Pain relief during childbirth. Modern methods of pain relief during childbirth: drug and natural pain relief Does Promedol help relieve pain during childbirth?
I noticed that most visitors to the site believe that since childbirth is a natural process, no anesthesia is required. However, there are many who are afraid of pain. In addition, pain relief is usually offered not at the request of the woman, but according to indications; it can also be offered to a woman who is ready to endure as much pain as nature allocates to her.
Non-drug methods of pain relief
Most women have probably heard that 70% of the intensity of pain is due to its perception and fear. Therefore, the logical conclusion is that if a woman is committed to a successful delivery and is not afraid of anything, then the pain will be less and the birth will be easier. However, unfortunately, we cannot always set ourselves up the way we want; we even seem to understand with our minds that there is no need to be afraid, but we are still afraid.
This is why preparation for childbirth is so important. Moreover, it is advisable that it should not be started a week before the birth, since positive attitude may not form so quickly. Schools for pregnant women are very helpful, where they talk about the physiology of childbirth and the origin of pain (after all, the unknown increases fear). Recently, the head of one of the maternity hospitals, in an interview on the website, expressed the opinion that such schools more harm than good. I think what was meant is that some schools form a negative attitude towards any medical manipulations and to doctors in general. This also happens, so you need to “filter” the information - remember tips on how to help yourself during childbirth, but do not be categorical about medical assistance. It is better to choose a school where there are classes with both psychologists and obstetricians-gynecologists.
Communication with young mothers is also useful; it helps to understand that low-pain childbirth is not so rare.
Except psychological mood there are some
Techniques to slightly reduce the intensity of pain:
Firstly, this is correct breathing. It is recommended to breathe during labor as follows: during contractions, take a deep, slow breath in through your nose, then exhale slowly through your mouth. Do not hold your breath. Breathe calmly between contractions. In this case, it is worth concentrating on breathing, this helps to distract from the pain and makes the birth process easier for the baby. At the end of the first stage of labor, when there is a desire to push, you need to either breathe quickly “like a dog”, or, on the contrary, use deep slow breathing ( deep breaths and exhale through the mouth), as you like. During pushing you need to dial full breasts air (as if you are going to dive under water), and with this air it is as if you are pushing the pain out of yourself; when the air runs out, quickly exhale and immediately inhale again, without “breathing” through the effort (you can catch your breath between attempts, the effort should be used to the maximum) .
The next pain-relieving technique is pressing on the bony protrusions. Needed with inside press on the bones protruding on the sides of the lower abdomen. Some people find that kneading their lower back helps. The husband helps a lot with this if he is present at the birth. You need to knead and rub your back intensively, up to the lungs. pain, this distracts from the pain of labor.
To relax between contractions, you need to imagine some situation where you feel good and pleasant, you are resting. For example, imagine lying on the seashore and listening to the sound of the waves. Or how you cuddle a small, warm baby. It’s better to think in advance what you will imagine, practice painting a picture and your feelings in colors (because already in childbirth, when you experience pain, as luck would have it, it’s difficult to remember something pleasant).
You can also use the anchoring technique known in NLP during childbirth. A few days before giving birth, when you feel especially good and pleasant, you experience strong positive emotions, massage your wrist. This will create an “anchor” in the wrist area. positive emotion, and then during childbirth, when you massage your “anchor”, you will feel the emotions and sensations with which this “anchor” is associated. (The anchor can be any area. The wrist is an example.)
In preparation for childbirth, you need to learn to relax your muscles so that they obey you, since muscle tension increases pain. This is taught at gymnastics for pregnant women. The technique is that you try, for example, to strain right leg And left hand, A left leg And right hand relaxed as much as possible, then change tension and relaxation. In general, you need to tense individual parts of the body. The rest should be relaxed. This way you will learn to control your muscles so that they relax as you wish. It's easy enough to ordinary life, but it’s difficult when you’re in pain and all tense.
Drug pain relief
Such a simple and familiar drug as no-spa can reduce the pain of contractions.
No-spa can be administered both intravenously and intramuscularly. No-spa does not inhibit labor and does not have a negative effect on the fetus. First of all, no-spa relaxes not the body of the uterus, but the cervix, due to which the opening of the cervix occurs faster. Therefore, no-spa can be used simultaneously with stimulation of labor.
No-spa is also used for differential diagnosis between the onset of labor and “false” (preparatory) contractions. If the contractions are “false”, then after the introduction of no-shpa they will stop within half an hour. If labor has begun, the contractions will continue.
Sometimes narcotic analgesics are used to relieve labor pain. The most famous is promedol. It is administered intravenously or intramuscularly, the effect lasts 2-4 hours, the opening of the cervix when administering promedol should be at least 3-4 cm. It does not completely relieve pain, but significantly reduces its severity. In addition, promedol has a calming effect, which changes a woman’s perception of pain. Typically, promedol is used when a woman in labor is tired. After the administration of promedol, the woman most often falls asleep (medicated sleep-rest). This is a prevention of secondary weakness of labor. After this medicated sleep Regular contractions of good strength are usually restored and positive dynamics are observed in the opening of the cervix.
However, this drug also has side effects. The most serious of these is fetal respiratory depression. After birth, the baby is lethargic, drowsy, and does not immediately latch on to the breast. The inhibitory effect of promedol on the fetus is most pronounced if the drug is administered 2-3 hours before birth. In addition, when promedol is administered, a woman may experience nausea and vomiting. If the negative effect of promedol is pronounced, the woman and/or child is given a promedol antagonist, naloxone.
The drug is completely eliminated from the mother's body within 2-3 days, so in the first days the child may receive an additional dose of promedol with mother's milk, which is why he may be somewhat lethargic and drowsy. This does not pose a danger to the child’s health, since the dose he receives is very small.
Epidural anesthesia
The next method of pain relief is epidural anesthesia. In this case, an anesthetic substance is injected into the space above the hard shell spinal cord. The most widely used drugs for this purpose are lidocaine and marcaine. The woman sits with her back to the doctor, bending over and tilting her head forward (or lies on her side, bending her back as much as possible - curled up). The doctor numbs the site of the intended puncture with an injection of novocaine. After this, the epidural needle is inserted between the vertebrae into the epidural space. A catheter (a thin plastic tube) is then inserted through the needle and the needle is removed. A syringe containing an anesthetic is attached to the catheter. Subsequently, the catheter is not removed until the end of labor, since, if necessary, an anesthetic substance can be added during labor. The effect begins 15-20 minutes after the administration of the anesthetic.
Indications for epidural anesthesia are severe gestosis (late toxicosis) during pregnancy, chronic diseases kidneys, heart, lungs, young age of the woman in labor, severe myopia (myopia), arterial hypertension (increased blood pressure). Also, epidural anesthesia is performed in cases of incoordination of labor (when, during strong painful contractions, the cervix dilates weakly, the rate of dilatation does not correspond to the strength and duration of contractions).
Contraindications for epidural anesthesia: spinal injuries or spinal surgery, bleeding disorders or taking medications that affect blood clotting, a scar on the uterus after a cesarean section or other operations, low blood pressure, pustular formations on the skin near the site of the intended puncture. In some cases, performing this type of anesthesia is difficult due to the woman’s severe obesity, because the doctor cannot feel the bony landmarks.
With this method of pain relief, pain sensations are completely turned off, but all other types of sensitivity are preserved. The woman can move, feel touch, she is completely conscious. Only the first stage of labor (the period of contractions) is anesthetized. By the end of the first period and the beginning of the pushing period, the anesthesia should wear off, as the woman must feel increased pain when pushing to understand that she is pushing correctly. After childbirth, if necessary, pain relief can be resumed (for example, when suturing ruptures birth canal).
With epidural anesthesia, the duration of labor usually increases. This is due to the fact that the strength of contractions decreases somewhat. In addition, a woman may experience a decrease in blood pressure to the point of fainting. No negative effects on the fetus were observed during this method of pain relief. IN postpartum period some women report headaches and temporary numbness in their legs.
The use of epidural anesthesia for everyone causes controversy among both doctors and women in labor. Some people wonder why Western countries Pain relief is provided to everyone, but we don’t. Probably because our women themselves do not strive for this. In addition, it is known that the frequency of cesarean sections in Western countries is higher, and many attribute this specifically to the use of epidural anesthesia and the occurrence of weakness in labor. At the same time, in my opinion, it is not worth canceling anesthesia at will, because fear and excessive pain in themselves are factors that can lead to abnormalities in labor.
Some opponents of epidural anesthesia argue that the use of pain relief during childbirth disrupts the psychological bond between mother and child. This thesis raises some doubts for me, since not a single method completely eliminates pain during childbirth; during the most crucial period of pushing, the woman fully feels everything that is supposed to be, so even if we assume that it is necessary to experience pain, this condition is met. Psychologists do not say that you need to experience pain for no less than a certain time, otherwise some statements would appear, for example, about the disruption of the connection between mother and child during rapid childbirth.
The argument that ancestors gave birth without any medical assistance also does not stand up to criticism, because when they gave birth without assistance, there was natural selection and a fairly high mortality rate during childbirth.
In conclusion, I want to say that, of course, the fewer medical interventions, the better, but the restrictions must be reasonable, and if the benefits greatly exceed possible risk, then you should not abandon the achievements of civilization.
During labor, there is sometimes a need for drug pain relief. This happens when anomalies develop, when the process of giving birth to a child is delayed. Deviations include premature passage amniotic fluid, weak labor, dysregulation. Promedol is used during childbirth so that the woman can rest and gain strength before the decisive breakthrough.
Promedol is considered a regional anesthesia drug. It is prescribed more often than other drugs. The medicine belongs to the group narcotic analgesics. The composition contains promedol 20 mg per 1 ml ampoule, the rest is water for injection.
It is administered intravenously, intramuscularly. The second option is preferable. If Promedol is administered during childbirth, the woman will rest for 30 minutes to 2 hours. The mother can completely relax and sleep.
The drug enters the mother's body and passes through the placenta.
During the action of Promedol, the child also sleeps. Therefore, the medicine must be administered no later than 2 hours before birth process. When the uterus is dilated by 8 cm, the product is not used. The born child must take his first breath on his own; under the influence of the drug he will sleep. If inserted before the cervix is 4 cm dilated, labor will weaken.
Promedol during childbirth has the following effects:
- anti-shock;
- antispasmodic;
- analgesic;
- mild sleeping pill.
Principle of influence:
- changes the emotional side of pain;
- makes the endogenous system active;
- disrupts the interneuron transmission of pain impulses;
- increases tone;
- strengthens contractions.
Compared to morphine, it has less effect on the respiratory system. Helps dilate the cervix during labor. When injected, the effect begins after 10–20 minutes, reaches its peak after 40 minutes, and lasts for 4 hours. If taken orally through the gastrointestinal tract, intestinal tract, the effect will be 2 times weaker.
Indications and contraindications
The drug is administered to stimulate the dilatation of the cervix, which provides pain relief during childbirth. Included in general anesthesia as an analgesic component.
Promedol is prescribed during childbirth:
- for pain of moderate to severe intensity;
- before, during, after surgery;
- with spasms of smooth muscles;
- for pain relief during labor.
Contraindications:
- depressed breathing;
- with caution in patients addicted to opioids;
- hypersensitivity;
- blood clotting disorder;
- infections;
- diarrhea.
Treat the drug with caution when bronchial asthma, renal, liver failure, arrhythmias. It is undesirable to use Promedol for intestinal diseases inflammatory in nature if there is a history of drug addiction. When the body is weakened, the drug is not administered.
Side effects:
- constipation, flatulence, gag reflexes;
- weakness, drowsiness;
- confusion;
- nervousness;
- discomfort;
- decreased blood pressure;
- skin rash;
- swelling.
Rarely, pain in the head area and blurred conscious perception may occur. Sometimes involuntary muscle twitching occurs. There may be ringing in the ears and slower reactions.
Effect on mother and child
In its structure, Promedol is similar to Morphine. In the UK the drug is called Meperidine, in America it is Demerol.
This drug is selected because of the licensing permission for its use. A dose of 150 mg is considered safe. An obstetrician-gynecologist who often uses the drug claims that 25 mg is enough to obtain the desired effect.
Impact on the baby. Promedol easily passes through the placenta. When the baby is due to be born within an hour, Demerol is not administered. Studies have shown that the drug produces the most depressing effect after administration 2–3 hours before the onset of labor.
If you administer Promedol during childbirth in a large dose, the effect on the fetus will be stronger. The dependence here is directly proportional. The baby’s liver is still immature, so the medicine is eliminated within 18 to 24 hours.
Demerol affects breast-feeding. It makes the process very difficult. After introduction into the woman’s body, the drug enters the milk, with which an additional dose is passed on to the baby. The baby is drowsy and has problems attaching to the breast. The mother does not associate these symptoms with the drug.
The consequences for the child when using Promedol during childbirth are observed within 6 weeks. During the doctor's examination, the baby screams, often wakes up, and shows anxiety. Doesn't calm down on its own.
Impact on mother. Anesthesia using medicines administered according to strict indications. If the woman in labor has used drugs in the past, the doctor will refuse pain relief with Promedol. The result will not be effective.
Women are wary of this type anesthesia, fearing drug addiction, severe consequences, influence on the child. The drug is administered once, so there is no reason for concern. It is used in the first stage of labor, when uterine contractions are painful. Any addiction develops with repeated use over a short period of time.
Demerol is administered through the thigh, buttock, and shoulder. The maximum concentration occurs 1 - 2 hours after injection. The cervix relaxes, dilates faster, and pain spasms are eliminated. The woman's consciousness is completely preserved. Despite the side effects, the drug is considered absolutely safe for women in labor. If Promedol does not work during childbirth, other medications with similar properties are used.
Analogues
Sensations during labor are associated with mental state women in labor. Pain, excitement, fear intensify the sensations. The muscles of the uterus tense, causing pain. Some women cope with its manifestation on their own with the help of various techniques breathing, relaxation, massage. Others need drug intervention to blunt the reaction. nervous system for pain.
Requirements for painkillers:
- fast-onset effect;
- suppression of fear and other emotions for a long period;
- do not have a negative impact on the body of the mother and baby;
- do not deprive women of the opportunity to participate in the birth process;
- do not cause drug addiction.
For pain relief, along with Promedol, the following are used:
- Fentanyl;
- Omnopon;
- Gomk;
- nitrous oxide.
The first three relate to narcotic analgesics. Their action is based on communication with opiate receptors. They are safe for mother and baby. Calms, relaxes, maintains consciousness. The drugs have an antispasmodic and analgesic effect, correct uterine contractions, and promote dilation of the cervix.
Fentanyl begins to act after 1 – 2 minutes. Active for half an hour. The rapid, strong effect is explained by its easy permeability and high lipophilicity. Gives a powerful calming effect, loss of pain while maintaining consciousness.
Omnopon is available in the form of powder and solution. Active analgesic, suppresses pain, inhibits conditioned reflexes. The main properties are due to the morphine it contains. When administered subcutaneously, the effect lasts for 3–5 hours.
Gomk is used if a woman in labor needs rest. Drowsiness occurs 10–15 minutes after administration. Relaxation lasts 3 – 5 hours.
Nitrous oxide. Inhalation anesthesia is widely used during childbirth. It is used when the cervix is dilated by 3–4 cm, if the pain of contractions is pronounced. Nitrous oxide is considered the main remedy. The advantage lies in safety for the mother and child. The action comes quickly and also ends. No negative effects were noticed, there is no smell.
Oxide is given through a mask using a special apparatus. The woman in labor inhales nitrogen and feels slightly dizzy. The effect of the gas begins within a minute, so a couple of deep breaths are taken at the beginning of the contraction.
Promedol is a synthetic drug that is weaker than Morphine. Has a moderate antispasmodic effect. Promedol during childbirth rarely causes nausea, vomiting, less depresses the respiratory system, and its consequences are mild. The drug allows you to rest during the birth process, the pain is dulled, but does not go away at all.
Some diseases are characterized severe attacks pain that not all painkillers can cope with. Therefore, in medical practice widely used medications are opioid analgesics, which are sold only with a doctor's prescription. One of these drugs is Promedol, which can disrupt the interneuronal transmission of pain impulses at any level of the human central nervous system. Acting as an opioid receptor agonist, the drug "Promedol" affects parts of the brain, changing emotional coloring pain. By pharmacological properties this medication is close to the drugs "Morphine" and "Fentanyl", it also significantly increases a person's health, has an average hypnotic effect and has a depressing effect on conditioned reflexes. However, unlike the drugs mentioned above, the drug “Promedol” is less likely to cause side effects such as vomiting and nausea, depresses the respiratory center less and has a more gentle antispasmodic effect on the ureters and bronchi. At the same time, it somewhat enhances the contractile activity and tone of the myometrium.
Forms of release of the drug "Promedol" and its composition
Outside our state, the analgesic "Promedol" has another non-patented international name"Trimeperidine hydrochloride", by which it is used as active substance for many drugs. Today, the release of the drug is reduced to three forms: tablets, ampoules and syringe tubes. The former are packaged in packs of 10 pieces and are available by prescription in pharmacies, while the latter are more often used in medical institutions for injections to patients. The Promedol solution is available in concentrations of 1% and 2% and contains 0.01 or 0.02 g of trimeperidine, respectively. The drug is administered subcutaneously, intramuscularly, and in some particularly difficult cases intravenously. Syringe tubes are used both in medical institutions and at home.
For what diseases can the analgesic Promedol be prescribed?
In order to purchase the drug "Promedol", a prescription for it must be obtained from a doctor who can correctly calculate the dose of the drug and draw up a treatment regimen. Indications for taking this drug may include: various diseases, accompanied pain syndrome strong and medium intensity. From the outside digestive system these are peptic ulcer of the duodenum and stomach, chronic pancreatitis, perforation of the esophagus. The medicine "Promedol" can also be prescribed to people who have been diagnosed with diseases genitourinary system, namely paranephritis, paraphimosis, acute dysuria and foreign bodies V urethra And bladder. This narcotic analgesic is also very effective for myocardial infarction, unstable angina, thrombosis hepatic artery, dissecting thromboembolism of the arteries of the extremities and pulmonary artery, pulmonary infarction, air embolism, spontaneous pneumothorax And acute pleurisy. The effect of "Promedol" also has a positive effect on pain in people suffering from acute neuritis, causalgia, glaucoma, lumbosacral radiculitis, thalamic syndrome and acute vesiculitis. Due to its rapid analgesic effect, the drug is used for severe injuries, burns and cancer.
Using Promedol during childbirth
This applies synthetic analogue means "Morphine" in the process of preparing the patient for various surgical interventions, as well as to enhance labor. Acting as a strong antispasmodic, it relaxes the cervix, thereby provoking its opening. At the same time, this drug affects the uterus of the woman in labor, somewhat increasing its contractions, and therefore speeds up labor. As a rule, the drug "Promedol" during childbirth is administered subcutaneously and intramuscularly into the buttock, thigh or shoulder. And only in exceptional cases, when the life of a child is at stake, it can be administered intravenously to the woman in labor. The analgesic effect after the injection appears within 10-15 minutes, after which the woman can regain some strength and safely give birth to the baby.
Consequences of using Promedol during childbirth
In general, this synthetic analgesic is considered the safest for mother and child during childbirth, but do not forget about individuality human body. Therefore, some women experience symptoms side effects uses of this medication such as vomiting, nausea, and slowness conditioned reflexes. You should also take into account the fact that the drug “Promedol”, the instructions for use confirm this, very quickly enters the bloodstream even when administered subcutaneously, and its maximum concentration is reached after 2-2.5 hours. Consequently, already 2-3 minutes after the mother’s injection, the child receives a narcotic analgesic through umbilical artery, which will be excreted from his body 7 times slower than that of the mother. After birth, such babies slowly recover respiratory function, drowsy, irritable and often refuse to breastfeed. In the first days of their life, these babies need special attention from neonatologists, as they may need, for example, artificial respiration or other measures to normalize vital processes.
Use of the drug "Promedol" in anesthesiology
Another area of medicine where the drug “Promedol” has found its way wide application, is anesthesiology. For premedication, a person is injected intramuscularly or subcutaneously with 1-2 ml of a solution of this anesthetic in combination with 0.5 mg of Atropine approximately 30-40 minutes before surgery. IN in case of emergency When the patient needs urgent premedication, these drugs are administered intravenously. During surgical intervention to a person under anesthesia, this drug is also administered in fractional doses to enhance analgesia, which helps stabilize blood pressure and reduce tachycardia. For general use, the drug “Promedol” in ampoules is used together with anticholinergics, antihistamines and antipsychotics. For central analgesia, a combination with antipsychotics and the drug Droperidol is used. The postoperative period for some patients also does not pass without the use of this narcotic analgesic; it is administered subcutaneously to relieve pain and how
Contraindications
It is dangerous to use any medications without a doctor’s prescription, especially narcotic drugs such as the analgesic Promedol. The instructions for use of this painkiller have many contraindications, which you should definitely read before you start taking it. Please note that this medicine should not be used for treatment during pregnancy, lactation, elderly people and children under two years of age. The instructions also contain a whole list of diseases for which taking Promedol is not only dangerous, but also absolutely forbidden. This list includes hypersensitivity to the components of the drug, depressed breathing, infections, blood clotting disorders, diarrhea due to lincosamides, cephalosporins, toxic dispersion or penicillins. You should stop taking the drug during treatment with MAO inhibitors, as well as for 21 days after stopping their use. This drug should be used with extreme caution for pain in the abdominal area of unknown etiology, bronchial asthma, arrhythmia, convulsions, arterial hypertension, respiratory failure, CHF, myxedema, renal, adrenal and liver failure, hypothyroidism, central nervous system depression, intracranial hypertension, heavy inflammatory diseases intestines.
Side effects of the drug
Taking into account the individuality of the human body, we can confidently say that any, even the safest medication can cause many adverse reactions. And if we consider the narcotic analgesic "Promedol", a prescription for which can only be obtained from a doctor, then its list of contraindications is even longer. So, the reaction of the gastrointestinal tract to taking this medicine is spasm of the biliary tract, vomiting, nausea, dry mouth, constipation, anorexia. If a person is diagnosed with acute inflammatory processes digestive system, then to the above list you can add paralytic intestinal obstruction, jaundice and toxic megacolon. In some people who take the drug, the senses and nervous system may “revolt.” Symptoms may include blurriness visual perception, dizziness, diplopia, headache, convulsions, involuntary muscle contractions, tremor, confusion, drowsiness, euphoria, disorientation, depression, tinnitus, paradoxical arousal and other disorders. Suppression by the drug "Promedol" respiratory system can also dramatically affect the patient’s well-being and lead to various problematic conditions, even coma. In some patients who used the drug "Promedol", reviews indicate visible manifestations arrhythmias, as well as sudden fluctuations in blood pressure. It may also cause problems when taking the drug. urinary system, which can manifest itself in decreased diuresis and urinary retention. In medical practice there are also cases when side effects the use of the drug "Promedol" was detected in the form allergic reactions such as laryngospasm, skin rash, swelling, bronchospasms and others. And even in cases where the body’s reactions described above do not appear, when taking the drug “Promedol”, the instructions for use suggest the appearance of mild side effects, such as nausea, vomiting and general weakness of the body.
Overdose and consequences of improper use of the drug "Promedol"
At misuse of this medicine or inaccurate calculation of doses, taking into account all the characteristics of the patient, the consequences can be the most unpredictable. In medical practice, there have been cases where an overdose not only increased the severity of side effects, but the patients experienced depression of consciousness and were diagnosed with acute miosis.
Correct actions in case of overdose
The main measures for the recovery of a person in case of an overdose of the drug "Promedol" should be aimed at supporting adequate pulmonary activity in combination with symptomatic therapy. To do this, the patient is injected intramuscularly or intravenously with a specific opioid antagonist, the drug Naloxone, which should quickly restore the functioning of the respiratory center. If after 2-3 minutes the expected effect does not occur, repeat the injection.
Rules for the sale of the drug and conditions for its storage
The drug is dispensed to the public in pharmacies only by prescription in quantities that do not exceed one full course of treatment. As for the storage of the narcotic analgesic "Promedol", the instructions for use clearly regulate compliance with all conditions. In particular, the medicine should be kept out of the reach of children, subject to temperature regime no higher than + 15°C.
Beverly Lawrence Beach, UK
(Excerpt from article Drug therapy in childbirth: how will she respond 20 years later?)
Midwifery today, 1999
Demerol ( promedol)
One of the drugs most often used in childbirth is pethidine, a synthetic narcotic substance similar in structure to morphine. In the UK it is known as "meperidine", in America - "Demerol" (and in Russia - "Promedol". - Translator's note)
It has become the drug of choice for most English midwives, mainly because it is the only narcotic drug that their license allows.
Typically, women are prescribed a dose of 150 mg, but those midwives who use small doses prescribe, for example, 25 mg and claim that this dose is also effective.
Demerol easily crosses the placenta. A child may have a very high sensitivity to it due to the immaturity of the blood-brain barrier (BBB - that which separates blood vessels and brain cells. - Approx. transl.) and due to the presence of a hepatic shunt (due to which the fetal blood is distributed, bypassing the liver, which neutralizes toxic substances. - Transl. note) (Burt, 1971). If the baby is expected to be born within an hour, most midwives will try to avoid using Demerol as there is a risk that the medicine will enter the baby's body. However, studies show that Demerol has the greatest depressant effect on the child’s respiratory system when administered 2-3 hours before birth. The higher the dose administered to the mother, the greater the effect on the fetus (Yerby, 1996).
Due to the immaturity of the child’s liver, it takes him much longer to remove the medicine from the body - from 18 to 23 hours.
Despite the fact that 95% of the drug dose is eliminated from the body within 2-3 days, this is of great importance for breastfeeding. Rajan showed that "Demerol is the drug that most interferes with breastfeeding." While breastfeeding, the mother often unwittingly gives the baby an extra dose of Demerol, since this medicine passes into the milk. She may not know what is causing the baby's sleepiness. and also the cause of her problems with putting it to her breast is Demerol.
Long-term effects of Demerol little studied. However, in children who received a large dose of Demerol during labor, these effects continued to be detected for 6 weeks: they cried more often during examination, were more restless and, when awakened, were less likely to calm down on their own. The effect of Demerol was most noticeable in children aged 7 days, especially in those who received a large dose (Belsey, 1981). Interestingly, researchers consider the effect of the drug for 6 weeks to be long-term effects. We would call long-term an effect that affects itself over many years.
Translation by V.A. Maslova
Pain relief for childbirth
Drug pain relief for childbirth
Popular medicinal pain relief for childbirth
Undoubtedly, childbirth is greatest event in a woman's life. But we will need a lot of strength, patience and diligence before meeting the baby. However, this is not what usually frightens pregnant women. The most common fear before childbirth is the fear of pain. Many women ask doctors for drug pain relief during labor. But are these procedures as “harmless” as some expectant mothers think?
Women's perception of pain during childbirth varies significantly. This process is entirely controlled by the nervous system, and it is fear that reduces the threshold of pain sensitivity. It turns out to be a kind of vicious circle: we hurt because we are afraid of pain.
When is drug pain relief necessary?
Sometimes during labor there is a need for additional drug pain relief. For example, medication assistance is necessary in the event of the development of certain labor anomalies that increase the duration of labor. Such deviations include: weakness of labor, incoordination (dysregulation) of labor, premature rupture amniotic fluid(happening before the onset of contractions or simultaneously with them).
These conditions really lengthen and complicate labor and take away the strength of the woman in labor. But the strength to the expectant mother very necessary: at the end of the second stage of labor she will have to do a lot of physical work - pushing! In order for a woman to rest and gain strength for the decisive event, painkillers are used during childbirth.
In addition, some women in labor have pathologically determined low threshold pain sensitivity. In other words, these women feel pain much earlier and much stronger than it should normally be. Of course, in this case, women also need additional drug pain relief for labor. It also happens that the use of drug pain relief is determined by the woman’s desire; this, as a rule, is possible when conducting childbirth under a voluntary health insurance contract.
Pain relievers
We will tell you about the most commonly used pain medications in the arsenal of obstetricians and anesthesiologists. These include narcotic analgesics and regional anesthesia drugs such as: Promedol, Epidural anesthesia and Nitrous oxide.
Promedol
Most often, promedol is prescribed for pain relief during labor. This drug belongs to the group of narcotic analgesics, in other words - it's a drug. It can be administered intramuscularly (which is preferable) or intravenously.
It is assumed that under the influence of the medicine you will be able to get a break from 30 minutes to two hours: relax and even sleep. In reality, it is quite difficult to predict in advance how a woman will react to the introduction of promedol.
There are women who, after such anesthesia, sleep peacefully until the birth of the baby, while others only get the opportunity to take a nap in between contractions. Promedol penetrates the placental barrier, and the baby also sleeps during the period of action of the drug. Associated with this feature is the upper time limit pain relief with promedol- no later than two hours before the baby is born.
Therefore, after dilation of the cervix by 8 cm, insertion promedola is not produced. After all, having been born, the child must take his first breath on his own, which means he should not be sleepy. It is also not customary to prescribe narcotic analgesics before the cervix is dilated by 4-5 cm, as this may contribute to the development of weak labor forces.
In addition to the actual pain relief of childbirth, promedol is also prescribed for the treatment various pathologies labor activity. For example, it is always used as an application (to mitigate the effect) before the introduction of a labor-stimulating substance - Oxytocin - when correcting weak labor.
Possible complications when administering narcotic analgesics during labor include nausea, vomiting, drowsiness, lethargy, confusion in the mother and “congestion” (residual effects). narcotic substance, manifested in vital lethargy important reflexes and functions, primarily breathing) at the time of birth of the baby - if pain relief was performed late.
Nitrous oxide
There is another method of medication labor pain relief. until recently, widely used in domestic and foreign obstetric practice. We are talking about the use of nitrous oxide, a gas that, when inhaled, reduces pain sensitivity. Currently, this method is practically not used due to low efficiency and large quantity complications (respiratory depression in a woman in labor).
In conclusion, I would like to draw the attention of expectant mothers to this fact. None medical intervention cannot harm - if it is justified. Therefore, before deciding to choose one or another method of labor pain relief, you need to seriously weigh the pros and cons together with your doctor.
Remember that pregnancy and childbirth are not a disease, but the most natural thing for female body state. This means that nature has provided everything in order to successfully cope with this task - so difficult and so happy on your own!
On my own behalf, I would like to add, remember - promendol is a drug, the effect of which on the child’s body has been poorly studied, and long-term effects have not been studied by anyone at all. So draw your own conclusions...
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 pain management during childbirth it allows you to relieve 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 irresistible desire“to go big” (these are attempts). 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 sensations, while the remaining half is due to psychological factors. Pain during childbirth can be false or true:
- They talk about false pain when discomfort provoked by 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
Labor anesthesia must be carried out in case of pathological course and/or existing chronic extragenital diseases in the woman in labor. Relieving pain during childbirth (analgesia) not only eases suffering and relieves emotional stress in a woman in labor, but 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 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 in 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 lateral 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 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 headboard, on the wall) or jump while sitting on a gymnastic ball.
Acupuncture
Water procedures
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 the electric current low frequency. 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
Inhalation 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-inhalation anesthesia
For this purpose, narcotic and non-narcotic drugs are administered intravenously or intramuscularly to the woman in labor. From narcotic drugs promedol and fentanyl are used, which help normalize discoordinated uterine contractions and have 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. 3 methods are used 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.
The positive aspects of this method: fast recovery 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 inhalation anesthesia: breathing problems, disruptions heart rate, 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). Typically used to relieve pain during labor when other methods of anesthesia cannot be used. Indications for a pudendal block are usually the need to apply obstetric forceps or vacuum extractor. Among the disadvantages of the method, the following are noted: pain relief is observed in only half of the women in labor, the possibility of the anesthetic getting into uterine arteries, which due to its cardiotoxicity can lead to fatal outcome, 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 high risk injection of medication into the fetal head. Currently, this type of pain relief during childbirth is practically not used due to high percentage 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) membrane 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. TO positive aspects This type of pain relief includes:
- 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 strength uterine contractions(that is, there is no risk of developing weakness of the generic forces);
- lowers blood pressure (which is especially important for arterial hypertension or gestosis);
- does not affect 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 various methods 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 (to prevent birth trauma the newborn is not protected from the perineum, 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. Typically used infiltration anesthesia soft tissues of the perineum with novocaine or lidocaine (in case of ruptures/incisions) and, less commonly, pudendal blockade. 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 must 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 possible complications 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, which are performed at the request of the 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 mother in labor for pain relief, therefore, there were medical indications to ease contractions, which was determined by the obstetrician and pain relief in in this case acted as part of treatment (for example, normalization of labor activity 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 this medical institution 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:
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The relative ones include:
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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: planned or emergency indications and on the obstetric situation. In most cases, in the absence absolute contraindications In addition to spinal anesthesia, the woman in labor is offered and given EDA or SMA (both for planned caesarean section and emergency). 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, tune yourself to successful outcome 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 “torment.” 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.
