Types of anesthesia for natural childbirth. Anesthesia during childbirth

Despite the constant development of medicine, anesthesia during childbirth is still not a 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. Much less often during childbirth, general anesthesia is used with drugs that immerse the 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 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 evaluate 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;
short 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;
the state of the cardiovascular system is 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 at the desired period of 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 injected through the arachnoid membrane, 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.

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

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

What are the indications for pain relief during natural childbirth?

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

What types of anesthesia can be used for natural childbirth?

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

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

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

Benefits and possible consequences of using anesthesia during childbirth

Name of pain relief method	Action and possible benefits	Potential risk to mother	Potential risk to baby
Analgesics (common painkillers, including opioids)	May relieve pain, reduce anxiety, and help you relax during labor. They do not block all sensations. Does not lead to loss of consciousness. They do not slow down labor or affect contractions.	Does not completely eliminate pain. May cause drowsiness or difficulty concentrating. May weaken memories of childbirth. May cause nausea, vomiting and itching. May lower blood pressure or slow breathing. May cause allergic reactions and breathing difficulties.	When administered immediately before birth: May cause drowsiness, making breastfeeding difficult immediately after birth. May slow breathing and weaken reflexes. May disrupt baby's thermoregulation.
	Blocks most sensations below the waist. It takes 10-20 minutes to start working. Can be used throughout the entire period of childbirth. The drug can be administered through a catheter several times, allowing you to reduce or increase its dose as needed.	Numbness may make pushing difficult, as well as problems with urination (bladder catheterization may be necessary). If the numbness extends to chest, this may make breathing difficult. If the needle damages a hard meninges, a woman may develop headache, lasting several days. Blood pressure may decrease. Slight dizziness or nausea and tinnitus may occur. If the needle touches a nerve while catheterizing the epidural space, the woman may feel an electrical shock in one leg. If the drug enters a vein, it may cause dizziness and seizures (in in rare cases). Although rare, there is a risk of allergic reactions, damage blood vessels, development infectious process or swelling in the epidural space. If labor progresses slowly when spinal anesthesia is used for pain relief, the drugs may wear off too quickly.	Decline blood pressure in the mother, it can cause a slowdown in the baby’s pulse and breathing.
Spinal anesthesia	Blocks most sensations below the ribcage. The action begins immediately and lasts 1-2 hours. When administered more than strong drugs can be used for pain relief during caesarean section.
Pudendal block	Used to numb the perineum, usually before an episiotomy.	It only anesthetizes the perineal area and does not affect the pain from contractions. Rarely causes any negative effects from mother or child.
General anesthesia	Can begin very quickly and lead to immediate loss of consciousness. Blocks almost all sensations, including pain. Used only when necessary (eg for immediate caesarean section)	A woman will not remember events while she is unconscious. The woman will be sleepy for a certain period of time. The patient may experience nausea or vomiting.	May make the baby drowsy, making it difficult breast-feeding immediately after birth. May reduce blood supply to baby.

Is childbirth possible without anesthesia?

Is it worth giving birth with anesthesia?

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

Taras Nevelichuk, anesthesiologist, specially for the site site

Useful video

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

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

How can doctors help?

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

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

Inhalation (mask) anesthesia. One form of pain relief is 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 introducing a solution of local anesthetic into the space above the dura mater of the spinal cord. These days, such anesthesia is widely used during childbirth. Becomes insensitive after injection Bottom part bodies. 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 fully conscious and can talk with others.

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

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

Application 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 of labor (shortening and weakening of contractions, slowing of cervical dilatation, labor stimulation with oxytocin to intensify contractions);
Caesarean section operation;
multiple births;
hypoxia ( oxygen deficiency) fetus - when using anesthesia, the likelihood of its occurrence decreases;
necessity 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 during recovery. birth canal.

Anesthesia without drugs

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

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

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

Rational breathing - there are several breathing techniques, 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 is good if the expectant mother knows that during a normal, uncomplicated birth she can take different poses and choose the most convenient one, in which this particular woman in labor can more easily endure contractions. Under active behavior also understand movement, walking, rocking, bending and various poses designed to relieve the load on the spine. Changing position is the first and most natural desire in case of any discomfort.

Hydrotherapy is the use of water to relieve pain from contractions. IN different situations During contractions, you can still use the bath or shower.

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

The right to choose

To use non-drug methods of pain relief, you need to know about these methods and have practical skills. A course of psychoprophylactic preparation for childbirth can be taken at a antenatal clinic or at a school for pregnant women, where you will be taught proper breathing during childbirth, 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 the maternity hospital, you need to consult a doctor about this. In some situations (when breech fetus, in case of premature birth), the doctor may limit the freedom of movement of the woman in labor and strongly recommend that the expectant mother lie down. But breathing and relaxation skills will be useful to you in any case.

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

When using medicinal 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 danger 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 medicinal methods at the request of a woman - a controversial issue and in every medical institution solved differently.

Childbirth is a complex and painful process. Many pregnant women worry about upcoming events and are afraid pain. Pain, especially prolonged pain, negatively affects the human psyche. The development of medicine has made it possible to create different variants anesthesia. Today, a woman can receive pain relief during childbirth, but:

Is it safe?
How does anesthesia affect the health of the mother and the fetus?
Is anesthesia performed according to indications or can any patient choose it?

These questions worry pregnant women, and here we will examine the topic of pain relief in detail. birth process.

In what cases is anesthesia indicated during childbirth?

The introduction of any chemical drugs into the body of the expectant mother is undesirable. Some types of anesthesia are considered relatively safe, while others can lead to complications.

Anesthesia during childbirth is not indicated for everyone; only the doctor decides whether it is necessary to administer a relaxing medication during such an important process.

Indications for pain relief:

There are a number of indications for which a doctor may prescribe mandatory anesthesia for a woman in labor.

Hypertension and some diseases of the heart and blood vessels in a woman in labor.
Diabetes.
Serious diseases of the respiratory system.
Some eye diseases.
Increased intracranial pressure.
Discoordination of labor (random intense contraction of the uterus).
The fruit is too large.
Narrow pelvis.
Cervical dystocia (excessive stretching of tissues leading to rupture of the cervix).
Psycho-emotional disorder (occurs in absolutely normal women from too long severe pain).
Gestosis (complicated form of toxicosis).
Breech presentation of the fetus or other abnormal position.
Prolonged labor (more than 10 hours).
Multiple pregnancy.

Depending on the condition of the pregnant woman, anesthesia can be prescribed by the attending physician as planned, even before the onset of labor, or according to circumstances, already during labor.

Many women want to give birth with anesthesia, even if there is no indication for this. Of course, you can order such a service, but you should understand that any anesthesia has Negative consequences and at normal birth such interference in the body is extremely undesirable.

It is important to remember that any anesthesia can have negative consequences.

Types of pain relief

There are medicinal and non-medicinal (physiological) methods of pain relief during labor. Let's consider all types in detail.

Non-drug methods for pain relief

Such methods do not have strong and quick effect, but are more designed for relaxation during contractions. But their main advantage is high security.

Massage

Physical pressure on certain points helps to significantly reduce pain during contractions. A woman can learn pain-relieving massage on her own through special courses.

Some women in labor hire a specialist at the clinic who massages the body throughout the entire period of labor. Massage not only reduces painful sensations, but also improves blood circulation, which is beneficial for the mother and fetus.

Massage can reduce pain during contractions.

Breathing exercises

Women are also taught special breathing techniques during labor and childbirth in courses. Alternating inhalations and exhalations according to a certain system is a useful and significant pain relief during childbirth. The downside is that as contractions intensify, many women forget about technique and simply do not find the strength to breathe properly.

Hydrotherapy

Water procedures significantly relax the muscles and reduce the pain of contractions. But hydrotherapy services are provided mainly only by high-quality clinics, and not all women can afford to give birth for free.

Water treatments will help you relax and reduce pain from contractions.

Transcutaneous electroanalgesia

Quite effective and safe way, which allows you to anesthetize the course of contractions. For this purpose, a special apparatus equipped with electrodes is used. Sensors are attached to the mother's lower back and electrical impulses are sent, the frequency and intensity of which can be adjusted. The current blocks pain signals traveling along the nerve endings of the spinal cord. Electroanalgesia also improves blood circulation, reducing the risk of fetal hypoxia.

Psychotherapy

A pregnant woman can resort to the services of a psychotherapist and reduce her pain through hypnotic techniques. This great way, in which pain decreases and there is a deep positive attunement to the birth process and subsequent events.

The list of natural physiological methods also includes pain relief during childbirth by taking special positions. This kind of “gymnastics” is taught to pregnant women at preparatory classes. A specialist in the maternity hospital can help you find relaxing positions.

On a note! Some have analgesic and relaxing effects essential oils(ylang-ylang, mint, bergamot, orange, jasmine). Inhaling the aromas of these oils goes perfectly with the ones described above. physiological methods and enhances their effect. Another addition could be pleasant, calm music..
Many aromatic oils have a relaxing effect on the body.

Drug pain relief

Used for drug anesthesia chemicals, acting quickly and efficiently. They completely block pain, but each of them has its own side effects. Let's consider all types of drug anesthesia acceptable for pregnant women.

The anesthetic is delivered through an inhalation mask. The drug used is mainly Nitrogen, less often Methoxyflurane, Pentran, Ftorotan, Trilene.

The woman independently takes the mask, applies it to her face and inhales the gas. The frequency of inhalations is done according to a certain pattern, which is selected by the doctor, focusing on the condition of the woman in labor.

Typically one of three options is selected:

Inhale the drug every half hour.
Inhale as the next contraction begins and remove the mask as soon as the spasm ends.
Breathe between contractions.

Inhalation anesthesia during childbirth is used only before certain point until the cervix has dilated to 5-6 cm. Such anesthesia cannot be used further. This method is losing its relevance due to the high gas consumption and leakage in the wards.

Almost instant pain relief.
Does not harm the child.
Prevents fetal hypoxia.
It is quickly eliminated from the body.

Side effects in the form of nausea, vomiting, headache, dizziness, confusion, failure of the respiratory system, tachycardia.

Intravenous and intramuscular injections

Into a vein or muscle area the woman in labor is administered drugs with narcotic or non-narcotic effects.

Non-narcotic medications include painkillers such as No-shpa, Analgin, Baralgin. Tranquilizers and sedatives (Relanium, Fentanyl, Nalbuphine, Elenium) can also be used, which increase the pain threshold, reduce fear, anxiety and nervous excitability.

In extremely rare cases, a woman is given anesthetic drugs Ketamine, Calypsol, Sombrevin through a vein. They quickly and completely relieve pain, but cause mass side effects, therefore their use is undesirable.

The most commonly used narcotic medications are Promedol and Fentanyl.

Medicines are quickly eliminated from the body.
Quite a strong anesthetic effect.

Anesthetic administered intravenously or intramuscularly enters the placenta through the blood and can have a negative effect on the baby.
Short action.
There are many side effects for the patient (confusion, nausea, dizziness, vomiting, changes in heart rate, headache).

Such labor anesthesia is carried out in very rare cases when the patient for some reason cannot be given another type of anesthesia.

Intravenous injections suitable in cases where other types of anesthesia are contraindicated for a woman in labor.

Today this is one of the most optimal types of anesthesia, which is used in most cases.

The anesthetic is injected into the epidural space, located in lumbar region spine. The following medications can be used: Lidocaine, Novocaine, Ropivacaine and their analogues. The essence of the technique is the penetration of the anesthetic into the epidural space and blocking the nerve roots of the spinal cord.

The effect of the drug occurs in approximately 20 minutes. The woman completely loses sensation in the area below the waist. In the upper part of the body, sensitivity remains.

Throughout the entire period of labor, the catheter remains in spinal region, which allows you to supply additional portions of anesthesia.

Pros of epidural anesthesia:

The woman in labor remains fully conscious and can move.
Eliminates discoordinated labor.
Does not affect the strength and frequency of uterine contractions.
Does not have a negative effect on the fetus.
Doesn't increase blood pressure.
The patient's heart function remains stable.
A gentle recovery from anesthesia.

The effect of anesthesia does not begin immediately; you have to wait 20-30 minutes.
If cerebrospinal fluid leaks into the epidural space during the puncture, the woman may subsequently for a long time suffer from severe headaches.
Difficulty breathing (due to blockage of the sternum muscles).
Pain at the puncture site, subsequent inflammation, difficult healing, hematomas.
Pain in the lumbar region that persists for 2-3 months.
When a needle enters a vessel, a variety of negative reactions are possible.
In extremely rare cases, if the needle is inserted incorrectly, paralysis of the lower limbs is possible.

Despite all the risks, epidural anesthesia during the birth process is one of the safest in terms of effects on the child.

Read more about epidural anesthesia in.

Spinal anesthesia

It is immediately worth noting that epidural and spinal (spinal) are different types of pain relief procedures during childbirth.

The drugs used are the same, but the needle is used spinal anesthesia is introduced deeper into the subarachnoid space itself. The effect of anesthesia occurs much faster than with an epidural, within 5 minutes.

The spinal method of pain relief requires a higher qualification of the doctor performing the puncture; the slightest mistake can lead to irreversible consequences. With this technique, the side effects are more pronounced, although the result is serious negative influences not happening.

It is important to know! Despite high efficiency spinal anesthesia, it does not work on everyone. About 5-6% of women do not respond at all to the injection of drugs into the epidural or subarachnoid area. Approximately 15% have low level pain relief.

Paracervical anesthesia

An outdated method of pain relief, which is practically no longer used, but the expectant mother should know about it.

An anesthetic drug (Novocaine, Lidocaine) is injected directly into the lateral vaults of the vagina, that is, around the uterine os. The procedure is carried out in the first stages of contractions, when the dilation has not yet reached 8 cm. Anesthesia blocks the nerve endings of the cervix, significantly reducing pain.

Paracervical anesthesia during childbirth leads to a slower heartbeat in the fetus (in more than 50% of cases), because of this side effect it was no longer used.

What type of pain relief is used after childbirth?

The birth process is divided into three stages: the period of contractions, the expulsion of the fetus and the release of the placenta. In some cases, the last, third stage in women occurs with complications. The placenta does not come out naturally after the required time and the patient requires manual cleaning.

In some cases, pain relief may also be required after childbirth.

In such a situation, anesthesia is required. If the birth took place under epidural anesthesia, then an additional dose is simply administered. In other cases it is used intravenous anesthesia short-term action (for 10-15 minutes). This time is quite enough to free the uterus from the placenta by mechanical intervention.

Some women experience perineal ruptures after the birth of their baby. When suturing, the doctor injects an anesthetic directly into the vaginal area.

After completing everything, the successful mother no longer needs pain relief. Over the next few days, you will feel quite strong cramps in your abdomen, as the uterus begins to contract, but this pain is short-lived and quite tolerable.

What type of anesthesia for childbirth is best?

It is impossible to give a definite answer to this question. In each individual case, one or another type of anesthesia may be more suitable. But if you look at it objectively, it is considered the best. The most important thing is that it is carried out by an experienced specialist.

It is also worth considering that each method has contraindications.

Finally

This was everyone's review possible types anesthesia during childbirth. Despite the fear of pregnant women about upcoming events and the desire to go through this process painlessly, the decision on the need and advisability of anesthesia must be made by a doctor. Now in private clinics a woman in labor can order anesthesia if she wishes, paying a certain amount for it. But even in such cases, it is necessary to consult with your supervising doctor in advance and weigh all the pros and possible negative consequences.

Currently there are many different types pain relief during childbirth. The doctor chooses one or several options for pain relief 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

For pain relief during labor in modern anesthesiology, various medicinal substances. 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 mainly 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.

Propanidide (sombrevin, epantol; a means 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 birthing woman’s body weight causes depression of vital signs. important functions fetal body. There is evidence that sombrevin and ketalar also have an effect on the body’s immunological system. Thus, when sombrevin is administered, the number of T- and B-lymphocytes decreases by 15 and 4%, while when ketalar is administered, they increase by 10 and 6%, respectively, which suggests that ketalar is less dangerous in pregnant women with allergic diseases with 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; drugs 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 a woman is 1-3 days, in newborns - 30 hours. In fetal blood highest concentration 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, usually not used non-narcotic analgesics(baralgin, analgin...), as they inhibit labor.

Promedol (a narcotic analgesic) is used in most Moscow clinics as a pain reliever. 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 fewer side effects compared to other intravenous anesthetics. However, a number of publications indicate possible unwanted manifestations diprivan during anesthesia, including the 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 (an inhalational anesthetic) is one of the components general anesthesia during 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, cardiovascular system, does not provide 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.

Relaxants (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 with impaired feto-placental permeability, some authors note a low Apgar score.

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 during childbirth is used for birth by cesarean section, it affects not only the woman in labor, but also the child.

Neuroleptanalgesia method

Enough wide use for pain relief during childbirth, he received 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.

Fentanyl is injected intramuscularly. The greatest effect is achieved when combined 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 the possibility of drug-induced depression in the 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 of pain relief during childbirth has been studied quite fully. The beneficial effect of epidural analgesia during pregnancy and childbirth, complicated by gestosis, nephropathy, late toxicosis, in the analgesia of labor in the breech presentation of the fetus is important; it has a beneficial effect on the course of premature birth, reducing 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, for chronic diseases lungs and kidneys, with edema, with 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 of the bladder and increased temperature (hyperthermia) are noted.

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 are caused severe pain in the back and changes in position 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 the administration of 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 an anesthetic syringe remedy 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, skin itching, and urinary retention.

Like all methods of pain relief, such anesthesia has a number of side effects and complications. Epidural anesthesia with concentrated solutions 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. ABOUT unpleasant sensations You must tell your doctor immediately! The most dangerous of the complications is inflammation of the peridural space, which can appear on days 7-8. This happens when the rules of asepsis and antiseptics are poorly followed. Another complication is hypotension (low 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 to. 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."