Pain relief during childbirth. Special types of PDA. Pain relief for childbirth: obstetrics, new methods

Sometimes, when passing by a ward where women in labor are waiting in the wings, I see the following picture: two women of about the same age and build, only one is writhing in agony, burning her husband and swearing that he will never see any more sex, and the second is lying quietly, reads a book, only occasionally being distracted by unpleasant contractions. I understand that the first lady is most likely a first-time mother, and for the second everything is already familiar and the birth canal has long been ready to bring another person into the world.

However, most often childbirth is a painful process that requires pain relief. And perhaps I will surprise someone, but federal law“On the Rights of Patients” there is a 12th section, which says that you have the right to pain relief for any pain. Including pain that occurs during childbirth. Yes, yes, in a hospital room you can take a bedpan and loudly hit the wall with it, shouting: “I want anesthesia with an anesthesiologist!!!” And Santa Claus... i.e. the anesthesiologist must appear.

The safest anesthesia

Humanity has come up with a lot of drugs for pain relief. But we understand that some effective methods pain medications may be toxic to the fetus. But all the power of medicine is aimed at birth healthy baby, under no circumstances should harm be caused to either the mother or the unborn child.

In this regard, the maximum safe method relief from pain - central blockade, including its types: spinal, caudal and the most common - epidural anesthesia.

The first two anesthesia are effective, but they are administered once and have a limited duration of action. But epidural anesthesia can work long time, since a woman is placed a catheter in the epidural space and painkillers can be administered through it for as long as desired (local anesthetics and narcotic drugs are more often administered).

What is the difficulty of carrying out

Many people think that installing an epidural catheter is aerobatics, because it’s poking around somewhere near the spinal cord! I'll tell you a secret: in fact, placing a catheter in lumbar region spine is quite a routine procedure, even interns perform it. There really are difficulties: people are different, there are many variations in the anatomy of the spine, and subcutaneous fat often hides structures - but still installing a catheter is not so difficult, honestly.

Another thing is to determine what concentration of the drug to administer, how much to administer, when to stop - here the qualifications of the anesthesiologist are already important! The main tenet of medicine is “Do no harm!” during childbirth it is doubly important, because the doctor is responsible for two lives. It happens that an incompetent specialist injects so much of the drug and such a concentration that the woman does not feel anything at all: no pain, no contractions - the muscles become stiff, the baby stands up like a stake in the birth canal. This is really a problem, and it’s good if a caesarean section saves the situation...

“Pitfalls” and how to insure yourself

Now let's look at this procedure from the anesthesiologist's perspective. Night. Maternity hospital A woman arrives, labor is in full swing, the woman requires anesthesia. A tired angry doctor comes. What kind of birth? What kind of pain relief? He still has to fight for appendicitis, and an ambulance with flashing lights is flying down the street, transporting a traffic injury. So what - will it fully relieve pain? Yes, he doesn’t even need money, he’ll pay himself, as long as they leave behind. But you need to sit next to the woman for 8–12 hours; natural childbirth is not a caesarean section for half an hour of work.

And it’s good if the specialist performs caudal anesthesia (single injection local anesthetic in the tailbone), but not everyone knows this method. So it’s no wonder if he prescribes a banal analgin. Well, what - cheap and cheerful. Did you prescribe anesthesia? Appointed! Will it be effective? Of course not! But according to the law, he completed his manipulation and will continue, cursing, to undergo emergency surgical interventions.

Therefore, dear women, do not download your rights when you are already in labor. You can ask, but you shouldn’t demand and conflict. What if some intern comes and learns pain management from you? The best thing you can do is to find a good, experienced anesthesiologist a month before giving birth and come to an agreement.

Just remember that anesthesiologists don’t drink, because they can go into a tailspin, they don’t eat sweets, because they understand that sugar is poison, and they don’t smell flowers, because they’ve snorted fluorotane in their lives to the point of cirrhosis of the liver. Well, that’s me, by the way.

Be healthy!

Vladimir Shpinev

Photo istockphoto.com

Unique. The severity of pain that a mother feels during the birth of a child varies from person to person. different women. This depends on many factors, such as the size and position of the fetus, the strength of contractions, and pain tolerance. For some women, use is enough to relieve pain. correct breathing and relaxation techniques, others may need anesthesia for childbirth.

May relieve pain during childbirth different kinds anesthesia. Epidural and spinal anesthesia are the most commonly used, but other pain relief options exist. Before giving birth, a woman needs to carefully ask her doctors about possible elimination or pain relief so you can make the best choices for you and your baby.

What are the indications for pain relief during natural childbirth?

A woman's desire is a sufficient indication for pain relief during childbirth. Sometimes analgesia is indicated for expectant mothers who have certain risk factors, even in the absence of such a desire. These situations are known to gynecologists, who in such cases refer women for consultation with an anesthesiologist.

What types of anesthesia can be used for natural childbirth?

As already indicated, any childbirth, if the woman wishes, can be anesthetized. However, there are contraindications to many methods.

During natural birth There are two main types of painkillers used:

• Analgesics- These are drugs that help relieve pain. These drugs include opioids (such as fentanyl or morphine). Although they can relieve pain, these remedies cannot completely relieve a woman in labor. In addition, they also reduce anxiety and help a woman relax. Analgesics should not be given before the baby is born because they can slow down the baby's reflexes and breathing.
• Anesthetics- these are drugs that block most sensations, including pain. Depending on how anesthetics are used, local, regional and general anesthesia are distinguished.

Benefits and possible consequences of using anesthesia during childbirth

Is childbirth possible without anesthesia?

Is it worth giving birth with anesthesia?

Every woman during pregnancy begins to think about whether it is worth using anesthesia during childbirth. Many of them think that natural childbirth is the only correct way, however, they often change their minds during very painful contractions. But there are safe and effective techniques pain relief that will help expectant mothers focus on pushing, and not on the pain from the baby moving through the birth canal. Every woman should remember that the decision to undergo anesthesia during childbirth belongs only to her.

Taras Nevelichuk, anesthesiologist, specially for the site site

Useful video

Pregnancy is wonderful. By the way, have you already managed to choose a name for the child? I hope so, but childbirth is ahead and you should think carefully about how to give birth.

If the situation is such that give birth naturally a woman cannot general anesthesia– mandatory medical procedure.

However, some women who have no obvious reason still insist on anesthesia during childbirth. According to statistics, only half of expectant mothers give birth without painkillers.

What types of anesthesia are used during pregnancy? Can anesthesia harm the health of the mother and/or child? We will try to give answers to all questions. But first, let's understand the terminology.

Anesthetics- these are substances that cause partial or complete loss sensitivity. The most popular anesthetics used during childbirth: general anesthesia, local anesthesia, epidural anesthesia, pudendal and spinal blockade.

General (full) anesthesia during childbirth

Several decades ago, when the slightest complications The doctor used general anesthesia. As a result of receiving general anesthesia, the body and brain enter a state of short but deep sleep.

Classic general anesthesia is administered in three ways: by mask (inhalation in Airways), intravenously or combined (in case of heavy operations on the heart or kidneys).

Due to its accelerated action, general anesthesia is used mainly for surgical childbirth and caesarean section, and also when for local anesthesia there is no time left because physiological characteristics the mother's body (curved spine, previous injuries). The duration of anesthesia is no more than 10 minutes. General anesthesia is considered relatively in a safe way pain relief, but is rarely used during childbirth.

Childbirth under general anesthesia must be carried out on an empty stomach, in order to avoid aspiration (reflux of food and liquid into the lungs, which can subsequently lead to the development of pneumonia). Performed under general anesthesia artificial ventilation lungs.

After the woman in labor regains consciousness, there is a feeling of disorientation, anxiety, sore throat as a consequence of the insertion of an endotracheal tube, nausea and vomiting, intestinal upset, and increased urination.

The anesthesia will be partially transferred to the baby, so the anesthesiologist tries to bring the baby out of the sleep state as close as possible to the time of birth, thereby reducing the effect of anesthesia on the baby. In order to avoid complications, delivery is performed on the left side with additional oxygen therapy.

When anesthesia enters a newborn's body, there is a high risk of central depression. nervous system, which is especially dangerous if the baby is premature or post-term.

Now you know in which cases it is possible and in which it is better to refuse general anesthesia. In the next article I will talk about.

Despite the constant development of medicine, anesthesia during childbirth is still not a mandatory procedure. Much depends on the features pain threshold women in labor: if she can endure a natural birth without the use of painkillers, they are not used unless there are indications for this. Used much less frequently during childbirth general anesthesia drugs that immerse a person in deep dream, 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 anesthesia is considered relatively safe for both the mother and her child, and makes childbirth more comfortable for the woman.

Types of pain relief during natural childbirth

There are non-drug (natural) and medicinal methods pain relief. Natural Methods 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. 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;
• heavy somatic diseases eg: diabetes mellitus.

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;
• state of cardio-vascular system 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 convulsive syndrome, which, although rare, can cause the death of a woman in labor;
• the drug begins to act only after 20 minutes, so with rapid and emergency childbirth the use of epidural anesthesia is not possible;
• if the drug is administered through arachnoid membrane, then 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 administered below the limit spinal cord into the space where it is localized cerebrospinal fluid. 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 effects in the newborn, for example: drowsiness, weakness, depression respiratory function, reluctance to take the breast. But these consequences pass rather quickly, since the drug used for pain relief gradually leaves the child’s body. Thus, the consequences of drug pain relief labor activity caused by the penetration of anesthetic drugs through the placenta to the fetus.

You need to understand that anesthesia blocks painful sensations, but this effect is not complete without unpleasant consequences. For a woman in labor, the introduction of anesthetics into the body affects the activity of the uterus, that is, the process of natural dilation of the cervix becomes slower. This means that the duration of labor may increase.

Decreased activity of the uterus means that contractions are suppressed and may stop altogether. In this case, specialists will be forced to introduce into the mother’s body medications for stimulation birth process, in some cases - use obstetric forceps or perform a caesarean section.

Also, after the use of anesthesia during childbirth, such side effects, such as headache, dizziness, heaviness in the limbs. With epidural and spinal anesthesia, blood pressure decreases. In general, the analgesic effect is achieved successfully with all types of anesthesia, but a feeling of pressure in the lower abdomen may persist.

IN developed countries More than 70% of women resort to pain relief during childbirth. Increasingly, women insist on pain relief during labor to minimize the pain of contractions, despite the fact that childbirth is a natural process that can occur without outside intervention. During natural childbirth, the body produces a significant amount of endorphins - hormones that provide physiological anesthesia, promote emotional uplift, and reduce feelings of pain and fear.

Useful video about epidural anesthesia during childbirth

I like!

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

Is there pain relief during childbirth?

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

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

Pain relief during childbirth - pros and cons

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

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

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

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

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

Types of pain relief during childbirth

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

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

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

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

Non-drug methods of labor pain relief

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

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

Medicinal methods of pain relief during childbirth

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

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

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

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

Modern methods of labor pain relief

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

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

Pain relief during childbirth - epidural anesthesia

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

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

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

Intravenous pain relief during childbirth

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

Natural pain relief during childbirth

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

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

How to prepare for childbirth without pain?

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

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

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