Modern medicine has enough methods to help overcome pain. Moreover, scientists were able to reduce the harm from analgesics for mom and baby to a minimum.
Anesthesia is required if during labor a complication occurs that increases their duration. For a woman to rest and accumulate strength, analgesics are used – drugs that completely or partially alleviate her condition.
Anesthesia is also required during the first and preterm birth, at birth of a large baby.
Young ladies with high sensitivity also need to relieve suffering. After all, the sharply expressed pain in itself inhibits labor activity, can provoke a spasm of the cervix and prevent its disclosure.
In Russia, in these cases, as a rule, antispasmodics are used (drugs that relax the smooth muscles of internal organs – they are injected intramuscularly), narcotic analgesics (they are injected both intramuscularly and intravenously), epidural and spinal anesthesia (intensive blockade of sensations and motor activity of the lower half body).
In the first stage of labor, when contractions are not very strong and short, and the cervix is just beginning to shorten and prepare for the opening, doctors resort to the help of antispasmodics. Usually it is “No-shpa” and rectal suppositories with papaverine or buscopan. “No-shpa” can be administered both intravenously and intramuscularly.
Advantages: these drugs weaken the spasms of smooth muscles of the cervix, stimulating its opening. For this reason, they do not pose a danger to the child. The advantage of rectal suppositories is that the medicine introduced in this form is absorbed bypassing the liver, and the harmful effect on the body is minimized.
Relief woman feels after 5 minutes. Antispasmodics are also often used if a woman gives birth to a second or third child.
Such deliveries take place much faster, so doctors prefer to do with small means.
Disadvantages: does not remove, but only alleviates pain. The effect lasts for only 2 hours.
Contraindications: individual intolerance.
In the active period of childbirth, 3-4 hours before the baby is born, narcotic analgesics, drugs based on narcotic substances, can be given to relieve the future mothers for pain relief. This method is used in most Russian maternity hospitals and can only be used when cervical dilatation is 5-6 cm. Previously, these substances cannot be used because they can weaken labor activity, later – they will get into the body of the baby with the bloodstream and immerse it in narcotic sleep.
Because of the side effects, they are administered once and in such a way that by the time the woman begins to try, their action ends. After all, a woman should actively participate in the process. To reduce the side effects and dose of the drug, analgesics are often combined with antispasmodics.
If side effects do occur, mom and baby are injected with substances that block the action of the drug (Nalorphine, Naloxone, Narcan). The action begins after 1 minute and lasts 2−4 hours.
Usually this time is enough for the state of the mother and baby to return to normal.
Narcotic analgesics quite a lot. Each of them has side effects.
Doctors always inform the woman about which drug will be administered. But the final choice is still for the anesthesiologist.
It takes into account the condition of a woman, how she endures pain (if it is bad, they will inject a drug that begins to act immediately), contraindications and, of course, the desire of the future mother. The most famous drugs are Promedol, Pentazocine (Leksir, Fortral), Pentidine, Butorphanol, Nalbuphine.
Advantages: all narcotic analgesics are rapidly absorbed into the blood. “Promedol” also acts as an antispasmodic – relaxes the cervix. 10 minutes after the introduction, you can already feel the soothing effect. “Petidine” and “Butorphanol” begin to act almost immediately. “Pentazocin” (“Leksir”, “Fortral”), unlike “Promedol” stimulates blood circulation and the process of childbirth, does not depress respiration.
It is believed that it can not be addictive. “Nalbuphine” does not affect the activity of the heart and blood circulation, and it is usually used in women with hypertension and problems of the cardiovascular system.
Disadvantages: drowsiness, nausea and vomiting in the mother and respiratory depression in the child (“Promedol”, “Petidine”, “Butorphanol”). Because of this, the baby may need artificial respiration. “Promedol” for 35−40% of women is ineffective, because it eliminates the pain only for a while.
The main drawback of Pentazocin is that the effect of its use is 2–3 times weaker than that of the notorious Promedol.
Contraindications: drug intolerance or drug use experience. For the baby – intrauterine hypoxia.
The ancestor of epidural anesthesia is sacral anesthesia (from the Latin sacrum – sacrum), during which an anesthetic was injected into the sacrum. It was first proposed by M. Katelin in 1901 for urological operations.
But this method had many side effects and a short effect.
The development of a more effective method of pain relief has led to the emergence of epidural anesthesia. It was first used in 1921.
The interest of surgeons to this method of anesthesia awoke after in 1931 the Italian surgeon Doliotti described in detail the technique of its implementation.
In Russia, the first epidural anesthesia was applied in 1933 by B.N. Kholtsov during urological surgery. In 1938, this method was successfully applied by the Soviet surgeons MB.
Abiyev and Kh.D. Gadzhiev, in 1939 – A.Ya. Dymsky.
In 1938, such anesthesia was applied in gynecology.
True, the method did not spread. Indeed, at that time, cocaine was used as an anesthetic, and in fairly large doses. Everything changed with the invention of local anesthetics – novocaine, lidocaine and their derivatives.
Due to this, since the 60s of the last century, epidural anesthesia has been used more actively.
Similar anesthesia of childbirth is common only in large perinatal centers and maternity homes. This is an expensive manipulation, moreover, it can be performed only by highly qualified doctors.
The needle is inserted into the epidural space (the space between the hard shell of the spinal cord and the walls of the spinal canal) of the lumbar spine. It reaches the dura mater, but does not pierce it.
A catheter is placed together with the needle through which a drug is infused that blocks the sensitivity of the lower half of the body. At the same time, pain signals from the uterus to the brain are cut off. The effect is felt in 10−20 minutes, with a single use lasts about 2 hours.
If the medication is received continuously, you can anesthetize the entire period of labor.
Such anesthesia is also used in the discoordination of labor activity – when different parts of the uterus contract asynchronously and the cervix does not open. This method helps maintain normal blood pressure in women with arterial hypertension.
For anesthesia used “Lidocaine”, “Novocain” and their derivatives.
Advantages: Mom is conscious and feels only a slight muscle tension. Drugs do not cross the placenta and therefore do not affect the child.
Disadvantages: Mom may have weakness in the legs, headache, low blood pressure, chills, a feeling of mild numbness in the lower body, and after childbirth – problems with urination. But side effects are less than in 1% of cases and are caused either by the physiological features of the mother, or by the mistake of the anesthesiologist.
Contraindications: unconsciousness of the woman, blood pressure below 100 mm Hg. Art., high intracranial pressure, inflammation in the area of the alleged puncture, sepsis, bleeding disorders, allergies and intolerance to drugs.
One of the latest advances in medicine is a combination of spinal and epidural anesthesia. The principle of operation and method of application of spinal anesthesia are almost the same as with epidural. Only in the first case the needle is inserted deeper – into the spinal space (the cavity between the soft and arachnoid membranes of the spinal cord, filled with cerebrospinal fluid) and pierces the hard membrane of the spinal cord.
It is possible to anesthetize in this way during labor only once. Therefore, often the leading perinatal centers use a combined method: at the very beginning of labor, spinal and then epidural anesthesia are performed. Through the catheter, the analgesic is first introduced into the spinal space, the pain goes away, the uterus tone is preserved.
When the action of drugs is terminated, the analgesic is already injected into the epidural space.
Without epidural “support”, spinal anesthesia is used when attempts are close.
Advantages: the effect comes faster – in 2-3 minutes. With the combined method, the expectant mother can walk during spinal anesthesia.
Disadvantages: the anesthetic effect lasts only about an hour.
Contraindications: since the same drugs are used in epidural and spinal anesthesia, the contraindications and possible side effects are the same. But with a highly qualified doctor, all risks are minimized.