Anesthesia during childbirth consequences. Epidural anesthesia during childbirth, technique, indications and contraindications, pros and cons, possible consequences and complications. Non-drug methods of labor pain relief

What is epidural anesthesia during childbirth, why is it needed, how is it carried out and is it worth doing - we will talk about all this in detail later in the article.

Epidural anesthesia during childbirth has become a salvation for many women. Many expectant mothers are afraid of the pain that will occur during childbirth. But today there is an injection into the spine during childbirth - as it is popularly called.

It completely anesthetizes the body below the waist, which facilitates the course of contractions, which exhaust the body. This gives you the opportunity to rest before pushing, which is very important for a woman. But like all good things, the epidural also has a downside, and the opinions of doctors also vary greatly.

I worked in a maternity hospital for about 15 years, I remember the times when this type pain relief has just appeared and in this article I will tell you about everything in detail.

Epidural anesthesia during childbirth: what is it?

Many pregnant women, even in the first trimester, begin to be interested in a logical question - an epidural during childbirth, what is it and how is it carried out? I don’t really like to answer this question, perhaps because... I am an “old school” doctor.

First of all, all women and girls should remember that childbirth is a natural process inherent in nature itself. A woman can bear it labor pain, which is instantly forgotten after the baby is born, so if there is no indication for an epidural, you should not think about it in advance.

If it's necessary

There is still no consensus on when to start the procedure. Some clinics prefer to administer anesthesia as soon as it becomes clear that the process has begun. This helps the mother in labor avoid not only pain, but also fatigue from it. Other clinics believe that the procedure is more appropriate when small opening uterus. That is, doctors wait until the uterus opens by 3-4 cm, make sure that labor is proceeding as expected, and only then carry out the procedure. This approach does not bring visible pleasure to the mother in labor, since she has to endure terrible pain it will take several hours.

Here everything goes at the discretion of the doctor, who bears full responsibility.

Epidural anesthesia during childbirth: which vertebra, technique

When the doctor decides that it is time to administer anesthesia, the anesthesiologist takes over. This person bears the same responsibility for the life and health of the woman as her leading doctor. He is the one who knows where epidural anesthesia is given during childbirth and how to administer it in order to minimize the risks for the woman. Scheme:

• The patient should assume a curled up position on her side. You must not move under any circumstances.
• The puncture site is treated. Anesthetics are used.
• An injection is given with an analgesic that will relieve skin sensitivity during the procedure. This is very important, since the woman in labor may twitch during the insertion of the needle. This answers a very popular question among women: is it painful to have epidural anesthesia during childbirth? No, only slight discomfort is felt.
• A puncture is made and a needle is inserted into the epidural space. This is where the name of this anesthesia comes from. The needle will be inserted until it reaches the dura mater.
• A catheter is placed through the needle, through which epidural anesthesia will be delivered during childbirth.
• The needle is removed.
• Pain medication is given. First in a small dose, in case of individual intolerance.
• After labor is over, the catheter is removed and the injection site is covered with a bandage. It is advisable for a woman not to get up for the first couple of hours.

When an epidural anesthesia is given, you are absolutely forbidden to move. Otherwise, the doctor may use a needle to puncture in the wrong place. The procedure is usually carried out between contractions to minimize risks. sudden movements. When the needle is inserted, the patient may feel strong pressure on your lower back. This is absolutely considered normal occurrence. When the catheter is inserted, you may feel a sharp ache in the leg or back, which is also normal.

The entire procedure should take only 10 minutes. The drugs begin to act within 20 minutes. Medicines can be administered continuously or once. This is decided directly by the doctor, but more often a continuous flow of anesthesia is preferred.

The main drugs used in such cases:

• Novocaine.
• Lidocaine.
• Bupivacaine.
• Ropivacaine.

The specific drug is selected by a doctor who knows his patient's medical history.

Indications and contraindications

Epidural anesthesia is not always used during childbirth; it has both a number of indications and contraindications.

Indications for epidural anesthesia during childbirth:

• Premature birth. When the fetus is not full term, it is important to minimize its risks when leaving the uterus. Anesthesia will relax the muscles, remove pain, and this will put less pressure on the child when passing birth canal.
• High blood pressure. As a rule, hypertension is a big risk for the patient. And an epidural during natural childbirth normalizes blood pressure.
• The need to perform a caesarean section. Sometimes the fetus is too large or there is a multiple pregnancy, then anesthesia is administered. It allows the woman to remain conscious and hear the baby's first cry.
• Crash labor activity. Sometimes this happens because of pain. An epidural during contractions will help enhance labor by reducing the secretion of adrenaline and norepinephrine, which prevent the uterus from opening.
• The desire of the patient herself. Every person is aware of what pain he can endure and what he cannot.
• Very long, difficult labor.

But there are also contraindications to epidural anesthesia during childbirth. These include:

• Increased cranial and low blood pressure.
• Presence of bacteria in the blood.
• Dehydration.
• Bleeding.
• Heart disease.
• Hypocoagulation.
• Infection in the area where the injection is to be given.
• Dilatation of the uterus by more than 7 cm.
• The patient's temperature.
• Neurological diseases.

The procedure is prescribed to people with epilepsy and diabetes with extreme caution and under the supervision of several doctors.

Whether epidural anesthesia is needed is decided by the woman in labor and her doctor.

If a woman has had a cesarean section, she may encounter the concept of prolonged epidural anesthesia during childbirth. Undoubtedly, - abdominal surgery, after which severe pain will occur. And medicine is trying to make it easier postoperative consequences. Therefore, the woman continues to be given anesthesia through a catheter. But a substance such as lidocaine, with prolonged administration, can cause tachyphylaxis. Long-term use of bupivocaine is also undesirable; it has cardiotoxic properties. Today, the safest drug for these is naropin or its analogue ripovacaine.

The effect of the procedure on the child and the mother’s body, consequences

The opinion of doctors about epidural anesthesia during natural childbirth is strictly positive. It is believed that the procedure does not affect the baby in any way. Those drugs that are injected into the epidural space cannot reach the fetus through the placenta. That is, the fetus is absolutely protected, and it is easier for it to pass through the birth canal, since the mother does not feel pain and her muscles relax.

The mother, unfortunately, may have Negative consequences from the procedure. Alas, there are risks always and everywhere. These include:

• Getting the anesthetic into the blood. The woman will immediately feel nausea and numbness in her mouth.
• Allergy.
• Long-term back pain.
• Headache.
• Problems with urination due to muscle hypotonicity.
• Pressure drop.
• Tingling sensation.
• Trembling throughout the body.

Also, expectant mothers are concerned about the following question: is it painful to give birth with epidural anesthesia? If the procedure is carried out on time, correctly, the drug is chosen based on the anamnesis, then there will be no pain.

It is important to know that epidural anesthesia is not performed during pushing. The medicine is calculated so that its effect ceases with pushing. The patient should feel when to push.

Childbirth with epidural anesthesia is becoming increasingly popular; a video of how the process occurs can be seen below. This will help expectant mothers decide and understand how childbirth occurs with epidural anesthesia. After all, it is important to be psychologically prepared for what lies ahead.

Failed procedure

The most important fear and risk is the anesthesiologist’s mistake. Unfortunately, the human factor is always present in medicine. And unsuccessful anesthesia may not always occur due to the fault of the doctor; if a woman twitches during the puncture, serious complications can arise.

The statistics are inexorable - in 5% of patients pain relief does not occur, and in another 15% pain relief does not occur completely. This is possible in the following cases:

• For spinal abnormalities.
• If the patient is overweight.
• If the doctor was unable to enter the epidural space.

There are cases when a woman in labor experiences pain relief strictly on one side: left or right. This is possible when partitions in the epidural space prevent the spread of the anesthetic. In such cases, you should immediately inform your doctor. He will either increase the dosage of the drug, or ask the woman in labor to lie on the other side, and if it does not help, he will give the injection again.

But there is also a more tragic situation. If we go back to the statistics again, one woman out of 250,000 can be paralyzed. This is a very small percentage, but it is possible. Sometimes there are cases of partial short-term paralysis. This also happens extremely rarely and goes away within a couple of days.

Epidural anesthesia: pros and cons

Having studied the full list of indications and contraindications, as well as all of them, one can draw conclusions about a procedure such as epidural anesthesia during childbirth; reviews from former patients are also important, since they will be able to explain first-hand how everything happens.

The benefits of the procedure include:

• No pain. This is a very important point. Childbirth is an extremely painful process, and today in the 21st century there is an opportunity to avoid this “hell”.
• Confidence that the patient will not suffer a hypertensive crisis during the process.
• At long labor An epidural will give a woman the opportunity to rest and gain strength for pushing.
• There is no stress, postpartum depression is less likely to occur.
• Absolutely harmless to the child.

But there is a fly in the ointment everywhere. The category “against epidurals” includes:

• Risk strong fall pressure, which is dangerous for hypotensive patients.
• Risk of long-term complications.
• Loss of psychological contact with the child. But this is extreme controversial point. Contact with the child does not arise through pain, and it cannot disappear just because the mother did not feel pain during childbirth. In the 21st century, these are prejudices.

In any case, a pregnant woman needs to weigh everything herself, talk to the doctor again, and then make a decision.

Conclusion

Epidural anesthesia makes it possible in the 21st century not to feel tearing pain during childbirth. This is a huge step in medicine and anesthesiology. Although there is still a category of people who do not accept innovations.

Does epidural anesthesia help during childbirth? Undoubtedly. Moreover, pain relief occurs 20 minutes after the administration of the anesthetic. In this case, the patient remains fully conscious, loss of sensation occurs below the waist.

As with any pain relief, an epidural has indications and contraindications. They all need to be taken into account when making a decision. It is also necessary to evaluate the consequences for the mother, since the substance does not affect the child; it does not reach him through the placenta.

Before making such a responsible decision, you should definitely consult with the gynecologist who is managing the pregnancy.

Epidural anesthesia during childbirth- is the most common. The main goal This method of childbirth is to reduce or completely eliminate pain, which ultimately makes childbirth comfortable for the mother and safe for the newborn.

Anesthesiologist performing epidural anesthesia for labor

This article reflects in a simple form all the technical aspects of epidural anesthesia for labor, clearly presents all the indications and contraindications for the epidural method of pain relief for labor, and also widely discloses all possible negative consequences and complications of epidural pain relief for labor:

Epidural anesthesia during childbirth and technique for its implementation

The following information is posted on the website of one of the US university clinics dealing with labor pain relief:

a) In the first stage of labor (lasts from the beginning of the first contractions to full disclosure cervix) the effects of epidural anesthesia of labor on the development of labor cannot be predicted and they are very individual:

Epidural anesthesia during childbirth may not have any effect on the process of labor itself;

There may be a slowdown in labor, requiring the introduction special drugs stimulating uterine contractions (oxytocin);

On the contrary, epidural anesthesia for labor may cause increased labor.

b) In the second stage of labor (expulsion period), epidural anesthesia causes a slowdown in labor. However, to date, there are no studies showing that this clinical effect of epidural anesthesia for labor leads to any negative effects on the laboring woman and the fetus.

Also on the website of the university clinic it is indicated that among some obstetrician-gynecologists there is still an opinion that epidural anesthesia during childbirth leads to an increased risk of transition natural birth in a cesarean section, both due to an increase in the duration of labor and due to a change in the location of the fetus in the pelvis caused by relaxation of the pelvic floor muscles.

In contrast, the American Society of Anesthesiologists website lists a number of misconceptions regarding epidural anesthesia for childbirth:

Misconception #1: Epidurals slow down labor.

To date, there are no studies showing that epidural anesthesia slows down the labor process. From the moment that epidural anesthesia for labor began to be used more and more often, in comparison with other types of anesthesia, for the anesthesia of initially “difficult” labor, the opinion arose that this type of pain relief makes childbirth difficult. However, these conclusions are nothing more than a misinterpretation of the data. On the contrary, research results have shown that in some women, epidural anesthesia during labor causes the pelvic floor muscles to relax, which leads to an acceleration of the labor process.

Misconception No. 2: Epidural anesthesia during childbirth leads to a cesarean section.

Again, there are no studies proving that epidural anesthesia during childbirth can be one of the reasons for the transition from natural childbirth to cesarean section. In fact, epidural anesthesia for labor is usually given to women who report the greatest pain during childbirth, unlike women, whose pain is relatively insignificant, this method of pain relief is not carried out for them. Greater pain during childbirth may be an indirect indicator narrow pelvis, large fetus or other clinical situations that in themselves suggest high probability performing a caesarean section.

Thus, given the ambiguity of specialists’ positions regarding the effect of epidural anesthesia on the course of labor, it is best to leave the question of choice to your doctors - an obstetrician and an anesthesiologist, who take responsibility for the health and life of you and your unborn child.

Fast, without painful childbirth and a healthy baby is a woman’s dream. But increasingly we have to face various complications. Epidural anesthesia is a popular and effective medical pain relief for labor. Some are delighted with the procedure, others are upset when they do not get the desired effect. How does it work and what are the consequences of epidural anesthesia during childbirth? Is it really safe?

Epidural anesthesia can be performed both for pain relief and for other indications. The effect largely depends on the characteristics of the woman’s body. What are the benefits of an epidural and what should you be wary of?

Causes of pain during childbirth

The Bible also said that a woman is destined to have a long and painful labor. For many centuries, women have been afraid of this moment, and maternal mortality, by today's standards, has gone through the roof. But already in the 20th century, various methods of pain relief began to be widely used, and the fear of childbirth decreased. The severity of pain during childbirth depends on the following points.

• Woman's pain threshold. Each person’s perception of unpleasant sensations is different and depends on the job nervous system. What causes terrible pain for some is tolerable for others.
• Psycho-emotional state. This is perhaps the most important point in the perception of pain. Calm, reasonable, naturally patient women give birth more easily. And those who are emotionally labile “require” pain relief. Chronic stress, fear of the process itself, and previous abnormal and painful births increase a woman’s sensitivity. You need to approach contractions already informed: know the basics of breathing and behavior in the maternity hospital. Courses at medical institutions, as well as forums and the media, help with this.
• Natural or induced. During the natural birth process, contractions in the first stage of labor are perceived as “ nagging pain in the lower abdomen or sacrum." Therefore, women often come to the maternity hospital already in pain. The use of various stimulants (prostaglandin-based gels and contractile drugs) leads to the development of labor that differs from “normal contractions”. Experienced doctors observe this even on the monitors of a CTG machine. Contractions have a higher amplitude, frequency, they are “like in textbooks.” This is due to the fact that during any stimulation, the muscles of the uterus contract all at once, while during natural childbirth, separate bundles alternate. No one has ever been able to imitate “nature” anywhere.
• Is there any birth pathology?. Excessively active contractions of the muscles of the uterus, discoordinated, as well as contractions during rapid labor always accompanied by severe pain.
• Number (parity) of births. In 2/3 of cases, the first birth is more painful than the subsequent ones. But this depends to a large extent on the woman’s perception of the process. It should also be taken into account that the first birth is often longer in time, and therefore is defined as more severe.

Ideally, natural childbirth occurs almost unnoticed by a woman - she can even do normal work at home until the point of pushing. Severe pain is a signal for the doctor and woman about the pathological course of the process. Epidural anesthesia is one of the effective methods for relieving discomfort and normalizing labor.

Features of epidural anesthesia

Epidural anesthesia involves the introduction medicinal substance into the shell space of the same name spinal cord. To locate the scene of action, there are special landmarks. Space puncture is performed from the back through skin with a special needle.

The spinal cord itself is surrounded by three membranes and enclosed in spinal canal, which is formed from vertebrae lying on top of each other. Subsequence anatomical location next:

• spinal cord - contains nerve cells and forms gray and white matter;
• soft shell - it is closely adjacent to the nerve cells;
• arachnoid membrane– between it and the soft tissue there is cerebrospinal fluid;
• hard shell– between it and the next layer, the periosteum of the spine, is the epidural space.

After introducing the drug into the epidural space, it begins to affect the passages here. nerve endings, causing loss of pain sensitivity only. At the same time, the woman can move freely, feel the temperature of objects and touch. Part of the medicine may enter the subarachnoid space, which will enhance its effect.

Difference from spinal anesthesia

Visually, epidural and spinal anesthesia are no different. The difference lies in the location of the medication. With epidural anesthesia, the drug is injected above the membranes of the spinal cord, and with spinal anesthesia - into the subarachnoid space (under the arachnoid membrane of the brain, where cerebrospinal fluid circulates).

The differences are in the needles. For execution spinal anesthesia thinner ones are required, and for epidural catheters are additionally needed for constant supply of medication and control of the required dose. The features of each method are briefly presented in the table.

Table - Difference between epidural and spinal anesthesia

In many countries, in addition to certain indications for epidural anesthesia during childbirth, this manipulation is performed at the request of the woman if contractions are painful for her. Some foreign clinics even include it in their mandatory management protocol normal birth. In post-Soviet countries, obstetricians and gynecologists are more often inclined to perform epidural anesthesia according to indications. The main ones include the following:

• painful contractions– if uterine contractions bring a woman pain that is unbearable by her standards, this may be the beginning of abnormal labor;
• pathological contractions– too frequent or, conversely, unproductive, which do not lead to dilatation of the cervix;
• arterial hypertension – in this case, doctors use a “side” effect of epidural anesthesia – a decrease in pressure, which is especially important during childbirth, since during contractions and severe pain, blood pressure numbers rise noticeably;
• gestosis - an epidural helps cope with pressure and shorten the time of labor;
• diabetes- at long labor It is more difficult to control blood sugar levels in women, which can lead to hypo- or hyperglycemic coma;
• shortening labor time– any other diseases in which it is in the woman’s interests not to delay birth process(for heart defects, heart failure) are a direct indication for epidural anesthesia.

Conditions for holding:

• the size of the pelvis corresponds to the weight of the fetus– in this case, the pelvis can be narrow, the main thing is that the baby is not large;
• cephalic presentation– if the child lies with the pelvic end down, obliquely or transversely, epidural anesthesia cannot be performed, since this increases the likelihood of complications;
• good fetal heartbeat - assessed based on the results of the CTG recording, there should be no signs of the child’s suffering;
• no signs of bleeding– at the time of epidural anesthesia, the doctor must exclude placental abruption.

Parity of births does not matter - epidural anesthesia can be performed during the first, second and subsequent births as a planned procedure or according to indications.

Benefits of the procedure

Epidural anesthesia for natural childbirth has the following advantages when used.

• Anesthetizes the process. Unpleasant sensations in a woman they decrease within 10-15 minutes after anesthesia. If pain occurs, the anesthesiologist adds the drug to a special catheter inserted into the epidural space. As a result, the woman is not so exhausted from constant contractions; important point, pushing, full of strength to act, and not in prostration after debilitating contractions of the uterus. An important “plus” is the effect of anesthesia at the time of suturing postpartum ruptures. There is also no need for additional medications in case of manual examination uterine cavity or curettage.
• Speeds up labor. In addition to the main effect, cervical dilation noticeably accelerates and labor time is reduced. This is especially important for women with somatic pathologies, for example, diabetes, arterial hypertension, heart defects, and also with gestosis.
• No consequences for the child. During research it was found that a small amount of The drugs enter the woman’s systemic bloodstream, but it does not have a significant effect on the baby. Acute hypoxia during labor during epidural anesthesia can occur for reasons unrelated to pain relief, for example, due to entanglement or placental abruption.
• Reduces blood pressure. This is one of the side effects of epidurals that is often used in medicinal purposes, for example, during childbirth in women with arterial hypertension, with gestosis.
• “Allows” other anesthesia. If necessary, epidural anesthesia does not interfere with general endotracheal or spinal anesthesia. Such situations arise when an emergency is needed caesarean section. Carrying out another type of anesthesia against the background of epidural anesthesia reduces the need to use narcotic drugs, muscle relaxants and other serious drugs.

In some European countries Almost 70% of births are performed with epidural anesthesia. In the post-Soviet space, the method has been actively used over the past ten years, but some doctors are still wary of it.

Disadvantages and consequences of epidural anesthesia during childbirth

Epidural anesthesia often leads to decreased uterine contractility during labor. There are no reliable studies on this matter due to the complexity of analyzing the situation. However, practicing doctors face such influence. To prevent such consequences of the procedure, 30-40 minutes after installing the catheter and introducing the substance into the epidural space, a constant infusion of uterotonics - drugs to stimulate contractions - is additionally established. Even in this case, the analgesic effect remains.

Performing epidural anesthesia requires a highly qualified doctor; otherwise, the risk of complications of the procedure increases. Their frequency is also influenced by the woman’s health, in particular the condition of the spine and previous inflammatory processes in the spinal cord membranes. The main complications and probable causes of their occurrence are described in the table.

Table - Disadvantages of epidural anesthesia for pregnant women

Delayed complications after epidural and spinal anesthesia include headache. Its appearance is associated with irritation of the membranes of the spinal cord, accidental puncture of the subarachnoid space, as well as with non-compliance by the mother in labor. bed rest within 12-24 hours after birth. Treatment for this complication includes rest, painkillers, and drinking plenty of fluids at least 2-3 l clean water per day.

Among the consequences for the back, a woman may feel slight pain for some time at the site of installation of the epidural catheter. This is due to tissue irritation and usually does not cause much concern. Back pain goes away within a few days.

Contraindications

Complications after epidural anesthesia can be minimized if contraindications to its use are strictly observed. These include the following:

• allergies to medications used;
• skin and pustular diseases at the puncture site;
• previous inflammation of the meninges;
• severe scoliosis (curvature of the spine);
• blood clotting disorder;
• tumors of the central and peripheral nervous system;
• with an established spinal hernia at the site of the intended puncture.

The essence of the process

In every medical institution There are some nuances to performing epidural anesthesia. But in general essence the process is the same.

At what stage of labor

There are several options for at what point in labor an injection is given to puncture the epidural space and install a catheter:

• immediately after contractions start– when the cervix is ​​dilated 1-2 cm;
• during active labor– and cervical dilatation of 3-4 cm.

Typically, if the dilation is more than 6 cm, epidural anesthesia is not prescribed, as this leads to a rapid completion of labor with an increased risk of injury to the mother and fetus.

How it goes

To carry out the manipulation, it is important that the woman remains motionless for several minutes. The following locations of body parts are possible:

• on the left side - the legs are tucked as close as possible to oneself, the head is to the sternum;
• in a sitting position - Often a nurse or doctor asks a woman to make her back “cat”, this means arching it as far back as possible, and pressing her head and legs towards her.

The position is chosen at the discretion of the specialist, based on his preferences and experience. The doctor must monitor the woman’s condition throughout the entire period of anesthesia. If necessary, he adds medicine or provides assistance. After the woman is laid down, an “injection in the back” is given. There are six steps involved.

1. Treatment of the injection site. For this purpose, alcohol, solutions based on iodine and other antiseptics are used.
2. Skin anesthesia. A small amount of local anesthetic is injected, causing pain comparable to a regular injection into the upper layers of the skin.
3. Puncture of the epidural space. With a special needle, the doctor pierces the skin and all layers to the required depth; usually the woman at this stage no longer feels any back pain, since local anesthesia was performed.
4. Attaching a syringe. By pulling the piston towards himself, the doctor makes sure that the needle does not enter the vessel.
5. Installation of the conductor. The needle for epidural anesthesia is hollow, it is removed as soon as the guidewire is installed inside it.
6. Securing the catheter. Using an adhesive tape, the catheter is secured to the skin of the back. It does not interfere with walking and lying down, and if necessary, you can attach a syringe to it and add medicine.

After puncture and installation, the birth proceeds according to the usual plan, but with epidural anesthesia. Gradually, the woman begins to notice a decrease in pain.

Since the rate of labor is individual for everyone, the anesthesiologist injects the medicine into the catheter in portions, focusing on the woman in labor’s complaints about emerging pain and taking into account the dilatation of the cervix. This way you can prolong the effect until the birth of the child. If it is necessary to suture ruptures or additional manipulations, no other anesthesia is required - only a portion of the medicine into the epidural catheter.

When the catheter is removed

As soon as the obstetrician-gynecologist and anesthesiologist come to general opinion that no further anesthesia is needed, the drug administration is stopped and the catheter can be removed. Usually it is left for several hours or a day as a “safety net.” The catheter can be removed by a nurse or an anesthesiologist, observing all sterile rules. A cotton ball is applied to the puncture site and secured with an adhesive plaster. The bandage can be removed after a day.

What effect to expect

Epidural anesthesia works during childbirth for every woman with her own characteristics. Some side effects develop more often, others do not notice them at all. If there are adhesions in the epidural space, there is a mechanical barrier to the spread of the drug, and the effect of anesthesia may be incomplete. The dose required for adequate pain relief is determined by the anesthesiologist. He also controls vital functions (breathing, heartbeat, blood pressure) and must correct them in a timely manner.

It is impossible to predict the effect of epidural anesthesia. Every tenth woman has an expected effect that is higher than what is achieved in practice.

There is an opinion that epidural anesthesia is dangerous during childbirth because it increases the frequency of cesarean sections. However, there is no reliable data and research in this area. It should be borne in mind that this anesthesia in most cases is prescribed to women from the group increased risk complications.

Epidural anesthesia is a modern method of labor pain relief. It is performed not only to relieve pain, but also to shorten the duration of labor if there are indications for this (for example, with diabetes, cardiovascular pathology). The advantages of epidural anesthesia are safety for mother and fetus, high efficiency and low number of complications. For a planned caesarean section, preference is given to spinal anesthesia or its combination with epidural, since the latter will not provide the necessary muscle relaxation and decrease in sensitivity.

Reviews: “If I had gone for the third, I would definitely have given birth with an epidural”

It helps well, you don’t feel anything below the belt, it feels like when you lay down your arm, you raise it, but it doesn’t obey, as if it’s not yours, here too, you don’t hear any pain, just when you push, you feel pressure on the bottom. They injected me when I was 4 cm dilated at about 11 p.m., and at 2 p.m. I was already taken to the birthing room, during which time I could at least lie down and even fall asleep), but they don’t add anesthesia to childbirth in order to feel everything, i.e. when you give birth, everything is like everyone else, as soon as the baby is born, they add medicine and then again you don’t feel anything, they cauterize, stitch up, and at least tell me anecdotes)))) I liked it, the main thing is to find a good anesthesiologist. There are no problems with my back. I also learned on the forum that the medicine does not enter the baby’s bloodstream, because it is injected into the epidural space.

Curious, https://deti.mail.ru/id1013295277/

The first birth was without anesthesia, the second was with anesthesia. Heaven and earth. During my first birth, I was so tired of the pain that by the time I started pushing I didn’t care what was happening, such apathy set in, I had no strength at all. During my second birth, the doctor suggested an epidural, and I didn’t refuse. The contractions were still felt, but not painfully, I was even able to sleep during the contractions. By the time she tried, she was cheerful and cheerful. Therefore, if I were going for the third one, I would definitely give birth with an epidural

Smetanina Elizaveta, https://deti.mail.ru/id1007952047/

I gave birth with epidural anesthesia. Although I didn't want to. But my birth was generally strange. Large fetus, and no labor activity. They injected me with some kind of hormonal gel and then contractions began without any breaks. Three hours later, the midwife said that I couldn’t stand it and let’s do anesthesia. After another two hours they did it. I was a little scared that something was being injected into my spine, but that’s okay, it helped a little. And they administered an additional dose every two hours, it seems. And then it all ended with a caesarean section with general anesthesia, because... The epidural no longer had any effect on me by that time. And after everything, I left quite quickly and easily, went to the toilet myself that same day, and on the fifth day I ran home with a receipt on my own responsibility. Before the epidural they said that afterward my legs in the pelvic area might not be very sensitive for a while, but I didn’t experience anything like that.

Knopa, http://www.komarovskiy.net/forum/memberlist.php?mode=viewprofile&u=335&sid=8d1fb629407dcff594ac26d6d0c8209b

I gave birth with an epidural, we discussed it with the doctors in advance, talked with the anesthesiologist, he told me how to lie down correctly and how to behave. I came to the maternity hospital with a 4 cm dilatation, it was tolerable, my stomach was very tense, but it was normal, the doctor even asked me if I could handle it myself, since I could handle the contractions so well, but I refused to give birth myself, I was afraid of what would happen next. The anesthesiologist came, I lay on my side, as if in a ring, and it was impossible to move, even if there was a contraction. I gave the injection, and after 10-15 minutes it worked, in principle everything was fine, but it’s different for everyone, I was shaking, it just stung me, I couldn’t stop, it was like I was frozen. And I didn’t feel any pain at all!

Angel, http://www.komarovskiy.net/forum/memberlist.php?mode=viewprofile&u=215&sid=8d1fb629407dcff594ac26d6d0c8209b

And my friend gave birth to her first with an epidural, and her second without. So she says that with the first one, she couldn’t come to her senses from the medications for several days + the baby had trouble latching on the breast and was generally lethargic (since the effect of the epidural also affects the baby). But with the second one, without medications, she says that she was able to take part in the birth herself, listened to what the midwife told her, and in the end she gave birth without ruptures (unlike the first time). + I felt great myself + the baby ate well and was lively right away. But everyone chooses for themselves what is best for them. I gave birth myself without an epidural and I don’t regret it at all.

Http://www.woman.ru/health/Pregnancy/thread/3840392/

Print

Any woman. As precisely 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. Exactly pain syndrome, which accompanies every birth, 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 individual psychological characteristics personality, as well as the specific circumstances that surround the birth act, can be easily tolerated or, on the contrary, very difficult.

Women for whom the pain of childbirth was 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 concerning pain relief during childbirth, based primarily on common sense and on 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, it is impossible to use the entire range of currently available medications and non-drug methods, since many of them, along with analgesia (pain relief), cause total loss 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 for best effect you can use combinations of them.

Pain relief for childbirth in the presence of severe chronic diseases in a woman is not only desirable, but necessary procedure, because it eases her suffering, relieves emotional stress and fear for one’s own health and the life of the child. Labor anesthesia not only relieves pain, but at the same time interrupts the functioning of adrenaline stimulation that occurs with any pain syndrome. Stopping the production of adrenaline allows you to reduce the load on the heart of a woman giving birth, expand blood vessels and, thereby, ensure good placental blood flow, and therefore better nutrition and oxygen delivery for the 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 effective procedure, which has possible side effects, so you cannot use it as you would like. Childbirth should be anesthetized only when a specific situation requires it, and not according to instructions or some standard averaged for everyone.

Therefore, the solution to the question “Should I perform labor anesthesia?” must be taken separately for each specific situation, based on the condition of the woman and fetus, the presence concomitant pathology and the course of labor. That is, pain relief must be performed if the woman does not tolerate labor pains well, or the child suffers from hypoxia, since in such a situation the benefits of medical manipulation far exceed possible risks side effects. If labor proceeds normally, the woman tolerates contractions calmly, and the child does not suffer from hypoxia, then you can do without anesthesia, since additional risks in the form of possible side effects from the manipulation are not justified. In other words, to make a decision on labor pain relief, you need to take into account the possible risks from not using this manipulation and from its use. The risks are then compared, and an option is selected in which the likelihood of cumulative adverse consequences (psychological, physical, emotional, etc.) for the fetus and woman will be minimal.

Thus, the issue of pain relief in childbirth cannot be approached from a position of faith, trying to classify this manipulation as, figuratively speaking, unconditionally “positive” or “negative”. Indeed, in one situation, pain relief will become positive and the right decision, and in the other - not, since there are no indications for this. Therefore, whether to give pain relief must be decided when labor begins, and the doctor will be able to assess the specific situation and the woman in labor, and make a balanced, sensible, meaningful, and not an emotional decision. And an attempt to decide in advance, before the onset of childbirth, how to relate to pain relief - positively or negatively - is a reflection of the emotional perception of reality and youthful maximalism, when the world is presented in black and white, and all events and actions are either unconditionally good or such definitely bad. In reality, this does not happen, so labor pain relief can be both a blessing and a disaster, like any other medicine. If the medicine is used as directed, it is beneficial, but if it is used without indication, it can cause serious harm to health. The same can be fully applied to pain relief during childbirth.

Therefore, we can draw a simple conclusion that pain relief during childbirth is necessary when there are indications for this on the part of the woman or child. If there are no such indications, then there is no need to anesthetize labor. In other words, the position on pain relief in each specific case should be rational, based on taking into account the risks and condition of the mother and child, and not on an emotional attitude to this manipulation.

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 labor

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 injection 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. The undoubted advantage of nitrous oxide is its ability to be used for pain relief during the period of expulsion of the fetus, that is, the actual birth of the child. Let us remind you that narcotic and non-narcotic analgesics cannot be used during the period of expulsion of the fetus, as this may negatively affect its condition.

During the expulsion period, especially during childbirth with a large fetus, you can use anesthesia with local anesthetics (Novocaine, Lidocaine, Bupivacaine, etc.), which are injected into the area of ​​the pudendal nerve, perineum and vaginal tissue located next to the cervix.

Drug methods of pain relief are currently widely used in obstetric practice in most maternity hospitals in the CIS countries and are quite effective.

The general scheme of using 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 frequency of application of vacuum extractor or obstetric forceps due to the incorrect behavior of a 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;
• Severe somatic pathology (for example, diabetes mellitus, arterial hypertension, etc.);
• Short pain threshold 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 local anesthetics are used for epidural anesthesia:

• 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. Low dose 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.

We all know that the birth process is accompanied by painful sensations for every woman in labor. Moreover, the pain threshold of every woman giving birth is completely different, as is the psychological attitude towards childbirth. Therefore, it is extremely important even before the moment of birth to try to tune in to the positive and believe that everything will be fine. Well, both the doctor who is managing the pregnancy and your loved ones and friends whom you trust can help you overcome the fear of childbirth. If your local gynecologist becomes your obstetrician, then this perfect option For . After all, during pregnancy you will become a team, discuss everything exciting questions and, for so much long time, thoroughly prepare for childbirth. In addition, you will be able to discuss in detail, consider all the options and choose the one that suits you perfectly.

What types of anesthesia are used during childbirth?

1. General anesthesia with medications helps eliminate pain sensitivity in all parts of the body, and also has an effect (usually negative) on consciousness and psychological condition women in labor.
2. General anesthesia, which will provide general anesthesia With artificial ventilation lungs. This method provides a long-term effect, but it is used either for caesarean section or in case of emergency. In this case, the woman in labor is unconscious.
3. Mask anesthesia is a form of anesthesia where an anesthetic is administered through a mask. As a rule, the mask is used during the first stage of labor, when the cervix is ​​dilated and the pain threshold is highest. This anesthesia is used when there is no need to completely turn off the consciousness of the woman in labor, but anesthesia is required.
4. Local anesthesia relieves pain in specific parts of the body. As a rule, an injection with an analgesic is used for local anesthesia.
5. Epidural anesthesia also refers to local method anesthesia, where an anesthetic is injected into the space above the dura mater of the spinal cord. After the injection, Bottom part The body becomes insensitive, but the woman in labor is fully conscious and can talk.
6. Local anesthesia is used after childbirth to relieve pain during suturing of soft tissue. In this case, the anesthetic is injected directly into the area of ​​the body that requires intervention.
7. Intravenous anesthesia is used when performing short-term operations during childbirth: releasing the retained part of the placenta, suturing. This anesthesia lasts only 10-20 minutes, during which the woman in labor sleeps.
8. Intramuscular and intravenous use narcotic analgesics. These medications reduce pain during childbirth and allow you to completely relax between contractions.

When is anesthesia necessary during childbirth?

Drug anesthesia is usually necessary in the following cases:

• the contractions are very painful, the woman in labor behaves restlessly;
• the woman in labor has a very
• premature birth;
• C-section;
• long labor;
• multiple births;
• fetal acid deficiency.

Alternative methods of anesthesia during childbirth

TO alternative methods Anesthesia during childbirth refers to measures that can reduce pain without resorting to painkillers. These include: massage, rational breathing, choosing the correct and comfortable position during childbirth, etc. All these methods of pain relief do not require the intervention of a doctor and are noted as very efficient look pain relief for childbirth, without complications. Well, if suddenly something goes wrong, your doctor will immediately decide on one method or another of drug anesthesia.

In conclusion, we note that today there are many ways to eliminate or muffle pain during childbirth. Therefore, you should not be afraid or worry about this. Tune in to the positive, look forward to the moments of anticipation with your “happiness” and be healthy!

Have an easy birth!

Especially for Ira Romaniy

From Guest

Well, it so happened that I had an unplanned cesarean section, but they gave me an epidural, everything was fine, only my head hurt a little afterwards, but still better than general anesthesia. A strong little baby was born, this is the most important thing)))