Modern methods of pain relief during childbirth: medical and natural pain relief. Types of anesthesia in childbirth

Pain relief during childbirth is becoming more common. And drugs for this purpose are becoming more effective and at the same time safer. Every woman experiences pain during natural childbirth. But each person's pain threshold and level of patience are different. In addition, increased pain may be a signal of a disorder. normal process childbirth.

That is why the question of whether or not to carry out labor pain relief should be decided in different situations differently. If there are no complications, the woman has the right to decide for herself whether to perform anesthesia or not. At the same time, the doctor must inform her about the effect of the drugs on her body and the body of the child, as well as warn about the possible consequences. If, in the process of childbirth, there is a need for additional medical manipulations, or the severity of pain adversely affects the health of the mother and the course labor activity, the doctor can independently decide on the need for anesthesia.

Medical relief of labor pain

Methods of anesthesia during childbirth depend on the health of the expectant mother and baby, as well as on the situation.

If during childbirth there is a need for surgical intervention, general anesthesia will be required. This situation is possible when it is necessary to carry out an emergency caesarean section, when labor has already begun, and complications have arisen. In addition, if it is necessary to surgically remove the placenta, perform curettage of the uterine cavity after childbirth, or suture the cervix. Anesthesia is performed by an anesthesiologist. He provides intravenous anesthesia during childbirth, or injects anesthesia through inhalation.

During the planned caesarean section usually using general anesthesia or epidural anesthesia. If, during general anesthesia, a woman sleeps, and she misses the moment the baby is born, then epidural anesthesia during childbirth allows you not to feel pain even during band surgery, while being fully conscious.

The essence of the method is that a woman is injected with an anesthetic into the interdiscal space of the spine. The anesthetic affects the area of ​​​​nerve endings, and the lower body completely loses sensitivity. The peculiarity of the method is that it practically does not harm the health of either the woman or the baby, but in the case medical error if the spinal cord is injured when the needle is inserted, the consequences can be very serious.

This procedure is also used for conducting natural childbirth. medicinal product given through a very thin catheter. With the right dose, a woman does not feel pain, but she feels tension during contractions and can control the effort during attempts. But there is a possibility that contractions with this type of anesthesia may weaken, and the process of childbirth will be delayed.

If a decrease in the activity of labor pains is required or it is necessary to give the woman in labor a little rest and gather strength, partial anesthesia is used during childbirth, drugs can be administered through an intravenous catheter, by inhalation or in the form of suppositories.

It can be tranquilizers (diazepam, Relanium). They do not have an analgesic effect, but they help relieve tension and help a woman better control her behavior during childbirth.

Antispasmodics, analgesics, and mild narcotic pain relievers such as promedol and lentazocine can be used as pain relievers. The latter also has the function of stimulating the birth process.

The indications for anesthesia are various pathologies and factors that often lead to complications. These include a narrow pelvis of the woman in labor, a large fetus or multiple pregnancy, and neurological disorders at a woman.

Anesthesia during childbirth has a wide variety of reviews. Of course, interference in the natural process of childbirth is not safe for either the mother or the child. Introduced mothers narcotic drugs can inhibit many of the vital functions of the baby, including respiratory. Any anesthesia in natural childbirth can change them normal flow, exposing the baby to additional loads. And epidural and spinal anesthesia are associated with risk to the mother.

That is why if there are no direct medical indications to anesthesia, it is best to use natural pain relief during childbirth, since there are many available and well-known techniques.

How to get rid of pain on your own

During childbirth, a woman cannot control the intensity of contractions, but she can perfectly control her feelings. The main factor that prevents you from enduring pain is ignorance. A woman must understand that the strength of the contractions will increase, and the interval between contractions will decrease. That is why, when contractions are less frequent than every 1.5-2 minutes, you need to distract yourself from them as much as possible, since this is not yet such strong pain. During this period, the ability to move and take a comfortable position helps a lot: stand bent over with support on a chair or bed, bend over, squat down, walk. When contractions become very painful and frequent, you need to concentrate on painful sensations. A woman can easily count to herself or out loud, predicting how long the fight will last, and in how many seconds the next one will come. Deep breathing helps to relax between contractions, and frequent shallow breathing during contractions.

Anesthesia during childbirth helps a woman to more easily transfer the process of the birth of a baby. The development of anesthetic techniques minimizes the risk. Let us consider in more detail the methods of anesthesia during delivery, find out which types of it are preferable, and how to anesthetize contractions during childbirth without drugs.

Do they give pain relief during childbirth?

Childbirth without pain recently seemed impossible. However, the development of medicine allows a pregnant woman to become a mother almost painlessly. At the same time, conditions of maximum comfort are created, which minimize the development of stressful conditions, eliminate fear. Completely docked pain syndrome, and with it, fear disappears on a subconscious level.

It is worth noting that anesthesia during childbirth is sometimes a prerequisite. Without anesthesia, delivery is not possible in the presence of chronic diseases. So, doctors alleviate the suffering of a woman in labor, completely relieve emotional stress. All this has a positive effect on speed. recovery period and its duration.

Pain relief during childbirth - pros and cons

Not all pregnant women choose easy childbirth without pain. Many speak out against anesthesia during this period. Their concerns are related to negative influence on the fetus of the anesthetic component. In addition, such pregnant women are confident that a baby born with anesthesia will be less able to adapt to new conditions. environment. However, modern methods of anesthesia completely exclude the presence of these factors.

Recent studies in the field of obstetrics have shown that competent pain relief in timely delivery, compliance with dosages, minimizes the development of complications. Talking about pain relief during childbirth, doctors call the following positive points:

• reduction of pain syndrome;
• exclusion of stress;
• prevention .

But like any medical procedure, an anesthetic injection during childbirth has disadvantages:

• the development of an allergic reaction;
• weakening of labor activity.

Types of anesthesia during childbirth

Methods of anesthesia during childbirth, depending on the means and methods used, are usually divided into:

• non-drug methods;
• medical;
• regional anesthesia.

The choice of anesthesia technique is determined by the condition of the fetus and the pregnant woman. Doctors consider the possibility of using anesthesia, paying attention to:

• gestational age;
• the number of fruits;
• no contraindications in a pregnant woman.

Non-pharmacological methods of labor pain relief

Non-drug pain relief during childbirth completely excludes the use of medicines. At the same time, doctors use various psychological techniques, physiotherapy,. So it is possible to distract the woman from the pain factor as much as possible, to reduce the suffering associated with the process, the expulsion of the fetus. Among the common techniques:

1. Psychoprophylaxis- conducting courses in which a pregnant woman is introduced to the peculiarities of the childbirth process, they are taught to relax, breathe, and strain properly.
2. Massage of the lumbar region and sacrum- reduces pain, helps to more easily endure the period of cervical dilatation.
3. Breathing technique- helps to relax, not so intense to feel the pain.
4. Acupuncture– installation of special needles in prenatal period helps to remove physical stress prepare a pregnant woman for childbirth.
5. Warm baths- reduce the tone of the uterine muscles, accelerate the process of disclosure, reduce pain.

Medical methods of labor pain relief

As the name implies, these methods of anesthesia involve the use of drugs. An analgesic for labor pain relief is selected individually. It should be borne in mind that such drugs are able to penetrate the placental barrier, so they can be used in a limited way - at a certain period of childbirth and at a dosage prescribed by a doctor. According to the method of administration of the anesthetic, it is customary to distinguish:

1. intravenous anesthesia. It involves the introduction of a drug directly into the general bloodstream, leading to a complete loss of consciousness. The patient is immersed in sleep, while sensitivity is excluded.
2. epidural anesthesia. It involves the introduction of a drug into the region of the spinal cord. As a result, the transmission of nerve impulses from lower divisions body.
3. Inhalation anesthesia. The anesthetic is administered through the respiratory tract.

Medical anesthesia of childbirth has a positive effect on the subsequent rehabilitation of a woman. Future mom does not feel fear emotional tension associated with the upcoming delivery. Modern principles of anesthesia in childbirth have many advantages, including:

• full control of the delivery process;
• no side effects;
• minimal effect on the fetus.

Modern methods of labor pain relief

Modern anesthesia of childbirth completely eliminates the development of complications associated with the use of drugs during the period of delivery. At the same time, the effect of anesthetic drugs on the fetus itself is minimized. It helps to give birth healthy child, accelerates recovery processes female body V postpartum period. Among the widely used modern techniques anesthesia:

• pudendal blockade (injection of an anesthetic into the pudendal nerve area);
• the introduction of drugs into the tissues of the birth canal (reduces sensitivity, reduces pain when the baby passes through birth canal).

Pain during childbirth - epidural anesthesia

Epidural anesthesia during childbirth is widely used due to high efficiency, no effect on the baby. At the same time, it is possible to provide the woman in labor with maximum comfort. The drug is injected into the area between 3 and 4 lumbar vertebrae. Stopping the transmission of nerve impulses eliminates the sensation of pain. The woman herself is conscious and can hear the first cry of her baby, as in natural childbirth.

However, this anesthesia during childbirth has its drawbacks. Among the main ones:

• incorrect behavior of a woman in labor, who does not feel well during the contraction;
• prolongation of the period of expulsion of the fetus;
• the risk of developing acute hypoxia in an infant due to a strong decrease blood pressure Mom.

Intravenous anesthesia during childbirth

Painkillers during childbirth are rarely administered intravenously. It is connected with high risk the development of complications. After the use of most anesthetics, there is a decrease in activity, the development of lethargy, which adversely affects the delivery process. In addition, there is the possibility of reducing the tone of muscle structures, which has a bad effect on the process of fetal expulsion: they become mild, have a short duration and intensity.

Natural pain relief during childbirth

Thinking about how to anesthetize childbirth, women often face natural methods anesthesia. These methods absolutely exclude the use of drugs, are safe for the baby and mother. Their action is aimed at relaxation. Among those:

• use of music therapy;
• massage of the lumbar region;
• physical activity.

How to prepare for childbirth without pain?

Considering the methods of pain relief in childbirth, it must be said that effective method is self-relaxation. Having mastered these skills, a woman will be able to alleviate her condition during childbirth. You need to learn this in advance, even in the process of bearing a baby. In order to control your body, you must:

1. Take a horizontal position.
2. Breathing should be slow and concentrated.
3. Raise one leg, then the other, feeling the tension.
4. Clench one hand into a fist, then the other hand.

Feeling the tension, it is necessary to fix the muscles for 5-10 seconds, then relax. This is done with each part of the body, gradually involving the muscles of the back, legs, abdomen, arms, and pelvis. These pain relief techniques during childbirth will help the woman in labor completely relax between contractions, take a break and continue the process. The delivery itself will be less painful, and complications such as rupture of the vagina and perineum will be avoided.

IN modern society more and more more women do not want to endure the strongest pain during childbirth that accompanies this process. In addition, there are situations when pain relief is indeed a medical necessity. But whatever the reason, anesthesia during childbirth is used almost everywhere, and today we will talk about how exactly it is used, whether it is worth using it, and also pay attention to the variety of options for anesthesia during childbirth.

Types of anesthesia during childbirth

Anesthesia used in natural childbirth can be divided into several categories:

• mask
• local
• intravenous
• Regional

Let's take a look at each method in more detail.

Mask anesthesia

What is this method? A special mask is put on the woman in labor, through which an anesthetic enters the lungs. Nitrous oxide is usually used for this method. In most cases, mask, or inhalation anesthesia, just perfectly relieves pain. In addition, in this case, the woman herself determines the dosage, that is, she inhales the anesthetic when it is really necessary, unlike other methods, when the medicine enters the body continuously.

Local anesthesia

This type is used, as a rule, in order to anesthetize a specific area. Usually applied during application postpartum sutures, or in the case when the doctor needs to surgical intervention, for example, make an incision in the perineum to provide the baby with a more comfortable passage through the birth canal.

Intravenous anesthesia

Here, the analgesic is usually with narcotic effect, administered intravenously. Sometimes the injection is given intramuscularly or subcutaneously. The effect depends on the method. At intravenous administration the effect comes faster, but the effect of the drug lasts less, with subcutaneous and intramuscular injections, on the contrary, the onset of relief should be continued, but the pain sensations will disappear for a longer line. This method of anesthesia is used if the opening of the uterus is much slower than it should be, and the woman in labor is already exhausted by contractions. This will provide her with a short rest.

Regional anesthesia

This method is perhaps the most common during childbirth at the present time. It is used both during natural childbirth and during the operation "caesarean section". Today we will talk about two types of regional anesthesia that are used more often than others.

spinal anesthesia

During spinal anesthesia during childbirth, an anesthetic drug is injected directly into meninges. The effect comes quickly enough - after a few minutes the woman ceases to feel the lower half of the body. By and large, this method of anesthesia is used during a "caesarean section", but sometimes the doctor decides to carry it out with natural flow childbirth. The duration of spinal anesthesia depends on the amount of anesthetic injected and lasts from one to several hours, depending on the situation.

Epidural anesthesia

Epidural anesthesia is also used both in natural childbirth and for "caesarean section". Differs from spinal in several key points. Anesthetic for epidural anesthesia is not injected into the sheath spinal cord, and into the epidural space, using a catheter, which ensures continuous access of the drug to the body of the woman in labor. As a rule, the medication is stopped immediately before the process of expulsion of the fetus, so that the woman can fully push. Another, and quite significant, difference between epidural anesthesia is that with it a woman can move independently, that is, the sensitivity of the lower body is not lost. Although sometimes this can happen as a side effect of overdosing the drug. Anesthesia after the introduction of the catheter occurs in ten to fifteen minutes.

General anesthesia during childbirth

Do not confuse anesthesia and local anesthesia if you are talking with your doctor about pain relief methods that will be used during the birth of your baby. With anesthesia, the woman is completely unconscious, while the use of anesthesia will allow her to immediately see her baby. Anesthesia today is extremely rarely used during childbirth, perhaps only in cases where an emergency "caesarean section" is required and the time for administration local anesthesia No. Childbirth reviews under general anesthesia far from always positive, because every mother would like to see her baby immediately after his birth.

Are unique. The severity of the pain that a mother feels during the birth of a child differs in different women. It depends on many factors, such as the size and position of the fetus, the strength of contractions, pain tolerance. For some women, pain relief is sufficient to use correct breathing and relaxation techniques, others may need anesthesia for childbirth.

May relieve pain during childbirth different kinds anesthesia. Epidural and spinal anesthesia are most commonly used, but there are other pain management options. A woman before giving birth should carefully ask her doctors about possible elimination or pain relief to make the best choice for you and your child.

What are the indications for analgesia in natural childbirth?

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

What types of anesthesia can be used for natural childbirth?

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

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

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

Benefits and possible consequences of using anesthesia during childbirth

Is it possible to give birth without anesthesia?

Should I give birth with anesthesia?

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

Taras Nevelychuk, anesthesiologist, specially for the site site

Useful video

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

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

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

1. Opening the cervix.

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

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

4. Resistance of the pelvic floor muscles.

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

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

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

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

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

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

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

2. Suppress negative emotions, a sense of fear, while not breaking on a long period conscience of the mother.

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

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

5. Do not cause drug addiction with the required course of taking the drug.

6. Be available for use in any obstetric facility.

The following groups of medications are used to anesthetize childbirth:

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

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

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

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

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

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

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

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

Diazepam does not have an analgesic effect, so it is prescribed in combination with narcotic or non-narcotic analgesics. Diazepam is able to accelerate the opening of the cervix, helps to remove anxiety state in a number of women in childbirth. However, it easily penetrates into the blood of the fetus, and therefore causes respiratory failure, a decrease in blood pressure and body temperature, and sometimes signs of neurological depression in newborns.

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

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

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

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

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

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

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

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

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

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

6.​ Epidural anesthesia in childbirth and caesarean section

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

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

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

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

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

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

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

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

The use of any painkillers during childbirth is carried out only by obstetrician-gynecologists and anesthesiologists-resuscitators. Nurses, anesthetists and midwives carry out the appointment of doctors, monitor the condition of the woman in labor and note possible side effects requiring a change in treatment.