What kind of anesthesia is best for childbirth. Methods of pain relief in childbirth: drug and non-drug - video. Medical pain relief during childbirth

It is clear that during childbirth the child must somehow leave the mother's womb. The uterus contracts, and the baby gradually comes out through the opened cervix and vagina. Pain during childbirth can occur due to stretching of the cervix, vagina, perineum, compression and rupture of soft tissues. Some women in labor suffer so much that their heart and breathing can be disturbed. In addition, prolonged pain often leads to premature fatigue, cessation of uterine contractions, hypoxia (lack of oxygen) of the fetus.

The question of whether it is necessary to resort to anesthesia for childbirth, each woman must decide for herself. Modern methods of anesthesia ( drug anesthesia, epidural anesthesia, etc.) are considered quite safe for both mother and child, and make the process of giving birth to a baby more comfortable.

However, many experts oppose labor pain relief. First, there is a risk (albeit small) side effects. Secondly, the natural course of childbirth is disturbed (the administration of drugs can slow down or weaken labor activity).

On the other hand, the threshold for pain sensitivity is different for everyone. Under the influence of "uncontrollable" prolonged pain in some women in labor, blood pressure may increase, the pulse becomes more frequent, and weakness in labor occurs. It harms the health of mother and child. In such cases, it is wiser to resort to anesthesia than to suffer unbearable pain.

However, it is best to prepare for childbirth in advance. With the help of the so-called psychoprophylactic preparation, it is possible to increase the threshold of pain sensitivity and facilitate the course of childbirth. It is believed that a woman who is psychologically ready for childbirth, who is well aware of all the stages of the birth process, who knows how to breathe properly, who knows the methods of self-elimination of pain and is focused on the result, may well do without anesthesia. In such cases, childbirth is not associated with "pain", but with the expectation of a miracle, great happiness - an early meeting with the most beloved and wonderful person that you have been waiting for so long.

There are several ways to reduce the pain of childbirth.

Psychological preparation

Birth pain is exacerbated by ignorance. Therefore, learn more about the birth process. Relevant information can be obtained from pregnancy schools, antenatal clinics or from specialized literature. Women who are psychologically ready for childbirth find it incomparably easier to give birth.

childbirth in water

A warm bath relaxes, distracts, has a good effect on labor and even improves the blood supply to the fetus. Staying in warm water can significantly reduce the pain of a woman in labor during the first stage of labor, when the cervix dilates. However, before filling the bath, seriously weigh the pros and cons of this type of childbirth.

Reflexology

Some clinics use acupuncture for pain relief. It relieves pain during labor pains and normalizes labor activity. In Russia, this method is not yet very popular, most likely due to the lack of professional acupuncturists.

Medication pain relief

They tried to anesthetize childbirth many years ago. For this, drugs were used, such as morphine, tincture of opium, and nitrous oxide. The main disadvantage of these methods is negative impact narcotic painkillers on the fetus. In particular, they can cause a weakening of breathing in an infant.

In modern obstetrics, of narcotic analgesics, promedol is most often used. It has a good analgesic effect and less than other drugs affect the child.

Often, due to painful prolonged contractions, women in labor spend sleepless night. Accumulated fatigue can interfere at the most crucial moment. In such cases, drugs that induce sleep are prescribed.

Before giving a woman painkillers, be sure to consult with an obstetrician-gynecologist and anesthesiologist.

Epidural anesthesia

This is a relatively young method of anesthesia. The doctor places a thin needle between the vertebrae and injects an anesthetic under hard shell spinal cord. In this case, painkillers are used local action: lidocaine, marcaine, ropelocaine and others. After the introduction of the drug, any sensitivity below the level of its administration is temporarily blocked.

Epidural anesthesia has its drawbacks. On the one hand, it provides good pain relief, but on the other hand, a woman cannot push effectively. Therefore, immediately before the birth of the child, epidural anesthesia is suspended. Besides, in rare cases epidural anesthesia can cause headaches and back pain that haunt a woman for quite long time after childbirth.

Sometimes epidurals are needed medical indications, for example, with the wrong position of the fetus, the birth of twins, as well as with some complications of pregnancy or childbirth.

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

However, the use of these drinks brought only minor relief, accompanied by serious adverse events, primarily drowsiness. In 1847, the English professor Simpson first applied ether anesthesia for labor pain relief.

Physiological basis of pain during childbirth. Contractions are usually accompanied by pain. varying degrees expressiveness. Many factors affect the pain in childbirth, their intensity, truly painless childbirth are rare. Pain during contractions is due to:

1. Opening the cervix.

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

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

4. Resistance of the pelvic floor muscles.

5. Accumulation of products of tissue metabolism, formed during prolonged uterine contractions and temporary disturbances in the blood supply to the uterus.

The intensity of pain depends on individual characteristics the threshold of pain sensitivity, the emotional mood of a woman and her attitude to the birth of a child. It is important not to be afraid of childbirth and labor pain. Nature has taken care to supply the woman with the painkillers she needs for childbirth. Among the hormones produced during childbirth, a woman's body secretes a large number of hormones of joy and pleasure - endorphins. These hormones help a woman to relax, relieve pain, give a feeling of emotional uplift. However, the mechanism for the production of these hormones is very fragile. If a woman experiences fear during childbirth, then a reflex suppression of the production of endorphins occurs and a significant amount of adrenaline (a stress hormone produced in the adrenal glands) is released into the blood. In response to the release of adrenaline, convulsive muscle tension occurs (as an adaptive form of response to fear), which leads to squeezing of muscle vessels and impaired blood supply to the muscles. Violation of the blood supply and muscle tension irritates the receptors of the uterus, which we feel as pain.

The effect of pain on the course of childbirth. The uterus has a complex system of receptors. There is a relationship between painful stimulation of the uterine receptors and the accumulation of the hormone of labor (oxytocin) in the pituitary gland. Facts set reflex influences various pain stimuli on the motor function of the uterus.

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

The main task of pain relief in childbirth is to try to break this vicious circle and do not bring the muscles of the uterus to overexertion. Many women prepared for childbirth manage to cope with this task on their own, without resorting to medication due to psychological stability and various psychotherapeutic techniques (relaxation, breathing, massage, water procedures). Other women simply need to be given the appropriate medical care easing the feeling of pain or dulling the reaction nervous system for pain. If this is not done on time, then overstressing the muscles of the uterus can lead to negative consequences for mother and fetus.

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

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

2. Suppress negative emotions, a sense of fear, while not disturbing the consciousness of the woman in labor for a long period.

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

4. Do not have a negative impact on labor activity, the ability of a woman to participate in childbirth and the course of the postpartum period.

5. Do not call drug addiction at the required course of taking the drug.

6. Be available for use in any obstetric facility.

The following groups of medications are used to anesthetize childbirth:

1. Antispasmodics - medicinal substances that reduce the tone and contractile activity of smooth muscles and blood vessels. Back in 1923, Academician A.P. Nikolaev suggested using an antispasmodic for pain relief during childbirth. Usually use the following drugs: DROTAVERIN (NO-SHPA), PAPAVERIN, BUSCOPAN. The appointment of antispasmodics is shown:

Women in labor who have not undergone sufficient psychoprophylactic training, showing signs of weakness, imbalance of the nervous system, too young and old women. In such cases, antispasmodics are used at the beginning of the active phase of the first stage of labor (at 2-3 cm of cervical dilatation) in order to prevent labor pains and only partially to eliminate them. It is important to wait for regular steady contractions, otherwise this process of childbirth may stop.

Women in childbirth, as an independent analgesic for already developed pain, or in combination with other means, with the opening of the cervix by 4 cm or more.

With the development of labor activity, antispasmodics do not affect the strength and frequency of contractions, do not violate the consciousness of the woman in labor and her ability to act. Antispasmodics well help to cope with the opening of the cervix, relieve spasm smooth muscle, reduce the duration of the first stage of labor. They do not have a negative effect on the fetus. From side effects there is a fall blood pressure, nausea, dizziness, weakness. However, these drugs have an analgesic effect is not pronounced.

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

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

In addition to pain relief, tramadol has a sedative effect, which is useful in case of a pronounced emotional component of labor pain. However, the sedative effect of tramadol allows it to be attributed to an intermediate position between analgesics and drugs. Respiratory depression in parturient women with the use of tramadol, as a rule, does not occur, rarely causes short-term dizziness, blurred vision, impaired perception, nausea, vomiting and itching. It is forbidden to use these drugs in late toxicosis of pregnancy (preeclampsia). However, the use of these drugs is limited because repeated injections they affect the nervous system of the fetus, cause a slowdown in the breathing of the newborn, violate its heartbeat. Premature newborns are especially sensitive to these drugs.

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

Diazepam has no analgesic effect, so it is prescribed in combination with narcotic or non-narcotic analgesics. Diazepam is able to accelerate the opening of the cervix, helps to remove anxiety state in a number of women in childbirth. However, it easily penetrates into the blood of the fetus, and therefore causes respiratory failure, a decrease in blood pressure and body temperature, and sometimes signs of neurological depression in newborns.

Droperidol causes a state of neurolepsy (calmness, indifference and alienation), has a strong antiemetic effect. In obstetric practice has received significant distribution. However, one should remember about side effects droperidol: it causes incoordination and weakness in the mother, respiratory depression and pressure drop in the newborn. With high blood pressure in a woman in labor, droperidol is combined with analgesics.

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

The mechanism of action of these drugs is based on interaction with opiate receptors. They are believed to be safe for both mother and child. They act soothingly, relaxes, while maintaining consciousness. They have an analgesic, antispasmodic effect, promote the opening of the cervix, contribute to the correction of uncoordinated uterine contractions.

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

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

5.​ Inhalation anesthesia for childbirth NITRIC OXIDE, TRILEN, PENTRAN

These methods of anesthesia have been used for a very long time. Ether is not currently used for labor pain relief, since it significantly weakens labor activity, can increase blood pressure, and adversely affect the fetus.

Inhalation anesthesia of childbirth by inhalation of painkillers is still widely used in obstetric practice. Inhalation anesthetics are used in the active phase of labor with the opening of the cervix by at least 3-4 cm and in the presence of severe pain in contractions.

Nitrous oxide is the main inhalant used for pain relief obstetric operations and for labor pain relief. The advantage of nitrous oxide is safety for the mother and fetus, the rapid onset of action and its rapid end, as well as the absence of a negative effect on contractile activity and pungent odour. They give nitrous oxide through a special apparatus using a mask. The woman in labor is introduced to the technique of using the mask and she herself applies the mask and inhales nitrous oxide with oxygen as needed. When inhaling it, a woman feels dizzy or nauseous. The action of the gas manifests itself in half a minute, so at the beginning of the fight you need to take a few deep breaths

Trilene is a clear liquid with a pungent odor. It has an analgesic effect even in small concentrations and with the preservation of consciousness. Does not suppress labor activity. It's well run fast active agent- after the cessation of inhalation, it quickly ceases to have an effect on the body. The downside is the bad smell.

6.​ Epidural anesthesia during labor and delivery caesarean section

The performance of epidural analgesia consists in blockade of pain impulses from the uterus along neural pathways entering the spinal cord at a certain level by injecting a local anesthetic into the space around the spinal cord membrane.

Performed by an experienced anesthesiologist. The time to start epidural analgesia is determined by the obstetrician and anesthesiologist, depending on the needs of the woman in labor and the child during childbirth. Usually it is carried out with an established regular labor activity and the opening of the cervix by at least 3-4 cm.

Epidural lumbar anesthesia is performed in the lower back with the woman in labor sitting or lying on her side. After treatment of the skin in the area lumbar spine anesthesiologist makes a puncture between the vertebrae and enters the epidural space of the spine. First, a trial dose of anesthetic is administered, then, if there are no side effects, a catheter is inserted and the desired dose is administered. Sometimes the catheter can touch a nerve, causing a shooting sensation in the leg. The catheter is attached to the back, if it is necessary to increase the dose, subsequent injections will no longer require a second puncture, but are made through the catheter.

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

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

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

Epidural anesthesia with a sufficient degree of safety can be used for caesarean section. If an epidural catheter is already in place at the time of delivery and it becomes necessary to perform a caesarean section, it is usually sufficient to inject an additional dose of anesthetic through the same catheter. More high concentration drug can cause a feeling of "numbness" in abdominal cavity sufficient for surgery

7. General anesthesia. Indications for the use of general anesthesia in childbirth are emergency situations, such as sharp deterioration child's condition and maternal bleeding. This anesthesia can be started immediately and causes a rapid loss of consciousness, allowing for an immediate caesarean section. In these cases, general anesthesia is relatively safe for the child.

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

The fact that childbirth should be anesthetized is less argued today than before. The evidence “for” is obvious: from long torment, a woman loses control over herself and ceases to follow the advice of obstetricians, risking harming herself and the child. But birth control method– with or without drugs – is still a topic of heated debate.

Supporters natural processes we are convinced: if a woman is prepared and properly tuned in for childbirth, then she can handle it herself - there are plenty of techniques, you just need to remember and apply them. Long before the advent modern medicines the mother went to quiet place and calmly did what was necessary. Several centuries ago, owning age-old wisdom midwives who helped in word and deed. A little more than two centuries ago, obstetrics began to develop rapidly, and previous practices were forgotten.

Non-pharmacological anesthesia of childbirth: breathing

This is one of the most ancient and popular techniques in our time. Proper, rational breathing gives the mother's body required amount oxygen, which helps to relieve muscle clamps and allows you to control yourself. To obtain the necessary skills, it is enough to take a course of preparation for childbirth. If you could not do this in advance, listen to the midwife - she will tell you how to breathe at different stages.

"Respiratory" pain relief helps women who are capable of self-control and concentration. Otherwise, with increased pain, the expectant mother, unable to cope with her emotions, will “lose” all her skills.

Ways of pain relief during childbirth: massage

There are special points, massaging which at the time of the contraction, you can reduce pain. Some of them are available for independent manipulation, the rest are more difficult to get to - you will need the help of a partner. Of course, pain relief with acupressure will not be absolute, but relief will be felt. The technique is also taught in courses to prepare for childbirth. If the expectant mother attends classes alone, then knowledge of anesthetic points will not be useful to her - it is not enough to influence only those located in the access zone.

Requires a "full set". for charging! If during contractions a woman gets up and actively moves, the pain subsides. This is easy to explain: when muscles work, hormones of joy are released - endorphins, which are natural painkillers. Physical activity improves blood flow in the uterine arteries, which favorably affects the condition of the child. Walking and other distracting activities during childbirth may not be allowed for everyone.

If the pregnancy has complications, you will have to give up vigorous activity.

Methods of pain relief during childbirth: water

Water helps to relax and relieve tension in many situations, and childbirth is no exception. Even an ordinary shower gives strength, increasing pain threshold. Some maternity and perinatal centers are equipped with bathtubs with hydromassage devices. If a amniotic sac burst before the opening of the cervix, water procedures are excluded, since the risk of infection entering the birth canal increases.

Physiotherapy method of labor pain relief

The physiotherapeutic method of pain relief is called electroanalgesia. Weak electrical discharges transmitted through the skin block the passage of pain impulses. Four electrodes are attached to the lower back. Holding the mode switch in her hands, the woman controls the strength of the impulse. The pain goes away only for a while, allowing the expectant mother to take a break from contractions. He also has contraindications, for example, varicose veins or cardiovascular diseases.

Physiotherapy method of pain relief: nitrogen

The history of medical anesthesia for childbirth began with chloroform, then it was replaced by “laughing gas” - nitric oxide. It is still relevant, because when mixed with oxygen, it helps to relax a little. Opiate (narcotic) analgesics, including morphine, were also tried, but not for long, noticing that the baby was also immersed in a kind of sleep along with the mother. Substances penetrated the placenta, and the baby was born lethargic, worse adapted to the surrounding changes. Modern analgesics and tranquilizers work easily, but they "reach" the baby. No visible harm, but still ...

Epidural anesthesia for childbirth

From painful sensations for the entire period of contractions, only epidural analgesia relieves. The method also has “side” advantages, for example, it relieves spasm of the cervix - a common complication in which the opening slows down, or even stops altogether. In the neglected version, the situation becomes the cause of a caesarean section. Epidural analgesia significantly reduces pressure. If a woman initially has it increased, then this disadvantage turns into dignity. Other options require medical intervention. The second disadvantage of this technique is its ability to slow down labor activity to one degree or another.

If the epidural slows down the course of events, stimulants (oxytocin) cannot be dispensed with.

There are also less significant drawbacks that overshadow the meeting with the baby - back pain at the injection site and headache, fever, chills, trembling large muscles, allergy.

Anesthesia during childbirth

If the doctor says that, for medical reasons, drug analgesia is necessary, you should not refuse it contrary to common sense. To remove doubts, it is better to understand the essence of each method and reasonably assess your capabilities. Information cannot be obtained from dubious sources, including the Internet, contact a gynecologist, or even better, a practicing obstetrician and anesthesiologist.

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Pain management during childbirth aims to provide comfortable conditions for a woman giving birth, avoids pain and stress, and also helps to prevent violations of labor.

Perception pain childbirth depends on such circumstances as physical condition, anxious expectation, depression, features of education. In many ways, the pain of childbirth is exacerbated by the fear of the unknown and possible danger as well as previous negative experiences. However, the pain will be lessened or better tolerated if the patient has confidence in the successful completion of the birth, a correct understanding of the birth process. Unfortunately, so far, none of the currently existing methods of pain relief in childbirth is absolutely ideal. To achieve the maximum effect, the choice of the method of anesthesia should be carried out individually. At the same time, it is necessary to take into account the physiological and psychological condition women in labor, the condition of the fetus and the obstetric situation. To increase the effectiveness of anesthesia importance has prenatal preparation, the purpose of which is to remove the fear of the uncertainty of the upcoming birth. In the process of such preparation, the pregnant woman must be informed about the essence of the processes that accompany pregnancy and childbirth. The patient is taught proper relaxation, exercises that strengthen the muscles of the abdomen and back, increase overall tone, different ways breathing during contractions and at the time of birth of the fetal head.

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

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

Narcotic analgesics are the most effective drugs used for labor pain relief. However, these drugs are used more to reduce than to complete cessation pain. With established labor activity in the active phase of the first stage of labor, these drugs contribute to the correction of uncoordinated uterine contractions. The choice of drug is usually based on the severity of potential side effects and the desired duration of action. Intravenous administration of drugs is preferred over intramuscular administration, since effective dose is reduced by 1/3-1/2, and the action begins much faster. Tranquilizers and sedatives are used during childbirth as components of medical pain relief to relieve arousal, as well as to reduce nausea and vomiting. In the active phase of labor, with the opening of the cervix more than 3-4 cm and the appearance of painful contractions, sedatives with narcotic analgesics in combination with antispasmodics (No-shpa intramuscularly). The use of narcotic analgesics should be stopped 2-3 hours before the expected moment of expulsion of the fetus, to prevent its possible drug depression.

Inhalation anesthesia for childbirth

Inhalation anesthesia of childbirth by inhalation of painkillers is also widely used in obstetric practice. Inhalation anesthetics are used in the active phase of labor with the opening of the cervix by at least 3-4 cm and in the presence of severe pain in contractions. The most common is the use of nitrous oxide (N2O) with oxygen, trichlorethylene (trilene) and methoxyflurane (pentran). Nitrous oxide is a colorless gas with a slight sweet smell, which is the most harmless inhalation anesthetic for mother and fetus. The most common ratios of nitrous oxide with oxygen are: 1:1, 2:1 and 3:1, allowing you to achieve the most optimal and stable analgesia. In the process of inhalation anesthesia, monitoring by medical personnel of the condition of the woman in labor is necessary. The effectiveness of analgesia largely depends on correct technique inhalation and rationally selected ratios of the components of the gas-narcotic mixture. Three options for achieving an analgesic effect can be used.

Variants of labor pain relief technique with inhalation anesthetics

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

Autoanalgesia in labor with nitrous oxide can be performed throughout the active phase of the first stage of labor until the cervix is ​​fully open. Due to the fact that nitrous oxide is excreted from the body through Airways, this provides greater controllability of the anesthesia process. With anesthesia during childbirth, after the cessation of inhalation of nitrous oxide, consciousness and orientation in the environment are restored within 1-2 minutes. Such analgesia during childbirth also has an antispasmodic effect, providing coordinated labor activity, preventing abnormal contractile activity of the uterus and fetal hypoxia. In addition to nitrous oxide, drugs such as trichlorethylene can also be used for inhalation anesthesia (it has a more pronounced analgesic effect compared to nitrous oxide); methoxyflurane (use is less controlled than nitrous oxide and trichlorethylene).

Epidural analgesia

Regional analgesia can also be successfully used to anesthetize childbirth. The cause of pain in the first stage of labor is the contraction of the muscles of the uterus, stretching of the cervix and tension ligamentous apparatus uterus. In the second stage of labor, due to stretching and stretching of the pelvic structures, additional pain occurs during the advancement of the fetus, which are transmitted through the sacral and coccygeal nerves. Therefore, to achieve pain relief during childbirth, it is necessary to block the transmission of pain impulses along the corresponding nerve bundles. This can be achieved with a pudendal nerve block, a caudal block, a spinal block, or an extended epidural block.

Epidural analgesia is one of the popular methods of labor pain relief. The implementation of epidural analgesia consists in blocking pain impulses from the uterus along the nerve pathways entering the spinal cord at a certain level by introducing a local anesthetic into the epidural space. Indications for epidural analgesia are: severe pain in contractions in the absence of the effect of other methods of anesthesia, discoordination of labor, arterial hypertension in childbirth, childbirth during and.

Contraindications to labor pain relief with epidural analgesia

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

Relative contraindications for epidural analgesia

1. Extensive back surgery that was previously performed.
2. extreme obesity and anatomical features, making it impossible to identify topographic landmarks.
3. Past or existing diseases of the central nervous system ( multiple sclerosis, epilepsy, muscular dystrophy and myasthenia gravis).

Epidural analgesia is carried out with established regular labor activity and the opening of the cervix by at least 3-4 cm. Only an anesthesiologist who owns this technique has the right to perform epidural anesthesia.

Anesthesia for violations of labor activity

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

Anesthesia of childbirth in diabetes mellitus

At diabetes at the beginning of the active phase of the first stage of labor, it is advisable to avoid the use of narcotic analgesics and the use of epidural analgesia is more preferable. This is due to the decrease Negative influence systemic analgesics and sedatives, the stress reaction of the woman in labor to pain is less pronounced, better control over the condition of the woman in labor is provided against the background of intact consciousness. In addition, epidural analgesia helps to prevent the development of rapid and rapid labor, allows for a painless controlled completion of labor. If necessary, against the background of epidural analgesia, it is possible operative delivery both through the natural birth canal (obstetrical forceps, vacuum extraction), and by emergency caesarean (after rapid amplification of the block). If there is no possibility and conditions for performing a regional block, it is possible to use inhalation analgesia, strengthening it with a pudendal nerve block.

Childbirth pain relief for heart disease

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

Anesthesia and preterm birth

Discussion

I gave birth with epidural analgesia. I didn’t have pain in the abdomen at all, but my lower back! Moreover, I was not afraid of childbirth, I knew how and what was happening, I breathed correctly, I did it myself light massage, but the birth went on for more than a day, the baby was born 5 kg. Of course, I could do without, but I was tired, squeezed and dreamed of losing consciousness, if only not to be present at this horror. Anesthesia helped further opening of the uterus and within two hours, in one effort, I gave birth to a healthy baby. Thanks to people who think how to alleviate the suffering of the mother!

I am a pediatrician, disabled 2-gr. musculoskeletal system. She gave birth to her two children herself, and I can say with confidence that the most the best pain relief is preparation for childbirth during pregnancy (swimming, sauna, baths, self-education, physical exercises), the presence of the husband, his care, psychological support, awareness of a woman about the physiology of childbirth and how to behave in childbirth (movement, posture during labor, etc.), warm water With sea ​​salt, lack of fear, etc. In this case, childbirth goes on endorphins.
If a woman is systematically intimidated in antenatal clinic during pregnancy, they stuff her with vitamins, calcium, they don’t tell her anything about how to prepare for childbirth physically (and not financially), then very often the case ends with birth trauma or caesarean. In our maternity hospitals, you can give birth normally if you are informationally savvy, and do not follow the intimidation, are physically prepared, and if you agree with the doctor so that he does not interfere much in the birth process.
It really doesn’t hurt to give birth when you know that this so-called. "pain" with every minute, second brings you closer to meeting with the desired creature that will be born. Fear, on the other hand, fetters, is transmitted to the child, causes pain in childbirth and discoordination of labor activity. What about birth control? This is one non-stop contraction, it is very painful, especially if a woman lies on her back, it is not physiological, it is harmful to the child (vena cava syndrome), THIS IS AGAINST ALL RULES!
Give birth without fear - and there will be no pain. GUARANTEE! Nature - it provides for everything, it is better to follow it, and not artificial methods of delivery.
By the way, my great-grandmother was a midwife, and no special education Did not have. She just KNEW how to help a woman in labor - DO NOT INTERFERE! She herself gave birth to eight children, and helped almost all the children in the village to be born, even took my mother. If she were alive, I would never have gone to give birth in the hospital.
Good luck everyone!
Natasha
13.03.2006

All the most important things in this article are written in the first paragraphs and for this I thank the doctor very much, maybe without knowing it he came out in support of natural childbirth and such an unknown concept in our country as protection psychological well-being women in labor. Her calmness, confidence in the positive outcome of childbirth, the opportunity to receive support from loved ones - this is the main pain relief for childbirth, absolutely harmless. Thanks to Dr. Makarov for reminding me that there is no perfect drug pain relief, maybe someone will refrain from using drugs in childbirth and give their child a chance to be born without them. But if by the time I read the article I had not given birth to three children, by the way, completely without medical anesthesia, I would probably be scared. For me, my husband's support, water, and a caring midwife were the best pain relief. Giving birth doesn't hurt that much!

Comment on the article "Pain relief in childbirth"

Then the whole scheme was outlined in my head, but, remembering the birth on oxytocin without anesthesia, I became cowardly and could not say that no, no one pricked me with oxytocin. I also had a very painful contraction of my uterus.

Discussion

I have the most painful uterus after the second birth was reduced. And after the third - it's normal, although I was waiting for a tin. It didn't happen :)

Pricked 3 days oxytocin, antibiotic and anesthesia. (I don't know which one). I have PCS and the first birth, it hurt a lot, especially after oxytocin. I kept worrying that I didn’t know what contractions and childbirth are in general, but PKC: I got up in the morning and went to the operation. And after oxytocin, it became clear how it would be ...
Nosh-pu was allowed, you could ask for a candle, and a heating pad with ice.

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

Discussion

I do not consider anesthesia a whim. I didn’t anesthetize the birth, but I was tolerable, if the pain is unbearable, I need to anesthetize, IMHO. And as for anesthesia, when it is necessary to alleviate the suffering of a dying person - is it generally necessary, is there any point in enduring it?

Well, specifically on the topic - in general, I do not consider anesthesia evil. but personally on my examples: during childbirth _now_, _knowing_ I would prefer not to anesthetize, in case of cancer - euthanasia instead of anesthesia. pure IMHO

Currently best way management of childbirth in infected women has not been fully defined. To make a decision, the doctor needs to know the results of a comprehensive virological research. Natural childbirth includes whole complex measures aimed at adequate pain relief prevention of fetal hypoxia and early rupture of amniotic fluid reduction of injuries birth canal at mother and skin baby. Only when all preventive measures are observed ...

Discussion

Absolutely agree. Unfortunately, at the moment there is no consensus on the safest management of childbirth with hepatitis C. According to statistics, the likelihood of a child being infected with hepatitis is slightly lower with a planned caesarean section than with natural childbirth. However, none of these methods can guarantee the safety of the child in terms of infection with hepatitis. Therefore, the choice of method of delivery is based more on the obstetric history than on knowledge of the presence of this infection.

In the afternoon I already said that anesthesia is not needed. Nothing hurt, neither the head, nor the back, not the legs. 2 ks with spinal. The first cop after 6 hours of childbirth, after anesthesia, I felt like in paradise, and after 15 minutes the child was already given.

Discussion

No need to be afraid. I also had some reasons for this, but in the end I gave birth naturally :) That's good too.

I went with my first daughter without any problems. one shot, everything was chopped off from chest to toe. I tried to consider the process in the reflection of the llamas and in the tile, but the medical staff spoke their teeth and did not let me look, which is a pity. I am glad that I heard the first cries of my daughter. They gave me a kiss on the heel :) very touching. She gave birth to the second one in the same way, only they exhausted all the nerves (she gave birth for free) - in the operating room she was shaking either from the cold, or from the nerves - the result: the anesthesia did not work - they gave me a general one. I did not hear the first screams, it was difficult to withdraw.

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

The issue of anesthesia during childbirth is always relevant for expectant mothers and is decided each time on an individual basis, depending on many factors.

As the due date approaches, every expectant mother, one way or another, thinks about the upcoming difficulties that are associated with the birth of a child. It's about about the severe pain that invariably accompanies birth process. Of course, each person is individual, and for some women, pain during childbirth is a completely tolerable, albeit unpleasant sensation, while for others it is a source of incredible torment.

It has been proven that in most cases a woman experiencing severe pain for a long time, at a decisive moment it may simply not be ready for the birth of a child naturally, the body is exhausted, and the woman in labor simply does not have the strength to push. To prevent this from happening, painkillers are used during childbirth.

Pain relief during childbirth can be used for a number of reasons:

1. As we have already said, the task of anesthesia is the comfort of a woman and her readiness for the birth of a child. In a quarter of women in labor, the pain threshold is so low that, while experiencing pain during contractions, some simply feel a sense of panic, may perform inappropriate actions, and do not listen to the doctor's instructions. In this case, the pain reliever used during childbirth is designed to eliminate the woman's restless behavior.
2. Pain is also relieved if a too large baby, or twins, is expected, and even during prolonged, or, conversely, premature, or "rapid" births.
3. It happens that during the birth process an emergency is required surgical intervention such as insertion of forceps, or removal of the placenta. In such cases, special preparations are also used, as a rule, intravenous.
4. The use of an anesthetic is considered effective if there is a risk of fetal hypoxia, or the expectant mother has a weak labor activity. Here the effect is directed in a slightly different direction, and not to relieve pain. With hypoxia, for example, the use of such drugs reduces the risk of oxygen starvation in a baby.

With regard to the risks associated with the use of drugs that relieve discomfort, then, contrary to popular belief that this can be detrimental to the health of the child, doctors think otherwise. As we have already said, the issue is resolved individually each time, and the effect is, of course, primarily aimed at bringing benefits, not harm. Of course, each drug has its own list of contraindications, but we will talk about this a little lower when we analyze which ones exist. modern methods anesthesia during childbirth.

Types of anesthesia during childbirth

Methods of pain relief during childbirth can be completely different, from the use medicines, to methods explaining how to anesthetize contractions during childbirth on their own. Let's start, perhaps, with the anesthesia of childbirth in modern conditions, that is, those methods, the basic principle of which is one or another introduction of medicines into the body.

Medical pain relief during childbirth

Drugs designed to reduce pain during contractions can enter the body in a variety of ways, from inhalations and compresses to intramuscular and intravenous injections. Let's take a look at what and how childbirth is anesthetized, in more detail.

Inhalations

For such anesthesia of childbirth, a mixture of nitrous oxide and oxygen is used. This combination gives a sufficiently high efficiency and is used during the opening of the cervix. The description of this method, by the way, gives an answer to the question “do they give labor pain relief in the first period?”, which includes the time of disclosure. The advantage of this method is that the woman herself determines the degree of pain and takes a breath as needed.

Intravenous anesthesia

What is injected into a vein during childbirth for pain relief? Most often, these drugs, designed to provide pain relief during childbirth, are various analgesics. By the way, they enter the body not only, but also intramuscularly, and with the help of special compresses. A similar relief method prenatal period is aimed at ensuring that a woman can fully relax between contractions and gain strength that will be needed during attempts.

Sometimes a doctor, when deciding which anesthesia to use during childbirth, opts for a drug such as promedol. Although promedol refers to drugs, it has been proven that its single use will not harm either the mother or the child. This drug is not used for last stage labor activity, otherwise this method may affect the baby's respiratory activity, in other words, it will be difficult for him to take his first breath.

Often, and especially during the birth of the first baby, a situation arises that labor activity is significantly delayed. In such cases, to give expectant mother rest, the doctors put her to sleep.

Epidural anesthesia

Here, pain medication during childbirth is injected into the back (spine) using a catheter. This method provides almost complete elimination of pain symptoms, but you need to remember that along with the pain, the ability to move independently for some time may disappear. It depends on the dosage of the administered drug, sometimes a woman can fully stand on her feet. The downside is the fact that during the use of this method, the woman in labor loses the ability to fully push. Therefore, shortly before the onset of attempts, the administration of the drug is suspended.

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