Types of anesthesia for natural childbirth. Modern methods of pain relief during childbirth: medication and natural pain relief

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. Held general anesthesia 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, chale in emergency cases.

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

Local anesthesia. When using local anesthesia Only certain parts of the body are deprived of pain sensitivity.

Epidural anesthesia. One of the forms of local anesthesia, which is provided by the introduction of a solution local anesthetic into the space above the dura mater of the spinal cord. 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 lower section spine - this is 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. The drug (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 syndrome which requires the use of medications);
large fruit;
long lasting labor;
premature birth;
weakness labor activity(shortening and weakening of contractions, slowing down the dilation of the cervix, 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

Massage

Pain relieving massage- this is an effect on certain points at which 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 get proper rest in the periods between them.

Rational breathing- there are several breathing techniques, which help to endure contractions easier. 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- it’s good if the expectant mother knows that during a normal, uncomplicated birth, you can take different positions and choose the most comfortable one, in which this particular woman in labor can more easily endure contractions. Active behavior 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- using water to relieve pain during contractions. IN different situations During contractions, you can still use the bath or shower.

Electroanalgesia- usage 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 antenatal clinic or at a pregnancy school that will teach you proper breathing during childbirth, they will show rational postures and help you master relaxation methods.

Postures, breathing, pain-relieving massage, hydrotherapy during normal labor can be used with almost no restrictions. IN maternity hospital You should consult your doctor about this. In some situations (when breech fetus, with 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 medicinal methods in the presence of medical indications depending on the condition of the mother and child at the time of birth.

When using drug anesthesia, the anesthesiologist first conducts a conversation with the woman, talking about the essence of the method that is planned to be 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 that states that a particular method of drug pain relief will be used at the request of the woman, drug pain relief 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.

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

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

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

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

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

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

Types of pain relief during childbirth

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

Drug pain relief during childbirth

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

Inhalations

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

Intravenous anesthesia

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

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

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

Epidural anesthesia

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

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Pain management during childbirth is becoming more common. And medicines for this purpose are becoming more effective and at the same time safer. During natural childbirth, every woman experiences pain. But each person's pain threshold and patience level 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 perform labor anesthesia must be decided differently in different situations. If there are no complications, the woman has the right to decide for herself whether to undergo pain relief or not. In this case, the doctor must inform her about the effect of the drugs on her body and the child’s body, and also warn about possible consequences. If during the process of childbirth there is a need for additional medical manipulations, or the severity of the pain negatively affects the health of the mother and the course of labor, the doctor can independently decide on the need for pain relief.

Medicinal relief of labor pain

Methods of pain relief 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 surgical intervention, will be needed general anesthesia. This situation is possible when it is necessary to perform 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 place stitches on the cervix. Anesthesia is performed by an anesthesiologist. He provides intravenous anesthesia during childbirth, or administers anesthesia through inhalation.

When performing a planned caesarean section, general anesthesia or epidural anesthesia is usually used. If a woman is asleep during general anesthesia, and she misses the moment of the birth of the baby, then epidural anesthesia during childbirth allows you not to feel pain even during a strip operation, while being fully conscious.

The essence of the method is that the woman is injected with an anesthetic into the interdisc space of the spine. The anesthetic affects the area of nerve endings, and the lower part of the 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 insertion of a needle causes injury to the spinal cord, the consequences can be very serious.

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

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

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

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

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

Pain relief during childbirth has a wide variety of reviews. Of course, interfering with the natural process of childbirth is unsafe for either the mother or the child. Introduced mothers narcotic drugs can depress many vital functions of the baby, including respiratory. Any anesthesia during natural childbirth can change it normal course, exposing the baby to additional stress. And epidural and spinal anesthesia are associated with risks for the mother.

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

How to get rid of pain yourself

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

Despite the constant development of medicine, anesthesia during childbirth is still not mandatory procedure. Much depends on the characteristics of the pain threshold of the woman in labor: if she can endure a natural birth without the use of painkillers, they are not used unless there is an indication for this. Used much less frequently during childbirth general anesthesia drugs that immerse a person in deep dream, but they are unsafe for the child, so it is most often recommended to resort to spinal or epidural anesthesia.

During pregnancy, many women are interested in issues of pain relief during childbirth, since it is no secret that the process is always associated with pain, which can be long-lasting and unbearable. They ask the doctor questions: is it possible to give birth without using pain relief methods and what is better - epidural anesthesia or general anesthesia? Modern methods anesthesia is considered relatively safe for both the mother and her child, and makes childbirth more comfortable for the woman.

Types of pain relief during natural childbirth

There are non-drug (natural) and medicinal methods of pain relief. Natural Methods completely safe and effective. These include: breathing techniques, massage, acupuncture, aromatherapy, relaxation, etc. If their use does not bring results, they resort to drug pain relief.

Methods of drug anesthesia include:

epidural anesthesia;
spinal anesthesia;
local anesthesia;
inhalation anesthesia;
general anesthesia.

In natural childbirth, they resort to the use of epidural and spinal anesthesia.

Epidural anesthesia

Epidural anesthesia qualitatively eliminates sensitivity in the lower part of the mother's body, but it does not affect her consciousness in any way. The stage of labor at which the doctor uses epidural pain relief varies from patient to patient depending on their pain threshold.

During epidural anesthesia, the anesthesiologist and obstetrician assess the condition of the mother and the unborn child, and also refer to the history of anesthesia in the past and the course of previous births, if any.

With epidural anesthesia, the drug is injected into the space of the spine in which the nerve roots. That is, the procedure is based on nerve blockade. This type of pain relief is usually used during natural childbirth to ease the process of contractions.

Technique:

the woman takes the “fetal” position, arching her back as much as possible;
the injection area is treated with an antiseptic;
an injection with an anesthetic drug is made into the spine area;
after the medicine begins to act, a thick needle is punctured into the epidural space until the anesthesiologist feels the dura;
after this, a catheter is inserted through which anesthetics will enter the woman’s body;
the needle is removed, the catheter is secured with adhesive tape on the back and a trial administration of the drug is carried out along it, during which the doctor carefully monitors the woman’s condition;
The woman should remain in a lying position for some time to avoid complications. The catheter remains in the back until the end of labor, and a new dose of medication will be injected through it periodically.

The catheterization procedure itself takes no more than 10 minutes, and the woman must remain as still as possible. The drug begins to act approximately 20 minutes after administration. For epidural pain relief, medications are used that do not penetrate the placental barrier and cannot harm the child: Lidocaine, Bupivacaine and Novocaine.

Indications for epidural anesthesia:

kidney disease;
myopia;
young age of the expectant mother;
low pain threshold;
premature labor;
incorrect presentation of the fetus;
heavy somatic diseases eg: diabetes mellitus.

Contraindications:

heart and vascular diseases;
poor blood clotting;
spinal injuries and deformities;
high risk of uterine bleeding;
inflammation in the puncture area;
increased intracranial pressure;
low blood pressure.

Positive sides:

a woman can move relatively freely during childbirth;
state of cardio-vascular system more stable in contrast to general anesthesia;
pain relief has virtually no effect on the fetus;
the catheter is inserted once for an indefinite period, so if necessary, medications can be administered through it required period time;
a woman will see and hear her child immediately after birth.

Negative sides:

the likelihood of an inadequate result of pain relief (in 5% of women the effect of the anesthetic is not achieved);
complex catheterization procedure;
the risk of intravascular administration of the drug, which is fraught with the development convulsive syndrome, which, although rare, can cause the death of a woman in labor;
the drug begins to act only after 20 minutes, so with rapid and emergency childbirth the use of epidural anesthesia is not possible;
if the drug is administered through arachnoid membrane, then a spinal block develops, and the woman requires emergency resuscitation.

Spinal anesthesia

Spinal anesthesia, like epidural anesthesia, is performed in almost the same way, but using a thinner needle. The difference between spinal and epidural anesthesia is as follows: the amount of anesthetic for spinal block significantly smaller, and it is introduced below the border of the spinal cord into the space where the cerebrospinal fluid is localized. The feeling of pain relief after injection of the drug occurs almost immediately.

The anesthetic is injected once into the spinal cord canal using a thin needle. Pain impulses are blocked and do not enter the brain centers. The proper result of pain relief begins within 5 minutes after the injection and lasts for 2-4 hours, depending on the chosen medication.

During spinal anesthesia, the woman in labor also remains conscious. She sees her baby immediately after birth and can put him to her breast. The spinal anesthesia procedure requires mandatory venous catheterization. A saline solution will flow into the woman's blood through the catheter.

Indications for spinal anesthesia:

gestosis;
kidney disease;
diseases of the bronchopulmonary system;
heart defects;
high degree of myopia due to partial retinal detachment;
incorrect presentation of the fetus.

Contraindications:

inflammatory process in the area of intended puncture;
sepsis;
hemorrhagic shock, hypovolemia;
coagulopathy;
late toxicosis, eclampsia;
acute pathologies of the central nervous system of non-infectious and infectious origin;
allergy to local anesthesia.

Positive sides:

100% guarantee of pain relief;
the difference between spinal anesthesia and epidural implies the use of a thinner needle, so the manipulation of drug administration is not accompanied by severe pain;
medications do not affect the condition of the fetus;
the muscular system of the woman in labor relaxes, which helps the work of specialists;
the woman is fully conscious, so she sees her child immediately after birth;
there is no likelihood of systemic influence of the anesthetic;
spinal anesthesia is cheaper than epidural;
the technique of administering the anesthetic is more simplified compared to epidural anesthesia;
quickly obtaining the effect of anesthesia: 5 minutes after administration of the drug.

Negative sides:

It is not advisable to prolong the effect of anesthesia for longer than 2-4 hours;
after pain relief, the woman should remain in a supine position for at least 24 hours;
headaches often occur after a puncture;
Several months after the puncture you may experience back pain;
the rapid effect of anesthesia is reflected in blood pressure, provoking the development of severe hypotension.

Consequences

The use of anesthesia during childbirth can cause short-term effects in the newborn, for example: drowsiness, weakness, depression respiratory function, reluctance to take the breast. But these consequences pass quite quickly, since medicine, used for pain relief, gradually leaves the child’s body. Thus, the consequences of drug anesthesia of labor are due to the penetration of anesthesia drugs through the placenta to the fetus.

Fear of pain during childbirth is rooted in a woman’s soul from the very beginning, and even after giving birth once, she can continue to be afraid. It is clear why it occurs; everyone says that there is nothing more painful than childbirth. Someone compares the pain of childbirth to breaking 20 bones at once, someone says that it was the greatest pain in his life.

If you are expecting a child, you, of course, try your best to be positive. Thanks to the availability of information, there comes an understanding that this is a natural process that should not cause much pain. By the end of the term, you calm down and the desire to end the pregnancy becomes stronger than these fears. But the question of whether childbirth is easier still remains. Even the most confident person should have hope that if it suddenly hurts too much, they will help him.

Do they take painkillers during childbirth?

Of course, do easy birth and can be painless, and analgesics during childbirth in one form or another are now used by almost 90% of women in labor. You can do it in such a way that the woman will simply oversleep them, and she will have to be woken up at the most crucial moment.

Painkillers during childbirth have even become a source additional income maternity hospitals, almost everywhere you can get this service for a fee ( we're talking about about epidural anesthesia). At the antenatal clinic you may be given a list of things you need for the maternity hospital; it may still include medications, designed to ease contractions.

Now you have plenty of chances to think through childbirth, although from the point of view of what is best for mother and child during physiological childbirth, birth without drugs is, of course, preferable.

How can you relieve pain during childbirth?

There are several options to make childbirth painless. They differ in effectiveness and safety. Another question is whether this is necessary. Sometimes loss of pain sensitivity is vital. For example, if contractions are strong, frequent, but ineffective, and the cervix does not open.

For this process The following methods are used:

Physiological. This is a relaxing lower back massage, calm music, special breathing techniques and exercise, bath and shower.
Spinal and - a special injection during childbirth in the spine with the introduction of drugs to spinal cord. The most reliable and modern method. This injection during childbirth begins to act literally after 5 minutes, completely relieving pain.
Other drugs are also used during childbirth, which are administered intramuscularly, intravenously and in other ways. These are mainly antispasmodics, narcotic analgesics and drugs affecting the central nervous system. Nitrous oxide (an anesthetic) is even used, which the woman breathes through a mask, independently adjusting the degree of pain relief.
Acupuncture and other physiotherapeutic methods of influence. Not used in all maternity hospitals.

It also happens: at the end of the second stage of labor, very intense, frequent contractions occur for about 40 minutes - 1 hour, leading to complete dilatation of the cervix. The fatigue that has accumulated over the past hours makes itself felt, a strong feeling of pressure appears on the bottom, the baby presses his head on the cervix and sacral plexus, the head presses tightly against the entrance to the pelvis and there is very little time left before the baby is born.

The woman who says a firm “no” to everyone medical interventions, at this time it may simply break. It is at such moments that a woman in labor most often screams - give me a caesarean section, do at least something, stop this! But right now it’s too late to do anything. If a woman in labor is given a medicine that really relieves pain, the baby may have complications after birth, for example, respiratory depression.

And then necessary injection They act as a placebo. For example, no-spa is introduced, which generally has no effect on the uterus. This injection is given only to calm the mother while she waits for it to take effect - she will have time to give birth.

How to relieve pain during childbirth yourself

The degree of severity of pain during childbirth largely depends on how the woman in labor perceives the birth act. If you resist contractions and clamp down, then your body quickly gets tired and you begin to feel pain. It often happens that a woman initially expects pain during childbirth and thereby provokes its appearance. This vicious circle- the stronger you resist contractions, the more pain, the stronger the pain, the more you clamp down. The uterus is working with all its might, but the cervix cannot open - you prevent it from doing this with your fear.

The pain syndrome increases due to the accumulation of lactic acid in the muscles of the uterus and its resistance to itself: some muscles work to open, while others spasm and do not allow it to open. Due to the fact that currently almost all expectant mothers have the opportunity to attend childbirth preparation courses, you have the opportunity to learn in advance how to relieve pain during childbirth yourself.

During the courses you will learn everything about special breathing and relaxation techniques during childbirth, about exercises that help, you will tune in to the fact that giving birth is not painful, and should not be painful. It’s good if your partner, not necessarily your husband, is with you during the birth. Even your mother, aunt or friend can act as an assistant during childbirth. She needs to take these courses with you. Here they will teach you how to do a relaxing massage during childbirth, breathe with the woman in labor, support and guide her at the right moment.

Yes, childbirth cannot be completely painless. Unpleasant sensations Of course there will be. You can partly influence how much discomfort and pain you will feel. And remember that if you suddenly fail, there is alternative ways relieve pain, analgesics are used during childbirth, if you need it, they will help you.