Pain relief during childbirth. Methods for isolating separated placenta

Childbirth - 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 medical supplies to reduce the intensity of sensations and prevent possible harm, both for 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 painful sensations the brain generates a response from the body - increased heart rate and breathing, increased blood pressure, 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 techniques relaxation, special poses, water procedures, acupuncture, massage. At correct use the combination of these methods in almost 75% of cases is enough to avoid resorting to medications.

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

In addition, pain relief during childbirth can reduce energy costs and avoid weakening. labor activity 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 diseases, diabetes, 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 pain relief is often used, both for planned and emergency operations caesarean section.

Application 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 deformations of the spine, serious cardiovascular and neurological diseases, 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

Primary requirements,Which are presented for labor pain relief:

– restoration of normal relationships between the cortex cerebral hemispheres and subcortical centers;

– removal of negative emotions, fear;

– complete safety of the method for mother and fetus;

– absence of a depressing effect on labor;

– shortening of the birth act;

– prevention and elimination of spasm of the muscles of the cervix and lower uterine segment;

– sufficient analgesic effect;

– maintaining the consciousness of the woman in labor, her ability to actively participate in the birth act;

- absence harmful influence for lactation and course postpartum period;

– simplicity and accessibility of the pain relief method for obstetric institutions of any type.

But not medicinal methods.

I. Methods that reduce painful stimuli:

1. Physiopsychoprophylaxis.

2. Freedom of movement for the woman in labor.

3. Support during childbirth by medical staff and partners.

4. Abdominal decompression.

II. Methods that activate peripheral receptors:

1. Acupuncture (acupuncture) and acupressure (this is acupuncture without needles

They help relieve pain during contractions, normalize labor and do not have a negative effect on the fetus. The method limits motor activity women in labor and requires careful monitoring, and therefore the session is limited in time.

2. Transcutaneous electrical nerve stimulation (TENS). The Delta-101 device is used, which is a single-channel electrical stimulator that generates asymmetrical bipolar impulses. Two pairs of electrodes in the form of plates with an area of ​​20 cm2 are fixed with adhesive tape in areas of maximum pain on the anterior skin abdominal wall and posteriorly paravertebral in the zone of segmental innervation ThX-LII.

3. Hydrotherapy (warm baths) - the disadvantage of this method is the difficulty of ensuring asepsis, monitoring the nature of the contractile activity of the uterus and the fetus, the moment of effusion amniotic fluid and etc.

4. Massage during childbirth - widely used in a number of countries; various types of massage stimulate skin receptors, increase neural activity of myelin fibers; these stimuli are transmitted faster than painful ones.

III. Methods that block pain impulses:

1. Electroanalgesia - the use of pulsed current allows you to achieve stable vegetative balance and avoid allergic reactions, to obtain the so-called “fixed” stage of therapeutic analgesia, which allows you to maintain consciousness during the birth act, verbal contact with the woman in labor without signs of excitement and transition to the surgical stage of anesthesia. To provide therapeutic analgesia for fatigue during childbirth, Elektronarkon-1 and Lenar devices are used. Before applying the electrodes, 15 minutes before the start of the pulsed current, premedication is carried out with promedol 2% - 1 ml (20 mg), pipolphen 2.5% - 1 ml (25 mg), metacin 0.1% - 1 ml (1 mg). Before applying the electrodes, the skin of the forehead and neck area is wiped with alcohol. Gauze napkins in 8-10 layers (3 by 3 cm), soaked in 0.9% sodium chloride solution, are placed under the electrodes. The cathode (negatively charged electrode) is applied to the forehead, the anode (positively charged electrode) is applied to the mastoid area. The pulse repetition rate is set within 750 Hz, the pulse duration is 0.5 ms. Then slowly increases pulse current to threshold sensations (tingling sensation, crawling “goosebumps”) in the area of ​​the electrodes. Every 15-20 minutes it is necessary to increase the average current value to a frequency of 1000-1500 Hz. The average current value is 0.8-1.2 mA with a session duration of 1.5-2 hours.

2. Hypnosis.

3. Focusing and distraction with the help of music and audio analgesia, i.e. the use of noise (“sound of the sea”, “sound of a falling wave”).

B. Medication methods– non-inhalation anesthesia, inhalation anesthesia, regional and local anesthesia. When prescribing medications for labor pain relief, we must remember that there is not a single sedative or hypnotic, not a single analgesic that does not penetrate the placenta and affect the fetus. To relieve pain during labor, a careful selection of medications and their combination are necessary, taking into account the condition of the particular woman in labor and the fetus. It is also important to take into account the period of birth. Pain during contractions occurs when the cervix dilates 3-4 cm, maximum painful sensations occur when the cervix is ​​dilated by 9-10 cm, but during this period not all drugs can be used due to their effect on the fetus.

Scheme of the sequence of pain relief during childbirth:

1. At the beginning of labor (latent phase of labor, cervical dilatation by 3-4 cm) with less painful contractions, it is used to relieve fear. Tranquilizers: trioxazine 0.6 g or elenium 0.05 g, seduxen 0.005 g.

2. With the development of regular labor and the appearance of severe pain in contractions, the combined or independent use of inhaled or narcotic analgesics in combination with sedatives or antispasmodics is indicated. For easily suggestible women in labor, use non-drug methods of pain relief (acupuncture, electroanalgesia, transcutaneous electrical neurostimulation).

3. In case of ineffectiveness of these methods of labor anesthesia or in the presence of extragenital pathology, gestosis, it is advisable to use long-term epidural (epidural) anesthesia.

The following combinations of drugs can be used:

20-40 mg promedol + 20 mg diphenhydramine + 40 mg no-shpa;

20-40 mg promedol + 10 mg seduxen + 40 mg papaverine;

2 mg Moradol + 10 mg Seduxen + 40 mg No-Spa;

50-100 mg meperidine + 25 mg promethazine (used abroad)

The listed drugs should be administered Intramuscularly to achieve results faster. The action of anesthetics begins 10-20 minutes after administration and lasts 2 hours. Pain relief with analgesics is used in case of severe pain in contractions, when the cervix is ​​opened by 3-4 cm and is stopped 2-3 hours before the expected moment of birth due to possible narcotic fetal depression. After the administration of these drugs, monotony is observed heart rate fetus on CTG, labor continues. A significant reduction in pain is observed in 30-60% of women in labor. Increasing doses of analgesics or reducing the intervals between administrations in order to achieve complete anesthesia can lead to the development of weakness of labor and increased blood loss during childbirth.

Therapeutic obstetric anesthesia indicated in the following situations:

– fatigue during childbirth;

– prolonged labor;

– discoordination of labor;

– pathological preliminary period.

In this case the following is used:

A solution of sodium hydroxybutyrate (GHB) 20% at a rate of 50-65 mg/kg (average 4 g of dry matter), administered intravenously slowly 5-20 minutes after premedication. Sleep occurs 3-8 minutes after administration of the drug and continues for 2.5 hours. The drug is contraindicated in severe forms of gestosis, bradycardia, and arterial hypertension.

Promedol solution 2% 1 ml intramuscularly;

Pipolfen solution 2.5% 1 ml intramuscularly;

Diphenhydramine solution 1% 1 ml intramuscularly.

During therapeutic anesthesia, the intensity of metabolic processes and oxygen consumption by tissues decreases. Decreases after rest metabolic acidosis, metabolic and oxidative processes increase, against the background of which the effect of uterotonic drugs increases. Obstetric anesthesia is prescribed by an obstetrician-gynecologist and performed by an anesthesiologist.

Inhalation methods of labor pain relief:

Nitrous oxide is the most common use of autoanalgesia with a mixture containing 40-60% nitrous oxide and 60-40% oxygen. Nitrous oxide does not accumulate in the body, so it can be used throughout labor. The woman in labor breathes the selected gas mixture during contractions, starting inhalation when she feels a contraction approaching. Continuous inhalation is also possible. The woman in labor is awake, can push, the duration of action of the mixture is short, side effects on the body of the mother and fetus are insignificant. If cyanosis, nausea, or vomiting occurs, nitrous oxide inhalation is stopped and pure oxygen is given.

Trilene (trichlorethylene) gives a more pronounced analgesic effect than nitrous oxide. The best option its use is periodic inhalation in a concentration not exceeding 1.5% by volume. Increasing the concentration or using the drug for more than 3-4 hours can lead to a weakening of labor, tachypnea and cardiac arrhythmia in the woman in labor, due to the cumulative effect of trilene.

Long-term epidural anesthesia (LPA) shown when:

– severe pain and lack of effect from other methods of pain relief;

– discoordination of labor;

– cervical dystocia;

– increased blood pressure during childbirth;

– gestosis;

– in pregnant women suffering from severe diseases of the heart and respiratory system.

Only an anesthesiologist performs DPA. VPA begins when regular labor is established and the cervix is ​​dilated by 3-4 cm. The method can be used throughout labor. The anesthetics used are 2% lidocaine solution, 2.5%; trimecaine solution, 0.25 0.5% bupivacaine solution.

Pudendal anesthesia carried out for pain relief in the second stage of labor during overlay operations obstetric forceps and a vacuum extractor, when switching off consciousness is not required when cutting the perineum and restoring its integrity. To ensure blockade of the pudendal nerve, located 0.5-1 cm proximal to the spina ischii, you need to inject 10 ml of 0.5-1.0% novocaine solution or 10 ml of 1% lidocaine into the ischiorectal space on each side (or through perineum, or through side walls vagina).

Most often, pain relief is carried out with a combination of drugs from several groups, for example:

• narcotic analgesic (promedol 20-40 mg) + tranquilizer and/or antipsychotic (seduxen 10 mg) + myotropic antispasmodic (papaverine 20-40 mg or no-spa 40 mg);
• narcotic analgesic (moradol 1-2 mg) + tranquilizer and/or neuroleptic (seduxen 10 mg) + myotropic antispasmodic (no-spa 40 mg) + general anesthetic;
• non-narcotic analgesic (tramal 100 mg) + antihistamine(diphenhydramine 20 mg) + myotropic antispasmodic (no-spa 40 mg) + anticholinergic (methacin 1 mg) - for cervical rigidity.

The feasibility of combined administration of drugs is justified by the different mechanisms of action of these groups.

1. Narcotic analgesics provide blockade of nociceptive afferentation. But due to the possibility of side effects, their dose is limited and it is necessary to potentiate the effect with other drugs.

2. Tranquilizers and antipsychotics increase the threshold of pain tolerance and block the autonomic components of the pain reaction.

3. Antispasmodics promote faster opening of the cervix.

4. General anesthetics have a hypnotic and analgesic effect, increasing the threshold of pain tolerance.

Drugs- most effective drugs systemic action for pain relief during labor. They eliminate pain by activating “opiate” receptors, which under physiological conditions respond to endogenous substances - endorphins. At intravenous administration their influence is carried out through μ1 receptors located in the cerebral cortex, in the thalamus, in the periaqueductal gray matter. When administered epidurally, they affect κ receptors localized in the substantia gelatinosa spinal cord, blocking the conduction of pain impulses from the uterus to the structures of the central nervous system.

Almost all drugs in this group have unwanted side effects side effects, first of all - respiratory depression in the mother and fetus. At intramuscular injection this complication is most pronounced 2-3 hours after administration, with intravenous administration - within 1 hour. In addition, with intramuscular administration, the effective dose is reduced by 1/3 - 1/2 and the effect begins after 40-50 minutes, in contrast from 5-10 minutes with intravenous administration. These points make the intravenous route of administration more preferable.

Another side effect of narcotic analgesics is peripheral vasodilation, causing orthostatic hypotension when trying to sit or stand and, in some cases, arrhythmia.

In 50% of cases, when using opioids, nausea and vomiting may occur due to stimulation of trigger zone chemoreceptors medulla oblongata. Opioids also inhibit intestinal motility and slow the digestion of food, which increases the risk of aspiration during general anesthesia.

Prescribing drugs during latency or at the beginning active phase labor may weaken uterine contractions. However, with established labor, they can correct discoordination of uterine contractions by reducing the secretion of adrenaline in response to pain relief.

Morphine It is used for pain relief during labor to a limited extent due to the pronounced depression of the respiratory center of newborns and the long duration of action (about 6 hours). The average dosage is 15-20 mg for intramuscular administration and 10 mg for intravenous administration.

Safer is the use of promedol (at a dose of 10 mg) with a duration of action of 1-1.5 hours with intravenous administration and 2 hours with intramuscular administration. 2 minutes after intravenous administration and within 1-5 hours of the subsequent period, a concentration equal to that in the mother’s blood is detected in the umbilical cord blood. In addition, repeated administrations may be accompanied by a cumulative effect. Promedol also has an antispasmodic effect, promoting the dilation of the cervix.

Fentanyl exceeds the analgesic effect of morphine by 100-400 times, its duration of action is about 40 minutes. He doesn't oppress contractile activity uterus The main side effect is a potentially high risk of respiratory depression. It enters the fetal blood within 1 minute, and after 5 minutes its maximum concentration is determined there.

The most common intravenous route is 0.1 mg fentanyl diluted in 20 ml saline (slowly). With this method of use, the drug is effective for correcting incoordination of labor and promotes rapid dilatation of the cervix. If necessary, it is possible to re-administer the drug after 3-4 hours or potentiate its effect with the antipsychotic droperidol (2.5 - 5 mg).

Opioid agonists-antagonists: butorphanol(stadol, moradol) and pentazocine(lexir, fortral) are safer than agonists, because they have a “ceiling” of respiratory depression. Large repeated doses maintain the analgesic effect without increasing the depressant effect. They have a pronounced sedative effect. The route of administration is either intravenous - 1 mg of butorphanol, or intramuscularly (1-2 mg). The analgesic effect occurs within 15-20 minutes and lasts 12 hours. The dose of pentazocine is 20-30 mg IM or 10-20 mg IV. This drug is used with caution for cardiovascular pathology - it can cause increased blood pressure and tachycardia.

Antagonists of narcotic analgesics are naloxone. In case of drug overdose, it is used in an initial dose of 0.4 mg IV for adults and 0.01 mg/kg IV or IM for newborns. The effect lasts up to 1-2 hours. Given its relatively short action, careful monitoring of the mother and newborn is necessary and repeated administration of the drug if necessary. With intramuscular administration of 0.2 mg naloxone, the duration of action is 48 hours.

Neuroleptics and tranquilizers are used during childbirth to relieve agitation, reduce nausea and vomiting. Benzodiazepines(Relanium, Sibazon, Seduxen, Midazolam) in combination with narcotic analgesics (ataralgesia) are indicated in cases of severe anxiety and agitation at a dose of 2.5 mg IM. The mechanism of action of the drugs is associated with an increase in the activity of endogenous γ-aminobutyric acid. Diazepam quickly penetrates the placental barrier, its concentration in the fetal blood exceeds its concentration in the maternal blood. The drug is characterized by a slow half-life in the body of the mother and fetus with the frequent development of side effects:

• limiting fetal heart rate variability;
• reduction muscle tone newborn;
• long-term violation of thermoregulation;
• respiratory depression; - hyperbilirubinemia of the newborn.

The latter develops against the background of impaired binding of bilirubin to albumin. It is more appropriate to prescribe a short-acting benzodiazepine, midazolam, whose half-life is 2 hours shorter and the metabolites are not active. Midazolam, in addition, has a very low concentration distribution coefficient in the blood of mother and fetus (0.15).

Droperidol has an antiemetic and anticonvulsant effect, reduces body temperature, improves peripheral circulation due to adrenergic blocking action. Drugs in this group are especially indicated for the delivery of women with severe forms of gestosis. Droperidol is administered at a dose of 5-7.5 mg every 2-2.5 hours. It has a potentiating effect in relation to narcotic analgesics (especially fentanyl), preventing the development of rigidity respiratory muscles when using the latter.

Tramal is an effective analgesic, which does not have a negative effect on contractile function uterus and fetal condition. 50-100 mg is administered intramuscularly.

Has a powerful analgesic effect ketamine(ketalar, calypsol), a dissociative drug, an antagonist of excitatory amino acids. The drug penetrates the placental barrier well, but at a dose of up to 1.5 mg/kg does not cause respiratory depression in a newborn. In doses up to 8 mg/kg it does not inhibit uterine contractility. The ability of ketamine to cause an increase in blood pressure and an increase in heart rate limits its use in women with gestosis and arterial hypertension. In 45% of cases it causes hallucinations and psychosis, so it is advisable to pre-administer 5 mg of seduxen. The drug causes an amnestic effect, so its use is not advisable if a woman wants to remember the process of childbirth.

According to various authors, recommended dosages range from 0.25-0.5 mg/kg IV every 30 minutes and 50 mg per hour (L. P. Chepky, R. A. Tkachenko, 2000) to 0.2-0. 4 mg/kg IV every 5 minutes up to 100 mg in 30 minutes (M. Morland, 1998). Lantsev E. A. and Moiseev V. N. recommend administering ketamine intravenously at a dose of 0.02-0.03 mg/kg/min.

α-adrenergic receptor agonist - clonidine used for pain relief during labor in women in labor with normal labor and good fetal condition, with moderate and severe preeclampsia. IV infusion is carried out for 90-120 minutes with individual selection of the injection rate, at which blood pressure decreases by 15-20 mmHg. Art. - 0.0005-0.001 mg/kg/h. The analgesic effect occurs within 10-15 minutes and continues for 3-4 hours after the end of the infusion. Against the background of clonidine infusion, a narcotic analgesic (promedol) is administered in a dosage reduced by 50%.

Used for pain relief during childbirth non-narcotic analgesics- cyclooxygenase inhibitors - analgin, baralgin. In terms of analgesic effect, these drugs are inferior to opioids, but do not have such undesirable side effects as euphoria, respiratory depression, and drug dependence. Non-narcotic analgesics most often used in combination with other analgesics and sedatives.

Lysenkov S.P., Myasnikova V.V., Ponomarev V.V.

Emergency conditions and anesthesia in obstetrics. Clinical pathophysiology and pharmacotherapy

How can doctors help?

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

Endotracheal anesthesia. General anesthesia is performed with artificial ventilation lungs. The method provides a long-lasting effect. In this case, a whole combination of drugs is used, and the anesthetic itself enters through the trachea into the lungs. This anesthesia is used for caesarean section and in emergency cases.

Inhalation (mask) anesthesia. One form of pain relief is the inhalational anesthetic nitrous oxide, which the mother inhales through a respirator-like mask. The mask is used during the first stage of labor, when the cervix dilates.

Local anesthesia. When local anesthesia is used, only certain parts of the body are deprived of pain sensitivity.

Epidural anesthesia. One of the forms of local anesthesia, which is provided by the introduction of a solution local anesthetic into the space above the dura mater of the spinal cord. These days, such anesthesia is widely used during childbirth. After the injection, the lower part of the body becomes insensitive. The nerves that carry pain signals to the brain from the uterus and cervix pass through the lower spine, where the anesthetic is injected. During the action of this type of anesthesia, the woman is fully conscious and can talk with others.

Local anesthesia. This method, which deprives any area of ​​skin of sensation, is often used after childbirth for pain relief during suturing of soft tissue. In this case, the anesthetic is administered directly instead of intervention.

Intravenous anesthesia. Medicine(anesthetic) is injected into a vein. The woman then falls asleep for a short time (10-20 minutes). Used when performing short-term surgical interventions during childbirth, for example, when releasing retained parts of the placenta, when applying obstetric forceps.

Use of narcotic analgesics. Narcotic analgesics are administered intramuscularly or intravenously, which reduces pain sensitivity during childbirth, and the woman is able to fully relax in the intervals between contractions.

Medical indications for pain relief

• very painful contractions, restless behavior of the woman (it must be borne in mind that, according to statistics, 10% of women in labor experience mild pain, which does not require treatment, 65% - moderate pain and 25% - severe pain syndrome which requires the use of medications);
• large fruit;
• long lasting labor;
• premature birth;
• weakness of labor (shortening and weakening of contractions, slowing of cervical dilatation, labor stimulation with oxytocin to intensify contractions);
• Caesarean section operation;
• multiple births;
• hypoxia (oxygen deficiency) of the fetus - when pain relief is used, the likelihood of its occurrence decreases;
• necessity surgical interventions during childbirth - application of forceps, manual removal of the placenta. In these situations it is more often used intravenous anesthesia. The same method is used immediately after childbirth at the time of restoration of the birth canal.

Anesthesia without drugs

Massage

Pain relieving massage- this is an effect on certain points at which nerves emerge on the surface of the body. Targeting these nerves causes some pain and thus distracts from the pain of labor. Classic relaxing massage - stroking the back and collar area. This massage is used both during contractions and in between them.

Without exception, all expectant mothers experience some anxiety in anticipation of childbirth. One of the reasons for such anxiety is the well-known idea that contractions are painful. Is it possible to influence the pain? And is the woman herself able to make her childbirth as easy and painless as possible? In this section we will talk in detail about all methods of pain relief, their pros and cons.

Relaxation- relaxation methods that help you endure contractions more easily and get proper rest in the periods between them.

Rational breathing- There are several breathing techniques that can help you endure contractions more easily. When used skillfully the right type breathing during a contraction we achieve a slight, pleasant dizziness. It is at this moment that the release of endorphins occurs (these hormones in large quantities produced during childbirth; endorphins have an analgesic and tonic effect and are released into the blood during contractions).

Active behavior during childbirth- it’s good if the expectant mother knows that during a normal, uncomplicated birth, you can take different positions and choose the most comfortable one, in which this particular woman in labor can more easily endure contractions. Active behavior also refers to movement, walking, rocking, bending and various poses designed to relieve stress on the spine. Changing position is the first and most natural desire in case of any discomfort.

Hydrotherapy- using water to relieve pain during contractions. IN different situations During contractions, you can still use the bath or shower.

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

The right to choose

To use non-drug methods of pain relief, you need to know about these methods and have practical skills. A course of psychoprophylactic preparation for childbirth can be taken at a antenatal clinic or at a school for pregnant women, where you will be taught proper breathing during childbirth, shown rational postures, and helped to master relaxation methods.

Postures, breathing, pain-relieving massage, hydrotherapy during normal labor can be used with almost no restrictions. In the maternity hospital, you need to consult a doctor about this. In some situations (with breech presentation of the fetus, with premature birth) the doctor may limit the freedom of movement of the woman in labor and strongly recommend to the expectant mother lie. But breathing and relaxation skills will be useful to you in any case.

The doctor will definitely prescribe medication if available. medical indications depending on the condition of the mother and child at the time of birth.

When using drug anesthesia, the anesthesiologist first conducts a conversation with the woman, talking about the essence of the method that is planned to be used, as well as its possible negative consequences. After this, the woman signs a consent to use one or another method of pain relief. It must be said that in emergency situations, when the life of a woman or child is in serious danger, this procedure is neglected.

Separately, it is necessary to say about the contract for childbirth. When concluding an agreement in which it is stated that a particular method of drug pain relief will be used at the request of the woman, drug pain relief is used when the woman in labor requests. In these cases, epidural anesthesia is more often used.

If in the situation with the presence of medical indications and with the contract for childbirth everything is more or less clear, then in other cases the use of medicinal methods at the request of the woman is a controversial issue and in each medical institution solved differently.

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. Used much less frequently during childbirth general anesthesia 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 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 of 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 are located. That is, the procedure is based on nerve blockade. This type of pain relief is usually used for natural delivery in order to facilitate 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;
• 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 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 effects in the newborn, for example: drowsiness, weakness, depression respiratory function, reluctance to take the breast. But these consequences pass quite quickly, since medicine, 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.

You need to understand that anesthesia blocks pain, but this effect does not come 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 inject into the mother’s body medications to stimulate the birth process, in some cases, use obstetric forceps or perform a caesarean section.

Also, after using anesthesia during childbirth, 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 birth 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

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