Anesthesia during childbirth. anesthesia methods. Anesthesia during childbirth in modern conditions

Are unique. The severity of the pain that a mother feels during the birth of a child varies from woman to woman. It depends on many factors, such as the size and position of the fetus, the strength of contractions, pain tolerance. Some women may need to use proper breathing and relaxation techniques to relieve pain, while others may need anesthesia during childbirth.

During childbirth, various types of anesthesia can relieve pain. Epidural and spinal anesthesia are most commonly used, but there are other pain management options. Before giving birth, a woman should carefully ask her doctors about the possible elimination or relief of pain in order to make the best choice for herself and her child.

What are the indications for analgesia in natural childbirth?

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

What types of anesthesia can be used for natural childbirth?

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

There are two main types of pain relievers used during natural childbirth:

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

Benefits and possible consequences of using anesthesia during childbirth

Is it possible to give birth without anesthesia?

Should I give birth with anesthesia?

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

Taras Nevelychuk, anesthesiologist, specially for the site site

Useful video

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

What types of anesthesia are used during childbirth?

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

When is anesthesia necessary for childbirth?

Medical anesthesia is usually needed in such cases:

• the contractions are very painful, the woman in labor is restless;
• the woman in labor is very;
• premature birth;
• C-section;
• prolonged childbirth;
• multiple pregnancy;
• fetal acid deficiency.

Alternative methods of anesthesia during childbirth

Alternative methods of anesthesia during childbirth include activities that can reduce pain without resorting to painkillers. These include: massage, rational breathing, choosing the right and comfortable posture during childbirth, etc. All these methods of pain relief do not require the intervention of a doctor and are noted as a very effective type of pain relief for childbirth, without complications. Well, if suddenly something goes wrong, then your doctor will immediately decide on one or another method of medical anesthesia.

In conclusion, we note that today, there are a lot of ways to eliminate or muffle pain during childbirth. Therefore, do not be afraid and worry about this. Tune in to the positive, look forward to the minutes of waiting with your "happiness" and be healthy!

Easy childbirth!

Specially for Ira Romaniy

From Guest

Well, it so happened that I had an unscheduled caesarean, but they did an epidural, everything is fine, only my head hurt a little later, but still better than general anesthesia. The baby-strong was born, this is the most important)))

A quick, painless delivery and a healthy baby is a woman's dream. But more and more often we have to face various complications. Epidural anesthesia is a popular and effective medical pain relief for childbirth. Some remain delighted with the procedure, others are upset that they have not received the desired effect. How does it work and what are the consequences of epidural anesthesia during childbirth? Is it really safe?

Epidural anesthesia can be performed both for the purpose of pain relief and for other indications. The effect largely depends on the characteristics of the woman's body. What are the benefits of epidural anesthesia, and what should be feared?

Causes of pain in childbirth

Even in the Bible it was said that a woman is destined to give birth for a long time and painfully. For many centuries, ladies were afraid of this moment, and maternal mortality, by today's standards, "went off scale." But already in the 20th century, various methods of pain relief began to be widely used, and the fear of childbirth decreased. The severity of pain during childbirth depends on the following points.

• Pain threshold of a woman. Each person perceives unpleasant sensations differently and depends on the work of the nervous system. What causes terrible pain in some, is tolerated by others.
• Psycho-emotional state. This is perhaps the most important point in the perception of pain. Calm, reasonable, naturally patient women give birth easier. And emotionally labile "require" anesthesia. Chronic stress, fear of the process itself, previous abnormal and painful childbirth increase the sensitivity of a woman. You need to approach contractions already informed: to know the basics of breathing and behavior in the hospital. Courses at medical institutions, as well as forums and the media, help with this.
• natural or induced. In the natural birth process, the contractions of the first stage of labor are perceived as "pulling pains in the lower abdomen or in the sacrum." Therefore, women often turn to the maternity hospital already in their attempts. The use of various stimulants (prostaglandin-based gels and contracting drugs) leads to the development of labor activity that is different from "normal contractions". Experienced doctors observe this even on the monitors of the CTG machine. Contractions have a higher amplitude, frequency, they are "like in textbooks." This is due to the fact that with any stimulation, the muscles of the uterus contract all at once, while during natural childbirth - alternately separate bundles. No one has yet been able to imitate "nature".
• Is there a pathology of childbirth. Excessively active contractions of the muscles of the uterus, discoordinated, as well as contractions during rapid labor are always accompanied by severe pain.
• Number (parity) of births. In 2/3 of cases, the first birth is more painful than the next. But it depends to a large extent on the perception of the process by a woman. It should also be borne in mind that the first births are often longer in time, and therefore are defined as more severe.

Ideally, natural childbirth proceeds almost imperceptibly in a woman - she can even do her usual work at home until the moment of an exhausting period. Severe pain is a signal for the doctor and the woman about the pathological course of the process. Epidural anesthesia is one of the effective methods for relieving discomfort and normalizing labor.

Features of epidural anesthesia

Epidural anesthesia involves the introduction of a medicinal substance into the same space of the membranes of the spinal cord. To locate the scene of action, there are special landmarks. The puncture of the space is carried out from the side of the back through the skin with a special needle.

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

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

After the drug is injected into the epidural space, it begins to act on the nerve endings passing here, causing the loss of only pain sensitivity. At the same time, a woman can move freely, feel the temperature of objects, touch. Partially, the drug can enter the subarachnoid space, which will enhance its effect.

Difference from spinal anesthesia

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

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

Table - The difference between epidural and spinal anesthesia

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

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

Conditions for holding:

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

The parity of childbirth does not matter - epidural anesthesia can be performed at the first, second and subsequent as a planned procedure or according to indications.

Benefits of the procedure

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

• Anesthetizes the process. Unpleasant sensations in a woman decrease within 10-15 minutes after anesthesia. If pain occurs, the anesthesiologist adds the drug to a special catheter inserted into the epidural space. As a result, a woman is not so exhausted from constant contractions, by the most important moment, attempts, she is full of strength to act, and is not in prostration after exhausting uterine contractions. An important "plus" is the effect of anesthesia at the time of suturing postpartum gaps. There is also no need for additional drugs in the case of manual examination of the uterine cavity or curettage.
• Speeds up childbirth. In addition to the main effect, the opening of the cervix is ​​noticeably accelerated and the time of delivery is reduced. This is especially important for women with somatic pathology, such as diabetes, hypertension, heart disease, and preeclampsia.
• No consequences for the child. In studies, it was found that a small amount of drugs enters the systemic circulation of a woman, but it does not have a significant effect on the baby. Acute hypoxia in labor during epidural anesthesia may occur for reasons unrelated to anesthesia, for example, entanglement or placental abruption.
• Reduces blood pressure. This is one of the side effects of the epidural, which is often used for medicinal purposes, for example, during childbirth in women with arterial hypertension, with preeclampsia.
• "Allows" other anesthesia. If necessary, epidural anesthesia does not interfere with general endotracheal anesthesia or spinal anesthesia. Similar situations arise when an emergency caesarean section is necessary. Conducting another type of anesthesia against the background of epidural anesthesia reduces the need for the use of narcotic drugs, muscle relaxants and other serious drugs.

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

Disadvantages and consequences of epidural anesthesia during childbirth

Epidural anesthesia often leads to a decrease in uterine contractions during childbirth. In this regard, there are no reliable studies due to the complexity of the analysis of the situation. However, practicing physicians face such influence. To prevent such consequences of the procedure, 30-40 minutes after the installation of the catheter and the introduction of the substance into the epidural space, a constant infusion of uterotonics, drugs to stimulate contractions, is additionally established. Even in this case, the analgesic effect is preserved.

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

Table - Cons of epidural anesthesia for pregnant women

Late complications after epidural and spinal anesthesia include headache. Its appearance is associated with irritation of the membranes of the spinal cord, accidental piercing of the subarachnoid space, and also with non-compliance with bed rest by the woman in labor within 12-24 hours after childbirth. Treatment of this complication includes rest, taking painkillers and drinking plenty of water at least 2-3 liters of clean water per day.

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

Contraindications

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

• allergies to the drugs used;
• skin and pustular diseases at the puncture site;
• transferred inflammation of the membranes of the brain;
• severe scoliosis (curvature of the spine);
• blood clotting disorder;
• tumors of the central and peripheral nervous system;
• with an established hernia of the spine at the site of the proposed puncture.

The essence of the process

Each medical institution has its own nuances of performing epidural anesthesia. But in general the essence of the process is the same.

At what stage of labor

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

• right after the fight started- when opening the cervix 1-2 cm;
• during active labor- and dilatation of the cervix 3-4 cm.

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

How does it go

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

• on the left side - while the legs are pressed as close as possible to themselves, the head - to the sternum;
• in a sitting position often a nurse or doctor asks a woman to make her back a “cat”, which means to bend as far back as possible, and press her head and legs to herself.

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

1. Treatment of the injection site. To do this, use alcohol, solutions based on iodine and other antiseptics.
2. Anesthesia of the skin. A small amount of local anesthetic is injected, and pain is felt, comparable to a conventional injection into the upper layers of the skin.
3. Puncture of the epidural space. With a special needle, the doctor pierces the skin and all layers to the required depth, usually the woman at this stage no longer feels any back pain, since local anesthesia was performed.
4. Attaching a syringe. By pulling the piston towards himself, the doctor makes sure that the needle has not entered the vessel.
5. Conductor installation. The epidural needle is hollow, it is removed as soon as the conductor is inserted into it.
6. Fixation of the catheter. The catheter is fixed to the skin of the back using adhesive tape. It does not interfere with walking and lying down, and if necessary, you can attach a syringe to it and add medicine.

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

Since the speed of labor is individual for everyone, the anesthesiologist injects the medicine into the catheter in portions, focusing on the complaints of the woman in labor for the pain that appears and taking into account the opening of the cervix. So you can prolong the action until the birth of the child. If it is necessary to close the gaps or additional manipulations, no other anesthesia is required anymore - only a portion of the medicine into the epidural catheter.

When the catheter is removed

As soon as the obstetrician-gynecologist and the anesthetist reach a common opinion that pain relief is no longer needed, the administration of the drug is stopped and the catheter can be removed. Usually it is left for several hours or a day for "insurance". The catheter can be removed by a nurse or an anesthesiologist in compliance with all the rules of sterility. A cotton ball is applied to the puncture site, which is fixed with adhesive tape. The bandage can be removed after a day.

What effect to expect

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

It is impossible to predict the effect of epidural anesthesia. For every tenth woman, the expected effect is higher than that which is obtained in practice.

There is an opinion that epidural anesthesia is dangerous during childbirth in that it increases the frequency of caesarean sections. However, there are no reliable data and studies in this area. It should be borne in mind that this pain relief in most cases is prescribed to women from a high-risk group of complications.

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

Reviews: “If I was going for the third, I would definitely give birth with an epidural”

It helps well, you don’t feel anything below the waist, it feels like when you lie down, you raise your hand, but it doesn’t obey, as if it’s not yours, here too, you don’t hear pain, just when you push, you feel pressure on the bottom. I was injected with a 4 cm opening at 23 o'clock somewhere, and at 02 I was already taken to the birth room, at least I lay down for this time, you can even fall asleep), but anesthesia is not added to childbirth to feel everything, i.e. when you give birth everything is like everyone else, as soon as the baby is born, they add medicine and then again you don’t feel anything, they burn it, sew it up, and you at least tell jokes)))) I liked it, the main thing is to find a good anesthesiologist. There are no problems with the back. I also learned at the forum that the medicine does not enter the bloodstream of the baby, because it is injected into the epidural space.

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

The first birth without anesthesia, the second with anesthesia. Heaven and earth. At the first birth, I was so tired of the pain that by the time of the attempts I didn’t care what was happening, such apathy set in, I didn’t have any strength at all. In the second birth, the doctor suggested an epidural, I did not refuse. All the contractions were felt, but not painfully, I was even able to sleep in the contractions. By attempts she was cheerful and cheerful. Therefore, if I were going for the third, I would definitely give birth with an epidural

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

I gave birth with an epidural. Even though she didn't want to. But my birth was generally strange. Large fruit, and no labor activity. I was injected with some kind of hormonal gel and then the contractions began without interruptions at all. Three hours later, the midwife said that I could not stand it and let's do anesthesia. They did it two hours later. I was scared that something was being injected into my spine, but nothing, it helped a little. And injected every two hours seems to be an additional dose. And then it all ended with a cesarean with general anesthesia, because. The epidural didn't work for me by that time. And after all that, I moved away quite quickly and easily, on the same day I went to the toilet myself, and on the fifth day I ran home with a receipt on my own responsibility. Before the epidural, they said that after that the legs in the pelvic area may not be very sensitive for some time, I didn’t have anything like that.

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

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

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

And my friend gave birth to the first with an epidural, and the second without. So she says that with the first - she couldn’t come to her senses from the drugs for several days + the child didn’t take the breast well and was generally sluggish (since the effect of the epidual also affects the baby). But with the second one without medication, she says that she herself was able to participate in childbirth, she listened to what the midwife told her - she eventually gave birth without breaks (unlike the first time). + she felt great herself + the child ate well and was lively right away. But everyone chooses for himself what is best for him. I gave birth on my own without an epidural and have no regrets.

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

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The main methods of anesthesia during childbirth

In modern obstetric practice, there are several effective methods of anesthesia. At the moment, epidural anesthesia during childbirth is considered optimal, which allows you to completely eliminate pain in the first stage of labor - when the cervix opens. In most cases, this moment is the most painful for a woman. And often the longest. Epidural anesthesia during natural childbirth makes this process painless. The essence of the procedure is that a local anesthetic solution is injected into the space above the membrane of the spinal cord. After the injection, within a couple of minutes, the entire lower body becomes insensitive. The signal from the brain is blocked and the woman does not experience pain. The advantage of epidural anesthesia is that, unlike general anesthesia, the woman remains conscious.

2. Inhalation anesthesia during childbirth

Less radical, but not as effective is inhalation anesthesia. It is a general anesthesia using nitrous oxide, which is fed into the lungs of the woman in labor through a special mask. Such anesthesia is used at the first stage of childbirth, like the previous method.

3. Local anesthesia during childbirth

Its essence boils down to the fact that only certain parts of the body are anesthetized. Thus, the woman in labor remains conscious throughout the entire period of childbirth.

4. Narcotic analgesics during childbirth

These drugs can be administered both intramuscularly and intravenously. Under their influence, the sensitivity to pain during childbirth decreases, the woman in labor can relax more between contractions.

This is not a complete list of methods of pain relief during natural childbirth without a caesarean section. However, obstetricians and gynecologists recognize them as the most rational and safe for mother and child. In any case, the method of anesthesia is prescribed individually in each case by the attending physician.

Methods of pain relief during childbirth with caesarean section

Conducting a caesarean section during childbirth is a frequent necessity. In this case, several types of anesthesia are used. And in some cases, the woman in labor herself can choose which method to use. However, obstetricians and gynecologists strongly recommend two types:

Epidural anesthesia;

· General anesthesia.

What determines the choice of anesthesia during childbirth

It is impossible to answer unequivocally which anesthesia is better for caesarean section. There are three main factors depending on which method of anesthesia should be chosen:

1. Psychological readiness for the operation. A woman can choose what she prefers: sleeping during labor or staying awake to see her newborn baby right away.

2. The level of equipment of the maternity hospital where the operation will be performed. It may be that the selected maternity hospital is not equipped with the necessary equipment to perform some types of anesthesia.

3. Qualification of specialists taking birth. First of all, this concerns the anesthesiologist and whether he can really carry out any of the methods of anesthesia with the same quality.

Let's consider both types of anesthesia in more detail and decide which anesthesia is better for caesarean section.

Anesthesia is performed by using three components: "preliminary anesthesia", the introduction of a tube through the trachea and the supply of anesthetic gas with oxygen, the introduction of a muscle relaxant. Only after all three steps have been completed can the operation begin.

The advantage of general anesthesia is that the woman in labor is sound asleep during all stages of the operation and does not feel pain. In addition, there are almost no contraindications to it. But at the same time, quite serious side effects and complications can occur.

Complications from general anesthesia during childbirth

· Headaches, dizziness, nausea and unpleasant muscle weakness.

· Allergic reactions, respiratory infections, pneumonia in especially critical cases.

Among other things, general anesthesia can affect the child:

Drowsiness and general weakness;
· Temporary problems with breathing;
Perinatal encephalopathy.

These negative effects are not common, but they can occur. But before you give up general anesthesia, note that effective techniques have been developed today to help the child normally endure the effects of anesthesia.

The principle of carrying out practically does not differ from that described above, so we will not again describe it in detail again. Let's dwell on the details not mentioned. Preparation for anesthesia begins on average half an hour before the operation. After the anesthesia takes effect, the specialists proceed directly to the caesarean section.

Despite the fact that epidural anesthesia is considered one of the most gentle and safe methods of pain relief, contraindications for its implementation everything is just like that:

The presence of skin inflammation or pustules that are within a radius of 10 cm from the puncture site;

problems with blood clotting;

Allergic reactions to some of the drugs used;

Diseases of the spine and osteochondrosis, which are accompanied by severe pain;

Incorrect position of the fetus;

Too narrow a pelvis or a large weight of the fetus.

Side effects are also possible. However, if we are talking about caesarean section, then with epidural anesthesia, their risk is significantly higher, with anesthesia with natural childbirth. The fact is that during the operation more drugs are introduced. Including narcotic substances, including fentanyl.

However, if the anesthesiologist is experienced and highly qualified, then complications in most cases are minimized. However, even in this case, certain discomfort after the operation may occur.

Consequences of epidural anesthesia

Trembling in the legs, pain in the head and in the back. Often, all these effects completely disappear a few hours after the operation, but the headache in rare cases stretches for several days, and sometimes even up to several months.

Problems with urination. A rare side effect is allergy. And almost always at the disposal of specialists there is everything necessary to eliminate such effects.

Nerve or spinal cord injury. An extremely rare phenomenon that occurs only during the work of a non-professional or inexperienced anesthetist.

It should also be remembered that during epidural anesthesia, a woman's legs go numb. For many, this is frightening and causes great discomfort.

Indications for anesthesia during childbirth

Both in the case of natural childbirth and childbirth by caesarean section, there are a number of indications for anesthesia:

Severe pain during contractions in a woman in labor. On average, about 25% of women in labor experience significant pain when anesthesia is urgently needed. About 65% experience moderate pain, and approximately 10% feel only minor pain;

The size of the fetus is too large, as its exit can provoke serious pain;

Too long delivery time;

Weak generic activity;

ALWAYS during a caesarean section;

With fetal hypoxia. In this case, anesthesia is one of the most effective methods to reduce the risk of its manifestation;

The need for surgical intervention during childbirth. In this case, intravenous anesthesia is mainly used.

Anesthesia with promedol during childbirth

Anesthesia during childbirth with promedol is one of the most popular methods. However, it should be remembered that promedol is a narcotic substance. Promedol is injected into a vein or into a muscle. In most cases, the injection allows you to take a break from pain from half an hour to two hours. Sometimes I even manage to sleep well. It all depends on the reaction of the body to the effects of the drug. Therefore, some women in labor sleep soundly until the very birth of the baby, while others only have time to take a short nap. The upper limit of the effect of the drug sometimes reaches two hours from the moment of delivery.

An injection after the cervix dilates more than 8 cm is not performed, as the child must take the first breath on his own. Accordingly, he must be vigorous, which is impossible if he is also affected by the drug. It is also not recommended to use promedol before the cervix opens at least up to 4 centimeters. If the injection is given before the cervix opens, this can be the main cause of birth weakness. In addition to the direct analgesic effect, promedol can be used to treat various pathologies of labor activity. It should be remembered that the drug may have a number of contraindications:

individual intolerance;

if there is depression of the respiratory center;

The presence of a blood clotting disorder;

Simultaneously with the intake of MAO inhibitors for the treatment of diseases of the central nervous system;

· high blood pressure;

· bronchial asthma;

depression of the nervous system;

heart rhythm disturbances.

Promedol during childbirth, the consequences for the child and mother can manifest in complications:

· Nausea and vomiting;
· Weakness;
· Confusion of consciousness;
Weakening of body reflexes;
· Violation of the respiratory function in a child.

In this regard, it is necessary to weigh the pros and cons of using promedol before making a choice in favor of the drug.

Modern methods and techniques for pain relief in childbirth, as you can already understand, are different. However, there is not always an urgent need for medical anesthesia for childbirth. In some cases, it is quite enough to perform some exposure without drugs to ensure a decrease in pain in a woman in labor. Let's consider the main ones.

Types of natural pain relief during childbirth

1. Pain relief massage. A specialist in the process of performing a massage affects the surface of the body and nerves, while causing minor pain. At the same time, attention is diverted from labor pains. In most cases, massage consists of stroking the back and collar area.

2. Relaxation. It does not always even require the intervention of a specialist to ease the pain. There are a number of relaxation techniques that can reduce pain levels and provide adequate rest in between.

3. Hydrotherapy. Childbirth in water, in which pain is noticeably reduced, and the birth itself occurs much faster. You can use both the shower and the bath during contractions.

4. Electroanalgesia. In this case, an electric current is used, which affects key biologically active points and allows you to better endure labor pains.

5. Fitball. Fitball makes it easier to endure contractions, you can sit or lie on it.

Additional types of anesthesia

spinal anesthesia- a single injection using a local anesthetic. The duration of action is from 1 to 4 hours, depending on the chosen anesthetic and the characteristics of the body of the woman in labor;

Combined technique- combines the best aspects of spinal and epidural anesthesia. This method is prescribed by an anesthesiologist;

Regional anesthesia- Anesthesia of individual areas. One of the most effective, safe and comfortable ways.

Each woman in labor has the right to choose the most appropriate method of anesthesia for her. However, the final decision is made jointly with the attending physician. To achieve the desired result and complete anesthesia in each case, you need to choose different methods. Otherwise, there may be negative consequences for the mother and child, as well as pain. Therefore, no matter what kind of childbirth is coming, the approach to choosing an anesthetic should be responsible and balanced.

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 options for 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 and during normal childbirth, such 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 do not have a strong and quick effect, but 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

A fairly effective and safe way 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. This is a wonderful way in which pain is reduced and there is a deep positive attunement 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” in preparatory classes. A specialist in the maternity hospital can help you find relaxing positions.

On a note! Some essential oils (ylang-ylang, mint, bergamot, orange, jasmine) have analgesic and relaxing effects. 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 aromatic 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 the 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, anesthetic drugs Ketamine, Calypsol, Sombrevin are injected into a woman through a vein. They quickly and completely relieve pain, but cause a lot of side effects, so 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 the 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 body, sensitivity is preserved.

Throughout the entire period of childbirth, the catheter remains in the spinal region, 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 labor 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 cerebrospinal fluid leaks into the epidural space during a puncture, a woman may subsequently experience severe headaches for a long time.
• 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 should be noted right away 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 there are no serious negative effects on the fetus.

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 a low level of pain relief.

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 in due time and the patient needs 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 each 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 of 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 doctor in advance and weigh all the pros and possible negative consequences.