Names of painkillers during childbirth. Pain relief for childbirth - indications, methods, consequences, reviews, price

Women experience pain differently. For some, special breathing techniques are enough to successfully overcome pain during childbirth; for others, pain management is recommended.

The choice of medications that help overcome pain during childbirth is large. We recommend studying possible options In order to subsequently make the right choice: discuss all possible options with your obstetrician long before the day of birth, so that at the right time you have all the necessary information.

It should also be remembered that in each individual case, the choice of painkiller depends on certain conditions and characteristics of childbirth and the woman’s health condition. The doctor will assess your condition, comfort and health during childbirth and help you decide on the method of pain relief.

You should not feel guilty about asking your doctor for pain relief. Only you know best how you feel, so only you can make decisions regarding pain relief during childbirth. Moreover, there is no need to worry about the safety of the pain medication. All drugs used for pain relief during childbirth are safe - both for you and for the baby.

Medicines for pain relief during labor and childbirth

There are three ways to relieve pain during labor and childbirth:

Local anesthesia is used during childbirth to numb a specific area or after birth if stitches are needed.

Regional anesthesia (epidural, spinal) is used by an anesthesiologist (a doctor who administers pain medication) during childbirth in order to reduce pain pleasant sensations. For both epidural and spinal anesthesia, anesthetic is injected into bottom part back, close to the nerves, which allows you to block pain over a large area of the body, while allowing you to stay awake. Regional anesthesia significantly reduces discomfort and pain during childbirth. It is also used if a caesarean section is necessary.

General anesthesia means insensitivity to pain with complete loss of consciousness. General anesthesia is safe, however, it is used extremely rarely, only when emergency conditions, because it does not allow the mother to see the child immediately after its birth.

In addition, pain medications may be injected into a vein or muscle to numb the pain. In this case, pain sensations are not completely blocked, however, you will feel much less pain. This method is used mainly at the beginning of labor so that you can rest and gain strength before giving birth, since the drugs affect the entire body and can cause drowsiness in you and the baby.

What is the difference between epidural and spinal anesthesia?

Spinal anesthesia involves injecting a drug into the middle of the dura mater, which is located next to the spine. For epidural anesthesia, the drug is injected into spinal column, outside the bursa surrounding the spinal cord.

Spinal anesthesia requires less drug than with an epidural; Moreover, spinal anesthesia works faster, however, it is more likely to cause headaches and low blood pressure.

How is regional anesthesia performed?

If you ask for regional anesthesia, you may have an epidural or spinal anesthesia, or a combination of these types of anesthesia. Your doctor will choose the type of regional anesthesia based on general condition Your health and how the birth proceeds.

After the anesthesiologist takes your medical history, he will numb a small area in your lower back with a local anesthetic. The anesthesiologist will then insert a special needle into the numb area to find the desired position and administer an anesthetic. After administering the drug, the anesthesiologist will remove the needle. In most cases, the doctor will leave an epidural catheter—a small plastic tube—at the site where the needle was inserted to administer medications during labor, if needed.

During the procedure, the woman can sit or lie on her side.

At what point during contractions is regional anesthesia performed?

The optimal time for regional anesthesia depends on the progress of labor, your condition, and the condition of the baby. Your obstetrician-gynecologist will choose best time for anesthesia.

Will anesthesia affect the baby?

Numerous studies have shown that regional anesthesia, both epidural and spinal, is safe for mother and baby.

How quickly will the anesthesia take effect and how long will it last?

Epidural anesthesia begins to take effect 10-20 minutes after administration. The analgesic effect lasts as long as you need it, since the drug can be administered through a catheter at any time.

Spinal anesthesia takes effect immediately after administration. The analgesic effect lasts about 2.5 hours. If labor is expected to last longer than this time, you will have an epidural catheter inserted to continue the drug.

Will you feel anything after the anesthetic is administered?

Although you will feel significant relief from the anesthesia, you may still feel pressure from the contractions. You may also feel pressure when being examined by a doctor.

Will I need to stay in bed after receiving regional anesthesia?

Not necessary. The anesthesiologist can provide pain relief so that you can sit in a chair or walk. Sitting and walking can promote labor. If you want to know more about this, ask your doctor about walking with an epidural. However, it should be remembered that this type of anesthesia is not possible in all cases.

Will regional anesthesia slow down labor?

For some women, contractions and labor slow down a little after regional anesthesia—not for long. Most women, however, find that regional anesthesia helps them relax, improves contractions and allows them to rest.

Nature arranged everything very wisely and harmoniously. Childbirth is natural process , and if it proceeds normally, the sensations that arise during childbirth cannot even be called pain. It is clear that these sensations cannot be called pleasure either. It is rather difficult, but very joyful and productive work, which any woman can handle.

The most beautiful thing about normal, natural childbirth is the feeling that your body is doing great work, which inevitably leads to great joy. It is very important for a woman give birth yourself, experience all stages of childbirth, and fully enjoy your well-deserved reward. The moment when a mother takes her newly born child in her arms and puts it to her breast is truly an incomparable moment of the most complete happiness.

Natural childbirth without stimulation and other drug interventions is possible easy and effective pain relief natural methods. These are methods that the mother herself can come to intuitively, they are suggested by nature and confirmed by scientific research.

Relaxation is the basis of labor pain relief

The biggest and important secret, which will help the mother relieve labor pain as much as possible and even get joy from the process- this is relaxation. This skill must be acquired during pregnancy. A calm, relaxed state of the mother greatly contributes to a successful and easy birth.

All methods natural pain relief work to relax a woman, give her pleasant sensations, and therefore effectively relieve pain. During childbirth painful sensations can only occur during contractions, pushing is painless. Relaxing during a contraction can significantly reduce pain, and relaxing between contractions significantly restores strength.

Let's take a closer look at all the methods that can help with this.

Breathing during childbirth: diaphragmatic breathing

This is breathing with the diaphragm, when in order to inhale we expand the belly, rather than raising our shoulders. This is how babies breathe opera singers and just healthy people. You should learn this type of breathing during pregnancy.

During childbirth, it is very effective to combine with relaxation of the perineal muscles and pelvic floor on the exhale. Don't forget to relax your facial muscles as well.

From 37 weeks, it is recommended to perform daily diaphragmatic-relaxation breathing in combination osteopathic gymnastics and continue to use it during childbirth. You can find out more about this in the “Guide to Preparing Parents for Birth and Raising.” healthy child" and on the disk " ".

General relaxation and diaphragmatic relaxation breathing in the second stage of labor until the midwife asks the woman in labor to actively push allows the woman to restrain the desire to push. And this ensures labor pain relief, smooth movement of the child towards the exit, slow stretching of the perineal tissue, reducing the likelihood of ruptures.

Relaxation and positive mental images

Take advantage of every opportunity to relax during labor. Exercise during pregnancy by practicing relaxation “” During labor, start by simply telling yourself “Relax” between contractions. Provide yourself with pleasant music or sounds of nature; dim the lights, create an atmosphere of privacy and comfort. A short prayer helps many people relax. Very effective positive thoughts. Think that the fight will definitely end and there will be rest.

With a contraction lasting 60 seconds, only 20 of them are the most painful. Try to determine the end of this peak - the moment from which the pain begins decrease. At the next contraction, the onset of this moment will be a signal for you to exhale with relief and additionally relax your perineum and the whole body. In addition, increasing intensity of contractions is a signal that you are getting closer to your reward - the birth of your baby.

During the fight exhale the air along with the pain. Imagine that you are packing the pieces of pain into lumps and that they are floating away from you like clouds.

After the contraction ends, take a deep breath. Then, as you exhale, try to release the accumulated tension. Don't remember the previous contraction or try to imagine the next one. Be transported to another planet - pleasant memories, pictures, images.

Think about the baby, focus on how it moves through the birth canal. During and between contractions, imagine how gracefully rose petals bloom, this will help your body open up and release the child. During a fight, tell yourself: “Don’t resist. let the baby out" It is very important not to resist the process, but to internally agree with it with all your soul. When a contraction approaches, you want to clench your teeth and shout “no,” but do the opposite, relax your mouth, smile and whisper “yes”.

Singing and sounding

Voiced slow exhalation helps to relax and removes “clamps”, which contributes to more rapid opening cervix. You can sing during childbirth in different ways, all options are effective. You can sing the sound " A" With open mouth. The sound is open and loud. Can buzz through closed lips, using the closed sound “M”. At the same time, the sensation in the body resembles vibration. You can make low, drawn-out moans, or even growl- such “deep” sounds help a lot. Be sure to keep your face, lips and larynx area relaxed.

Touch and massage during childbirth

During different periods of labor, your attitude towards touch and massage may change - you just liked them, but after a few minutes they are already annoying and distracting. But in any case, your assistants should master the techniques of pain-relieving massage:

massage with pads thumbs pit area lower back and sacrum;
light massage faces fingers;
massage uterine projection points on the palm (between the bases of the third and ring finger);
stroking the back of the fingers upwards along the spine and down the sides;
scrolling fists on both sides of the sacrum, in the area of the center of the buttocks, in the area of the ridges iliac bones;
placing palms on area lower back and the sacrum crosswise;
« disclosure» pelvis with palms - two palms on both sides of the spine in the lower back, then we spread the bases of the palms outward, sliding over the skin;
pressing“cup” the palms on the pits and warm them up, massage the iliac crests with the palms;
pressing on the sacrum- place the palm of one hand on the other and press on the sacrum, gradually increasing the force by five counts, and also gradually loosening the pressure by five counts. This technique will help with strong contractions;
sawing- as you inhale - from top to bottom, rub your lower back and sacrum in a zigzag manner with the edge of your palm, as you exhale - from bottom to top;
kneading hands and feet; large muscles of the shoulder, thigh, buttocks, legs;
stroking on the back and hips for better relaxation.

More about pain-relieving massage techniques you can read. To help you, massage techniques, along with birthing positions and partner support, are clearly shown in the video guide “Preparing for Natural Childbirth.”

Birth positions and movement ()

During childbirth you need to move, take different positions, special birth positions. The worst thing you can do is just lie there. It just consists of birth positions. Having mastered it during pregnancy, you will make childbirth easier for yourself. After all, it will be easy and comfortable for the body to take familiar poses that will make it easier pelvic opening and child advancement.

Liberty movements during childbirth- the right of a woman in labor. In modern Russian maternity hospitals, women giving birth are often asked to simply lie down with contractions. Choose a maternity hospital for natural childbirth, taking into account the capabilities and rules of the particular maternity hospital. Read more about the criteria for choosing a maternity hospital for partner natural childbirth.

Our friend is water

Warm water (shower or bath) has a wonderful analgesic and relaxing effect. Only the temperature should not be higher than 38° C. In the first stage of labor, while you are still at home, warm water will help you relax and gain strength.

Maternity hospitals may have their own rules in this regard. It makes sense to find out in advance about the possibility and conditions of taking a bath during childbirth in.

Warmth on the sacrum

Extremely simple and effective remedy, available to everyone.
Warm compress on the sacrum helps to relax and relieves pain. Make sure the temperature heating pads was not higher than 38° C. It is better to wrap the heating pad soft cloth so that her touch causes pleasant sensations.

Homeopathy ()

During pregnancy, you should consult a homeopathic doctor. Before birth, he can choose individually for you homeopathic remedies to prevent complications during childbirth. You can stock up in advance homeopathic first aid kit for childbirth in accordance with the recommendations of the homeopath. The “Guide to Preparing Parents for Having and Raising a Healthy Child” contains a list and description of homeopathic remedies that can help with different periods childbirth

Aromatherapy ()

This is also recognized natural remedy pain relief during childbirth, promoting relaxation of the woman in labor and an easy, harmonious birth. Particularly effective during childbirth essential oils lavender and verbena.

When choosing essential oils, pay attention Special attention on their quality. As a rule, cheap oils are diluted with synthetic substitutes, which means they have less effect. Essential oils can be used different ways: in an aroma lamp, aroma pendant, or adding a couple of drops to Massage Oil or a bath.

Attention! It's worth keeping in mind that homeopathic medicines should be used separately from essential oils, since essential oils can neutralize effect of homeopathic remedies.

Choose the methods that you like for your birth

As you can see, there are quite a few ways to make your childbirth less painful, easier and more harmonious. Natural childbirth without pain- this is reality! You can combine natural pain relief methods as you wish, use them all, or only those that you like. Think over your birth, draw up a plan, discuss it in every detail with your assistants and maternity hospital staff.

And when the big day comes, remember that you need to fully relax, let go of all worries, achieve complete peace of mind. Your assistants must also be absolutely calm. Then the hard work of giving birth to a child will be remembered as the most joyful experience in your life, and your happy meeting with your baby will be a well-deserved reward for your efforts.

Despite the constant development of medicine, anesthesia during childbirth is still not a mandatory procedure. Much depends on the features pain threshold women in labor: if she can endure a natural birth without the use of painkillers, they are not used unless there are indications for this. Much less often during childbirth, general anesthesia is used with drugs that put a person into deep sleep, 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 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, epidural and spinal anesthesia are used.

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. Used for epidural pain relief medicines, which do not penetrate the placental barrier and cannot harm the baby: 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, For example: diabetes.

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 a spinal block is significantly less, and it is administered below the limit spinal cord into the space where it is localized cerebrospinal fluid. 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;
no probability systemic influence 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 consequences in the newborn, for example: drowsiness, weakness, respiratory depression, reluctance to latch on. But these consequences pass rather quickly, since the drug used for pain relief gradually leaves the child’s body. Thus, the consequences of drug pain relief labor activity caused by the penetration of anesthetic drugs through the placenta to the fetus.

Currently there are many different types and methods of pain relief. The doctor chooses one or several options depending on the woman’s wishes (if they discussed this in advance), depending on the condition of the woman in labor and the condition of the child at the time of birth.

Anesthetics

In modern anesthesiology, various medicinal substances are used to relieve labor pain. Premedication is carried out during the preparation process. Premedication includes the prescription of sedatives, analgesics, anticholinergics and other drugs. The use of these drugs is intended to reduce the negative impact on the body emotional stress, prevent possible side effects associated with anesthesia, facilitates anesthesia (it is possible to reduce the concentration or dose of the drug used narcotic drug, the excitation phase is less pronounced, etc.) Anesthesia is carried out using various medications. Medicines can be administered intramuscularly, intravenously or inhalation. All anesthetics act primarily on the central nervous system. Drugs acting on the central nervous system include: analgesics, tranquilizers, narcotic analgesics, etc. The proposed list of drugs is far from complete, but in my opinion it gives an idea of the drugs and their effects.

Propanidid(sombrevin, epanthol; agent for intravenous anesthesia) - when administered intravenously, it quickly binds to plasma proteins, quickly decomposes into inactive metabolites, and is not detected in the blood 25 minutes after administration. The narcotic effect occurs immediately after the administration of sombrevin, after 20-40 seconds. The surgical stage of anesthesia lasts 3-5 minutes. Propanidide causes a more pronounced hypnotic effect than an analgesic one. Sombrevin penetrates the placental barrier, but after 15 minutes it decomposes into inactive components. There is evidence that sombrevin can lead to respiratory depression, acidosis in the fetus, cause allergic reactions at the mother's.

Ketamine hydrochloride(calypsol, ketalar; analgesic) - half-life is about 2 hours. After intravenous administration the narcotic effect occurs within 30 seconds and lasts 10 minutes; after intramuscular injection- after 5 minutes and lasts 15 minutes. Has a strong analgesic effect, does not relax skeletal muscles and does not inhibit reflexes from respiratory tract. In pregnant women, it increases the tone of the uterus. Ketamine penetrates the placental barrier and in doses of more than 1.2 mg/kg of the mother's body weight causes depression of the vital functions of the fetus. There is evidence that sombrevin and ketalar also have an effect on the body’s immunological system. Thus, when administered sombrevin, the number of T- and B-lymphocytes decreases by 15 and 4%, while when administered ketalar, they increase by 10 and 6%, respectively, which suggests that ketalar is less dangerous in pregnant women with allergic diseases. diseases, blood loss and immune system deficiency. This is important, since during pregnancy there is a shift in immune system mother's body, which consists in a decrease in cellular and humoral immunity In addition, a number of immunological systems are directly related to perinatal damage to the central nervous system of the fetus.

Barbiturates(sodium thiopental, hexenal; means for non inhalation anesthesia) - after intravenous administration, 65-70% of the dose of barbiturates binds to plasma proteins, and the remaining free fraction has a narcotic effect. The narcotic effect of barbiturates is based on inhibition of the cerebral cortex and blockade of synapses. Barbiturates - weak acids, having a low molecular weight, penetrate the placental barrier, and the degree of depression in the fetus is directly proportional to the concentration of the anesthetic in the mother’s blood.

Diazepam(relanium, seduxen; tranquilizers) - sedatives that relieve irritability, nervousness, stressful state. At oral administration absorbed in an amount of about 75%, the maximum level in plasma occurs after 1-1.5 hours. In the liver, 98-99% of diazepam is metabolized into the enterohepatic circulation. The half-life in the blood plasma of women is 1-3 days, in newborns - 30 hours. In the fetal blood, the highest concentration is created 5 minutes after intravenous administration. In the umbilical cord blood of a newborn, the concentration of diazepam is equal to its concentration in venous blood mother when administered in a dose exceeding 10 mg or more. At the same time, the concentration of diazepam in the brain is low. In this case, apnea in newborns, hypotension, hypothermia, and sometimes signs of neurological depression are common. Diazepam is able to accelerate the dilatation of the cervix, helps relieve anxiety state in a number of women in labor.

Promedol(narcotic analgesic) is easily absorbed by any route of administration. The maximum concentration in plasma is determined after 1-2 hours. The mechanism of action of promedol is based on interaction with opiate receptors. It has an analgesic, sedative effect, and depresses the respiratory center. After parenteral administration the analgesic effect occurs within 10 minutes and lasts 2-4 hours. Promedol has an antispasmodic effect and promotes dilatation of the cervix. Easily penetrates the placenta. 2 minutes after intravenous and somewhat later after intramuscular administration, a concentration appears in the umbilical cord blood approximately equal to that in the maternal blood plasma, but there may be significant fluctuations in individual fetuses depending on their intrauterine state. The more time passes from the moment of administration of the drug, the higher its concentration in the blood of the newborn. The maximum concentration of promedol and its toxic metabolite in the blood plasma of a newborn was observed 2-3 hours after its administration to the mother. The half-life of promedol elimination from the body of a newborn is approximately 23 hours, and in the mother - 3 hours. Promedol is generally considered safe for mother and baby. However, in some cases, the drug can cause depression in the newborn due to the fact that it has an inhibitory effect on the processes of glycolysis and respiratory center. Promedol, like all morphine-like drugs, has a number of disadvantages, the main of which is that in effective doses (more than 40 mg) it depresses breathing and causes severe drug addiction, can cause a state of stupor, nausea, vomiting, atony smooth muscle, constipation, depression, decrease blood pressure. Promedol can cause respiratory depression and drowsiness in a child. After birth, breathing is restored, but children do not immediately latch onto the breast.

The described side effects are inherent in almost all potent analgesics, with the exception of pentazocine (Lexir, Fortral). For pain relief, non-narcotic analgesics (baralgin, analgin...) are usually not used, since they inhibit labor.

Promedol(narcotic analgesic) is used in most Moscow clinics as an anesthetic. Promedol has an analgesic and antispasmodic effect (helps accelerate the opening of the pharynx). An injection of promedol is administered into the buttock or thigh. Promedol manifests itself in different ways. For some, it has a calming effect, relaxes, and causes drowsiness, although consciousness is completely preserved. For someone else, some women lose control of themselves, experience a state of intoxication, and may feel nauseous and stagger.

Pentazocine(lexir, fortral; narcotic analgesic) - indicated for pain relief during labor. It has a stimulating effect on hemodynamics and respiration, and also has a birth-stimulating effect. Does not have a pronounced sedative effect. This drug is considered to be non-narcotic, incapable of causing addiction, that is, an analgesic without a psychometic effect.

Diprivan(propofol) is a new ultra-short-acting intravenous anesthetic. Diprivan quickly induces sleep, maintains the inclusion of consciousness throughout the infusion (infusion) of the drug with fast recovery consciousness after stopping the infusion, has less than other intravenous anesthetics side effect. However, a number of publications indicate possible undesirable manifestations of diprivan during anesthesia, including a deterioration of certain parameters of central hemodynamics, although data on this issue are extremely contradictory. From a pharmacological point of view, diprivan is not an anesthetic, but a hypnotic.

Nitrous oxide(a means for inhalation anesthesia) - is one of the components of general anesthesia for caesarean section. The drug is insoluble in lipids. It is absorbed very quickly (2-3 minutes) and excreted unchanged by the lungs. 5-10 minutes after the start of inhalation, tissue saturation with anesthetic reaches its maximum. In 5-6 minutes it is completely eliminated from the blood. A relatively weak anesthetic with a high degree of safety when mixed with oxygen. It affects only the central nervous system, does not depress respiration, the cardiovascular system, does not have negative influence on the liver, kidneys, metabolism, contractile activity uterus. It quickly penetrates the placenta, after 2-19 minutes the concentration of nitrous oxide in the blood of the umbilical cord vein is 80% of the level in the mother's blood. Long-term inhalation of nitrous oxide sometimes results in the birth of a baby with low Apgar scores.

Nitrous oxide is given through a special apparatus using a mask. The woman in labor is introduced to the technique of using nitrous oxide; in the future, she puts on a mask herself and inhales nitrous oxide with oxygen during contractions. During pauses between contractions, the mask is removed. Nitrous oxide mixed with oxygen significantly reduces pain without completely eliminating it and causes euphoria. It is used at the end of the first stage of labor. The effect of the gas appears after half a minute, so at the beginning of the contraction you need to do a few deep breaths. The gas dulls the pain; when inhaling it, the woman feels dizzy or nauseous. Nitrous oxide is usually given in combination with narcotic analgesics.

Relaxers(ditylin, listenol, myorelaxin; muscle relaxants) - are slowly and incompletely absorbed into the digestive tract. Do not penetrate the placenta. Causes persistent muscle relaxation. These relaxants do not affect the condition of the newborn, but in some newborns, when feto-placental permeability is impaired, some authors note low rating according to the Apgar scale.

The use of drugs for the treatment of pain and anxiety in women in labor involves the use of anesthetics and analgesics, both narcotic and non-narcotic, and their combination with sedatives and neuroleptics.

General anesthesia

Most often, general anesthesia is used for childbirth by caesarean section. General anesthesia affects not only the mother in labor, but also the child.

Neuroleptanalgesia method

The method of neuroleptanalgesia, which provides a kind of mental peace, satisfactory analgesia, accompanied by stabilization of hemodynamic parameters and the absence of a significant effect on the nature of labor, has become quite widespread for pain relief.

Fentanyl is injected intramuscularly. Greatest effect achieved by combining it with droperidol. If necessary, a repeat dose is administered after 3 to 4 hours.

Neuroleptanalgesia is not recommended for use if the patient has severe hypertension (high blood pressure), increased tone bronchioles You need to be prepared for development opportunities drug-induced depression newborn Narcotic analgesics have a depressive effect on respiratory function newborn

Ataralgesia method

Another common method of labor pain relief. The ataralgesia method is a combination of analgesics with diazepam, seduxen and other benzodiazepam derivatives. Benzodiazepane derivatives are among the safest tranquilizers; their combination with analgesics is especially indicated for severe fear, anxiety and mental stress. The combination of dipyridole with seduxen has a beneficial effect on the course of labor, shortening the total duration and period of cervical dilatation.

However, there is an effect on the condition of the newborn, in the form of lethargy, low indicators according to the Apgar scale, low neuroreflex activity.

Epidural analgesia method

This method has been studied quite thoroughly. The beneficial effect of epidural analgesia is important during pregnancy and childbirth, complicated by gestosis, nephropathy, late toxicosis, in the analgesia of labor in the breech presentation of the fetus, it has a beneficial effect on the course of premature birth, shortening the period of cervical dilatation and lengthening the period of expulsion, which contributes to a smoother advancement of the head. At the same time, under the influence of epidural analgesia, the muscles of the perineum relax and the pressure on the fetal head decreases. It is indicated for congenital and acquired heart defects, chronic diseases of the lungs and kidneys, edema, myopia (myopia) and damage to the retina.

At the same time, epidural analgesia may cause a decrease in uterine activity. There was also an increase in the duration of labor and a decrease in uterine activity in the second stage of labor during epidural analgesia, which contributed to an increase in the number of surgical deliveries (application of forceps, C-section). A negative hemodynamic effect is also known. In addition, hypotension is noted Bladder, increased temperature (hyperthermia).

Currently used for epidural analgesia various drugs (local anesthetics, narcotic and non-narcotic analgesics, diazepam, ketamine). Lidocaine is the most widely used drug in pregnant women. Lidocaine is metabolized in the liver. Cumulation (accumulation) of the drug often occurs, which subsequently manifests itself as neuro- and cardiotoxicity in relation to the mother and fetus.

Epidural analgesia provides long-lasting and highly effective pain relief from the onset of labor until birth, but can cause serious complications.

The principle of epidural analgesia in labor is that the anesthetic is injected into the epidural space and blocks the subdural nerves in the T10 to L1 segments. It is effective when contractions cause severe back pain and position changes do not help or are difficult. Its time should be calculated so that the effect of the anesthetic ceases by the second stage of labor, otherwise labor may slow down and the risk of episiotomy and forceps may increase. Anesthesia should be stopped when pushing begins. This period requires “personal” participation from the woman. Anesthesia is not stopped in the second stage of labor (pushing period), if necessary special indications, for example, myopia.

Standard technique for epidural analgesia in labor

IN obstetric practice Combined subdural-epidural anesthesia and analgesia are used. The epidural space is punctured with an epidural needle, through which a needle is then inserted to puncture the subdural space. After removal of the subdural needle, the epidural space is catheterized. The main application of the method is introduction narcotic analgesics For effective pain relief contractions followed by the use of continuous infusion epidural analgesia from the end of the first stage of labor.

An epidural takes about 20 minutes to administer. The woman is asked to curl up with her knees touching her chin. The puncture is performed in a lateral or sitting position. Many anesthesiologists use a sitting position for puncture, since in this position it is easier to identify the midline of the back, which often causes certain difficulties due to edema subcutaneous tissue lumbar region and sacrum. The back is treated with an anesthetic solution. After local anesthesia, the skin is pierced with a thick needle to facilitate subsequent needle insertion for epidural analgesia. The epidural needle is slowly advanced into the interspinous junction (the doctor inserts a hollow needle into intervertebral disc). A syringe is attached to it. Anesthesiologist administers anesthetic syringe in the lower back. The medicine is delivered through a tube inside the needle as needed. The needle is not removed, which allows you to administer an additional dose if necessary. The effect of the anesthetic wears off after 2 hours. It may be accompanied by some difficulty in movement and trembling in the hands. Some women feel weakness and headache, as well as heaviness in the legs, which sometimes lasts for several hours, itchy skin, urinary retention.

Like all methods of anesthesia, such anesthesia has a number of side effects and complications. Epidural anesthesia with concentrated solutions of local anesthetics can increase the duration of the first and second stages of labor, and then the need for oxytocin arises (oxytocin increases contractility uterus) or surgical delivery.

There may be such side effects such as respiratory depression, lower back pain, temporary numbness of the limbs, headache, dizziness, nausea, vomiting, itching, depression. You should immediately report any unpleasant sensations to your doctor! The most dangerous complication is inflammation of the peridural space, which can appear on days 7-8. This happens when the rules of asepsis and antiseptics are poorly observed. Another complication is hypotension (decreased blood pressure). It occurs as a result of an overdose of the drug; to prevent this from happening, the woman in labor is given medications that increase vascular tone.

A competent and highly qualified doctor, understanding the seriousness of the entire procedure, will explain to the woman all the pros and cons and will not perform epidural anesthesia unless absolutely necessary, simply because he was asked. Most anesthesiologists discuss with women the effectiveness and benefits of this method for both mother and baby and the risks possible complications. After which the woman signs papers stating that she is familiar with all the pros and cons and agrees to this procedure. (“It is a natural sense of self-protection for the anesthesiologist to want written consent; the obstetrician should note in her notes that the woman agrees to the epidural, and the anesthesiologist would be wise to simply sign the note.”) Take your time during a normal pregnancy and during normally developing labor, do an epidural.

It's a different matter when the only way anesthetize childbirth and carry it out safely. Then try, after talking with your doctor, to be as favorable as possible about this procedure! Positive attitude- this is 90% success! In the process of choosing, you can doubt, think about, weigh, choose what is best for you now, BUT, when you have made a decision, follow only it! Vanity and tossing around in the mind will only ruin things.

Women who are subsequently dissatisfied with epidural analgesia during labor usually come to the maternity hospital with a strong attitude towards this method of pain relief and agree to have it only when there is time for detailed explanations not anymore. One should adhere to the tactic of “explain, but not persuade.” This means that, while explaining to a woman all the advantages of spinal methods of pain relief, one should not insist on their choice. This is due to the fact that when analyzing complications, it very often turns out in retrospect that most of the troubles occur in those women who categorically refused epidural anesthesia or analgesia, but succumbed to the doctor’s persuasion. Apparently, there is something more serious than our ideas about clinical physiology spinal methods of pain relief. Certainly, perfect time to discuss with expectant parents the role of spinal pain relief methods - before birth."

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

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

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

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

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

Methods for pain relief during labor

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

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

Non-drug methods

Non-drug methods include various psychological methods of distraction from pain:

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

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

Medication methods

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

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

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

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

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

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

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

During childbirth large fruit at the pushing stage, you can use local anesthetics - “Novocaine” and “Lidocaine”, the injection is given in the area of the pudendal nerve, vaginal and perineal tissue.

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

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

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

Epidural anesthesia

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

To anesthetize or not?

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