General anesthesia during childbirth. Natural pain relief during childbirth. Inhalation pain relief for labor

Natalia Gouda
Obstetrician-gynecologist, head of the observational department of the maternity hospital, Mytishchi

Magazine "9 months"
№01 2006
For pain relief during childbirth, it is used as non-drug methods(they do not require syringes, medications, doctors), and medicinal ones, which can only be carried out with the help of a specialist.

How can doctors help?

General anesthesia. When using these types of pain relief, pain sensitivity in all parts of the body is lost. Along with the loss pain sensitivity During general anesthesia, medications also affect consciousness.

Endotracheal anesthesia. Held general anesthesia With artificial ventilation lungs. The method provides a long-lasting effect. In this case, a whole combination of drugs is used, and the anesthetic itself enters through the trachea into the lungs. This anesthesia is used for caesarean section and 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 of local anesthetic into the space above the dura mater spinal cord. These days, such anesthesia is widely used during childbirth. Becomes insensitive after injection Bottom part bodies. The nerves that carry pain signals to the brain from the uterus and cervix pass through the lower spine, where the anesthetic is injected. During the action of this 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. Medicine(anesthetic) is injected into a vein. The woman then falls asleep for a short time (10-20 minutes). 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
very painful contractions, restless behavior of the woman (it must be borne in mind that, according to statistics, 10% of women in labor experience mild pain, which does not require treatment, 65% - moderate pain and 25% - severe pain syndrome which requires the use of medications);
large fruit;
long lasting labor;
premature birth;
weakness of labor (shortening and weakening of contractions, slowing of cervical dilatation, labor stimulation with oxytocin to intensify contractions);
Caesarean section operation;
multiple births;
hypoxia ( oxygen deficiency) fetus - when using anesthesia, the likelihood of its occurrence decreases;
the need for surgical interventions during childbirth - application of forceps, manual removal of the placenta. In these situations, intravenous anesthesia is more often used. The same method is used immediately after childbirth during recovery. birth canal.

Anesthesia without drugs

An anesthetic massage is an effect on certain points where nerves emerge on 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 fully rest in the periods between them.

Rational breathing- there are several breathing techniques, which help to endure contractions easier. When used skillfully the right type 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 is good if the expectant mother knows that during a normal, uncomplicated birth, she can take different positions and choose the most comfortable one, in which the 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 is the use of water to relieve pain from contractions. In different situations, during contractions you can use a bath or shower one way or another.

Electroanalgesia - use electric current to influence biologically active points, which also helps to endure labor pain.

The right to choose

To use non-drug methods of pain relief, you need to know about these methods and have practical skills. A course of 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 need to 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 that the expectant mother lie down. 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 danger 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 medicinal methods at the request of the woman - this is a controversial issue and is resolved differently in each medical institution.

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 among pregnant women themselves and doctors, since this characteristic 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 the individual psychological characteristics of the individual, as well as the specific circumstances that surround the birth act, can be tolerated easily or, on the contrary, very difficult.

Women for whom the pain of childbirth was tolerated relatively easily or, in the terminology of the 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 “be patient” for the sake of healthy baby, and the latter are ready for 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 regarding labor pain relief, relying, first of all, on common sense and data from serious, reliable research.

Pain relief for childbirth - definition, essence and general characteristics of medical manipulation

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.). Choosing the optimal one for each specific woman method of labor pain relief is carried out jointly by an obstetrician-gynecologist and an anesthesiologist. Efficiency various methods labor pain relief is not the same, 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 alleviates her suffering, relieves emotional stress and fear for her 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, dilate blood vessels and, thereby, ensure good placental blood flow, and therefore better nutrition and oxygen delivery for the child. Effective relief of pain during childbirth allows you to reduce the energy costs of a woman’s body and her stress. 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.

Pain relief during childbirth - pros and cons (should I have pain relief during childbirth?)

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 an effective procedure that 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 probability 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.

Indications for the use of labor anesthesia

• Hypertension in a woman in labor;
• Increased blood pressure in a woman during childbirth;
• Childbirth due to gestosis or preeclampsia;
• Severe diseases of the cardiovascular and respiratory systems;
• Heavy somatic diseases in a woman, for example, diabetes mellitus, etc.;
• Cervical dystocia;
• Discoordination of labor;
• Severe pain during childbirth, felt by the woman as unbearable (individual pain intolerance);
• Severe fear, emotional and mental stress in a woman;
• Delivery of a large fetus;
• Breech presentation of the fetus;
• Young age of the woman in labor.

Methods (methods) for pain relief during childbirth

Non-drug methods of pain relief include various psychological techniques, physiotherapeutic procedures, correct 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.

Methods of pain relief during childbirth: medicinal and non-medicinal - video

Non-drug (natural) labor pain relief

• Psychoprophylaxis before childbirth (attending special courses where a woman gets acquainted with the process of childbirth, learns to breathe correctly, relax, push, etc.);
• Massage of the lumbar and sacral spine;
• Proper deep breathing;
• Hypnosis;
• Acupuncture (acupuncture). Needles are placed on the following points - on the stomach (VC4 - guan-yuan), hand (C14 - hegu) and lower leg (E36 - tzu-san-li and R6 - san-yin-jiao), in the lower third of the lower leg;
• Transcutaneous electrical nerve stimulation;
• Electroanalgesia;
• Warm baths.

The most common methods of non-drug pain relief during labor are massage of the lower back and sacrum, being in water during contractions, correct 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.

Pain-relieving massage and birth positions - video

Drug pain relief for childbirth

• Intravenous or intramuscular administration of drugs that relieve pain and eliminate anxiety (for example, Promedol, Fentanyl, Tramadol, Butorphanol, Nalbuphine, Ketamine, Trioxazine, Elenium, Seduxen, etc.);
• Inhalation administration of drugs (for example, nitrous oxide, Trilene, Methoxyflurane);
• Introduction of local anesthetics into the area of ​​the pudendal nerve (pudendal blockade) or into the tissue of the birth canal (for example, Novocaine, Lidocaine, etc.).

IN last years there is a tendency to replace narcotic analgesics with non-narcotic ones, such as Tramadol, Butorphanol, Nalbuphine, Ketamine, etc. Non-narcotic opioids, synthesized in recent years, have a good analgesic effect and at the same time 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 for inhalation anesthesia During childbirth, nitrous oxide (N 2 O, “laughing gas”) is most often used. The effect occurs a few minutes after inhaling the gas, and after stopping the supply of the drug, its complete elimination occurs within 3 to 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. An undoubted advantage 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 currently widely used in obstetric practice in 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, Nalbufin, 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 by 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 anesthetics can be injected into the area of ​​the pudendal nerve (pudendal block).

Epidural pain relief during childbirth (epidural anesthesia)

• Does not increase the need for delivery by emergency caesarean section;
• Increases the frequency of applying a vacuum extractor or obstetric forceps due to the incorrect behavior of the woman in labor, who does not feel well when and how to push;
• The period of fetal expulsion with epidural anesthesia is slightly longer than without labor anesthesia;
• May cause acute fetal hypoxia due to sharp decline pressure of the woman in labor, which is relieved by sublingual application of nitroglycerin spray. Hypoxia can last a maximum of 10 minutes.

• Preeclampsia;
• Premature birth;
• Young age of the woman in labor;
• Heavy somatic pathology(for example, diabetes mellitus, arterial hypertension, etc.);
• Low pain threshold of women.

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 are used for epidural anesthesia: local anesthetics:

• Bupivacaine - 5 - 10 ml of 0.125 - 0.375% solution is administered fractionally after 90 - 120 minutes, and infusion - 0.0625 - 0.25% solution at 8 - 12 ml/h;
• Lidocaine - 5 - 10 ml of 0.75 - 1.5% solution is administered fractionally after 60 - 90 minutes, and infusion - 0.5 - 1.0% solution at 8 - 15 ml/h;
• Ropivacaine - 5 - 10 ml of 0.2% solution is administered fractionally after 90 minutes, and infusion - 0.2% solution at 10 - 12 ml/hour.

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 maximum possible effectiveness. A low dose of narcotic analgesic and local anesthetic reduces the risk of lowering blood pressure and developing toxic side effects.

If an emergency caesarean section is 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.

Means (drugs) for pain relief during childbirth

The best analgesic effect is achieved with epidural anesthesia and intravenous administration narcotic analgesics in combination with antispasmodics or tranquilizers.

Promedol for pain relief during childbirth

Promedol is 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.

Since ancient times, people have perceived pain during childbirth as evil and attributed it to punishment coming from supernatural forces. To appease these forces, amulets were used or special rituals were performed. Already in the Middle Ages, they tried to use decoctions of herbs, poppy heads or alcohol to relieve pain during childbirth.

However, the use of these drinks brought only minor relief, while being accompanied by serious adverse events, primarily drowsiness. In 1847, English professor Simpson was the first to use ether anesthesia to relieve pain during childbirth.

Physiological basis of pain during childbirth. Contractions are usually accompanied by pain of varying severity. Many factors influence pain during childbirth, its intensity, truly painless childbirth are rare. Pain during contractions is caused by:

1. Dilatation of the cervix.

2. Contraction of the uterus and tension of the uterine ligaments

3. Irritation of the peritoneum, the inner surface of the sacrum due to mechanical compression of this area during the passage of the fetus.

4. Resistance of the pelvic floor muscles.

5. Accumulation of tissue metabolism products formed during prolonged contraction of the uterus and temporary disruption of the blood supply to the uterus.

The strength of the pain depends on individual characteristics the threshold of pain sensitivity, the emotional state of the woman and her attitude towards the birth of the child. It is important not to be afraid of childbirth and labor pain. Nature took care of providing the woman with the painkillers she needed for childbirth. Among the hormones produced during childbirth, a woman’s body releases a large amount of hormones of joy and pleasure - endorphins. These hormones help a woman relax, relieve pain, and give a feeling of emotional uplift. However, the mechanism for producing these hormones is very fragile. If a woman experiences fear during childbirth, then the production of endorphins is reflexively suppressed and a significant amount of adrenaline (a stress hormone produced in the adrenal glands) is released into the blood. In response to the release of adrenaline, convulsive muscle tension occurs (as an adaptive form of response to fear), which leads to compression of muscle vessels and disruption of blood supply to the muscles. Poor blood supply and muscle tension irritate the uterine receptors, which we feel as pain.

The influence of pain on the course of labor. There is a complex system of receptors in the uterus. There is a relationship between pain stimulation of the uterine receptors and the accumulation of the labor hormone (oxytocin) in the pituitary gland. Evidence has been established of the reflex effects of various painful stimuli on the motor function of the uterus.

The sensations during childbirth largely depend on mental state women. If all the attention of a woman in labor is concentrated only on pain, a disruption of homeostatic mechanisms and disruption of normal labor may occur. Pain, fear and anxiety during childbirth stimulate that part nerve fibers, which irritate the circular fibers of the uterine muscle, thereby resisting the pushing forces of the longitudinal fibers of the uterus and disrupt the dilation of the cervix. Two powerful muscles begin to oppose each other, this puts the muscles of the uterus under enormous tension. The tension is of medium level and is perceived as pain. Overexertion causes disruption of the baby's blood supply through the placenta. If this phenomenon is short-term, then the condition of the fetus does not suffer, since its life support requires much less oxygen saturation in the blood than for an adult. But if this situation persists for a long time, then due to the lack of oxygen, irreversible damage to the tissues and organs of the fetus may occur, primarily to its brain, as the organ most dependent on oxygen.

The main task of labor pain relief is to try to break this vicious circle and not to overstress the uterine muscles. Many women prepared for childbirth manage to cope with this task on their own, without resorting to medication, due to psychological stability and various psychotherapeutic techniques (relaxation, breathing, massage, water procedures). Other women simply need appropriate medical care to reduce the pain or dull the reaction nervous system for pain. If this is not done in time, then over-tension of the uterine muscle can lead to negative consequences for mother and fetus.

Medications used for pain relief during labor must meet the following requirements:

1. Have a fairly strong and fast-onset analgesic effect.

2. Suppress negative emotions, feelings of fear, without disturbing a long period consciousness of the woman in labor.

3. Do not have a negative effect on the body of the mother and fetus, weakly penetrate through the placenta and into the fetal brain.

4. Not have a negative impact on labor, the woman’s ability to participate in childbirth and the course of the postpartum period.

5. Don't call drug addiction with the required course of taking the drug.

6. Be available for use in any obstetric institution.

The following groups of medications are used to relieve labor pain:

1. Antispasmodics - medicinal substances, reducing the tone and contractile activity of smooth muscles and blood vessels. Back in 1923, Academician A.P. Nikolaev proposed using an antispasmodic for pain relief during childbirth. Usually used the following drugs: DROTAVERINE (NO-SHPA), PAPAVERINE, BUSKOPAN. The prescription of antispasmodics is indicated:

Women in labor who have not undergone sufficient psychoprophylactic training, who show signs of weakness, imbalance of the nervous system, too young and elderly women. IN similar cases antispasmodics are used at the beginning of the active phase of the first stage of labor (at 2-3 cm of cervical dilatation) for the purpose of prevention labor pains and only partly to eliminate them. It is important to wait for regular, steady contractions, otherwise this labor process may be delayed.

For women in labor, as an independent painkiller for already developed pain, or in combination with other drugs, when the cervix is ​​dilated by 4 cm or more.

When labor has developed, antispasmodics do not affect the strength and frequency of contractions, and do not interfere with the consciousness of the woman in labor and her ability to act. Antispasmodics are good at helping to cope with the dilatation of the cervix, relieve spasm of smooth muscles, and reduce the duration of the first stage of labor. Negative influence do not affect the fetus. Side effects include a drop in blood pressure, nausea, dizziness, weakness. However, these drugs do not have a pronounced analgesic effect.

2.​ Non-narcotic analgesics: ANALGIN, TRAMAL, TRAMADOL. The use of drugs in this group, despite the good analgesic effect, during childbirth has some limitations.

In particular, analgin, when prescribed at the very beginning of labor, can weaken uterine contractions and lead to the development of weakness of labor. This is due to the fact that analgin suppresses the production of prostaglandins, which accumulate in the uterine wall in order to provide correct work muscles of the uterus. At the same time, when labor is pronounced, analgin does not affect uterine contractility. In addition, analgin affects blood clotting, which can increase blood loss during childbirth. And the use of a combination of analgesics with antispasmodics shortens the duration of the first stage of labor. Contraindications for the use of analgin during childbirth are impaired renal or liver function, blood diseases, and bronchial asthma.

In addition to being a pain reliever, tramadol has sedative effect, which turns out to be useful when there is a pronounced emotional component of labor pain. However, the sedative effect of tramadol allows it to be classified as intermediate between analgesics and narcotics. As a rule, respiratory depression in a woman in labor does not occur when using tramadol; it rarely causes short-term dizziness, blurred vision, impaired perception, nausea, vomiting and itching. The use of these drugs for late toxicosis of pregnancy (preeclampsia) is prohibited. However, the use of these drugs is limited, since with repeated administration they affect the nervous system of the fetus, slow down the breathing of the newborn, and disrupt it. heartbeat. Premature newborns are especially sensitive to these drugs.

3. Sedatives - sedatives that relieve irritability, nervousness, and stress. These include DIAZEPAM, HEXENAL, THIOPENTAL, DROPERIDOL Hexenal and thiopental are used during childbirth as components of drug pain relief to relieve agitation, as well as to reduce nausea and vomiting. Side effects of these drugs include hypotension and respiratory depression. They quickly penetrate the placental barrier, but at low doses do not cause significant depression in mature, full-term newborns. These drugs are rarely prescribed during childbirth. The main indication for their use is to obtain a rapid sedative and anticonvulsant effect in pregnant women with severe forms of gestosis.

Diazepam does not have an analgesic effect, so it is prescribed in combination with narcotic or non-narcotic analgesics. Diazepam is able to accelerate the dilation of the cervix and helps relieve anxiety in a number of women in labor. However, it easily penetrates into the blood of the fetus, and therefore causes breathing problems, a decrease in blood pressure and body temperature, and sometimes signs of neurological depression in newborns.

Droperidol causes a state of neurolepsy (calmness, indifference and aloofness) and has a strong antiemetic effect. It has become widespread in obstetric practice. However, one should remember the side effects of droperidol: it causes incoordination and weakness in the mother, respiratory depression and a drop in blood pressure in the newborn. For high blood pressure in a woman in labor, droperidol is combined with analgesics.

4.​ Narcotic analgesics: PROMEDOL, FENTANYL, OMNOPON, GHB

The mechanism of action of these drugs is based on interaction with opiate receptors. They are considered safe for mother and baby. They have a calming effect, relaxing, maintaining consciousness. They have an analgesic, antispasmodic effect, promote dilatation of the cervix, and help correct uncoordinated uterine contractions.

However, everything narcotic drugs have a number of disadvantages, the main of which is that in high doses they depress breathing and cause drug dependence, a state of stupor, nausea, vomiting, constipation, depression, decreased blood pressure. The drugs easily penetrate the placenta, and the more time passes from the moment of administration of the drug, the higher its concentration in the blood of the newborn. The maximum concentration of promedol in the blood plasma of a newborn was observed 2-3 hours after its administration to the mother. If birth occurs at this time, the drug causes temporary respiratory depression in the baby.

Sodium hydroxybutyrate (GHB) is used when it is necessary to provide rest to a woman in labor. As a rule, when the drug is administered, sleep occurs within 10-15 minutes and lasts 2-5 hours.

5.​ Inhalation pain relief for labor NITSOXIDE, TRILENE, PENTRANE

These methods of pain relief have been used for a very long time. Ether is currently not used for pain relief in labor, as it significantly weakens labor, can increase blood pressure, and have an adverse effect on the fetus.

Inhalation analgesia of labor by inhaling painkillers is still widely used in obstetric practice. Inhalational anesthetics are used during the active phase of labor when the cervix is ​​dilated by at least 3-4 cm and in the presence of severe painful contractions.

Nitrous oxide is the main one inhalation agent, used both for pain relief in obstetric operations and for pain relief in childbirth. The advantage of nitrous oxide is its safety for the mother and fetus, the rapid onset of action and its rapid completion, as well as the absence of a negative effect on contractile activity and a strong odor. Nitrous oxide is given through special apparatus using a mask. The woman in labor is introduced to the technique of using a mask and she herself applies the mask and inhales nitrous oxide and oxygen as needed. When inhaling it, a woman feels dizzy or nauseous. The effect of the gas appears after half a minute, so at the beginning of the contraction you need to take several deep breaths

Trilene is clear liquid with a pungent odor. It has an analgesic effect even in small concentrations and while maintaining consciousness. Does not suppress labor. This is a well-controlled, fast-acting remedy - after stopping inhalation it quickly ceases to have an effect on the body. The disadvantage is the unpleasant smell.

6.​ Epidural anesthesia during labor and caesarean section

Performing epidural analgesia involves blocking pain impulses from the uterus along the nerve pathways entering the spinal cord at a certain level by injecting a local anesthetic into the space around the spinal cord membrane.

Performed by an experienced anesthesiologist. The time to start epidural analgesia is determined by the obstetrician and anesthesiologist depending on the needs of the mother and baby during labor. It is usually carried out when regular labor is established and the cervix is ​​dilated by at least 3-4 cm.

A lumbar epidural is performed in the lower back with the woman in labor sitting or lying on her side. After treating the skin in the lumbar spine, the anesthesiologist makes a puncture between the vertebrae and enters the epidural space of the spine. First, a test dose of anesthetic is administered, then, if there are no side effects, a catheter is installed and the required dose is administered. Sometimes the catheter may touch a nerve, causing a shooting sensation in the leg. The catheter is attached to the back; if it is necessary to increase the dose, subsequent injections will no longer require repeated puncture, but are performed through the catheter.

Pain relief usually develops 10-20 minutes after the epidural insertion and can be continued until the end of labor and is usually very effective. Epidural anesthesia is safe for mother and baby. Side effects include decreased blood pressure, back pain, weakness in the legs, and headaches. More severe complications- toxic reaction to local anesthetics, respiratory arrest, neurological disorders. They are extremely rare.

Sometimes the use of epidural anesthesia leads to a weakening of labor. At the same time, the woman cannot push effectively, and thus the percentage of surgical interventions (obstetric forceps) increases.

Contraindications to the use of epidural anesthesia are: blood clotting disorders, infected wounds, scars and tumors at the puncture site, bleeding, diseases of the nervous system and spine.

Epidural anesthesia can be used with a reasonable degree of safety for caesarean section. If an epidural catheter is already installed during labor and a caesarean section becomes necessary, it is usually sufficient to administer an additional dose of anesthetic through the same catheter. A higher concentration of the drug allows you to cause a feeling of “numbness” in the abdominal cavity, sufficient for surgery

7. General anesthesia. Indications for the use of general anesthesia during childbirth are: emergency situations, such as sharp deterioration condition of the child and maternal bleeding. This anesthesia can be started immediately and causes quick loss consciousness, which allows for an immediate caesarean section. In these cases general anesthesia relatively safe for the child.

The use of any painkillers during childbirth is carried out only by obstetrician-gynecologists and anesthesiologists-resuscitators. Nurses, anesthetists and midwives follow doctors' orders, monitor the mother's condition and note possible side effects that require changes in treatment.

Pain management during childbirth is becoming more common. And medicines for this purpose are becoming more effective and at the same time safer. During natural childbirth, every woman experiences pain. But each person's pain threshold and patience level are different. In addition, increased pain may be a signal of a disorder normal process childbirth

That is why the question of whether or not to perform labor anesthesia must be decided differently in different situations. If there are no complications, the woman has the right to decide for herself whether to undergo pain relief or not. In this case, the doctor must inform her about the effect of drugs on her body and the child’s body, and also warn about possible consequences. If during the process of childbirth there is a need for additional medical manipulations, or the severity of the pain negatively affects the health of the mother and the course of labor, the doctor can independently decide on the need for pain relief.

Medicinal relief of labor pain

Methods of pain relief during childbirth depend on the health of the expectant mother and baby, as well as on the situation.

If during childbirth there is a need surgical intervention, you will need general anesthesia. This situation is possible when it is necessary to perform an emergency caesarean section when labor has already begun and complications have arisen. In addition, if it is necessary to surgically remove the placenta, perform curettage of the uterine cavity after childbirth, or place stitches on the cervix. Anesthesia is performed by an anesthesiologist. He carries out intravenous anesthesia during childbirth, or administers anesthesia through inhalation.

When performing a planned caesarean section, general anesthesia or epidural anesthesia is usually used. If a woman is asleep during general anesthesia, and she misses the moment of the birth of the baby, then epidural anesthesia during childbirth allows you not to feel pain even during a strip operation, while being fully conscious.

The essence of the method is that the woman is injected with an anesthetic into the interdisc space of the spine. The anesthetic affects the area nerve endings, and the lower part of the body completely loses sensitivity. The peculiarity of the method is that it practically does not harm the health of either the woman or the baby, but in the event of a medical error, if a spinal cord injury is caused when inserting a needle, the consequences can be very serious.

This procedure is also used for natural childbirth. The medicine is delivered through a very thin catheter. With the right dose, the woman does not feel pain, but she feels tension during contractions and can control the effort during pushing. But there is a possibility that contractions with this type of anesthesia may weaken and the birth process will be delayed.

If it is necessary to reduce the activity of labor pains or it is necessary to give the woman in labor a little rest and gather her strength, partial anesthesia during childbirth is used; drugs can be administered through an intravenous catheter, by inhalation or in the form of suppositories.

These can be tranquilizers (diazepam, relanium). They do not have an analgesic effect, but they help relieve tension and help the woman better control her behavior during childbirth.

Antispasmodics, analgesics and mild narcotic painkillers such as promedol and lentazocine can be used as painkillers. The latter also has the function of stimulating the birth process.

Indications for pain relief are various pathologies and factors that often lead to complications. These include the narrow pelvis of the woman in labor, a large fetus or multiple pregnancy, as well as neurological disorders in women.

Pain relief during childbirth has a wide variety of reviews. Of course, interfering with the natural process of childbirth is unsafe for either the mother or the child. Drugs administered to the mother can depress many vital functions baby, including respiratory. Any anesthesia during natural childbirth can change it normal course, exposing the baby to additional stress. And epidural and spinal anesthesia are associated with risks for the mother.

That is why, if there are no direct medical indications for anesthesia, it is best to use natural pain relief during childbirth, fortunately there are many accessible and well-known techniques.

How to get rid of pain yourself

During childbirth, a woman cannot control the intensity of contractions, but she can perfectly control her sensations. The main factor preventing you from enduring pain is ignorance. A woman must understand that the strength of contractions will increase, and the interval between contractions will decrease. That is why, when contractions occur less frequently than every 1.5-2 minutes, you need to distract yourself from them as much as possible, since this is not yet such strong pain. During this period, being able to move and accept is very helpful. comfortable position: stand bending over with support on a chair or bed, bend over, squat, walk. When contractions become very painful and frequent, you need to concentrate on the pain. A woman can easily count to herself or out loud, predicting how long the contraction will last and how many seconds later the next one will come. Deep breathing helps relax between contractions, and frequent shallow breathing during contractions.

Pain relief during childbirth helps a woman more easily cope with the birth of her baby. Advances in anesthetic techniques are minimizing the risk. Let's take a closer look at the methods of anesthesia during childbirth, find out which types are preferable, and how to relieve pain during childbirth without drugs.

Is there pain relief during childbirth?

Childbirth without pain recently seemed impossible. However, the development of medicine allows a pregnant woman to become a mother almost painlessly. At the same time, conditions of maximum comfort are created that minimize the development stress conditions, eliminate fear. The pain syndrome is completely relieved, and along with it, fear at the subconscious level disappears.

It is worth noting that pain relief during childbirth is sometimes a prerequisite. Delivery in the presence of chronic diseases is not possible without anesthesia. Thus, doctors alleviate the suffering of a woman in labor and completely relieve emotional stress. All this has a positive effect on speed recovery period and its duration.

Pain relief during childbirth - pros and cons

Not all pregnant women choose an easy, pain-free birth. Many people speak out against anesthesia during this period. Their concerns are related to negative impact on the fetus of the anesthetic component. In addition, such pregnant women are confident that a baby born with pain relief will adapt worse to new conditions environment. However, modern pain management techniques completely eliminate the presence of these factors.

Recent studies in the field of obstetrics have proven that proper pain management during timely childbirth, compliance with dosages, minimizes the development of complications. When talking about pain relief during childbirth, doctors name the following positive aspects:

• reduction of pain syndrome;
• eliminating stress;
• prevention .

But like any medical procedure, an anesthetic injection during childbirth has disadvantages:

• development of an allergic reaction;
• weakening of labor.

Types of pain relief during childbirth

Methods of pain relief during childbirth, depending on the means and methods used, are usually divided into:

• non-drug methods;
• medicinal;
• regional anesthesia.

The choice of anesthesia technique is determined by the condition of the fetus and the pregnant woman. Doctors take into account the possibility of using anesthesia, paying attention to:

• gestational age;
• number of fruits;
• no contraindications for a pregnant woman.

Non-drug methods of labor pain relief

Non-drug pain relief during childbirth completely eliminates the use of drugs. At the same time, doctors use various psychological techniques, physical procedures, etc. This way it is possible to distract the woman as much as possible from pain factor, reduce suffering associated with the process of expulsion of the fetus. Among the common techniques:

1. Psychoprophylaxis– conducting courses in which a pregnant woman is introduced to the peculiarities of the birth process, taught how to relax, breathe, and push correctly.
2. Massage of the lumbar and sacral area– reduces pain, makes it easier to endure the period of cervical dilatation.
3. Breathing technique– helps to relax and not feel pain so intensely.
4. Acupuncture– installation of special needles in the prenatal period helps to remove physical stress, prepare a pregnant woman for childbirth.
5. Warm baths– reduce the tone of the uterine muscles, accelerate the process of dilatation, and reduce pain.

Medicinal methods of pain relief during childbirth

As the name implies, these methods of anesthesia involve the use of drugs. Analgesic for labor pain relief is selected individually. It should be taken into account that such drugs are able to penetrate the placental barrier, so their use can be limited - at a certain period of labor and in the dosage prescribed by the doctor. According to the method of administering the anesthetic, it is customary to distinguish:

1. Intravenous anesthesia. It involves the introduction of a drug directly into the general bloodstream, leading to a complete loss of consciousness. The patient falls asleep, and sensitivity is eliminated.
2. Epidural anesthesia. Involves administering the drug to the spinal cord area. As a result, the transmission of nerve impulses from lower sections bodies.
3. Inhalation anesthesia. The anesthetic is administered through the respiratory tract.

Drug pain relief during labor has a positive effect on the woman’s subsequent rehabilitation. Future mom has no fear emotional stress associated with the upcoming birth. Modern principles pain relief during labor has many benefits, including:

• full control of the delivery process;
• no side effects;
• minimal impact on the fetus.

Modern methods of labor pain relief

Modern labor anesthesia completely eliminates the development of complications associated with the use of medications during delivery. At the same time, the effect of anesthetic drugs on the fetus itself is minimized. It helps give birth healthy child, accelerates recovery processes female body V postpartum period. Among the common, widely used modern pain management techniques:

• Pudendal block (injection of anesthetic into the area of ​​the pudendal nerve);
• injection of drugs into the tissues of the birth canal (reduces sensitivity, reduces pain when the baby passes through the birth canal).

Pain relief during childbirth - epidural anesthesia

Epidural pain relief during childbirth is widespread due to its high efficiency and lack of effect on the baby. At the same time, it is possible to provide the mother in labor with maximum comfort. The drug is injected into the area between the 3rd and 4th lumbar vertebrae. Stopping the transmission of nerve impulses eliminates the feeling of pain. The woman herself is conscious and can hear the first cry of her baby, as with natural childbirth.

However, this pain relief during childbirth has its drawbacks. Among the main ones:

• incorrect behavior of a woman in labor who does not feel well during contractions;
• prolongation of the period of expulsion of the fetus;
• the risk of developing acute hypoxia in the baby due to a strong decrease in blood pressure in the mother.

Intravenous pain relief during childbirth

Painkillers during childbirth are rarely administered intravenously. This is due to high risk development of complications. After using most anesthetics, there is a decrease in activity and the development of lethargy, which negatively affects the process of delivery. In addition, there is a possibility of a decrease in the tone of muscle structures, which has a bad effect on the process of expulsion of the fetus: they become weakly expressed, have a short duration and intensity.

Natural pain relief during childbirth

When thinking about how to relieve pain during childbirth, women often face natural methods anesthesia. These methods absolutely exclude the use of drugs and are safe for the baby and mother. Their action is aimed at relaxation. Among them:

• use of music therapy;
• massage of the lumbar region;
• physical activity.

How to prepare for childbirth without pain?

Considering methods of pain relief during childbirth, it must be said that effective method is self-relaxation. Having mastered these skills, a woman will be able to alleviate her condition during childbirth. You need to learn this in advance, while still carrying a baby. In order to control your body you need to:

1. Take a horizontal position.
2. Breathing should be slow and concentrated.
3. Raise one leg, then the other, feeling the tension.
4. Make a fist with one hand, then the other.

When you feel tension, you need to fix the muscles for 5-10 seconds, then relax. This is done with each part of the body, gradually using the muscles of the back, legs, abdomen, arms, and pelvis. These methods of pain relief during childbirth will help the mother in labor to completely relax during the period between contractions, take a break and continue the process. The delivery itself will be less painful, and complications such as rupture of the vagina and perineum will be avoided.