Promedol during childbirth consequences. Painkillers

It is very important from the very beginning of pregnancy to begin psychological preparation for childbirth, to tune in to happy outcome. A doctor who observes your pregnancy can be of great help in this, of course, only if there is complete understanding between you. Ideally, when the same doctor conducts childbirth. During pregnancy, you become members of the same team, and during childbirth you will enjoy powerful psychological support.

Types of anesthesia

Most commonly used:

• promedol(narcotic substance that is administered intravenously or intramuscularly)
• epidural anesthesia(an anesthetic is injected into the space in front of the dura that surrounds the spinal cord)

Does anesthesia affect the child

Promedol in the dose that is used to anaesthetize childbirth does not harmful influence to the fruit. However, the baby can sleep with the mother.

Epidural anesthesia is considered essential for gentle delivery, it makes childbirth less traumatic for the fetus, since the main obstacle that the fetal head encounters during advancement, the cervix, softens significantly and opens faster.

Which is better: promedol or epidural anesthesia

It depends on many circumstances that only a doctor can assess.

But you need to keep in mind that promedol can only be administered once, so it is better to enter it when strong contractions and the cervix is ​​well opened, since its effect lasts 1-1.5 hours. Promedol does not completely relieve pain, but it significantly reduces the severity of pain, it is perceived differently.

And when conducting epidural anesthesia, the pain is removed completely, anesthesia can be added through a thin catheter as the pain increases.

Epidural anesthesia is done only by very experienced anesthesiologists who are fluent in this technique, so such a complication as injury spinal cord, is practically excluded. A rare but common complication is headache after childbirth, which resolves very soon.

Minuses

Of course, epidural anesthesia has its pitfalls. First of all, this method of anesthesia is not suitable for everyone. Contraindications include: allergic reactions on the local anesthetics(drugs used in the treatment of teeth: lidocaine - as a local anesthetic it is perfect, novocaine, etc.), poor clotting blood, fever, neurological diseases, bleeding, obesity, festering wounds in the lumbar region. Of course, no one does anesthesia until a regular labor activity and in the event that a woman refuses it, preferring to endure pain courageously. Until what moment to endure and when to turn to professional help, each woman decides for herself. In principle, many women in labor manage to do without painkillers. Someone gets high pain threshold and even the first birth is easy and fast. If you manage to endure, it is better, of course, to endure, anesthesiologists understand this. It would be a mistake to compare epidural anesthesia with a mint candy, which is suitable for everyone without exception and is known to be safe. This method also has side effects and complications. The most common complication is headache, which can last up to three weeks. This is a consequence of unintentional puncture of the hard meninges when the needle enters the vertebra a little further than it should. This happens even in experienced professionals in 1% of cases in the world. These pains respond well to treatment and pass without consequences. Another problem is the decline blood pressure. To prevent this complication, about 500 ml of fluid is injected into the vein for 5 minutes before anesthesia. Rarely, but it happens that a highly concentrated local anesthetic solution slows down the birth process. Other side effects include pain at the injection site (which can last up to seven days) and allergic reactions. Some are confused by the fact that the use of epidural anesthesia deprives the woman in labor of the opportunity to move independently. However, many of these disadvantages are still covered by one big plus: women who give birth without wild pain often leave the maternity hospital with the intention of giving birth there to a second, and maybe third child.

Ultimately, giving birth with or without anesthesia is a woman's personal decision. The main thing is that it should be accepted reasonably and honestly. No matter how the birth goes, the knowledge that you have somewhere to retreat, that in no case will you be left alone with unbearable pain, is in itself a very powerful calming factor, which allows many to do without the help of an anesthesiologist .

During labor, it is sometimes necessary medical anesthesia. This happens with the development of anomalies, when the process of childbirth is delayed. Deviations include premature departure amniotic fluid, weak labor activity, dysregulation. Promedol is used during childbirth so that a woman can relax, gain strength before a decisive breakthrough.

Promedol is considered a regional anesthetic drug. It is prescribed more often than other means. The medicine belongs to the group of narcotic analgesics. As part of Promedol, it takes 20 mg per 1 ml ampoule, the rest is water for injection.

It is administered intravenously, intramuscularly. The second option is preferable. If you enter Promedol during childbirth, the woman will rest from 30 minutes to 2 hours. Mom can completely relax, sleep.
The drug enters the mother's body, passes through the placenta.

During the action of Promedol, the child also sleeps. Therefore, the drug should be administered no later than 2 hours before the onset of the birth process. When the uterus has opened 8 cm, the remedy is not used. The born child must take the first breath on his own, under the influence of the drug he will sleep. If you enter before the opening of the cervix at 4 cm, labor activity will weaken.

Promedol during childbirth has an effect:

• antishock;
• antispasmodic;
• analgesic;
• mild sedative.

Impact principle:

1. changes the emotional side of pain;
2. makes the endogenous system active;
3. disrupts interneuronal transmission of pain impulses;
4. increases tone;
5. enhances contractions.

Compared to morphine, it has less effect on the respiratory system. Helps to dilate the cervix during labor. When injected, the action begins after 10-20 minutes, reaches a peak after 40 minutes, lasts for 4 hours. If taken orally through the stomach - intestinal tract, the effect will be weaker by 2 times.

Indications and contraindications

The drug is administered to stimulate the opening of the cervix, pain relief occurs during childbirth. Included in general anesthesia as an analgesic component.

Promedol is prescribed in childbirth:

• with pain of medium, strong intensity;
• before, on time, after surgery;
• with spasms of smooth muscles;
• to anesthetize the birth process.

Contraindications:

• oppressed breathing;
• with caution in patients who are 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 inflammatory bowel diseases, if there is a history of drug addiction. When the body is weakened, the drug is not administered.

Side effects:

1. constipation, flatulence, gag reflexes;
2. weakness, drowsiness;
3. confusion;
4. nervousness;
5. discomfort;
6. pressure reduction;
7. skin rash;
8. puffiness.

Rarely, pain in the head area, vagueness of conscious perception may appear. Sometimes there are muscle twitches of an involuntary nature. Ringing in the ears is possible, the reaction slows down.

Impact on mother and child

In its structure, Promedol is similar to Morphine. In the UK, the drug is called Meperidine, in America - Demerol.

This drug is chosen because of the licensed permission to use it. A dose of 150 mg is considered safe. An obstetrician-gynecologist who often uses the drug claims that 25 mg is enough to get the desired effect.

Influence on the baby. Promedol easily passes through the placenta. When the baby should be born within an hour, Demerol is not administered. Studies have shown that the drug produces the most depressing effect after administration 2 to 3 hours before the onset of labor.

If you enter Promedol during childbirth in 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 excreted for 18 to 24 hours.

Demerol affects breast-feeding. It makes the process very difficult. After the introduction into the body of a woman, the drug enters the milk, with which the baby passes in an additional dose. The child has drowsiness, there are problems with breastfeeding. 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.

Influence on the mother. Anesthesia with medicines administered under strict guidelines. If the woman in labor has used drugs in the past, the doctor will refuse anesthesia with Promedol. The result will be ineffective.

Women are wary of this type of 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 period of labor, when uterine contractions are painful. Any dependence develops with repeated use in a short period of time.

Demerol is injected through the thigh, buttock, shoulder. The maximum concentration occurs after 1 - 2 hours after injection. The cervix relaxes, opens faster, spasms of pain 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 did not work during childbirth, other medicines with similar properties.

Analogues

Feelings during labor are associated with mental state women in labor. Pain, excitement, fear intensify sensations. The muscles of the uterus tighten, causing pain syndrome. Some women independently cope with its manifestation with the help of various methods of breathing, relaxation, massage. Others need medication to blunt the reaction nervous system for pain.

Requirements for painkillers:

1. fast-acting effect;
2. suppression of fear, other emotions for a long period;
3. not render negative impact on the body of the mother, baby;
4. not deprive women of the opportunity to participate in the birth process;
5. not cause addiction.

For anesthesia, along with Promedol, the following are used:

• fentanyl;
• Omnopon;
• Gomk;
• nitrous oxide.

The first three are narcotic analgesics. Their action is based on the connection with opiate receptors. They are safe for mother and baby. Soothe, relax, keep the mind. The drugs have an antispasmodic, analgesic effect, correct uterine contractions, and contribute to the opening of the cervix.

Fentanyl begins to act after 1 - 2 minutes. Active for half an hour. Rapid strong impact due to easy permeability, high lipophilicity. Gives a powerful calming effect, loss of pain while maintaining consciousness.

Omnopon is available as a powder, solution. Active analgesic, suppresses pain, inhibits conditioned reflexes. The main properties are due to the morphine contained in it. When administered subcutaneously, the effect persists 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. Widely used in childbirth inhalation anesthesia. It is used when the cervix is ​​dilated by 3-4 cm, if the pain of contractions is pronounced. The main agent is nitrous oxide. The advantage lies in the safety for the mother, the child. The action comes quickly, and also ends. Negative influence is not noticed, there is no smell.

They give nitrous oxide through a mask with a special apparatus. The woman in labor inhales nitrogen, feels a slight dizziness. The effect of the gas comes in a minute, so a couple of deep breaths are taken at the beginning of the contraction.

Promedol refers to synthetic drugs, weaker than Morphine. It has a moderate antispasmodic effect. Promedol during childbirth rarely causes nausea, vomiting, less depresses the respiratory system, its consequences are mild. The drug allows you to relax during the birth process, the pain dulls, but does not go away at all.

Update: October 2018

Almost all women are afraid of the upcoming birth and to a greater extent this fear is due to the expectation of pain during the birth process. According to statistics, pain during childbirth, which is so pronounced 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 tolerable. Modern pain relief during childbirth, it allows you to alleviate and even stop labor pain, but is it necessary for everyone?

Why does labor pain occur?

Labor pain is a subjective sensation that is caused by irritation of nerve receptors in the process (i.e., its stretching), significant contractions of the uterus itself (contractions), stretching of blood vessels and tension of the utero-sacral folds, as well as ischemia (impaired blood supply) muscle fibers.

• Pain during contractions is formed in the cervix and uterus. As the stretching and opening of the uterine pharynx and stretching of the lower uterine segment, 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 vegetative and motor reactions (increased heart rate and respiration, rise blood pressure, nausea and emotional arousal).

In the straining period, when the opening of the uterine os is complete, the pain is due to the advancement of the fetus through the birth canal and the pressure of its presenting part on the tissue birth canal. Compression of the rectum causes an irresistible desire to "go big" (this is the attempts). In the third period, the uterus is already free from the fetus, and the pain subsides, but does not disappear completely, since there is still an afterbirth in it. Moderate uterine contractions (the pain is not as pronounced as during contractions) allow the placenta to separate from the uterine wall and stand out.

Labor pain is directly related to:

• fruit size
• the size of the pelvis, constitutional features
• the number of births in history.

In addition to unconditioned reactions (irritation of nerve receptors), conditioned reflex moments (negative mood for childbirth, fear of childbirth, anxiety for oneself and the child) are also involved in the mechanism of the formation of labor pain, as a result of which adrenaline is released, which narrows blood vessels even more and increases ischemia myometrium, which leads to a decrease in pain threshold.

In total, the physiological side of labor pain accounts for only 50% of pain, while the remaining half is due to psychological factors. Pain in childbirth can be false and true:

• They talk about false pain when discomfort provoked by the fear of childbirth and the inability to control their reactions and emotions.
• True pain occurs with any violation of the birth process, which really requires anesthesia.

It becomes clear that most women in labor are able to survive childbirth without anesthesia.

The need for labor pain relief

Anesthesia of childbirth should be carried out in case of their pathological course and / or existing chronic extragenital diseases in a woman in labor. Easing pain in childbirth (analgesia) not only relieves suffering and relieves emotional stress in a woman in labor, but also interrupts the connection between the uterus - spinal cord - brain, which does not allow the body to form a brain response to pain stimuli in the form of autonomic reactions.

All this leads to stability of cardio-vascular system(normalization of pressure and heartbeat) and improvement of uteroplacental blood flow. Besides, effective pain relief childbirth reduces energy costs, reduces oxygen consumption, normalizes work respiratory system(prevents hyperventilation, hypocapnia) and prevents narrowing of the uteroplacental vessels.

But the above factors do not mean that medical anesthesia for childbirth is required for all women in labor without exception. natural pain relief during childbirth, it activates the antinociceptive system, which is responsible for the production of opiates - endorphins or happiness hormones that suppress pain.

Methods and types of anesthesia for childbirth

All types of anesthesia for labor pain are divided into 2 large groups:

• physiological (non-drug)
• pharmacological or medical anesthesia.

Physiological methods of pain relief include

Psychoprophylactic training

This preparation for childbirth begins in antenatal clinic and ends one to two weeks before the expected due date. Training in 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 in childbirth and self-help. It is important for a pregnant woman to receive a positive charge for childbirth, to discard her fears and prepare for childbirth not as a difficult test, but as a joyful event.

Massage

During contractions, self-massage will help relieve pain. You can stroke the sides of the abdomen in a circular motion, collar area, lumbar region or press with fists on points parallel to the spine in lumbar during the fights.

Proper breathing

Pain relief poses

There are several positions of the body, by adopting which, the pressure on the muscles and perineum decreases and the pain weakens somewhat:

• squatting with knees wide apart;
• kneeling, having previously separated them;
• standing on all fours, raising the pelvis (on the floor, but not on the bed);
• lean on something, tilting the body forward (on the back of the bed, on the wall) or bounce 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, waist). Unfortunately, not all maternity hospitals are equipped with special baths or pools, so this method of anesthesia cannot be used by all women in labor. If the contractions started at home, then before the ambulance arrives, you can stand in the shower, leaning against the wall or take a warm bath (provided that the water has not broken).

Transcutaneous electrical nerve stimulation (TENS)

2 pairs of electrodes are placed on the back of the patient in the lumbar and sacral region, through which electricity low frequency. Electrical impulses block the transmission of pain stimuli in the roots of the spinal cord, and also improve blood circulation in the myometrium (prevention of intrauterine hypoxia).

Aromatherapy and Audiotherapy

The inhalation of aromatic oils allows you to relax and relieves some of the pain of labor. 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, intravenously or intramuscularly, narcotic and not narcotic drugs. From drugs promedol, fentanyl are used, which help to normalize discoordinated uterine contractions, have a sedative effect and reduce the secretion of adrenaline, which increases the pain threshold. In combination with antispasmodics (baralgin), they accelerate the opening of the uterine os, which shortens the first stage of labor. But narcotic drugs cause CNS depression in the fetus and newborn, so it is not advisable to administer them at the end of the period of contractions.

Of the non-narcotic drugs for labor pain relief, tranquilizers (Relanium, Elenium) are used, which not only relieve pain, but 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.

Inhalation anesthetics

This method of pain relief during childbirth consists in inhalation through the mask by the woman in labor inhalation anesthetics. To date similar way anesthesia is scarce where it is used, although not so long ago there were bottles of nitrous oxide in every maternity hospital. From inhalation anesthetics, nitrous oxide, halothane, trilene are used. In view of the high consumption of medical gases and the contamination of the delivery room with them, the method has lost popularity. 3 methods of inhalation anesthesia are used:

• inhalation of a mixture of gas and oxygen continuously with interruptions after 30 0 40 minutes;
• inhalation only with the onset of the contraction and cessation of inhalation with the end of the contraction:
• inhalation of medical gas only in between contractions.

Positive sides this method: fast recovery consciousness (after 1 - 2 minutes), antispasmodic effect and coordination of labor activity (prevention of the development of anomalies of generic forces), prevention of fetal hypoxia.

Side effects of inhalation anesthesia: respiratory failure, failures heart rate, confusion, nausea and vomiting.

Regional anesthesia

Regional anesthesia consists of blocking certain nerves, spinal cord roots, or nerve ganglia (nodes). Used in childbirth the following types regional anesthesia:

• Pudendal nerve block or pudendal anesthesia

The blockade of the pudendal nerve consists in the introduction of a local anesthetic (10% lidocaine solution is more often used) 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 edge of the rectal sphincter). It is usually used to relieve pain during labor and delivery, when other methods of anesthesia cannot be used. Indications for pudendal blockade, as a rule, are the need for the imposition of obstetric forceps or a vacuum extractor. Among the shortcomings of the method, the following were noted: anesthesia is observed only in half of women in labor, the possibility of anesthetic entering the uterine arteries, which, in view of its cardiotoxicity, can lead to death, only the perineum is anesthetized, while spasms in the uterus and lower back persist.

• Paracervical anesthesia

Paracervical anesthesia is permissible only for anesthesia of the first stage of labor and consists in the introduction of a local anesthetic into the lateral fornix of the vagina (around the cervix), due to which the blockade of the paracervical nodes is achieved. It is used when opening the uterine os by 4-6 cm, and when almost complete disclosure (8 cm) is reached, paracervical anesthesia is not performed in mind high risk injection of medication into the fetal head. Currently, this type of anesthesia in childbirth is practically not used due to the high percentage of development of bradycardia (slow heartbeat) in the fetus (in about 50-60% of cases).

• Spinal: epidural or epidural 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 vertebrae) and spinal anesthesia (injection of an anesthetic under the dura mater, arachnoid (middle) membranes not reaching the soft meninges - subarachnoid space).

Anesthesia with EDA occurs after some time (20-30 minutes), during which the anesthetic penetrates into the subarachnoid space and blocks nerve roots spinal cord. Anesthesia for SMA occurs immediately, as the drug is injected precisely into the subarachnoid space. The positive aspects of this type of anesthesia include:

• high percentage of efficiency:
• does not cause loss or confusion;
• if necessary, you can extend the analgesic effect (due to the installation of an epidural catheter and the introduction of additional doses of drugs);
• normalizes discoordinated labor activity;
• does not reduce the strength of uterine contractions (that is, there is no risk of developing weakness of the generic forces);
• lowers blood pressure (which is especially important for hypertension or preeclampsia);
• does not affect respiratory center in the fetus (there is no risk of intrauterine hypoxia) and in a woman;
• if necessary abdominal delivery the regional block can be strengthened.

Who is indicated for anesthesia during childbirth?

Despite many advantages various methods pain relief during childbirth, relief of labor pain is carried out only if there are medical indications:

• preeclampsia;
• C-section;
• young age of the woman in labor;
• childbirth began prematurely (in order to prevent birth trauma of the newborn, protection of the perineum is not carried out, which increases the risk of ruptures of the birth canal);
• estimated fetal weight of 4 kg or more (high risk of obstetric and birth injuries);
• childbirth lasts 12 hours or more (protracted, including those with a previous pathological preliminary period);
• medical rhodostimulation (when oxytocin or prostaglandins are connected 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 straining period (myopia high degree, preeclampsia, eclampsia);
• discoordination of tribal forces;
• childbirth with two or more fetuses;
• dystocia (spasm) of the cervix;
• increasing fetal hypoxia during childbirth;
• instrumental interventions in the pushing and subsequent periods;
• suturing incisions and ruptures, 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 methods of anesthesia are used after childbirth?

After separation of the placenta, the doctor examines the birth canal for their integrity. If ruptures of the cervix or perineum are detected, and an episiotomy has also been performed, then it becomes necessary to suture them under anesthesia. As a rule, infiltration anesthesia of the soft tissues of the perineum with novocaine or lidocaine (in case of tears / incisions) is used, and less often 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 carried out if instrumental management of the second and third stages of labor is necessary (fruit-destroying operation, manual separation of the placenta, application of obstetric forceps, etc.)?

In such cases, it is desirable to perform spinal anesthesia, in which the woman is conscious, but there is no sensitivity 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 the anesthesia technique, his experience and the clinical situation (the presence of bleeding, the need for rapid anesthesia, for example, with the development of eclampsia on birth table etc.). The method of intravenous anesthesia (ketamine) has proven itself quite 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 in advance with the obstetrician and anesthetist the pain relief during childbirth using the EDA method. But every woman should remember that epidural anesthesia during childbirth is not prerequisite rendering medical care childbirth, 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 own this technique, the consent of the obstetrician leading the birth, and, of course, the 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 pain relief was performed without a request from the part of the woman in labor for pain relief, therefore, there were medical indications to facilitate contractions, which was established by the obstetrician and anesthesia in this case acted as part of the treatment (for example, the normalization of labor activity with discoordination of labor forces).

How much does EDA cost for 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. To date, the price of EDA ranges from (approximately) $50 to $800.

Can everyone have spinal (EDA and SMA) anesthesia in labor?

No, there are a number of contraindications in which spinal anesthesia cannot be performed:

What is the anesthesia for caesarean section?

The method of anesthesia during caesarean section is chosen by the obstetrician together with the anesthetist and coordinated with the woman in labor. In many ways, the choice of anesthesia depends on how the operation will be performed: according to planned or emergency indications and on the obstetric situation. In most cases, in the absence of absolute contraindications to spinal anesthesia, the woman in labor is offered and performed EDA or SMA (both for planned caesarean section and for emergency). But in some cases, endotracheal anesthesia (EDA) is the method of choice for anesthesia for abdominal delivery. During EDA, the woman in labor is unconscious, cannot breathe on her own, and a plastic tube is inserted into the trachea through which oxygen enters. Drugs for anesthesia in this case are administered intravenously.

What other methods of non-medical pain relief can be used during childbirth?

In addition to the methods of physiological pain relief during childbirth listed above, auto-training can be done to facilitate contractions. During painful uterine contractions, talk with the child, express the joy of a future meeting with him, set yourself up for a successful outcome of childbirth. If auto-training does not help, try to distract yourself from the pain during the fight: sing songs (quietly), read poetry or repeat the multiplication table aloud.

Example from practice: I gave birth to a young woman with a very long braid. The birth was the first, the contractions seemed to her very painful, and she constantly asked for a caesarean section in order to stop these "torments". It was impossible to distract her from the pain, until a thought occurred to me. I told her to unplait her braid, otherwise she was too disheveled, comb it and braid it again. The woman was so carried away by this process that she almost missed the attempts.

I noticed that most site visitors 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 a woman, but according to indications, it can also be offered to a woman who is ready to endure as much pain as nature allots her.

Non-pharmacological 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 set up for 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, it seems that we even understand intellectually that there is no need to be afraid, but we are still afraid.

This is why preparing for childbirth is so important. Moreover, it is desirable that it be started not a week before the birth, since positive attitude may not develop as quickly. Schools for pregnant women are very helpful, where they talk about the physiology of the birth act 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 site, expressed the opinion that such schools do more harm than good. I think it was meant that some schools form a negative attitude towards any medical manipulations and doctors in general. This also happens, so you need to “filter” the information - remember the tips on how to help yourself in childbirth, but do not be categorical about medical care either. It is better to choose a school where there are classes with both psychologists and obstetrician-gynecologists.

Communication with young mothers is also useful, it helps to understand that painless childbirth is not so rare.

In addition to the psychological mood, there are some

Techniques to slightly reduce the intensity of pain:

First, it is correct breathing. Breathing during childbirth is recommended as follows: for a contraction, a deep slow breath through the nose, then a slow exhalation through the mouth. Don't hold your breath. Breathe calmly between contractions. At the same time, it is worth concentrating on breathing, this helps to distract from the pain, and facilitates the process of childbirth for the baby. At the end of the first stage of labor, when there is a desire to push, you need to either breathe often “like a dog”, or vice versa, use deep slow breathing (deep inhalation and exhalation through the mouth), as you like. During an attempt, you need to dial full chest air (as if you are going to dive under water), and with this air it’s as if you are pushing the pain out of yourself, when the air runs out, exhale quickly and immediately inhale again, without “breathing out” the attempt (you can catch your breath between attempts, you need to use the attempt to the maximum) .

The next anesthetic technique is pressure on the bony protrusions. Need with inside press on the bones protruding on the sides in the lower abdomen. For some, kneading the lower back helps. The husband helps a lot in this if he is present at the birth. You need to knead and rub your back intensively, you can feel light pain, this distracts from labor pain.

To relax between contractions, you need to imagine some situation where you feel good and pleasant, you are resting. For example, imagine yourself lying on the beach and listening to the sound of the waves. Or how you cuddle a little warm baby. It is better to think in advance what you will imagine, to practice in paints to describe to yourself a picture and your feelings (because already in childbirth, when you experience pain, as luck would have it, it is difficult to remember something pleasant).

Also in childbirth, you can use the well-known NLP technique anchoring. A few days before the birth, when you are especially good and pleasant, you experience strong positive emotions, massage your wrist. By doing this, you will create an “anchor” in the wrist area for a positive emotion, and then during childbirth, when you massage your “anchor”, you will feel those emotions and sensations with which this “anchor” is associated. (Any area can be an anchor. Wrist is an example.)

In preparation for childbirth, you need to learn how to relax your muscles so that they obey you, as muscle tension increases pain. This is taught in gymnastics for pregnant women. The technique is that you are trying, for example, to strain your right leg and left hand, and the left leg right hand as relaxed as possible, then change tension and relaxation. In general, you need to strain certain parts of the body. The rest should be relaxed. So you learn to control your muscles so that they relax as you wish. It's easy enough in normal life, but difficult when you're in pain and cringing.

Medical pain relief

Such a simple and familiar drug as no-shpa can reduce the pain of contractions. No-shpa can be administered both intravenously and intramuscularly. No-shpa does not cause oppression of labor activity and does not have a negative effect on the fetus. First of all, no-shpa does not relax the body of the uterus, but the cervix, due to which the cervix opens faster. Therefore, no-shpa can be used simultaneously with the stimulation of labor.

No-shpa 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 activity has begun, then the contractions will continue.

Sometimes narcotic analgesics are used to relieve childbirth. The most famous promedol. It is administered intravenously or intramuscularly, the action lasts 2-4 hours, the opening of the cervix with the introduction of 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 the perception of pain by a woman. Usually promedol is used for fatigue of the woman in labor. After the introduction of promedol, a woman most often falls asleep (medicated sleep-rest). This is the prevention of secondary weakness of labor activity. After such a drug-induced sleep, regular contractions of good strength are usually restored and there is positive dynamics in the opening of the cervix.

However, this drug also has side effects. The most serious of these is respiratory depression in the fetus. After childbirth, the child is lethargic, drowsy, does not immediately take the breast. The inhibitory effect of promedol on the fetus is most pronounced if the drug is administered 2-3 hours before delivery. In addition, with the introduction of promedol, a woman may experience nausea and vomiting. With a pronounced negative effect of promedol, the antagonist of promedol, naloxone, is administered to a woman and / or child.

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, due to which he may be somewhat lethargic, drowsy. This does not pose a danger to the health of the child, since the dose that 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 of the 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 lying on her side, bending her back as much as possible - curled up). The doctor anesthetizes the site of the alleged puncture with an injection of novocaine. The epidural needle is then inserted between the vertebrae into the epidural space. Then a catheter (thin plastic tube) is 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 can be added during childbirth. The effect begins 15-20 minutes after the administration of the anesthetic.

The indications for epidural anesthesia are severe preeclampsia (late toxicosis) during pregnancy, chronic diseases kidneys, heart, lungs, young age of the woman in labor, severe myopia (nearsightedness), arterial hypertension(increased blood pressure). Also, epidural anesthesia is performed with discoordination of labor activity (when, with strong painful contractions, the cervix opens weakly, the rate of opening does not correspond to the strength and duration of contractions).

Contraindications for epidural anesthesia: spinal injury or surgical interventions on the spine, bleeding disorders or taking drugs that affect clotting, a scar on the uterus after a caesarean section or other operations, low blood pressure, pustular formations on the skin near the site of the proposed puncture. In some cases, this type of anesthesia is difficult to perform due to the woman's severe obesity, because the doctor cannot find bone landmarks.

With this method of anesthesia, pain is completely turned off, but all other types of sensitivity are preserved. A woman can move, feel touch, she is fully conscious. Anesthetize only the first stage of childbirth (the period of contractions). By the end of the first period and the beginning of the period of pushing, the effect of anesthesia should be terminated, as the woman must feel increased pain during attempts to understand that she is pushing correctly. After childbirth, if necessary, anesthesia can be resumed (for example, when suturing ruptures of the birth canal).

With epidural anesthesia, the duration of labor usually increases. This is due to the fact that the strength of contractions is somewhat reduced. In addition, a woman may have a decrease in blood pressure up to fainting. There were no negative effects on the fetus during this method of anesthesia. IN postpartum period some women say headache and temporary leg numbness.

The use of epidural anesthesia by everyone causes controversy among both doctors and women in labor. Some wonder why in Western countries anesthesia is carried out for everyone without exception, but we do not. Probably because in our country women themselves do not aspire to this. Moreover, it is known that the frequency caesarean sections in Western countries is higher, and many attribute this 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 anomalies in labor activity.

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 relieves the pain of childbirth completely, in the most crucial pushing period, a woman fully feels everything that is supposed to, therefore, 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 at least some specific time, otherwise some statements would appear, for example, about a violation of the connection between mother and child during a quick birth.

The argument that the ancestors gave birth without any medical assistance also does not stand up to criticism, because when they gave birth without help, there was natural selection and a fairly high mortality rate during childbirth.

In conclusion, I want to say that, of course, the less medical interventions, the better, but the limits must be reasonable, and if the benefit greatly exceeds possible risk, then you should not abandon the achievements of civilization.

The fear of severe pain during childbirth scares every woman. It is well known that contractions are accompanied by pain, which increases as delivery approaches. However, the pain threshold for pregnant women is different, and if for one it is pain that can be overcome, then for the other it is a great torment.

Promedol during childbirth
The older generation of women advise the woman in labor to be patient - they say, everyone endured and this is the norm. However, isn't it more expedient to experience the exceptionally joyful sensations of the birth of a baby than to suffer in anticipation of unbearable suffering?

Pain relief during childbirth with promedol
Promedol during childbirth refers to pharmacological group means that can reduce pain, calm the puerperal.
Non-drug therapies include the following:

• psychoprophylactic preparation of women;
• analgesic massage;
• water procedures;
• certain ways of breathing;
• comfortable postures;
• reflex and aromatherapy methods.

In the event that all of the above methods do not have the desired effect, it is advisable to resort to the use of medications.

Promedol during childbirth consequences
The main question that worries a woman in delivery room – possible consequences for a child from the use of an anesthetic drug. You should know that Promedol in its composition is a synthetic analogue of morphine. The substance is considered to be safe enough for mother and child during labor. However, in some women, Promedol can cause such side reactions:

• nausea;
• feeling of intoxication;
• staggering.

Speaking about the impact on the child, the drug penetrates the placenta 2 minutes after ingestion. The concentration of the substance in the umbilical artery is identical to the content in the blood of a woman.

The main disadvantage of Promedol during childbirth is the long-term excretion from the blood of the baby. For comparison, the withdrawal from the body of a baby is 7 times slower than a woman in labor.

Respectively, side effects from the drug for the baby are drowsiness and respiratory depression. The use of this kind of analgesics during childbirth does not affect the formation of the baby's dependence on such substances in the future. In spite of high efficiency drug, 35-40% of women in labor, the drug does not anesthetize enough.

In order to behave calmly during contractions, not to worry, not to succumb to stress, doctors recommend visiting special clinics during gestation.

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