Anesthesia of childbirth in modern conditions. Relative contraindications for epidural analgesia. What to Consider

Unfortunately, none of the currently known methods of medical anesthesia of childbirth is not perfect. All of them, one way or another, affect the fetus and the duration of labor, and their use is not always possible. However, there are methods of pain relief that do not have any contraindications for mom and baby.

Methods of non-drug pain relief are absolutely harmless, very simple and effective, they can be used at any stage of childbirth. Self-anesthetic methods include birth massage, special breathing techniques, relaxing postures and movement techniques, the use of a fitball (gymnastic ball) and aquatherapy during childbirth. In order to master these techniques, only one thing is required - desire!

active position

First and the most important factor reducing pain from contractions is active behavior in childbirth. This term refers to the free behavior of the woman in labor, the constant change of positions and movement around the ward, the search for the most comfortable body position. The movements themselves significantly reduce general feeling pain. And not only because any action is distracting.

First, the level pain depends on circulation. During a contraction, the muscle fibers of the uterus contract, while expending energy. The main "energy fuel" for the work of all cells in our body is oxygen; myometrial cells (uterine muscles) are no exception. As you know, oxygen is arterial blood; therefore, cell respiration depends on the level and speed of arterial blood flow. When the body is stationary, the total blood flow decreases, the supply of oxygen to the uterine muscle slows down, and pain increases. If a woman in labor walks around the ward or moves in a comfortable position, as a result of the movement, the level of blood flow increases, and the cells of the uterus are better supplied with oxygen. Therefore, with active behavior in childbirth, pain from contractions is much weaker than with a stationary position. Even in the case when, for medical reasons, a woman in labor cannot get up, she can actively behave during a fight - sway, spring on the bed, spread and bring her knees together. These small movements significantly reduce the pain of a contraction.

Secondly, the feeling of pain depends on the general tension. More precisely, between these concepts - pain and tension - there is a direct proportional relationship. That is, the more we strain, the more painful it is for us, and vice versa. During a contraction, when the uterus tightens and painful sensations appear, some women instinctively “freeze”, completely stopping moving. This behavior of the woman in labor is caused by fear of pain. The woman in labor, as it were, hides for the duration of the contraction from pain and from herself. In childbirth, this behavior does not bring relief: "freezing", the expectant mother unconsciously strains, which leads to a sharp increase in pain. The main assistant in the fight against excessive tension during contractions is physical activity. After all, when we are in motion, our muscles alternately tense and relax; therefore, hypertonicity (excessive muscle tension) is excluded. And if the movement helps to relax, then it reduces general level pain.

Movements during childbirth can be very diverse. If the birth proceeds without complications, the choice of the type of movements during the contraction remains with the woman in labor. In this case, there is one, but very important limitation. At any stage of childbirth, sharp, jerky movements should not be made. Here are examples of the most common active behaviors during a fight:

• walking along the ward or corridor;
• tilts to the sides and forward;
• sipping and turning the whole body;
• shaking and rotating movements of the pelvis;
• shifting from foot to foot;
• transfer of body weight from socks to heels and vice versa;
• half squats;
• bending and arching of the spine;
• in the prone position: swinging the pelvis, turning from side to side, springy movements of the hips, bringing and spreading the legs.

During fights, you should behave freely, choosing the most comfortable position body. There are many well-known positions that reduce discomfort during contractions and help you relax. The main principle by which a woman in labor chooses a position for the duration of the contraction is the level of comfort, stability and relaxation. Most "generic" poses use four points of support and predominantly vertical position body; there are also "lying" poses. However, in order for the postures to help, you should change the position of the body as often as possible and do not forget to move a little within any posture. To reduce pain during childbirth, try the following positions during labor:

• Stand by the bed (sink, window sill, bedside table) with your legs slightly apart. Lean your hands on the bed, relax your back and stomach, as if transferring the weight of your body to your arms and legs. Swing from side to side, back and forth, shift from foot to foot, shake your pelvis.
• Stand in the position of a sumo wrestler: legs wide apart and half-bent at the knees, the body is slightly tilted forward, hands rest on the middle of the thighs. Shift from foot to foot or sway from side to side.
• Squat down with your legs wide apart and leaning on a full foot. Behind the back there should be a fixed support (headboard, bedside table, wall). Stand with your feet shoulder-width apart, put your hands on your hips. Swing left and right, back and forth. Get on the bed on all fours with your legs slightly apart. Alternately arch and arch your back at the spine.
• Stand on the bed in a knee-elbow position, legs slightly apart, and sway from side to side. You can put a pillow under your elbows. Kneel on the bed, rest your hands on the back of the bed, Shift from one knee to another. Squat down facing the bed. Hands and head can be put on the bed.
• Sit on the ship, placing it on a chair or a special bench (you can’t sit on the chair itself - this creates excessive pressure on the perineum and can harm the baby). Bend your legs at the knees and spread them wide apart (both the vessel and the bench are always in the ward).
• Stand at the head of the bed or bedside table. Place your arms bent at the elbows on it. Get down on your haunches, as if sagging on your hands,
• If you are tired and want to lie down, lie on your side with your knees and hips bent.

There are so-called "partner positions" for which a woman in labor will need an assistant. Here are some of the simplest and most convenient positions for pain relief of contractions:

• Stand facing your partner and wrap your arms around his neck, top press your body against your partner, turn your head to the side. Bend your legs at the knees, spread them as wide as possible and sway from side to side without lifting your legs from the floor.
• Stand like a train in front of your partner. Ask him to put forward his arms bent at the elbows (boxer's pose). Spread your legs wide bent at the knees, lean back on your partner and hang on his arms, like on gymnastic rings, without lifting your legs from the floor and swaying (in this position, the woman in labor is fixed under the armpits on the partner’s forearms).
• Ask your partner to sit on the edge of a chair or bed with your legs wide apart. Squat down with your back to your partner, legs wide apart and leaning on a full foot, Lean back on your partner and sway from side to side.
• Lie on your side and ask your partner to sit next to the bed. Bend the leg located on top at the knee and rest it on the shoulder of the partner. Try to bend and unbend this leg (ask your partner to offer a little resistance to this action).

AT recent times in many women in labor, they are allowed to use a fitball to anesthetize childbirth. Fitball is a rubber gymnastic ball that is commonly used for aerobics and Pilates. With the help of a fitball, you can take a wide variety of poses, easily changing one to another, guaranteed to relax and move continuously, while saving strength. For use during contractions, the fitball is not fully inflated so that it remains soft and springy. On the ball, you can take all the poses listed above; in addition, there are special poses with a fitball:

• swing, rotate the pelvis, spring, roll from side to side, sitting on the ball;
• get on all fours, leaning on the ball with your chest, arms and chin and swinging on it;
• lie on your side, placing the ball under your side and arm and springing on it;
• lean on the ball with your back in a reclining-half-sitting position with legs wide apart;
• swing, pushing back from the ball; sit or kneel, leaning on the ball with outstretched arms and springing;
• lie on your side, placing the ball between the calves of the legs and bouncing them.

As you can see, active behavior in childbirth does not require special physical training. In order to use the "active", you need only the knowledge and desire of the woman in labor to be a participant in childbirth, and not a passive patient.

Pain relieving breath

The most effective way to anesthetize childbirth is with special breathing techniques. The analgesic effect of breathing is based on hyperoxygenation - supersaturation of the blood with oxygen. The respiratory center of the brain, registering an excess of oxygen in the blood of a woman in labor, sends an impulse to the pituitary gland - the main hormonal gland responsible for the release of endorphins. These substances, called "pleasure hormones", regulate the threshold of human pain sensitivity. The more endorphins are released, the higher the pain threshold; that is why proper breathing in contractions and attempts to anesthetize no worse than analgesics.

Breathing techniques can be used at any stage of childbirth without restrictions. They are applicable in any position of the body, they are equally effective in helping both with normal flow childbirth, and with the development of various deviations of labor activity.

At the beginning of labor, when contractions are practically painless, it is recommended to use "belly breathing". At the beginning of the contraction, the woman in labor takes a relaxed, slow breath through her nose, and then exhales air through her mouth for a long time (as if blowing on water). Such breathing helps to relax, relieves nervous excitement and provides high blood oxygen saturation, stimulating and anesthetizing contractions.

By the middle of the first stage of labor, when the contractions increase and become painful, “candle breathing” helps a lot. It's frequent shallow breathing, in which a short breath is taken through the nose, and exhaled through the mouth (as if we were blowing out a candle). As contractions intensify, breathing becomes more intense, but still remains very frequent. Breathing in this way should only be during a contraction; at the end of pain, the woman in labor makes deep breath and exhale, aligning the breath, and rest until the next contraction.

At the moment of full disclosure of the cervix, when the contractions become especially long and frequent, it is most effective to breathe in a "train". This breathing is an alternation of the previous techniques. At the beginning of the fight, the expectant mother uses breathing with her stomach, saving strength. As the pain intensifies, breathing quickens and at the peak of the contraction becomes as intense as possible. Then, as the contraction subsides, the woman in labor calms and evens out her breathing.

In the second stage of labor, when the fetus begins to move along the birth canal, each contraction is accompanied by false call to defecate (the desire to empty the intestines). This sensation is caused by the pressure of the fetal head on the rectum, located next to the vagina. At this stage, the woman in labor needs to avoid premature ones and relax as much as possible, helping the baby to descend through the birth canal. To achieve this goal during the fight you need to breathe "dog". This is rapid, shallow mouth breathing, really reminiscent of a dog's breathing. When breathing "dog" the diaphragm is the main muscle abdominals- is in constant motion, which makes the attempt impossible. Breathing has the maximum analgesic and relaxing effect.

Magic touch

Another effective way non-drug pain relief in childbirth is massage. By stimulating certain points and zones on the body during contractions, the expectant mother can independently regulate the pain impulse, reducing the level of pain and relaxing.

The most "popular" massage area among women in labor is the lower back, or rather, the sacral region. The sacrum is a fixed connection of the vertebrae in the lower part of the spine. In this region spinal cord located sacral nerve plexus: ganglion, which innervates the uterus and other organs of the small pelvis. Stimulating the sacral zone during the contraction ( Bottom part back in the middle), the woman in labor blocks the transmission nerve impulse thus reducing pain. Massage can be carried out with one or two hands, massaging the area with the pads and knuckles, the base of the fist, the base of the palm, inside palms or hand massager. Movements during the massage can be stroking, pressing, you can pat, pinch and even lightly tap the affected area. To on the skin sacral region there was no irritation, you can periodically lubricate it with cream or oil. If you haven’t stocked up on massage oil, don’t be discouraged: ask the midwife for liquid Vaseline oil, which is always in the hospital.

During the contraction, the protrusions of the pelvic bones on the sides of the abdomen can be stimulated. These bones should be treated in the same way as the sacral area. You can try different methods: squeeze, press and release, stroke, pinch. Choose the type of massage stimulation that most effectively reduces pain for you. This method is a kind of distraction that transfers the source of pain.

Periodically during the contraction, gently stroke the lower abdomen in a semicircle, the region of the fundus of the uterus (the most upper part). The same stroking movements can be made by moving the hands from the lateral protrusions of the pelvic bones along inguinal fold towards the perineum and back. These movements calm the woman in labor, help to relax and improve blood circulation in the uterine area,

The next massage option is most convenient to apply while lying on your side or sitting on the ball. Hold it down inner sides palms to inner surface hips. During the fight, move your hands with pressure, without lifting your palms, from the groin to the knees and back. The recurrent nerve that innervates the pelvic organs passes through this area. Massaging the inner surface of the thigh helps to reduce pain and relax as much as possible.

In partnership childbirth the assistant can constantly carry out a light relaxing massage of the whole body, avoiding only the area of ​​\u200b\u200bthe chest, perineum and abdomen of the woman in labor. The touch of hands loved one soothes the expectant mother and helps to relax better.

Water as a helper

The main plus of aquatherapy is the relaxing and analgesic properties of water. AT warm water contractions are felt softer, blood circulation improves, the woman in labor has the opportunity to relax and take a comfortable position of the body, less tired. Water eliminates the occurrence of such side factors discomfort during childbirth, such as dry skin, increased sweating chills or feeling hot

Recently, many maternity hospitals have begun to use not drug anesthesia contractions with the help of water. For childbirth with aquatherapy, special showers and a reservoir with hydromassage are used, located in the maternity ward. Premises for water procedures in the rodblok are disinfected in a special way. Of course, staying in water during childbirth without risk to the health of the mother and fetus is possible only under the supervision of a qualified medical specialist. When using a special bathroom, the expectant mother should fit in it entirely, being able to turn around and change the position of the body. The water temperature must not exceed normal temperature body (36.0°С-37.0°С) and not fall below 30.0°С. Next to the woman in labor (in the shower or near the massage bath) there should always be a birth partner or a maternity hospital specialist.

Unfortunately, this wonderful method of anesthesia can not always be used. Staying in a water tank during childbirth can be considered absolutely safe only as long as the baby and the uterine cavity are protected by a wall. After the rupture of the membranes, the last barrier between the sterile uterus and the non-sterile vagina disappears. After all, water through the vagina can penetrate the uterine cavity and cause infection. There are fewer restrictions for using the shower in childbirth: this method will have to be abandoned only if the doctor recommends bed rest to the woman in labor.

If the birth proceeds without complications, you can visit the shower quite often during the entire first stage of labor. This requires two conditions: the presence in the maternity block of a shower room equipped for women in labor, and the possibility of observing the expectant mother during water procedures. Shower cabins for women in labor are made open (without doors - for the possibility of medical observation), pallets with a "non-slip" coating are used, and convenient handrails are installed along the walls. During the entire stay in the shower next to the expectant mother, a midwife or doctor should be inseparable. Of course, this is possible only in the case of individual management of childbirth; however, in partner childbirth, the spouse of the woman in labor can become the "observer" and assistant.

An optimal analgesic and relaxing effect can be achieved using a jet of water, like an aqua massager. To do this, you need to take the shower head in your hand and, changing the water pressure from low to medium and even strong, water your stomach in a circular motion throughout the fight. If you have an assistant, you can ask him to massage the lower back and sacral area with a jet of water. Between contractions, it is worth making the pressure of the water weaker and direct the jet to the face, shoulders, chest and legs, achieving complete relaxation. The ideal water temperature for labor pain relief is 36-40°C; more low temperature acts on nervous system exciting but too hot water may cause bleeding.

The birth of a child is the most wonderful event in a woman's life. Of course, the process preceding this event requires a lot of strength and patience from the expectant mother. But wait from childbirth torments and unbearable pain not worth it; childbirth is a rewarding job. And if a woman was preparing for childbirth, knows how to help herself and goes to give birth with a smile, this exciting event becomes a real holiday. And there is no place for pain on a holiday!

Elizaveta Novoselova, obstetrician-gynecologist, Moscow

Discussion

And it was easiest for me exactly as they told me to lie down - on my left side! Neither squatting, nor on all fours, nor walking helped, it was not only painful, but also very tiring.

Absolutely amateurish article, is purely theoretical. In maternity hospitals Russian Federation You simply will not be allowed to apply any of these "methods" to facilitate childbirth. When I took a certain position to relieve pain, my doctor quickly responded: "Who taught you that? Come on, I don't like it like that." That's it. And we all know how to read smart books, no need to plagiarize.

Comment on the article "Pain relief in childbirth"

There are some labors with an epidural, although it was configured without. In childbirth, the doctor insisted on anesthesia, and in my case, after the introduction of anesthesia, labor activity did not weaken, contractions and attempts were the first with the epidural, if not she, I would have died of pain because the contractions were anesthetized, but ...

Discussion

I join the questions of the curious, congratulations or how :)))
I won’t tell you on the topic, I gave birth both times myself, but in terms of contractions, my body is such that I don’t feel anything until the very birth, so pain relief is not necessary, I wouldn’t miss it :)
The only thing is that they injected something for the second time (I don’t remember the names of medicines well). And the reaction of the child to this was definitely. AT this moment find out if the child's problems are the result of all this. It is clear that no one will say for sure, and I am unlikely to have a third birth :) But if there were, I would not give anything to inject. Only if the reason is absolutely serious, and so - let everything be natural. IMHO, it takes much longer and more expensive to deal with the consequences than to endure the process of childbirth.
All, IMHO, of course.

For what purpose are you interested? Giving birth soon and I missed everything?))
The first ones I had were with an epidural, they did it late and badly. For my taste (and in my youth I myself did epidurals to other unfortunate people) doing this business during contractions is quite troublesome. It is necessary to fix the body motionless. If the marriage is a rod, then curl up and lie still - it can be problematic. I personally anesthetized one half of the body - the leg, the half-ass and part of the belly, the second half I continued to feel perfectly.
I was also let down by the fact that they immediately laid me down, added anesthetic to the catheter and fussed in every possible way, rather to no avail. My back hurt for a long time and severely at the puncture site.
The second time I was smarter, did not give up, walked to the last, managed quickly and without anesthesia.
Well, in general - you get to compare the first and second births, and this is not very correct. The first ones are longer and more complicated by default, well, most often it is.
I hope there will be my third birth) and I hope even faster than the second) I would run)

Discussion

A very non-trivial view of epidural anesthesia. All sorts of nonsense is written there, but the video clip itself is interesting. Take a look if you have time.

By the way, 16 hours of contractions in the first birth is practically the norm. If there was no stimulation in the first, the second will definitely go faster and easier. Although, it seems to me that psychological point second birth is always scarier, because you already know exactly what the pain will be.

having endured all the contractions with the first child, she gave birth to the second with an epidural - she is very satisfied, for the 3rd time they simply did not have time to deliver it, she gave birth 1 hour after she arrived at the maternity hospital.

contractions. medical questions. Pregnancy and childbirth. He brought a candle (some kind of painkiller) and said that if after 2 hours it does not help, then call him. no-shpa promotes contractions if childbirth. It has a relaxing effect on the muscles of the uterus, with ...

Discussion

I had VERY strong workouts during my second pregnancy. Starting from 36-37 weeks. Just very. Moreover, they also interfered with the tone. It was a horror. My mom had the same thing with her first pregnancy.
By the way, my childbirth began again like sweatpants and did not intensify for quite a long time. Up to 5 cm of opening, I was almost sure that these were sweatpants. But after 6 cm, the difference became noticeable.

Childbirth is a complex and painful process. Many pregnant women worry about upcoming events and are afraid of pain. Pain, especially prolonged, negatively affects the human psyche. The development of medicine has made it possible to create different variants anesthesia. Today, a woman can receive pain relief during childbirth, but:

• Is it safe?
• How does anesthesia affect the health of the woman in labor and the fetus?
• Is anesthesia done according to indications or can any patient choose it?

These questions are of concern to pregnant women, and here we will analyze in detail the topic of pain relief in the birth process.

When is anesthesia indicated during childbirth?

The introduction of any chemicals into the body of a future mother is undesirable. Some types of anesthesia are considered relatively safe, others can lead to complications.

Anesthesia during childbirth is far from being shown to everyone, only the doctor decides whether it is necessary to administer a relaxing medication during such an important process.

Indications for anesthesia:

• Hypertension and some diseases of the heart, blood vessels in a woman in labor.
• Diabetes.
• Serious diseases of the respiratory system.
• Some eye diseases.
• Increased intracranial pressure.
• Discoordination of labor activity (chaotic intensive contraction of the uterus).
• Too big fruit.
• Narrow pelvis.
• Dystocia of the cervix (excessive stretching of tissues leading to rupture of the cervix).
• Psycho-emotional disorder (occurs in absolutely normal women from too long severe pain).
• Gestosis (complicated form of toxicosis).
• Breech presentation of the fetus or other incorrect position.
• Prolonged labor (more than 10 hours).
• Multiple pregnancy.

Depending on the condition of the pregnant woman, anesthesia can be prescribed by the attending physician as planned, even before the onset of labor or, according to circumstances, already during labor.

Many women want to give birth with anesthesia, even if there is no indication for this. Of course, you can order such a service, but you should understand that any anesthesia has negative consequences when normal delivery such an intervention in the body is highly undesirable.

Types of anesthesia

There are pharmacological and non-pharmacological (physiological) methods of pain relief during labor. Let's consider in detail all types.

Non-drug treatments for pain

Such methods are not strong and quick effect, and are more designed for relaxation during contractions. But their main advantage is high security.

Massage

Physical impact on certain points helps to significantly reduce pain during contractions. A woman can learn pain-relieving massage on her own in special courses.

Some women in labor hire a specialist in the clinic who massages the body throughout the entire period of contractions. Massage not only reduces pain, but also improves blood circulation, which is beneficial for the woman in labor and the fetus.

Breathing exercises

Special breathing techniques during labor and childbirth are also taught to women in courses. The alternation of inhalations and exhalations according to a certain system is a useful and essential pain relief during childbirth. The downside is that with the intensification of contractions, many women forget about the technique, and simply do not find the strength in themselves to breathe properly.

Hydrotherapy

Water procedures significantly relax the muscles and reduce the pain of contractions. But hydrotherapy services are provided, basically, only by high-class clinics, and not all women can afford to give birth for a fee.

Transcutaneous electroanalgesia

Quite efficient and safe way, which allows you to anesthetize the course of contractions. For this, a special apparatus equipped with electrodes is used. Sensors are attached to the lower back of the woman in labor and electrical impulses are triggered, the frequency and intensity of which can be adjusted. The current blocks the pain signals passing through the nerve endings of the spinal cord. Electroanalgesia also improves blood circulation, reducing the risk of fetal hypoxia.

Psychotherapy

A pregnant woman can resort to the services of a psychotherapist, and reduce her pain through hypnotic techniques. it lovely way, in which pain is reduced and there is a deep positive adjustment to the birth process and subsequent events.

The list of natural physiological methods also includes pain relief during childbirth by adopting special positions. Pregnant women are taught such “gymnastics” at preparatory classes. A specialist in the maternity hospital can help you find relaxing positions.

On a note! Some have analgesic and relaxing effects. essential oils(ylang-ylang, mint, bergamot, orange, jasmine). The inhalation of the aromas of these oils is perfectly combined with the above physiological methods and enhances their effect. Another addition can be pleasant calm music..
Many aroma oils have a relaxing effect on the body.

Medical pain relief

With medical anesthesia, chemical preparations are used that act quickly and effectively. They completely block the pain, but each of them has its own side effects. Consider all types of medical anesthesia acceptable for pregnant women.

The anesthetic is given through an inhalation mask. As a drug, mainly Nitrogen is used, less often Methoxyflurane, Pentran, Fluorotan, Trilene.

The woman independently takes the mask, puts it on her face and inhales the gas. The frequency of breaths is done according to a certain scheme, which the doctor selects, focusing on the condition of the woman in labor.

Usually one of three options is chosen:

1. Inhale the drug every half hour.
2. Inhale with the start of the next contraction and remove the mask as soon as the spasm ends.
3. Breathe between contractions.

Inhalation anesthesia during childbirth is used only up to a certain point, until the cervix has opened up to 5-6 cm. Further, such anesthesia cannot be used. This method loses its relevance due to the high gas consumption and leakage in the wards.

• Almost instant analgesic effect.
• Does not harm the child.
• Prevents fetal hypoxia.
• It is quickly excreted from the body.

• Side effects in the form of nausea, vomiting, headache, dizziness, confusion, failure in respiratory system, tachycardia.

Intravenous and intramuscular injections

Drugs of narcotic or non-narcotic action are injected into the vein or muscle area of ​​the woman in labor.

Non-narcotic medicines include painkillers such as No-shpa, Analgin, Baralgin. Tranquilizers and sedative drugs (Relanium, Fentanyl, Nalbuphine, Elenium) can also be used, which increase the pain threshold, reduce fear, anxiety and nervous excitability.

In extremely rare cases through a vein, a woman is injected with anesthetic drugs Ketamine, Calypsol, Sombrevin. They quickly and completely relieve pain, but cause mass side effects and therefore their use is undesirable.

Of the narcotic drugs, Promedol, Fentanyl are more often used.

• Medicines are quickly excreted from the body.
• Sufficiently strong anesthetic effect.

• Painkillers administered intravenously or intramuscularly enter the placenta through the blood and can have a negative effect on the baby.
• Short action.
• Many side effects for the patient (confusion, nausea, dizziness, vomiting, change in pulse rate, headache).

Such anesthesia of childbirth is carried out in very rare cases, when for some reason the patient cannot be given another type of anesthesia.

Today it is one of the most optimal types of anesthesia, which is used in most cases.

The anesthetic is injected into the epidural space located in lumbar spine. As medicines can be used: Lidocaine, Novocaine, Ropivacaine and their analogues. The essence of the technique is the penetration of the anesthetic into the epidural space, and blocking the nerve roots of the spinal cord.

The effect of the drug occurs in about 20 minutes. A woman completely loses sensitivity in the area below the waist. In the upper part of the body, sensitivity is preserved.

During the entire period of labor, the catheter remains in place. vertebral department, which allows you to apply additional portions of anesthesia.

Benefits of epidural anesthesia:

• The woman in labor remains fully conscious and can move.
• Eliminates discoordinated tribal activity.
• Does not affect the strength and frequency of uterine contractions.
• Does not adversely affect the fetus.
• Does not increase pressure.
• The work of the patient's heart remains stable.
• Soft recovery from anesthesia.

• The effect of anesthesia does not begin immediately, you have to wait 20-30 minutes.
• If during the puncture into the epidural space leaks cerebrospinal fluid, subsequently a woman can for a long time suffer severe headaches.
• Difficulty breathing (due to blockage of the muscles of the sternum).
• Soreness at the puncture site, subsequent inflammation, difficult healing, hematomas.
• Pain in the lumbar region that persists for 2-3 months.
• When a needle enters a vessel, a variety of negative reactions are possible.
• In extremely rare cases, if the needle is inserted incorrectly, paralysis of the lower extremities is possible.

Despite all the risks, epidural anesthesia during the birth process is one of the safest in terms of impact on the child.

Read more about epidural anesthesia in.

spinal anesthesia

It is immediately worth noting that epidural and spinal (spinal) are different types of pain relief procedures during childbirth.

The drugs used are the same, but the needle is inserted deeper into the subarachnoid space itself during spinal anesthesia. The effect of anesthesia occurs much faster than with the "epidural", after 5 minutes.

The spinal method of anesthesia requires a higher qualification of the doctor making the puncture, the slightest mistake can lead to irreversible consequences. With this technique, side effects are more pronounced, although serious negative influences not happening.

It's important to know! Despite the high effectiveness of spinal anesthesia, it does not work for everyone. About 5-6% of women do not react at all to the introduction of drugs into the epidural or subarachnoid region. Approximately 15% have low level anesthesia.

Paracervical anesthesia

An outdated method of anesthesia, which is practically not used anymore, but the expectant mother should know about it.

An anesthetic drug (Novocaine, Lidocaine) is injected directly into the lateral fornix of the vagina, that is, around the uterine os. The procedure is carried out at the first stages of contractions, when the dilatation has not yet reached 8 cm. Anesthesia blocks the nerve endings of the cervix, significantly reducing pain.

Paracervical analgesia in childbirth leads to a slowing of the heartbeat in the fetus (in more than 50% of cases), because of this side effect, it was discontinued.

What type of anesthesia is used after childbirth

The birth process is divided into three stages: the period of contractions, the expulsion of the fetus and the exit of the placenta. In some cases, the last, third stage in women passes with a complication. The placenta does not come out naturally after the prescribed time and the patient requires manual cleaning.

In such a situation, anesthesia is required. If the birth took place under epidural anesthesia, then an additional dose is simply administered. In other cases, short-term intravenous anesthesia is used (for 10-15 minutes). This time is quite enough to free the uterus from the placenta by mechanical intervention.

Some women experience perineal ruptures after having a baby. When suturing, the doctor makes an injection with an anesthetic directly into the vaginal area.

After the completion of all, the held mother no longer needs anesthesia. The following days, quite strong cramps will be felt in the abdomen, as the uterus will begin to contract, but this pain is short-term and quite tolerable.

What is the best type of anesthesia for childbirth?

A definite answer to this question cannot be given. In every individual case one or another type of anesthesia may be more suitable. But if you look objectively, it is considered the best. The most important thing is that it is carried out by an experienced specialist.

It should also be borne in mind that each method has contraindications.

Finally

This was an overview of all possible types anesthesia during childbirth. Despite the fear of pregnant women about upcoming events and the desire to go through this process painlessly, the decision on the need and expediency of anesthesia should be made by the doctor. Now in private clinics, a woman in labor can optionally order anesthesia, paying a certain amount for this. But even in such cases, it is necessary to consult with your observing doctor in advance and weigh all the pros and possible negative consequences.

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

What causes pain during childbirth?

In the first stage of labor, contractions of the uterus (contractions) and expansion of the cervix cause excessive irritation. nerve endings which in turn send a signal that the brain interprets as pain. In addition, stretching of blood vessels and muscles occurs, as well as 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 advancement through the birth canal.

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

It should be noted that in many respects the degree of 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, expectation of pain, negative mood increase the amount of adrenaline produced, as a result of which the perception of pain increases. Conversely, calmness and balance contribute to the production of endorphins (hormones of joy), which naturally block the perception of pain.

Do they give pain relief during childbirth?

In 100% of cases, methods of non-drug (physiological) anesthesia are shown: proper breathing, various relaxation techniques, special postures, water procedures, acupuncture, massage. At correct application a combination of these methods in almost 75% of cases is enough not to resort to medications.

If a physiological methods do not give a result or there are objective medical indications related to the health of the woman, the obstetric situation or the course of the birth process, drug anesthesia is used. This helps not only to reduce the suffering of the woman in labor, but also avoids backlash the body to pain, thereby normalizing the heartbeat and breathing, lowering blood pressure and increasing blood circulation in the pelvic region.

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

Types of pain relief during natural childbirth:

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

The most safe and effective methods of regional anesthesia are considered: epidural and spinal anesthesia.

- epidural anesthesia

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

Indications for the use of epidural anesthesia can be considered:

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

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

The procedure for placing a catheter and inserting a needle is quite complicated and requires certain skills and experience from an 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 the drug. 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 the peripheral nerves to the brain, so the sensitivity below the level of the chest is completely absent, while the woman in labor is completely conscious. This method anesthesia is often used, both for planned and for emergency operations caesarean section.

The use of spinal anesthesia guarantees an analgesic effect in 100% of cases (with an epidural there is about a 5% chance bad result), 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 end of anesthesia, as well as a significant decrease in blood pressure.

When is anesthesia contraindicated?

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

• low level of platelets in the blood and a violation of blood clotting (including after the introduction of heparin);
• bleeding;
• inflammatory processes in the area of ​​drug administration;
• tumors, infections or injuries of the central nervous system;
• hypotension (blood pressure level below 100 mm Hg);
• individual intolerance to administered drugs.

An obstacle to the introduction of painkillers may be the categorical refusal of the woman in labor, without whose consent it is impossible to carry out the procedure.

Also contraindications in some cases may be injuries and deformities 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 with the help of natural remedies. medical 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 focus on positive thoughts about the birth of a baby.

Specially for- Elena Kichak

Natalia Gouda
Obstetrician-gynecologist, head of the observational department of the maternity hospital, Mytishchi

Magazine "9 months"
№01 2006
Used for pain relief in childbirth non-drug methods(they do not need syringes, medicines, doctors), and medications, which can only be carried out with the help of a specialist.

How can doctors help?

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

Endotracheal anesthesia. Held general anesthesia With artificial ventilation lungs. The method provides lasting effect. In this case, a whole combination of drugs is used, and the anesthetic itself enters through the trachea into the lungs. Such anesthesia is used for caesarean section, chale in emergency cases.

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

Local anesthesia. When applied local anesthesia 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. Nowadays, such anesthesia is widely used during childbirth. After the injection, the lower part of the body becomes insensitive. The nerves through which pain signals are sent to the brain from the uterus and cervix pass through lower section spine - this is where the anesthetic is injected. During the action of this kind of anesthesia, the woman is fully conscious and can talk with others.

Local anesthesia. This method, which desensitizes any part of the skin, is often used after childbirth for pain relief during suturing of soft tissues. In this case, the anesthetic is administered directly instead of intervention.

intravenous anesthesia. medicinal product(anesthetic) is injected into a vein. At the same time, the woman falls asleep for a short time (10-20 minutes). It is used when performing short-term surgical interventions during childbirth, for example, when releasing retained parts of the placenta, when applying obstetric forceps.

The use of narcotic analgesics. Narcotic analgesics administered intramuscularly or intravenously, while pain sensitivity decreases during childbirth, the woman gets the opportunity to fully relax in the intervals between contractions.

Medical indications for pain relief
very painful contractions, restless behavior of a woman (it should be borne in mind that, according to statistics, 10% of women in labor experience mild pain that does not require treatment, 65% moderate pain and 25% severe pain syndrome that requires the use of medications);
large fruit;
long-term childbirth;
premature birth;
weakness of labor activity (shortening and weakening of contractions, slowing down the opening of the cervix, oxytocin labor stimulation to enhance contractions);
caesarean section operation;
multiple pregnancy;
hypoxia ( oxygen deficiency) fetus - when anesthesia is used, the likelihood of its occurrence decreases;
the need for surgical interventions during childbirth - the imposition of forceps, manual removal of the placenta. In these situations, intravenous anesthesia is more often used. The same method is used immediately after childbirth at the time of recovery. birth canal.

Anesthesia without drugs

Anesthetic massage is an effect on certain points at which nerves come to the surface of the body. The action on these nerves causes some soreness and thus distracts from labor pain. Classic relaxing massage - stroking the back, collar zone. This massage is used both during contractions and in between.

Without exception, all expectant mothers experience some anxiety in anticipation of childbirth. One of the reasons for such anxiety is the well-known idea of ​​painful contractions. Can pain be affected? And can a woman herself make her birth as easy and painless as possible? In this section, we will talk in detail about all methods of anesthesia, their pros and cons.

Relaxation - methods of relaxation that help to endure contractions more easily and fully rest in between periods.

Rational breathing - there are several breathing techniques that help to endure contractions more easily. With the skillful use of the right type of breathing during the fight, we achieve a light, pleasant dizziness. It is at this moment that endorphins are released (these hormones in in large numbers produced during childbirth; endorphins have an analgesic and tonic effect and are released into the blood precisely during the fight).

Active behavior during childbirth is good if the expectant mother knows that during normal, uncomplicated childbirth, 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 is also understood as movement, walking, swaying, tilting and various postures designed to unload the spine. Change of position is the first and most natural desire for any discomfort.

Hydrotherapy is the use of water to relieve contractions. AT different situations during contractions, one way or another, you can use the bath or shower.

Electroanalgesia - use electric current to influence the biological active points, which also helps to endure the pain of childbirth.

The right to choose

To use non-drug methods of anesthesia, you need to know about these methods, to have practical skills. A course of psychoprophylactic preparation for childbirth can be taken in antenatal clinic or at a pregnancy school that teaches you proper breathing during childbirth, shows you rational postures, and helps you learn relaxation techniques.

Postures, breathing, analgesic massage, hydrotherapy during normal labor can be used almost without restriction. AT maternity hospital about this, you need to consult a doctor. In some situations (when breech presentation fetus, at premature birth) the doctor can restrict the freedom of movement of the woman in labor and strongly recommend that the expectant mother lie down. But the skills of breathing, relaxation will be useful to you in any case.

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

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 applied, as well as its possible negative consequences. After that, the woman signs a consent to the use of a particular method of anesthesia. It must be said that in emergency situations when the life of a woman or child is threatened serious danger, this procedure is neglected.

Separately, it must be said about the contract for childbirth. When concluding an agreement, which indicates that one or another method of drug anesthesia will be used at the request of the woman, drug anesthesia is used when the woman in labor asks. In these cases, epidural anesthesia is more commonly used.

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

So the wonderful nine months of waiting have passed, very soon there will be an addition to your family. But, the closer the day the baby appears, the more fears the expectant mother has. Many people want pain relief during childbirth. But this is a natural process, every woman can easily cope without anesthetics.

This article will be devoted to such an issue as labor pain relief, its pros and cons will be described in detail. What threatens such intervention by obstetricians to you and your unborn child, you will also find out. Types can be varied. What exactly? Read more about this.

Pain relief in childbirth: obstetrics, new methods

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

Anesthetization of childbirth to a woman who is psychologically prepared and consciously approached the planning of the birth of a baby is most often not required. But still there are cases when anesthesia is carried out according to the indications of a doctor.

Indications for anesthesia

Do anesthesia during childbirth, if there are:

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

If none of the above is observed, then anesthesia during childbirth is usually not required.

Types of anesthesia

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

Non-pharmacological methods of labor pain relief

This safest group of methods is especially popular among obstetricians. What applies here? Effective and simple exercises, which can be started at any stage of labor activity: breathing exercises, labor massage, aqua therapy and reflexology.

Despite the existence of more efficient medicinal methods, many consciously refuse them in favor of non-drug ones. natural pain relief during childbirth includes:

• activity;
• correct breathing;
• massage;
• childbirth in water;
• reflexology.

The arrival of a baby is the significant event in your life. Non-drug methods of childbirth pain relief, completely harmless and useful for both you and your baby, will help you leave only positive impressions from this day.

Activity during childbirth

It is very important to choose an active position during contractions, and not a passive one. Help yourself and your baby to be born.

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

• rolling from toe to heel;
• bending forward and to the side;
• swaying the pelvis, circular movements;
• arching and bending of the spine;
• active walking;
• fitball swings.

Breathing exercises

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

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

• first contractions;
• increase in the intensity of contractions;
• dilatation of the cervix;
• push period.

During the first fights

This type is different in that it is an even and deep breathing that oxygenates the blood of the child and mother. Concentrate on the account. Inhale through your nose for four counts and exhale through your mouth for six counts. Lips should be folded into a tube. You are distracted from pain, gymnastics gives a relaxing effect. It can even be used during times of panic or extreme stress to calm down.

During intense contractions

During this period, you need to calm down, now is the time to apply the dog breathing technique. These are superficial, shallow breaths and exhalations through the mouth, the tongue needs to be slightly stick out of the mouth. You should not think about how you look at the moment, the maternity hospital is a place where you only need to think about your well-being and about the child, especially, believe me, you are not the only one!

The moment of dilatation of the cervix

This is the peak, more painful than now, you will not be! But you need to endure it, childbirth without pain relief in a medical way is still preferable. Now it is worth speeding up breathing, taking superficial quick breaths and exhalations. Fold your lips into a tube, inhale through your nose, and exhale through your mouth. When the contraction lets go, calm down a little, it is better to breathe deeply and evenly. This method allows you to slightly relieve acute pain.

The period of attempts

All the worst is over, there are no more fights. Your baby will be born very soon. If the birth is not complicated, then the child will appear after 1-2 attempts. It is necessary to push 2-3 times for an attempt. Do not panic, because now is the final moment, almost painless. If you feel sorry for yourself and disobey the orders of the obstetrician, you will have to use tools, from which there will be quite painful sensations. When an attempt begins, you need to make a deep inhale-exhale-deep breath and hold your breath for 10-15 seconds, while you have to push. Don't bother anus or straining your eyes, so you can get hemorrhoids, stroke and other unpleasant and dangerous consequences.

Another important announcement: the period between contractions and attempts is needed in order to rest, relax and even out your breathing. You need to train daily during pregnancy in order to be able to pull yourself together during childbirth. Bring your breathing to automatism, and you will independently control yourself and facilitate your birth.

Other options

Modern methods labor pain relief includes a large list of all kinds of procedures, but especially effective (non-drug) are massage, childbirth in water and reflexology.

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

How does water help? In a warm bath, the pain of contractions is easier to tolerate, water also has a relaxing effect. The expectant mother can take a comfortable position for herself and just relax, while avoiding chills, elevated temperature and sweating, dry skin.

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

Medical pain relief

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

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

epidural blockade

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

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

Spinal block

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

• you remain conscious;
• the effect lasts two hours;
• anesthetizes the whole body thoracic and below.

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

Spinal epidural combination

It's relative new technology when the above two methods are combined. Such anesthesia lasts much longer, while the mother is conscious. The first two hours are further - epidural.

drugs

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

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

Narcotic substances can be administered both intramuscularly and intravenously (through a catheter), the second option is the most successful, since the dosage of the drug can be adjusted. This method is good because the pain is blocked for about six hours and the woman in labor can rest. The effect comes in a couple of minutes. Of course, there are also negative sides: You and your baby may have slowed breathing.

Local anesthesia

It is not used to relieve pain during contractions, but it is very effective if the vagina needs to be incised or stitched after tears. The injection is made directly into the vaginal area, the effect occurs almost instantly, pain in the injection area is temporarily blocked. There are no bad side effects for you or your child.

perineal blockade

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

tranquilizers

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

postpartum period

They also provide pain relief after childbirth. What for? So that a woman can relax and gain strength. What may be of concern:

• spasms caused by uterine contractions;
• places of breaks and cuts;
• difficult trips to the toilet;
• chest pain;
• cracking of the nipples (with improper feeding).

If the pain is caused by tears and cuts, then painkillers or ointments are offered, but if the birth was taken correctly and you follow personal hygiene, then there should be no pain, or they should be minimal. During suturing, the doctor is obliged to anesthetize, and how this will happen should be discussed with you in advance.

There are several ways to minimize pain:

• frequent and short water procedures;
• special cooling pad (will help to avoid swelling);
• store pads in the refrigerator (will dull the pain);
• tune in for a speedy recovery;
• worry less about cuts and tears (avoid infection, do not sudden movements, this will help you to recover quickly);
• sitting on a special pillow (exerts minimal pressure on the problem area).

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

• do special exercises;
• lie on your stomach;
• do a massage.

The following exercise will help with back pain: lie on hard surface, bend your right leg at the knee and keep your knee right hand. Point your heel with your left hand right leg to the groin. Stay in this position for a few seconds, rest and repeat the exercise. If the back hurts on the left side, then do everything in the same way with the left leg.