What is the best pain relief during childbirth? Standard technique for epidural analgesia in labor

Pain relief during childbirth helps a woman more easily cope with the birth of her baby. Advances in anesthetic techniques are minimizing the risk. Let's take a closer look at the methods of anesthesia during childbirth, find out which types are preferable, and how to relieve pain during childbirth without drugs.

Is there pain relief during childbirth?

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

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

Pain relief during childbirth - pros and cons

Not all pregnant women choose an easy, pain-free birth. Many people speak out against anesthesia during this period. Their concerns are related to the negative impact of the anesthetic component on the fetus. In addition, such pregnant women are confident that a baby born with anesthesia will adapt worse to new environmental conditions. However, modern pain management techniques completely eliminate the presence of these factors.

Recent studies in the field of obstetrics have proven that proper pain management during timely childbirth, compliance with dosages, minimizes the development of complications. When talking about pain relief during childbirth, doctors name the following positive aspects:

reduction of pain syndrome;
eliminating stress;
prevention .

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

development of an allergic reaction;
weakening of labor.

Types of pain relief during childbirth

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

non-drug methods;
medicinal;
regional anesthesia.

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

gestational age;
number of fruits;
no contraindications for a pregnant woman.

Non-drug methods of labor pain relief

Non-drug pain relief during childbirth completely eliminates the use of drugs. At the same time, doctors use various psychological techniques, physical procedures, etc. This way it is possible to distract the woman as much as possible from the pain factor and reduce the suffering associated with the process of expulsion of the fetus. Among the common techniques:

Psychoprophylaxis– conducting courses in which a pregnant woman is introduced to the peculiarities of the birth process, taught how to relax, breathe, and push correctly.
Massage of the lumbar and sacral area– reduces pain, makes it easier to endure the period of cervical dilatation.
Breathing technique– helps to relax and not feel pain so intensely.
Acupuncture– installation of special needles in the prenatal period helps relieve physical stress and prepare the pregnant woman for childbirth.
Warm baths– reduce the tone of the uterine muscles, accelerate the process of dilatation, and reduce pain.

Medicinal methods of pain relief during childbirth

As the name implies, these methods of anesthesia involve the use of drugs. Analgesic for labor pain relief is selected individually. It should be taken into account that such drugs are able to penetrate the placental barrier, so their use can be limited - at a certain period of labor and in the dosage prescribed by the doctor. According to the method of administering the anesthetic, it is customary to distinguish:

Intravenous anesthesia. It involves the introduction of a drug directly into the general bloodstream, leading to a complete loss of consciousness. The patient falls asleep, and sensitivity is eliminated.
Epidural anesthesia. Involves administering the drug to the spinal cord area. As a result, the transmission of nerve impulses from the lower parts of the body is blocked.
Inhalation anesthesia. The anesthetic is administered through the respiratory tract.

Drug pain relief during labor has a positive effect on the woman’s subsequent rehabilitation. The expectant mother does not experience fear or emotional stress associated with the upcoming birth. Modern principles of pain relief during childbirth have many advantages, including:

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

Modern methods of labor pain relief

Modern labor anesthesia completely eliminates the development of complications associated with the use of medications during delivery. At the same time, the effect of anesthetic drugs on the fetus itself is minimized. This helps to give birth to a healthy child and accelerates the recovery processes of the female body in the postpartum period. Among the common, widely used modern pain management techniques:

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

Pain relief during childbirth - epidural anesthesia

Epidural pain relief during childbirth is widespread due to its high efficiency and lack of effect on the baby. At the same time, it is possible to provide the mother in labor with maximum comfort. The drug is injected into the area between the 3rd and 4th lumbar vertebrae. Stopping the transmission of nerve impulses eliminates the feeling of pain. The woman herself is conscious and can hear the first cry of her baby, as with natural childbirth.

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

incorrect behavior of a woman in labor who does not feel well during contractions;
prolongation of the period of expulsion of the fetus;
the risk of developing acute hypoxia in the baby due to a strong decrease in blood pressure in the mother.

Intravenous pain relief during childbirth

Painkillers during childbirth are rarely administered intravenously. This is due to a high risk of complications. After using most anesthetics, there is a decrease in activity and the development of lethargy, which negatively affects the process of delivery. In addition, there is a possibility of a decrease in the tone of muscle structures, which has a bad effect on the process of expulsion of the fetus: they become weakly expressed, have a short duration and intensity.

Natural pain relief during childbirth

When thinking about how to relieve pain during childbirth, women often come across natural anesthesia methods. These methods absolutely exclude the use of drugs and are safe for the baby and mother. Their action is aimed at relaxation. Among them:

use of music therapy;
massage of the lumbar region;
motor activity.

How to prepare for childbirth without pain?

When considering methods of labor pain relief, it must be said that self-relaxation is an effective method. Having mastered these skills, a woman will be able to alleviate her condition during childbirth. You need to learn this in advance, while still carrying a baby. In order to control your body you need to:

Take a horizontal position.
Breathing should be slow and concentrated.
Raise one leg, then the other, feeling the tension.
Make a fist with one hand, then the other.

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

Pain relief during childbirth is aimed at providing comfortable conditions for the laboring woman, avoiding pain and stress, and also helps prevent labor disturbances.

The perception of pain by a woman in labor depends on circumstances such as physical condition, anxious anticipation, depression, and characteristics of upbringing. In many ways, pain during childbirth is intensified by fear of the unknown and possible danger, as well as previous negative experiences. However, the pain will be reduced or better tolerated if the patient has confidence in the successful completion of labor and a correct understanding of the labor process. Unfortunately, so far, none of the currently existing methods of pain relief during childbirth is absolutely ideal. To achieve maximum effect, the choice of pain relief method should be individualized. In this case, it is necessary to take into account the physiological and psychological state of the woman in labor, the condition of the fetus and the obstetric situation. To increase the effectiveness of pain relief, prenatal preparation is important, the purpose of which is to remove the fear of the unknown of the upcoming birth. In the process of such preparation, the pregnant woman must be informed about the essence of the processes accompanying pregnancy and childbirth. The patient is taught proper relaxation, exercises that strengthen the abdominal and back muscles, increase overall tone, and different breathing methods during contractions and at the time of birth of the fetal head.

Acupuncture can be used as one of the methods of non-drug pain relief during labor. Most often, when using this method, only partial pain relief occurs, and most patients require the use of additional methods of pain relief. Another method of non-drug labor pain relief is transcutaneous electrical nerve stimulation (TENS), which has been used for many years. During labor, two pairs of electrodes are placed on the mother's back. The degree of electrical stimulation varies according to the needs of each individual woman and can be adjusted by the patient herself. This form of analgesia is safe, non-invasive, and can be easily administered by a nurse or midwife. The main disadvantage of the method is the difficulty in using electronic monitoring of the fetal condition, despite the fact that transcutaneous electrical neurostimulation itself does not affect the fetal heart rate.

However, the most important thing for pain relief during labor is the use of appropriate medications. Methods for pain relief during labor can be divided into three types: intravenous or intramuscular administration of drugs to relieve pain and anxiety; inhalation pain relief for labor; local infiltration application and regional blockades.

Narcotic analgesics are the most effective drugs used to relieve labor pain. However, these drugs are used to reduce pain rather than completely stop it. With established labor in the active phase of the first stage of labor, these drugs help correct uncoordinated uterine contractions. The choice of drug is usually based on the severity of potential side effects and the desired duration of action. Intravenous administration of drugs is preferable compared to intramuscular administration, since the effective dose is reduced by 1/3-1/2, and the effect begins much faster. Tranquilizers and sedatives are used during childbirth as components of drug pain relief to relieve agitation, as well as to reduce nausea and vomiting. In the active phase of labor, when the cervix is dilated more than 3-4 cm and painful contractions occur, sedatives with narcotic analgesics in combination with antispasmodics (No-spa intramuscularly) are prescribed. The use of narcotic analgesics should be stopped 2-3 hours before the expected moment of expulsion of the fetus, to prevent possible narcotic depression.

Inhalation pain relief for labor

Inhalation analgesia of labor by inhaling painkillers is also widely used in obstetric practice. Inhalation anesthetics are used during the active phase of labor when the cervix is dilated by at least 3-4 cm and in the presence of severe painful contractions. The most common are nitrous oxide (N2O) with oxygen, trichlorethylene (trilene) and methoxyflurane (pentrane). Nitrous oxide is a colorless gas with a slight sweetish odor that is the most harmless inhalational anesthetic for mother and fetus. The most common ratios of nitrous oxide to oxygen are: 1:1, 2:1 and 3:1, allowing for the most optimal and sustained analgesia. During the process of inhalation anesthesia, it is necessary to monitor the condition of the woman in labor by medical personnel. The effectiveness of pain relief largely depends on the correct inhalation technique and rationally selected ratios of the components of the gas-narcotic mixture. Three options can be used to achieve an analgesic effect.

Options for labor pain relief using inhalational anesthetics

Inhalation of the gas-narcotic mixture occurs continuously with periodic breaks after 30-40 minutes.
Inhalation is carried out with the beginning of the contraction and ends with its end.
Inhalation occurs only in pauses between contractions, so that by the time they begin, the required degree of pain relief is achieved.

Autoanalgesia during labor with nitrous oxide can be performed throughout the active phase of the first stage of labor until the cervix is fully dilated. Due to the fact that nitrous oxide is eliminated from the body through the respiratory tract, this provides greater control over the pain relief process. During pain relief during childbirth, after stopping inhalation of nitrous oxide, consciousness and orientation in the environment are restored within 1-2 minutes. Such analgesia during labor also has an antispasmodic effect, ensuring coordinated labor, preventing abnormalities in uterine contractility and fetal hypoxia. The use of a gas-narcotic mixture of nitrous oxide and oxygen is the most acceptable in obstetric practice for pain relief during labor. In addition to nitrous oxide, drugs such as trichlorethylene (has a more pronounced analgesic effect compared to nitrous oxide) can also be used for inhalation anesthesia; methoxyflurane (use is less controlled than nitrous oxide and trichlorethylene).

Epidural analgesia

Regional analgesia can also be successfully used to relieve labor pain. The cause of pain in the first stage of labor is contraction of the uterine muscles, stretching of the cervix and tension of the uterine ligaments. In the second stage of labor, due to stretching and elongation of the pelvic structures during the advancement of the fetus, additional pain sensations arise, which are transmitted along the sacral and coccygeal nerves. Therefore, to achieve pain relief during childbirth, the transmission of pain impulses along the corresponding nerve bundles should be blocked. This can be achieved by a pudendal nerve block, a caudal block, a spinal block, or an extended epidural block.

Epidural analgesia is one of the popular methods of labor pain relief. Performing epidural analgesia involves blocking pain impulses from the uterus along the nerve pathways entering the spinal cord at a certain level by injecting a local anesthetic into the epidural space. Indications for epidural analgesia are: severe painful contractions in the absence of effect from other methods of pain relief, incoordination of labor, arterial hypertension during labor, childbirth during and.

Contraindications to labor pain relief with epidural analgesia

Bleeding during pregnancy and shortly before childbirth.
Use of anticoagulants or decreased activity of the blood coagulation system.
The presence of a focus of infection in the area of the proposed puncture.
A tumor at the site of the intended puncture is also a contraindication to epidural analgesia.
Volumetric intracranial processes accompanied by increased intracranial pressure.

Relative contraindications to epidural analgesia

Previous extensive back surgery.
Extreme obesity and anatomical features that make it impossible to identify topographic landmarks.
Past or existing diseases of the central nervous system (multiple sclerosis, epilepsy, muscular dystrophy and myasthenia gravis).

Epidural analgesia is carried out when regular labor is established and the cervix is dilated by at least 3-4 cm. Only an anesthesiologist who knows this technique has the right to perform epidural anesthesia.

Pain relief for labor disorders

Disorders of labor also deserve attention. Adequate timely treatment of labor incoordination, as a rule, contributes to its normalization. The choice of appropriate therapy is carried out taking into account the age of the women, obstetric and somatic history, the course of pregnancy, and an objective assessment of the condition of the fetus. With this type of abnormal labor, the most reasonable method of treatment is long-term epidural analgesia. A common anomaly of labor is weakness, which is corrected by intravenous administration of drugs that enhance uterine contractility. Before prescribing birth-stimulating drugs if the patient is tired, it is necessary to provide the woman with rest in the form of pharmacological sleep. Proper and timely provision of rest leads to the restoration of impaired functions of the central nervous system. In these situations, rest helps restore normal metabolism. For this purpose, a wide arsenal of medications is used, which are prescribed by the doctor on an individual basis, depending on the current obstetric situation and the condition of the woman in labor. In obstetric practice, the method of electroanalgesia is also used, the use of which allows one to achieve stable vegetative balance and avoid allergic reactions that may occur when using pharmacological drugs (neuroleptics, ataractics, analgesics). Unlike pharmacological drugs, the use of pulsed current makes it possible to obtain the so-called “fixed” stage of therapeutic analgesia, which makes it possible to maintain consciousness during the birth act, verbal contact with the woman in labor without signs of her excitement and transition to the surgical stage of anesthesia.

Pain relief for childbirth with diabetes

In case of diabetes mellitus at the beginning of the active phase of the first stage of labor, it is advisable to avoid the use of narcotic analgesics and the use of epidural analgesia is more preferable. This is due to the fact that the negative impact of systemic analgesics and sedatives is reduced, the mother’s stress response to pain is less pronounced, and better control over the mother’s condition is ensured while consciousness is preserved. In addition, epidural analgesia helps prevent the development of rapid and rapid labor and allows for painless, controlled completion of labor. If necessary, against the background of epidural analgesia, surgical delivery is possible both through the natural birth canal (obstetric forceps, vacuum extraction) and by emergency cesarean section (after quickly strengthening the block). If there is no possibility and conditions for performing a regional block, it is possible to use inhalation analgesia, enhancing it with a block of the pudendal nerve.

Pain relief for childbirth with heart disease

For rheumatic heart diseases, pain relief should be carried out until delivery and continue in the early postpartum period. These requirements are best met by an extended lumbar epidural block. This technique allows you to eliminate pushing in the second stage of labor, and provides the necessary conditions for the application of obstetric forceps and the use of vacuum extraction. If a caesarean section becomes necessary, an extended lumbar epidural block can be extended to the required level. This method of pain relief helps prevent the development of acute heart failure with pulmonary edema and decreased venous return. In a patient with a prosthetic valve and using heparin, it is advisable to use tranquilizers and narcotic analgesics or inhalational analgesia without hyperventilation for pain relief during labor. In the second stage of labor it should be supplemented with a pudendal nerve block.

Anesthesia and premature birth

During management, the use of narcotic analgesics and sedatives during labor should be avoided. Carefully performed regional anesthesia is the best type of pain relief for the delivery of a premature fetus. An extended lumbar epidural block, maintained throughout labor, is an ideal form of analgesia, as it allows for strict control of the course of labor and perineal dissection. If a caesarean section is necessary, the epidural block can be quickly reinforced. 03/11/2007 01:08:05, Tina

I am a pediatrician, 2-degree disabled in the musculoskeletal system. I gave birth to my two children myself, and I can say with confidence that the best pain relief is preparation for childbirth during pregnancy (swimming, sauna, baths, self-education, physical exercise), the presence of the husband, his caring, psychological support, the woman’s awareness of the physiology of childbirth and about how to behave during childbirth (movement, postures during contractions, etc.), warm water with sea salt, lack of fear, etc. In this case, childbirth is fueled by endorphins.
If a woman is methodically intimidated in the antenatal clinic throughout pregnancy, stuffed with vitamins and calcium, and not told anything about how to prepare for childbirth physically (and not financially), then very often the matter ends in birth trauma or cesarean. In our maternity hospitals, you can give birth normally if you are information-savvy and don’t give in to intimidation, are physically prepared, and if you agree with the doctor so that he does not interfere too much with the birth process.
It really doesn't hurt to give birth when you know that this so-called... “pain” with every minute, second brings you closer to meeting the desired creature that will be born. Fear constrains, is passed on to the child, causes pain during childbirth and discoordination of labor. What about labor stimulation?! This is one, continuous contraction, it is very painful, especially if the woman is lying on her back, it is not physiological, it is harmful for the child (vena cava syndrome), IT IS AGAINST ALL THE RULES!
Give birth without fear - and there will be no pain. GUARANTEE! Nature - she provides everything, it is better to follow it, and not artificial methods of childbirth.
By the way, my great-grandmother was a midwife, and had no special education. She simply KNEW how to help a woman in labor - DON’T INTERFERE! She herself gave birth to eight children, and helped almost all the children in the village to be born, even accepted my mother. If she had been alive, I would never have gone to the maternity hospital to give birth.
Good luck everyone!
Natasha
13.03.2006

03/14/2006 04:39:44, Natasha

All the most important things in this article are written in the first paragraphs and for this many thanks to the doctor; perhaps without knowing it, he came out in support of natural childbirth and such a concept, still unknown in our country, as protecting the psychological well-being of the woman in labor. Her calmness, confidence in a positive outcome childbirth, the opportunity to receive support from loved ones - this is the main pain relief for childbirth, absolutely harmless. Thanks to Dr. Makarov for the reminder that there is no perfect drug pain relief, perhaps someone can refrain from using drugs during childbirth and give their child a chance to be born without them. But if by the time I read the article I had not given birth to three children, by the way, completely without drug pain relief, I would probably have been scared. For me, the best pain relief was the support of my husband, water and a caring midwife. Giving birth isn't that painful!

02/27/2006 21:36:39, Svetlana

Sometimes, walking past a ward where women in labor are waiting in the wings, I see the following picture: two women of about the same age and build, only one is writhing in agony, burning her husband and swearing that he will never see any more sex, and the second is lying quietly, reads a book, only occasionally being distracted by unpleasant contractions. I understand that the first lady is most likely a first-time mother, and for the second everything is already familiar and the birth canal has long been ready to bring another person into the world.

However, most often childbirth is a painful process that requires pain relief. And perhaps I will surprise someone, but the federal law “On the Rights of Patients” has section 12, which says that you have the right to pain relief for any pain. Including pain that occurs during childbirth. Yes, yes, in a hospital room you can take a bedpan and loudly hit the wall with it, shouting: “I want anesthesia with an anesthesiologist!!!” And Santa Claus... i.e. the anesthesiologist must appear.

The safest anesthesia

Humanity has come up with a lot of drugs for pain relief. But we understand that some effective methods of pain relief can be toxic to the fetus. But all the power of medicine is aimed at the birth of a healthy baby; in no case should harm be caused to either the mother or the unborn child.

In this regard, the safest method of pain relief is central blockade, including its types: spinal, caudal and the most common - epidural anesthesia.

The first two anesthesia are effective, but they are administered once and have a limited duration of action. But epidural anesthesia can last for a long time, since the woman is placed a catheter in the epidural space and painkillers can be administered through it for as long as desired (local anesthetics and narcotic drugs are more often administered).

What is the difficulty of carrying out

Many people think that installing an epidural catheter is aerobatics, because it’s poking around somewhere near the spinal cord! I’ll tell you a secret: in fact, placing a catheter in the lumbar spine is quite a routine procedure, even interns perform it. There really are difficulties: people are different, there are many variations in the anatomy of the spine, and subcutaneous fat often hides structures - but still, installing a catheter is not so difficult, honestly.

Another thing is to determine what concentration of the drug to administer, how much to administer, when to stop - here the qualifications of the anesthesiologist are already important! The main tenet of medicine is “Do no harm!” during childbirth it is doubly important, because the doctor is responsible for two lives. It happens that an incompetent specialist injects so much of the drug and such a concentration that the woman does not feel anything at all: no pain, no contractions - the muscles become stiff, the baby stands up like a stake in the birth canal. This is really a problem, and it’s good if a caesarean section saves the situation...

“Pitfalls” and how to insure yourself

Now let's look at this procedure from the anesthesiologist's perspective. Night. Maternity hospital A woman arrives, labor is in full swing, the woman requires anesthesia. A tired angry doctor comes. What kind of birth? What kind of pain relief? He still has to fight for appendicitis, and an ambulance with flashing lights is flying down the street, transporting a traffic injury. So what - will it fully relieve pain? Yes, he doesn’t even need money, he’ll pay himself, as long as they leave behind. But you need to sit next to the woman for 8–12 hours; natural childbirth is not a caesarean section for half an hour of work.

And it’s good if a specialist performs caudal anesthesia (a single injection of local anesthetic into the tailbone), but not everyone knows this method. So it’s no wonder if he prescribes a banal analgin. Well, what - cheap and cheerful. Did you prescribe anesthesia? Appointed! Will it be effective? Of course not! But according to the law, he completed his manipulation and will continue, cursing, to undergo emergency surgical interventions.

Therefore, dear women, do not download your rights when you are already in labor. You can ask, but you shouldn’t demand and conflict. What if some intern comes and learns pain management from you? The best thing you can do is to find a good, experienced anesthesiologist a month before giving birth and come to an agreement.

Just remember that anesthesiologists don’t drink, because they can go into a tailspin, they don’t eat sweets, because they understand that sugar is poison, and they don’t smell flowers, because they’ve snorted fluorotane in their lives to the point of cirrhosis of the liver. Well, that’s me, by the way.

Be healthy!

Vladimir Shpinev

Photo istockphoto.com

Pregnancy in a woman’s life is one of the most beautiful periods that will be remembered for a lifetime. The natural end of this period is childbirth. Childbirth, in the understanding of many women, is associated with severe pain; everyone experiences it differently. Quite often, women agree to anesthesia during childbirth because of the huge number of negative childbirth experiences of other women. However, it is worth understanding that childbirth is individual for everyone, and often you do not need to resort to pain relief. What is anesthesia during childbirth and when is it necessary? We will learn from our article.

Is anesthesia really necessary during childbirth?

The term “anesthesia” originally came to us from the Greek language; literally, it has two meanings:

A person's inability to feel anything;
Anesthesia for surgical purposes.

Today, pain relief is widely used during the birth process. Doctors strongly recommend that some women in labor use this service. This is due to the fact that childbirth is a long process, and the body of the expectant mother is individual in its own way. Some women get so tired during contractions that they have no strength left to push. To avoid this, women in labor agree to undergo anesthesia in order to rest for a while from contractions and not feel pain.

Anesthesia also has some placebo effects. Women who agreed to pain relief experience less fear of childbirth, i.e. Anesthesia also has a psychological aspect.

Anesthesia during childbirth can be either medicinal or non-medicinal. We'll talk about this below. In any case, the permissible dose of the medicine must be agreed with a specialist. In some cases, there are certain contraindications to this manipulation.

Be that as it may, when agreeing to anesthesia, a woman must understand that the medicine administered to her will definitely reach the child, therefore anesthesia has both pros and cons. In addition, complete loss of sensitivity during childbirth is extremely undesirable. Natural childbirth is always much better for the baby, but here the issue is decided on an individual basis. It is best to resort to anesthesia if there are indications for it.

In some cases, anesthesia is necessary for medical reasons, namely:

High blood pressure in a woman in labor, a tendency to hypertension;
Preeclampsia in a pregnant woman, preeclampsia;
Cardiovascular diseases;
Respiratory dysfunction;
Diabetes mellitus in a woman in labor;
Incorrect position of the cervix;
Severe pain from the birth process in a woman, the inability to bear it;
Very large fruit;
Incorrect presentation of the unborn baby;
Explicit fear of the expectant mother before childbirth.

Depending on how the birth proceeds, the doctor decides whether to use anesthesia. There are several types of anesthesia, we will talk about them now.

medications are administered strictly according to doctor’s indications, and non-drug methods of facilitating childbirth are available to every mother

Methods of pain relief during childbirth

Anesthesia can be either natural (non-drug) or medicinal.

Non-drug methods of pain relief during childbirth

If the woman in labor feels well and tolerates contractions normally, then medical anesthesia is not used by the doctor. Natural ways to relieve pain and tension would be appropriate here, namely:

Proper breathing during contractions and pushing;
Ability to relax between contractions, distraction;
Water birth;
Contractions in the correct position, convenient for transferring them;
Aromatherapy.

There are other ways to relax during the birth process, these include:

Back massage;
Hypnosis of a woman in labor;
Acupuncture;
Taking a warm bath.

Every woman knows best what will be best for her at the moment. We would like to dwell in more detail on the most effective methods of pain relief during natural childbirth.

Activity of the expectant mother during childbirth

During contractions, a woman should be moderately active: sudden movements are of no use, but lying down is not very useful. Doctors advise doing light exercise to relieve pain. Bends in different directions, circular movements of the pelvis, and rolling from toe to heel are useful. Many experts recommend using a fitball - contractions are easiest to endure on it, and it is very useful for blood circulation.

Breathing exercises

Breathing during childbirth is the most effective method to endure contractions as painlessly as possible. In addition, it is beneficial for the child - during childbirth he may experience oxygen starvation. With proper breathing, you can minimize pain and set yourself up for a positive experience. You can learn breathing exercises on your own - at special courses for expectant mothers, or at home by watching videos on the Internet.

Massage

During the course, expectant mothers will be told what points there are on the body that can be used to reduce pain. They are located in the lumbar and sacral spine. If the expectant mother goes to give birth with her husband or another loved one, you can ask him to give a massage.

Water birth

There is also such a way of easy childbirth - this is birth in water. Today, this method causes a lot of controversy. But if you think that it is optimal for you, then enlist the support of an experienced midwife. Warm water helps a woman in labor relax and concentrate on contractions.

The perinatal period of a baby's life is one of the most important. Childbirth and the first hours of a child’s life leave a serious imprint on its further development.

Drug pain relief during childbirth

Anesthesia during childbirth often occurs with the help of drugs. Below we will talk about modern medicinal methods of pain relief.

Epidural anesthesia

Epidural and spinal anesthesia are used most often in cases of natural childbirth in a woman. An epidural affects the area below the back, thereby blocking pain. It begins to act 10 - 20 minutes after administration.

Epidural anesthesia is anesthesia into the spine. How epidural anesthesia is given: the doctor inserts a catheter with medicine into the back area, through which the pain medication is delivered. During the administration of the medicine, the woman must lie still, otherwise there is a risk of getting into the wrong place. All manipulations are performed by an experienced anesthesiologist, after which he monitors the woman’s condition and decides whether a new dose of pain relief is necessary.

This method has both advantages and disadvantages. The advantages include the following:

There is virtually no risk for the baby;
The cardiovascular system is not exposed to the aggressive effects of the drug;
An anesthetic drug can be administered throughout the entire period of labor, depending on the condition of the woman in labor.

Disadvantages of epidural anesthesia:

Some women continue to feel pain;
The procedure for administering the drug through a catheter requires high professionalism, since it is quite complex to perform;
An epidural cannot be administered to a woman in labor during rapid labor, since its effect begins after 20 minutes, which is why the question of whether everyone is given it disappears by itself.;
After an epidural, your back sometimes hurts.

Among the types of anesthesia, epidural is one of the safest; there are no complications after it.

Spinal anesthesia

Spinal anesthesia begins to act immediately as soon as the drug is injected into the mother's back, blocking sensations below the chest. It works for an hour or two. In addition, for spinal anesthesia, the doctor uses a very thin needle, which is inserted into the area where the cerebrospinal fluid is located. This type of anesthesia can also be used for caesarean section if strong medications are used.

Additionally, during this procedure, the woman is given a catheter into a vein to avoid possible complications.

Many mothers may be concerned about how long such anesthesia lasts. The answer is: from 2 to 4 hours. The epidural effect is 2 times less, but there are practically no consequences for the back.

Pros of spinal anesthesia:

No pain when inserting a needle into the spine;
The fetus is not at risk;
The cost is lower than epidural anesthesia;
The woman sees everything, her consciousness remains clear;
Instant effect.

However, this procedure also has disadvantages:

After pain relief using this method, the woman should lie down for several hours without getting up;
After the puncture, headaches are possible for some time;
Painful symptoms in the back are possible;
Development of hypotension.

Pudendal anesthesia

It is also called local anesthesia, since the doctor numbs only the perineal area. A woman may not feel this, since this is done during a contraction. The need for this anesthesia is caused by an episiotomy. Pudendal anesthesia is not harmful for both the expectant mother and the baby.

General anesthesia

General anesthesia is used during childbirth only in case of urgent need, and only for caesarean section. Indications for such a procedure may be a sharp deterioration in the condition of the child or mother, as well as uterine bleeding. The doctor injects the patient with medicine into a vein, after which the woman falls asleep.

Why is general anesthesia dangerous? The fact that it affects the fetus causes drowsiness and deterioration of blood supply, a negative effect on its nervous system and further physical development. However, this is the best method to save both the mother and her baby.

After a while, a woman may experience dizziness, nausea, vomiting, drowsiness, and body pain, but these symptoms disappear the next day.

Inhalation anesthesia

This is anesthesia during childbirth, which is used when the cervix is not ready to fully dilate, and the woman in labor experiences severe pain from contractions. It does not suppress the birth process, the woman quickly regains consciousness. In addition, this method is the safest.

Epidural and spinal anesthesia are popular today; these and other techniques have their pros and cons

Postpartum pain relief

Doctors often find that a woman who has given birth experiences severe pain. What complications can occur after childbirth?

Spasms of the uterus caused by its contractions;
Pain at the sites of ruptures;
Inability to go to the toilet;
Pain in the chest area;
Incorrect attachment to the breast, causing cracked nipples.

If you have the symptoms described above, the doctor will suggest you take a painkiller and apply a medicinal ointment to the site of the ruptures or incisions. In other cases, pain rarely accompanies a woman, provided she follows the rules of hygiene.

Other methods of self-administered local anesthesia:

Shower regularly;
Cooling compress on the perineal area (you can use a bottle of water and store it in the freezer);
Do not make sudden movements;
Postpartum pads can be stored in the refrigerator to minimize pain.

Medicines for pain relief

They are divided into several types:

Antispasmodics;
Non-narcotic analgesics;
Narcotic analgesics;
Analgesics;
Sedatives.

Antispasmodics

They relieve pain well in women in labor and promote rapid dilatation of the cervix, thereby shortening the stage of labor. Antispasmodics are indicated for young women in labor and older women. There is no risk to the woman's fetus. These include: no-shpa, papaverine, buscopan.

Non-narcotic analgesics

They have an analgesic and psychological effect, relieving anxiety in the woman in labor. These include analgin and tramadol.

Narcotic analgesics

They are safe for the baby, but have a number of side effects for the mother:

Nausea, vomiting, dizziness;
Difficulty breathing;
Sharply reduce blood pressure;
Constipation;
Depression.

These include Pentazocine, Pethidine, Butorphanol, Promedol. The latter is the most effective in pain relief.

Analgesics

Some pain sensations are blocked, consciousness remains clear. They have many negative consequences for the child and for the mother. This includes opioids and other pain medications.

Sedatives

Their action is more aimed at relieving anxiety in the expectant mother; unfortunately, they do not have the best effect on the fetus. The baby's blood pressure may decrease, the heart rate may increase, and respiratory functions may be impaired. These include Diazepam, Droperidol, Thiopental.

Any painkillers analgesics carry certain risks for the baby and the expectant mother. However, their use in exceptional cases may be justified.

Pros and cons of anesthesia during childbirth

Pain relief has pros and cons. Today, opinions regarding the importance of anesthesia during childbirth are radically divided. Let's consider the advantages of childbirth with anesthesia.

Anesthesia during childbirth: why for?

It’s hard not to notice the obvious benefits of painkillers:

The opening of the cervix accelerates, and, accordingly, the time of contractions decreases;
The baby passes through the birth canal more successfully;
Relieving stress in a woman in labor;
Psychoprophylactic effect on fetal hypoxia.
The drug does not stay in the baby’s body, the risk is minimal.

Despite the obvious advantages of anesthesia, there are still negative consequences.

Anesthesia during childbirth: why against it?

Even though the risk is minimal, it still exists:

Inaccurate administration of the drug;
Drowsiness and lethargy of the child;
The natural dilatation of the cervix becomes difficult, labor lasts longer;
Often contractions stop, which is undesirable for the birth process;
Women in labor complain of headaches after anesthesia, nausea, and body aches.

Whether to have anesthesia during childbirth or not - every woman has the right to decide for herself. On forums you can often see positive reviews from young mothers regarding pain relief. Many people say that anesthesia during childbirth greatly facilitated contractions and the pushing stage.

Unfortunately, nowadays more and more women are resorting to childbirth under anesthesia for no apparent reason, without thinking about the side effects. It is very important to listen to the doctor’s opinion and understand at what stage of labor it is done. In case of rapid labor, anesthesia is contraindicated; in difficult childbirth, it is recommended.

How much does labor anesthesia cost? The price of anesthesia varies depending on the method of anesthesia and the amount of medicine.

Is it painful to have anesthesia? This question worries many expectant mothers. However, if the health of the unborn baby is in the balance, then this issue fades into the background. Childbirth is difficult not only for you, but also for the child. No matter how high-quality modern pain relief techniques are, natural childbirth is always preferable.

Update: October 2018

Almost all women are afraid of the upcoming birth, and this fear is largely due to the expectation of pain during the birth process. According to statistics, pain during childbirth, which is so severe that it requires anesthesia, is experienced by only a quarter of women in labor, and 10% of women (second and subsequent births) characterize labor pain as quite tolerable and bearable. Modern anesthesia during childbirth can alleviate and even stop labor pain, but is it necessary for everyone?

Why does pain occur during childbirth?

Labor pain is a subjective sensation that is caused by irritation of nerve receptors in the process (that is, its stretching), significant contractions of the uterus itself (contractions), stretching of blood vessels and tension of the uterosacral folds, as well as ischemia (deterioration of blood supply) of muscle fibers.

Pain during labor occurs in the cervix and uterus. As the uterine os stretches and opens and the lower uterine segment stretches, the pain increases.
Pain impulses, which are formed when the nerve receptors of the described anatomical structures are irritated, enter the roots of the spinal cord, and from there to the brain, where pain sensations are formed.
A response comes back from the brain, which is expressed in the form of autonomic and motor reactions (increased heart rate and breathing, increased blood pressure, nausea and emotional arousal).

In the period of pushing, when the opening of the uterine pharynx is complete, pain is caused by the advancement of the fetus along the birth canal and the pressure of its presenting part on the tissue of the birth canal. Compression of the rectum causes an irresistible desire to “go big” (this is pushing). In the third period, the uterus is already free of the fetus, and the pain subsides, but does not disappear completely, since it still contains the placenta. Moderate uterine contractions (the pain is not as severe as during contractions) allow the placenta to separate from the uterine wall and be released.

Labor pain is directly related to:

fruit size
pelvic size, constitutional features
number of births in history.

In addition to unconditioned reactions (irritation of nerve receptors), the mechanism of formation of labor pain also involves conditioned reflex moments (negative attitude towards childbirth, fear of childbirth, worry about oneself and the child), as a result of which adrenaline is released, which further narrows the blood vessels and increases ischemia myometrium, which leads to a decrease in the pain threshold.

In total, the physiological side of labor pain accounts for only 50% of pain, while the remaining half is due to psychological factors. Pain during childbirth can be false or true:

They talk about false pain when unpleasant sensations are provoked by the fear of childbirth and the inability to control one’s reactions and emotions.
True pain occurs when there is any disruption in the birth process, which actually requires anesthesia.

It becomes clear that most women in labor are able to survive childbirth without pain relief.

The need for pain relief during labor

Pain relief during labor must be carried out in case of its pathological course and/or existing chronic extragenital diseases in the woman in labor. Relieving pain during childbirth (analgesia) not only alleviates suffering and relieves emotional stress in the woman in labor, but also interrupts the connection between the uterus - spinal cord - brain, which prevents the body from forming a brain response to painful stimuli in the form of vegetative reactions.

All this leads to stability of the cardiovascular system (normalization of blood pressure and heart rate) and improvement of uteroplacental blood flow. In addition, effective pain relief during labor reduces energy costs, reduces oxygen consumption, normalizes the functioning of the respiratory system (prevents hyperventilation, hypocapnia) and prevents narrowing of the uteroplacental vessels.

But the factors described above do not mean that drug pain relief for labor is required for all women in labor without exception. Natural pain relief during childbirth activates the antinociceptive system, which is responsible for the production of opiates - endorphins or happiness hormones that suppress pain.

Methods and types of pain relief for childbirth

All types of pain relief for labor pain are divided into 2 large groups:

physiological (non-drug)
pharmacological or drug pain relief.

Physiological methods of pain relief include

Psychoprophylactic preparation

This preparation for childbirth begins at the antenatal clinic and ends one to two weeks before the expected due date. Training at the “school of mothers” is conducted by a gynecologist who talks about the course of childbirth, possible complications and teaches women the rules of behavior during childbirth and self-help. It is important for a pregnant woman to receive a positive charge for childbirth, cast aside her fears and prepare for childbirth not as a difficult ordeal, but as a joyful event.

Massage

Self-massage will help relieve pain during contractions. You can stroke the side surfaces of the abdomen in a circular motion, the collar area, the lumbar region, or press with your fists on points located parallel to the spine in the lumbar region during contractions.

Correct breathing

Pain-relieving poses

There are several body positions, taking which, the pressure on the muscles and perineum decreases and the pain weakens somewhat:

squatting with knees wide apart;
standing on your knees, having previously separated them;
standing on all fours, raising the pelvis (on the floor, but not on the bed);
lean on something, tilting your body forward (on the back of the bed, on the wall) or jump while sitting on a gymnastic ball.

Acupuncture

Water treatments

Taking a warm (not hot!) shower or bath has a relaxing effect on the muscles of the uterus and skeletal muscles (back, lower back). Unfortunately, not all maternity hospitals are equipped with special baths or pools, so this method of pain relief cannot be used by all women in labor. If contractions start at home, then until the ambulance arrives, you can stand in the shower, lean against the wall, or take a warm bath (provided that your water has not broken).

Transcutaneous electrical nerve stimulation (TENS)

2 pairs of electrodes are applied to the patient’s back in the lumbar and sacral region, through which a low-frequency electric current is supplied. Electrical impulses block the transmission of pain stimuli in the roots of the spinal cord, and also improve blood supply in the myometrium (prevention of intrauterine hypoxia).

Aromatherapy and audiotherapy

Inhaling aromatic oils allows you to relax and relieves labor pain somewhat. The same can be said about listening to pleasant, quiet music during contractions.

Pharmacological methods of pain relief include

Non-inhalational anesthesia

For this purpose, narcotic and non-narcotic drugs are administered intravenously or intramuscularly to the woman in labor. Narcotic drugs used include promedol and fentanyl, which help normalize discoordinated uterine contractions, have a sedative effect and reduce the secretion of adrenaline, which increases the threshold of pain sensitivity. In combination with antispasmodics (, baralgin), they accelerate the opening of the uterine pharynx, which shortens the first stage of labor. But narcotic drugs cause central nervous system depression in the fetus and newborn, so it is not advisable to administer them at the end of labor.

Of the non-narcotic drugs for pain relief during labor, tranquilizers (Relanium, Elenium) are used, which not so much relieve pain as relieve negative emotions and suppress fear; non-narcotic anesthetics (ketamine, sombrevin) cause confusion and insensitivity to pain, but do not impair respiratory function, do not relax skeletal muscles and even increase the tone of the uterus.

Inhalational anesthetics

This method of pain relief during childbirth involves the mother inhaling inhalational anesthetics through a mask. At the moment, this method of anesthesia is used in few places, although not so long ago cylinders with nitrous oxide were available in every maternity hospital. Inhalational anesthetics include nitrous oxide, fluorotane, and trilene. Due to the high consumption of medical gases and the contamination of the delivery room with them, the method has lost popularity. There are 3 methods of inhalation anesthesia:

inhalation of a mixture of gas and oxygen continuously with breaks after 30 0 40 minutes;
inhalation only at the beginning of the contraction and stopping inhalation at the end of the contraction:
inhalation of medical gas only in between contractions.

Positive aspects of this method: rapid restoration of consciousness (after 1 - 2 minutes), antispasmodic effect and coordination of labor (prevention of the development of abnormalities in labor), prevention of fetal hypoxia.

Side effects of inhalational anesthesia: breathing problems, heart rhythm disturbances, confusion, nausea and vomiting.

Regional anesthesia

Regional anesthesia involves blocking specific nerves, spinal roots, or nerve ganglia. The following types of regional anesthesia are used during childbirth:

Pudendal nerve block or pudendal anesthesia

Blockade of the pudendal nerve involves the introduction of a local anesthetic (usually a 10% lidocaine solution) through the perineum (transperineal technique) or through the vagina (transvaginal method) to the points where the pudendal nerve is localized (the middle of the distance between the ischial tuberosity and the edges of the rectal sphincter). It is usually used to relieve pain during labor when other methods of anesthesia cannot be used. Indications for a pudendal block are usually the need to use obstetric forceps or a vacuum extractor. Among the disadvantages of the method, the following are noted: pain relief is observed only in half of women in labor, the possibility of the anesthetic entering the uterine arteries, which, due to its cardiotoxicity, can lead to death, only the perineum is anesthetized, while spasms in the uterus and lower back persist.

Paracervical anesthesia

Paracervical anesthesia is permissible only for pain relief in the first stage of labor and consists of injecting a local anesthetic into the lateral vaults of the vagina (around the cervix), thereby achieving blockade of the paracervical nodes. It is used when the uterine pharynx is opened by 4–6 cm, and when almost complete dilation is achieved (8 cm), paracervical anesthesia is not performed due to the high risk of introducing the drug into the fetal head. Currently, this type of pain relief during childbirth is practically not used due to the high percentage of development of bradycardia (slow heartbeat) in the fetus (approximately 50–60% of cases).

Spinal: epidural or peridural anesthesia and spinal anesthesia

Other methods of regional (spinal) anesthesia include epidural anesthesia (injection of anesthetics into the epidural space located between the dura mater (outer) of the spinal cord and the vertebrae) and spinal anesthesia (introduction of anesthetic under the dura mater, arachnoid (middle) mater without reaching the pia mater meninges - subarachnoid space).

Pain relief from EDA occurs after some time (20–30 minutes), during which the anesthetic penetrates the subarachnoid space and blocks the nerve roots of the spinal cord. Anesthesia for SMA occurs immediately, since the drug is injected precisely into the subarachnoid space. The positive aspects of this type of pain relief include:

high percentage of efficiency:
does not cause loss or confusion;
if necessary, you can extend the analgesic effect (by installing an epidural catheter and administering additional doses of drugs);
normalizes discoordinated labor;
does not reduce the strength of uterine contractions (that is, there is no risk of developing weakness of labor forces);
lowers blood pressure (which is especially important for arterial hypertension or gestosis);
does not affect the respiratory center in the fetus (there is no risk of developing intrauterine hypoxia) and in the woman;
if abdominal delivery is necessary, the regional block can be strengthened.

Who is indicated for pain relief during labor?

Despite the many advantages of various methods of pain relief during childbirth, relief of labor pain is carried out only if there are medical indications:

gestosis;
C-section;
young age of the woman in labor;
labor began prematurely (in order to prevent birth trauma to the newborn, the perineum is not protected, which increases the risk of rupture of the birth canal);
estimated fetal weight of 4 kg or more (high risk of obstetric and birth injuries);
labor lasts 12 hours or more (prolonged, including with a preceding pathological preliminary period);
drug labor stimulation (when oxytocin or prostaglandins are added intravenously, contractions become painful);
severe extragenital diseases of the woman in labor (pathology of the cardiovascular system, diabetes mellitus);
the need to “turn off” the pushing period (high myopia, preeclampsia, eclampsia);
discoordination of generic forces;
birth of two or more fetuses;
dystocia (spasm) of the cervix;
increasing fetal hypoxia during childbirth;
instrumental interventions in the pushing and afterbirth periods;
suturing incisions and tears, manual examination of the uterine cavity;
rise in blood pressure during childbirth;
hypertension (indication for EDA);
incorrect position and presentation of the fetus.

Question - answer

What pain relief methods are used after childbirth?

After separation of the placenta, the doctor examines the birth canal to ensure its integrity. If ruptures of the cervix or perineum are detected, and an episiotomy has been performed, then there is a need to suturing them under anesthesia. As a rule, infiltration anesthesia of the soft tissues of the perineum with novocaine or lidocaine (in case of ruptures/incisions) and, less commonly, pudendal blockade are used. If EDA was performed in the 1st or 2nd period and an epidural catheter was inserted, then an additional dose of anesthetic is injected into it.

What kind of anesthesia is performed if instrumental management of the second and third stages of labor is necessary (fertility surgery, manual separation of the placenta, application of obstetric forceps, etc.)?

In such cases, it is advisable to perform spinal anesthesia, in which the woman is conscious, but there is no sensation in the abdomen and legs. But this issue is decided by the anesthesiologist together with the obstetrician and largely depends on the anesthesiologist’s knowledge of pain management techniques, his experience and the clinical situation (the presence of bleeding, the need for quick anesthesia, for example, with the development of eclampsia on the birth table, etc.). The method of intravenous anesthesia (ketamine) has proven itself well. The drug begins to act 30 - 40 seconds after administration, and its duration is 5 - 10 minutes (if necessary, the dose is increased).

Can I pre-order EDA during labor?

You can discuss pain relief during labor using the EDA method with your obstetrician and anesthesiologist in advance. But every woman should remember that epidural anesthesia during childbirth is not a mandatory condition for providing medical care to a woman in labor, and the mere desire of the expectant mother to prevent labor pain does not justify the risk of possible complications of any “ordered” type of anesthesia. In addition, whether EDA will be performed or not depends on the level of the medical institution, the presence of specialists in it who know this technique, the consent of the obstetrician leading the birth, and, of course, payment for this type of service (since many medical services that are performed at will patient are additional and, accordingly, paid).

If EDA was performed during childbirth without the patient’s request for pain relief, will you still have to pay for the service?

No. If epidural anesthesia or any other labor anesthesia was carried out without a request from the woman in labor to relieve pain, therefore, there were medical indications for easing contractions, which was established by the obstetrician and pain relief in this case acted as part of the treatment (for example, normalization of labor in case of discoordination of labor forces ).

How much does EDA cost during childbirth?

The cost of epidural anesthesia depends on the region in which the woman in labor is located, the level of the maternity hospital, and whether the hospital is private or public. Today, the price of EDA ranges (approximately) from $50 to $800.

Can everyone have spinal (EDA and SMA) anesthesia during childbirth?

No, there are a number of contraindications for which spinal anesthesia cannot be performed:

Absolute:

the woman’s categorical refusal of spinal anesthesia;
blood coagulation disorders and a very low platelet count;
anticoagulant therapy (heparin treatment) on the eve of childbirth;
obstetric bleeding and, as a result, hemorrhagic shock;
sepsis;
inflammatory processes of the skin at the site of the intended puncture;
organic lesions of the central nervous system (tumors, infections, injuries, high intracranial pressure);
allergy to local anesthetics (lidocaine, bupivacaine and others);
blood pressure level is 100 mm Hg. Art. and below (any type of shock);
scar on the uterus after intrauterine interventions (high risk of missing uterine rupture due to the scar during childbirth);
incorrect position and presentation of the fetus, large size of the fetus, anatomically narrow pelvis and other obstetric contraindications.

Relative ones include:

spinal column deformity (kyphosis, scoliosis, spina bifida;
obesity (difficulty with puncture);
cardiovascular diseases in the absence of constant cardiac monitoring;
some neurological diseases (multiple sclerosis);
lack of consciousness in the woman in labor;
placenta previa (high risk of obstetric hemorrhage).

What kind of pain relief is given during a caesarean section?

The method of pain relief during a cesarean section is chosen by the obstetrician together with the anesthesiologist and agreed upon with the woman in labor. In many ways, the choice of anesthesia depends on how the operation will be performed: for planned or emergency reasons and on the obstetric situation. In most cases, in the absence of absolute contraindications to spinal anesthesia, the woman in labor is offered and performed EDA or SMA (both for planned and emergency caesarean section). But in some cases, endotracheal anesthesia (EDA) is the method of choice for pain relief for abdominal delivery. During EDA, the woman in labor is unconscious, unable to breathe on her own, and a plastic tube is inserted into the trachea, through which oxygen is supplied. In this case, anesthetic drugs are administered intravenously.

What other methods of non-drug pain relief can be used during childbirth?

In addition to the above methods of physiological pain relief during childbirth, you can do auto-training to ease contractions. During painful uterine contractions, talk to the child, express the joy of a future meeting with him, and set yourself up for a successful outcome of childbirth. If auto-training does not help, try to distract yourself from the pain during a contraction: sing songs (quietly), read poetry or repeat the multiplication table out loud.

Case study: I gave birth to a young woman with a very long braid. It was her first birth, the contractions seemed very painful to her, and she constantly asked for a caesarean section to stop this “torture.” It was impossible to distract her from the pain until one thought occurred to me. I told her to undo the braid, otherwise it was too disheveled, to comb it and braid it again. The woman was so carried away by this process that she almost missed the attempts.