Pain relief during childbirth: the pros and cons of different methods
Studies have shown that a significant portion of pain is directly related to the psychological experiences of patients. For example, representatives of the African tribe, living away from civilization, described their birth with the words “pressure”, “tension” or “bursting”, but not one of them spoke of “pain”. So it's not so scary! If you still want to use pain relief, see what methods exist today. And about how to properly prepare for childbirth, read here.
The ideal anesthesia formula is simple - good anesthesia plus a minimum of side effects - epidural anesthesia almost completely meets these criteria. In addition, it refers to the so-called regional methods, that is, it acts locally and therefore does not affect the clarity of the patient’s consciousness.
How does this happen?
A woman sitting or lying on her side is asked to arch her back and use a syringe with a thin needle to give an injection that anesthetizes the skin in the lumbar region. After that, a needle with a catheter is inserted through the ligaments of the spine, the woman in labor, and an anesthetic drug begins to enter the body. A few minutes later, heat spreads over the patient's legs, and after him comes numbness of the lower body - from the lower back to the heels. There is a common belief that during the injection, the doctor can damage the spinal cord, but if the injection is done by a qualified anesthetist, nothing like this will happen: the fact is that the fibers of this very spinal cord end much higher than the place into which the needle is inserted.
How it works?
The main feature of the "epidural" is that, while eliminating pain, it at the same time remains sensitive to touch and pressure. In other words, a woman feels and realizes the contractions, but at the same time they do not hurt her. The flow of the drug into the body can be controlled: in most cases, the doctor does this, but sometimes a woman in labor, by clicking on a special button, controls the pain itself. In addition to pain relief, the “epidural” also knows how to lower blood pressure: given the common “pregnant complications” - arterial hypertension (a constant increase in pressure) and preeclampsia (vascular problems) - this property is very much appreciated by doctors.
Important: If a woman has no "arterial problems", then in parallel with epidural anesthesia, she needs to put a dropper with saline solution - it will prevent a sharp decrease in pressure.
In general, this type of anesthesia is considered very effective, but, alas, for some women in labor this method of anesthesia simply does not work. As a rule, the anatomical structure of a particular woman is to blame for this: in the epidural space, where, in fact, the drug is administered, there may be partitions or adhesions that interfere with the proper distribution of the drug. This is especially common in patients with injuries or diseases of the spine: if you have problems with your back, be sure to mention them in a preliminary conversation with the anesthetist. Many pregnant women are inspired by stories about the miracles of the "epidural" and begin to literally beg their doctor about it, but only if desired, such a procedure is practically never performed. Epidural anesthesia is a serious medical manipulation with a number of side effects, carried out only according to the indications of doctors. Read also what tests you need to pass to pregnant women to check their health and protect themselves and the baby.
"Epidural" is used not only for labor pain relief. This type of anesthesia is used for cesarean section and in the postpartum period (in case you need to sew tears or conduct a manual examination of the uterine cavity).
Epidural Anesthesia: Pros and Cons
- sufficient security;
- prolonged, well-controlled pain relief;
- maintaining clarity of consciousness;
- the ability to apply in the postpartum period;
- inability to actively move in the first stage of labor;
- decrease in the strength and effectiveness of uterine contractions: as a result, the birth process may be delayed, and doctors will be forced to do a cesarean;
- the risk of a sharp drop in blood pressure;
- postpartum migraines and back pain, sometimes lasting several days.
Breathing exercises for expectant mothers
- Break the word “baby” into syllables and, with a slow deep breath, pronounce “maaaaa” to yourself, and with the same deep exhalation, “lyyysh”. Proper breathing will help to relax and saturate the body with oxygen. Inhale through the nose, exhale through the mouth: if possible, exhale should be longer than the inhalation.
- "Blow out the candle." Inhale, as usual, with your nose, and exhale with your mouth, slightly opening and rounding your lips, as if you want to extinguish the light.
- "Warm your hands." Inhale through your nose, and in order to breathe out correctly, imagine that you want to warm your hands frozen in the cold: the exhale should turn out to be plentiful and hot.
- "Two through one." During the fight, take one deep breath with your nose, and behind it - two short breaths with your mouth or, conversely, two short breaths with your nose and long breath with your mouth - as you prefer.
- . "Breath of the stomach." When the time comes to push, you will have to actively use the diaphragm. At the same time, take the deepest breath in your mouth, not as usual - with your chest, but with your stomach (this type of breathing is called abdominal). Do not exhale while you are trying. And only after the end of the attempt slowly, through the mouth, release air.
Short sleep and other pain relief methods
With prolonged or complicated births, as well as in the presence of a number of chronic diseases, a woman is often immersed in the so-called medication sleep-rest.
How does this happen?
The patient is given an injection of a hypnotic-analgesic drug (promedol is most often used), the effect of which can last from 30 minutes to two and a half hours.
How it works?
The introduced medicine not only gives the woman a short break and relieves psychological fatigue, it normalizes the work of uterine contractile fibers, reduces their oxygen demand and eliminates muscle spasm. Moreover, for most pregnant women, such a provoked dream is practically no different from the usual one - they easily wake up and do not experience any unpleasant sensations after awakening.
Just like epidural anesthesia, this method of pain relief is done exclusively for medical reasons. The fact is that all drugs used for medical sleep have a significant side effect - they inhibit the breath of the woman in labor and the baby, and this, in turn, can lead to fetal hypoxia. After such childbirth, especially careful monitoring is always carried out on infants: infants can be lethargic and / or take a bad breast or nipple - however, with proper care, all these phenomena disappear after a couple of days. If we talk about the effect of medical sleep on a woman, then after the birth is over, she can greatly decrease pressure: this usually happens in cases when a newly minted mother rises excessively from the bed. As a rule, after applying anesthesia, doctors advise patients to limit their movements as much as possible on the first postpartum day.
Medical sleep: pros and cons
- elimination of the psychological component of pain;
- effective fight against weakness and discoordination of labor;
- simplicity of the procedure (does not require sophisticated equipment);
- short-term exposure: it is impossible to put a woman into sleep at all times of childbirth - at least two hours before the baby is supposed to be born, drug administration must be stopped;
- serious side effects compared to other methods;
- much more time is required to stop the analgesic and hypnotic effects of the drug
To reduce anxiety and pain during childbirth, the oldest method of inhalation anesthesia, which is popularly called the "laughing gas", is often used. This “cocktail” of eighty percent of nitrous oxide and twenty percent of oxygen was first offered to women in labor as early as 1880, and since then its composition has not changed at all.
How does this happen?
Feeling the next fight is approaching, the woman independently picks up the inhaler and takes a deep breath. That's all.
How it works?
After 30 seconds, the “merry mixture” is absorbed into the blood, and the body immediately increases the production of endorphins - pleasure hormones that reduce anxiety, reduce pain and cause a feeling of euphoria. The effect of each breath occurs after a maximum of 60 seconds and lasts at least five minutes, so this "anesthesia" is especially good for the first - the most painful - period of childbirth. The concentration of nitrous oxide in the blood is easy to control: if a woman has healthy lungs, the gas is removed quite quickly, and if necessary, the doctor who watches the woman in labor simply stops its delivery. This method can be used to anesthetize labor, both on its own and in combination with other methods: for example, if doctors decide that a woman urgently needs to have a cesarean section, then inhalation will combine without any problems with subsequent general anesthesia. There are practically no contraindications to this procedure, they include only lung diseases that can interfere with the proper intake of the mixture in the blood, and fetal hypoxia (acute and chronic) - in this case, excessive inhalation of the “laughing gas” can increase the oxygen deficiency experienced by the baby.
Inhalation anesthesia: pros and cons
- almost complete absence of side effects for mother and baby;
- ease of use;
- affordable price (the mixture is inexpensive);
- rapid termination, if necessary;
- compatibility with other methods of pain relief;
- the need for special equipment for preparing the gas mixture and feeding it to the delivery room;
- incomplete efficiency: for most women, pain does not completely pass, and for 20% of women in labor, the method does not work at all.
On the Internet, there is often mention of another analgesic technique - percutaneous electroneurostimulation (TENS): to relieve unpleasant sensations, electrodes are attached to the lower back of a woman on both sides of the spine, by which tiny current discharges are then released. CHENS is usually used in the first stage of childbirth or in the event that the process of the birth of a child is too rapid. This method does not have any side effects on the mother and baby, however, modern doctors consider it ineffective and troublesome and therefore practically do not use it in their practice. It happens that pregnant women are so afraid of the upcoming birth that they ask doctors for general anesthesia, but qualified and conscientious doctors respond to such proposals with a categorical refusal. The fact is that under anesthesia, labor is completely “turned off”, and this does not affect the baby’s condition in the best way - this technique is used only in emergency situations, for example, with incorrect presentation of the fetus or with sudden bleeding in a woman in labor.