Pain relief during childbirth: modern methods. Types of anesthesia for natural childbirth

Almost all women are afraid upcoming birth and to a greater extent this fear is due to the expectation of pain during the birth process. According to statistics, pain during childbirth, which is so severe that it requires anesthesia, is experienced by only a quarter of women in labor, and 10% of women (second and subsequent births) characterize labor pain as quite tolerable and bearable. Modern anesthesia during childbirth can alleviate and even stop labor pain, but is it necessary for everyone?

Why does pain occur during childbirth?

Labor pain is a subjective sensation that is caused by irritation of nerve receptors in the process (that is, its stretching), significant contractions of the uterus itself (contractions), stretching of blood vessels and tension of the uterosacral folds, as well as ischemia (deterioration of blood supply) of muscle fibers.

• Pain during labor occurs in the cervix and uterus. As the uterine os stretches and opens, stretching of the lower uterine segment increases painful sensations.
• Pain impulses that are formed when the nerve receptors described are irritated anatomical structures, arrive in the roots spinal cord, and from there to the brain, where pain sensations are formed.
• A response comes back from the brain, which is expressed in the form of vegetative and motor reactions (increased heart rate and breathing, rise blood pressure, nausea and emotional agitation).

In the period of pushing, when the opening of the uterine pharynx is complete, pain is caused by the movement of the fetus along the birth canal and the pressure of its presenting part on the tissue of the birth canal. Compression of the rectum causes an irresistible desire to “go big” (this is pushing). In the third period, the uterus is already free of the fetus, and the pain subsides, but does not disappear completely, since it still contains the placenta. Moderate uterine contractions (pain is not as pronounced as during contractions) allow the placenta to separate from uterine wall and stand out.

Labor pain is directly related to:

• fruit size
• pelvic size, constitutional features
• number of births in history.

In addition to unconditioned reactions (irritation of nerve receptors), the mechanism of formation of labor pain also involves conditioned reflex moments (negative attitude towards childbirth, fear of childbirth, worry about oneself and the child), as a result of which there is a release of adrenaline, which further narrows blood vessels and increases myometrial ischemia, which leads to a decrease in the pain threshold.

In total, the physiological side of labor pain accounts for only 50% of pain sensations, while the remaining half is due to psychological factors. Pain during childbirth can be false or true:

• They talk about false pain when discomfort provoked by fear of childbirth and the inability to control one’s reactions and emotions.
• True pain occurs when there is any disruption in the birth process, which actually requires anesthesia.

It becomes clear that most of mothers are able to survive childbirth without pain relief.

The need for pain relief during labor

Pain relief during labor must be carried out in case of its pathological course and/or existing chronic extragenital diseases in the woman in labor. Relieving pain during childbirth (analgesia) not only alleviates suffering and relieves emotional stress in the woman in labor, but also interrupts the connection between the uterus - spinal cord - brain, which prevents the body from forming a brain response to painful stimuli in the form of vegetative reactions.

All this leads to stability of cardio-vascular system(normalization of blood pressure and heart rate) and improvement of uteroplacental blood flow. Besides, effective pain relief childbirth reduces energy costs, reduces oxygen consumption, normalizes work respiratory system(prevents hyperventilation, hypocapnia) and prevents narrowing of the uteroplacental vessels.

But the factors described above do not mean that drug pain relief for labor is required for all women in labor without exception. Natural pain relief during childbirth activates the antinociceptive system, which is responsible for the production of opiates - endorphins or happiness hormones that suppress pain.

Methods and types of pain relief for childbirth

All types of pain relief for labor pain are divided into 2 large groups:

• physiological (non-drug)
• pharmacological or drug pain relief.

Physiological methods of pain relief include

Psychoprophylactic preparation

This preparation for childbirth begins at the antenatal clinic and ends one to two weeks before the expected due date. Training at the “school of mothers” is conducted by a gynecologist who talks about the course of childbirth, possible complications and teaches women the rules of behavior during childbirth and self-help. It is important for a pregnant woman to receive a positive charge for childbirth, cast aside her fears and prepare for childbirth not as a difficult ordeal, but as a joyful event.

Massage

Self-massage will help relieve pain during contractions. You can stroke the sides of the abdomen in a circular motion, the collar area, lumbar region or press with your fists on points located parallel to the spine in lumbar region during contractions.

Correct breathing

Pain-relieving poses

There are several body positions, which, when taken, reduce the pressure on the muscles and perineum and relieve the pain somewhat:

• squatting with knees wide apart;
• standing on your knees, having previously separated them;
• standing on all fours, raising the pelvis (on the floor, but not on the bed);
• lean on something, tilting your body forward (on the back of the bed, on the wall) or jump while sitting on a gymnastic ball.

Acupuncture

Water procedures

Taking a warm (not hot!) shower or bath has a relaxing effect on the muscles of the uterus and skeletal muscles (back, lower back). Unfortunately, not all maternity hospitals are equipped with special baths or pools, so this method of pain relief cannot be used by all women in labor. If contractions start at home, then until the ambulance arrives, you can stand in the shower, lean against the wall, or take a warm bath (provided that your water has not broken).

Transcutaneous electrical nerve stimulation (TENS)

2 pairs of electrodes are applied to the patient’s back in the lumbar and sacral region, through which the electricity low frequency. Electrical impulses block the transmission of pain stimuli in the roots of the spinal cord, and also improve blood supply in the myometrium (prevention of intrauterine hypoxia).

Aromatherapy and audiotherapy

Inhalation aromatic oils allows you to relax and relieves labor pain somewhat. The same can be said about listening to pleasant, quiet music during contractions.

Pharmacological methods of pain relief include

Non-inhalational anesthesia

For this purpose, narcotic and non-narcotic drugs are administered intravenously or intramuscularly to the woman in labor. Narcotic drugs used include promedol and fentanyl, which help normalize discoordinated uterine contractions, have a sedative effect and reduce the secretion of adrenaline, which increases the threshold of pain sensitivity. In combination with antispasmodics (, baralgin), they accelerate the opening of the uterine pharynx, which shortens the first stage of labor. But narcotic drugs cause central nervous system depression in the fetus and newborn, so it is not advisable to administer them at the end of labor.

Of the non-narcotic drugs for pain relief during labor, tranquilizers (Relanium, Elenium) are used, which not so much relieve pain as relieve negative emotions and suppress fear; non-narcotic anesthetics (ketamine, sombrevin) cause confusion and insensitivity to pain, but do not impair respiratory function, do not relax skeletal muscles and even increase the tone of the uterus.

Inhalational anesthetics

This method of pain relief during childbirth involves the mother inhaling inhalational anesthetics through a mask. At the moment, this method of anesthesia is used in few places, although not so long ago cylinders with nitrous oxide were available in every maternity hospital. Inhalational anesthetics include nitrous oxide, fluorotane, and trilene. Due to the high consumption of medical gases and the contamination of the delivery room with them, the method has lost popularity. There are 3 methods of inhalation anesthesia:

• inhalation of a mixture of gas and oxygen continuously with breaks after 30 0 40 minutes;
• inhalation only at the beginning of the contraction and stopping inhalation at the end of the contraction:
• inhalation of medical gas only in between contractions.

Positive sides this method: fast recovery consciousness (after 1 – 2 minutes), antispasmodic effect and coordination labor activity(prevention of the development of abnormalities in labor), prevention of fetal hypoxia.

Side effects of inhalation anesthesia: breathing problems, disruptions heart rate, confusion, nausea and vomiting.

Regional anesthesia

Regional anesthesia involves blocking specific nerves, spinal cord roots, or nerve ganglia (nodes). Used during childbirth the following types regional anesthesia:

• Pudendal nerve block or pudendal anesthesia

Blockade of the pudendal nerve involves the introduction of a local anesthetic (usually a 10% lidocaine solution) through the perineum (transperineal technique) or through the vagina (transvaginal method) to the points where the pudendal nerve is localized (the middle of the distance between the ischial tuberosity and the edges of the rectal sphincter). Typically used to relieve pain during labor when other methods of anesthesia cannot be used. Indications for a pudendal block are usually the need to apply obstetric forceps or vacuum extractor. Among the disadvantages of the method, the following are noted: pain relief is observed only in half of women in labor, the possibility of the anesthetic entering the uterine arteries, which, due to its cardiotoxicity, can lead to fatal outcome, only the perineum is anesthetized, while spasms in the uterus and lower back persist.

• Paracervical anesthesia

Paracervical anesthesia is permissible only for pain relief in the first stage of labor and consists of injecting a local anesthetic into the lateral vaults of the vagina (around the cervix), thereby achieving blockade of the paracervical nodes. It is used when the uterine pharynx is opened by 4–6 cm, and when almost complete dilation is achieved (8 cm), paracervical anesthesia is not performed due to the high risk of introducing the drug into the fetal head. Currently, this type of pain relief during childbirth is practically not used due to the high percentage of development of bradycardia (slow heartbeat) in the fetus (approximately 50–60% of cases).

• Spinal: epidural or peridural anesthesia and spinal anesthesia

Other methods of regional (spinal) anesthesia include epidural anesthesia (injection of anesthetics into the epidural space located between the dura mater (outer) of the spinal cord and the vertebrae) and spinal anesthesia (introduction of anesthetic under the dura mater, arachnoid (middle) membrane without reaching the pia mater meninges - subarachnoid space).

Pain relief with EDA occurs after some time (20 - 30 minutes), during which the anesthetic will penetrate into the subarachnoid space and block nerve roots spinal cord. Anesthesia for SMA occurs immediately, since the drug is injected precisely into the subarachnoid space. TO positive aspects This type of pain relief includes:

• high percentage of efficiency:
• does not cause loss or confusion;
• if necessary, you can extend the analgesic effect (by installing an epidural catheter and administering additional doses of drugs);
• normalizes discoordinated labor;
• does not reduce the strength of uterine contractions (that is, there is no risk of developing weakness of labor forces);
• lowers blood pressure (which is especially important for arterial hypertension or gestosis);
• does not affect the respiratory center in the fetus (there is no risk of developing intrauterine hypoxia) and in the woman;
• if abdominal delivery is necessary, the regional block can be strengthened.

Who is indicated for pain relief during labor?

Despite the many advantages various methods pain relief during childbirth, relief of labor pain is carried out only if there are medical indications:

• gestosis;
• C-section;
• young age of the woman in labor;
• labor began prematurely (to prevent birth trauma the newborn is not protected from the perineum, which increases the risk of rupture of the birth canal);
• estimated fetal weight of 4 kg or more (high risk of obstetric and birth injuries);
• labor lasts 12 hours or more (protracted, including with a preceding pathological preliminary period);
• drug labor stimulation (when oxytocin or prostaglandins are added intravenously, contractions become painful);
• severe extragenital diseases of the woman in labor (pathology of the cardiovascular system, diabetes);
• the need to “turn off” the pushing period (myopia high degree, preeclampsia, eclampsia);
• discoordination of generic forces;
• birth of two or more fetuses;
• dystocia (spasm) of the cervix;
• increasing fetal hypoxia during childbirth;
• instrumental interventions in the pushing and afterbirth periods;
• suturing incisions and tears, manual examination of the uterine cavity;
• rise in blood pressure during childbirth;
• hypertension (indication for EDA);
• incorrect position and presentation of the fetus.

Question answer

What pain relief methods are used after childbirth?

After separation of the placenta, the doctor examines the birth canal to ensure its integrity. If ruptures of the cervix or perineum are detected, and an episiotomy has been performed, then there is a need to suturing them under anesthesia. As a rule, infiltration anesthesia of the soft tissues of the perineum with novocaine or lidocaine (in case of ruptures/incisions) and, less commonly, pudendal blockade are used. If EDA was performed in the 1st or 2nd period and an epidural catheter was inserted, then an additional dose of anesthetic is injected into it.

What kind of anesthesia is performed if instrumental management of the second and third stages of labor is necessary (fertility surgery, manual separation of placenta, application of obstetric forceps, etc.)?

In such cases, it is advisable to perform spinal anesthesia, in which the woman is conscious, but there is no sensation in the abdomen and legs. But this issue is decided by the anesthesiologist together with the obstetrician and largely depends on the anesthesiologist’s knowledge of pain management techniques, his experience and the clinical situation (the presence of bleeding, the need for quick anesthesia, for example, with the development of eclampsia on the birth table, etc.). The method of intravenous anesthesia (ketamine) has proven itself well. The drug begins to act 30 - 40 seconds after administration, and its duration is 5 - 10 minutes (if necessary, the dose is increased).

Can I pre-order EDA during labor?

You can discuss pain relief during childbirth using the EDA method with your obstetrician and anesthesiologist in advance. But every woman should remember that epidural anesthesia during childbirth is not a prerequisite for providing medical care mother in labor, and the mere desire of the expectant mother to prevent labor pain does not justify the risk possible complications any “ordered” type of anesthesia. In addition, whether EDA will be performed or not depends on the level of the medical institution, the presence of specialists in it who know this technique, the consent of the obstetrician leading the birth, and, of course, payment for this type of service (since many medical services, which are performed at the request of the patient, are additional and, accordingly, paid).

If EDA was performed during childbirth without the patient’s request for pain relief, will you still have to pay for the service?

No. If epidural anesthesia or any other labor anesthesia was carried out without a request from the mother in labor for pain relief, therefore, there were medical indications to ease contractions, which was established by the obstetrician, and pain relief in this case acted as part of the treatment (for example, normalization of labor in case of discoordination of labor forces).

How much does EDA cost during childbirth?

The cost of epidural anesthesia depends on the region in which the woman in labor is located, the level of the maternity hospital and whether this medical institution private or public. Today, the price of EDA ranges (approximately) from $50 to $800.

Can everyone have spinal (EDA and SMA) anesthesia during childbirth?

No, there are a number of contraindications for which spinal anesthesia cannot be performed:

Absolute: a woman's categorical refusal spinal anesthesia; blood coagulation disorders and a very low platelet count; anticoagulant therapy (heparin treatment) on the eve of childbirth; obstetric bleeding and, as a result, hemorrhagic shock; sepsis; inflammatory processes of the skin at the site of the proposed puncture; organic lesions of the central nervous system(tumors, infections, injuries, high intracranial pressure); allergy to local anesthetics(lidocaine, bupivacaine and others); level blood pressure is 100 mmHg. Art. and below (any type of shock); scar on the uterus after intrauterine interventions (high risk of missing uterine rupture due to the scar during childbirth); incorrect position and presentation of the fetus, large size of the fetus, anatomically narrow pelvis and other obstetric contraindications.

Relative ones include: deformation spinal column(kyphosis, scoliosis, spina bifida; obesity (difficulty with puncture); cardiovascular diseases in the absence of constant cardiac monitoring; some neurological diseases(multiple sclerosis); lack of consciousness in the woman in labor; placenta previa (high risk of obstetric hemorrhage).

What kind of pain relief is given during a caesarean section?

The method of pain relief during a cesarean section is chosen by the obstetrician together with the anesthesiologist and agreed upon with the woman in labor. In many ways, the choice of anesthesia depends on how the operation will be performed: planned or emergency indications and on the obstetric situation. In most cases, in the absence absolute contraindications In addition to spinal anesthesia, the woman in labor is offered and given EDA or SMA (both for planned caesarean section and emergency). But in some cases, endotracheal anesthesia (EDA) is the method of choice for pain relief for abdominal delivery. During EDA, the woman in labor is unconscious, unable to breathe on her own, and a plastic tube is inserted into the trachea, through which oxygen is supplied. In this case, anesthetic drugs are administered intravenously.

What other methods of non-drug pain relief can be used during childbirth?

In addition to the above methods of physiological pain relief during childbirth, you can do auto-training to ease contractions. During painful uterine contractions, talk to the child, express the joy of a future meeting with him, and set yourself up for a successful outcome of childbirth. If auto-training does not help, try to distract yourself from the pain during a contraction: sing songs (quietly), read poetry or repeat the multiplication table out loud.

Case study: I gave birth to a young woman with a very long braid. It was her first birth, the contractions seemed very painful to her, and she constantly asked for a caesarean section to stop this “torture.” It was impossible to distract her from the pain until one thought occurred to me. I told her to undo the braid, otherwise it was too disheveled, to comb it and braid it again. The woman was so carried away by this process that she almost missed the attempts.

The process of childbirth is a very exciting and painful process that is difficult to endure not only morally, but also physically. Probably every woman who gave birth during labor was visited by the thought of pain relief. Some say that this is an excellent way to endure childbirth normally, while others believe that pain relief can negatively affect the baby’s health and the process of labor.

Methods of pain relief during childbirth

When contractions begin and later woman experiences severe pain, which can sometimes provoke a malfunction of the heart, breathing and blood pressure. For certain indications, pain relief may be recommended to protect the life of the expectant mother and fetus.

Medical anesthesia

1. Mask anesthesia. With the help of nitrous oxide, a woman is put into a state of anesthesia and thus helped to painlessly endure the period of labor, when the cervix dilates. The medicine is administered by inhalation by inhalation.

2. Endotracheal general anesthesia. The medicine is injected into the lungs through the trachea and provides long-term pain relief. Also, in combination with this type of anesthesia, artificial ventilation is used. The anesthetic consists of several drugs; its use is possible only as prescribed by an obstetrician and anesthesiologist. This type of pain relief is used during a caesarean section.

3. Intravenous anesthesia. Anesthesia is injected into a vein, causing the woman in labor to fall asleep for a short time.

4. Local anesthesia. To reduce the sensitivity of certain parts of the body during labor, a woman may be given an intramuscular injection, which will numb a specific part of the body.

5. Epidural anesthesia. A new and very popular method of pain relief during childbirth. When administering this type of anesthesia, the anesthesiologist inserts a small thin needle between the vertebrae of the woman in labor and injects an anesthetic through it. hard shell spinal cord. This way you can temporarily deprive of sensitivity those parts of the body that are located below the injection site. The good thing about this method is that it allows the woman to be conscious and feel pretty good.

The disadvantage of this method is that without experiencing pain during contractions, it is difficult for a woman to maintain labor and facilitate the birth of a child.

6. Drug pain relief. When choosing an anesthesia method, you should ask what medications are used to relieve pain. Previously, narcotic drugs were widely used, which included tincture of opium, morphine, nitrous oxide and others. It is known that they negatively affect the child’s health to one degree or another. IN modern medicine A relatively safe analogue of these drugs, promedol, is used.

In addition to standard types of anesthesia, there are non-drug methods of pain relief during childbirth.

Non-drug pain relief

1. Psycho-emotional preparation. One of the most important factors in the fight against pain during childbirth. The fact is that women who know what awaits them and understand how childbirth takes place endure contractions easier and less painfully and have better control over themselves.

2. Massage. By stretching, for example, the muscles of the neck, collar area, lower back and back, you can distract a woman from pain in the abdomen and pelvis and relax tense muscles.

3. Reflexology. Acupuncture is considered quite effective method pain relief during childbirth.

4. Hydrotherapy. Staying in a warm bath or shower at a comfortable temperature can temporarily relieve pain and ease contractions.

Only a doctor can decide to prescribe pain relief during childbirth. There are certain indications for this. But if the obstetrician during the birth process sees that severe and prolonged pain weakens the woman in labor, threatens her health, or that she has low pain threshold, he must administer anesthesia so that the birth process ends safely and the lives of the mother and fetus are safe.

The issue of pain relief during childbirth is always relevant for expectant mothers and is resolved every time. individually depending on many factors.

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

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

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

1. As we have already said, the task of pain relief is the woman’s comfort and her readiness for the birth of a child. A quarter of women in labor have a pain threshold so low that, experiencing pain during labor, some simply experience a feeling of panic, may perform inappropriate actions, and do not listen to the doctor’s instructions. In this case, the painkiller used during childbirth is designed to eliminate the woman's restless behavior.
2. Painful sensations are also relieved if the baby is expected to be too large, or twins, and also during long, or, conversely, premature or “rapid” labor.
3. It happens that during the birth process an emergency is required surgical intervention, for example, applying forceps, or removing the placenta. In such cases, special drugs are also used, usually intravenous.
4. The use of an anesthetic is considered effective if there is a risk of fetal hypoxia, or the expectant mother has weak labor. Here the effect is directed in a slightly different direction, and not towards relieving pain. In case of hypoxia, for example, the use of such drugs reduces the risk oxygen starvation at the baby's.

As for the risks associated with the use of drugs that relieve discomfort, then, contrary to the popular belief that this can have a detrimental effect on the child’s health, doctors believe otherwise. As we have already said, the issue is resolved individually each time, and the effect is, of course, primarily aimed at bringing benefit and not harm. Of course, each drug has its own list of contraindications, but we will talk about this a little lower when we look at what exist. modern methods pain relief during childbirth.

Types of pain relief during childbirth

Pain relief techniques during childbirth can be completely different, from the use medicines, to techniques that explain how to relieve pain during childbirth yourself. Let's start, perhaps, with pain relief during childbirth. modern conditions, that is, those methods the main principle of which is one or another introduction of medications into the body.

Drug pain relief during childbirth

Medicines designed to reduce pain during contractions may enter the body in different ways, from inhalations and compresses, to their intramuscular and intravenous administration. Let's take a closer look at how and how labor pain is relieved.

Inhalations

For such labor pain relief, a mixture of nitrous oxide and oxygen is used. This combination is quite effective and is used during dilatation of the cervix. The description of this method, by the way, gives an answer to the question “is labor anesthetized in the first period?”, which includes the time of dilatation. The advantage of this method is that the woman herself determines the degree of pain and takes a breath as needed.

Intravenous anesthesia

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

Sometimes a doctor, when deciding what kind of pain relief to use during childbirth, chooses a drug such as promedol. Although promedol is a narcotic drug, it has been proven that its one-time use will not harm either the mother or the child. This drug is not used on last stage labor, otherwise this method may affect the baby’s respiratory activity; in other words, it will be difficult for him to take his first breath.

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

Epidural anesthesia

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

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Childbirth is natural physiological process, which is the logical conclusion of pregnancy. A specific characteristic of the birth process is considered to be severe pain, which frightens many people. nulliparous women and leaves an indelible emotional mark for the rest of your life, discouraging the desire to give birth again. Anesthesia during childbirth helps create the most comfortable conditions, relieving pain and reducing fear levels. This is very important for those women in labor who have heightened emotional perception - it has been proven that intense pain in such patients it contributes to the development of pathologies during childbirth.

Childbirth is a process that is accompanied by pain, therefore modern world Anesthesia is often used during contractions

The choice of drug for pain relief during childbirth is very limited - the drug should not completely relieve sensitivity, and the muscles should not completely relax, as this leads to a weakening of labor. Currently, all types of anesthesia have their advantages and disadvantages, so each case requires an individual approach.

In addition to pain relief during labor, anesthesia has other important indications. These include:

• A woman has a history of hypertension.
• Increased blood pressure during childbirth.
• Pregnancy complicated by gestosis and eclampsia.
• Chronic diseases respiratory organs and cardiovascular system.
• Somatic pathologies, for example, diabetes.
• Cervical dystocia.
• Discoordinated uterine contractions.
• Individual immunity to pain (the woman describes the pain as unbearable).
• The fetus is in a breech position.
• Large fruit - with natural childbirth in this case, the woman is especially hurt.
• Young woman giving birth.

Methods for pain relief during labor

All types of pain relief during childbirth can be divided into two large groups: medicinal and non-drug methods.

There are also non-drug methods of pain relief, for example, proper breathing during contractions, which can be learned in childbirth preparation courses

Non-drug methods

Non-medicinal include various psychological methods distractions from pain:

• Psychological preparation before childbirth (courses for pregnant women).
• Deep correct breathing.
• Physio- and water procedures.
• Massage of the lower back and sacrum.
• Acupuncture and electroanalgesia.

Non-drug methods are not effective enough to help give birth painlessly, but are completely safe for both the mother and the child, without causing undesirable consequences. Those who are “against” medical intervention in the process of childbirth use the above methods.

Medication methods

Pain relief with special drugs is more effective, but is often very limited by the condition of the mother and fetus. We should not forget about possible unpleasant consequences - almost all anesthetics are able to penetrate the placental barrier and exert their effect on the child - this is the main argument against painkillers. In addition, pain relief is not carried out at all stages of labor.

According to the method of administration, anesthesia can be divided into types:

• Intramuscular or intravenous injections(administration of analgesics in combination with tranquilizers).
• Inhalation method (for example, using nitrous oxide).
• Local anesthesia (injection of the drug into the tissues of the birth canal).
• Epidural anesthesia.

Epidural anesthesia is very popular as it effectively relieves pain during contractions.

Today the most effective drugs Narcotic analgesics such as Promedol and Tramadol are considered to relieve pain during childbirth. In most cases medicinal substance is administered intravenously in combination with antispasmodics (“No-spa”), which help accelerate the process of dilation of the cervix. In addition, tranquilizers can additionally be used to reduce emotional distress. The use of narcotic analgesics is quite limited - it is better not to use them when the cervix is ​​dilated by less than 3 cm, and 2 hours before the period of pushing, the administration of the drug should be stopped. Such measures are associated with the prevention of the development of hypoxia in the fetus. The use of drugs during the first contractions is against the risk of stopping labor - doctors will have to resort to stimulation of the process.

Ketamine and Butorphanol are also used to relieve labor pain. These drugs produce a good analgesic effect, have a reduced effect on the fetus and the process of cervical dilatation, and do not cause negative consequences.

Inhalation analgesia for labor is common in Western countries, where the level of medical care taller. Anesthetics delivered by inhalation do not have negative consequences on uterine contractility, do not penetrate the placental barrier and do not reduce sensitivity, allowing the woman in labor to actively participate in the birth process. The most common inhalational anesthetic is nitrous oxide, or laughing gas. Entering the body, the gas begins to act within a few minutes and is just as quickly removed from the respiratory system. An undeniable advantage This method is possible for its use at the stage of fetal expulsion - other methods of pain relief cannot be used at this stage. In addition, the woman herself can control the administration of the drug, turning on the inhaler at those moments when it is especially painful.

When delivering a large fetus at the pushing stage, you can use local anesthetics - Novocaine and Lidocaine; the injection is given in the area of ​​the pudendal nerve, vaginal and perineal tissues.

Sometimes you have to use local anesthesia, if the fetus is very large, which threatens the mother with ruptures

All obstetricians-gynecologists use a single labor pain relief scheme, which looks like this:

1. On initial stages tranquilizers are administered to relieve fear and tension.
2. After dilation of the cervix to 4 cm with strong pain syndrome it is possible to administer narcotic and non-narcotic analgesics in combination with antispasmodics, and it is also possible to use nitrous oxide.
3. A couple of hours before the period of pushing, the administration of analgesics is stopped, the use of inhalation anesthesia and the administration of local anesthetics are allowed.

Epidural anesthesia

Epidural anesthesia stands apart from all types of anesthesia - it involves the injection of an anesthetic into the epidural space of the spinal canal. Currently, this method of pain relief for the labor process has received wide use due to high efficiency- a woman is installed special catheter between the third and fourth lumbar vertebrae, through which the anesthetic drug enters. The drug has virtually no effect on the fetus, but can somewhat slow down the process of dilatation of the cervix. In many European countries birth process and if the woman in labor does not mind, these are indications for epidural anesthesia. Before carrying out this type of anesthesia, all possible consequences should be assessed as best as possible.

To anesthetize or not?

On the question of whether anesthesia is needed to relieve pain during childbirth, society is divided into two camps - “for” and “against”. Experts agreed that anesthesia brings undeniable benefit with the right approach. Like any medical procedure, pain relief can cause unpleasant consequences both in the mother and in the child, so you cannot use anesthesia whenever and however you want. resort to medicinal methods pain relief should be done when the woman is obviously in a lot of pain, as well as in the presence of other specific indications. In the case when the birth proceeds normally, without complications, then possible risk for pain relief is unjustified. The doctor must compare the risks, carefully weigh the pros and cons, and make a decision on how to give birth based on each specific situation.

We all know that the birth process is accompanied by painful sensations for every woman in labor. Moreover, the pain threshold for every woman giving birth is completely different, as is psychological attitude to childbirth. Therefore, it is extremely important even before the moment of birth to try to tune in to the positive and believe that everything will be fine. Well, both the doctor who is managing the pregnancy and your loved ones and friends whom you trust can help you overcome the fear of childbirth. If your local gynecologist becomes your obstetrician, then this is an ideal option for. After all, during pregnancy you will become a team, discuss all the exciting issues and, for so much 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 medications helps eliminate pain sensitivity in all parts of the body, and also has an effect (usually negative) on consciousness and psychological condition women in labor.
2. General anesthesia, which will provide general anesthesia With artificial ventilation lungs. This method provides a long-term effect, but it is used either for caesarean section or in case of emergency. In this case, the woman in labor is unconscious.
3. Mask anesthesia is a form of anesthesia where an anesthetic is administered through a mask. As a rule, the mask is used during the first stage of labor, when the cervix is ​​dilated 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 on certain parts bodies. As a rule, for local anesthesia an injection with an analgesic is used.
5. Epidural anesthesia also refers to local method anesthesia, where an anesthetic is injected into the space above the dura mater of the spinal cord. After the injection, Bottom part The body becomes insensitive, but the woman in labor is fully conscious and can talk.
6. Local anesthesia is used after childbirth to relieve pain during suturing of soft tissue. In this case, the anesthetic is injected directly into the area of ​​the body that requires intervention.
7. Intravenous anesthesia is used when performing short-term operations during childbirth: release 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 narcotic analgesics. These medications reduce pain during childbirth and allow you to completely relax between contractions.

When is anesthesia necessary during childbirth?

Drug anesthesia is usually necessary in the following cases:

• the contractions are very painful, the woman in labor behaves restlessly;
• the woman in labor has a very
• premature birth;
• C-section;
• long labor;
• multiple births;
• fetal acid deficiency.

Alternative methods of anesthesia during childbirth

TO alternative methods Anesthesia during childbirth refers to measures that can reduce pain without resorting to painkillers. These include: massage, rational breathing, choosing the correct and comfortable position during childbirth, etc. All these methods of pain relief do not require the intervention of a doctor and are noted as very efficient look pain relief for childbirth, without complications. Well, if suddenly something goes wrong, your doctor will immediately decide on one method or another of drug anesthesia.

In conclusion, we note that today there are many ways to eliminate or muffle pain during childbirth. Therefore, you should not be afraid or worry about this. Tune in to the positive, look forward to the moments of anticipation with your “happiness” and be healthy!

Have an easy birth!

Especially for Ira Romaniy

From Guest

Well, it so happened that I had an unplanned cesarean section, but they did an epidural, everything was fine, only my head hurt a little afterwards, but still better than general anesthesia. A strong little baby was born, this is the most important thing)))