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It is very important to start from the very beginning of pregnancy psychological preparation for childbirth, prepare for a successful outcome. The doctor who is monitoring your pregnancy can be of great help with this, of course, only if there is complete mutual understanding between you. It is ideal when the same doctor conducts the birth. During pregnancy, you become members of the same team, and during childbirth you will benefit from powerful psychological support.

Types of pain relief

Most often used:

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

Does pain management affect the child?

Promedol in the dose that is used for pain relief during labor does not have any effect harmful influence for the fruit. However, the baby can sleep with the mother.

Epidural anesthesia is considered extremely necessary for the gentle management of labor; it makes childbirth less traumatic for the fetus, since the main obstacle that the fetal head encounters during its advancement, the cervix, softens significantly and opens faster.

Which is better: promedol or epidural anesthesia

This depends on many circumstances that only a doctor can evaluate.

But you need to keep in mind that promedol can be administered only once, so it is better to administer it when contractions are strong 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 the pain; it is perceived differently.

And with epidural anesthesia, the pain is completely relieved; pain relief can be added through a thin catheter as the pain intensifies.

Epidural anesthesia is performed 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 goes away very quickly.

Minuses

Of course, epidural anesthesia has its pitfalls. First of all, this method of pain relief is not suitable for everyone. Contraindications include: allergic reactions to local anesthetics (drugs used in dental treatment: lidocaine - as a local anesthetic it is excellent, novocaine, etc.), poor blood clotting, elevated temperature, neurological diseases, bleeding, obesity, purulent wounds in the lumbar region. Of course, no one gives anesthesia until regular labor is established and in the event that the woman refuses it, preferring to bravely endure the pain. Each woman decides for herself how long to endure and when to turn to professional help. In principle, many women in labor manage to do without painkillers. Some people have a high pain threshold and even the first birth goes easily and quickly. If you can endure it, it’s better, of course, to endure it, anesthesiologists understand this. It would be a mistake to compare epidural anesthesia to 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 the consequence of an unintentional puncture of the dura mater, when the needle enters the vertebra a little further than it should. This happens even among experienced specialists in 1% of cases in the world. These pains respond well to treatment and go away without consequences. Another problem is lowering blood pressure. To prevent this complication, before anesthesia, about 500 ml of liquid is injected into a vein for 5 minutes. It is rare, but it happens that a highly concentrated solution of local anesthetic slows down the labor process. Other side effects include pain at the injection site (which can last up to seven days) and allergic reactions. Some people are confused by the fact that the use of epidural anesthesia deprives the woman in labor of the ability to move independently. However, many of these disadvantages are still offset by one big advantage: women who give birth without extreme pain often leave the maternity hospital with the intention of giving birth to a second, and perhaps a third, child there.

Ultimately, whether to give birth with or without anesthesia is a woman's personal decision. The main thing is that it is accepted wisely and honestly. No matter how the birth goes, the knowledge that you have somewhere to retreat to, 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 .

Popular medicinal pain relief for childbirth

Undoubtedly, childbirth is the 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 of amniotic fluid (occurring 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 are very necessary: ​​at the end of the second stage of labor she will have a big physical labor- push! 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 a pathologically low pain sensitivity threshold. 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 during 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 is 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. This feature is associated with the upper time limit for pain relief with promedol - no later than two hours before the birth of the baby.

Therefore, after the cervix is ​​dilated by 8 cm, promedol is not administered. After all, after being 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 labor, promedol is also prescribed for the treatment of various pathologies of labor. 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.

TO possible complications when narcotic analgesics are administered during childbirth, nausea, vomiting, drowsiness, lethargy, confusion in the mother and “congestion” (the residual effect of the narcotic substance, manifested in the sluggishness of vital reflexes and functions, primarily breathing) at the time of birth in 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. It's about 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 a large number of complications (respiratory depression in the woman in labor).

In conclusion, I would like to draw the attention of expectant mothers to this fact. No medical intervention can 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 state for the female body. This means that nature has provided everything in order to successfully cope with this task - so difficult and so happy on your own!

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1 tablet includes 25 mg trimeperidine .

1 ml injection solution includes 10 mg or 20 mg trimeperidine .

Release form

The drug Promedol is available in the form of tablets of 10 or 20 pieces per package, as well as in the form of a 1% or 2% injection solution in ampoules of 5, 10, 100, 150, 200, 250 or 500 pieces per package.

pharmachologic effect

Analgesic, antishock, antispasmodic, uterotonic, hypnotic.

Pharmacodynamics and pharmacokinetics

The drug Promedol belongs to the pharmacological group narcotic (opioid ), with the main analgesic effect. The active substance of Promedol according to the INN classification is trimeperidine , exhibits an agonistic effect on opioid receptors . Activates endogenous painkiller (antinociceptive ) system , thereby violating different levels CNS, transportation pain impulses between neurons . Trimeperidine also influences higher departments brain , modifying the emotional coloring pain syndrome .

The pharmacological effects of Promedol are similar to those and are expressed by an increase pain threshold with symptoms of pain of various origins, inhibition, as well as mild hypnotic effect .Suppression respiratory center , when using Promedol, manifests itself to a lesser extent compared with Morphine . The drug is less likely to cause symptoms such as nausea And vomit , somewhat enhances contractile function And myometrial tone , has moderate antispasmodic effectiveness in relation to ureters And bronchi, as well as a spasmogenic effect, inferior to the action Morphine , towards intestines And biliary tract .

The development of the analgesic effect of Promedol, when administered parenterally, is observed after 10-20 minutes, rapidly increases and reaches its maximum value after 40 minutes. High analgesic effects last for 2-4 hours, when carried out - more than 8 hours.

Oral administration provides an analgesic effect of the drug, which is 1.5-2 times less than when administered parenterally.

For any delivery method trimeperidine into the body, its absorption proceeds quite quickly. TCmax when taken orally is observed after 60-120 minutes. When administered intravenously, the contents trimeperidine in plasma decreases rapidly and after 2 hours only trace concentrations are detected.

With plasma proteins trimeperidine binds by 40%. Basic metabolism passes into liver through a hydrolysis process releasing normeperidine And meperidic acid and further conjugation. T1/2 takes from 2.4 to 4 hours, increasing slightly.

Excreted kidneys V small quantities, including unchanged by 5%.

Indications for use

Cupping pain syndrome medium and strong intensity with:

• pain after surgery surgical intervention ;
• pain in patients;
• unstable angina ;
• delaminating aortic aneurysm ;
• renal artery ;
• acute pericarditis ;
• pulmonary artery and arteries of the extremities;
• air;
• acute pleurisy ;
• heart attack lung ;
• spontaneous pneumothorax ;
• perforation of the esophagus;
• chronic;
• paranephritis ;
• acute dysuria ;
• renal and hepatic colic ;
• acute attack;
• priapism ;
• acute;
• lumbosacral radiculitis;
• causalgia ;
• acute vesiculitis ;
• thalamic syndrome;
• acute neuritis ;
• injuries and burns;
• protrusion intervertebral disc;
• foreign bodies in the urethra, rectum, bladder.

Promedol is prescribed in obstetric practice with the aim of labor pain relief and as a lung stimulant labor activity.

IN surgical practice the drug is indicated for premedication and in the composition as an analgesic component (for example, conducting neuroleptanalgesia in combination with antipsychotics ).

Pulmonary edema , spicy left ventricular failure And cardiogenic shock , are also among the indications for the use of Promedol.

Contraindications

Absolute contraindications to taking Promedol are:

• patient to trimeperidine ;
• age up to 2 years;
• painful conditions in which there is respiratory depression ;
• parallel therapy using MAO inhibitors , as well as up to 21 days after their cancellation.

There are also a number of relative contraindications in which the use of Promedol is possible only with extreme caution, these are:

• respiratory failure ;
• and/or liver;
• chronic heart failure ;
• adrenal insufficiency ;
• traumatic brain injury;
• CNS depression ;
• myxedema ;
• urethral stricture ;
• surgical manipulations on the urinary system or gastrointestinal tract;
• convulsions ;
• obstructive pulmonary disease , chronic course;
• arterial hypotension ;
• emotional lability;
• cachexia ;
• elderly age;
• weakened patients;
• inflammatory in nature;
• (including history).

Side effects

• blurred vision;
• diplopia ;
• convulsions ;
• involuntary muscle contractions;
• weakness;
• confusion ;
• unusual or nightmares;
• anxiety;
• paradoxical arousal;
• muscle stiffness (especially respiratory);
• retardation of psychomotor reactions ;
• tinnitus.

Promedol at prescribed for And stimulation of labor . Injections are carried out intramuscularly or subcutaneously in doses of 20-40 mg, with a positive assessment of the condition of the fetus and dilatation of the cervix by 3-4 cm. Promedol promotes relaxation of the cervical muscles , thereby speeding up the process of its disclosure. The last injection should be given 30-60 minutes before the intended delivery , to avoid negative consequences during childbirth associated with suppression of fetal breathing .

The maximum parenteral dose for adult patients is 40 mg, and the maximum daily dose is 160 mg.

For children over 2 years of age, the dose of Promedol is from 0.1 to 0.5 mg/kg, with subcutaneous, intramuscular and rarely intravenous administration. Repeated injections to relieve pain can be carried out after 4-6 hours.

When carrying out, as its component, Promedol is administered intravenously at 0.5-2.0 mg/kg/hour. Maximum dose throughout the entire duration of treatment operations , should be no more than 2 mg/kg/hour.

It is carried out in a dose of 0.1-0.15 mg/kg, pre-diluted Promedol in 2-4 ml of sodium chloride for injection. The onset of the effect of the procedure is observed after 15-20 minutes, the peak of action occurs after approximately 40 minutes, with a gradual decrease in effectiveness over 8 hours or more.

Overdose

In case of an overdose of Promedol, the main negative effect is depression of consciousness And respiratory suppression , up to state . Various increased side effects may also be observed. A characteristic feature diagnosing an overdose may be miosis (constriction of the pupils).

Interaction

During parallel use of Promedol with sleeping pills And sedatives , anxiolytics, antipsychotics , muscle relaxants , ethanol, means general anesthesia and others narcotic analgesics , intensifies CNS and respiratory depression .

When taken systematically barbiturates , especially Phenobarbital , observed a decrease in analgesic effect trimeperidine .

Promedol can increase effectiveness antihypertensive drugs (diuretics , ganglion blockers etc.).

Antidiarrheal And anticholinergic means can lead to urinary retention , heavy constipation , intestinal obstruction .

Trimeperidine enhances the effects of drugs with anticoagulant activity, and therefore, when used together, monitoring is necessary plasma prothrombin .

Therapy using , currently available or carried out previously, reduces the effect of Promedol.

Combined treatment with MAO inhibitors may cause serious consequences associated with braking or overexcitation of the central nervous system and lead to development hypotensive or hypertensive crises .

The effects are reduced when taken together with Promedol.

Naloxone , being an antidote trimeperidine , eliminates its side effects: suppression of breathing , analgesia, CNS depression . At drug addiction accelerates the development of symptoms " withdrawal syndrome «.

Also affects the acceleration of symptoms " withdrawal syndrome " at drug addiction . After administration of the drug, persistent and difficult to eliminate symptoms appear quite quickly, sometimes within 5 minutes, and are observed for 2 days.

Terms of sale

To purchase this drug, you need a correctly completed Promedol prescription for Latin, on established by the rules form, with all attached details and seals.

Storage conditions

Both the injection solution and Promedol tablets belong to list A. The storage temperature of the drug is 8-15°C.

Best before date

For tablets and solution – 5 years.

special instructions

During therapy with Promedol, it is better to refrain from thin and hazardous work, as well as from driving a car.

With systematic use of Promedol, it may develop drug-like addiction .

For children

Prescribed to children over 2 years of age, strictly according to indications, in exactly recommended doses, with extreme caution and under the supervision of a doctor.

With alcohol

Treatment with Promedol should not be combined with drinking alcoholic beverages.

During pregnancy (and lactation)

During periods (except for cases of onset of labor, in which the drug is indicated as an analgesic and stimulant), as well as during periods, Promedol is prescribed with extreme caution, taking into account all possible negative effects of therapy for the mother, fetus or newborn.

The thought of labor pain frightens many pregnant women. In the arsenal of modern obstetrics and gynecology, there are two groups of pain-relieving methods: non-drug and medicinal. The first methods include psychoprophylactic preparation of pregnant women, the use of pain-relieving massage, water during childbirth, special breathing methods, postures that reduce pain during childbirth, methods of reflexology, aromatherapy, etc. The second group includes methods using various pharmacological drugs that have analgesic, sedative, and hypnotic effects. They will become the subject of our conversation.

The use of opiates for pain relief during childbirth has been known for a long time. It began more than 3000 years ago. Also in Ancient Greece and Egypt, doctors alleviated the labor pain of women, usually from noble families, by fumigating the room where the birth took place with opium. In addition, the woman in labor was given a decoction of poppy heads containing opiates. However, with such anesthesia it was impossible to accurately determine the dose of opiates. Therefore, often the woman simply fell asleep, and the birth process was slowed down.

Is it possible to do without medications?

Medicines used to relieve labor pain are very effective. However, pharmacological pain relief has a significant drawback compared to non-drug methods: all drugs penetrate into the blood to a greater or lesser extent, pass through the uteroplacental barrier and can cause various side effects and complications on the part of the child and the woman in labor. Therefore, the use of these drugs during childbirth is carried out according to strict medical indications.

Typically, drug pain relief (anesthesia) is required during the first birth, during long-term or prolonged labor. premature birth, at large fruit. Anesthesia is often performed after the rupture of amniotic fluid to avoid a prolonged anhydrous period, which increases the risk of infection; when using oxytocin, which increases contractions and pain during them.

When prescribing medications for labor pain relief, an individual approach is required. Naturally, various surgical interventions are impossible without the use of modern methods pain relief. In addition, pronounced pain itself inhibits the normal course of labor, inhibits labor, leads to spasm of the cervix and prevents its opening. Therefore, if there are indications and low effectiveness of non-drug methods of pain relief, they resort to drug anesthesia.

In Russian maternity hospitals, the most commonly used inhalation of nitrous oxide, inhalation anesthesia (injection of an anesthetic through the respiratory tract), epidural anesthesia (injection of an anesthetic into the space above the dura mater of the spinal cord in the lumbar region) and administration of narcotic analgesics (in common parlance - “narcotics”), o which will be discussed.

What are narcotic analgesics?

Trimepyridine (PROMEDOL) and pentazocine (FORTRAL, LEXIR) are usually used to relieve painful contractions. Modern narcotic analgesics include PETHIDINE, NALBUFINE and BUTORPHANOL.

Drug anesthesia, including narcotic analgesics, must be carried out according to strict indications. The penetration of medicinal substances through the placental barrier to the child depends on: many factors: the surface area and thickness of the placenta, the duration of pregnancy; the intensity of uteroplacental blood circulation, from the permeability of the placental barrier, which increases with various pathological processes and complications of pregnancy. The health status of the mother and fetus plays an important role. If a woman has had experience using drugs in the past, doctors will refuse this type of pain relief, as it will be ineffective.

Morphine - the founder of modern drugs

The ancestor of modern drugs is morphine (MORPHINE HYDROCHLORIDE). This is one of the most powerful components of opium (from the Greek opos - juice) - the frozen milky juice from the heads of the hypnotic poppy. Therefore, morphine and all its derivatives are called opiates or opioid analgesics (painkillers).

Morphine, like other narcotic analgesics, has a pronounced inhibitory effect on the central nervous system (CNS). The main effect of morphine is its analgesic effect. In addition, morphine has a calming effect, and the psychological component of pain is extremely large. It is not without reason that fear and anticipation of pain during childbirth greatly increases the pain during contractions. Other effects of morphine and its synthetic analogs include decreased breathing and heart rate, decreased body temperature, and constricted pupils. When high doses are administered, respiratory arrest may occur due to paralysis of the respiratory center. Morphine leads to difficulty urinating and constipation, disrupts the secretion of bile, reduces the secretion of digestive juices, can cause nausea and vomiting, lowers blood pressure, dilates blood vessels that feed the heart.

Due to the widespread prevalence of drug addiction, the attitude towards drugs and their use among women in labor is very wary, since many have heard about the serious consequences of drug use, including the development of drug addiction. In fact, the use of narcotic analgesics during childbirth is usually carried out once - in the first stage of labor, during painful contractions. Psychological and, especially, physical dependence on drugs develops only with sufficiently frequent administration of narcotic substances over a short period of time.

Previously, morphine was widely used in maternity hospitals to reduce the pain of contractions. However, due to the pronounced side effects of this drug, its easy passage through the placental barrier and significant respiratory depression in the child, as well as due to the weakening of uterine contractions under the influence of morphine, preference is now given to modern, synthetic and semi-synthetic narcotic drugs medicines, which will be discussed below.

Mechanism of action of narcotic analgesics

Narcotic analgesics act on special structures - opiate receptors, having a pronounced effect on the central nervous system. IN human body drug-like substances are synthesized - endorphins, enkephalins. These are the so-called “hormones of joy.” The effect of these hormones and similar substances on opiate receptors causes a decrease in pain, a feeling of joy, mental comfort, etc. When drugs are administered, the transmission of pain impulses is inhibited, and the subjective perception of pain, its assessment and reaction to it are also disrupted. Thus, the use of narcotic analgesics during childbirth reduces acute pain during contractions and promotes relaxation and calm. At the same time, the woman falls asleep or dozes, the painful contractions weaken, but not completely.

Drugs used to relieve labor pain

The most common narcotic analgesic used during childbirth, as well as in preparation for various surgical interventions (premedication), is PROMEDOL. This is a synthetic analogue of morphine.

Usually PROMEDOL is injected into the thigh, shoulder or buttock subcutaneously or intramuscularly, less often intravenously. The drug is quickly absorbed into the blood, reaching maximum concentration 1-2 hours after injection. By binding to opiate receptors, PROMEDOL has an analgesic and sedative effect. In addition, the drug acts as an antispasmodic - it eliminates spasm of the cervix, causing it to relax and open as quickly as possible. At the same time, PROMEDOL somewhat enhances uterine contractions, stimulating the birth process.

The analgesic effect of PROMEDOL appears within 10 minutes after administration in most women in labor. Consciousness is completely preserved. PROMEDOL is considered a fairly safe drug for mother and child during childbirth. However, in some women in labor, PROMEDOL can cause adverse reactions: nausea, less often vomiting, feeling of intoxication, staggering.

PROMEDOL easily penetrates the placenta, affecting the child. Already 2 minutes after the administration of the narcotic analgesic, its concentration in the blood of the umbilical artery leading to the fetus is equal to the content of PROMEDOL in the maternal blood. The maximum concentration in the blood of the fetus is achieved 2 - 3 hours after administration of the narcotic analgesic to the mother. A big disadvantage of PROMEDOL during childbirth is the slow elimination of the drug from the baby’s blood - it occurs 7 times slower than in a woman in labor.

The main side effect observed in newborns after maternal use of PROMEDOL is respiratory depression and drowsiness. PROMEDOL inhibits the work of the respiratory center - a section of the central nervous system, which is responsible for the functioning of the respiratory system and breathing. After birth, the baby’s breathing is restored, but usually such babies

They don't take the breast right away. Occasionally, with severe respiratory depression, urgent assistance from a neonatologist and artificial respiration may be required. The use of narcotic analgesics during childbirth in no way contributes to the development of drug addiction in the child in the future.

It should be taken into account that for 35-40% of women PROMEDOL is not an effective pain reliever.

Another narcotic analgesic used during childbirth is PENTAZOCINE (LEXIR, FORTRAL). Unlike MORPHINE and PROMEDOL, PENTAZOCINE has a stimulating effect on blood circulation (increases blood pressure, increases heart rate), does not depress respiration, and also has a birth-stimulating effect. In addition, PENTAZOCINE does not cause drug dependence, does not have a hypnotic effect, and does not cause euphoria. However, the analgesic effect of this narcotic drug is weaker than that of morphine.

PETITIONS, NALBUFIN and BOOTS

FANOL is administered intramuscularly or subcutaneously in the first stage of labor - dilation of the cervix - to reduce pain during contractions. When administered intravenously, these drugs act faster but last less long. Like all narcotic analgesics, PETHIDINE, NALBUFINE and BUTORFAI penetrate the placenta, causing inhibition of the fetal central nervous system and respiratory depression in the infant.

Due to the fact that narcotic analgesics can be administered only once, and also taking into account the development of the listed side effects and the fact that narcotic analgesics administered during a slight opening of the cervix can weaken labor, the drugs are administered in such a way that by the pushing period of labor their action has ended. As a rule, narcotic analgesics are administered when the cervix is ​​dilated 5 - 6 cm. Usually, in a maternity hospital, the side effects of narcotic analgesics can be dealt with quite easily.

Combined use of narcotic drugs with other medicines allows you to reduce the dose of the drug and prevent the development of side effects.

If necessary, to eliminate the side effects of narcotic analgesics, their antagonists are administered - substances with the opposite effect, displacing the drug from opiate receptors - NALOXONE or NALORPHINE. For newborns, NALOXONE is injected into the umbilical vein. The effect of antagonists of narcotic analgesics manifests itself quickly - approximately 1 minute after administration, and lasts up to 2-4 hours.

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 do more harm than good. I think what was meant is that some schools form a negative attitude towards any medical procedures and towards 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 care. 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 the desire to push arises, you need to either breathe frequently “like a dog,” or, on the contrary, use deep slow breathing (deep inhalation and exhalation through the mouth), as you prefer. While pushing, you need to take in a full chest of air (as if you are about to dive under water), and with this air, as if pushing the pain out of yourself, when the air runs out, quickly exhale and immediately inhale again, without “breathing out” the push (you can catch your breath between attempts , pushing 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, until you feel slight pain, this distracts you 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 hold a small, warm baby close to you. 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).

Also during childbirth you can use the well-known NLP technique anchoring. A few days before giving birth, when you feel 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 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 tense your right leg and left hand, and the 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. This is easy enough in normal life, but difficult when you are in pain and everything is shrinking.

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 cause inhibition of labor and does not have any negative influence for the fruit. 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-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 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 such 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 dura mater 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 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 in the 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. During the 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 in Western countries pain relief is provided to everyone without exception, but in our country it is not. 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 benefit greatly outweighs the possible risk, then one should not abandon the achievements of civilization.