How can doctors help?
General anesthesia. When using these types of anesthesia, pain sensitivity in 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 is used medicines, and the anesthetic itself enters through the trachea into the lungs. This anesthesia is used for caesarean section, chale in emergency cases.
Inhalation (mask) anesthesia. One form of pain relief is the inhalational anesthetic nitrous oxide, which the mother inhales through a respirator-like mask. The mask is used during the first stage of labor, when the cervix dilates.
Local anesthesia. When using 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 solution local anesthetic into the space above the dura mater of the spinal cord. These days, such anesthesia is widely used during childbirth. After the injection, the lower part of the body becomes insensitive. The nerves that carry pain signals to the brain from the uterus and cervix pass through lower section spine - this is where the anesthetic is injected. During the action of this type of anesthesia, the woman is fully conscious and can talk with others.
Local anesthesia. This method, which deprives any area of skin of sensation, is often used after childbirth for pain relief during suturing of soft tissue. In this case, the anesthetic is administered directly instead of intervention.
Intravenous anesthesia. The drug (anesthetic) is injected into a vein. The woman then falls asleep for a short time (10-20 minutes). It is used when performing short-term surgical interventions during childbirth, for example, when releasing retained parts of the placenta, when applying obstetric forceps.
Use of narcotic analgesics. Narcotic analgesics are administered intramuscularly or intravenously, which reduces pain sensitivity during childbirth, and the woman is able to fully relax in the intervals between contractions.
Medical indications for pain relief
Anesthesia without drugs
Massage
Pain relieving massage- this is an effect on certain points at which nerves exit the surface of the body. Targeting these nerves causes some pain and thus distracts from the pain of labor. Classic relaxing massage - stroking the back and collar area. This massage is used both during contractions and in between them.
Without exception, all expectant mothers experience some anxiety in anticipation of childbirth. One of the reasons for such anxiety is the well-known idea that contractions are painful. Is it possible to influence the pain? And is the woman herself able to make her childbirth as easy and painless as possible? In this section we will talk in detail about all methods of pain relief, their pros and cons.
Relaxation- relaxation methods that help you endure contractions more easily and get proper rest in the periods between them.
Rational breathing- There are several breathing techniques that can help you endure contractions more easily. By skillfully using the correct type of breathing during a contraction, we achieve a slight, pleasant dizziness. It is at this moment that endorphins are released (these hormones are produced in large quantities during childbirth; endorphins have an analgesic and tonic effect and are released into the blood during contractions).
Active behavior during childbirth- it’s good if the expectant mother knows that during a normal, uncomplicated birth, you can take different positions and choose the most comfortable one, in which this particular woman in labor can more easily endure contractions. Active behavior also refers to movement, walking, rocking, bending and various poses designed to relieve stress on the spine. Changing position is the first and most natural desire in case of any discomfort.
Hydrotherapy- using water to relieve pain during contractions. IN different situations During contractions, you can still use the bath or shower.
Electroanalgesia- the use of 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 psychoprophylactic preparation for childbirth can be taken at antenatal clinic or at a school for pregnant women, where they will teach you proper breathing during childbirth, show you rational postures, and help you learn relaxation methods.
Postures, breathing, pain-relieving massage, hydrotherapy during normal labor can be used with almost no restrictions. In the maternity hospital, you should consult a doctor about this. In some situations (with breech presentation of the fetus, with premature birth) the doctor may limit the freedom of movement of the woman in labor and strongly recommend to the expectant mother lie. But breathing and relaxation skills will be useful to you in any case.
The doctor will definitely prescribe medication if there are medical indications, depending on the condition of the mother and child at the time of birth.
When using drug pain relief the anesthesiologist first conducts a conversation with the woman, talking about the essence of the method that is planned to be used, as well as its possible negative consequences. After this, the woman signs a consent to use one or another method of pain relief. It must be said that in emergency situations When the life of a woman or child is in serious danger, this procedure is neglected.
Separately, it is necessary to say about the contract for childbirth. When concluding an agreement in which it is stated that a particular method of drug pain relief will be used at the request of the woman, drug pain relief is used when the woman in labor requests. In these cases, epidural anesthesia is more often used.
If in the situation with the presence of medical indications and with the contract for childbirth everything is more or less clear, then in other cases the use of medicinal methods at the request of the woman is a controversial issue and in each medical institution solved differently.
Childbirth is a natural physiological process, but despite this, pain is an almost integral component of it. Only about 10% of women characterize labor pain as insignificant; this is mainly typical for 2 or 3 births. At the same time, almost 25% of women in labor require medical supplies to reduce the intensity of sensations and prevent possible harm, both for mother and child.
In the first stage of labor, contractions of the uterus (contractions) and dilation of the cervix cause excessive irritation nerve endings, which in turn send a signal interpreted by the brain as pain. In addition, the vessels and muscles are stretched, and the intensity of their blood supply decreases, which can also increase the severity of pain.
In the second period, the main factor contributing to the occurrence of pain is the pressure of the presenting part of the fetus on the lower part of the uterus, and its movement through the birth canal.
In response to increasing painful sensations the brain generates a response from the body - increased heart rate and breathing, increased blood pressure, excessive emotional arousal.
It is worth noting that in many ways the intensity of pain during childbirth depends not only on the level of the woman’s pain threshold, but also on her psycho-emotional state. Stress, fear, anticipation of pain, and a negative attitude increase the amount of adrenaline produced, resulting in increased perception of pain. On the contrary, calmness and balance contribute to the production of endorphins (hormones of joy), which naturally block the perception of pain.
In 100% of cases, methods of non-drug (physiological) pain relief are indicated: correct breathing, various relaxation techniques, special poses, water treatments, acupuncture, massage. When used correctly, the combination of these methods is enough in almost 75% of cases to avoid resorting to medications.
If physiological methods do not produce results or there are objective medical indications related to the woman’s health, obstetric situation or course birth process, drug pain relief is used. This helps not only to reduce the suffering of the mother in labor, but also avoids negative reaction body to pain, thereby normalizing heartbeat and breathing, reducing blood pressure and increasing blood circulation in the pelvic area.
In addition, pain relief during labor can reduce energy costs and avoid weakening of labor in cases where the duration of the first period exceeds 12 hours.
Many previously widely used methods of anesthesia and analgesia are now fading into the background due to the excessive number of side effects. These include inhalation pain relief, causing short-term clouding of consciousness and depressing the respiratory activity of the fetus, and intravenous administration of various analgesic drugs and antispasmodics that easily penetrate through the placenta into the fetal bloodstream.
The safest and most effective methods of regional anesthesia are considered to be epidural and spinal anesthesia.
With this method, under local anesthesia, an anesthetic drug (Lidocaine, Novocaine) is injected into the epidural space of the spine using a thick needle. As a rule, the procedure itself, including insertion of the catheter, takes no more than 10 minutes. The effect of the drug occurs within 15-20 minutes and lasts up to half an hour, after which, if necessary, a new dose can be administered.
Indications for the use of epidural anesthesia include:
The decision on the need to use epidural anesthesia is made by the obstetrician-gynecologist together with the anesthesiologist, taking into account the patient’s medical history, the condition of the fetus and the course of labor.
The procedure for placing a catheter and inserting a needle is quite complex and requires certain skills and experience from the anesthesiologist.
The technology is not significantly different from epidural anesthesia; it is performed using a thinner needle and with a smaller amount of medication. In this case, the anesthetic itself is injected directly into the area where it is located. cerebrospinal fluid. The effect of such an injection occurs almost instantly and can last from 2 to 4 hours.
Spinal anesthesia completely blocks the transmission of impulses from peripheral nerves to the brain, so sensitivity below chest level is completely absent, while the woman in labor is completely conscious. This method pain relief is often used during both planned and emergency caesarean sections.
Application spinal anesthesia guarantees an analgesic effect in 100% of cases (with an epidural there is approximately a 5% chance of failure), the procedure is practically painless, and the drugs used do not harm either the woman in labor or the fetus.
Side effects include possible headaches and back pain after the anesthesia wears off, as well as a significant decrease in blood pressure.
There are a number of contraindications for which spinal or epidural anesthesia is strictly not recommended. These include:
An obstacle to the administration of painkillers may be the categorical refusal of the woman in labor, without whose consent the procedure cannot be carried out.
Also, contraindications in some cases may include injuries and deformities of the spine, serious cardiovascular and neurological diseases, and obesity.
In conclusion
In order to minimize possible negative feelings, it is important to try to get rid of the fear of pain during childbirth in advance. Most women in labor are able to cope with it on their own using natural, non-drug methods, but if necessary, the doctor will always prescribe additional medications. With this in mind, you can stop worrying that the pain will become unbearable and concentrate on positive thoughts about the birth of your baby.
Especially for- Elena Kichak
Basic requirementsWhich are presented for labor pain relief:
– restoration of normal relationships between the cortex cerebral hemispheres and subcortical centers;
– removal of negative emotions, fear;
– complete safety of the method for mother and fetus;
– absence of a depressing effect on labor;
– shortening of the birth act;
– prevention and elimination of spasm of the muscles of the cervix and lower uterine segment;
– sufficient analgesic effect;
– maintaining the consciousness of the woman in labor, her ability to actively participate in the birth act;
- absence harmful influence for lactation and the postpartum period;
– simplicity and accessibility of the pain relief method for obstetric institutions of any type.
A. Non-drug methods.
I. Methods that reduce painful stimuli:
1. Physiopsychoprophylaxis.
2. Freedom of movement for the woman in labor.
3. Support during childbirth by medical staff and partners.
4. Abdominal decompression.
II. Methods that activate peripheral receptors:
1. Acupuncture (acupuncture) and acupressure (this is acupuncture without needles
They help relieve pain during contractions, normalize labor and do not have a negative effect on the fetus. The method limits motor activity women in labor and requires careful monitoring, and therefore the session is limited in time.
2. Transcutaneous electrical nerve stimulation (TENS). The Delta-101 device is used, which is a single-channel electrical stimulator that generates asymmetrical bipolar impulses. Two pairs of electrodes in the form of plates with an area of 20 cm2 are fixed with adhesive tape in areas of maximum pain on the anterior skin abdominal wall and posteriorly paravertebral in the zone of segmental innervation ThX-LII.
3. Hydrotherapy (warm baths) – the disadvantage of this method is the difficulty of ensuring asepsis, monitoring the nature of contractile activity of the uterus and the fetus, the moment of rupture of amniotic fluid, etc.
4. Massage during childbirth - widely used in a number of countries; various types of massage stimulate skin receptors, increase neural activity of myelin fibers; these stimuli are transmitted faster than painful ones.
III. Methods that block pain impulses:
1. Electroanalgesia - the use of pulsed current allows you to achieve stable vegetative balance, avoid allergic reactions, obtain the so-called “fixed” stage of therapeutic analgesia, which allows you to maintain consciousness during the birth act, verbal contact with the woman in labor without signs of excitement and transition to the surgical stage of anesthesia. To provide therapeutic analgesia for fatigue during childbirth, Elektronarkon-1 and Lenar devices are used. Before applying the electrodes, 15 minutes before the start of the pulsed current, premedication is carried out with promedol 2% - 1 ml (20 mg), pipolphen 2.5% - 1 ml (25 mg), metacin 0.1% - 1 ml (1 mg). Before applying the electrodes, the skin of the forehead and neck area is wiped with alcohol. Gauze napkins in 8-10 layers (3 by 3 cm), soaked in 0.9% sodium chloride solution, are placed under the electrodes. The cathode (negatively charged electrode) is applied to the forehead, the anode (positively charged electrode) is applied to the area mastoid processes. The pulse repetition rate is set within 750 Hz, the pulse duration is 0.5 ms. Then slowly increases impulse current to threshold sensations (tingling sensation, crawling “goosebumps”) in the area of the electrodes. Every 15-20 minutes it is necessary to increase the average current value to a frequency of 1000-1500 Hz. The average current value is 0.8-1.2 mA with a session duration of 1.5-2 hours.
2. Hypnosis.
3. Focusing and distraction with the help of music and audio analgesia, i.e. the use of noise (“sound of the sea”, “noise of a falling wave”).
IN. Medication methods - Not inhalation anesthesia, inhalation anesthesia, regional and local anesthesia. Upon appointment medicines for pain relief during labor, we must remember that there is not a single sedative or hypnotic, not a single analgesic that would not penetrate the placenta and would not affect the fetus. To relieve pain during labor, a careful selection of medications and their combination are necessary, taking into account the condition of the particular woman in labor and the fetus. It is also important to take into account the period of birth. Pain during contractions occurs when the cervix is dilated by 3-4 cm, maximum pain occurs when the cervix is dilated by 9-10 cm, but during this period not all drugs can be used due to their effect on the fetus.
Scheme of the sequence of pain relief during childbirth:
1. At the beginning of labor (latent phase of labor, cervical dilatation by 3-4 cm) with less painful contractions, it is used to relieve fear. Tranquilizers: trioxazine 0.6 g or elenium 0.05 g, seduxen 0.005 g.
2. With the development of regular labor and the appearance of severe painful contractions, the combined or independent use of inhaled or narcotic analgesics in combination with sedatives or antispasmodics is indicated. For easily suggestible women in labor, use non-drug methods of pain relief (acupuncture, electroanalgesia, transcutaneous electrical neurostimulation).
3. In case of ineffectiveness of these methods of labor anesthesia or in the presence of extragenital pathology, gestosis, it is advisable to use long-term epidural (epidural) anesthesia.
Can be used the following combinations drugs:
20-40 mg promedol + 20 mg diphenhydramine + 40 mg no-shpa;
20-40 mg promedol + 10 mg seduxen + 40 mg papaverine;
2 mg Moradol + 10 mg Seduxen + 40 mg No-Spa;
50-100 mg meperidine + 25 mg promethazine (used abroad)
The listed drugs should be administered Intramuscularly to achieve results faster. The action of anesthetics begins 10-20 minutes after administration and lasts 2 hours. Pain relief with analgesics is used in case of severe pain in contractions, when the cervix is opened by 3-4 cm and is stopped 2-3 hours before the expected moment of birth due to possible narcotic fetal depression. After the administration of these drugs, monotony is observed heart rate fetus on CTG, labor continues. A significant reduction in pain is observed in 30-60% of women in labor. Increasing doses of analgesics or reducing the intervals between administrations in order to achieve complete anesthesia can lead to the development of weakness of labor and increased blood loss during childbirth.
Therapeutic obstetric anesthesia shown in following situations:
– fatigue during childbirth;
– prolonged labor;
– discoordination of labor;
– pathological preliminary period.
In this case the following is used:
A solution of sodium hydroxybutyrate (GHB) 20% at a rate of 50-65 mg/kg (average 4 g of dry matter), administered intravenously slowly 5-20 minutes after premedication. Sleep occurs 3-8 minutes after administration of the drug and continues for 2.5 hours. The drug is contraindicated in severe forms of gestosis, bradycardia, and arterial hypertension.
Promedol solution 2% 1 ml intramuscularly;
Pipolfen solution 2.5% 1 ml intramuscularly;
Diphenhydramine solution 1% 1 ml intramuscularly.
During therapeutic anesthesia, the intensity decreases metabolic processes and tissue oxygen consumption. Decreases after rest metabolic acidosis, metabolic and oxidative processes increase, against the background of which the effect of uterotonic drugs increases. Obstetric anesthesia is prescribed by an obstetrician-gynecologist and performed by an anesthesiologist.
Inhalation methods of labor pain relief:
Nitrous oxide is the most common use of autoanalgesia with a mixture containing 40-60% nitrous oxide and 60-40% oxygen. Nitrous oxide does not accumulate in the body, so it can be used throughout labor. The woman in labor breathes the selected gas mixture during contractions, starting inhalation when she feels a contraction approaching. Continuous inhalation is also possible. The woman in labor is awake, can push, the duration of action of the mixture is short, side effects on the body of the mother and fetus are insignificant. If cyanosis, nausea, or vomiting occurs, nitrous oxide inhalation is stopped and pure oxygen is given.
Trilene (trichlorethylene) gives a more pronounced analgesic effect than nitrous oxide. The optimal option for its use is periodic inhalation in a concentration not exceeding 1.5% by volume. Increasing the concentration or using the drug for more than 3-4 hours can lead to a weakening of labor, tachypnea and cardiac arrhythmia in the woman in labor, due to the cumulative effect of trilene.
Long-term epidural anesthesia (LPA) shown when:
– severe pain and lack of effect from other methods of pain relief;
– discoordination of labor;
– cervical dystocia;
– increased blood pressure during childbirth;
– gestosis;
– in pregnant women suffering from severe diseases of the heart and respiratory system.
Only an anesthesiologist performs DPA. VPA begins when regular labor is established and the cervix is dilated by 3-4 cm. The method can be used throughout labor. The anesthetics used are 2% lidocaine solution, 2.5%; trimecaine solution, 0.25 0.5% bupivacaine solution.
Pudendal anesthesia performed for pain relief in the second stage of labor during operations involving the application of obstetric forceps and a vacuum extractor, when switching off consciousness is not required, when dissecting the perineum and restoring its integrity. To ensure blockade of the pudendal nerve, located 0.5-1 cm proximal to the spina ischii, you need to inject 10 ml of 0.5-1.0% novocaine solution or 10 ml of 1% lidocaine into the ischiorectal space on each side (or through perineum, or through side walls vagina).
Everyone is afraid of labor pain, absolutely all women who are preparing or just planning to become mothers. Some to a greater extent, some to a lesser extent. But the issue of anesthesia during childbirth is approached thoroughly, mainly by pregnant women who will soon go to childbirth. So let's figure out what types of drug pain relief there are? And why, in fact, is all this necessary, because nature hardly gave us such pain during childbirth that we are not able to withstand...
People have been trying to relieve pain during childbirth since ancient times. In Ancient Egypt, for example, the wives of noble townspeople gave birth in rooms fumigated with opiate (narcotic) fumes. In ancient Rome, noble ladies giving birth were given alcohol and a decoction of poppy heads, which also contained opiates. Opiates (PROMEDOL) are still a common means of relieving labor pain.
In the Middle Ages, any attempts to anesthetize childbirth were persecuted by the Inquisition. Both the woman in labor and the person administering pain relief were punished, as this was considered a grave sin in relation to the laws of the Bible. At the end of the 19th century. Ether anesthesia was discovered and successfully used to relieve labor pain. Then, for some time, labor was anesthetized with chloroform (one of the first inhalational anesthetics), but this method was not widely used due to respiratory depression in newborns.
In the pelvis abdominal cavity, perineum and rectum are located pain receptors, which, reacting to changes occurring in a woman’s body during childbirth, formulate a signal of pain, transmitting it to the brain.
In the first stage of labor, under the influence of contractions (when the muscles of the uterus contract) the cervix opens. During contractions, the shape of the uterus and its position in the abdominal cavity change relative to the organs and tissues that surround it. The uterine ligaments are stretched, the uterine tissue is in a state of oxygen deficiency. All this results in a reaction in the brain, pain. The increase in pain occurs in proportion to the degree of dilatation of the cervix. The difference in pain between different women is determined by the fact that each woman has pain receptors in different places, so each woman feels pain in her own way. Accordingly, women describe the pain they feel during the first stage of labor in different ways. But most often this pain is described as “pain during menstruation, but stronger,” less common descriptions are “pulls in the lower back,” “radiates to the sacrum,” and others.
In the second stage of labor, when the so-called “expulsion” of the fetus occurs, the cervix is already dilated and the fetus, under the influence of uterine contractions called “pushing,” begins its movement along the birth canal. As he moves, the nature of the pain changes. The fruit has strong pressure on the rectum (this is what determines the desire of women in labor to “poop”) as well as the surrounding soft tissues. Added to this are more intense contractions of the uterus, which are explained by the fact that the fetus needs to overcome the resistance of the ring of the pelvic bones. Thus, sufficient pressure is exerted in the perineal area and the underlying organs; the receptors located there, again, send a signal to the brain about the “problems” that are happening here. During the second stage of labor, women describe pain as strong desire“push”, pain and pressure in the perineum, rectum, tailbone area. The pain weakens while the woman pushes, and disappears completely with the birth of the child. The woman feels relieved.
In the third stage of labor (postpartum), the placenta, the so-called “baby place,” begins to separate from the walls of the uterus, and with the help of several uterine contractions it is pushed out. Then the uterus begins to contract. Painful sensations during postpartum contraction The uterus can be compared either to pain during the first stage of labor, or to aching pain during menstruation. If during childbirth there are various types ruptures - in addition to all of the above pain sensations after childbirth, a woman experiences pain as if from a wound or abrasion. If there are tears, the woman is not recommended to sit down for at least 2 weeks after giving birth and removing the stitches.
In fact, all of the above is quite tolerable, but under the influence of fear and uncertainty about the future, they are perceived as much more painful than they really are. You can read more about this in our article “Everything you need to know about labor pain” () It has been noticed that women who are prepared and have a positive attitude give birth with less severity painful sensations. However, a large number of women experience severe pain during childbirth. Pain leads to psycho-emotional stress and fatigue, and fatigue, in turn, can lead to disruption of the contractile activity of the uterus and intrauterine suffering of the fetus.
The use of drug pain relief for labor ensures the most comfortable state of the woman in labor that is possible during childbirth, relieving stress and fear. There are also a number of obstetric situations in which the use of drug pain relief during childbirth is necessary (for example, obstetric operations: application of obstetric forceps, cesarean section, etc.).
In modern obstetrics, there are a number of different methods of labor pain relief, which can be used both for special medical reasons and at the request of the woman, if there are no contraindications to pain relief. It should be remembered that painkillers penetrate the placenta and have a varying degree of effect on the fetus. The exception is epidural anesthesia. Therefore, the decision on the need for pain relief during labor and the method of pain relief is always made by the obstetrician together with the anesthesiologist, taking into account the period of labor in which the mother is in labor, her condition and the condition of the fetus.
The following methods are used for drug pain relief during labor:
Tranquilizers include, for example,
SEDUXEN, RELANIUM, DIAZEPAM. Drugs of this pharmacological group are not true painkillers - their use is aimed at relieving tension and stress during childbirth. This is especially important in situations where the woman in labor experiences particular fear and anxiety, for example, during gestosis, premature birth, or if the expectant mother is very excited.
As a rule, these drugs are used in combination with other analgesics. They are often used before a cesarean section for emergency reasons to calm the woman in labor.
These drugs are administered intramuscularly. A contraindication to the use of tranquilizers is the presence of diseases of the central and peripheral nervous system, epilepsy. Drugs from the group of tranquilizers rarely have any negative effect on the mother and the fetus, because they are used once or twice during childbirth. However, as with any drug, an allergic reaction may develop. Children may experience decreased muscle tone, low temperature body, breathing problems, sometimes decreased sucking reflex. However, such side effects mainly occur in those babies whose mothers took tranquilizers. long time.
Narcotic (opioid) analgesics. IN obstetric practice PRO-MEDOL is widely used, since of all existing narcotic analgesics it has a less pronounced effect on the fetus. The concept of “narcotic”, as a rule, frightens patients, but when used during childbirth, PROMEDOL does not cause any addiction, because in order for addiction to develop, the drug must be used for a long time, and during childbirth it is administered once or twice. As a rule, PROMEDOL is used during prolonged labor, when the woman in labor needs to rest before the upcoming labor. PROMEDOL is also used before the administration of OXYTOCIN (a drug for birth stimulation) to mitigate its effect. PROMEDOL is administered intramuscularly, its effect begins approximately 10-20 minutes after administration and lasts approximately two hours. In some women, when using PRO-MEDOL, the pain subsides, and they can even fall asleep and sleep for 2 hours in a row, while in others this drug has virtually no analgesic effect. In large doses, PROMEDOL can weaken labor, so it is not used until the cervix is dilated by 3-4 cm, that is, labor is not “set up” properly.
It should be remembered that, penetrating the placenta, PROMEDOL acts on the child, and he falls asleep. And at the moment of birth, the baby should not sleep, as he needs to take his first breath. Therefore, 2 hours before the expected birth of the child, the administration of PROMEDOL is stopped (as a rule, this corresponds to 8 cm of cervical dilatation). Side effects of PROMEDOL are allergic reactions, drowsiness, dizziness, visual disturbances, and respiratory depression. Respiratory depression in the fetus is especially dangerous. If this happens, then immediately after birth he needs the help of a neonatologist. The child is intubated (a special tube is inserted into the upper airway through which oxygen is pumped into the lungs) to help him breathe. Such a baby is placed in a pediatric intensive care unit until PROMEDOL wears off and the child begins to breathe on his own. However, with proper use of the drug, side effects are rare.
Contraindications to the use of PROMEDOL are allergic reactions and respiratory failure.
Previously, inhalation anesthesia was a fairly common means of pain relief during childbirth. Today it is used less often due to the advent of modern methods of pain relief, such as epidural anesthesia. However, it is still used in a number of maternity hospitals.
Nitrous oxide is most often used in obstetric practice for inhalation anesthesia. To relieve labor pain, a mixture containing 40% nitrous oxide and 6% oxygen is used. It is a colorless gas with a slight pleasant odor. In maternity wards it is contained in cylinders. The mixture is given to the expectant mother through a special mask. Feeling the approach of contractions, the woman in labor independently presses the mask to her face and takes a deep breath. This method is called autoanalgesia (auto - “oneself”, analgesia - “pain relief”, Greek), that is, the woman herself controls the degree and frequency of pain relief. After inhaling, the sensation of pain subsides and a feeling similar to euphoria sets in, which is why nitrous oxide is also called “laughing gas”.
Nitrous oxide should be used when labor is already established, that is, when the cervix is dilated 4-5 cm, so that labor does not weaken. The effect of one breath is short-lived and lasts several minutes, since the drug is very quickly eliminated from the body through breathing, which is its undoubted advantage. Because of fast action Nitrous oxide can be used throughout labor (both during contractions and during pushing), since the woman in labor is awake and can push. Thus, nitrous oxide is indicated for short-term pain relief in both the first and second stages of labor and during water births. Despite the fact that the drug quickly penetrates the placenta, it has minimal effect on the fetus.
Side effects and complications include dizziness, nausea, and vomiting. In these cases, inhalation of nitrous oxide is stopped and the woman in labor is allowed to breathe pure oxygen. There are no contraindications for the use of nitrous oxide during normal labor.
Epidural anesthesia is the most modern, effective and safe method of labor pain relief. Numerous studies have shown that this type pain relief has no effect on the fetus.
Epidural anesthesia begins from the moment the cervix is dilated by 3-4 cm, since earlier administration of the drug can weaken or stop labor. The administration of the anesthetic substance is stopped some time before the pushing period (when the cervix is fully or almost fully dilated) so that the woman in labor can push adequately.
The epidural procedure is performed by a highly qualified anesthesiologist with the mother in labor sitting or lying on her side. The skin is first treated with an antiseptic solution, a puncture (puncture) of the skin in the lumbar region is performed under local anesthesia, and a special hollow needle is placed into the epidural space of the spine (this is the space between the wall of the spine and the hard shell covering the spinal cord). A catheter, which is a thin soft tube, is inserted through a needle into the epidural space, then the needle is removed and the catheter is secured to the skin of the back with an adhesive plaster. Further administration of the anesthetic drug is carried out through a catheter. The anesthetic substance washes the nerve circuits responsible for the sensitivity of the lower half of the body, in particular the pelvis and perineum, and provides adequate pain relief. The drug for epidural anesthesia can be administered not only once into the catheter, but also continuously in doses through an infusion pump (a compact portable device into which a syringe with medicine is installed, and using a special program the drug is administered to the patient in a certain dose), which significantly improves the effect of pain relief and makes it uniform.
Pain relief occurs 5-15 minutes after administration of the medicine. During epidural anesthesia, a woman does not feel pain during contractions, but she may feel contractions of the uterus. Sensitivity is fully restored a few hours after the end of epidural anesthesia.
However, all these complications are currently rare.
Pain relief in postpartum period required when it is necessary to conduct a manual examination of the uterine cavity and when suturing ruptures of the birth canal or perineum, as well as perineal incisions.
Normally, after the birth of a baby, the placenta separates from the walls of the uterus and is released out along with the membranes. However, sometimes the placenta does not separate on its own, or when the placenta separates, its lobules and membranes remain in the uterine cavity. In this case, it is necessary to conduct a manual examination of the uterine cavity and remove the unseparated placenta or its remaining parts and membranes. Also, after childbirth, sometimes the uterus does not contract well enough, and this is accompanied by heavy bleeding. In cases where medications cannot help the uterus contract, a “massage of the uterus on a fist” is performed. The doctor inserts his hand into the uterine cavity, and with the other hand holds it on top and thus massages it. In this case, as a rule, the bleeding stops. Any penetration into the uterine cavity is extremely painful and requires anesthesia.
If a woman was given epidural anesthesia during childbirth, then to perform manual intervention in the uterine cavity or suturing postpartum ruptures, it is enough just to add an anesthetic to the catheter and carry out all the necessary manipulations under continued epidural anesthesia.
If there was no epidural anesthesia during childbirth, then the postpartum woman is given a short-term general intravenous anesthesia. Drugs are injected into a woman's vein to intravenous anesthesia(for example, DIPRIVAN), and she falls asleep for 10-15 minutes - just this amount of time is usually enough to carry out the necessary interventions. If more time is required, then anesthesia is prolonged by adding medications. Side effects and complications are extremely rare in the form of allergic reactions to the drug.
Suturing of postpartum tears or closure, if epidural anesthesia was not performed during childbirth, is carried out under local anesthesia. An anesthetic substance (usually LIDOCAINE) is injected into the valves from a syringe, and after sensitivity disappears, all necessary manipulations are performed. If there are minor superficial damage to the mucous membrane, it is possible to use a spray with LIDOCAINE to restore the integrity of the damaged tissue. In the presence of deep, multiple ruptures of the cervix, heavy bleeding from the vessels, it is advisable to perform a paracervical blockade (a local anesthetic is injected on the side; from the cervix), because correction of such damage takes a long time, and manipulations performed on the cervix and pressure) of surgical instruments cause discomfort and pain to the mother in labor. Also, paracervical blockade helps to reduce and sometimes stop bleeding. In this case, the analgesic effect usually occurs within 5-6 minutes.
In the presence of allergic reactions to local anesthetic and in case of deep injuries to the vagina, short-term intravenous anesthesia is used.
Thus, today obstetricians-gynecologists have a large supply of various means and methods of pain relief during childbirth. Despite their relative safety, the prescription of a particular method of anesthesia is carried out taking into account the individual characteristics of the individual woman in labor, the obstetric situation and the condition of the fetus. The decision to provide pain relief during labor is made jointly by the obstetrician-gynecologist and the anesthesiologist. In obstetrics, pain management is always carried out under the supervision of an experienced anesthesiologist, and the woman is under his supervision during the procedure and for some time after it.
During normal physiological labor, pain relief may not be required. But if such a need does arise, there is no need to be afraid of using various medications and methods of pain relief, since they are all in experienced hands and time-tested.
Fear of childbirth (especially the first in life) is a standard phenomenon. But, as a rule, they are afraid not of the birth itself, but of the pain that the girl experiences at this time. Yes, labor takes place different people differently. Some say that everything is almost painless, while others say that the pain is simply unbearable. Here, a lot depends on the characteristics of the mother’s body. In this article we will look in detail at pain relief during childbirth, its types, indications and contraindications. The information will be useful for those who are planning to give birth to a child, but are afraid of pain and do not know what pain relief methods exist today.In modern obstetric practice there are several effective ways pain relief. At the moment, epidural anesthesia during childbirth is considered optimal, allowing to completely eliminate pain in the first stage of labor - when the cervix opens. In most cases, this is the moment that is most painful for a woman. And often the longest. Epidural anesthesia during natural childbirth makes the process painless. The essence of the procedure is that a local anesthetic solution is injected into the space above the spinal cord membrane. After the injection, within a couple of minutes the entire lower part of the body becomes insensitive. The signal from the brain is blocked and the woman does not experience pain. The advantage of epidural anesthesia is that, unlike general anesthesia the woman remains conscious.
Inhalation anesthesia is less radical, but also not as effective. It is a general anesthesia using nitrous oxide, which is supplied to the lungs of the woman in labor through a special mask. This type of anesthesia is used in the first stage of labor, just like the previous method.
Its essence boils down to the fact that only certain areas of the body are anesthetized. Thus, the woman in labor remains conscious throughout the entire period of labor.
These drugs can be administered either intramuscularly or intravenously. Under their influence, sensitivity to pain during childbirth is reduced, and the woman in labor can relax more between contractions.
This is far from full list methods of pain relief during natural childbirth without cesarean section. However, obstetricians and gynecologists recognize them as the most rational and safe for mother and child. In any case, the method of pain relief is prescribed individually in each specific case by the attending physician.
A caesarean section during childbirth is often necessary. IN in this case Several types of pain relief are used. And in some cases, the woman in labor can choose which method to use. However, obstetrics and gynecology specialists strongly recommend two types:
· Epidural anesthesia;
· General anesthesia.
It is impossible to answer unequivocally which anesthesia is better for caesarean section. There are three main factors depending on which the method of pain relief should be chosen:
1. Psychological preparedness for surgery. A woman can choose whether she prefers to sleep during labor or remain awake to see her newborn baby right away.
2. Level of equipment of the maternity hospital, where the operations will be performed. It may be that the selected maternity hospital is not equipped with the necessary equipment to perform certain types of anesthesia.
3. Qualification of specialists giving birth. First of all, this concerns the anesthesiologist and whether he can really perform any of the methods of pain relief equally well.
Let's look at both types of anesthesia in more detail and decide which anesthesia is better for a caesarean section.
Anesthesia is performed using three components: “preliminary anesthesia”, insertion of a tube through the trachea and supply of anesthetic gas with oxygen, and administration of a muscle relaxant. Only after all three steps have been completed can the operation begin.
The advantage of general anesthesia is that the woman in labor sleeps soundly during all stages of the operation and does not feel pain. In addition, there are almost no contraindications to it. But at the same time, quite serious side effects and complications can occur.
· Headaches, dizziness, nausea and unpleasant muscle weakness.
Allergic reactions, infection respiratory tract, pneumonia in particularly critical cases.
Among other things, general anesthesia can affect the child:
· Drowsiness and general weakness;
· Temporary breathing problems;
· Perinatal encephalopathy.
Similar negative consequences are not common, but can occur. But before you give up general anesthesia, please note that today effective techniques, helping the child to tolerate the effects of anesthesia normally.
The principle of implementation is practically no different from that described above, so we will not describe it in detail again. Let's dwell on the unmentioned details. Preparation for anesthesia begins on average half an hour before the operation. After the anesthesia takes effect, specialists proceed directly to performing a cesarean section.
Despite the fact that epidural anesthesia is considered one of the most gentle and safe methods pain relief, contraindications for its implementation still there is:
· The presence of skin inflammations or pustules that are located within a radius of 10 cm from the puncture site;
· Problems with blood clotting;
· Allergic reactions to some of the drugs used;
· Diseases of the spine and osteochondrosis, which are accompanied by severe pain;
· Incorrect position of the fetus;
· Too much narrow pelvis or high fetal weight.
Side effects are also possible. However, if we are talking about caesarean section, then with epidural anesthesia their risk is significantly higher, with anesthesia with natural childbirth. The fact is that more drugs are administered during surgery. Including narcotic substances, including fentanyl.
However, if the anesthesiologist is experienced and highly qualified, then complications in most cases are minimized. However, even in this case, certain discomfort may occur after the operation.
· Trembling legs, headaches and back pain. Often, all these consequences completely disappear a few hours after the operation, but in rare cases the headache lasts for several days, and sometimes even up to several months.
· Problems with urination. Rare side effect– allergies. And almost always specialists have everything they need to eliminate such effects.
· Nerve or spinal cord injury. An extremely rare phenomenon that occurs only during the work of an unprofessional or inexperienced anesthesiologist.
It should also be remembered that with epidural anesthesia, a woman’s legs will go numb. This frightens many and causes severe discomfort.
Both in the case of natural childbirth and birth by cesarean section, there are a number of indications for anesthesia:
· Severe pain during labor in a woman in labor. On average, about 25% of women in labor experience significant pain when anesthesia is urgently needed. About 65% experience moderate pain, and approximately 10% experience only minor pain;
· Too much large size the fetus, since its release can cause serious pain;
· Labor takes too long;
· Weak labor;
· ALWAYS during a caesarean section;
· With fetal hypoxia. In this case, anesthesia is one of the most effective techniques reduce the risk of its manifestation;
· The need for surgical intervention during childbirth. In this case, intravenous anesthesia is mainly used.
Pain relief during childbirth with promedol is one of the most popular methods. However, it should be remembered that promedol is narcotic substance. Promedol is injected into a vein or muscle. In most cases, the injection allows you to take a break from pain for half an hour to two hours. Sometimes I even manage to sleep normally. It all depends on the body’s reaction to the effects of the drug. Therefore, some women in labor sleep soundly until the baby is born, while others only have time to take a short nap. Upper limit the effect of the drug sometimes reaches two hours from the moment of birth.
The injection is not performed after the cervix is dilated more than 8 cm, as the baby must take the first breath on his own. Accordingly, he must be cheerful, which is impossible if he is also affected by the drug. It is also not recommended to use promedol before the cervix is dilated to at least 4 centimeters. If the injection is given before the cervix dilates, this can be a major cause of labor weakness. In addition to the direct analgesic effect, promedol can be used to treat various types of pathologies of labor. It should be remembered that the drug may have a number of contraindications:
· individual intolerance;
· if there is depression of the respiratory center;
presence of a blood clotting disorder;
simultaneously with taking MAO inhibitors for the treatment of diseases of the central nervous system;
· high blood pressure;
· depression of the nervous system;
heart rhythm disturbances.
Promedol during childbirth can cause complications for the child and mother:
· Nausea and vomiting;
· Weakness;
Confusion;
· Weakening of body reflexes;
· Violation respiratory function in a child.
In this regard, it is necessary to weigh the pros and cons of using promedol before choosing the drug.
Modern methods and techniques for pain relief during childbirth, as you may already understand, are different. However, there is not always an urgent need for drug pain relief during labor. In some cases, it is quite enough to perform some exposure without drugs to ensure a reduction in pain in the woman in labor. Let's look at the main ones.
1. Pain-relieving massage. In the process of performing a massage, a specialist acts on the surface of the body and nerves, while causing minor pain. At the same time, attention is diverted from labor pain. In most cases, the massage consists of stroking the back and collar area.
2. Relaxation. It is not always necessary to even require the intervention of a specialist to relieve the pain. There are a number of relaxation methods that can reduce pain levels and provide adequate rest in between.
3. Hydrotherapy. Childbirth in water, during which pain is noticeably reduced, and the birth itself occurs much faster. You can use either a shower or a bath during contractions.
4. Electroanalgesia. In this case it is used electric current, which affects key biologically active points and allows you to better tolerate labor pain.
5. Fitball. The fitball makes it easier to endure contractions; you can sit or lie on it.
Spinal anesthesia– a single injection using a local anesthetic. The duration of action is from 1 to 4 hours, depending on the chosen anesthetic and the characteristics of the mother’s body;
Combined technique- combines best sides spinal and epidural anesthesia. This method is prescribed by an anesthesiologist;
Regional anesthesia– pain relief individual areas. One of the most effective, safe and comfortable ways.
Every woman in labor has the right to choose the method of pain relief that is most suitable for her. However, the final decision is made together with the attending physician. To achieve desired result and complete anesthesia in each specific case must be chosen different methods. Otherwise, there may be negative consequences for the mother and child, as well as pain. Therefore, no matter what kind of birth is coming, the approach to choosing a pain reliever should be responsible and balanced.
