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Childbirth is an absolutely natural physiological act and usually does not require additional medical intervention, except for the assistance of a midwife. But in some cases, especially if the pregnancy was complicated by various diseases or there is an indication for a cesarean section, pain relief is simply necessary. Painful sensations in women occur during contractions, when the first stage of labor lasts and the cervix opens. They are associated with strong tension and contraction of the uterine muscles. Depending on the magnitude of a woman’s pain threshold, as well as on individual mental reactions, it can be either barely noticeable or unbearable.
Why is pain relief needed?
Since ancient times, humanity has been trying to find a way to reduce pain in women in labor. In ancient times, decoctions of herbs and smoking were used for this; later, synthetic painkillers appeared. Childbirth is one of the most painful processes, and the medieval concept of the need for female suffering is, fortunately, a thing of the past.
Research by modern scientists directly suggests that excessive pain during childbirth sharply increases the level of adrenaline and norepinephrine in the blood, and this can lead to disruption of oxygen transport in the body. As a result, the frequency of contractions may decrease with the possible development of fetal hypoxia.*
What is epidural anesthesia
The epidural space surrounds the outside of the dura mater, which covers the entire spinal cord. In the epidural space of the lumbar region there are nerve endings that conduct pain impulses from the uterus. An injection is made in the lumbar region and an anesthetic is injected.
When painkillers are administered, sensitivity is temporarily switched off, which allows the woman in labor to stop feeling pain. The dose of the anesthetic drug is selected and adjusted for partial or complete pain relief.
Unlike general anesthesia, epidural anesthesia allows the woman in labor to remain conscious at all stages. Most often, such anesthesia, unless there are special indications, is used only for the period of contractions, which can last for several hours, and the woman gives birth without anesthesia.
How labor is pain relieved in modern obstetrics
Many women who are in an “interesting position” are worried about the fear of upcoming labor pain. But it turns out that modern obstetrics has learned to regulate pain perception during childbirth. There are methods of both drug and non-drug pain relief. Let's talk about this in order to apply the acquired knowledge in practice.
Non-drug pain relief
These are methods in which you do not need to use any medications. We list the 5 main and most effective options for non-drug pain relief.
Psychological preparation
The unknown breeds fear. A woman, especially a first-time mother, does not know how the birth process will proceed, what will happen ahead and how long she will have to wait before the baby is born. However, the Pregnant School will help dispel all fears. During the classes, doctors will talk about the main points that you will have to face during childbirth, teach you how to react to them correctly, and what to do to help the baby be born.
The knowledge gained will help harmonize the nervous system and reduce the level of anxiety. Psychological preparation creates a favorable background that eliminates the fear of pain during childbirth.
Muscle training
It is important to start training as early as possible. This method will bring the best results to those women who began “pumping” almost from the first days of conception.
You need to train not only the pelvic floor muscles, but also all the muscles of the body, because during childbirth there is not a single muscle that does not work. If pregnancy proceeds without complications, then the woman has no restrictions on sufficient physical activity. You can engage in any sport, the main thing is that you are comfortable and do not experience pain. Walking, swimming, yoga, fitness and any other option will do. There is no universal sport designed specifically for pregnant women. So choose according to your preferences.
Relax
During childbirth, all organs and systems of the mother's body experience stress. Therefore, to reduce pain, learn to relax. It really can be done if you practice. Any relaxation technique will do. Rehearse in advance during pregnancy in order to help yourself and your baby at the most crucial moment, because during childbirth the baby experiences severe stress. It’s not easy for him, just like it is for you.
Breath
Proper breathing saturates the body with oxygen and thereby distracts from pain. There are a huge number of techniques that explain how to breathe correctly during childbirth. It is quite easy to get confused in such diversity. But there is one universal rule. You need to take a deep breath through your nose and exhale slowly through your mouth, with your lips folded into a tube.
Massage
Massage of the lumbar and sacral region helps reduce the severity of labor pain. You can massage these areas yourself or ask a partner who is next to you. In addition to such help, partner childbirth is also good because you receive serious moral support.
Drug pain relief
One common method of drug-based pain relief is epidural analgesia (“a shot in the back”). The anesthesiologist, according to all the rules, inserts a catheter into the space between the dura mater and the periosteum of the spine. Pain medications are delivered through this conduit. It is important to understand that the catheter is not inserted into the spinal cord; it is located in the space where the nerve trunks responsible for pain sensitivity are located. Local anesthetics, which are used for epidural analgesia, block the conduction of electrical impulses along these trunks and thereby prevent labor pain.
Modern medicine has learned to control pain during childbirth in different ways. Consult your gynecologist and choose the option that will be most optimal for you during this important period. And remember that non-drug methods are available always and everywhere, so they are worth taking advantage of.
Spinal or epidural?
These two types of pain relief are very often confused, because they are really similar in appearance, especially for those who are far from medicine. However, there are differences between them.
Spinal . This anesthesia uses a thin needle through which an anesthetic is injected into the cerebrospinal fluid. Nowadays, this method is used less and less, because if performed incorrectly or if contraindications are not identified, it can lead to serious consequences.
Epidural . For this type of anesthesia, local anesthesia is first performed, after which a puncture is made at the puncture site with a special needle that penetrates to the dura mater. When performing this manipulation, it is very important not to move so that the doctor’s hand does not tremble. A catheter is inserted into the puncture through a needle, through which anesthetics enter the epidural space. His tube will remain in your back as long as necessary to maintain the pain-relieving effects of the medications. After removing the catheter, only a small puncture will remain, which will be treated and covered with a bandage.
How is epidural anesthesia given during childbirth?
Any intervention in a woman’s body during pregnancy and childbirth is coordinated with an obstetrician-gynecologist; the indications for this type of anesthesia, the condition of both the mother and the fetus are comprehensively assessed for maximum safety of the process. The patient is placed in a lateral position with her legs adducted, or sitting with her back arched. A venous catheter must be installed, followed by drip administration of at least 500 ml of crystalloid solution in order to prevent a pathological decrease in blood pressure after the manipulation.
The puncture site (the distance between the spinous processes of the lumbar vertebrae L2-L3) is treated with antiseptic solutions, anesthetized with local anesthetics, then a puncture is made with a special puncture needle, a catheter is inserted into the epidural space, an aseptic sticker is applied and the patient is placed in a lateral position, the first dose is administered through the catheter painkiller.
At this moment, it is very important to assess the condition of the woman and child - measuring pulse, blood pressure, monitoring the fetal heart rate.
Effect of anesthesia on a child
Proponents of “natural childbirth”, without any anesthesia, insist that drugs can negatively affect the fetus. However, modern research refutes this fact: as a result of the tests, it was found that epidural anesthesia does not affect the child in any way, but greatly facilitates the birth process.** In addition, for this type of anesthesia, drugs are used that do not penetrate the placental membrane of the fetus .
The main advantage of epidural anesthesia during childbirth is that a woman can relax, calm down and confidently move on to the process of expulsion of the fetus without neurosis and stress.
When is epidural anesthesia given during childbirth?
According to the World Health Organization, 25–30% of women in labor rate pain during natural childbirth as unbearable. According to the legislation of the Russian Federation, namely Article 19 of Federal Law No. 323 “On the fundamentals of protecting the health of citizens in the Russian Federation,” every patient has the right to pain relief. Thus, in the absence of medical contraindications, a woman’s desire for pain relief during childbirth is a sufficient indication for the use of epidural anesthesia and other modern methods of pain relief. In addition, there are generally accepted indications and contraindications for regional anesthesia methods. The absolute indications for epidural anesthesia during childbirth are:
- Increased blood pressure of any etiology (preeclampsia, hypertension, symptomatic arterial hypertension).
- The presence of somatic diseases: heart defects (not all), respiratory diseases - bronchial asthma, kidney diseases - glomerulonephritis, high degree of vision loss, increased intracranial pressure.
- The presence of current or previous venous or arterial thrombosis.
- Young women giving birth under 18 years of age.
- Intrauterine fetal death, where the main aspect is the psychological state of the woman.
The consequences of the lack of epidural anesthesia after childbirth for mother and baby in the above clinical situations can be very serious.
Relative indications for epidural anesthesia are:
- Anomalies of labor, namely discoordinated labor.
- Premature birth (birth at gestational age earlier than 37, but later than 22 weeks).
- Large fruit.
- Caesarean section operation.
Epidural anesthesia during childbirth ensures a minimal drug load on the fetus and newborn, which is a huge advantage during premature birth, when the baby’s nervous system is especially vulnerable. The level of stress hormones in the mother’s blood is reduced, disruption of fetoplacental blood flow and disruption of oxygen transport to the child are prevented due to excessive contractions of the uterus. Also, according to statistical data, there is a decrease in injuries to the birth canal (ruptures of the cervix, vagina and perineum) due to muscle relaxation and a softer, smoother flow of the birth process. With maximum adherence to pain management technology, there is no deterioration in the condition of the fetus and newborn, the frequency of surgical delivery does not increase, and the risk of neurological consequences is minimal.
Indications for pain relief
Unfortunately, not all medical institutions can yet make an independent decision about the use of anesthetics. In most cases, the following situations are indications for the need for epidural anesthesia.
Premature pregnancy. Relaxing the pelvic floor muscles allows the baby to pass through the birth canal more easily without encountering resistance. For babies who were born prematurely, unnecessary stress is contraindicated, so if there are no indications for a caesarean section or other individual characteristics of the pregnancy, it is recommended to give birth with epidural anesthesia.
Discoordination of labor. This is the name of a condition in which contractions last longer than expected, but the dilation of the cervix is not sufficient. In this case, epidural anesthesia will relieve spasm and help labor.
High blood pressure. If you have hypertension, childbirth can lead to strokes or other dangerous consequences, so doctors may prescribe either a cesarean section or use an epidural, which will help normalize blood pressure levels.
The need for surgical intervention. In cases where general anesthesia cannot be used, but surgical assistance is required, epidural anesthesia is used as an alternative option.
Pain relief without drugs
So, if a woman is in good health and there are no complications during labor, then you can try to avoid painful sensations using various physiological methods: massage, water procedures, gymnastics and special breathing. All processes in the body are interconnected: if a woman is afraid, then a muscle spasm occurs, causing oxygen deficiency in the blood vessels and acute pain. Tension of the facial muscles causes a response spasm of the uterine uterus and delayed dilation of the cervix. Based on these data, when contractions occur, you need to relax and calm down, feeling that the pain is going away every minute.
Of course, it is not easy to immediately master such a technique, so during pregnancy it is necessary to attend special courses for expectant mothers, which teach the correct breathing tactics at different stages of childbirth, show basic relaxation techniques and exercises to relieve pain. Such courses can and should be attended with a partner, since many exercises are based on teamwork.
For physical exercise, you don’t need any special devices, you just need to listen to yourself and change positions more often, since physical activity makes labor easier and reduces pain. If the doctor has not prescribed bed rest, you need to walk more, preferably lying only on your side. Sitting is undesirable, as this creates pressure on the perineum.
Many women benefit from water procedures, but they can only be carried out if the water has not broken, since the risk of infection is very high. A warm bath with hydromassage is a great way to relieve tension and help you relax, but either a partner or someone from the medical staff must be present during the procedure. You can also use a shower cabin, directing streams of water to your back and lower abdomen. The water should be at a temperature of about thirty-six degrees so as not to cause bleeding. Aromatherapy, self-hypnosis and other techniques, including massage, are also quite effective in relieving severe pain. If desired, you can resort to a variety of techniques to minimize pain, but before using them, you should definitely talk with the doctor leading the birth.
When not to use
Any medical intervention has its contraindications, and this includes epidural anesthesia. However, even the presence of contraindications is not a reason to give birth without anesthesia. In this case, doctors can choose alternative ways to reduce the pain threshold.
Low blood pressure. With low blood pressure, the administration of painkillers can cause a sharp drop in blood pressure.
Spinal deformity. If a woman has degenerative disorders in the spinal column, it is extremely curved or abnormal, access for a boat will be difficult. This means that when the drug is administered, it may end up in the wrong place or may not block pain.
Inflammation in the puncture area. In case of any inflammatory processes in the lumbar region (the site of epidural anesthesia), injections are prohibited, as they can provoke suppuration or other unpleasant consequences of infection in the blood.
Blood clotting disorder. Some painkillers can thin the blood, which is especially dangerous if uterine bleeding occurs during childbirth.
Intolerance to a certain group of drugs. Usually analogues are simply used, but in rare cases epidural anesthesia becomes impossible
Unconscious state. Firstly, an unconscious woman, in principle, does not feel pain, and secondly, she cannot give her consent to the use of anesthesia, which is required when prescribing a certain group of drugs
Consequences and complications
In most cases, epidural anesthesia is well tolerated without negative consequences for mother and child. However, there are situations when unpleasant complications actually occur, usually in the woman in labor.
Entry of drugs into the venous system. If the doctor gets into a vessel during a puncture, and the anesthetic ends up in the bloodstream, the woman will feel weakness, dizziness, and numbness of the limbs. Fortunately, this is all fixable: usually such reactions occur instantly, even when the catheter is installed, and if the anesthesiologist is notified in a timely manner, unpleasant consequences can be avoided. Therefore, if you experience any of the above symptoms during epidural anesthesia, you should inform your doctor.
Allergy. Unfortunately, no one is protected from possible negative reactions of the body to the anesthetic. If you have allergic reactions (especially to medications or, for example, anesthesia administered during dental treatment), you must tell your doctor about it. This will greatly help the doctor, who will select the correct drug and its dosage, and will protect you from allergic reactions and anaphylactic shock.
Back pain. Some women, in reviews of the use of anesthesia during childbirth, complain that after an epidural the lumbar spine hurts. This happens at the site of puncture and installation of the catheter. This pain usually goes away quickly in the postpartum period. But you should definitely tell your doctor about it.
Fall in blood pressure. Most painkillers actually lower blood pressure significantly. To avoid dizziness, doctors usually recommend that their patients lie down and drugs are administered through a catheter in small doses.
Pain relief during childbirth
Sometimes, when passing by 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 inject, how much to inject, 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 are 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.
Other disadvantages of anesthesia
Most of the consequences depend on whether the anesthesiologist performs his manipulations correctly and whether the woman in labor follows all the doctors’ recommendations. The fact is that if the drug is administered incorrectly, pain relief may occur partially (in 15% of cases) or not at all (5%). Often, incorrect insertion is due to a woman’s excess weight or abnormalities in the development of her spine.
Another rare phenomenon is “mosaic” anesthesia. It occurs due to the fact that there are partitions in the epidural space that do not allow the medicine to be evenly distributed throughout the fluid. Loss of sensation on one side of the body should be immediately reported to the anesthesiologist, and he will adjust the dose of drugs.
Cons of the procedure
Most opponents of epidural anesthesia insist that during childbirth, a woman produces large amounts of the hormone oxytocin, which causes attachment to the child. And if you “block” pain with painkillers, its production will stop, and the “maternal instinct” will not work. Women who have given birth with an epidural and are raising children will easily destroy the myth of absent attachment.
Possible negative consequences are complications from inappropriate medications. Therefore, questions about allergies need to be addressed in advance. So there are practically no downsides to epidural anesthesia, and conclusions about “irreparable harm” that are not supported by facts should not be taken into account.
Pain relief after childbirth
During natural childbirth, there is no need for anesthesia. But it can occur when a woman undergoes an incision of the perineum to facilitate the birth of the fetal head - an episiotomy. You may also need painkillers for the first few days.
Postpartum anesthesia is also necessary when a woman has a caesarean section to reduce pain.
The means, timing, and regimens for using medications are determined by the doctor based on the specific situation. A woman should not choose her own remedy to relieve pain. You need to know the composition of medications and contraindications to them in order to avoid negative effects on the newborn. If taking strong medications is indicated, your doctor may recommend stopping breastfeeding until the condition returns to normal.
Pros of the procedure
We live in a modern world in which everything is done for maximum comfort. Outdated ideas that a woman in labor must suffer in order to have the right to be called a mother are today considered extremely inhumane. The advantages of epidural anesthesia are:
- pain relief during labor, which can be truly unbearable for the mother
- the opportunity to take a break when contractions have been going on for several hours, and even sleep
- lowering blood pressure in hypertensive patients
- preventing the negative consequences of excessive pain, which can provoke fetal hypoxia
- normalizing uterine contraction, relaxing the cervix and helping the baby pass through the birth canal
- relief of nausea and vomiting
- absence of depression of the respiratory centers in the mother and newborn
In addition, if an emergency caesarean section is necessary, the anesthesiologist will simply increase the dose of drugs and the operation can begin immediately.
Does anesthesia affect the fetus?
With spinal anesthesia during childbirth, with strict adherence to the technique and timely exclusion of contraindications, there are no consequences. Anesthetics act only locally; they enter the mother’s blood only in small quantities; this volume does not pass through the placental barrier.
When general anesthesia is used, the woman switches off completely, psychological stress is eliminated. Therefore, on the one hand, this method of anesthesia during childbirth is preferable. But on the other hand, the effect on the fetus is more pronounced. The longer the operation lasts, the more the drug enters the fetus’s body, breaking the placental barrier, and the more pronounced the side effects: depression of consciousness, cardiac activity and respiration.
The newborn will be lethargic. Respiratory and cardiac problems and breast refusal are possible. If ketamine is used for intravenous anesthesia, it, on the contrary, has a stimulating effect, unlike the others: on cardiac activity and the respiratory system. Gradually the concentration of the medicine ends, the baby’s condition returns to normal.
There is also a negative effect on the mother: the dilatation of the cervix slows down, which is why the total duration of labor is lengthened. Doctors select the dose of anesthetic individually to prevent overdose and inhibition of contractile activity. In such cases, additional stimulation and sometimes a caesarean section will be required.
Headaches and dizziness are common. With epidural and spinal anesthesia, blood pressure drops.
How else to make childbirth easier
Not all women necessarily want to give birth using anesthesia. However, even in this case, you can make the birth process easier for yourself.
- Pregnancy needs to be planned well in advance, giving up all bad habits, building a diet and daily routine, seeing a doctor and trying to avoid stress if possible.
- Before giving birth, you need to attend training courses in it, where you will be told in detail about how to breathe correctly and what to do when contractions begin. Such lessons are needed in order to prepare not only physically, but also emotionally.
- During contractions, you can use some massage techniques: they are usually discussed in courses. In addition, it is very important to breathe properly and try not to scream, as this takes oxygen away from the child
