We understand the pain relief of pregnant women together with the resuscitator of the maternity hospital.
– Let’s immediately define that the word “anesthesia” is not entirely appropriate here. Anesthesia is one of the types of anesthesia, which involves the administration of centrally acting analgesics to cause, among other things, a loss of consciousness. It is used extremely rarely during childbirth (caesarean section is another story). Everything else is anesthesia. Let’s talk about her.
Head of the intensive care unit of the maternity hospital No. 5, Volgograd
There are psychological methods of pain relief during childbirth, when a woman is so well prepared for this process that she may not feel pain at all. Physiotherapy is also used – a special shower and the like. All this is aimed at achieving pain relief (analgesia).
As for drug pain relief, there are two options: the use of centrally acting analgesics (narcotics) and regional anesthesia (epidural, spinal, sometimes paravertebral). Epidural is the most popular because it has very significant advantages. First, it is well controlled. Secondly, it can be carried out for quite a long time – up to one and a half days.
If necessary, it is permissible to find the catheter (through which the medicine flows) in the epidural (epidural) space (under the arachnoid membrane of the spinal cord) even for up to three days, all this time anesthesia can be performed. And, thirdly, efficiency. This applies, by the way, to all types of regional anesthesia. If analgesics of central action only change our perception of pain, then regional types of anesthesia consist in the complete local interruption of pain impulses to the central nervous system. Let me explain with an example of a light bulb. Analgesics throw a curtain over this light bulb, and it continues to burn with the same intensity, although we see less intense light. And regional anesthesia increases the resistance in the lamp circuit, because of this it burns weaker.
Who decides on the use of anesthesia in a particular case? Most often, the doctor is an obstetrician-gynecologist who leads the birth. This is not specified in advance, the decision is made directly during childbirth. There are, of course, women who say: I’m afraid of everything, I will give birth only with an “epidural”. But the corresponding psychological work is carried out with them. It does not happen that the decision on anesthesia is made in advance, before childbirth.
During childbirth, there are a number of objective reasons for the appointment of drug pain relief. Well, the requests of the woman in labor are taken into account, of course. No one will do anything against her will.
As a doctor who has been dealing with pain relief for 12 years, I think so. If modern technologies allow you to avoid unpleasant sensations, why not apply them. Regional methods of pain relief are absolutely harmless to the child for one simple reason: the drug is not injected into the bloodstream. It is introduced into the epidural space of the mother’s spine, where it is subsequently destroyed. The child does not get it. If everything is done correctly, there are no contraindications, then this method does not carry any harm to the mother either.
Spinal anesthesia during childbirth is also used infrequently. This is also a regional method of anesthesia, in which the local anesthetic is injected not into the epidural space, but directly into the spinal cord. The force of anesthesia is higher here than with epidural anesthesia, the speed of the onset of action is also much higher, but the disadvantage is that we cannot leave a catheter in the spinal space, here the drug is injected simultaneously. Therefore, this method is possible only in the last stage of labor, if the contractions are extremely painful. By the way, the effect of one injection of the drug here lasts up to four hours (with an epidural – up to one and a half). I repeat, the decision is made only with the consent of the woman in labor.
Who needs anesthesia in the first place? They always try to anesthetize premature birth – since everything happens quickly, a woman does not have time to prepare, and therefore her pain threshold is higher. Pain relief also relaxes the mother’s body, and the baby is more comfortable to be born.
Young primiparous also always try to relieve pain. Also, the reason for anesthesia is the presence of extragenital pathologies, arterial hypertension. Well, from an ethical point of view, the reason for pain relief is the delivery of a dead fetus.
The advantage of regional methods of anesthesia is that after them the woman does not need to “move away.” Neither consciousness nor breathing changes in any way. Within two hours after giving birth, a woman can begin to fulfill her maternal responsibilities.