Methods of pain relief during childbirth. Methods of pain relief during childbirth: medicinal and non-medicinal - video

Unique. The amount of pain a mother feels during childbirth varies from woman to woman. This depends on many factors, such as the size and position of the fetus, the strength of contractions, and pain tolerance. For some women, using proper breathing and relaxation techniques is enough to relieve pain; others may need anesthesia during childbirth.

May relieve pain during childbirth different kinds anesthesia. The most commonly used are epidural and spinal anesthesia, however, there are other options for pain relief. Before giving birth, a woman needs to carefully ask her doctors about possible elimination or pain relief so you can make the best choices for you and your baby.

What are the indications for pain relief during natural childbirth?

A woman's desire 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 indicated, any childbirth, if the woman wishes, can be anesthetized. However, there are contraindications for many methods.

During natural childbirth, two main types of pain medications are used:

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

Benefits and possible consequences of using anesthesia during childbirth

Is childbirth possible without anesthesia?

Is it worth giving birth with anesthesia?

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

Taras Nevelichuk, anesthesiologist, specially for the site site

Useful video

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

Magazine "9 months"
№01 2006
To relieve pain during childbirth, both non-medicinal methods are used (they do not require syringes, drugs, or doctors) and medicinal methods, which can only be carried out with the help of a specialist.

How can doctors help?

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

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

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

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

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

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

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

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

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

Anesthesia without drugs

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

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

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

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

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

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

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

The right to choose

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

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

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

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

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

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

Pregnancy in a woman’s life is one of the most beautiful periods that will be remembered for a lifetime. The natural end of this period is childbirth. Childbirth, in the understanding of many women, is associated with severe pain; everyone experiences it differently. Quite often, women agree to anesthesia during childbirth because huge amount negative childbirth experiences of other women. However, it is worth understanding that childbirth is individual for everyone, and often you do not need to resort to pain relief. What is anesthesia during childbirth and when is it necessary? We will learn from our article.

Is anesthesia really necessary during childbirth?

The term “anesthesia” originally came to us from the Greek language; literally, it has two meanings:

1. A person's inability to feel anything;
2. Anesthesia for surgical purposes.

Today, pain relief is widely used during the birth process. Doctors strongly recommend that some women in labor use this service. This is due to the fact that childbirth - Long procces, and the body expectant mother individual in its own way. Some women get so tired during contractions that they have no strength left to push. To avoid this, women in labor agree to undergo anesthesia in order to rest from contractions for a while and not feel pain.

Anesthesia also has some placebo effects. Women who agreed to pain relief experience less fear of childbirth, i.e. Anesthesia also has a psychological aspect.

Anesthesia during childbirth can be either medicinal or non-medicinal. We'll talk about this below. Anyway, permissible dose medications must be agreed with a specialist. In some cases there is also certain contraindications to this manipulation.

Be that as it may, when agreeing to anesthesia, a woman must understand that the medicine administered to her will definitely reach the child, therefore anesthesia has both pros and cons. In addition, complete loss of sensitivity during childbirth is extremely undesirable. Natural childbirth is always much better for the baby, but here the issue is already resolved in individually. It is best to resort to anesthesia if there are indications for it.

In some cases, anesthesia is necessary for medical reasons, namely:

1. High blood pressure in a woman in labor, a tendency to hypertension;
2. Preeclampsia in a pregnant woman, preeclampsia;
3. Cardiovascular diseases;
4. Respiratory dysfunction;
5. Diabetes mellitus in a woman in labor;
6. Incorrect position of the cervix;
7. Severe pain from the birth process in a woman, the inability to bear it;
8. Very large fruit;
9. Incorrect presentation of the unborn baby;
10. Explicit fear of the expectant mother before childbirth.

Depending on how the birth proceeds, the doctor decides whether to use anesthesia. There are several types of anesthesia, we will talk about them now.

Methods of pain relief during childbirth

Anesthesia can be either natural (non-drug) or medicinal.

Non-drug methods of pain relief during childbirth

If the woman in labor feels well and tolerates contractions normally, then medical pain relief not used by a doctor. Would be appropriate here natural ways relieve pain and tension, namely:

1. Proper breathing during contractions and pushing;
2. Ability to relax between contractions, distraction;
3. Water birth;
4. Contractions in correct posture, convenient for carrying them;
5. Aromatherapy.

There are other ways to relax during the birth process, these include:

1. Back massage;
2. Hypnosis of a woman in labor;
3. Acupuncture;
4. Taking a warm bath.

Every woman knows better herself that in this moment it will be better for her. We would like to dwell in more detail on the most effective methods of pain relief during natural childbirth.

Activity of the expectant mother during childbirth

During contractions, a woman should be moderately active: sudden movements no use, but lying down isn’t very useful either. Doctors advise doing light exercise to relieve pain. Bends are useful different sides, circular movements of the pelvis, rolling from toe to heel. Many experts recommend using a fitball - contractions are easiest to endure on it, and it is very useful for blood circulation.

Breathing exercises

Breathing during childbirth is the most effective method the most painless way to endure contractions. In addition, it is beneficial for the child - during childbirth he may experience oxygen starvation. With proper breathing, you can minimize pain and set yourself up for a positive experience. You can learn breathing exercises on your own - at special courses for expectant mothers, or at home by watching videos on the Internet.

Massage

During the course, expectant mothers will be told what points there are on the body that can be used to reduce pain. They are located in the lumbar and sacral regions spine. If the expectant mother goes to give birth with her husband or another loved one, you can ask him to give a massage.

Water birth

There is also such a way of easy childbirth - this is birth in water. Today, this method causes a lot of controversy. But if you think that it is optimal for you, then enlist the support of an experienced midwife. Warm water helps a woman in labor relax and concentrate on contractions.

The perinatal period of a baby's life is one of the most important. Childbirth and the first hours of a child’s life leave a serious imprint on its further development.

Drug pain relief during childbirth

Anesthesia during childbirth often occurs with the help of drugs. Below we will talk about modern medications pain relief.

Epidural anesthesia

Epidural and spinal anesthesia are used most often in cases of natural childbirth in a woman. An epidural acts on the area below the back, thereby blocking painful sensations. It begins to act 10 - 20 minutes after administration.

Epidural anesthesia is anesthesia into the spine. How epidural anesthesia is given: the doctor inserts a catheter with medicine into the back area, through which the pain medication is delivered. During the administration of the medicine, the woman must lie still, otherwise there is a risk of getting into the wrong place. All manipulations are performed by an experienced anesthesiologist, after which he monitors the woman’s condition and decides whether a new dose of pain relief is necessary.

This method has both advantages and disadvantages. The advantages include the following:

1. There is virtually no risk for the baby;
2. The cardiovascular system is not exposed to the aggressive effects of the drug;
3. An anesthetic drug can be administered throughout the entire period of labor, depending on the condition of the woman in labor.

Disadvantages of epidural anesthesia:

1. Some women continue to feel pain;
2. The procedure for administering the drug through a catheter requires high professionalism, since it is quite complex to perform;
3. An epidural cannot be administered to a woman in labor during rapid labor, since its effect begins after 20 minutes, which is why the question of whether everyone is given it disappears by itself.;
4. After an epidural, your back sometimes hurts.

Among the types of anesthesia, epidural is one of the safest; there are no complications after it.

Spinal anesthesia

Spinal anesthesia begins to act immediately as soon as the drug is injected into the mother's back, blocking sensations below the chest. It works for an hour or two. In addition, for spinal anesthesia, the doctor uses a very thin needle, which is inserted into the area where the cerebrospinal fluid is located. This type of anesthesia can also be used for caesarean section if strong medications are used.

Additionally, during this procedure, the woman is given a catheter into a vein to avoid possible complications.

Many mothers may be concerned about how long such anesthesia lasts. The answer is: from 2 to 4 hours. The epidural effect is 2 times less, but there are practically no consequences for the back.

Pros of spinal anesthesia:

1. No pain when inserting a needle into the spine;
2. The fetus is not at risk;
3. The cost is lower than epidural anesthesia;
4. The woman sees everything, her consciousness remains clear;
5. Instant effect.

However, this procedure also has disadvantages:

1. After pain relief using this method, the woman should lie down for several hours without getting up;
2. After the puncture, headaches are possible for some time;
3. Possible pain symptoms in back;
4. Development of hypotension.

Pudendal anesthesia

It is also called local anesthesia, since the doctor numbs only the perineal area. A woman may not feel this, since this is done during a contraction. The need for this anesthesia is caused by an episiotomy. Pudendal anesthesia is not harmful for both the expectant mother and the baby.

General anesthesia

General anesthesia is used during childbirth only in case of urgent need, and only for caesarean section. Indications for such a procedure may be sharp deterioration condition of the child or mother, as well as uterine bleeding. The doctor injects the patient with medicine into a vein, after which the woman falls asleep.

Why is it dangerous? general anesthesia? The fact that it affects the fetus, causes drowsiness and deterioration of blood supply, Negative influence on his nervous system and further physical development. However this best method to save both the mother and her baby.

After a while, a woman may experience dizziness, nausea, vomiting, drowsiness, and body pain, but these symptoms disappear the next day.

Inhalation anesthesia

This is an anesthesia for childbirth, which is used when the cervix is ​​not ready to fully dilate, and the woman in labor experiences severe pain from contractions. It does not suppress the birth process, the woman quickly regains consciousness. In addition, this method is the safest.

Postpartum pain relief

Doctors often find that a woman who has given birth experiences severe pain. What complications can occur after childbirth?

1. Spasms of the uterus caused by its contractions;
2. Pain at the sites of ruptures;
3. Inability to go to the toilet;
4. Pain in the chest area;
5. Incorrect attachment to the breast, causing cracked nipples.

If you have the symptoms described above, the doctor will suggest you drink painkillers and apply medicinal ointment. In other cases, pain rarely accompanies a woman, provided she follows the rules of hygiene.

Other methods of self-administered local anesthesia:

1. Shower regularly;
2. Cooling compress on the perineal area (you can use a bottle of water and store it in the freezer);
3. Do not make sudden movements;
4. Postpartum pads can be stored in the refrigerator to minimize pain.

Medicines for pain relief

They are divided into several types:

1. Antispasmodics;
2. Non-narcotic analgesics;
3. Narcotic analgesics;
4. Analgesics;
5. Sedatives.

Antispasmodics

They relieve pain well in women in labor and promote rapid dilatation of the cervix, thereby shortening the stage of labor. Antispasmodics are indicated for young women in labor and older women. There is no risk to the woman's fetus. These include: no-shpa, papaverine, buscopan.

Non-narcotic analgesics

They have an analgesic and psychological effect, relieving anxiety in the woman in labor. These include analgin and tramadol.

Narcotic analgesics

They are safe for the baby, but have a number of side effects for the mother:

1. Nausea, vomiting, dizziness;
2. Difficulty breathing;
3. Sharply reduce blood pressure;
4. Constipation;
5. Depression.

These include Pentazocine, Pethidine, Butorphanol, Promedol. The latter is the most effective in pain relief.

Analgesics

Some pain sensations are blocked, consciousness remains clear. They have many negative consequences for the child and for the mother. This includes opioids and other pain medications.

Sedatives

Their action is more aimed at relieving anxiety in the expectant mother; unfortunately, they do not have the greatest effect on the fetus. in the best possible way. The baby's blood pressure may drop and the heartbeat may increase, respiratory functions. These include Diazepam, Droperidol, Thiopental.

Any painkillers analgesics carry certain risks for the baby and the expectant mother. However, their use in exceptional cases may be justified.

Pros and cons of anesthesia during childbirth

Pain relief has pros and cons. Today, opinions regarding the importance of anesthesia during childbirth are radically divided. Let's consider the advantages of childbirth with anesthesia.

Anesthesia during childbirth: why for?

It’s hard not to notice the obvious benefits of painkillers:

1. The opening of the cervix accelerates, and, accordingly, the time of contractions decreases;
2. The baby passes through the birth canal more successfully;
3. Relieving stress in a woman in labor;
4. Psychoprophylactic effect on fetal hypoxia.
5. The drug does not stay in the baby’s body, the risk is minimal.

Despite the obvious advantages of anesthesia, there are still negative consequences.

Anesthesia during childbirth: why against it?

Even though the risk is minimal, it still exists:

1. Inaccurate administration of the drug;
2. Drowsiness and lethargy of the child;
3. The natural dilatation of the cervix becomes difficult, labor lasts longer;
4. Often contractions stop, which is undesirable for the birth process;
5. Women in labor complain of headaches after anesthesia, nausea, and body aches.

Every woman has the right to decide for herself whether to have anesthesia during childbirth or not. On forums you can often see positive reviews from young mothers regarding pain relief. Many people say that anesthesia during childbirth greatly facilitated contractions and the pushing stage.

Unfortunately, currently everything more women resort to childbirth under anesthesia without visible indications, without thinking about side effects. It is very important to listen to the doctor’s opinion and understand at what stage of labor it is done. In case of rapid labor, anesthesia is contraindicated; in difficult childbirth, it is recommended.

How much does labor anesthesia cost? The price of anesthesia varies depending on the method of anesthesia and the amount of medicine.

Is it painful to have anesthesia? This question worries many expectant mothers. However, if the health of the unborn baby is in the balance, then this issue fades into the background. Childbirth is not easy not only for you, but also for the child. No matter how high-quality modern pain relief techniques are, natural childbirth is always preferable.

The answer to this question largely depends on your preferences and how your labor progresses. All women experience pain differently. Every birth is different. Some women do not require pain relief at all. For others, pain relief gives them more control during labor. Ultimately you have to decide what's best for you.

Whether to use pain relief during childbirth is up to you. But you should take into account the recommendations of your doctor, the capabilities of the medical institution and the specifics of your birth.

Sometimes you don't know what type of pain relief you would prefer until labor begins. For every woman, her birth is unique. In addition, your ability to cope with pain can be affected by factors such as the length of labor, the size and position of the baby, and how you feel when labor begins. It's impossible to predict how you'll cope with the pain of your first labor, and subsequent ones can often go very differently.

Even before the first contractions begin, it's a good idea to think about your preferred method of pain relief. It would also be helpful to discuss this with your doctor. Whatever birth plan you set for yourself, be prepared to change it. Often things don't go according to plan. In addition, when making a decision, remember that childbirth is not a test of endurance. Just because you want pain relief doesn't mean you failed.

What should you consider?

To help you choose the right pain management option for you, ask yourself the following questions when considering your options:

• What is the essence of the method?
• How will it affect me?
• How will it affect the child?
• How quickly will it work?
• How long does the analgesic effect last?
• Do I need to organize anything or practice in advance?
• Can it be combined with other pain relief methods?
• Can I use it at home before going to the hospital?
• At what point in labor can this method be used?

Possible options

These days, women have many more options to ease the pain of childbirth than before. All options are divided into two large groups: medicinal pain relief and natural ways to relieve pain. By exploring all your options in advance, you can make an informed decision about pain management during labor.

Knowledge itself eases the pain. Fear, together with all the circumstances of childbirth, significantly increases the pain. If you know what to expect during labor and have considered all pain management options, you will likely have a smoother labor than those who are stressed and afraid.

Drug pain relief. Medicines to relieve pain are called analgesics. Drugs used for pain relief during childbirth belong to the group of drugs. In experienced hands they are useful and quite reliable. They can be given by injection or intravenously. Depending on the type and dose used, these drugs can be used to either reduce pain (analgesia) or eliminate sensation during a caesarean section (surgical anesthesia). Two examples of pain management techniques used during childbirth are epidural and spinal blocks.

Natural methods. Natural methods of childbirth do not involve the use of drugs. There are many methods, some have been used for centuries. Two examples of such birthing techniques are massage and relaxation.

Drug pain relief

Drug pain relief can be very helpful during childbirth. It relieves pain and allows you to rest between contractions. You may require or refuse pain relief as labor progresses, but remember that different periods childbirth medicines may have different positive and negative effects. When choosing a method of pain relief, you must take into account how labor is progressing and what stage it is at.

The stage of labor at which you receive pain medication is just as important as the type of medication you receive. The medicine the mother receives has an effect on the baby, but the extent of the effect depends on the type of medicine, the dose, and how close to birth. For example, if between the time you receive narcotic pain medication and the time of birth baby will pass With enough time, your body will have time to process the medicine, and after birth the baby will have only minimal effects from the effects of the painkiller. Otherwise, the baby will be sleepy and will not be able to suck. In rare cases, the child may have difficulty breathing. All these consequences are short-term and can be treated if necessary.

Epidural block

It is a local analgesic or anesthetic that can be used during childbirth or before caesarean section. The painkiller is injected into the lower back, outside the fluid duct surrounding the spinal cord. It takes about 20 minutes to install the blockade, and after another 10-20 minutes it will begin to work.

Behind. An epidural block mainly relieves pain in the lower body without slowing down labor too much and is safe for the baby. The medicine flows slowly through the catheter and provides long-lasting pain relief. While receiving pain relief, you remain conscious. By pressing a button, you can receive small additional doses of medication if needed. Some facilities may use a combination of epidural and spinal blocks, which will leave you with enough muscle strength to walk.

Against. The blockade may be less effective on one side of the body than the other. It may also lower your blood pressure, which will slow down heartbeat child. Doctors will constantly monitor your blood pressure and increase it if necessary. In rare cases, you will feel very strong for a few days after giving birth. headache when you get up. If the block was done during a caesarean section, the numbness may spread to your chest and you may have difficulty breathing for a while. Because you won't be able to empty your bladder with an epidural, you will need a catheter. If the epidural block does not work well, another procedure may be needed.

Spinal block

This is a local anesthetic used immediately before a caesarean section or during labor if the baby is expected to be born within two hours. The injection is given directly into the fluid surrounding the spinal cord in the lower back and works quickly.

Behind. The spinal block provides complete pain relief from the chest down for two hours. The medicine is usually given once. You remain conscious.

Against. Just like an epidural block, a spinal block can affect one side of the body less than the other, can lower blood pressure—which slows the baby's heart rate—and cause severe headaches for several days after birth. If the anesthesia affects your chest, you may experience difficulty breathing and a catheter may be needed due to a bladder blockage.

Spinal-epidural combination

This new technique, providing quick and long-lasting pain relief.
The anesthesiologist carefully inserts the epidural needle into your lower back. He then places a thinner spinal needle inside the epidural (so the shot is only given once), passes it through the membrane surrounding the spinal cord, and injects a small dose of medication into the spinal fluid. The spinal needle is removed, the epidural catheter remains.

At the beginning of labor, in the first 1-2 hours, a spinal injection works predominantly. When its effect wears off, the epidural block begins to work.

With any puncture of the spinal canal, neurological complications are possible, both at the time of the blockade and in the long term. If you have had epidural or spinal anesthesia, six months after birth you need to consult a neurologist to rule out further problems.

Drugs

Various drugs can be injected intramuscularly into the thighs or buttocks or intravenously through a catheter. If a catheter is inserted, you can control the dosage. The product takes effect within a few minutes.

Behind. Drugs reduce sensitivity to pain for 2-6 hours. They provide the opportunity to rest without causing muscle weakness.

Against. Drugs can make you and your baby drowsy and have difficulty breathing. The child's reflexes may also become temporarily slower.

Local anesthesia

Local anesthesia does not relieve the pain of contractions, but is used if the vaginal area needs to be numbed, an incision (episiotomy) is needed to widen the vaginal opening, or stitches are needed to close tears after childbirth. The injection is given in the tissue at the opening of the vagina and works quickly.

Behind. Local anesthesia temporarily eliminates pain in a specific location. Negative consequences for mother or child are rare.

Against. Local anesthesia does not relieve pain during contractions. Allergic reactions are possible. In rare cases, giving the medicine into a vein may lower your blood pressure.

Perineal blockade

Used immediately before the baby is born to relieve pain in the perineum. An injection of local anesthetic into the vaginal wall takes effect within seconds.

Behind. Relieves pain in the lower part of the vagina and perineum for about an hour. Negative consequences for mother or child are rare.

Against. The pain from contractions does not go away. The blockade can only affect one side of the vagina. Possible allergic reaction. If the medicine is given into a vein, your blood pressure may decrease.

Tranquilizers

Occasionally, tranquilizers are used to relieve anxiety and provide rest. initial stage childbirth They may be given as tablets, intramuscular injections into the thigh or buttock, or intravenously through an IV. When injected or through a dropper, they act very quickly.

Behind. Tranquilizers relieve anxiety and provide rest for several hours.

Against. Tranquilizers do not relieve pain. May cause drowsiness, reduce your awareness of what is happening, reduce muscle tone and child activity.

Natural Methods

In this case, you preemptively refuse to use medications and rely on other ways to relieve pain.
Natural (non-medical) pain relief works in different ways. They can stimulate the body to produce natural painkillers (endorphins). These substances distract you from pain, calm and relax, helping you better manage yourself.

Natural pain relief methods can help you manage your pain, but they don't completely eliminate it. Many women would do well to try non-drug ways to relieve labor pain before pursuing other options.

Natural pain relief can be very helpful during both early and active labor. Only during the transitional stage, when the cervix dilates to a full 10 cm, and when pushing, women who have chosen natural pain relief, feel significant pain.

Natural methods of pain relief include breathing and relaxation techniques and many other methods.

Breathing techniques

Breathing techniques, like other natural pain relief methods, do not require medications or medical supervision. You control everything yourself. It is assumed to use measured, controlled breathing during contractions. By focusing on your breathing, you take your mind off the pain and relax your muscles so that the tension that aggravates the pain goes away. Deep, controlled, slow breathing also reduces nausea and dizziness. Perhaps more importantly, breathing this way delivers more oxygen to you and your baby.

Better study breathing techniques and practice them before giving birth. They are taught in most childbirth schools. If someone is going to help you during birth, take them with you to school so they can learn breathing techniques and then help you. The more you practice, the easier it will be to use these methods when contractions begin.

Breathing exercises will begin to work immediately as soon as you start doing them. However, these methods are not always successful because they depend on your reaction to labor pains, which cannot be predicted, and on your ability to focus on anything other than the pain. Breathing techniques can be combined with other types of pain relief.

Lamaze method. This is a philosophy of childbirth and a breathing technique used during childbirth. The philosophy states that childbirth is a natural, normal, healthy process, and that education and support give a woman the strength to rely on herself during childbirth. The training focuses on relaxation techniques, but also teaches how to program your body to respond to pain through training and practice. For example, you are taught controlled breathing exercises, which are a much smarter way to deal with pain than holding your breath and tensing your muscles.

Instructors teach expectant mothers to begin and end each contraction with a deep cleansing breath: we inhale through the nose, imagining cold, clean air. We exhale slowly through the mouth, imagining how the tension is released. Deep breathing signals to everyone in labor that the contraction is starting or ending and signals to your body that it can relax.

During childbirth, different levels of Lamaze breathing are used, as described below. When you use this method, start with the first move and continue as long as it works, and then move on to the next level.

• Level 1: breathing at a slow pace. You breathe this way when you are relaxed or asleep. Take a deep, slow breath in through your nose and exhale through your mouth about half as slow as you normally would. If you want, you can repeat the phrase: “I (inhale) calm (exhale),” or “One-two-three (inhale), one-two-three (exhale).” You can breathe in the rhythm of steps or swaying.
• Level 2: breathing at a changed pace. Breathe faster than usual but shallowly to prevent hyperventilation: “One-two (inhale), one-two (exhale), one-two (inhale), one-two (exhale).” Relax your body, especially your jaw. Focus on a rhythm that can be faster at the peak of the contraction and slower as it eases.
• Level 3: breathing according to the model. Use this type of breathing towards the end of labor or when contractions are particularly strong. Rhythm
  a little faster than normal, as in level 2 breathing, but now take short breaths and exhale “ha-ha-ha-hoo”, which will force you to focus on the breath rather than the pain. Repeat. Start slow. Increase the speed at the peak of the contraction and decrease as it weakens. Keep in mind that as you increase speed, your breathing should be shallower to avoid hyperventilation - if your arms or legs feel numb, slow down. Such symptoms can result from too much carbon dioxide leaving the body. If you feel better when you moan or make other sounds, don't be shy. Relax your muscles, keep your eyes open and focus.
• Breathing while holding back efforts. If you want to push, but the cervix is ​​not yet fully dilated and you need to hold back, exhale little by little, as if blowing out a candle, until the urge to push passes.
• Breathing while pushing. When your cervix is ​​fully dilated and your doctor says it's time to push, take a couple of deep breaths and push when you feel the need. Push for about 10 seconds. Exhale. Take another breath and push again. Contractions at this stage last for a minute or longer, so it is important to breathe in at regular intervals and not hold your breath.

Your preferences and scrum patterns will help you decide when to use breathing exercises during childbirth. you can use different techniques and even invent your own. Even if you plan to use medication for pain relief during labor, it is important to learn breathing and relaxation techniques.

Relaxation techniques

Relaxation is the release of tension from the mind and body through conscious effort. By reducing muscle tension during childbirth, you can remove the fear-stress-pain cycle. Relaxation helps your body work more naturally, preserving energy for the efforts yet to come. Relaxation and controlled breathing are the basis of measures that a woman can use to improve her well-being during childbirth. All these methods are usually taught in a childbirth school.

Relaxation does not mean fighting pain, which would lead to even more tension. Instead, it lets the pain roll through your body while you focus on stress-relieving and distracting exercises.

Relaxation is something that can be learned and is most effective if practiced before labor occurs. The more practice you have, the more confident you will feel during labor.

Here are some tips on how to master the art of relaxation:

• Find a quiet place to practice.
• If you want, turn on some soft music.
• Take a comfortable position, lean on the pillows.
• Breathe deeply and slowly. As you inhale, feel the coolness of the air. As you exhale, feel the tension go away.
• Identify areas of tension in your body and focus on relaxing them.

Step by step relaxation. Using this technique, you relax muscle groups between or during contractions, or periodically throughout labor when you feel yourself becoming too tense. Starting from the head or feet, relax one muscle group at a time, moving to the other end of the body. If you find it difficult to isolate the muscles, first tense each group for a few seconds, then relax and feel the tension go away. Please pay Special attention to relax the jaws and hands: many women unconsciously tense their faces and clench their fists during contractions.

Relaxation by touch. This is similar to the previous method, but the twist is that you relax each muscle group as your laborer presses on that part of your body. He may press or rub in a circular motion for 5-10 seconds, then move on to the next area. For example, first they will rub your temples, then the back of your head, then your back and shoulders, arms and finally your legs.

Massage. Various massage techniques can help you relax during labor. These may include rhythmic stroking of the shoulders, neck, back, abdomen and legs; kneading or rubbing the feet and palms; head massage with fingertips. Massage can relieve muscle pain and tension and stimulate the skin and deeper tissues. It can be done at any time. A properly done massage gives a long-lasting effect. Massage helps you relax and blocks pain. Many women experience pain primarily in their back during childbirth, and back massage can really help them.

You may want to apply firm pressure to your lower back as this good way relieve back pain during childbirth.

Even before giving birth, you need to find out with your assistant what types of massage you prefer. But don't forget that things will go much better if during childbirth you are ready to change previously made decisions.

Imagination control. This method helps women during childbirth create an environment where they feel good and calm. This method, also called daydreaming, will help you relax at any time during labor. You need to imagine yourself in a pleasant and quiet place. For example, you imagine yourself sitting on a warm sandy beach or walking in a beautiful green forest. Such a place can be real or imagined. Sometimes your imagination can be helped by recordings of the sounds of the sea surf, rain, birdsong, or any soft music of your choice.

Meditation. Focusing on a calming object, image, or word will help you relax and feel less pain. Focus on one point. It could be something in the room, such as a picture you brought with you, or an imaginary object, or a word you repeat over and over again. When some distracting thoughts enter your mind, let them pass without delving into them, and focus again on the chosen point.

Aromatherapy. To promote relaxation and relieve labor pain naturally, try using soothing scents. At home, you can light a scented candle or aroma lamp. Take a pillow soaked in your favorite scent with you to the maternity hospital. Or use lightly during massage flavored oil. Aromatherapy will help you relax and reduce stress and tension. However, childbirth may increase sensitivity to certain odors, so do not overdo it with scenting. Simple scents like lavender are best.

Music. Music gives you the opportunity to focus on something other than pain and helps you relax during labor. If you have practiced relaxation and breathing techniques with music at home, take these cassettes or disks with you to the hospital or use them during a home birth. Many women use the player to listen to their favorite music and eliminate various distractions.

Other methods

Free movement during labor allows you to find the most comfortable position. So, once you're seated, change your position often to find the one that works best for you. Movement also improves blood circulation. Change position as soon as you feel like it. Some women find rhythmic movements, such as rocking or standing on all fours, to be calming and distracting from pain.

You can also try these methods:

Hot and cold. Applying hot and cold can help relieve labor pain naturally. The purpose of this application is to make you comfortable so that you can relax. You can use hot and cold at the same time. Hot heat relieves muscle tension. You can use a hot towel, a compress, a bottle of hot water, a bag of heated cereal. To reduce pain! hot and cold can be placed on the shoulders, back, lower abdomen. You can use cold compresses, chilled cans of drinks, or ice packs. For many women, back pain is relieved by applying cold ice to the lower back. A cold, damp towel on your face will help relieve tension and keep you refreshed during labor. You can suck on ice cubes - this is also refreshing and distracting.

Shower and bath. In many medical institutions there is a shower in the birth rooms. Sometimes even baths and Jacuzzis to make labor easier. Warm water soothes pain naturally by blocking the transmission of pain impulses to the brain. Warm water helps you relax. You can use this method at home, before going to the maternity hospital. If you are using a shower, you can sit on the seat and direct the water onto your back or stomach. Ask your assistant to join you.

Childbirth ball. This is a large rubber ball that can be used to relieve pain naturally. Sitting or leaning on the ball will reduce discomfort from contractions, relieve back pain and help the baby descend into the birth canal. They can give you a ball at the maternity hospital. Or you will have to buy it and bring it with you. Ask experts to teach you how to use the ball most effectively. Its use can be combined with other techniques such as massage or touch relaxation.

Who is a doula?

This is a woman specially trained to assist in childbirth. Women have helped each other during childbirth for centuries. But the role of a doula is a more formal and modern interpretation of such assistance. Some women prepare to give birth by including a doula in their birth plan.

What is she doing? Its main task is to help a woman during childbirth. It will not replace your doctor or health care providers during labor and delivery. She will offer additional help and advice. Most doulas are mothers themselves. Most also attended childbirth school.

Sometimes doulas start working already at early stage pregnancy, explaining what to expect during labor and helping you create a birth plan. If you wish, a doula will come to your home at the very beginning of labor and provide support during the first contractions.

But their real work becomes apparent in the maternity hospital or hospital. A doula will offer you - and your partner - ongoing support. When labor has already started, she will help, bring you ice or massage your back. It will help you use breathing and relaxation techniques correctly. She will advise which position to choose. What’s even more important is that she will provide you and your partner with moral support and say good words, will calm down.

She can also act as a mediator, helping you make informed decisions during labor and delivery. She will explain medical terms and procedures. She will convey your wishes to the doctor. However, a doula cannot produce medical examinations, assist at the birth of a child, give or not give consent for you to medical procedures.

A doula provides expectant mothers with extra support and attention as they bring their baby into the world. It provides emotional support, which is very important for a woman during childbirth. Some studies show that women who used doula support had fewer complications during childbirth.

However, the help of a doula is not necessary and is not very often used. It is most useful for those who are giving birth to their first child and for single mothers for whom no one can provide long-term help. For most pregnant women, the functions of a doula can be quite successfully performed by a partner or one of the family members. In addition, many maternity facilities have very many staff per patient - often one-on-one - so the help of a doula may be unnecessary if nurses and nannies are willing to offer all the services.

How to find a doula? The doctor at the facility where you are planning to give birth can provide you with a list. Sometimes doula services are offered at the maternity hospital. Some charge a flat fee for all their services, while others use a sliding scale.

Anticonvulsant medications during labor

Anticonvulsant medications reduce smooth muscle tension internal organs, including the uterus. For this purpose, the drugs buscopan or scopol-min are often used. As a supplement to them, painkillers in the form of rectal suppositories or an injection into a vein. Intramuscular injections too painful and generally not recommended.

Anticonvulsant medications at normal dosages do not have side effects per child. But only with very severe pain the effect of these drugs may not be enough.

Tocolytics are a reliable means of stopping labor for a short time (for example, until epidural anesthesia is given).

Painkillers during childbirth

Opiates

There are various medications that affect the perception of pain. Among them, opiates are the most effective.

Initially, opiates were obtained from the juice of unripe poppy pods, but today they are also produced artificially. For many centuries people have known about the effects that opium has. Its ability to reduce pain is based on changing the brain's perception. But despite all the effectiveness of opiates during childbirth, they can only be used in small doses, because they penetrate the placenta and reach the child. And therein lies the problem. The drug, while providing its analgesic effect, simultaneously inhibits the work of the child’s respiratory center. After birth, respiratory depression in the newborn can lead to serious consequences. This is the reason for the limited use of opiates.

The most commonly used medications during childbirth are pethidine (Dolantin), tramadol (Tramal), pyritamide (Dipidolor), buprenorphine (Temgesic) and pengazocin (Fortran). The woman in labor should receive them not intramuscularly, but in the form of a slow intravenous infusion.

Epidural anesthesia

Epidural anesthesia (EA) is today the main method of pain relief. It is reliable, safe and very rarely leads to complications. The undeniable advantage of PDA is that it does not turn off consciousness and does not affect side effect per child. Women experience an epidural as a great relief, especially if contractions are extremely painful or labor has been going on for too long.

With this method, the anesthesiologist, under local anesthesia, inserts a thin catheter through a hollow needle into the spinal canal. Having secured it with a plaster, he injects anesthetic medicine through it into the spinal canal. local action, which effectively relieves pain within 30 minutes. If necessary, additional doses can be injected through the catheter. Anesthesia often causes weakness in your legs, so that you are no longer able to walk or your mobility is limited. But with the appropriate dosage of the medication, childbirth is possible both standing and sitting.

Sometimes, in case of unsuccessful insertion of the cannula, pain relief occurs only partially or only on one side. But usually the anesthesiologist quickly corrects the situation. Just be sure to tell him if you continue to feel pain.

The moment for PDA does not depend on the degree of opening of the uterine pharynx. You can ask for an epidural even when labor is already well advanced and the baby is expected to be born within just a couple of hours. This will not cause any negative consequences for you or your baby.

Women often fear that due to PDA they will not be able to be active enough during childbirth. But there is no cause for concern in this regard. The anesthesiologist selects the dose of the medication in such a way as to achieve pain relief, but without affecting the muscles. So you will be quite capable of actively pushing during the expulsion phase of the fetus.

In some exceptional cases, the use of epidural anesthesia as a means of pain relief during childbirth should be abandoned:

• if a woman is not sure that this will help her;
• at strong fall maternal blood pressure;
• for blood clotting disorders;
• at infectious disease mothers;
• for acute oxygen starvation child;
• during childbirth in water;
• with intolerance to painkillers.

Special types of PDA

For pain relief, doctors have at their disposal additional methods, which, however, are rarely used due to high efficiency PDA.

Patient-controlled epidural anesthesia (PACEA). This method allows you, within certain limits, to control the dosage of the painkiller using a pump.

Combined spinal-epidural anesthesia (CSEA). With this method, the medication is first injected directly into the spinal canal and then injected through a catheter as needed. Pain relief occurs very quickly.

Spinal anesthesia (SA) at the last minute. This method is used when labor is already close to completion and we're talking about about relieving pain for just the remaining two to three hours. In this case, the anesthetic drug is also injected directly into the spinal canal. But an epidural catheter is not installed - usually it is no longer needed: the child is born before the effect of the drug wears off.

General anesthesia during childbirth is an exceptional case

General anesthesia during childbirth is used only in the event of an unexpected deterioration in the condition of the mother or child, when surgery becomes inevitable. In all other cases, preference is given local anesthesia. The risks associated with it are significantly lower than with general anesthesia.

Unfortunately, none of the currently known methods of drug pain relief for childbirth is perfect. All of them, in one way or another, affect the fetus and the duration of labor and their use is not always possible. However, there are methods of pain relief that have no contraindications for mother and baby.

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

Active position

The first and most important factor in reducing pain from contractions is active behavior during childbirth. This term refers to the free behavior of a woman in labor, constantly changing positions and moving around the ward, searching for the most comfortable body position. The movements themselves significantly reduce the overall sensation of pain. And not only because any action is distracting.

Firstly, the level of pain depends on blood circulation. During the fight muscle fibers The uterus contracts, expending energy. The main “energy fuel” for the functioning of all cells in our body is oxygen; myometrial cells (uterine muscles) are no exception. As is known, oxygen is contained in arterial blood; therefore, cell respiration depends on the level and speed of arterial blood flow. When the body is stationary, the overall blood flow decreases, the supply of oxygen to the uterine muscle slows down and pain increases. If a woman in labor walks around the ward or moves within comfortable posture, due to movement, the level of blood flow increases, and the uterine cells are better supplied with oxygen. Therefore, with active behavior during childbirth, the pain from contractions is much weaker than with a stationary position. Even if, for medical reasons, a woman in labor cannot get up, she can behave actively during a contraction - sway, spring on the bed, spread her knees and bring them together. These minor movements significantly reduce the pain from contractions.

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

Movements during childbirth can be very diverse. If childbirth proceeds without complications, the choice of the type of movements during contractions remains with the woman in labor. In this case, there is one, but very important limitation. At no stage of labor should you make sudden, jerky movements. Here are examples of the most common types of active behavior during a contraction:

• walking along the ward or corridor;
• bending to the sides and forward;
• stretching and turning the whole body;
• rocking and rotating movements of the pelvis;
• shifting from foot to foot;
• transferring body weight from toes to heels and back;
• half squats;
• flexion and arching of the spine;
• in a lying position: swinging the pelvis, turning from side to side, springing movements of the hips, abducting and spreading the legs.

During contractions, you should behave freely, choosing the most comfortable body position. There are many well-known positions that reduce discomfort during contractions and help you relax. The main principle by which a woman in labor chooses a position during labor is the level of comfort, stability and relaxation. Most birthing poses use four points of support and a predominantly vertical body position; There are also “lying” poses. However, in order for the poses to help, you should change your body position as often as possible and remember to move a little within any pose. To reduce pain during labor, try taking the following positions during contractions:

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

There are so-called “partner poses” for which the woman in labor will need an assistant. Here are a few of the simplest and convenient positions for pain relief from contractions:

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

IN Lately In many maternity hospitals, women in labor are allowed to use a fitball to relieve pain during labor. A fitball is a rubber exercise ball commonly used for aerobics and Pilates. With the help of a fitball, you can take a wide variety of poses, easily changing one to another, guaranteed relaxation and continuous movement, while saving energy. For use during contractions, the fitball is not fully inflated so that it remains soft and springy. You can take all the poses listed above on the ball; In addition, there are special poses with a fitball:

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

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

Pain relieving breath

The most effective way to relieve labor pain is with special breathing techniques. The analgesic effect of breathing is based on hyperoxygenation - oversaturation of the blood with oxygen. The respiratory center of the brain, registering excess oxygen in the blood of a woman in labor, sends an impulse to the pituitary gland, the main hormonal gland of the body, responsible for the release of endorphins. These substances, called “pleasure hormones,” regulate a person’s pain sensitivity threshold. The more endorphins are released, the higher the pain threshold; that's why correct breathing during contractions and pushing, it relieves pain no worse than analgesics.

Breathing techniques can be used at any stage of labor without restrictions. They are applicable in any body position and help equally effectively with normal course childbirth, and with the development of various deviations of labor.

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

By the middle of the first stage of labor, when contractions increase and become painful, “candle breathing” helps a lot. This is frequent shallow breathing, in which a short inhalation is made through the nose and exhalation through the mouth (as if we are blowing out a candle). As the contractions intensify, breathing becomes more intense, but still remains very rapid. You should only breathe in this way during a contraction; after the pain stops, the woman in labor does deep breath and exhale, evening out your breathing, and rest until the next contraction.

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

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

Magic touches

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

The most “popular” massage area for women in labor is the lower back, or more precisely, the sacral region. The sacrum is the fixed connection of the vertebrae at the bottom of the spine. The sacrum is located in this area of ​​the spinal cord nerve plexus: ganglion, innervating the uterus and other pelvic organs. By stimulating the sacral area (lower back in the middle) during contractions, the woman in labor blocks the transmission of nerve impulses, thus reducing pain. Massage can be performed with one or two hands, massaging the area with the pads and knuckles of the fingers, the base of the fist, the base of the palm, inside palms or a hand massager. Movements during a massage can be stroking, pressing, patting, pinching and even lightly tapping the area to be treated. To prevent irritation from occurring on the skin of the sacral area, you can periodically lubricate it with cream or oil. If you haven’t stocked up on massage oil, don’t worry: ask your midwife for liquid Vaseline oil, which is always available in the maternity hospital.

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

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

The next massage option is most convenient to use while lying on your side or sitting on a ball. Hold it down internal sides palms to inner surface hips. During a contraction, move your hands with pressure, without lifting your palms, from the groin to the knees and back. The recurrent nerve passes through this area, innervating pelvic organs. Massaging the inner thigh helps reduce pain and maximize relaxation.

In partner childbirth, the assistant can constantly perform a light relaxing massage of the whole body, avoiding only the chest, perineum and abdomen of the woman in labor. Touch of hands loved one calms the expectant mother and helps her relax better.

Water as a helper

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

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

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

If childbirth proceeds without complications, you can visit the shower quite often throughout the first stage of labor. For this, two conditions are necessary: ​​the presence in the maternity unit of a shower equipped for women in labor, and the ability to observe the expectant mother during water procedures. Shower stalls for women in labor are made open (without doors - to allow medical observation), trays with a “non-slip” coating are used, and comfortable handrails are installed on the walls. During the entire stay in the shower, a midwife or doctor must remain with the expectant mother. Of course, this is only possible in the case of individual management of childbirth; however, during a partner birth, the spouse of the woman in labor can become an “observer” and assistant.

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

The birth of a child is the most wonderful event in a woman’s life. Of course, the process preceding this event requires a lot of strength and patience from the expectant mother. But you shouldn’t expect pain and unbearable pain from childbirth; childbirth is rewarding work. And if a woman has prepared for childbirth, knows how to help herself and goes into labor with a smile, this exciting event becomes a real holiday. And pain has no place at the holiday!