Modern women in labor are luckier than their mothers and grandmothers. Medicine is ready to offer them effective ways reducing labor pain. One of these methods is epidural anesthesia, which is quite widely used both during physiological childbirth and during surgical childbirth.
In this article we'll talk about how such anesthesia is done, what its advantages and disadvantages are and whether it can have negative consequences.
Peridural or epidural anesthesia is a method of gentle anesthesia. In order to relieve pain, the patient does not need to be put into medicated sleep completely. The woman remains conscious, but an epidural injection into the spine completely or partially deprives her of sensitivity in some areas of the body.
The spine is part of the central nervous system, it contains numerous endings of nerve processes that send impulse signals to the brain. This is how the signal of pain is transmitted. The pain center in the cerebral cortex receives it, analyzes it, and the person begins to feel pain.
The technique of epidural anesthesia is that it is into the spine, or more precisely, into its epidural space, using a long lumbar needle and catheter that medicines, which block the sending of a pain impulse. As a result, the brain simply does not receive or understand signals from certain nerve endings. For pain relief different parts throughout the body, medications are injected into different parts of the spinal column.
During childbirth and during surgical delivery, there is a need to deprive the lower part of the body of sensitivity, and therefore the injection is given in the lumbar spine.
The nerve roots are washed with a drug - an anesthetic injected through a catheter, their sensitivity is temporarily dulled or disappears completely. At natural childbirth drugs and dosages used are different than for caesarean section. A woman who gives birth herself is thus able to more easily endure labor pains, but a complete decrease in sensitivity does not occur; she feels the lower part of the body.
During a caesarean section, there is a need for longer and deeper pain relief, so not only analgesics are administered, as in the first case, but also ketamine.
Drugs used for epidural anesthesia undergo special specific purification; the resulting solutions are intended only for spinal or epidural use. The anesthesiologist knows which drug to administer and in what quantity. He is based not so much on the woman’s weight as on her height.
Apply up to 2 ml of medication to each segment of the spinal column that needs to be anesthetized. Plays a role and general condition women in labor, her pain threshold, individual characteristics of her health condition.
Analgesia through the introduction of painkillers into the epidural space is considered today a fairly safe method, therefore the Ministry of Health recommends it as a first-line solution in situations where it is necessary to local anesthesia during childbirth or deeper anesthesia as an alternative to general anesthesia during childbirth surgery.
All the pros and cons of this type of pain reduction should be taken into account by two specialists - the doctor who conducts childbirth or operates and the anesthesiologist. They also take into account the wishes of the mother in labor.
Thus, a woman can always refuse an epidural injection during childbirth or express her disagreement with this method of anesthesia before a cesarean section. In this case will apply alternative methods, which we will discuss below.
The undoubted advantage of epidural pain relief is that it helps a woman survive more easily. difficult moments. With a caesarean section, a woman retains clarity of consciousness and can see how her baby will be born. Recovery from such anesthesia is incomparably shorter and easier than recovery from general anesthesia. The disadvantages are that epidural anesthesia can cause harm.
Aggravating consequences after using such anesthesia during childbirth may include prolongation of the labor period, weakening of contractions, which can be dangerous for the child and mother.
Complications, according to statistics, do not occur so often - approximately in one case per 50 thousand births. For approximately 15-17% of women in labor, epidural anesthesia does not act as desired - it is not possible to achieve the required degree of pain relief, which means that the sensitivity to pain is partially preserved, which makes the work of surgeons and obstetricians difficult.
Epidural anesthesia can have negative consequences for women who have problems with hemostasis. A bleeding disorder can lead to the formation of hematomas in the puncture area with a small amount of blood entering the cerebrospinal fluid.
If pain relief is performed by an experienced doctor, there is nothing to worry about. Without significant difficulty, he will be able to determine the exact location of the puncture and the rate of administration of the medicine. But a negligent and incompetent doctor can injure the hard spinal membranes, which can lead to cerebral fluid leaks and central nervous system dysfunction. If the needle goes deeper than necessary and injures the subarachnoid space of the spine, the woman may experience convulsions and lose consciousness. In severe cases, paralysis occurs.
After using this method of pain reduction, women often experience headaches, and these pains can persist for up to several months. For the most part, they go away on their own over time.
The harm to a child from the effects of drugs is almost equivalent to general anesthesia. In some cases, there is a risk of heartbeat disturbances and the occurrence of oxygen starvation and respiratory failure after the baby is born.
Contrary to popular belief that such anesthesia is a serious burden on the heart, doctors say that the heart and blood vessels of a woman in labor who was injected with an anesthetic lumbar puncture, work normally, stably.
For many pregnant women, this method of reducing pain causes fear. It is psychologically difficult to accept the very fact of an injection into the spine. It is most difficult for those who are indicated for surgical childbirth. Not every pregnant woman is ready to see all stages of her own surgery.
No woman in labor can be given an epidural if she categorically objects to it. Therefore, the main contraindication is the patient’s own desire. If a woman believes that she can cope with labor pains herself or prefers to lie down on operating table under general anesthesia, she only needs to sign a waiver.
But there are women who just want to be helped in this way. And here certain obstacles may arise that will not allow doctors to perform epidural anesthesia. Absolute contraindications include:
Relative contraindications to epidural anesthesia are:
Refuse by relative indications can also women with high degree obesity. They will not do epidural anesthesia if the second birth occurs with a scar on the uterus - pain relief can make the symptoms of uterine rupture completely invisible if it occurs.
Such anesthesia is not given to women who have started bleeding, as well as if labor takes place against the background of decreased blood pressure, dehydration.
Peridural anesthesia can also be dangerous in case of acute fetal hypoxia. If in birth process something went wrong, complications began and other obstetric response measures had no effect, a decision is made to perform emergency surgery caesarean section. In this case, the woman is given only general anesthesia. General anesthesia is also recommended if additional surgery, for example, removal of the uterus after cesarean section.
For women with heart failure and pacemakers, such anesthesia can only be performed with the permission of a cardiac surgeon. If such a specialist is not available and permission has not been obtained in advance, the administration of painkillers into the spine may be refused.
If for some reason a woman is contraindicated for epidural anesthesia, this does not mean that she will have to endure severe pain. When performing an artificial birth (cesarean section), the woman will be given general anesthesia, which has no contraindications in principle. In this case, an anesthetic will be injected intravenously, and after such an injection the patient will simply fall asleep. She will not feel how the anesthesiologist inserts a tracheal tube into the trachea and connects it to the machine artificial ventilation lungs.
The degree of blockade of pain with this method is very high.
Spinal anesthesia, in which the administration of drugs is carried out over more deep level– level of the subarachnoid space of the spinal column, cannot be considered as an alternative, since the same list of contraindications applies to it.
To reduce pain during physiological labor, intravenous injections of systemic pain medications can be used.
Only epidural anesthesia, which is planned for a caesarean section, requires special preparation. This is standard preparation for surgery and premedication (sedatives and sleeping pills on the eve of planned surgery). If there is a need for epidural anesthesia during childbirth, no preparation is required.
The woman is placed either in a side lying position with her legs adducted, or in a sitting position with her back arched. After this, the doctor performs an aseptic treatment of the skin area and begins to determine the injection point. Typically, to reduce pain during contractions, a needle is inserted between the first and second lumbar vertebrae. A 16-18G needle is inserted in the sagittal plane.
Once in the epidural space, the doctor will feel the “failure” of the needle and the absence of resistance when further advancing the catheter. After the aspiration test, the first test dose of drugs is administered (usually Lidocaine or Bupivacaine is used). The catheter remains at the puncture site. If necessary, medication can be added through it if the woman begins to feel pain again. Therefore, she cannot lie on her back. Contractions will occur in a lying position on the right or left side; you need to change sides every hour.
Pain relief begins to take effect 15-20 minutes after administration of the drug. The duration of pain relief may vary and depends on the dosage. Often during natural childbirth, doctors use a technique in which the patient herself regulates the dosage - if pain occurs, she lets the anesthesiologist know about it, who administers the “supplement” as required.
The most desirable is epidural anesthesia, which is administered for premature birth if the child’s condition is stable. It allows the mother in labor to relax and the process labor is underway faster. During the first birth, when the pain is stronger and the duration of the process is longer, there is also quite often a need for relaxation using epidural anesthesia.
Regional anesthesia also helps with incoordination labor activity, with a sharp increase in a woman’s blood pressure, during natural childbirth, if the baby is large or gigantic, or during the birth of twins. Difficult and protracted labor is also rarely done without such analgesia; it gives relaxation, and this helps dilate the cervix.
When the pushing stage begins, epidural anesthesia is usually not prescribed. Its main task is to promote the opening of the cervix, and when pushing begins, this is no longer necessary - the cervix is completely opened. In addition, the woman must push and act in close tandem with the obstetrician so that the baby is born faster and without negative consequences for the health of the mother and the baby.
Average duration delivery operations – 25-45 minutes. The very fact of using epidural anesthesia will make the operation a little longer - the duration of the latent period until the anesthesia takes effect (15-20 minutes).
Because surgical childbirth requires deeper desensitization, the anesthesiologist must be sure that the patient is well before administering anesthesia. The woman's blood pressure and heart rate are measured. A special cuff, which will continuously measure pressure in real time and display data on the monitor, is attached to the arm.
The position of the body when introducing instruments into the spine will be the same as during natural childbirth - the woman in labor will either sit or lie on her side. The doctor makes marks with a pencil directly on the skin of the back. The vertebrae between which the needle must be inserted to numb the surgical birth are between the 2nd and 5th lumbar vertebrae. The most appropriate puncture site is determined after the fact and on the spot.
As in the case of pain relief during childbirth, the skin is subject to careful aseptic treatment. A thin needle passes through the so-called ligamentum flavum between two vertebrae. As soon as the resistance becomes negative, the needle “falls in” and a syringe with a catheter is attached to it. The absence of resistance on the other side of the needle will mean that entry into the epidural space was successful.
The test dose is administered after hitting the desired point. The initial assessment of the effect of the drugs takes about three minutes. If there is an effect, the woman begins to feel numb, and the main dose of medication is administered smoothly and slowly.
Surgeons begin the operation after the appropriate command from the anesthesiologist. This specialist remains next to the woman in labor throughout the entire process of surgical birth, talks with her, and adds the required amount of medications through the catheter.
Support is provided until the operation is completed. Throughout the caesarean section, the woman's well-being is closely monitored by the anesthesiologist and midwife.
All this time the woman can see and hear everything that is happening. This provides two wonderful opportunities - to see the baby being born and to put the baby to the breast right in the operating room, which is extremely useful for the subsequent establishment of lactation.
When a woman has an epidural before surgical delivery, the anesthesiologist is always prepared to administer general anesthesia. This is the rule. It may turn out that the “epidural” will be carried out with a mistake, it will not work, and therefore at any moment the specialist must be ready to give the woman general anesthesia.
The safety of a woman and her child depends on several factors, which it makes sense to ask in advance when choosing one or another maternity hospital:
There is no need to be ashamed of your own curiosity. When choosing a maternity hospital, you should ask all these questions. A woman has every right to know which category of doctor will perform her operation or give her anesthesia, whether the maternity hospital has modern equipment and when it was last changed, what drugs are used for epidural anesthesia.
In their reviews, many women note that they never managed to completely get rid of all discomfort after epidural anesthesia. Official Description such cases and reasons are included in the protocol of epidural anesthesia, which is the main clinical recommendation for doctors. So, epidural anesthesia may be ineffective if:
The famous pediatrician Evgeny Komarovsky has repeatedly emphasized that epidural anesthesia is a very good modern method of pain reduction. It is highly effective and almost safe.
But the human factor is most clearly demonstrated in it - if the anesthesiologist is skillful and qualified, the woman’s birth will be very comfortable and calm. If the specialist makes a mistake, epidural anesthesia can be quite dangerous for the woman in labor and her child.
Women often ask whether such anesthesia is paid for, or whether they need to pay extra for it. If birth takes place in private clinic, under the contract of provision medical services, then the procedure is paid. Its cost ranges from 7 to 15 thousand rubles, depending on the region and the specific clinic. The exact cost can be found out in advance, when concluding a contract for childbirth.
In state maternity hospitals and perinatal centers who receive women in labor compulsory medical insurance policy, epidural anesthesia is completely free. It can be used at any time during labor, at the request of the woman in labor or the recommendation of the doctor leading the birth.
Childbirth is a complex and painful process. Many pregnant women worry about upcoming events and are afraid of pain. Pain, especially prolonged pain, negatively affects the human psyche. The development of medicine has made it possible to create different options for anesthesia. Today, a woman can receive pain relief during childbirth, but:
These questions worry pregnant women, and here we will examine in detail the topic of pain relief during the labor process.
The introduction of any chemical drugs into the body of the expectant mother is undesirable. Some types of anesthesia are considered relatively safe, while others can lead to complications.
Anesthesia during childbirth is not indicated for everyone; only the doctor decides whether it is necessary to administer a relaxing medication during such an important process.
Indications for pain relief:
There are a number of indications for which a doctor may prescribe mandatory anesthesia for a woman in labor.Depending on the condition of the pregnant woman, anesthesia can be prescribed by the attending physician as planned, even before the onset of labor, or according to circumstances, already during labor.
Many women want to give birth with anesthesia, even if there is no indication for this. Of course, you can order such a service, but you should understand that any anesthesia has negative consequences even if normal birth such interference in the body is extremely undesirable.
It is important to remember that any anesthesia can have negative consequences. There are medicinal and non-medicinal (physiological) methods of pain relief during labor. Let's consider all types in detail.
Such methods do not have a strong and quick effect, but are more designed for relaxation during contractions. But their main advantage is high security.
Physical pressure on certain points helps to significantly reduce pain during contractions. A woman can learn pain-relieving massage on her own through special courses.
Some women in labor hire a specialist at the clinic who massages the body throughout the entire period of labor. Massage not only reduces painful sensations, but also improves blood circulation, which is beneficial for the mother and fetus.
Massage can reduce pain during contractions. Women are also taught special breathing techniques during labor and childbirth in courses. Alternating inhalations and exhalations according to a certain system is a useful and significant pain relief during childbirth. The downside is that as contractions intensify, many women forget about technique and simply don’t find the strength to correct breathing.
Water procedures significantly relax the muscles and reduce the pain of contractions. But hydrotherapy services are provided mainly only by high-quality clinics, and not all women can afford to give birth for free.
Water treatments will help you relax and reduce pain from contractions. Quite effective and safe way, which allows you to anesthetize the course of contractions. For this purpose, a special apparatus equipped with electrodes is used. Sensors are attached to the mother's lower back and electrical impulses are sent, the frequency and intensity of which can be adjusted. The current blocks pain signals traveling along the nerve endings of the spinal cord. Electroanalgesia also improves blood circulation, reducing the risk of fetal hypoxia.
A pregnant woman can resort to the services of a psychotherapist and reduce her pain through hypnotic techniques. This is a wonderful way to reduce pain and create a deep positive attunement to the birth process and subsequent events.
The list of natural physiological methods also includes pain relief during childbirth by taking special positions. This kind of “gymnastics” is taught to pregnant women at preparatory classes. A specialist in the maternity hospital can help you find relaxing positions.
Note!
Some essential oils (ylang-ylang, mint, bergamot, orange, jasmine) have an analgesic and relaxing effect. Inhaling the aromas of these oils goes perfectly with the ones described above. physiological methods and enhances their effect. Another addition could be a pleasant calm music
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Many aromatic oils have a relaxing effect on the body.
Medical anesthesia uses chemicals that act quickly and effectively. They completely block pain, but each of them has its own side effects. Let's consider all types of drug anesthesia acceptable for pregnant women.
The anesthetic is delivered through an inhalation mask. The drug used is mainly Nitrogen, less often Methoxyflurane, Pentran, Ftorotan, Trilene.
The woman independently takes the mask, applies it to her face and inhales the gas. The frequency of inhalations is done according to a certain pattern, which is selected by the doctor, focusing on the condition of the woman in labor.
Typically one of three options is selected:
Inhalation anesthesia during childbirth is used only up to a certain point, until the cervix has dilated to 5-6 cm. Such anesthesia cannot be used further. This method is losing its relevance due to the high gas consumption and leakage in the wards.
Drugs with narcotic or non-narcotic effects are injected into a vein or muscle area of the woman in labor.
Non-narcotic medications include painkillers such as No-shpa, Analgin, Baralgin. Tranquilizers and sedatives (Relanium, Fentanyl, Nalbuphine, Elenium) can also be used, which increase the pain threshold, reduce fear, anxiety and nervous excitability. 
In extremely rare cases, a woman is given anesthetic drugs Ketamine, Calypsol, Sombrevin through a vein. They quickly and completely relieve pain, but cause a lot of side effects, so their use is undesirable.
The most commonly used narcotic medications are Promedol and Fentanyl.
Such labor anesthesia is carried out in very rare cases when the patient for some reason cannot be given another type of anesthesia.
Intravenous injections suitable in cases where other types of anesthesia are contraindicated for a woman in labor. Today this is one of the most optimal types of anesthesia, which is used in most cases.
The anesthetic is injected into the epidural space, located in the lumbar spine. The following medications can be used: Lidocaine, Novocaine, Ropivacaine and their analogues. The essence of the technique is the penetration of the anesthetic into the epidural space and blocking the nerve roots of the spinal cord. 
The effect of the drug occurs in approximately 20 minutes. The woman completely loses sensation in the area below the waist. In the upper part of the body, sensitivity remains.
Throughout the entire period of labor, the catheter remains in spinal region, which allows you to supply additional portions of anesthesia.
Pros of epidural anesthesia:
Despite all the risks, epidural anesthesia during the birth process is one of the safest in terms of effects on the child.
Read more about epidural anesthesia in.
It is immediately worth noting that epidural and spinal (spinal) are different types pain relief procedures during childbirth.
The same drugs are used, but during spinal anesthesia the needle is inserted deeper into the subarachnoid space itself. The effect of anesthesia occurs much faster than with an epidural, within 5 minutes.
The spinal method of pain relief requires higher qualifications of the doctor performing the puncture; the slightest mistake can lead to irreversible consequences. With this technique, the side effects are more pronounced, although the result is serious negative influences doesn't happen.
Important to know! Despite the high effectiveness of spinal anesthesia, it does not work on everyone. About 5-6% of women do not respond at all to the injection of drugs into the epidural or subarachnoid area. Approximately 15% experience low levels of pain relief.
An outdated method of pain relief, which is practically no longer used, but the expectant mother should know about it.
An anesthetic drug (Novocaine, Lidocaine) is injected directly into the lateral vaults of the vagina, that is, around the uterine os. The procedure is carried out in the first stages of contractions, when the dilation has not yet reached 8 cm. Anesthesia blocks the nerve endings of the cervix, significantly reducing pain.
Paracervical anesthesia during childbirth leads to a slower heartbeat in the fetus (in more than 50% of cases), because of this side effect it was no longer used.
The birth process is divided into three stages: the period of contractions, the expulsion of the fetus and the release of the placenta. In some cases, the last, third stage in women occurs with complications. The placenta does not come out naturally after the required time and the patient needs manual cleaning.
In some cases, pain relief may also be required after childbirth. In such a situation, anesthesia is required. If the birth took place under epidural anesthesia, then an additional dose is simply administered. In other cases, short-acting intravenous anesthesia is used (for 10-15 minutes). This time is quite enough to free the uterus from the placenta by mechanical intervention.
Some women experience perineal ruptures after the birth of their baby. When suturing, the doctor injects an anesthetic directly into the vaginal area.
After completing everything, the successful mother no longer needs pain relief. Over the next few days, you will feel quite strong cramps in your abdomen, as the uterus begins to contract, but this pain is short-lived and quite tolerable.
It is impossible to give a definite answer to this question. In each individual case, one or another type of anesthesia may be more suitable. But if you look at it objectively, it is considered the best. The most important thing is that it is carried out by an experienced specialist.
It is also worth considering that each method has contraindications.
This was everyone's review possible types anesthesia during childbirth. Despite pregnant women's fear of upcoming events and the desire to go through this process painlessly, the decision on the need and advisability of anesthesia should be made by the doctor. Now in private clinics a woman in labor can order anesthesia if she wishes, paying a certain amount for it. But even in such cases, it is necessary to consult with your supervising doctor in advance and weigh all the pros and possible negative consequences.
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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!
Childbirth are a natural physiological process that completes the pregnancy of any woman. As a physiological process, childbirth has certain characteristics and is accompanied by a number of specific manifestations. One of the most well-known manifestations of labor is pain. It is the pain syndrome that accompanies every childbirth that is the subject of numerous discussions, both by pregnant women themselves and by doctors, since this characteristic of the birth act seems to be the most powerfully emotionally charged and deeply affecting the psyche.Any pain has a very specific effect on the human psyche, causing deep emotional experiences and creating a stable memory of the event or factor that was accompanied by the pain syndrome. Since pain accompanies almost the entire labor act, which normally can last from 8 to 18 hours, any woman remembers this process for the rest of her life. Pain during childbirth has a bright emotional coloring, which, depending on individual psychological characteristics personality, as well as the specific circumstances that surround the birth act, can be easily tolerated or, on the contrary, very difficult.
Women for whom the pain of childbirth was endured relatively easily or, in the terminology of the mothers themselves, “was tolerable”, have absolutely no idea what other representatives of the fair sex experienced and felt, who, due to the will of circumstances, felt terrible, unbearable pain.
Based on their sensory experience, two radical positions arise in relation to pain relief during childbirth - some women believe that it is better to “suffer” for the sake of a healthy baby, while others are ready to take any drug, even one that is very “harmful” for the child, that will save them from hellish, unbearable torment. Of course, both positions are radical and therefore cannot be true. The truth lies somewhere in the area of the classical “golden mean”. Let's consider various aspects related to pain relief during labor, relying, first of all, on common sense and data from serious, reliable research.
Childbirth pain relief is based on the use of various medicinal and non-medicinal techniques that reduce the level of mental anxiety, relieve tension and stop the conduction of pain impulses. To relieve labor pain, you cannot use the entire range of currently available medications and non-drug methods, since many of them, along with analgesia (pain relief), cause complete loss of sensitivity and muscle relaxation. A woman during childbirth should remain sensitive, and the muscles should not relax, as this will lead to a stop in labor and the need to use stimulant drugs.
All currently used methods of labor pain relief are not ideal, since each method has pros and cons, and therefore, in a particular case, the method of relieving the pain of labor must be selected individually, taking into account the psychological and physical condition women, as well as the obstetric situation (position, fetal weight, pelvic width, repeat or first birth, etc.). The choice of the optimal method of labor anesthesia for each individual woman is carried out jointly by an obstetrician-gynecologist and an anesthesiologist. The effectiveness of various methods of labor pain relief varies, so combinations of them can be used for the best effect.
Pain relief during labor in the presence of severe chronic diseases in a woman is not just desirable, but necessary procedure, because it eases her suffering, relieves emotional stress and fear for one’s own health and the life of the child. Labor anesthesia not only relieves pain, but at the same time interrupts the functioning of adrenaline stimulation that occurs with any pain syndrome. Stopping the production of adrenaline allows you to reduce the load on the heart of a woman giving birth, expand blood vessels and, thereby, ensure good placental blood flow, and therefore better nutrition and oxygen delivery for the baby. Effective relief of pain during childbirth can reduce the energy expenditure of a woman’s body and the stress of her respiratory system, as well as reduce the amount of oxygen she needs and, thereby, prevent fetal hypoxia.
However, not all women need pain relief during labor, since they tolerate this physiological act normally. But you shouldn’t draw the opposite conclusion that everyone can “endure it.” In other words, labor pain relief is a medical procedure that should be performed and used if necessary. In each case, the doctor decides which method to use.
Unfortunately, at present, the issue of pain relief in childbirth is dividing society into two radically opposed camps. Adherents of natural childbirth believe that pain relief is unacceptable, and even if the pain is unbearable, you need to, figuratively speaking, grit your teeth and endure, sacrificing yourself to the unborn baby. Women with the described position are representatives of one, radical part of the population. They are very fiercely opposed by representatives of another part of women who adhere to the exact opposite, but equally radical position, which can be conventionally designated as an “adept” of pain relief during childbirth. Adherents of pain relief believe that this medical procedure is necessary for all women, regardless of the risks, the condition of the child, the obstetric situation and other objective indicators of a particular situation. Both radical camps argue fiercely with each other, trying to prove their absolute rightness, justifying possible complications pain and pain relief with the most incredible arguments. However, no radical position is correct, since neither the consequences of severe pain nor the possible side effects of various pain management methods can be ignored. It should be recognized that labor anesthesia is an effective medical procedure that can reduce pain, relieve associated stress and prevent fetal hypoxia. Thus, the benefits of pain relief are obvious. But, like any other medical procedure, labor anesthesia can provoke a number of side effects on the part of the mother and child. These side effects, as a rule, are transient, that is, temporary, but their presence has a very unpleasant effect on the woman’s psyche. That is, pain relief is effective procedure, which has possible side effects, so you cannot use it as you would like. Childbirth should be anesthetized only when a specific situation requires it, and not according to instructions or some standard averaged for everyone.
Therefore, the solution to the question “Should I perform labor anesthesia?” must be taken separately for each specific situation, based on the condition of the woman and fetus, the presence concomitant pathology and the course of labor. That is, pain relief must be performed if the woman does not tolerate labor pains well, or the child suffers from hypoxia, since in such a situation the benefits of medical manipulation far exceed possible risks side effects. If labor proceeds normally, the woman tolerates contractions calmly, and the child does not suffer from hypoxia, then you can do without anesthesia, since additional risks in the form of possible side effects from the manipulation are not justified. In other words, to make a decision on labor pain relief, you need to take into account the possible risks from not using this manipulation and from its use. The risks are then compared, and an option is selected in which the likelihood of cumulative adverse consequences (psychological, physical, emotional, etc.) for the fetus and woman will be minimal.
Thus, the issue of pain relief in childbirth cannot be approached from a position of faith, trying to classify this manipulation as, figuratively speaking, unconditionally “positive” or “negative”. Indeed, in one situation, pain relief will become positive and the right decision, and in the other - not, since there are no indications for this. Therefore, whether to give pain relief must be decided when labor begins, and the doctor will be able to assess the specific situation and the woman in labor, and make a balanced, sensible, meaningful, and not an emotional decision. And an attempt to decide in advance, before the onset of childbirth, how to relate to pain relief - positively or negatively - is a reflection of the emotional perception of reality and youthful maximalism, when the world is presented in black and white, and all events and actions are either unconditionally good or such definitely bad. In reality, this does not happen, so labor pain relief can be both a blessing and a disaster, like any other medicine. If the medicine is used as directed, it is beneficial, but if it is used without indication, it can cause serious harm to health. The same can be fully applied to pain relief during childbirth.
Therefore, we can draw a simple conclusion that pain relief during childbirth is necessary when there are indications for this on the part of the woman or child. If there are no such indications, then there is no need to anesthetize labor. In other words, the position on pain relief in each specific case should be rational, based on taking into account the risks and condition of the mother and child, and not on an emotional attitude to this manipulation.
Currently, labor pain relief is indicated in the following cases: Non-drug methods of pain relief include various psychological techniques, physiotherapeutic procedures, proper deep breathing and other methods based on distraction from pain.
Medicinal methods of labor pain relief, as the name implies, are based on the use of various medications that have the ability to reduce or stop pain.
Regional anesthesia, in principle, can be classified as a medical method, since it is produced using modern powerful painkillers that are administered into the space between the third and fourth lumbar vertebrae. Regional anesthesia is the most effective method of pain relief during labor, and therefore is currently used very widely.
The most secure, but also the least in effective ways labor pain relief are non-drug, which include a combination of various methods based on distraction from pain, the ability to relax, creating a pleasant atmosphere, etc. The following currently apply non-drug methods labor pain relief: The most common ways are not drug pain relief childbirth are massage of the lower back and sacrum, being in the water during contractions, proper breathing and the ability to relax. All these methods can be used by a woman in labor independently, without the help of a doctor or midwife.
Medicinal methods of labor pain relief are highly effective, but their use is limited by the woman’s condition and possible consequences for the fetus. All currently used analgesics are able to penetrate the placenta, and therefore can be used to relieve pain during labor. limited quantities(dosages) and in strictly defined phases of labor. The entire set medicinal methods labor pain relief, depending on the method of drug use, can be divided into the following types: IN recent years there is a tendency to replace narcotic analgesics with non-narcotic ones, such as Tramadol, Butorphanol, Nalbuphine, Ketamine, etc. Non-narcotic opioids, synthesized in recent years, have a good analgesic effect and at the same time cause less pronounced biological reactions.
Inhalational anesthetics have a number of advantages over other drugs, since they do not affect the contractile activity of the uterus, do not penetrate the placenta, do not impair sensitivity, allow the woman to fully participate in the birth act and independently resort to the next dose of laughing gas when she deems it necessary. Currently, nitrous oxide (N 2 O, “laughing gas”) is most often used for inhalational anesthesia during childbirth. The effect occurs a few minutes after inhaling the gas, and after stopping the supply of the drug it complete elimination occurs within 3 – 5 minutes. The midwife can teach the woman to inhale nitrous oxide on her own as needed. For example, breathe during contractions, and do not use gas in between. The undoubted advantage of nitrous oxide is its ability to be used for pain relief during the period of expulsion of the fetus, that is, the actual birth of the child. Let us remind you that narcotic and non-narcotic analgesics cannot be used during the period of expulsion of the fetus, as this may negatively affect its condition.
During the expulsion period, especially during childbirth with a large fetus, you can use anesthesia with local anesthetics (Novocaine, Lidocaine, Bupivacaine, etc.), which are injected into the area of the pudendal nerve, perineum and vaginal tissue located next to the cervix.
Drug methods of pain relief are now widely used in obstetric practice most maternity hospitals in the CIS countries and are quite effective.
General application scheme medications for labor pain relief can be described as follows:
1.
At the very beginning of labor, it is useful to administer tranquilizers (for example, Elenium, Seduxen, Diazepam, etc.), which relieve fear and reduce the pronounced emotional coloring of pain;
2.
When the cervix is dilated by 3–4 cm and painful contractions appear, narcotic (Promedol, Fentanyl, etc.) and non-narcotic (Tramadol, Butorphanol, Nalbuphine, Ketamine, etc.) opioid painkillers can be administered in combination with antispasmodics (No-shpa, Papaverine, etc.). It is during this period that non-drug methods of labor pain relief can be very effective;
3.
When the cervix is dilated by 3–4 cm, instead of administering painkillers and antispasmodics, you can use nitrous oxide, teaching the woman in labor to independently inhale the gas as needed;
4.
Two hours before the expected expulsion of the fetus, the administration of narcotic and non-narcotic painkillers should be stopped. To relieve pain in the second stage of labor, either nitrous oxide or local anesthetic injections into the area of the pudendal nerve (pudendal block) can be used.
Regional analgesia (epidural anesthesia) has become increasingly widespread in recent years due to its high efficiency, accessibility and harmlessness to the fetus. These methods make it possible to provide maximum comfort to a woman with minimal impact on the fetus and the course of labor. The essence of regional methods of labor pain relief is the introduction of local anesthetics (Bupivacaine, Ropivacaine, Lidocaine) into the area between two adjacent vertebrae (third and fourth) of the lumbar spine (epidural space). As a result, the transmission of pain impulses along the nerve branches is stopped, and the woman does not feel pain. The drugs are injected into the part of the spinal column where the spinal cord is absent, so there is no need to fear damage to it. Painkillers for epidural anesthesia (as well as narcotic analgesics) can begin to be administered no earlier than the dilatation of the cervix by 3–4 cm. However, the catheter is inserted into the epidural space in advance, when the woman’s contractions are still rare and less painful, and the woman can lie in the fetal position 20 – 30 minutes without moving.
Labor pain relief medications can be given as a continuous infusion (like an IV) or in fractions (boluses). With continuous infusion, a certain number of drops of the drug enter the epidural space over an hour, which provides effective pain relief. With fractional administration, drugs are injected in a certain amount at clearly defined intervals.
The following local anesthetics are used for epidural anesthesia:
If for some reason local anesthetics cannot be used for epidural anesthesia (for example, a woman is allergic to drugs of this group, or she suffers from heart defects, etc.), then they are replaced with narcotic analgesics - Morphine or Trimeperedine. These narcotic analgesics are also fractionally or infused into the epidural space and effectively relieve pain. Unfortunately, narcotic analgesics can provoke unpleasant side effects, such as nausea, itching of the skin and vomiting, which, however, can be easily controlled by the administration of special drugs.
Currently, it is common practice to use a mixture of a narcotic analgesic and a local anesthetic to produce epidural anesthesia during childbirth. This combination allows you to significantly reduce the dosage of each drug and relieve pain with the greatest possible efficiency. A low dose of narcotic analgesic and local anesthetic reduces the risk of lowering blood pressure and developing toxic side effects.
If an emergency caesarean section is necessary, epidural anesthesia can be enhanced by introducing a larger dose of anesthetic, which is very convenient both for the doctor and for the woman in labor, who will remain conscious and will see her baby immediately after removal from the uterus.
Today, epidural anesthesia in many maternity hospitals is considered a standard obstetric procedure, accessible and not contraindicated for most women.
Currently, medications from the following pharmacological groups are used to relieve labor pain: The best analgesic effect is achieved with epidural anesthesia and intravenous administration narcotic analgesics in combination with antispasmodics or tranquilizers.
Promedol is administered intramuscularly and begins to act within 10 to 15 minutes. Moreover, the duration of the analgesic effect of one dose of Promedol is from 2 to 4 hours, depending on the individual sensitivity of the woman. However, the drug penetrates perfectly through the placenta to the fetus, so when using Promedol, you should definitely monitor the child’s condition using CTG. But Promedol is relatively safe for the fetus, since it does not cause any irreversible disorders or damage to it. Under the influence of the drug, the child may be born lethargic and drowsy, will have difficulty latching on the breast and will not immediately be out of breath. However, all these short-term disturbances are functional, and therefore will quickly pass, after which the child’s condition is completely normalized.
If epidural analgesia is unavailable, Promedol is practically the only available and effective analgesic that relieves pain during childbirth. In addition, with induced labor, which accounts for up to 80% of its total number in the CIS countries, Promedol is literally a “saving” drug for a woman, since in such cases contractions are extremely painful.
Unfortunately, none of the currently known methods of drug pain relief for childbirth is perfect. All of them, in one way or another, affect the fetus and the duration of labor and their use is not always possible. However, there are methods of pain relief that have no contraindications for mother and baby.
Methods of non-drug pain relief are absolutely harmless, very simple and effective, and can be used at any stage of childbirth. Self-numbing methods include birth massage, special breathing techniques, relaxing poses and movement techniques, the use of a fitball (gymnastic ball) and aquatherapy during childbirth. In order to master these techniques, only one thing is required - desire!
First and the most important factor Reducing pain from contractions is active behavior during childbirth. This term denotes the free behavior of a woman in labor, permanent shift posture and movement around the ward, searching for the most comfortable body position. The movements themselves significantly reduce the overall sensation of pain. And not only because any action is distracting.
Firstly, the level of pain depends on blood circulation. During contractions, the muscle fibers of the uterus contract, wasting energy. The main “energy fuel” for the functioning of all cells in our body is oxygen; myometrial cells (uterine muscles) are no exception. As is known, oxygen is contained in arterial blood; therefore, cell respiration depends on the level and speed of arterial blood flow. When the body is stationary, the overall blood flow decreases, the supply of oxygen to the uterine muscle slows down and pain increases. If a woman in labor walks around the room or moves in a comfortable position, as a result of the movement, the level of blood flow increases and the uterine cells are better supplied with oxygen. Therefore, with active behavior during childbirth, the pain from contractions is much weaker than with a stationary position. Even if, for medical reasons, a woman in labor cannot get up, she can behave actively during a contraction - sway, spring on the bed, spread her knees and bring them together. These minor movements significantly reduce the pain from contractions.
Secondly, the feeling of pain depends on the general tension. More precisely, between these concepts - pain and tension - there is a direct line proportional dependence. That is, the more we tense up, the more painful it is for us, and vice versa. During a contraction, when the uterus tenses and painful sensations appear, some women instinctively “freeze,” stopping moving completely. This behavior of a woman in labor is caused by fear of pain. The woman in labor seems to be hiding from the pain and from herself during the contraction. During childbirth, this behavior does not bring relief: “freezing”, the expectant mother unconsciously tenses, which leads to a sharp increase in pain. The main assistant in the fight against excessive tension during contractions is physical activity. After all, when we are in motion, our muscles alternately tense and relax; therefore, hypertonicity (excessive muscle tension) is excluded. And if movement helps you relax, it means it reduces your overall pain level.
Movements during childbirth can be very diverse. If childbirth proceeds without complications, the choice of the type of movements during contractions remains with the woman in labor. In this case, there is one, but very important limitation. At no stage of labor should you make sudden, jerky movements. Here are examples of the most common types of active behavior during a contraction:
For medical questions, be sure to consult your doctor first
Childbirth is a natural and painful process. Moreover, every woman feels pain differently. Some people find it tolerable, others find it unbearable. It happens that one woman gives birth to a baby without any intervention from medical staff, while another simply needs this help. In this case we talk about diverse. So what types of pain relief are there and how safe are they?
No matter how strange it may seem, a woman’s positive psychological attitude is excellent remedy, which can significantly reduce pain during the birth of a baby. If the expectant mother is psychologically ready for the process itself, if she does not “wind up” herself, does not “squeeze” and wait for pain, then everything will go much easier. It has already been proven that with the onset of contractions, many women begin to feel pain only because they are waiting for it. Instead of getting ready for serious work and helping the baby to be born as soon as possible, they begin to be intensely afraid of pain. Self-hypnosis, you see, is a serious thing. However, we will not deny that many women, due to some individual characteristics, actually experience severe pain.
What can be advised in these cases? Relax. Believe me, wise nature also took care of pain relief during childbirth, but women sometimes harm themselves. A pregnant woman must realize and firmly get it into her head: the more she tightens, the more painful it will be for her. And vice versa: pain will be minimal if the woman can relax. If you become familiar with breathing techniques that promote relaxation before giving birth, master them, and apply the acquired knowledge at the onset of labor, then you can pass this exam with an A plus. After all, in a calm state, a woman in labor produces a sufficient amount of endorphin hormones, which can reduce unpleasant physical sensations, help relax, reduce pain and have a beneficial effect on the course of labor. It is also important to listen to the advice of an obstetrician-gynecologist who “commands the parade”, then you can significantly alleviate the condition.
Many women find massage to cope with the pain of childbirth. It is especially good to stimulate points located in the buttocks and. Moreover, a warm bath can help you relax. This is relevant if the woman is still at home or if the conditions in the maternity hospital allow it. This procedure helps to relax during contractions, relieve tension in the muscles,.
Reflexology is one of the most safe methods pain relief during childbirth. This method is suitable for all women in labor without exception, since it is non-drug and does not affect the whole body, but its specific points. Using this method, you can reduce pain and interrupt transmission nerve impulses into the brain, promote the release of pain-relieving hormones.
To tell the truth, with the help of this method there is not a complete, but a relative effect on the pain centers, therefore, special means are often used along with acupuncture.
Often, medications are used to relieve pain during childbirth. In particular, we are talking about drugs from group A, which includes analgesics. True, they are used in cases of extreme necessity: only when the expectant mother cannot do without their use. In general, pain relief with drugs is used if a woman experiences nausea, vomiting, or is too focused on pain and cannot concentrate on the birth process. Analgesics are administered intravenously, intramuscularly, using compresses (applied to certain places), as inhalers.
Sometimes the doctor decides to use Promedol. This - narcotic substance, which is administered intravenously or intramuscularly. Of course, it does not completely relieve pain, but it significantly reduces it. It has already been proven that a single dose of Promedol does not negatively affect the child’s health. However, its use a second time is unacceptable.
In addition to medications included in the group of antispasmodics and narcotics, others are used, for example, anesthetics, neuroleptics, and tranquilizers.
During this procedure, a painkiller is injected into the space between the lumbar vertebrae in front of the dura mater surrounding the spinal cord. In this case, known anesthetics are used (for example, Lidocaine or Bupivacaine). As a result of this procedure, the roots of large nerves are blocked, and the woman does not feel pain at all. This method of pain relief allows you to “top up” the anesthetic substance from time to time, if necessary. This is done through a thin catheter. But at the same time, the woman should know that after this manipulation she will not be able to move independently for some time.
Unfortunately, this method of pain relief is not suitable for everyone. If a woman has poor clotting blood or observed elevated temperature, if she has neurological diseases, then it will not suit her. It is also not suitable for women who are obese or allergic to local anesthetics.
Of the “side effects” that often arise as a result of epidural anesthesia, we can note headache. Sometimes it can last up to three weeks. This happens if the needle is inserted a little deeper than it should be. Today doctors know how to deal with such consequences and effectively eliminate this pain.
We looked at the most popular methods of easing or eliminating pain that occurs during the most important event in the life of a pregnant woman - the birth of her child. But you should know that the decision on pain relief during childbirth is made by doctors depending on how severe the pain is, and is applied only on the condition that all manipulations will be safe for the baby.
Especially for- Ksenia Dakhno
