Which anesthesia is better for childbirth. Pain relief during childbirth

The wonderful nine months of waiting have passed, very soon there will be an addition to your family. But the closer the day the baby is born, the more fears the expectant mother has. Many people want to undergo labor pain relief. But this is a natural process, every woman can cope without anesthetic drugs.

This article will focus on the issue of labor pain relief; its pros and cons will be described in detail. You will also find out what such intervention on the part of obstetricians poses to you and your unborn child. The types can be varied. Which ones exactly? Read more about this.

Pain relief for childbirth: obstetrics, new methods

During childbirth, pain occurs due to muscle spasm, which intensifies due to the release of adrenaline. Often a woman experiences panic attack, aggravating physical suffering.

A woman who is psychologically prepared and has consciously approached planning the birth of a baby most often does not need pain relief during labor. But there are still cases when anesthesia is performed according to doctor’s indications.

Indications for pain relief

They give pain relief during childbirth if:

premature birth;
severe pain;
long contractions;
multiple births;
C-section;
slow labor;
fetal hypoxia;
the need for surgical intervention.

If none of the above is observed, then pain relief during labor is usually not required.

Types of anesthesia

Modern medicine can present the following types of pain relief during childbirth: medicinal and non-medicinal. In this case, your doctor must prescribe a type of anesthesia that will not harm either you or your child. It should be noted that a woman in labor cannot prescribe pain relief for herself if there is no direct indication for it.

Non-drug methods of labor pain relief

This safest group of methods is especially popular among obstetricians. What does this include? Effective and simple exercises that can be started at any stage of labor: breathing exercises, birth massage, aquatherapy and reflexology.

Despite the presence of more effective medicinal methods, many consciously refuse them in favor of non-drug options. Natural pain relief during childbirth includes:

activity;
correct breathing;
massage;
water birth;
reflexology.

The arrival of a baby is the most an important event in your life. They will help you leave only positive impressions of this day. non-drug methods labor pain relief, completely harmless and beneficial for both you and your baby.

Activity during labor

It is very important during contractions to choose an active position rather than a passive one. Help yourself and your baby to be born.

If you have an uncomplicated birth, then choose exercises for yourself, the main thing is to make it easier for you. However, sudden movements are strictly prohibited. Take note of the following:

rolling from toe to heel;
bending forward and to the side;
rocking the pelvis, circular movements;
arching and flexion of the spine;
active walking;
swinging on a fitball.

Breathing exercises

It is worth mastering breathing techniques even before childbirth, during pregnancy. The advantage of this method is the possibility of combination with other types of pain relief. You don’t need a doctor’s supervision; you can control the process yourself. You will feel relief immediately, and most importantly, you will pull yourself together. There are several breathing exercises techniques. If someone close to you will be present with you at the birth, then he should be familiar with these exercises in order to help you during the birth process.

How it works? You need to distract yourself from the pain by concentrating on breathing. The deeper and smoother it is, the easier it is for you and your baby, because he receives more oxygen. And if this method is used together with it, the effect will be much better, your child will feel comfortable. There are several periods during which breathing should differ:

first contractions;
increased intensity of contractions;
dilatation of the cervix;
period of pushing.

During the first contractions

This type is different in that it is smooth and deep breathing, which saturates the blood of the baby and mother with oxygen. Focus on the count. Inhale through your nose for four counts and exhale through your mouth for six counts. The lips should be folded into a tube. You are distracted from pain, gymnastics gives a relaxing effect. It can be used even during panic or severe stress to calm down.

During intense contractions

During this period you need to calm down, now is the time to use the technique dog breath. These are shallow, shallow inhalations and exhalations through the mouth, the tongue needs to stick out a little from the mouth. You shouldn’t think about how you look at the moment, the maternity hospital is a place where you only need to think about your well-being and about the child, especially, believe me, you are not the only one!

Moment of cervical dilatation

This is the peak, you won’t be in more pain than now! But you need to endure this; childbirth without pain relief using medication is still preferable. Now it’s worth speeding up your breathing, taking shallow, quick inhalations and exhalations. Form your lips into a tube, inhale through your nose and exhale through your mouth. When the contraction releases, calm down a little, it is better to breathe deeply and evenly. This method allows you to slightly ease the acute pain.

Period of pushing

The worst is over, there are no more contractions. Your baby will be born very soon. If the birth is not complicated, then the baby will appear after 1-2 attempts. You need to push 2-3 times per push. Don't panic, because now is the final moment, almost painless. If you feel sorry for yourself and disobey the orders of the obstetrician, you will have to use tools that will be enough painful sensations. When pushing begins, you need to take a deep breath, exhale, deep breath and hold your breath for 10-15 seconds, while pushing. Don't push anus or straining your eyes, you can get hemorrhoids, stroke and other unpleasant and dangerous consequences.

Another important announcement: the period between contractions and pushing is needed in order to rest, relax and even out your breathing. You need to exercise every day during pregnancy so that you can pull yourself together during childbirth. Bring your breathing to automaticity, and you will control yourself and make labor easier.

Other options

Modern methods labor pain relief includes a large list of various procedures, but especially effective (non-drug) are massage, water birth and reflexology.

How to massage during contractions? There are points on the body that, by acting on them, can significantly reduce and soothe pain. In our case - sacral zone. You can do this either yourself or ask the person who is nearby. This area can be stroked, pinched, massaged, or lightly tapped. To avoid redness and irritation in the massage area, periodically lubricate the area with cream or oil.

How does water help? In a warm bath, the pain of contractions is easier to bear; water also has a relaxing effect. The expectant mother can take a comfortable position and just relax, while you will avoid chills, elevated temperature and sweating, dry skin.

What is reflexology? Modern pain relief for childbirth also includes a method such as acupuncture. It helps improve labor and reduce the pain of contractions. As you can see, there are a lot of options, which one you choose is your personal decision.

Drug pain relief

In addition to the above natural methods, there are more effective ones, but, accordingly, more dangerous ones. Modern methods of medicinal labor pain relief include the following:

epidural block;
spinal block;
spinal-epidural combination;
drugs;
local anesthesia;
perineal blockade;
tranquilizers.

Epidural block

Everyone has heard, but not everyone knows the intricacies of this procedure. Let's start with the fact that during childbirth it can be either partial or complete. If childbirth takes place naturally, then drugs are administered on the basis that they are only enough for the first contraction (that is, contractions); during pushing, the effect of the drug ends. In this case, only pain signals in the area below the navel are blocked, motor ability remains, the person is conscious and can hear the first cries of his baby. If you wish or special indications They can also relieve pain in the second stage of labor (pushing), but this is dangerous, since you do not feel the signals of your body and labor can be significantly delayed or go completely wrong. If there is no such need, then do not anesthetize the pushing; during it, the pain is more tolerable.

Second option - In this case, a larger dose is administered than in the previous option, and is also blocked physical activity. The advantage of such anesthesia is the opportunity to immediately see and hear the baby.

Spinal block

This is also an injection that is given in the lower back, into the fluid around the spinal cord. This is a less expensive method compared to epidural anesthesia.

you remain conscious;
the effect lasts two hours;
relieves pain throughout the body thoracic and below.

may cause severe headaches;
lowers blood pressure;
may cause difficulty breathing.

Spinal-epidural combination

It's relative new technology when the two above methods are combined. This anesthesia lasts much longer, while the mother remains conscious. For the first two hours, the epidural is effective.

Drugs

No matter how strange and contradictory it may sound, drugs are also used during childbirth, but extremely rarely, in special cases. What drugs are used? This:

"Promedol";
"Fortal";
"Lexir";
"Pethidine";
"Nalbuphine";
"Butorphanol".

Narcotic substances can be administered either intramuscularly or intravenously (via a catheter); the second option is the most successful, since the dosage of the drug can be adjusted. This method is good because the pain is blocked for about six hours and the woman in labor can rest. The effect occurs within a couple of minutes. Of course there is also negative sides: Breathing may slow down for both you and your baby.

Local anesthesia

It is not used to relieve pain during contractions, but it is very effective when making an incision in the vagina or stitching after a tear. The injection is made directly into the vaginal area, the effect occurs almost instantly, pain in the injection area is temporarily blocked. Neither you nor your child will experience any bad side effects.

Perineal blockade

The injection is made directly into the vaginal wall, blocking pain on only one side. This injection is given immediately before the baby is born. The effect of the drug lasts no more than an hour and has no side effects. This type Anesthesia is not suitable for the period of contractions.

Tranquilizers

Tranquilizers are used for relaxation; injections are given at the first stage, when contractions are rare and not so sensitive. Such drug anesthesia for childbirth dulls awareness and has a hypnotic effect, reducing the child’s activity, but does not completely relieve pain. Tranquilizers can be in the form of tablets or administered intravenously or intramuscularly. When administered intravenously, the effect is immediate.

Postpartum period

Pain relief is also provided after childbirth. For what? So that a woman can relax and gain strength. What may concern:

spasms caused by contractions of the uterus;
places of ruptures and cuts;
difficulty going to the toilet;
chest pain;
cracking of the nipples (due to improper feeding).

If the pain is caused by tears and incisions, then painkillers or ointments are suggested, but if the birth was carried out correctly and you pay attention to personal hygiene, then there should be no pain, or it should be minimal. During suturing, the doctor is obliged to numb the pain, and how this will happen should be discussed with you in advance.

There are several ways to minimize pain:

frequent and short-term water procedures;
special cooling pad (will help avoid swelling);
store the pads in the refrigerator (they will dull the pain);
get ready for a speedy recovery;
Disturb the site of cuts and tears less (avoid infection, do not make sudden movements, this will contribute to a quick recovery);
sitting on a special cushion (exerts minimal pressure on the problem area).

Pain associated with uterine contractions goes away on its own a week after the baby is born. To reduce them:

perform special exercises;
lie on your stomach;
get a massage.

The following exercise will help with back pain: lie on a hard surface, bend your right leg at the knee and hold your knee right hand. With your left hand, guide the heel of your right foot toward your groin. Stay in this position for a few seconds, rest and repeat the exercise. If your back hurts on the left side, then do the same with your left leg.

Childbirth is a complex and painful process. Many pregnant women worry about upcoming events and are afraid of 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 in detail the topic of pain relief during the labor 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 even if 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 pain, 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 essential oils (ylang-ylang, mint, bergamot, orange, jasmine) have an analgesic and relaxing effect. 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 aroma 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 pain threshold, reduce fear, anxiety and nervous excitability.

In extremely rare cases, a woman is given the anesthetic drugs Ketamine, Kalipsol, Sombrevin through a vein. They quickly and completely relieve pain, but cause a lot of side effects, so 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.
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 the lumbar 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 provide negative impact for the fruit.
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 during puncture there is leakage into the epidural space cerebrospinal fluid, subsequently the woman can 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 there are no serious negative effects on the fetus.

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 labor leads to a slower heartbeat in the fetus (in more than 50% of cases); due to 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.

Unique. The severity of pain that a mother feels during the birth of a child varies from person to person. different women. This depends on many factors, such as the size and position of the fetus, the strength of contractions, and pain tolerance. For some women, use is enough to relieve pain. correct breathing and relaxation techniques, others may need anesthesia for 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 for many methods.

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

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

Benefits and possible consequences of using anesthesia during childbirth

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 (catheterization may be needed Bladder). If the numbness extends to chest, this may make breathing difficult. If the needle damages a hard meninges, a woman may develop a headache that lasts 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 rare cases). Although rare, there is a risk of allergic reactions, damage to 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 childbirth, 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 moving the baby around 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

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 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.

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 muscle reflexes. 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 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 the immune system of the mother’s body, consisting 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 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. When administered orally, it is 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 dilation of the cervix and helps relieve anxiety 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 dependence, 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 (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 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 a negative effect 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 take several 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, 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

More often general anesthesia during childbirth, it is used for childbirth by caesarean 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. 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 the possibility of drug-induced depression in the newborn. Narcotic analgesics have a depressive effect on the respiratory function of the 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 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, 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 (forceps, Caesarean 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 may severe 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 occurs. 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 from 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 ligament (the doctor inserts a hollow needle into the 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 pain relief, 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.

Side effects such as respiratory depression, lower back pain, temporary numbness of the limbs, headache, dizziness, nausea, vomiting, itching, and depression may occur. 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 medicines, increasing 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 the clinical physiology of spinal methods of pain relief. Of course, perfect time to discuss with expectant parents the role of spinal pain relief methods - before birth."

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

However, the use of these drinks brought only minor relief, while being accompanied by serious adverse events, primarily drowsiness. In 1847, English professor Simpson was the first to use ether anesthesia to relieve pain during childbirth.

Physiological basis of pain during childbirth. Contractions are usually accompanied by pain varying degrees expressiveness. Many factors influence pain during childbirth, its intensity; truly painless childbirth is rare. Pain during contractions is caused by:

1. Dilatation of the cervix.

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

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

4. Resistance of the pelvic floor muscles.

5. Accumulation of tissue metabolism products formed during prolonged contraction of the uterus and temporary disruption of the blood supply to the uterus.

The strength of the pain sensation depends on the individual characteristics of the threshold pain sensitivity, emotional mood women and their relationship to the birth of a child. It is important not to be afraid of childbirth and labor pain. Nature took care of providing the woman with the painkillers she needed for childbirth. Among the hormones produced during childbirth, a woman’s body releases a large amount of hormones of joy and pleasure - endorphins. These hormones help a woman relax, relieve pain, and give a feeling of emotional uplift. However, the mechanism for producing these hormones is very fragile. If a woman experiences fear during childbirth, then the production of endorphins is reflexively suppressed and the release of significant amount adrenaline (a stress hormone produced in the adrenal glands) into the blood. In response to the release of adrenaline, convulsive muscle tension occurs (as an adaptive form of response to fear), which leads to compression of muscle vessels and disruption of blood supply to the muscles. Poor blood supply and muscle tension irritate the uterine receptors, which we feel as pain.

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

The sensations during childbirth largely depend on mental state women. If all the mother's attention is concentrated only on pain, a disruption of homeostatic mechanisms and disruption of normal labor may occur. Pain, fear and anxiety during childbirth stimulate that part nerve fibers, which irritate the circular fibers of the uterine muscle, thereby resisting the pushing forces of the longitudinal fibers of the uterus and disrupt the dilation of the cervix. Two powerful muscles begin to oppose each other, this puts the muscles of the uterus under enormous tension. The tension is of medium level and is perceived as pain. Overexertion causes disruption of the baby's blood supply through the placenta. If this phenomenon is short-term, then the condition of the fetus does not suffer, since its life support requires much less oxygen saturation in the blood than for an adult. But if this situation persists for a long time, then due to the lack of oxygen, irreversible damage to the tissues and organs of the fetus may occur, primarily to its brain, as the organ most dependent on oxygen.

The main task of labor pain relief is to try to break this vicious circle and not to overstress the uterine muscles. Many women prepared for childbirth manage to cope with this task on their own, without resorting to medication, due to psychological stability and various psychotherapeutic techniques (relaxation, breathing, massage, water procedures). Other women simply need to be given appropriate medical care, reducing the feeling of pain or dulling the nervous system's response to pain. If this is not done in time, then over-tension of the uterine muscle can lead to negative consequences for mother and fetus.

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

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

2. Suppress negative emotions, feelings of fear, without disturbing a long period consciousness of the woman in labor.

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

4. Not have a negative impact on labor, the woman’s ability to participate in childbirth and the course of the postpartum period.

5. Don't call drug addiction with the required course of taking the drug.

6. Be available for use in any obstetric institution.

Used for pain relief during labor the following groups medicines:

1. Antispasmodics- medicinal substances that reduce tone and contractile activity smooth muscles and blood vessels. Back in 1923, Academician A.P. Nikolaev proposed using an antispasmodic for pain relief during childbirth. Usually used the following drugs: DROTAVERINE (NO-SHPA), PAPAVERINE, BUSKOPAN. The prescription of antispasmodics is indicated:

Women in labor who have not undergone sufficient psychoprophylactic training, who show signs of weakness, imbalance of the nervous system, too young and elderly women. In such cases, antispasmodics are used at the beginning of the active phase of the first stage of labor (at 2-3 cm of cervical dilatation) to prevent labor pain and only partly to eliminate it. It is important to wait for regular, steady contractions, otherwise this labor process may be delayed.

For women in labor, as an independent painkiller for already developed pain, or in combination with other drugs, when the cervix is dilated by 4 cm or more.

When labor has developed, antispasmodics do not affect the strength and frequency of contractions, and do not interfere with the consciousness of the woman in labor and her ability to act. Antispasmodics are good at helping to cope with the dilatation of the cervix, relieve spasm of smooth muscles, and reduce the duration of the first stage of labor. They do not have a negative effect on the fetus. From side effects There is a drop in blood pressure, nausea, dizziness, and weakness. However, these drugs do not have a pronounced analgesic effect.

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

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

In addition to being a pain reliever, tramadol has sedative effect, which turns out to be useful when there is a pronounced emotional component of labor pain. However, the sedative effect of tramadol allows it to be classified as intermediate between analgesics and narcotics. As a rule, respiratory depression in a woman in labor does not occur when using tramadol; it rarely causes short-term dizziness, blurred vision, impaired perception, nausea, vomiting and itching. The use of these drugs for late toxicosis of pregnancy (preeclampsia) is prohibited. However, the use of these drugs is limited because repeated administrations they affect the nervous system of the fetus, slow down the breathing of the newborn, and disrupt it heartbeat. Premature newborns are especially sensitive to these drugs.

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

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

Droperidol causes a state of neurolepsy (calmness, indifference and aloofness) and has a strong antiemetic effect. It has become widespread in obstetric practice. However, you should remember side effects droperidol: it causes incoordination and weakness in the mother, respiratory depression and a drop in blood pressure in the newborn. For high blood pressure in a woman in labor, droperidol is combined with analgesics.

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

The mechanism of action of these drugs is based on interaction with opiate receptors. They are considered safe for mother and baby. They have a calming effect, relaxing, maintaining consciousness. They have an analgesic, antispasmodic effect, promote dilatation of the cervix, and help correct uncoordinated uterine contractions.

However, everything narcotic drugs have a number of disadvantages, the main of which is that in high doses they depress breathing and cause drug dependence, a state of stupor, nausea, vomiting, constipation, depression, and decreased blood pressure. The drugs easily penetrate the placenta, and 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 in the blood plasma of a newborn was observed 2-3 hours after its administration to the mother. If birth occurs at this time, the drug causes temporary respiratory depression in the baby.

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

5. Inhalation pain relief for labor NITSOXIDE, TRILENE, PENTRANE

These methods of pain relief have been used for a very long time. Ether is currently not used for pain relief in labor, as it significantly weakens labor, can increase blood pressure, and have an adverse effect on the fetus.

Inhalation analgesia of labor by inhaling painkillers is still widely used in obstetric practice. Inhalational anesthetics are used in active phase labor when the cervix is dilated by at least 3-4 cm and in the presence of severe painful contractions.

Nitrous oxide is the main inhalational agent used for both obstetric pain relief and labor pain relief. The advantage of nitrous oxide is safety for mother and fetus, rapid attack action and its rapid completion, as well as the absence of a negative effect on contractile activity and a pungent odor. Nitrous oxide is given through a special apparatus using a mask. The woman in labor is introduced to the technique of using a mask and she herself applies the mask and inhales nitrous oxide and oxygen as needed. When inhaling it, a woman feels dizzy or nauseous. The effect of the gas appears after half a minute, so at the beginning of the contraction you need to take several deep breaths

Trilene is a clear liquid with a pungent odor. Has an analgesic effect even in small concentrations and maintaining consciousness. Does not suppress labor. It's well controlled fast active remedy- after stopping inhalation, it quickly ceases to have an effect on the body. The disadvantage is the unpleasant smell.

6. Epidural anesthesia during labor and caesarean section

Epidural analgesia involves blocking pain impulses from the uterus through nerve pathways, included in spinal cord at a certain level by injecting a local anesthetic into the space around the spinal cord membrane.

Performed by an experienced anesthesiologist. The time to start epidural analgesia is determined by the obstetrician and anesthesiologist depending on the needs of the mother and baby during labor. It is usually carried out when regular labor is established and the cervix is dilated by at least 3-4 cm.

A lumbar epidural is performed in the lower back with the woman in labor sitting or lying on her side. After treating the skin in the lumbar spine, the anesthesiologist makes a puncture between the vertebrae and enters the epidural space of the spine. First, a test dose of anesthetic is administered, then, if there are no side effects, a catheter is installed and the required dose is administered. Sometimes the catheter may touch a nerve, causing a shooting sensation in the leg. The catheter is attached to the back; if it is necessary to increase the dose, subsequent injections will no longer be required repeated puncture, but are produced through a catheter.

Pain relief usually develops 10-20 minutes after the epidural insertion and can be continued until the end of labor and is usually very effective. Epidural anesthesia is safe for mother and baby. Side effects include decreased blood pressure, back pain, weakness in the legs, and headaches. More severe complications - toxic reaction to local anesthetics, respiratory arrest, neurological disorders. They are extremely rare.

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

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

Epidural anesthesia can be used with a reasonable degree of safety for caesarean section. If an epidural catheter is already installed during labor and a caesarean section becomes necessary, it is usually sufficient to administer an additional dose of anesthetic through the same catheter. More high concentration the drug allows you to cause a feeling of “numbness” in abdominal cavity sufficient for surgery

7. General anesthesia. Indications for the use of general anesthesia during childbirth are emergency situations, such as sharp deterioration condition of the child and maternal bleeding. This anesthesia can be started immediately and causes quick loss consciousness, which allows for an immediate caesarean section. In these cases, general anesthesia is relatively safe for the child.

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