Types of anesthesia for natural childbirth. Pain relief during childbirth

Pain relief during childbirth is aimed at providing comfortable conditions for the laboring woman, avoiding pain and stress, and also helps prevent labor disturbances.

The perception of pain by a woman in labor depends on circumstances such as physical condition, anxious anticipation, depression, and characteristics of upbringing. In many ways, pain during childbirth is intensified by fear of the unknown and possible danger, as well as previous negative experiences. However, the pain will be reduced or better tolerated if the patient has confidence in the successful completion of labor and a correct understanding of the labor process. Unfortunately, so far, none of the currently existing methods of pain relief during childbirth is absolutely ideal. To achieve maximum effect, the choice of pain relief method should be individualized. In this case, it is necessary to take into account the physiological and psychological state of the woman in labor, the condition of the fetus and the obstetric situation. To increase the effectiveness of pain relief, prenatal preparation is important, the purpose of which is to remove the fear of the unknown of the upcoming birth. In the process of such preparation, the pregnant woman must be informed about the essence of the processes accompanying pregnancy and childbirth. The patient is taught proper relaxation, exercises that strengthen the abdominal and back muscles, increase overall tone, and different breathing methods during contractions and at the time of birth of the fetal head.

Acupuncture can be used as one of the methods of non-drug pain relief during labor. Most often, when using this method, only partial pain relief occurs, and most patients require the use of additional methods of pain relief. Another method of non-drug labor pain relief is transcutaneous electrical nerve stimulation (TENS), which has been used for many years. During labor, two pairs of electrodes are placed on the mother's back. The degree of electrical stimulation varies according to the needs of each individual woman and can be adjusted by the patient herself. This form of analgesia is safe, non-invasive, and can be easily administered by a nurse or midwife. The main disadvantage of the method is the difficulty in using electronic monitoring of the fetal condition, despite the fact that transcutaneous electrical neurostimulation itself does not affect the fetal heart rate.

However, the most important thing for pain relief during labor is the use of appropriate medications. Methods for pain relief during labor can be divided into three types: intravenous or intramuscular administration of drugs to relieve pain and anxiety; inhalation pain relief for labor; local infiltration application and regional blockades.

Narcotic analgesics are the most effective drugs used to relieve labor pain. However, these drugs are used to reduce pain rather than completely stop it. With established labor in the active phase of the first stage of labor, these drugs help correct uncoordinated uterine contractions. The choice of drug is usually based on the severity of potential side effects and the desired duration of action. Intravenous administration of drugs is preferable compared to intramuscular administration, since the effective dose is reduced by 1/3-1/2, and the effect begins much faster. Tranquilizers and sedatives are used during childbirth as components of drug pain relief to relieve agitation, as well as to reduce nausea and vomiting. In the active phase of labor, when the cervix is ​​dilated more than 3-4 cm and painful contractions occur, sedatives with narcotic analgesics in combination with antispasmodics (No-spa intramuscularly) are prescribed. The use of narcotic analgesics should be stopped 2-3 hours before the expected moment of expulsion of the fetus, to prevent possible narcotic depression.

Inhalation pain relief for labor

Inhalation analgesia of labor by inhaling painkillers is also 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. The most common are nitrous oxide (N2O) with oxygen, trichlorethylene (trilene) and methoxyflurane (pentrane). Nitrous oxide is a colorless gas with a slight sweetish odor that is the most harmless inhalational anesthetic for mother and fetus. The most common ratios of nitrous oxide to oxygen are: 1:1, 2:1 and 3:1, allowing for the most optimal and sustained analgesia. During the process of inhalation anesthesia, it is necessary to monitor the condition of the woman in labor by medical personnel. The effectiveness of pain relief largely depends on the correct inhalation technique and rationally selected ratios of the components of the gas-narcotic mixture. Three options can be used to achieve an analgesic effect.

Options for labor pain relief using inhalational anesthetics

1. Inhalation of the gas-narcotic mixture occurs continuously with periodic breaks after 30-40 minutes.
2. Inhalation is carried out with the beginning of the contraction and ends with its end.
3. Inhalation occurs only in pauses between contractions, so that by the time they begin, the required degree of pain relief is achieved.

Autoanalgesia during labor with nitrous oxide can be performed throughout the active phase of the first stage of labor until the cervix is ​​fully dilated. Due to the fact that nitrous oxide is eliminated from the body through the respiratory tract, this provides greater control over the pain relief process. During pain relief during childbirth, after stopping inhalation of nitrous oxide, consciousness and orientation in the environment are restored within 1-2 minutes. Such analgesia during labor also has an antispasmodic effect, ensuring coordinated labor, preventing abnormalities in uterine contractility and fetal hypoxia. The use of a gas-narcotic mixture of nitrous oxide and oxygen is the most acceptable in obstetric practice for pain relief during labor. In addition to nitrous oxide, drugs such as trichlorethylene (has a more pronounced analgesic effect compared to nitrous oxide) can also be used for inhalation anesthesia; methoxyflurane (use is less controlled than nitrous oxide and trichlorethylene).

Epidural analgesia

Regional analgesia can also be successfully used to relieve labor pain. The cause of pain in the first stage of labor is contraction of the uterine muscles, stretching of the cervix and tension of the uterine ligaments. In the second stage of labor, due to stretching and elongation of the pelvic structures during the advancement of the fetus, additional pain sensations arise, which are transmitted along the sacral and coccygeal nerves. Therefore, to achieve pain relief during childbirth, the transmission of pain impulses along the corresponding nerve bundles should be blocked. This can be achieved by a pudendal nerve block, a caudal block, a spinal block, or an extended epidural block.

Epidural analgesia is one of the popular methods of labor pain relief. 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 epidural space. Indications for epidural analgesia are: severe painful contractions in the absence of effect from other methods of pain relief, incoordination of labor, arterial hypertension during labor, childbirth during and.

Contraindications to labor pain relief with epidural analgesia

1. Bleeding during pregnancy and shortly before childbirth.
2. Use of anticoagulants or decreased activity of the blood coagulation system.
3. The presence of a focus of infection in the area of ​​the proposed puncture.
4. A tumor at the site of the intended puncture is also a contraindication to epidural analgesia.
5. Volumetric intracranial processes accompanied by increased intracranial pressure.

Relative contraindications to epidural analgesia

1. Previous extensive back surgery.
2. Extreme obesity and anatomical features that make it impossible to identify topographic landmarks.
3. Past or existing diseases of the central nervous system (multiple sclerosis, epilepsy, muscular dystrophy and myasthenia gravis).

Epidural analgesia is carried out when regular labor is established and the cervix is ​​dilated by at least 3-4 cm. Only an anesthesiologist who knows this technique has the right to perform epidural anesthesia.

Pain relief for labor disorders

Disorders of labor also deserve attention. Adequate timely treatment of labor incoordination, as a rule, contributes to its normalization. The choice of appropriate therapy is carried out taking into account the age of the women, obstetric and somatic history, the course of pregnancy, and an objective assessment of the condition of the fetus. With this type of abnormal labor, the most reasonable method of treatment is long-term epidural analgesia. A common anomaly of labor is weakness, which is corrected by intravenous administration of drugs that enhance uterine contractility. Before prescribing birth-stimulating drugs if the patient is tired, it is necessary to provide the woman with rest in the form of pharmacological sleep. Proper and timely provision of rest leads to the restoration of impaired functions of the central nervous system. In these situations, rest helps restore normal metabolism. For this purpose, a wide arsenal of medications is used, which are prescribed by the doctor on an individual basis, depending on the current obstetric situation and the condition of the woman in labor. In obstetric practice, the method of electroanalgesia is also used, the use of which allows one to achieve stable vegetative balance and avoid allergic reactions that may occur when using pharmacological drugs (neuroleptics, ataractics, analgesics). Unlike pharmacological drugs, the use of pulsed current makes it possible to obtain the so-called “fixed” stage of therapeutic analgesia, which makes it possible to maintain consciousness during the birth act, verbal contact with the woman in labor without signs of her excitement and transition to the surgical stage of anesthesia.

Pain relief for childbirth with diabetes

In case of diabetes mellitus at the beginning of the active phase of the first stage of labor, it is advisable to avoid the use of narcotic analgesics and the use of epidural analgesia is more preferable. This is due to the fact that the negative impact of systemic analgesics and sedatives is reduced, the mother’s stress response to pain is less pronounced, and better control over the mother’s condition is ensured while consciousness is preserved. In addition, epidural analgesia helps prevent the development of rapid and rapid labor and allows for painless, controlled completion of labor. If necessary, against the background of epidural analgesia, surgical delivery is possible both through the natural birth canal (obstetric forceps, vacuum extraction) and by emergency cesarean section (after quickly strengthening the block). If there is no possibility and conditions for performing a regional block, it is possible to use inhalation analgesia, enhancing it with a block of the pudendal nerve.

Pain relief for childbirth with heart disease

For rheumatic heart diseases, pain relief should be carried out until delivery and continue in the early postpartum period. These requirements are best met by an extended lumbar epidural block. This technique allows you to eliminate pushing in the second stage of labor, and provides the necessary conditions for the application of obstetric forceps and the use of vacuum extraction. If a caesarean section becomes necessary, an extended lumbar epidural block can be extended to the required level. This method of pain relief helps prevent the development of acute heart failure with pulmonary edema and decreased venous return. In a patient with a prosthetic valve and using heparin, it is advisable to use tranquilizers and narcotic analgesics or inhalational analgesia without hyperventilation to relieve labor pain. In the second stage of labor it should be supplemented with a pudendal nerve block.

Anesthesia and premature birth

Discussion

But I gave birth with epidural analgesia. I didn’t have any pain in my abdomen at all, but I did have pain in my lower back! Moreover, I was not afraid of childbirth, I knew how and what was happening, I was breathing correctly, I gave myself a light massage, but the birth lasted more than a day, the baby was born 5 kg. Of course, it would have been possible to get by, but I was tired, pinched and dreamed of losing consciousness, just not to be present at this horror. The anesthesia helped further open the uterus and within two hours, with one push, I gave birth to a healthy baby. Thanks to the people who think about how to alleviate the suffering of a mother!

I am a pediatrician, 2-degree disabled in the musculoskeletal system. I gave birth to my two children myself, and I can say with confidence that the best pain relief is preparation for childbirth during pregnancy (swimming, sauna, baths, self-education, physical exercise), the presence of the husband, his caring, psychological support, the woman’s awareness of the physiology of childbirth and about how to behave during childbirth (movement, postures during contractions, etc.), warm water with sea salt, lack of fear, etc. In this case, childbirth is fueled by endorphins.
If a woman is methodically intimidated in the antenatal clinic throughout pregnancy, stuffed with vitamins and calcium, and not told anything about how to prepare for childbirth physically (and not financially), then very often the matter ends in birth trauma or cesarean. In our maternity hospitals, you can give birth normally if you are information-savvy and don’t give in to intimidation, are physically prepared, and if you agree with the doctor so that he does not interfere too much with the birth process.
It really doesn't hurt to give birth when you know that this so-called... “pain” with every minute, second brings you closer to meeting the desired creature that will be born. Fear constrains, is passed on to the child, causes pain during childbirth and discoordination of labor. What about labor stimulation?! This is one, continuous contraction, it is very painful, especially if the woman is lying on her back, this is not physiological, it is harmful for the child (vena cava syndrome), THIS IS AGAINST ALL THE RULES!
Give birth without fear - and there will be no pain. GUARANTEE! Nature - she provides everything, it is better to follow it, and not artificial methods of childbirth.
By the way, my great-grandmother was a midwife, and had no special education. She simply KNEW how to help a woman in labor - DON’T INTERFERE! She herself gave birth to eight children, and helped almost all the children in the village to be born, even accepted my mother. If she had been alive, I would never have gone to the maternity hospital to give birth.
Good luck everyone!
Natasha
13.03.2006

All the most important things in this article are written in the first paragraphs and for this many thanks to the doctor; perhaps without knowing it, he came out in support of natural childbirth and such a concept, still unknown in our country, as protecting the psychological well-being of the woman in labor. Her calmness, confidence in a positive outcome childbirth, the opportunity to receive support from loved ones - this is the main pain relief for childbirth, absolutely harmless. Thanks to Dr. Makarov for the reminder that there is no perfect drug pain relief, perhaps someone can refrain from using drugs during childbirth and give their child a chance to be born without them. But if by the time I read the article I had not given birth to three children, by the way, completely without drug pain relief, I would probably have been scared. For me, the best pain relief was the support of my husband, water and a caring midwife. Giving birth isn't that painful!

Comment on the article "Pain relief for childbirth"

Then the whole scheme was outlined in my head, but, remembering the birth on oxytocin without pain relief, I became faint-hearted and could not say that no, no one injected me with oxytocin. In addition, my uterus was contracting very painfully.

Discussion

My uterus contracted the most painfully after the second birth. And after the third - it’s normal, although I expected it to be tough. But it didn't happen :)

I was injected with oxytocin, antibiotic and painkiller for 3 days. (I don’t know which one). I had ACL and my first birth, it hurt a lot, especially after oxytocin. I kept worrying that I didn’t know what contractions and childbirth were in general, but ACL: I got up in the morning and went to the operation. And after oxytocin it became clear how it would be...
Nosh-pu was allowed, you could ask for a candle and a hot water bottle with ice.

I didn’t give birth pain relief, but it was tolerable for me; if the pain is unbearable, you need to give birth pain relief, IMHO. And as for pain relief, when it is necessary to alleviate the suffering of a dying person - is this generally necessary, is there any point in enduring?

Discussion

I don't think anesthesia is a whim. I didn’t give birth pain relief, but it was tolerable for me; if the pain is unbearable, you need to give birth pain relief, IMHO. And as for pain relief, when it is necessary to alleviate the suffering of a dying person - is this generally necessary, is there any point in enduring?

Well, specifically on the topic - in general, I don’t consider anesthesia an evil. but personally, based on my examples: during childbirth _now_, _knowing_, I would prefer not to undergo pain relief, during cancer - instead of anesthesia, euthanasia. pure IMHO

At present, the optimal method of managing labor in infected women has not been fully determined. To make a decision, the doctor needs to know the results of a comprehensive virological study. Natural childbirth includes a whole range of measures aimed at adequate pain relief, prevention of fetal hypoxia and early rupture of amniotic fluid, reducing injuries to the birth canal of the mother and the baby’s skin. Only if all preventive measures are followed does...

Discussion

I completely agree. Unfortunately, at the moment there is no consensus on the safest management of childbirth with hepatitis C. According to statistics, the likelihood of a child becoming infected with hepatitis is somewhat lower during a planned caesarean section than during a natural birth. However, none of these methods can guarantee the safety of a child from hepatitis infection. Therefore, the choice of method of obstetric care is based more on obstetric history than on knowledge of the presence of this infection.

At lunchtime I already said that pain relief was not needed. Nothing hurt, not my head, not my back, not my legs. 2 ks with spinal. The first CS after 6 hours of labor, after anesthesia I felt like in heaven, and after 15 minutes the baby was delivered.

Discussion

There is no need to be afraid. I also had some reasons for this, but in the end I gave birth naturally :) That’s also good.

I went with my first daughter without any problems. one prick, everything was cut off from chest to toe. I tried to look at the process in the reflection of the llamas and in the tiles, but the medical staff spoke their teeth and did not let me look, which is a pity. I'm glad I heard my daughter's first cries. They let me kiss my heel:) very touching. I gave birth to my second in the same way, only all my nerves were exhausted (I gave birth for free) - in the operating room I was shaking either from the cold or from nerves - the result: the anesthesia did not work - they gave me general anesthesia. I didn’t hear the first screams, it was difficult to escape.

1 ... when you visit your grandmother, you put on a hat just before you ring the doorbell of her apartment. After all, she doesn’t like it so much if you walk around in winter without a hat! 2 ... your apartment is not always in perfect order. What’s more, his reign is so short-lived that it often goes unnoticed. 6 ... you are convinced that tears make you irresistible. And you don’t believe the mirrors that are trying to convince you otherwise - this is bad lighting, but in reality it’s not...

The wonderful nine months of waiting have passed, very soon there will be an addition to your family. But the closer the day the baby is born, the more fears the expectant mother has. Many people want to undergo labor pain relief. But this is a natural process, every woman can cope without anesthetic drugs.

This article will focus on the issue of labor pain relief; its pros and cons will be described in detail. You will also find out what such intervention on the part of obstetricians poses to you and your unborn child. The types can be varied. Which ones exactly? Read more about this.

Pain relief for childbirth: obstetrics, new methods

During childbirth, pain occurs due to muscle spasm, which intensifies due to the release of adrenaline. Often a woman experiences a panic attack, which aggravates physical suffering.

A woman who is psychologically prepared and has consciously approached planning the birth of a baby most often does not need pain relief during labor. But there are still cases when anesthesia is performed according to doctor’s indications.

Indications for pain relief

They give pain relief during childbirth if:

• premature birth;
• severe pain;
• long contractions;
• multiple births;
• C-section;
• slow labor;
• fetal hypoxia;
• the need for surgical intervention.

If none of the above is observed, then pain relief during labor is usually not required.

Types of anesthesia

Modern medicine can present the following types of pain relief during childbirth: medicinal and non-medicinal. In this case, your doctor must prescribe a type of anesthesia that will not harm either you or your child. It should be noted that a woman in labor cannot prescribe pain relief for herself if there is no direct indication for it.

Non-drug methods of labor pain relief

This safest group of methods is especially popular among obstetricians. What does this include? Effective and simple exercises that can be started at any stage of labor: breathing exercises, birth massage, aquatherapy and reflexology.

Despite the availability of more effective medicinal methods, many deliberately refuse them in favor of non-drug methods. Natural pain relief during childbirth includes:

• activity;
• correct breathing;
• massage;
• water birth;
• reflexology.

The birth of a baby is the most important event in your life. Non-drug methods of labor pain relief, which are completely harmless and useful for both you and your baby, will help you leave only positive impressions of this day.

Activity during labor

It is very important during contractions to choose an active position rather than a passive one. Help yourself and your baby to be born.

If you have an uncomplicated birth, then choose exercises for yourself, the main thing is to make it easier for you. However, sudden movements are strictly prohibited. Take note of the following:

• rolling from toe to heel;
• bending forward and to the side;
• rocking the pelvis, circular movements;
• arching and flexion of the spine;
• active walking;
• swinging on a fitball.

Breathing exercises

It is worth mastering breathing techniques even before childbirth, during pregnancy. The advantage of this method is the possibility of combination with other types of pain relief. You don’t need a doctor’s supervision; you can control the process yourself. You will feel relief immediately, and most importantly, you will pull yourself together. There are several breathing exercises techniques. If someone close to you will be present with you at the birth, then he should be familiar with these exercises in order to help you during the birth process.

How it works? You need to distract yourself from the pain by concentrating on breathing. The deeper and smoother it is, the easier it is for you and your baby, because he receives more oxygen. And if this method is used together with it, the effect will be much better, your child will feel comfortable. There are several periods during which breathing should differ:

• first contractions;
• increased intensity of contractions;
• dilatation of the cervix;
• period of pushing.

During the first contractions

This type is different in that it is smooth and deep breathing, which saturates the blood of the baby and mother with oxygen. Focus on the count. Inhale through your nose for four counts and exhale through your mouth for six counts. The lips should be folded into a tube. You are distracted from pain, gymnastics gives a relaxing effect. It can even be used during times of panic or extreme stress to calm you down.

During intense contractions

During this period you need to calm down, now is the time to use the dog breathing technique. These are shallow, shallow inhalations and exhalations through the mouth, the tongue needs to stick out a little from the mouth. You shouldn’t think about how you look at the moment, the maternity hospital is a place where you only need to think about your well-being and about the child, especially, believe me, you are not the only one!

Moment of cervical dilatation

This is the peak, you won’t be in more pain than now! But you need to endure this; childbirth without pain relief using medication is still preferable. Now it’s worth speeding up your breathing, taking shallow, quick inhalations and exhalations. Form your lips into a tube, inhale through your nose and exhale through your mouth. When the contraction releases, calm down a little, it is better to breathe deeply and evenly. This method allows you to slightly ease the acute pain.

Period of pushing

The worst is over, there are no more contractions. Your baby will be born very soon. If the birth is not complicated, then the baby will appear after 1-2 attempts. You need to push 2-3 times per push. Don't panic, because now is the final moment, almost painless. If you feel sorry for yourself and do not obey the orders of the obstetrician, you will have to use instruments, which will cause quite painful sensations. When pushing begins, you need to take a deep breath, exhale, deep breath and hold your breath for 10-15 seconds, while pushing. Do not push on the anus or strain your eyes, as this can cause hemorrhoids, stroke and other unpleasant and dangerous consequences.

Another important announcement: the period between contractions and pushing is needed in order to rest, relax and even out your breathing. You need to exercise every day during pregnancy so that you can pull yourself together during childbirth. Bring your breathing to automaticity, and you will control yourself and make labor easier.

Other options

Modern methods of labor pain relief include a large list of various procedures, but particularly effective (non-drug) are massage, water birth and reflexology.

How to massage during contractions? There are points on the body that, by acting on them, can significantly reduce and soothe pain. In our case - the sacral zone. You can do this either yourself or ask the person who is nearby. This area can be stroked, pinched, massaged, or lightly tapped. To avoid redness and irritation in the massage area, periodically lubricate the area with cream or oil.

How does water help? In a warm bath, the pain of contractions is easier to bear; water also has a relaxing effect. The expectant mother can take a comfortable position and just relax, while you will avoid chills, fever, sweating, and dry skin.

What is reflexology? Modern pain relief for childbirth also includes a method such as acupuncture. It helps improve labor and reduce the pain of contractions. As you can see, there are a lot of options, which one you choose is your personal decision.

Drug pain relief

In addition to the above-mentioned natural methods, there are also more effective, but, accordingly, more dangerous. Modern methods of medicinal labor pain relief include the following:

• epidural block;
• spinal block;
• spinal-epidural combination;
• drugs;
• local anesthesia;
• perineal blockade;
• tranquilizers.

Epidural block

Everyone has heard, but not everyone knows the intricacies of this procedure. Let's start with the fact that during childbirth it can be either partial or complete. If childbirth takes place naturally, then drugs are administered on the basis that they are only enough for the first contraction (that is, contractions); during pushing, the effect of the drug ends. In this case, only pain signals in the area below the navel are blocked, motor ability remains, the person is conscious and can hear the first cries of his baby. If you wish or have special indications, the second stage of labor (pushing) can also be anesthetized, but this is dangerous, since you do not feel your body’s signals and labor can be significantly delayed or go completely wrong. If there is no such need, then do not anesthetize the pushing; during it, the pain is more tolerable.

Second option - In this case, a larger dose is administered than in the previous option, and motor activity is also blocked. The advantage of such anesthesia is the opportunity to immediately see and hear the baby.

Spinal block

This is also an injection that is given in the lower back, into the fluid around the spinal cord. This is a less expensive method compared to epidural anesthesia.

• you remain conscious;
• the effect lasts two hours;
• relieves pain throughout the body from the thoracic region and below.

• may cause severe headaches;
• lowers blood pressure;
• may cause difficulty breathing.

Spinal-epidural combination

This is a relatively new technology that combines the two above methods. This anesthesia lasts much longer, while the mother remains conscious. For the first two hours, the epidural is effective.

Drugs

No matter how strange and contradictory it may sound, drugs are also used during childbirth, but extremely rarely, in special cases. What drugs are used? This:

• "Promedol";
• "Fortal";
• "Lexir";
• "Pethidine";
• "Nalbuphine";
• "Butorphanol".

Narcotic substances can be administered either intramuscularly or intravenously (via a catheter); the second option is the most successful, since the dosage of the drug can be adjusted. This method is good because the pain is blocked for about six hours and the woman in labor can rest. The effect occurs within a couple of minutes. Of course, there are also negative aspects: breathing may slow down for both you and the child.

Local anesthesia

It is not used to relieve pain during contractions, but it is very effective when making an incision in the vagina or stitching after a tear. The injection is made directly into the vaginal area, the effect occurs almost instantly, pain in the injection area is temporarily blocked. Neither you nor your child will experience any bad side effects.

Perineal blockade

The injection is made directly into the vaginal wall, blocking pain on only one side. This injection is given immediately before the baby is born. The effect of the drug lasts no more than an hour and has no side effects. This type of anesthesia is not suitable for the period of labor.

Tranquilizers

Tranquilizers are used for relaxation; injections are given at the first stage, when contractions are rare and not so sensitive. Such drug pain relief during labor dulls awareness and has a hypnotic effect, reducing the child’s activity, but does not completely relieve pain. Tranquilizers can be in the form of tablets or administered intravenously or intramuscularly. When administered intravenously, the effect is immediate.

Postpartum period

Pain relief is also provided after childbirth. For what? So that a woman can relax and gain strength. What may concern you:

• spasms caused by contractions of the uterus;
• places of ruptures and cuts;
• difficulty going to the toilet;
• chest pain;
• cracking of the nipples (due to improper feeding).

If the pain is caused by tears and incisions, then painkillers or ointments are suggested, but if the birth was carried out correctly and you pay attention to personal hygiene, then there should be no pain, or it should be minimal. During suturing, the doctor is obliged to numb the pain, and how this will happen should be discussed with you in advance.

There are several ways to minimize pain:

• frequent and short-term water procedures;
• special cooling pad (will help avoid swelling);
• store the pads in the refrigerator (they will dull the pain);
• get ready for a speedy recovery;
• Disturb the site of cuts and tears less (avoid infection, do not make sudden movements, this will contribute to a quick recovery);
• sitting on a special cushion (exerts minimal pressure on the problem area).

Pain associated with uterine contractions goes away on its own a week after the baby is born. To reduce them:

• perform special exercises;
• lie on your stomach;
• get a massage.

The following exercise will help with back pain: lie on a hard surface, bend your right leg at the knee and hold your knee with your right hand. With your left hand, guide the heel of your right foot toward your groin. Stay in this position for a few seconds, rest and repeat the exercise. If your back hurts on the left side, then do the same with your left leg.

Childbirth is a natural physiological process, but despite this, pain is an almost integral component of it. Only about 10% of women characterize labor pain as insignificant; this is mainly typical for 2 or 3 births. At the same time, almost 25% of women in labor require medications to reduce the intensity of sensations and prevent possible harm to both mother and child.

What causes pain during childbirth?

During the first stage of labor, contractions of the uterus (contractions) and dilation of the cervix cause excessive irritation of the nerve endings, which in turn send a signal interpreted by the brain as pain. In addition, the vessels and muscles are stretched, and the intensity of their blood supply decreases, which can also increase the severity of pain.

In the second period, the main factor contributing to the occurrence of pain is the pressure of the presenting part of the fetus on the lower part of the uterus, and its movement through the birth canal.

In response to increasing pain, the brain generates a response from the body - increased heart rate and breathing, increased blood pressure, and excessive emotional arousal.

It is worth noting that in many ways the intensity of pain during childbirth depends not only on the level of the woman’s pain threshold, but also on her psycho-emotional state. Stress, fear, anticipation of pain, and a negative attitude increase the amount of adrenaline produced, resulting in increased perception of pain. Conversely, calmness and balance promote the production of endorphins (hormones of joy), which naturally block the perception of pain.

Is there pain relief during childbirth?

In 100% of cases, methods of non-drug (physiological) pain relief are indicated: proper breathing, various relaxation techniques, special poses, water treatments, acupuncture, massage. When used correctly, the combination of these methods is enough in almost 75% of cases to avoid resorting to medications.

If physiological methods do not produce results or there are objective medical indications related to the woman’s health, obstetric situation or the course of the birth process, drug pain relief is used. This helps not only to reduce the suffering of the mother in labor, but also avoids the body’s negative reaction to pain, thereby normalizing heartbeat and breathing, lowering blood pressure and increasing blood circulation in the pelvic area.

In addition, pain relief during labor can reduce energy costs and avoid weakening of labor in cases where the duration of the first period exceeds 12 hours.

Types of pain relief during natural childbirth:

Many previously widely used methods of anesthesia and analgesia are now fading into the background due to the excessive number of side effects. These include inhalation anesthesia, which causes short-term clouding of consciousness and depresses the respiratory activity of the fetus, and intravenous administration of various analgesic drugs and antispasmodics that easily penetrate through the placenta into the fetal bloodstream.

The safest and most effective methods of regional anesthesia are considered to be epidural and spinal anesthesia.

- epidural anesthesia

With this method, under local anesthesia, an anesthetic drug (Lidocaine, Novocaine) is injected into the epidural space of the spine using a thick needle. As a rule, the procedure itself, including insertion of the catheter, takes no more than 10 minutes. The effect of the drug occurs within 15-20 minutes and lasts up to half an hour, after which, if necessary, a new dose can be administered.

Indications for the use of epidural anesthesia include:

• high myopia;
• low pain threshold and unstable psycho-emotional state of the patient;
• malposition;
• premature onset of labor;
• kidney disease, diabetes mellitus, late-term toxicosis.

The decision on the need to use epidural anesthesia is made by the obstetrician-gynecologist together with the anesthesiologist, taking into account the patient’s medical history, the condition of the fetus and the course of labor.

The procedure for placing a catheter and inserting a needle is quite complex and requires certain skills and experience from the anesthesiologist.

- spinal anesthesia

The technology is not significantly different from epidural anesthesia; it is performed using a thinner needle and with a smaller amount of medication. In this case, the anesthetic itself is injected directly into the area where the cerebrospinal fluid is located. The effect of such an injection occurs almost instantly and can last from 2 to 4 hours.

Spinal anesthesia completely blocks the transmission of impulses from peripheral nerves to the brain, so sensitivity below chest level is completely absent, while the woman in labor is completely conscious. This method of pain relief is often used during both planned and emergency cesarean sections.

The use of spinal anesthesia guarantees an analgesic effect in 100% of cases (with an epidural there is approximately a 5% chance of failure), the procedure is practically painless, and the drugs used do not harm either the woman in labor or the fetus.

Side effects include possible headaches and back pain after the anesthesia wears off, as well as a significant decrease in blood pressure.

In what cases is anesthesia contraindicated?

There are a number of contraindications for which spinal or epidural anesthesia is strictly not recommended. These include:

• low platelet levels in the blood and bleeding disorders (including after heparin administration);
• bleeding;
• inflammatory processes in the area of ​​drug administration;
• tumors, infections or injuries of the central nervous system;
• hypotension (blood pressure level below 100 mmHg);
• individual intolerance to administered drugs.

An obstacle to the administration of painkillers may be the categorical refusal of the woman in labor, without whose consent the procedure cannot be carried out.

Also, contraindications in some cases may include injuries and deformities of the spine, serious cardiovascular and neurological diseases, and obesity.

Finally

In order to minimize possible negative feelings, it is important to try to get rid of the fear of pain during childbirth in advance. Most women in labor are able to cope with it on their own using natural, non-drug methods, but if necessary, the doctor will always prescribe additional medications. With this in mind, you can stop worrying that the pain will become unbearable and concentrate on positive thoughts about the birth of your baby.

Especially for- Elena Kichak

Fear of childbirth almost every woman experiences it because childbirth is usually associated with severe pain. And of course, most pregnant women want an answer to the question: how to give birth quickly and easily. There are various ways to manage pain, from breathing techniques to medication interventions.

Some of them can be practiced during pregnancy.

Every person's body contains anti-pain system, which is somehow activated. Throughout life, a person encounters pain of various types. The pain experienced during childbirth is considered one of the most severe.

The human body has developed mechanisms by which it copes with pain. At the biological level, these are hormones: endorphin, enkephalin and oxytocin, which provide a somewhat clouded state of consciousness when in contact with pain and work as natural analgesic factors.

For the natural pain relief system to work properly, it is necessary to provide comfortable conditions during childbirth. Under stress caused by fear, tension, the presence of strangers or too bright light, adrenal hormones are actively released. These hormones neutralize the effects of endorphins, enkephalins and oxytocin.

In addition to the natural pain relief system, there are such methods of pain relief as:

Pain management practices from psychology

You can learn to relax during intense pain using deep breathing and visual imagery. At the moment of acute pain, you need to begin to exhale it slowly, taking a deep breath and exhaling for a long time, and imagine that instead of pain, the body is filled with warm and bright sunlight (or any other soothing and pleasant image). It is best to practice in advance by doing meditation and studying your body (what path does inhaled and exhaled air take, how muscles work when breathing, etc.).

Exercises with fitball, ropes and wall bars

Increasingly, fitballs can be seen in prenatal wards. With their help, they do various exercises to relax and reduce pain. For example, you can do the following exercise: Sit on a fitball with a straight back and slightly relax your shoulders. Feet rest on the floor and are spread wide apart. The pelvis begins to make smooth circular movements: from side to side, clockwise and counterclockwise, forward and backward. The movement is synchronous with breathing - one circle of slow inhalation, one circle of long exhalation. Always exhale through your mouth. The lips are relaxed. This exercise can be done at home as preparation for childbirth.

In modern birthing rooms you can also find ropes. To stretch and relax your aching lower back, you need to do the following exercise: while standing, tightly clasp the rope with your hands, slightly relax your legs at the knees (while more emphasis remains in your hands). There will be a feeling of stretching of the entire back. The same exercise can be done at the wall bars.

If the prenatal ward is without additional equipment, then instead of a support you can use a headboard, a chair, a window sill or a wall.

Partner help

In case of joint birth, the exercise described above can be performed with a partner. His shoulders will act as support. Your partner can massage your lower back, this will improve blood circulation and relax the muscles, which will help reduce pain.

Breathing during childbirth

Proper breathing can help make labor easier. Having mastered the correct breathing technique, it will be easier for a woman to endure painful sensations. By breathing correctly, a woman helps the obstetrician’s work and childbirth goes smoothly.

The obstetrician guides and suggests when you need to take a deep breath and push, and in which case – pause in pushing and start breathing quickly.

In antenatal clinics they conduct courses for pregnant women where they talk about breathing technique And stages of labor. Such courses also help prepare mentally for the birth process. Not knowing how childbirth will go often causes stress for pregnant women. On the contrary, being prepared and understanding what will happen at different stages reduces stress levels.

Medical anesthesia

There are times when medical intervention is indispensable. During childbirth, the following types of anesthesia are used:

Epidural anesthesia: answers to frequently asked questions

Epidural anesthesia is considered to be a major breakthrough in obstetrics in recent decades. Now it is used in almost all maternity hospitals during caesarean section And during natural childbirth to give the woman in labor a rest.

The use of anesthesia also allows for a comfortable childbirth experience, after which women are not afraid to give birth for the second and subsequent times.

There is an opinion among some patients that the use of anesthesia is a departure from the natural process, that is, the woman does not experience all the feelings that she should experience during childbirth. However, this opinion is not entirely true. The use of epidural anesthesia allows some sensations to be retained - patients feel contractions and even straining during the pushing period. The preservation of sensations (except painful ones) after anesthesia in a woman during childbirth depends on the dosage and the experience of the anesthesiologist.

Many women have the following questions: is it worth having anesthesia and why is it given during childbirth, what side effects are there, etc. Below are answers to the most popular questions about epidural anesthesia.

• What is epidural anesthesia and what is its purpose?

Epidural anesthesia is a medical method of pain relief during labor. To stop the pain, an anesthetic is injected into the body in the area of ​​2-5 lumbar vertebrae. This is the epidural space in which the nerve endings are located. The anesthetic blocks the nerve plexuses that go to the uterus and thereby the sensation of pain is reduced and dulled, while uterine contractions are felt, but pain is not.

• What are the benefits of anesthesia?

Pain relief allows childbirth to be carried out comfortably, gently and through the natural birth canal. All this is possible because epidural anesthesia has a powerful therapeutic antispasmodic effect. This effect promotes smoother and faster cervical dilatation and a smoother birth. Pain relief restores a woman's strength and helps her give birth quickly and easily.

During the active phase of labor, contractions become frequent and prolonged, the cervix begins to dilate, during contractions all nerve endings are compressed and their blood supply deteriorates. This causes pain. Anesthesia helps relieve this pain.

• Can a woman make an agreement with her doctor in advance about the use of pain relief?

The decision to provide pain relief during labor is made by the woman giving birth and the doctor delivering the baby. A woman may express a desire to use anesthesia and, as a rule, if there are no contraindications, the doctor will accommodate.

Anesthesia may be prescribed for medical reasons. During labor, anesthesia can be not only a factor that reduces pain, but also a factor that will improve the birth process.

• How many times during childbirth can you give pain relief?

Epidural anesthesia is used once during childbirth. A guidewire is inserted, then a catheter is secured, which is connected to a syringe and dosed administration of the drug begins throughout the entire birth. The catheter is a very thin conductor that does not interfere with the woman lying on her back and does not cause any inconvenience. The catheter is removed after birth.

• At what point in labor is it most appropriate to administer analgesia?

Anesthesia is given at the time of more severe pain. This usually coincides with a more active phase of labor, when the opening of the uterine os is three to four centimeters. The decision to administer the drug earlier is made by the obstetrician together with the anesthesiologist, if there are indications for administering anesthesia.

• Indications for epidural anesthesia.

Delivery of a large fetus.

Complicated course of the first birth - if there were deep ruptures of the cervix.

Preeclampsia (increased swelling and pressure, cramps, loss of protein in the urine).

Discoordination of labor.

Epidural anesthesia is not given when the patient enters the maternity hospital during the pushing period. This decision is made because the period of pushing can be equal in time to the installation of anesthesia, that is, the speed of birth of the baby is approximately equal to the speed of administration of anesthesia.

• What side effects can there be after using anesthesia?

Headaches, numbness in the legs, and back pain may occur after an epidural. To avoid negative consequences, anesthesiologists carry out premedication and a number of other preparatory measures. An osteopath and a neurologist, as well as preventive rehabilitation, can help cope with the consequences that have arisen.

Finally

If there are no contraindications, then you can go to water aerobics or yoga for pregnant women. With the help of such exercises, muscles acquire tone and elasticity, and endurance is trained, which will help make the birth process easier.

If possible, it is worth attending courses for pregnant women or watching breathing lessons. During the courses, pregnant women are taught how to give birth without pain, how to breathe correctly, and are also told about the stages of childbirth. Women who breathe correctly during childbirth and follow the instructions of their obstetricians give birth faster and easier. Well, you shouldn’t rely only on epidural anesthesia and remember that it is prescribed according to indications. You need to explore other methods of relaxation, for example, breathing, exercises on a fitball or psychological practices. All this together will help a woman give birth easily and without pain.

Despite the constant development of medicine, anesthesia during childbirth is still not a mandatory procedure. Much depends on the characteristics of the pain threshold of the woman in labor: if she can endure a natural birth without the use of painkillers, they are not used unless there is an indication for this. Much less often during childbirth, general anesthesia is used with drugs that put a person into deep sleep, but they are unsafe for the child, so it is most often recommended to resort to spinal or epidural anesthesia.

During pregnancy, many women are interested in issues of pain relief during childbirth, since it is no secret that the process is always associated with pain, which can be long-lasting and unbearable. They ask the doctor questions: is it possible to give birth without using pain relief methods and what is better - epidural anesthesia or general anesthesia? Modern methods of anesthesia are considered relatively safe for both the mother and her child, and make childbirth more comfortable for the woman.

Types of pain relief during natural childbirth

There are non-drug (natural) and medicinal methods of pain relief. Natural methods are completely safe and effective. These include: breathing techniques, massage, acupuncture, aromatherapy, relaxation, etc. If their use does not bring results, they resort to drug pain relief.

Methods of drug anesthesia include:

• epidural anesthesia;
• spinal anesthesia;
• local anesthesia;
• inhalation anesthesia;
• general anesthesia.

In natural childbirth, epidural and spinal anesthesia are used.

Epidural anesthesia

Epidural anesthesia qualitatively eliminates sensitivity in the lower part of the mother's body, but it does not affect her consciousness in any way. The stage of labor at which the doctor uses epidural pain relief varies from patient to patient depending on their pain threshold.

During epidural anesthesia, the anesthesiologist and obstetrician assess the condition of the mother and the unborn child, and also refer to the history of anesthesia in the past and the course of previous births, if any.

With epidural anesthesia, the drug is injected into the space of the spine in which the nerve roots are located. That is, the procedure is based on nerve blockade. This type of pain relief is usually used during natural childbirth to ease the process of contractions.

Technique:

• the woman takes the “fetal” position, arching her back as much as possible;
• the injection area is treated with an antiseptic;
• an injection with an anesthetic drug is made into the spine area;
• after the medicine begins to act, a thick needle is punctured into the epidural space until the anesthesiologist feels the dura;
• after this, a catheter is inserted through which anesthetics will enter the woman’s body;
• the needle is removed, the catheter is secured with adhesive tape on the back and a trial administration of the drug is carried out along it, during which the doctor carefully monitors the woman’s condition;
• The woman should remain in a lying position for some time to avoid complications. The catheter remains in the back until the end of labor, and a new dose of medication will be injected through it periodically.

The catheterization procedure itself takes no more than 10 minutes, and the woman must remain as still as possible. The drug begins to act approximately 20 minutes after administration. For epidural pain relief, medications are used that do not penetrate the placental barrier and cannot harm the child: Lidocaine, Bupivacaine and Novocaine.

Indications for epidural anesthesia:

• kidney disease;
• myopia;
• young age of the expectant mother;
• low pain threshold;
• premature labor;
• incorrect presentation of the fetus;
• severe somatic diseases, for example: diabetes.

Contraindications:

• heart and vascular diseases;
• poor blood clotting;
• spinal injuries and deformities;
• high risk of uterine bleeding;
• inflammation in the puncture area;
• increased intracranial pressure;
• low blood pressure.

Positive sides:

• a woman can move relatively freely during childbirth;
• the state of the cardiovascular system is more stable in contrast to general anesthesia;
• pain relief has virtually no effect on the fetus;
• the catheter is inserted once for an indefinite period, so if necessary, medications can be administered through it at the desired period of time;
• a woman will see and hear her child immediately after birth.

Negative sides:

• the likelihood of an inadequate result of pain relief (in 5% of women the effect of the anesthetic is not achieved);
• complex catheterization procedure;
• the risk of intravascular administration of the drug, which is fraught with the development of convulsive syndrome, which, although rare, can cause the death of a woman in labor;
• the drug begins to act only after 20 minutes, so in case of rapid and emergency childbirth, the use of epidural anesthesia is not possible;
• If the drug is injected through the arachnoid membrane, a spinal block develops and the woman requires emergency resuscitation.

Spinal anesthesia

Spinal anesthesia, like epidural anesthesia, is performed in almost the same way, but using a thinner needle. The difference between spinal and epidural anesthesia is as follows: the amount of anesthetic for a spinal block is significantly less, and it is injected below the border of the spinal cord into the space where the cerebrospinal fluid is localized. The feeling of pain relief after injection of the drug occurs almost immediately.

The anesthetic is injected once into the spinal cord canal using a thin needle. Pain impulses are blocked and do not enter the brain centers. The proper result of pain relief begins within 5 minutes after the injection and lasts for 2-4 hours, depending on the chosen medication.

During spinal anesthesia, the woman in labor also remains conscious. She sees her baby immediately after birth and can put him to her breast. The spinal anesthesia procedure requires mandatory venous catheterization. A saline solution will flow into the woman's blood through the catheter.

Indications for spinal anesthesia:

• gestosis;
• kidney disease;
• diseases of the bronchopulmonary system;
• heart defects;
• high degree of myopia due to partial retinal detachment;
• incorrect presentation of the fetus.

Contraindications:

• inflammatory process in the area of ​​intended puncture;
• sepsis;
• hemorrhagic shock, hypovolemia;
• coagulopathy;
• late toxicosis, eclampsia;
• acute pathologies of the central nervous system of non-infectious and infectious origin;
• allergy to local anesthesia.

Positive sides:

• 100% guarantee of pain relief;
• the difference between spinal anesthesia and epidural implies the use of a thinner needle, so the manipulation of drug administration is not accompanied by severe pain;
• medications do not affect the condition of the fetus;
• the muscular system of the woman in labor relaxes, which helps the work of specialists;
• the woman is fully conscious, so she sees her child immediately after birth;
• there is no likelihood of systemic influence of the anesthetic;
• spinal anesthesia is cheaper than epidural;
• the technique of administering the anesthetic is more simplified compared to epidural anesthesia;
• quickly obtaining the effect of anesthesia: 5 minutes after administration of the drug.

Negative sides:

• It is not advisable to prolong the effect of anesthesia for longer than 2-4 hours;
• after pain relief, the woman should remain in a supine position for at least 24 hours;
• headaches often occur after a puncture;
• Several months after the puncture you may experience back pain;
• the rapid effect of anesthesia is reflected in blood pressure, provoking the development of severe hypotension.

Consequences

The use of anesthesia during childbirth can cause short-term consequences in the newborn, for example: drowsiness, weakness, respiratory depression, reluctance to latch on. But these consequences pass rather quickly, since the drug used for pain relief gradually leaves the child’s body. Thus, the consequences of drug anesthesia of labor are due to the penetration of anesthesia drugs through the placenta to the fetus.