is calm and confident.
I am a patient. More than once in my life I found myself in operating table.
I am a mother. My motherhood began with a caesarean section under epidural anesthesia.
23.06.2011
Updated and supplemented 08.08.2015
Vereshchagina, anesthesiologist-resuscitator, category 2
The answer to this question largely depends on your preferences and how your labor progresses. All women experience pain differently. Every birth is different. Some women do not require pain relief at all. For others, pain relief gives them more control during labor. Ultimately you have to decide what's best for you.
Whether to use pain relief during childbirth is up to you. But you should take into account the recommendations of your doctor, the capabilities of the medical institution and the specifics of your birth.
Sometimes you don't know what type of pain relief you would prefer until labor begins. For every woman, her birth is unique. In addition, your ability to cope with pain can be affected by factors such as the length of labor, the size and position of the baby, and how you feel when labor begins. It's impossible to predict how you'll cope with the pain of your first labor, and subsequent ones can often go very differently.
Even before the first contractions begin, it's a good idea to think about your preferred method of pain relief. It would also be helpful to discuss this with your doctor. Whatever birth plan you set for yourself, be prepared to change it. Often things don't go according to plan. In addition, when making a decision, remember that childbirth is not a test of endurance. Just because you want pain relief doesn't mean you failed.
To choose for yourself suitable way pain management, ask yourself the following questions when considering your options:
These days, women have many more options to ease the pain of childbirth than before. All options are divided into two large groups: drug anesthesia and natural ways pain relief. By exploring all your options in advance, you can make an informed decision about pain management during labor.
Knowledge itself eases the pain. Fear, together with all the circumstances of childbirth, significantly increases the pain. If you know what to expect during labor and have considered all pain management options, you will likely have a smoother labor than someone who is stressed and afraid.
Drug pain relief. Medicines to relieve pain are called analgesics. Drugs used for pain relief during childbirth belong to the group of drugs. In experienced hands they are useful and quite reliable. They can be given by injection or intravenously. Depending on the type and dose used, these drugs can be used to either reduce pain (analgesia) or eliminate sensation during a caesarean section (surgical anesthesia). Two examples of pain management techniques used during childbirth are epidural and spinal blocks.
Natural methods. Natural methods of childbirth do not involve the use of drugs. There are many methods, some have been used for centuries. Two examples of such birthing techniques are massage and relaxation.
Drug pain relief can be very helpful during childbirth. It relieves pain and allows you to rest between contractions. You may require or refuse pain relief as labor progresses, but remember that different periods childbirth medicines may have different positive and negative effects. When choosing a method of pain relief, you must take into account how labor is progressing and what stage it is at.
The stage of labor at which you receive pain medication is just as important as the type of medication you receive. The medicine the mother receives has an effect on the baby, but the extent of the effect depends on the type of medicine, the dose, and how close to birth. For example, if enough time passes between the time you receive a narcotic painkiller and the time your baby is born, your body will have time to process the medication and your baby will have minimal effects from the painkiller after birth. Otherwise, the baby will be sleepy and will not be able to suck. In rare cases, the child may have difficulty breathing. All these consequences are short-term and can be treated if necessary.
It is a local analgesic or anesthetic that can be used during labor or before a caesarean section. The painkiller is injected into the lower back, outside the fluid duct surrounding the spinal cord. It takes about 20 minutes to install the blockade, and after another 10-20 minutes it will begin to work.
For. An epidural block mainly relieves pain in the lower body without slowing down labor too much and is safe for the baby. The medicine flows slowly through the catheter and provides long-lasting pain relief. While receiving pain relief, you remain conscious. By pressing a button, you can receive small additional doses of medication if needed. Some facilities may use a combination of epidural and spinal blocks, which will leave you with enough muscle strength to walk.
Against. The blockade may be less effective on one side of the body than the other. It can also lower your blood pressure which will slow down heart rate child. Doctors will constantly monitor your blood pressure and increase it if necessary. In rare cases, you will feel very strong for a few days after giving birth. headache when you get up. If the block was done during a caesarean section, the numbness may spread to chest, and you will find it difficult to breathe for a while. Because you won't be able to empty your bladder with an epidural, you will need a catheter. If the epidural block does not work well, another procedure may be needed.
This is a local anesthetic used immediately before a caesarean section or during labor if the baby is expected to be born within two hours. The injection is given directly into the fluid surrounding the spinal cord in the lower back and works quickly.
For. The spinal block provides complete pain relief from the chest down for two hours. The medicine is usually given once. You remain conscious.
Against. Just like an epidural block, a spinal block can affect one side of the body less than the other, can lower blood pressure—which slows the baby's heart rate—and cause severe headaches for several days after birth. If the anesthesia affects your chest, you may experience difficulty breathing due to blockage bladder a catheter may be needed.
This is a new technique that provides quick and long-lasting pain relief.
The anesthesiologist carefully inserts the epidural needle into your lower back. He then places a thinner spinal needle inside the epidural (so the shot is only given once), passes it through the membrane surrounding the spinal cord, and injects a small dose of medication into the spinal fluid. The spinal needle is removed, the epidural catheter remains.
At the beginning of labor, in the first 1-2 hours, a spinal injection works predominantly. When its effect wears off, the epidural block begins to work.
With any puncture of the spinal canal, neurological complications both at the time of the blockade and remotely. If you have had epidural or spinal anesthesia, six months after giving birth you need to consult a neurologist to rule out further problems.
Various drugs can be injected intramuscularly into the thighs or buttocks or intravenously through a catheter. If a catheter is inserted, you can control the dosage. The product takes effect within a few minutes.
For. Drugs reduce sensitivity to pain for 2-6 hours. They provide the opportunity to rest without causing muscle weakness.
Against. Drugs can make you and your baby drowsy and have difficulty breathing. The child's reflexes may also become temporarily slower.
Local anesthesia does not relieve the pain of contractions, but is used when the vaginal area needs to be desensitized, when an incision (episiotomy) is required to widen the vaginal opening, or when lacerations need to be stitched after childbirth. The injection is given in the tissue at the opening of the vagina and works quickly.
For. Local anesthesia temporarily relieves painful sensations in a certain place. Negative consequences for mother or child are rare.
Against. Local anesthesia does not relieve pain during contractions. Allergic reactions are possible. In rare cases, giving the medicine into a vein may lower your blood pressure.
Used immediately before the baby is born to relieve pain in the perineum. An injection of local anesthetic into the vaginal wall takes effect within seconds.
For. Relieves pain in the lower part of the vagina and perineum for about an hour. Negative consequences for mother or child are rare.
Against. The pain from contractions does not go away. The blockade can only affect one side of the vagina. Possible allergic reaction. If the medicine is given into a vein, your blood pressure may decrease.
Occasionally, tranquilizers are used to relieve anxiety and provide rest. initial stage childbirth They may be given in tablet form, intramuscular injections into the thigh or buttock or intravenously through a drip. When injected or through a dropper, they act very quickly.
For. Tranquilizers relieve anxiety and provide rest for several hours.
Against. Tranquilizers do not relieve pain. They can cause drowsiness, reduce your awareness of what is happening, and reduce muscle tone and activity of the child.
In this case, you preemptively refuse to use medications and rely on other ways to relieve pain.
Natural (non-medical) pain relief works in different ways. They can stimulate the body to produce natural painkillers (endorphins). These substances distract you from pain, calm and relax, helping you better manage yourself.
Natural pain relief methods can help you manage your pain, but they don't completely eliminate it. Many women would do well to try non-drug ways to relieve labor pain before pursuing other options.
Natural pain relief can be very helpful in both early and active labor. Only during the transitional stage, when the cervix dilates to a full 10 cm, and when pushing, women who have chosen natural pain relief, feel significant pain.
Natural methods of pain relief include breathing and relaxation techniques and many other methods.
Breathing techniques like others natural methods pain relief, do not require medications or medical supervision. You control everything yourself. It is assumed to use measured, controlled breathing during contractions. By focusing on your breathing, you take your mind off the pain and relax your muscles so that the tension that aggravates the pain goes away. Deep, controlled, slow breathing also reduces nausea and dizziness. Perhaps more importantly, breathing this way delivers more oxygen to you and your baby.
It is better to learn breathing techniques and practice them before giving birth. They are taught in most childbirth schools. If someone is going to help you during birth, take them with you to school so they can learn breathing techniques and then help you. The more you practice, the easier it will be to use these methods when contractions begin.
Breathing exercises will begin to work immediately as soon as you start doing them. However, these methods are not always successful because they depend on your reaction to labor pains, which cannot be predicted, and on your ability to focus on anything other than the pain. Breathing techniques can be combined with other types of pain relief.
Lamaze method. This is the philosophy of childbirth and breathing technique, used during childbirth. The philosophy states that childbirth is a natural, normal, healthy process, and that education and support give a woman the strength to rely on herself during childbirth. The training focuses on relaxation techniques, but also teaches how to program your body to respond to pain through training and practice. For example, you are taught controlled breathing exercises, which are a much smarter way to deal with pain than holding your breath and tensing your muscles.
Instructors teach expectant mothers to begin and end each contraction with a deep cleansing breath: we inhale through the nose, imagining cold, clean air. We exhale slowly through the mouth, imagining how the tension is released. Deep breathing signals to everyone in labor that the contraction is beginning or ending, and to your body that it can relax.
During childbirth, different levels of Lamaze breathing are used, as described below. When you use this method, start with the first move and continue as long as it works, and then move on to the next level.
Your preferences and contractions will help you decide when to use breathing exercises during labor. You can use different techniques and even invent your own. Even if you plan to use medication for pain relief during labor, it is important to learn breathing and relaxation techniques.
Relaxation is the release of tension from the mind and body through conscious effort. By reducing muscle tension during childbirth, you can eliminate the fear-tension-pain cycle. Relaxation helps your body work more naturally, preserving energy for the efforts yet to come. Relaxation and controlled breathing are the basis of measures that a woman can use to improve her well-being during childbirth. All these methods are usually taught in a childbirth school.
Relaxation does not mean fighting pain, which would lead to even more tension. Instead, it lets the pain roll through your body while you focus on stress-relieving and distracting exercises.
Relaxation is something that can be learned and is most effective if practiced before labor occurs. The more practice you have, the more confident you will feel during labor.
Here are some tips on how to master the art of relaxation:
Step by step relaxation. Using this technique, you relax muscle groups between or during contractions, or periodically throughout labor when you feel yourself becoming too tense. Starting from the head or feet, relax one muscle group at a time, moving to the other end of the body. If you find it difficult to isolate the muscles, first tense each group for a few seconds, then relax and feel the tension go away. Please pay special attention to relax the jaws and hands: many women unconsciously tense their faces and clench their fists during contractions.
Relaxation by touch. This is similar to the previous method, but the twist is that you relax each muscle group as your laborer presses on that part of your body. He can press or rub in a circular motion 5-10 seconds, then move on to the next section. For example, first they will rub your temples, then the back of your head, then your back and shoulders, arms and finally your legs.
Massage. Various ways massages will help you relax during childbirth. These may include rhythmic stroking of the shoulders, neck, back, abdomen and legs; kneading or rubbing the feet and palms; head massage with fingertips. Massage can relieve muscle pain and tension, stimulate the skin and more deep tissue. It can be done at any time. A properly done massage gives long lasting effect. Massage helps you relax and blocks pain. Many women experience pain primarily in their back during childbirth, and back massage can really help them.
You may want to apply firm pressure to your lower back as this good way relieve back pain during childbirth.
Even before giving birth, you need to find out with your assistant what types of massage you prefer. But don't forget that things will go much better if during childbirth you are ready to change previously made decisions.
Imagination control. This method helps women during childbirth create an environment where they feel good and calm. This method, also called daydreaming, will help you relax at any time during labor. You need to imagine yourself in a pleasant and calm place. For example, you imagine yourself sitting on a warm sandy beach or walking in a beautiful green forest. Such a place can be real or imagined. Sometimes your imagination can be helped by recordings of the sounds of the sea surf, rain, birdsong, or any soft music of your choice.
Meditation. Focusing on a calming object, image, or word will help you relax and feel less pain. Focus on one point. It could be something in the room, such as a picture you brought with you, or an imaginary object, or a word you repeat over and over again. When some distracting thoughts enter your mind, let them pass without delving into them, and focus again on the chosen point.
Aromatherapy. To promote relaxation and relieve labor pains naturally, try using calming scents. At home, you can light a scented candle or aroma lamp. Take a pillow soaked in your favorite scent with you to the maternity hospital. Or use a lightly scented oil when massaging. Aromatherapy will help you relax and reduce stress and tension. However, childbirth may increase sensitivity to certain odors, so do not overdo it with scenting. Simple scents like lavender are best.
Music. Music gives you the opportunity to focus on something other than pain and helps you relax during labor. If you have practiced relaxation and breathing techniques with music at home, take these cassettes or disks with you to the hospital or use them during a home birth. Many women use the player to listen to their favorite music and eliminate various distractions.
Free movement during labor allows you to find the most comfortable position. So, once you're seated, change your position often to find the one that works best for you. Movement also improves blood circulation. Change position as soon as you feel like it. Some women find rhythmic movements, such as rocking or standing on all fours, to be calming and distracting from pain.
You can also try these methods:
Hot and cold. Applying hot and cold can help relieve labor pain naturally. The purpose of this application is to make you comfortable so that you can relax. You can use hot and cold at the same time. Hot heat relieves muscle tension. You can use a hot towel, a compress, a bottle of hot water, a bag of heated cereal. To reduce pain! hot and cold can be placed on the shoulders, back, lower abdomen. You can use cold compresses, chilled cans of drinks, or ice packs. For many women, back pain is relieved by applying cold ice to the lower back. A cold, damp towel on your face will help relieve tension and keep you refreshed during labor. You can suck on ice cubes - this is also refreshing and distracting.
Shower and bath. In many medical institutions there is a shower in the birth rooms. Sometimes even baths and Jacuzzis to make labor easier. Warm water soothes pain naturally by blocking transmission pain impulses into the brain. Warm water helps you relax. You can use this method at home, before going to the hospital. If you are using a shower, you can sit on the seat and direct the water onto your back or stomach. Ask your assistant to join you.
Childbirth ball. This is a large rubber ball that can be used to relieve pain naturally. Sitting or leaning on a ball will reduce the discomfort of contractions, ease back pain and help your baby lower himself into position. birth canal. They can give you a ball at the maternity hospital. Or you will have to buy it and bring it with you. Ask experts to teach you how to use the ball most effectively. Its use can be combined with other techniques such as massage or touch relaxation.
This is a woman specially trained to assist in childbirth. Women have helped each other during childbirth for centuries. But the role of a doula is a more formal and modern interpretation of such assistance. Some women prepare to give birth by including a doula in their birth plan.
What is she doing? Its main task is to help a woman during childbirth. It will not replace your doctor or health care providers during labor and delivery. She will offer additional help and advice. Most doulas are mothers themselves. Most also attended childbirth school.
Sometimes doulas start working already at early stage pregnancy, explaining what to expect during labor and helping you create a birth plan. If you wish, a doula will come to your home at the very beginning of labor and provide support during the first contractions.
But their real work becomes apparent in the maternity hospital or hospital. A doula will offer you - and your partner - ongoing support. When labor has already started, she will help, bring you ice or massage your back. It will help you use breathing and relaxation techniques correctly. She will advise which position to choose. What’s even more important is that she will provide you and your partner with moral support and say kind words, will calm down.
She can also act as a mediator, helping you make informed decisions during labor and delivery. She will explain medical terms and procedures. She will convey your wishes to the doctor. However, a doula cannot produce medical examinations, assist at the birth of a child, give or not give consent for you to medical procedures.
A doula provides expectant mothers with extra support and attention as they bring their baby into the world. It provides emotional support, which is very important for a woman during childbirth. Some studies show that women who used doula support had fewer complications during childbirth.
However, the help of a doula is not necessary and is not very often used. It is most useful for those who are giving birth to their first child and for single mothers for whom no one can provide long-term help. For most pregnant women, the functions of a doula can be quite successfully performed by a partner or one of the family members. In addition, many maternity facilities have very many staff per patient - often one-on-one - so the help of a doula may be unnecessary if nurses and nannies are willing to offer all the services.
How to find a doula? The doctor at the facility where you are planning to give birth can provide you with a list. Sometimes doula services are offered at the maternity hospital. Some charge a flat fee for all their services, while others use a sliding scale.
Anticonvulsant medications reduce tension smooth muscle internal organs, including the uterus. For this purpose, the drugs buscopan or scopol-min are often used. As a supplement to them, painkillers in the form of rectal suppositories or an injection into a vein. Intramuscular injections too painful and generally not recommended.
Anticonvulsant medications at normal dosages do not have any side effects on the child. But only with very severe pain the effect of these drugs may not be enough.
A reliable means of stopping labor for short time(for example, until the epidural anesthesia is done) are tocolytics.
There are various medications that affect the perception of pain. Among them, opiates are the most effective.
Initially, opiates were obtained from the juice of unripe poppy pods, but today they are also produced artificially. For many centuries people have known about the effects that opium has. Its ability to reduce pain is based on changing the brain's perception. But despite all the effectiveness of opiates during childbirth, they can only be used in small doses, because they penetrate the placenta and reach the child. And therein lies the problem. The drug, while providing its analgesic effect, simultaneously inhibits the work of the child’s respiratory center. After birth, respiratory depression in the newborn can lead to serious consequences. This is the reason for the limited use of opiates.
The most commonly used medications during childbirth are pethidine (Dolantin), tramadol (Tramal), pyritamide (Dipidolor), buprenorphine (Temgesic) and pengazocin (Fortran). The woman in labor should receive them not intramuscularly, but in the form of a slow intravenous infusion.
Epidural anesthesia (EA) is today the main method of pain relief. It is reliable, safe and very rarely leads to complications. The undeniable advantage of PDA is that it does not turn off consciousness and does not affect side effect per child. Women experience an epidural as a great relief, especially if contractions are extremely painful or labor has been going on for too long.
With this method, the anesthesiologist under local anesthesia inserts through a hollow needle into spinal canal thin catheter. Having secured it with a plaster, he injects anesthetic medicine through it into the spinal canal. local action, which effectively relieves pain within 30 minutes. If necessary, additional doses can be injected through the catheter. Anesthesia often causes weakness in your legs, so that you are no longer able to walk or your mobility is limited. But with the appropriate dosage of the medication, childbirth is possible both standing and sitting.
Sometimes, in case unsuccessful introduction cannulas, pain relief occurs only partially or only on one side. But usually the anesthesiologist quickly corrects the situation. Just be sure to tell him if you continue to feel pain.
The moment for PDA does not depend on the degree of opening of the uterine pharynx. You can ask for an epidural even when labor is already well advanced and the baby is expected to be born within just a couple of hours. This will not cause any negative consequences for you or your baby.
Women often fear that due to PDA they will not be able to be active enough during childbirth. But there is no cause for concern in this regard. The anesthesiologist selects the dose of the medication in such a way as to achieve pain relief, but without affecting the muscles. So you will be quite capable of actively pushing during the expulsion phase of the fetus.
In some exceptional cases, the use of epidural anesthesia as a means of pain relief during childbirth should be abandoned:
For pain relief, doctors have at their disposal additional methods, which, however, are rarely used due to high efficiency PDA.
Patient-controlled epidural anesthesia (PACEA). This method allows you, within certain limits, to control the dosage of the painkiller using a pump.
Combined spinal-epidural anesthesia (CSEA). With this method, the medication is first injected directly into the spinal canal and then injected through a catheter as needed. Pain relief occurs very quickly.
Spinal anesthesia (SA) at the last minute. This method is resorted to when labor is already close to completion and the point is to relieve pain for only the remaining two to three hours. In this case, the anesthetic drug is also injected directly into the spinal canal. But an epidural catheter is not installed - usually it is no longer needed: the child is born before the effect of the drug wears off.
General anesthesia during childbirth is used only in the event of an unexpected deterioration in the condition of the mother or child, when surgery becomes inevitable. In all other cases, local anesthesia is preferred. The risks associated with it are significantly lower than with general anesthesia.
In most cases, during a planned caesarean section, anesthesiologists choose spinal (spinal) anesthesia. At the same time, the woman in labor is in an active, awake state, which ensures work safety respiratory tract. With such anesthesia, the child is born in very good condition. Also, spinal anesthesia is indicated in case of urgent need to perform a caesarean section.
The essence of the technique and its features
Spinal anesthesia can be used for relatively little experience the work of an anesthesiologist. Anesthesia acts quickly, providing good conditions for the actions of the operating surgeon. Spinal anesthesia is performed at the same point as the epidural, but with some differences. For example, for a spinal one, a much thinner needle is used, and the doses of anesthetic to ensure a spinal block are smaller. The anesthetic is injected below the spinal cord into the area containing cerebrospinal fluid.
The spinal block is performed with the woman lying on her side or sitting. If a woman is sitting on the operating table, then her feet are placed on a stand, and her body leans forward as much as possible. The procedure can also be performed with the woman lying on her left side with her hips bent and knees tucked. A small area of the back is then treated with an antiseptic solution, and a thin needle is slowly inserted between the two vertebrae to administer spinal anesthesia. Just a few minutes after the drug enters the body, a partial blockade of nerve fibers in the legs and lower back occurs. The woman in labor feels warmth, then numbness occurs, sensitivity decreases, relax calf muscles, and the surgeon can begin the operation within 5 minutes.
After the spinal anesthetic is administered, sterile gauze is applied to the injection site and secured with a plaster. A woman in labor never lies on her back during surgery - in this position the vena cava is compressed, causing hypotension (decreased pressure). Usually, with spinal anesthesia, the pain relief is so high quality that the woman does not even understand that she is being operated on. For rare unpleasant sensations, anesthesia can always be supplemented with the introduction of a powerful intravenous analgesic, or the woman will be transferred to general anesthesia.
Benefits of spinal anesthesia
Contraindications for carrying out
The main contraindications to spinal anesthesia are:
The only complications that can be mentioned are headache and lower back pain, which usually disappear within a day after surgery. The main thing is not to try to get up and walk faster. Resting for 12 hours after spinal anesthesia is the recommended condition. In general, pain is rare, so spinal anesthesia can be considered the safest.
In most cases, during a planned caesarean section, anesthesiologists choose spinal (spinal) anesthesia. At the same time, the woman in labor is in an active, awake state, which ensures the safety of the respiratory tract. With this anesthesia, the child is born in very good condition. Also, spinal anesthesia is indicated in case of urgent need to perform a caesarean section.
The essence of the technique and its features
Spinal anesthesia can be used with relatively little experience of the anesthesiologist. Anesthesia acts quickly, providing good conditions for the operating surgeon. Spinal anesthesia is performed at the same point as the epidural, but with some differences. For example, for a spinal one, a much thinner needle is used, and the doses of anesthetic to ensure a spinal block are smaller. The anesthetic is injected below the spinal cord into the area containing cerebrospinal fluid.
The spinal block is performed with the woman lying on her side or sitting. If a woman is sitting on the operating table, then her feet are placed on a stand, and her body leans forward as much as possible. The procedure can also be performed with the woman lying on her left side with her hips bent and knees tucked. A small area of the back is then treated with an antiseptic solution, and a thin needle is slowly inserted between the two vertebrae to administer spinal anesthesia. Just a few minutes after the drug enters the body, a partial blockade of nerve fibers in the legs and lower back occurs. The woman in labor feels warm, then numbness occurs, sensitivity decreases, the calf muscles relax, and the surgeon can begin the operation within 5 minutes.
After the spinal anesthetic is administered, sterile gauze is applied to the injection site and secured with a plaster. A woman in labor never lies on her back during surgery - in this position the vena cava is compressed, causing hypotension (decreased pressure). Usually, with spinal anesthesia, the pain relief is so high quality that the woman does not even understand that she is being operated on. For rare unpleasant sensations, anesthesia can always be supplemented with the administration of a powerful intravenous analgesic, or the woman will be transferred to general anesthesia.
Benefits of spinal anesthesia
Contraindications for carrying out
The main contraindications to spinal anesthesia are:
The only complications that can be mentioned are headache and lower back pain, which usually disappear within a day after surgery. The main thing is not to try to get up and walk faster. Resting for 12 hours after spinal anesthesia is the recommended condition. In general, pain is rare, so spinal anesthesia can be considered the safest.
