An injection in the back during childbirth, as they call it. Modern methods of pain relief during childbirth: medication and natural pain relief

Modern women in labor are luckier than their mothers and grandmothers. Medicine is ready to offer them effective ways to reduce labor pain. One of these methods is epidural anesthesia, which is quite widely used both during physiological childbirth and during surgical childbirth.

This article will talk about how such anesthesia is done, what its advantages and disadvantages are, and whether it can have negative consequences.

What it is?

Peridural or epidural anesthesia is a method of gentle anesthesia. In order to relieve pain, the patient does not need to be put into medicated sleep completely. The woman remains conscious, but an epidural injection into the spine completely or partially deprives her of sensitivity in some areas of the body.

The spine is part of the central nervous system and contains numerous nerve endings that send impulse signals to the brain. This is how the signal of pain is transmitted. The pain center in the cerebral cortex receives it, analyzes it, and the person begins to feel pain.

The technique of epidural anesthesia is that drugs are injected into the spine, or more precisely, into its epidural space, using a long lumbar needle and catheter, which block the sending of a pain impulse. As a result, the brain simply does not receive or understand signals from certain nerve endings. To relieve pain in different parts of the body, medications are injected into different parts of the spinal column.

During childbirth and during surgical delivery, there is a need to deprive the lower part of the body of sensitivity, and therefore the injection is given in the lumbar spine.

The nerve roots are washed with a drug - an anesthetic injected through a catheter, their sensitivity is temporarily dulled or disappears completely. During natural childbirth, the drugs and dosages used are different than for caesarean section. A woman who gives birth herself is thus able to more easily endure labor pains, but a complete decrease in sensitivity does not occur; she feels the lower part of the body.

During a caesarean section, there is a need for longer and deeper pain relief, so not only analgesics are administered, as in the first case, but also ketamine.

Drugs used for epidural anesthesia undergo special specific purification; the resulting solutions are intended only for spinal or epidural use. The anesthesiologist knows which drug to administer and in what quantity. He is based not so much on the woman’s weight as on her height.

Apply up to 2 ml of medication to each segment of the spinal column that needs to be anesthetized. The general condition of the woman in labor, her pain threshold, and the individual characteristics of her health also play a role.

Advantages and disadvantages

Analgesia through the introduction of painkillers into the epidural space is considered today to be a fairly safe method, therefore the Ministry of Health recommends it as a first-line solution in situations where it is necessary to provide local anesthesia during childbirth or deeper anesthesia as an alternative to general anesthesia during childbirth surgery.

All the pros and cons of this type of pain reduction should be taken into account by two specialists - the doctor who conducts childbirth or operates and the anesthesiologist. They also take into account the wishes of the mother in labor.

Thus, a woman can always refuse an epidural injection during childbirth or express her disagreement with this method of anesthesia before a cesarean section. In this case, alternative methods will be used, which we will discuss below.

The undoubted advantage of epidural pain relief is that it helps a woman get through difficult moments more easily. With a caesarean section, a woman retains clarity of consciousness and can see how her baby will be born. Recovery from such anesthesia is incomparably shorter and easier than recovery from general anesthesia. The disadvantages are that epidural anesthesia can cause harm.

Aggravating consequences after using such anesthesia during childbirth may include prolongation of the labor period, weakening of contractions, which can be dangerous for the child and mother.

Complications, according to statistics, do not occur so often - approximately in one case per 50 thousand births. For approximately 15-17% of women in labor, epidural anesthesia does not act as desired - it is not possible to achieve the required degree of pain relief, which means that the sensitivity to pain is partially preserved, which makes the work of surgeons and obstetricians difficult.

Epidural anesthesia can have negative consequences for women who have problems with hemostasis. A bleeding disorder can lead to the formation of hematomas in the puncture area with a small amount of blood entering the cerebrospinal fluid.

If pain relief is performed by an experienced doctor, there is nothing to worry about. Without significant difficulty, he will be able to determine the exact location of the puncture and the rate of administration of the medicine. But a negligent and incompetent doctor can injure the hard spinal membranes, which can lead to cerebral fluid leaks and central nervous system dysfunction. If the needle goes deeper than necessary and injures the subarachnoid space of the spine, the woman may experience convulsions and lose consciousness. In severe cases, paralysis occurs.

After using this method of pain reduction, women often experience headaches, and these pains can persist for up to several months. For the most part, they go away on their own over time.

The harm to a child from the effects of drugs is almost equivalent to general anesthesia. In some cases, there is a risk of heartbeat disturbances and the occurrence of oxygen starvation and respiratory failure after the baby is born.

Contrary to the popular belief that such anesthesia is a serious burden on the heart, doctors claim that the heart and blood vessels of a woman in labor who was given an anesthetic by lumbar puncture are working normally and stably.

For many pregnant women, this method of reducing pain causes fear. It is psychologically difficult to accept the very fact of an injection into the spine. It is most difficult for those who are indicated for surgical childbirth. Not every pregnant woman is ready to see all stages of her own surgery.

Who is it contraindicated for?

No woman in labor can be given an epidural if she categorically objects to it. Therefore, the main contraindication is the patient’s own desire. If a woman believes that she can cope with labor pains herself or prefers to lie on the operating table under general anesthesia, she only needs to sign a corresponding waiver.

But there are women who just want to be helped in this way. And here certain obstacles may arise that will not allow doctors to perform epidural anesthesia. Absolute contraindications include:

patient disagreement;
the presence of a purulent inflammatory process, pustules and a purulent rash on the back in the area of the intended puncture;
coagulopathy (especially against the background of severe forms of gestosis).

Relative contraindications to epidural anesthesia are:

diseases of the female nervous system, especially those associated with spinal dysfunction;
tattoos at the site of the intended puncture;
deformation changes in the back, spinal injuries (in case of injuries in the lumbar region, the injection will most likely be refused);
hemorrhage (pathological hemorrhages in different parts of the body);
systemic sepsis in a woman in labor;
high risk of distress syndrome in the fetus (in case of premature birth, when the fetal lung tissue is not fully mature).

Women with a high degree of obesity can also be denied according to relative indications. They will not do epidural anesthesia if the second birth occurs with a scar on the uterus - pain relief can make the symptoms of uterine rupture completely invisible if it occurs.

Such anesthesia is not given to women who have started bleeding, or if childbirth occurs against the background of low blood pressure or dehydration.

Peridural anesthesia can also be dangerous in case of acute fetal hypoxia. If something went wrong during the birth process, complications began and other obstetric response measures did not have an effect, a decision is made to perform an emergency cesarean section. In this case, the woman is given only general anesthesia. General anesthesia is also recommended if additional surgery is required, for example, removal of the uterus after cesarean section.

For women with heart failure and pacemakers, such anesthesia can only be performed with the permission of a cardiac surgeon. If such a specialist is not available and permission has not been obtained in advance, the administration of painkillers into the spine may be refused.

Alternatives

If for some reason a woman is contraindicated for epidural anesthesia, this does not mean that she will have to endure severe pain. During an artificial birth (cesarean section), the woman will be given general anesthesia, which has no contraindications in principle. In this case, an anesthetic will be injected intravenously, and after such an injection the patient will simply fall asleep. She will not feel the anesthesiologist insert a tracheal tube into her trachea and connect her to a ventilator.

The degree of blockade of pain with this method is very high.

Spinal anesthesia, in which drugs are administered to a deeper level - the level of the subarachnoid space of the spinal column, cannot be considered as an alternative, since the same list of contraindications applies to it.

To reduce pain during physiological labor, intravenous injections of systemic pain medications can be used.

During physiological childbirth

Only epidural anesthesia, which is planned for a caesarean section, requires special preparation. This is standard preparation for surgery and premedication (sedatives and sleeping pills on the eve of a planned operation). If there is a need for epidural anesthesia during childbirth, no preparation is required.

The woman is placed either in a side lying position with her legs adducted, or in a sitting position with her back arched. After this, the doctor performs an aseptic treatment of the skin area and begins to determine the injection point. Typically, to reduce pain during contractions, a needle is inserted between the first and second lumbar vertebrae. A 16-18G needle is inserted in the sagittal plane.

Once in the epidural space, the doctor will feel the “failure” of the needle and the absence of resistance when further advancing the catheter. After the aspiration test, the first test dose of drugs is administered (usually Lidocaine or Bupivacaine is used). The catheter remains at the puncture site. If necessary, medication can be added through it if the woman begins to feel pain again. Therefore, she cannot lie on her back. Contractions will occur in a lying position on the right or left side; you need to change sides every hour.

Pain relief begins to take effect 15-20 minutes after administration of the drug. The duration of pain relief may vary and depends on the dosage. Often during natural childbirth, doctors use a technique in which the patient herself regulates the dosage - if pain occurs, she lets the anesthesiologist know about it, who administers the “supplement” as required.

The most desirable is epidural anesthesia, which is administered for premature birth if the child’s condition is stable. It allows the woman in labor to relax and the birth process goes faster. During the first birth, when the pain is stronger and the duration of the process is longer, there is also quite often a need for relaxation using epidural anesthesia.

Regional anesthesia also helps with incoordination of labor, with a sharp increase in a woman’s blood pressure, during natural childbirth, if the baby is large or gigantic, or during the birth of twins. Difficult and protracted labor is also rarely done without such analgesia; it gives relaxation, and this helps dilate the cervix.

When the pushing stage begins, epidural anesthesia is usually not prescribed. Its main task is to promote the opening of the cervix, and when pushing begins, this is no longer necessary - the cervix is completely opened. In addition, the woman must push and act in close tandem with the obstetrician so that the baby is born faster and without negative consequences for the health of the mother and the baby.

During caesarean section

The average duration of the delivery operation is 25-45 minutes. The very fact of using epidural anesthesia will make the operation a little longer - the duration of the latent period until the anesthesia takes effect (15-20 minutes).

Because surgical childbirth requires deeper desensitization, the anesthesiologist must be sure that the patient is well before administering anesthesia. The woman's blood pressure and heart rate are measured. A special cuff, which will continuously measure pressure in real time and display data on the monitor, is attached to the arm.

The position of the body when introducing instruments into the spine will be the same as during natural childbirth - the woman in labor will either sit or lie on her side. The doctor makes marks with a pencil directly on the skin of the back. The vertebrae between which the needle must be inserted to numb the surgical birth are between the 2nd and 5th lumbar vertebrae. The most appropriate puncture site is determined after the fact and on the spot.

As in the case of pain relief during childbirth, the skin is subject to careful aseptic treatment. A thin needle passes through the so-called ligamentum flavum between two vertebrae. As soon as the resistance becomes negative, the needle “falls in” and a syringe with a catheter is attached to it. The absence of resistance on the other side of the needle will mean that entry into the epidural space was successful.

The test dose is administered after hitting the desired point. The initial assessment of the effect of the drugs takes about three minutes. If there is an effect, the woman begins to feel numb, and the main dose of medication is administered smoothly and slowly.

Surgeons begin the operation after the appropriate command from the anesthesiologist. This specialist stays next to the woman in labor throughout the entire process of surgical birth, talks with her, and adds the required amount of medications through the catheter.

Support is provided until the operation is completed. Throughout the caesarean section, the woman's well-being is closely monitored by the anesthesiologist and midwife.

All this time the woman can see and hear everything that is happening. This provides two wonderful opportunities - to see the baby being born and to put the baby to the breast right in the operating room, which is extremely useful for the subsequent establishment of lactation.

When a woman has an epidural before surgical delivery, the anesthesiologist is always prepared to administer general anesthesia. This rule is. It may turn out that the “epidural” will be carried out with a mistake, it will not work, and therefore at any moment the specialist must be ready to give the woman general anesthesia.

What does safety depend on?

The safety of a woman and her child depends on several factors, which it makes sense to ask in advance when choosing one or another maternity hospital:

level of qualifications and competence of the anesthesiologist;
level of training and qualifications of obstetricians and surgeons;
availability of modern medical equipment (needles, dispensers, lumbar catheters, monitors) in the maternity institution;
use in practice of modern and safe anesthetic drugs (Naropin, Bupivacaine);
constant monitoring of the condition of the mother and child.

There is no need to be ashamed of your own curiosity. When choosing a maternity hospital, you should ask all these questions. A woman has every right to know which category of doctor will perform her operation or give her anesthesia, whether the maternity hospital has modern equipment and when it was last changed, what drugs are used for epidural anesthesia.

Why does it still hurt?

In their reviews, many women note that they were never able to completely get rid of all the unpleasant sensations after undergoing epidural anesthesia. An official description of such cases and reasons is included in the epidural anesthesia protocol, which is the main clinical recommendation for doctors. So, epidural anesthesia may be ineffective if:

the operation began before the drug was completely distributed throughout the epidural space;
the initial dose of the drug was too small;
mosaic blockade occurs (the drug is distributed unevenly, and one side is anesthetized, but the other is not or partially loses sensitivity);
individual lack of perception of the drug (changing the drug to another helps);
the patient’s young age (the ligaments in the spine are soft, so getting into them is falsely interpreted by the anesthesiologist as getting into the epidural space, loss of resistance).

Doctor Komarovsky's opinion

The famous pediatrician Evgeny Komarovsky has repeatedly emphasized that epidural anesthesia is a very good modern method of pain reduction. It is highly effective and almost safe.

But the human factor is most clearly demonstrated in it - if the anesthesiologist is skillful and qualified, the woman’s birth will be very comfortable and calm. If the specialist makes a mistake, epidural anesthesia can be quite dangerous for the woman in labor and her child.

Price

Women often ask whether such anesthesia is paid for, or whether they need to pay extra for it. If the birth takes place in a private clinic, under a contract for the provision of medical services, then the procedure is paid. Its cost ranges from 7 to 15 thousand rubles, depending on the region and the specific clinic. The exact cost can be found out in advance, when concluding a contract for childbirth.

In state maternity hospitals and perinatal centers that accept women in labor under the compulsory medical insurance policy, epidural anesthesia is completely free. It can be used at any time during labor, at the request of the woman in labor or the recommendation of the doctor leading the birth.

Sometimes, walking past a ward where women in labor are waiting in the wings, I see the following picture: two women of about the same age and build, only one is writhing in agony, burning her husband and swearing that he will never see any more sex, and the second is lying quietly, reads a book, only occasionally being distracted by unpleasant contractions. I understand that the first lady is most likely a first-time mother, and for the second everything is already familiar and the birth canal has long been ready to bring another person into the world.

However, most often childbirth is a painful process that requires pain relief. And perhaps I will surprise someone, but the federal law “On the Rights of Patients” has section 12, which says that you have the right to pain relief for any pain. Including pain that occurs during childbirth. Yes, yes, in a hospital room you can take a bedpan and loudly hit the wall with it, shouting: “I want anesthesia with an anesthesiologist!!!” And Santa Claus... i.e. the anesthesiologist must appear.

The safest anesthesia

Humanity has come up with a lot of drugs for pain relief. But we understand that some effective methods of pain relief can be toxic to the fetus. But all the power of medicine is aimed at the birth of a healthy baby; in no case should harm be caused to either the mother or the unborn child.

In this regard, the safest method of pain relief is central blockade, including its types: spinal, caudal and the most common - epidural anesthesia.

The first two anesthesia are effective, but they are administered once and have a limited duration of action. But epidural anesthesia can last for a long time, since the woman is placed a catheter in the epidural space and painkillers can be administered through it for as long as desired (local anesthetics and narcotic drugs are more often administered).

What is the difficulty of carrying out

Many people think that installing an epidural catheter is aerobatics, because it’s poking around somewhere near the spinal cord! I’ll tell you a secret: in fact, placing a catheter in the lumbar spine is quite a routine procedure, even interns perform it. There really are difficulties: people are different, there are many variations in the anatomy of the spine, and subcutaneous fat often hides structures - but still, installing a catheter is not so difficult, honestly.

Another thing is to determine what concentration of the drug to administer, how much to administer, when to stop - here the qualifications of the anesthesiologist are already important! The main tenet of medicine is “Do no harm!” during childbirth it is doubly important, because the doctor is responsible for two lives. It happens that an incompetent specialist injects so much of the drug and such a concentration that the woman does not feel anything at all: no pain, no contractions - the muscles become stiff, the baby stands up like a stake in the birth canal. This is really a problem, and it’s good if a caesarean section saves the situation...

“Pitfalls” and how to insure yourself

Now let's look at this procedure from the anesthesiologist's perspective. Night. Maternity hospital A woman arrives, labor is in full swing, the woman requires anesthesia. A tired, angry doctor arrives. What kind of birth? What kind of pain relief? He still has to fight for appendicitis, and an ambulance with flashing lights is flying down the street, transporting a traffic injury. So what - will it fully relieve pain? Yes, he doesn’t even need money, he’ll pay himself, as long as they fall behind. But you need to sit next to the woman for 8–12 hours; natural childbirth is not a caesarean section for half an hour of work.

And it’s good if a specialist performs caudal anesthesia (a single injection of local anesthetic into the tailbone), but not everyone knows this method. So it’s no wonder if he prescribes a banal analgin. Well, what - cheap and cheerful. Did you prescribe anesthesia? Appointed! Will it be effective? Of course not! But according to the law, he completed his manipulation and will continue, cursing, to undergo emergency surgical interventions.

Therefore, dear women, do not download your rights when you are already in labor. You can ask, but you shouldn’t demand and conflict. What if some intern comes and learns pain management from you? The best thing you can do is to first, a month before giving birth, find a good, experienced anesthesiologist and come to an agreement.

Just remember that anesthesiologists don’t drink, because they can go into a tailspin, they don’t eat sweets, because they understand that sugar is poison, and they don’t smell flowers, because they’ve snorted fluorotane in their lives to the point of cirrhosis of the liver. Well, that’s me, by the way.

Be healthy!

Vladimir Shpinev

Photo istockphoto.com

Childbirth is a complex and painful process. Many pregnant women worry about upcoming events and are afraid of pain. Pain, especially prolonged pain, negatively affects the human psyche. The development of medicine has made it possible to create different options for anesthesia. Today, a woman can receive pain relief during childbirth, but:

Is it safe?
How does anesthesia affect the health of the mother and the fetus?
Is anesthesia performed according to indications or can any patient choose it?

These questions worry pregnant women, and here we will examine in detail the topic of pain relief during the labor process.

In what cases is anesthesia indicated during childbirth?

The introduction of any chemical drugs into the body of the expectant mother is undesirable. Some types of anesthesia are considered relatively safe, while others can lead to complications.

Anesthesia during childbirth is not indicated for everyone; only the doctor decides whether it is necessary to administer a relaxing medication during such an important process.

Indications for pain relief:

There are a number of indications for which a doctor may prescribe mandatory anesthesia for a woman in labor.

Hypertension and some diseases of the heart and blood vessels in a woman in labor.
Diabetes.
Serious diseases of the respiratory system.
Some eye diseases.
Increased intracranial pressure.
Discoordination of labor (random intense contraction of the uterus).
The fruit is too large.
Narrow pelvis.
Cervical dystocia (excessive stretching of tissues leading to rupture of the cervix).
Psycho-emotional disorder (occurs in absolutely normal women from too long severe pain).
Gestosis (complicated form of toxicosis).
Breech presentation of the fetus or other abnormal position.
Prolonged labor (more than 10 hours).
Multiple pregnancy.

Depending on the condition of the pregnant woman, anesthesia can be prescribed by the attending physician as planned, even before the onset of labor, or according to circumstances, already during labor.

Many women want to give birth with anesthesia, even if there is no indication for this. Of course, you can order such a service, but you should understand that any anesthesia has negative consequences and during normal childbirth such intervention in the body is extremely undesirable.

It is important to remember that any anesthesia can have negative consequences.

Types of pain relief

There are medicinal and non-medicinal (physiological) methods of pain relief during labor. Let's consider all types in detail.

Non-drug methods for pain relief

Such methods do not have a strong and quick effect, but are more designed for relaxation during contractions. But their main advantage is high security.

Massage

Physical pressure on certain points helps to significantly reduce pain during contractions. A woman can learn pain-relieving massage on her own through special courses.

Some women in labor hire a specialist at the clinic who massages the body throughout the entire period of labor. Massage not only reduces pain, but also improves blood circulation, which is beneficial for the mother and fetus.

Massage can reduce pain during contractions.

Breathing exercises

Women are also taught special breathing techniques during labor and childbirth in courses. Alternating inhalations and exhalations according to a certain system is a useful and significant pain relief during childbirth. The downside is that as contractions intensify, many women forget about technique and simply do not find the strength to breathe properly.

Hydrotherapy

Water procedures significantly relax the muscles and reduce the pain of contractions. But hydrotherapy services are provided mainly only by high-quality clinics, and not all women can afford to give birth for free.

Water procedures will help you relax and reduce pain from contractions.

Transcutaneous electroanalgesia

A fairly effective and safe way to relieve pain during contractions. For this purpose, a special apparatus equipped with electrodes is used. Sensors are attached to the mother's lower back and electrical impulses are sent, the frequency and intensity of which can be adjusted. The current blocks pain signals traveling along the nerve endings of the spinal cord. Electroanalgesia also improves blood circulation, reducing the risk of fetal hypoxia.

Psychotherapy

A pregnant woman can resort to the services of a psychotherapist and reduce her pain through hypnotic techniques. This is a wonderful way to reduce pain and create a deep positive attunement to the birth process and subsequent events.

The list of natural physiological methods also includes pain relief during childbirth by taking special positions. This kind of “gymnastics” is taught to pregnant women during preparatory classes. A specialist in the maternity hospital can help you find relaxing positions.

On a note! Some essential oils (ylang-ylang, mint, bergamot, orange, jasmine) have an analgesic and relaxing effect. Inhaling the aromas of these oils goes well with the physiological methods described above and enhances their effect. Another addition could be pleasant, calm music..
Many aromatic oils have a relaxing effect on the body.

Drug pain relief

Medical anesthesia uses chemicals that act quickly and effectively. They completely block pain, but each of them has its own side effects. Let's consider all types of drug anesthesia acceptable for pregnant women.

The anesthetic is delivered through an inhalation mask. The drug used is mainly Nitrogen, less often Methoxyflurane, Pentran, Ftorotan, Trilene.

The woman independently takes the mask, applies it to her face and inhales the gas. The frequency of inhalations is done according to a certain pattern, which is selected by the doctor, focusing on the condition of the woman in labor.

Typically one of three options is selected:

Inhale the drug every half hour.
Inhale as the next contraction begins and remove the mask as soon as the spasm ends.
Breathe between contractions.

Inhalation anesthesia during childbirth is used only up to a certain point, until the cervix has dilated to 5-6 cm. Such anesthesia cannot be used further. This method is losing its relevance due to the high gas consumption and leakage in the wards.

Almost instant pain relief.
Does not harm the child.
Prevents fetal hypoxia.
It is quickly eliminated from the body.

Side effects in the form of nausea, vomiting, headache, dizziness, confusion, failure of the respiratory system, tachycardia.

Intravenous and intramuscular injections

Drugs with narcotic or non-narcotic effects are injected into a vein or muscle area of the woman in labor.

Non-narcotic medications include painkillers such as No-shpa, Analgin, Baralgin. Tranquilizers and sedatives (Relanium, Fentanyl, Nalbuphine, Elenium) can also be used, which increase the pain threshold, reduce fear, anxiety and nervous excitability.

In extremely rare cases, a woman is given anesthetic drugs Ketamine, Calypsol, Sombrevin through a vein. They quickly and completely relieve pain, but cause a lot of side effects, so their use is undesirable.

The most commonly used narcotic medications are Promedol and Fentanyl.

Medicines are quickly eliminated from the body.
Quite a strong anesthetic effect.

Anesthetic administered intravenously or intramuscularly enters the placenta through the blood and can have a negative effect on the baby.
Short action.
There are many side effects for the patient (confusion, nausea, dizziness, vomiting, changes in heart rate, headache).

Such labor anesthesia is carried out in very rare cases when the patient for some reason cannot be given another type of anesthesia.

Intravenous injections are suitable in cases where other types of anesthesia are contraindicated for the woman in labor.

Today this is one of the most optimal types of anesthesia, which is used in most cases.

The anesthetic is injected into the epidural space, located in the lumbar spine. The following medications can be used: Lidocaine, Novocaine, Ropivacaine and their analogues. The essence of the technique is the penetration of the anesthetic into the epidural space and blocking the nerve roots of the spinal cord.

The effect of the drug occurs in approximately 20 minutes. The woman completely loses sensation in the area below the waist. In the upper part of the body, sensitivity remains.

Throughout the entire period of labor, the catheter remains in the spinal region, which allows additional doses of anesthesia to be administered.

Pros of epidural anesthesia:

The woman in labor remains fully conscious and can move.
Eliminates discoordinated labor.
Does not affect the strength and frequency of uterine contractions.
Does not have a negative effect on the fetus.
Doesn't increase blood pressure.
The patient's heart function remains stable.
A gentle recovery from anesthesia.

The effect of anesthesia does not begin immediately; you have to wait 20-30 minutes.
If cerebrospinal fluid leaks into the epidural space during a puncture, the woman may subsequently suffer from severe headaches for a long time.
Difficulty breathing (due to blockage of the sternum muscles).
Pain at the puncture site, subsequent inflammation, difficult healing, hematomas.
Pain in the lumbar region that persists for 2-3 months.
When a needle enters a vessel, a variety of negative reactions are possible.
In extremely rare cases, if the needle is inserted incorrectly, paralysis of the lower limbs is possible.

Despite all the risks, epidural anesthesia during the birth process is one of the safest in terms of effects on the child.

Read more about epidural anesthesia in.

Spinal anesthesia

It is immediately worth noting that epidural and spinal (spinal) are different types of pain relief procedures during childbirth.

The same drugs are used, but during spinal anesthesia the needle is inserted deeper into the subarachnoid space itself. The effect of anesthesia occurs much faster than with an epidural, within 5 minutes.

The spinal method of pain relief requires higher qualifications of the doctor performing the puncture; the slightest mistake can lead to irreversible consequences. With this technique, the side effects are more pronounced, although there are no serious negative effects on the fetus.

It is important to know! Despite the high effectiveness of spinal anesthesia, it does not work on everyone. About 5-6% of women do not respond at all to the injection of drugs into the epidural or subarachnoid area. Approximately 15% experience low levels of pain relief.

Paracervical anesthesia

An outdated method of pain relief, which is practically no longer used, but the expectant mother should know about it.

An anesthetic drug (Novocaine, Lidocaine) is injected directly into the lateral vaults of the vagina, that is, around the uterine os. The procedure is carried out in the first stages of contractions, when the dilation has not yet reached 8 cm. Anesthesia blocks the nerve endings of the cervix, significantly reducing pain.

Paracervical anesthesia during labor leads to a slower heartbeat in the fetus (in more than 50% of cases); due to this side effect, it was no longer used.

What type of pain relief is used after childbirth?

The birth process is divided into three stages: the period of contractions, the expulsion of the fetus and the release of the placenta. In some cases, the last, third stage in women occurs with complications. The placenta does not come out naturally after the required time and the patient requires manual cleaning.

In some cases, pain relief may also be required after childbirth.

In such a situation, anesthesia is required. If the birth took place under epidural anesthesia, then an additional dose is simply administered. In other cases, short-acting intravenous anesthesia is used (for 10-15 minutes). This time is quite enough to free the uterus from the placenta by mechanical intervention.

Some women experience perineal ruptures after the birth of their baby. When suturing, the doctor injects an anesthetic directly into the vaginal area.

After completing everything, the successful mother no longer needs pain relief. Over the next few days, you will feel quite strong cramps in your abdomen, as the uterus begins to contract, but this pain is short-lived and quite tolerable.

What type of anesthesia for childbirth is best?

It is impossible to give a definite answer to this question. In each individual case, one or another type of anesthesia may be more suitable. But if you look at it objectively, it is considered the best. The most important thing is that it is carried out by an experienced specialist.

It is also worth considering that each method has contraindications.

Finally

This was an overview of all possible types of anesthesia for childbirth. Despite the fear of pregnant women about upcoming events and the desire to go through this process painlessly, the decision on the need and advisability of anesthesia must be made by a doctor. Now in private clinics a woman in labor can order anesthesia if she wishes, paying a certain amount for it. But even in such cases, it is necessary to consult with your supervising doctor in advance and weigh all the pros and possible negative consequences.

Epidural anesthesia in “mammy” circles is usually called an epidural. The phenomenon, although new, is very popular and, judging by the reviews, “saving.” Those who gave birth with an epidural are completely delighted, those who did not give birth at all and are afraid of childbirth like fire - also for her, those who gave birth successfully without pain and anesthesia - as usual: neither for nor against. However, every woman still needs to know what it is, with what and how it is eaten.

Epidural anesthesia is performed only before the start of pushing, during the period of painful contractions, because its main purpose is to block pain, while the woman feels the contractions and, most importantly, remains conscious.

The puncture (injection) site is the epidural space of the spine (where the spinal cord ends). Using a needle, a catheter is attached to the back, through which as many injections are administered as is safe and necessary for the “suffering” woman in labor. The local anesthetic blocks the nerve impulses that transmit pain signals to the brain. And after 20 minutes you will not feel any pain, and sometimes even the entire lower part of your body.

Epidural is a necessity...

Definitely, the woman in labor herself makes the decision whether to inject or not to inject the “magic” injection. Usually, a woman decides what to do long before giving birth. After all, there are no strict medical indications for epidural anesthesia. It is usually used only for severe pain during vaginal delivery. It can also be used instead of general anesthesia for caesarean section. It is believed that it is better if the operation takes place with the mother fully conscious, naturally without pain. Epidurals are also used for postpartum procedures.

In addition to the fact that this anesthesia alleviates “contraction” pain, it also shortens the period of cervical dilatation and has absolutely no effect on the newborn, because the drug enters the child’s blood in very small doses.

Most often, an epidural is offered for severe gestosis, fetoplacental insufficiency, arterial hypertension, diseases of the respiratory system, severe heart defects and other conditions.

...or a whim?

Many women, without even feeling the pain of labor, deliberately plan to anesthetize the process of contractions. It’s easy to say that this is a woman’s whim, but doctors assure that if a woman is catastrophically afraid of childbirth, then even slight pain can cause stress not only for her, but also for the unborn baby. And the stressful course of childbirth cannot bring anything good. This is why obstetricians and gynecologists do not dissuade “fearful” mothers from getting an epidural.

Women who gave birth using epidural anesthesia are absolutely no different from those who gave birth, as they say, in a “natural” way. They felt the contractions, and the fact that the pain was minimal was only a plus, because only positive emotions remained from the birth process. Psychologists say that after an “epidural birth,” women more easily agree to have another birth.

Epidural anesthesia during childbirth: contraindications

However, not every woman can take advantage of such a seductive pain-relieving method. Epidural anesthesia has multiple contraindications that must be taken into account during childbirth, otherwise there is a high risk of having the opposite effect: causing complications instead of relief.

Contraindications to epidural anesthesia are:

birth bleeding;
problems with blood clotting;
low platelet count in the blood;
uncorrected hypovolemia (decreased circulating blood volume);
damage to the skin at the injection site;
tattooing at the puncture site;
tumors or infections at the site of the intended injection;
increased intracranial pressure;
arrhythmia;
epilepsy;
allergy to the injected anesthetic;
increased body temperature;
organic diseases of the central nervous system (multiple sclerosis, muscle atrophy);
heart defects;
cardiovascular collapse;
traumatic shock;
posthemorrhagic collapse;
intestinal obstruction;
spinal cord diseases;
diseases and disorders of the spine, etc.

Regarding the latter: epidural anesthesia is contraindicated in case of scoliosis, high degree lordosis, tuberculous spondylitis, some spinal injuries or operations in this area, displacement and prolapse of intervertebral discs in the area of the intended puncture. But curvature of the spine is not an absolute contraindication to epidural anesthesia, although it may cause some difficulties.

In addition, 12 hours before the epidural, you should not inject Clexane.

It should be understood that contraindications to epidural anesthesia can be absolute (that is, excluding its use in any case) and relative (which come into effect only in specific cases), which a qualified specialist must know about. For example, relative contraindications to an epidural are obesity, reduced age, and the young age of the woman in labor.

Consequences of epidural anesthesia during childbirth

And now about all the pros and cons in brief. The most important thing in a successful epidural is an experienced anesthesiologist. All sorts of consequences, both pleasant and not so pleasant, depend on it.

Also important is the use of high-quality tools and especially drugs. Most often, domestic medicine offers the familiar Lidocaine, the effect of which is very short, and its safety is poor (they say that this drug can inhibit labor). Only Bupivacaine and Ropivacaine provide a truly good and safe effect, and we have a hard time with them.

It is impossible not to mention the obvious disadvantages of epidural anesthesia. The most important disadvantage and common complication is headache, which can last for a very long time after childbirth (sometimes up to 3 months!).

Also, as a result of the anesthesia, blood pressure may decrease, back pain may occur, and, rarely, allergic reactions to the injected drug may occur. And the ability to move after such an injection is sharply reduced, the feet and legs often swell.

You may also be concerned about other more dangerous consequences of an epidural. They even talk about meningitis and paralysis of the mother in labor, and fetal asphyxia is also attributed here. But if you believe everything they say, you won’t want to live like that at all. What is the most important thing in childbirth? Right! Positive attitude! Therefore, dear bellies, don’t worry about anything. I’m sure you’re strong and you definitely won’t need an epidural!

Especially for- Tanya Kivezhdiy

From Guest

I gave birth to my first with an epidural, my arms went numb instead of my legs... I wanted to kill the anesthesiologist, who opened his eyes from shock and threw up his hands saying “in history this is possible, but in practice I have not seen this.” Thank God everything went away by the end of labor... but I didn’t feel any relief from the pain of labor!!! Now I’m going to give birth to my second and will refuse this procedure!! But everyone has their own head, which must make a decision independently. I just want to warn you that sometimes things may not go according to plan(((

From Guest

I gave birth for the second time with an epidural, the contractions passed with minimal pain, when I went to give birth I didn’t feel anything at all, just a feeling of expansion, and I gave birth to another plus in just an hour. It's quick and almost painless. Only a good memory compared to that first time without an injection, I don’t wish anyone to endure all this pain. So, expectant mothers, don’t be afraid of the injection; it’s not noticeable at all and give birth with it!

From Guest

We had a cesarean with an epidural, but I didn’t feel anything painful, but after 6 months had passed, I had pain in my spine, I couldn’t stand bent over, and I couldn’t walk with a child in my arms for a long time, my spine started to ache, just like if any a draft down the back. And everyone I know has the same problems. So, God willing, the birth will happen somehow without her.

Today's women have more options for pain relief during labor than ever before. A woman in labor can not only use various natural methods of pain relief. Medicines have also become more effective and safe. With such a variety of analgesics as there are today, the expectant mother must be well informed.

It is best to study the issues of natural and medicinal pain relief two months before giving birth. It is not at all interesting to undergo a crash course in pain relief after the first contractions appear. Of course, safe and effective pain relief during labor depends on your cooperation with your doctor. However, learning to use your brain and body to improve the efficiency of labor and relieve pain is much more important than knowing which analgesic or gas your doctor will suggest. Below is what you need to know and what you should do to reduce discomfort during labor.

Why do you experience pain during childbirth?

Pushing a melon-sized baby through a cervix, which at the start of labor is no larger than the size of a bean seed, requires serious effort, as well as good elasticity. Muscles cannot contract and tissues cannot stretch without the body knowing about it. Your uterus has to work hard to do its job during labor and delivery.

Contrary to popular belief, the source of pain is usually not the contraction of the uterine muscles. Pain during childbirth is mainly caused by the expansion of the cervix, vagina and surrounding tissues as the baby passes through the birth canal. During childbirth, the uterus does not push the baby out. What actually happens is that the contractions of the uterus push apart and lift the muscles of the cervix, opening the way for the baby's head. (Imagine how a cowl-neck sweater stretches when you poke your head through it.) The muscles and ligaments in the pelvis are equipped with pressoreceptors as well as nerve endings that respond to pain, and therefore the stretching of these tissues causes sharp sensations that can perceived as pain, especially if the surrounding muscles are tense.

Like all muscles, the muscles of the uterus do not hurt unless they are forced to do work for which they were not designed. Tired, tense and stretched muscles hurt, and so you need to learn how to help your labor muscles work more efficiently. When a muscle is too tired, its internal chemical and electrical processes are disrupted. These physiological changes cause pain.

Purpose of pain

Why is childbirth so painful? The concept of "Eve's curse" - painful childbirth as a punishment for every woman because Eve ate the apple from the tree of the knowledge of good and evil - is no longer accepted as either biblical theology or acceptable post-feminist philosophy. The theory that pain during childbirth is a rite of passage that prepares a woman for the difficult responsibilities of motherhood is also not popular. Even the most respected specialists in the field of obstetrics and gynecology cannot provide a satisfactory scientific explanation for why pain is necessary during childbirth. Therefore, we again have to rely only on common sense.

It is not surprising that many women ask for an epidural when making an appointment at the hospital. Movies and television often portray pregnancy as a disease that must be endured, and childbirth as a crisis point in the disease, when the woman lying in bed must be treated with drugs. Obstetrics specialists, on the contrary, try not to even utter the word “pain,” using instead a special term such as “labor contractions.”

Maybe pain plays a useful role during childbirth? Having given birth to several children and observed thousands of women who endured (or did not endure) labor pains, we came to two conclusions regarding the role of pain in the birth process.

1. Pain serves a useful function.

2. Unbearable pain during childbirth cannot be considered normal, necessary or beneficial.

Too much pain is a signal from the body that this muscle group is not working as nature intended, or that something is going wrong and requires increased attention. If you're running a marathon and feel painfully tired, you take this as a signal that you need to eat or drink water, that you need to change your breathing rhythm or running pace. You take the necessary steps to regain strength and relieve pain while continuing to move towards your goal.

The same thing happens during childbirth. If a woman in labor feels unbearable pain in her back, she takes this as a signal to change her body position until relief comes. What's good for the mother is also good for the baby: by changing the position, she allows the baby to move around and find an easier - and less painful - way out. Properly interpreted and used wisely, pain is a valuable aid during labor and delivery. Listen to her signals. This is why pain during childbirth is considered “good pain” in some cultures.

“Purpose-based pain” is not a game-changing “New Age” theory invented by men, a few courageous women, or an out-of-touch scientist who himself

I have never experienced such pain. It has nothing in common with concepts calling for patience; the principle “without pain there will be no result” leads nowhere. (Even sports medicine experts don't believe in it anymore.) Think of pain as a communication tool in the labor process: pain that is tolerable means that the cervix is doing its job, dilating enough for you to push the baby through, while pain that is intolerable means that pain indicates that you need to make changes in your actions.

How do you feel the pain

To cope well with the pain of childbirth, you must understand how the body produces the sensation of pain and how the brain perceives it. If you trace the process of a normal labor contraction from the stretched tissues of the pelvis to the cry of “Ouch!”, you will realize that you have the opportunity to influence the relationship between how much pain the stretched tissues produce and how it is perceived by the brain.

When a contraction begins, the tissues are stretched and tiny pressoreceptors in the nerve fibers are irritated, which send short impulses to the spinal cord. If the surrounding tissues are tense, pain receptors are also irritated. In the spinal cord, these impulses pass through a kind of gateway, which delays some impulses and allows others to pass through, which then enter the brain and are perceived as pain. In this way, you can target pain in three areas: where it occurs, in the spinal cord gateway, and in the brain where pain is perceived. When developing your own pain management technique, you need to use a variety of methods that allow you to manage pain in all three of these zones.

Another way to understand the pain pathway is to imagine pain impulses as miniature racing cars. They start from the place of irritation in the pelvic area and strive to get to the parking lot, that is, to the microscopic pain receptors located on the nerve cells of the spinal cord and brain. The more cars are in the parking lot, the stronger your sensations. You have the opportunity to influence the activity of these cars. Firstly, you can limit the number of starting cars. To do this, you need to practice relaxation techniques to protect your muscles from fatigue and tension. You can also use effective birthing positions that allow your muscles to do the job they are designed to do. Second, you can close the spinal cord's "gateway" without allowing cars to pass through it. Pleasant tactile sensations, such as massage, send positive impulses that can block the transmission of pain along the spinal cord. In addition, you can create a congestion in the gateway by sending too many competing machines into it, such as impulses from music, from certain mental images, or from back pressure. And lastly, you can fill up the parking spaces in your brain so much that there is simply no room left for pain-bearing “cars.” This is precisely the effect that painkillers have by blocking the area of pain perception. You can achieve the same effect naturally by using your body's own painkillers called "endorphins."

Additionally, distraction techniques can be used to fill the brain's receptors and block the perception of pain. In this case, you tend to fill your brain with extraneous images, and focusing on them weakens the perception of pain. These techniques look good in childbirth classes and even work when you practice them in your own living room, but they often prove useless once actual labor begins. Concentrating on any image requires enormous mental discipline, the achievement of which takes many years. For most women in labor, an attempt to get distracted develops into psychological stress, which puts her on the brink of a breakdown. Our experience tells us that neither the brain nor the body of a laboring mother relaxes when she tries to concentrate on something extraneous to take her mind off the birth. Managing pain during labor requires attention to both the brain and the muscles.

Martha's Note: During my first labor, I tried a distraction technique: focusing my eyes on one point, breathing at a certain pace, and beating a rhythm with my fingers. But when the pain became so severe that this method no longer helped, I intuitively began to do what brought me relief: I allowed my body to take over and do the job for which it was created. Learning to surrender to my body during labor instead of controlling it helped me relax—both mentally and physically.

Development of our own pain relief system

All people perceive pain differently: for one it is “sensitive”, and for another it “hurts”. For this reason, every woman entering the maternity ward should have her own pain management system, as well as a backup plan. Responsibility lies, first of all, with the woman in labor herself. Assistants assisting during childbirth perform only the functions of consultants. While no amount of book reading or pre-training can fully prepare you for what labor will feel like, we're willing to bet that the more informed and prepared you are, the less afraid you'll be and the less painful it will be. childbirth. In showing how to design a pain management system that's right for you, we'll focus on ways to reduce both pain production and pain perception.

Forget about your fears. Pain and fear are related. The effectiveness of the powerful muscles of the uterus depends on the coordinated work of your hormonal system, nervous system and circulatory system. Fear disrupts the functioning of all three of these systems. Fear and anxiety cause your body to produce stress hormones, which counteract the beneficial hormones designed to speed up labor and ease discomfort. This leads to increased pain and prolongation of labor. Fear also causes physiological reactions that reduce blood flow and oxygen supply to the uterus. Deprived of sufficient oxygen, muscles quickly tire, and pain occurs in tired muscles. Tight muscles not only hurt, but they also have a harder time coordinating to open the cervix sufficiently to push the baby through. Normally, the muscles of the upper segment of the uterus contract, pushing the baby out, and the muscles of the lower segment relax and move apart. These coordinated movements allow the cervix to open, allowing the baby's head to pass through. Fear acts directly on the muscles in the lower segment, causing them to contract instead of relaxing. As a result, the strong muscles of the upper segment of the uterus compress the tense muscles of the lower segment and cervix, increasing pain and slowing down labor.

Get rid of your fears before labor begins. Certain fears during childbirth are completely normal, and they are based on anxiety about facing pain. However, unaddressed fears can have a negative impact on the birth process. Although labor without fear is just as rare as labor without pain, you should make an effort to overcome your fears before labor begins. Here's how to do it.

Be specific about your fears. What are you especially afraid of during childbirth? Are you afraid, for example, of pain, having had negative experiences in the past? Or are you afraid of caesarean section and episiotomy? Perhaps you are afraid of losing control in the midst of labor? Perhaps you are afraid that your child will have problems? Make a list of all your fears and next to each item write what you can do to prevent these fears from coming true. In addition, you must understand that not everything is in your control and decide not to worry about what you cannot change.

Make sure you are informed. The more you know, the less you will be afraid. There are no identical births, and even for one woman, all births are different, but they all proceed according to a certain pattern. Between the first contractions of the uterus and the expulsion of the fetus, certain sensations (“contractions”) are always present. If you understand what is happening and why, and how it may feel, no pain will take you by surprise. Understanding what they can expect—and when it will end—helps most birthing mothers feel confident they can handle labor. A good childbirth class will help you understand what's going on and why. But no courses will tell you what exactly you will feel, because it depends on your specific condition and your ability to help labor. The intensity of the sensations experienced often takes a woman by surprise. Some people don't like it and begin to resist contractions, allowing fear to get the better of them.

Invite a professional assistant. An experienced woman who has given birth herself and who has made it her profession to study the normal sensations of labor and how to manage it will be of invaluable assistance to you during labor. This professional assistant will help you interpret your sensations, make recommendations for pain relief, and help you understand and participate in decisions made by medical staff.

Surround yourself with fearless helpers. Try to reduce unnecessary fear in the delivery room. By now you probably already know which family members and friends perceive childbirth as a “horror story” and which do not. Fear is contagious. Never allow any of these shy helpers to be present at the birth. Don't think that this is the right time to prove something to your mother. If she is afraid of childbirth, it is better to have her watch the video after it is over, rather than being present in the delivery room and infecting you with her fears.

Avoid fearful memories. Don't bring baggage from past fears into the delivery room. Childbirth usually brings up unpleasant memories of a previous difficult birth or even rape. In the midst of the most intense contractions, you may automatically tense up, reacting to memories of events from the distant past. Let go of the emotional consequences of past traumatic events before giving birth. If necessary, seek help from a psychologist.

Dr. Bill's Note: Many men, including fathers-to-be, fear childbirth. They do not understand what labor pains are, it is very difficult for them to see how their wife suffers, and they are not able to help her. Even the most sensitive and fearless man can become frightened in the midst of the most intense contractions or when the situation suddenly changes. It is useful to vaccinate your husband against fear so that he cannot infect you. Prepare your spouse for what he will see and hear during labor. Tell him what might happen if the process doesn't go as planned. And try not to show your own fear. If he feels that you are not afraid, he is unlikely to be afraid himself. A calm and confident assistant will give your husband the rest he needs and will also help him focus on his responsibilities, which are to support you and experience with you, rather than protecting you from this completely natural process.

Take responsibility for your decisions

Although a painless birth is less common than a newborn sleeping through the night, you are largely able to control pain—if you're willing to do so. Check for the following factors that affect how painful labor will be.

Have you made a mistake in choosing a doctor or midwife? Is he actively involved in your learning process and does he help you trust your body during birth? Does every conversation with him leave you with the feeling that your birth will be normal? Or is this person creating an atmosphere of fear around childbirth, filling your head with possible troubles and complications?

Do you understand the birth process itself? Do you know what happens during uterine contractions and what these “contractions” are for? Do you understand how standing upright during labor or changing positions can affect how you feel?

Are you equipped with various relaxation techniques?

Have you hired a professional assistant, especially if you may not be able to contact the doctor or midwife you rely on once labor begins?

Are you sure that everyone invited to attend the birth (girlfriends, relatives and husband) are going to support you and will not undermine your faith in yourself with their fear?

Do you understand what technologies (such as electronic fetal monitoring) will be used during labor and delivery? Are you confident that you have enough knowledge to be involved in decisions regarding the use of these technologies during childbirth?

Do you know about the different methods of drug pain relief, such as narcotics and epidurals? Do you understand their advantages and disadvantages?

Do you realize how important it is to relax and let your body take the lead during labor? Are you determined to accept the position that suits you best, rather than straining against labor or becoming a passive patient, spending most of your time in a horizontal position?

You should enter the delivery room after you have received complete answers to all these questions. If a woman has her own answers to these questions, then she is more likely to be satisfied with her birth.

Learn to relax the muscles involved in labor

"Relax? Are you joking? During contractions, it feels like a huge truck is driving through my stomach!” This is what one of our friends told the midwife during childbirth. “Relax” is not a meaningless word thrown at a woman doing the hardest job of her life by helpless onlookers. This is exactly what she must do to help labor. By relaxing, she will help the uterus do its job, instead of opposing it. It is the ability to relax that determines the line that separates the pleasant memories of childbirth, which you will cherish for the rest of your life, from the “horrible story” that you will try to quickly forget.

Why do you need to relax? If you relax all your muscles and only the uterus contracts, this will reduce discomfort and speed up the birth process. If you have tight muscles in any part of your body, especially your face or neck, this tension will be transferred to your pelvic muscles, which should be relaxed during contractions. Pain in tense muscles is felt more strongly than in relaxed ones, and they get tired faster. Chemical changes in tired and tense muscles lower the pain threshold, causing you to experience more pain than if you were working an unrestrained muscle. When tense muscles resist the continuous involuntary contractions of the uterus, the result of this resistance is pain. Muscle fatigue quickly leads to mental fatigue, reducing your ability to cope with pain. You lose the ability to evaluate your options and make changes in your actions that would reduce your suffering.

Running a marathon is hard and long work. Childbirth takes even longer, but the hard work is done in short bursts, alternating with periods of rest - like charge and discharge. As soon as the contraction is over, you should completely take your mind off it to be able to get a good rest. If you don't relax between contractions, you lose your ability to recover and function effectively during the next contraction. Over time, contractions become more intense and take more and more strength. That's why it's important to relax so you can save your strength for what lies ahead - the active labor and pushing stages, when it will take a huge amount of effort to cope with the hardest work you'll ever do.

Relaxation also allows you to maintain the necessary balance of hormones. As we noted above, two types of hormones contribute to the effectiveness of childbirth. Adrenaline hormones (also called “stress hormones”) give your body the extra energy it needs in stressful situations, such as childbirth. These hormones are often described as “fight or flight” and serve to protect the body. The hormone epinephrine is a natural drug produced by the body that acts as a pain reliever. During labor, your body needs enough of these hormones to cope with the heavy lifting - but not too much so that you stay calm and your muscles and brain can function effectively. Stress hormones can even cause blood to flow away from the hard-working uterus to vital organs such as the brain, heart and kidneys.

Another group of hormones that help you during labor are natural pain relievers known as endorphins. (This word is made up of two parts: endogenous, which means “produced within the body,” and ***, a chemical compound that relieves pain.) These are drugs produced by your body that help you relax during times of stress or relieve pain. These physiological assistants during childbirth are produced in nerve cells. They attach to the locations of pain receptors in nerve cells, dulling the perception of pain. Vigorous exercise increases the production of endorphins, and during an intense activity like childbirth, they are automatically released into the bloodstream - unless you do something to block them. Muscle stiffness blocks the production of endorphins. Levels of these hormones are highest during the second stage of labor, when contractions are most intense. Like man-made drugs, endorphins affect different women differently, which may explain why some women in labor experience more pain than others. Endorphins are better than artificial drugs. Instead of the periodic surges and subsequent periods of discomfort that drugs provide, endorphins provide constant pain relief during labor and a feeling of euphoria that birthing mothers call a “natural high.” Relaxation will allow these natural pain relievers to take effect. Fear and anxiety can increase levels of stress hormones and counteract the pain-relieving effects of endorphins. If your soul is calm, your body will not experience as much pain.

Endorphins also help you transition from labor to motherhood. Their levels peak immediately after birth and return to prenatal levels only after two weeks. Endorphins stimulate the secretion of prolactin, a calming “maternal” hormone that regulates milk production and psychologically prepares you for the joy of motherhood. Additionally, endorphins help you stay calm during pregnancy. Studies have shown that endorphins increase when you laugh. Perhaps the proverb is right: “A cheerful disposition is the key to a healthy body and a strong spirit.”

If your mind and body are working as nature intended during labor, your body will maintain a balance of stress hormones and pain-relieving endorphins. Fear and fatigue upset the balance in favor of stress hormones, resulting in increased pain and slower labor. As you relax during labor, you will be surprised at how much control your brain has over your body. You will feel relief and the baby will be born faster.

How to relax. One of the criteria when choosing childbirth preparation courses should be the time allocated to teach you to understand what degree of relaxation is necessary during childbirth. In fact, your ability to relax is controlled by your subconscious mind. Reading books and listening to lectures will not help you relax. You should devote as much time as possible to practical relaxation exercises. Seek further assistance if necessary. Perhaps individual consultations and classes will help you overcome the “relaxation barrier”. Below are some relaxation techniques that both Martha and the women we counsel find most effective during childbirth.

Relax and don't resist. The principle of “relax and do not resist” serves as the basis for all the exercises discussed below: relax between contractions and do not resist during contractions. These two words must be remembered throughout childbirth.

Prepare yourself with relaxing thoughts that will help you follow your body's natural actions. When you feel the beginning of a contraction, you should not tense your muscles in preparation for what is about to happen, but take a deep breath, relax and not resist. Exercises that use this principle will prepare you to say to yourself, “A contraction is coming—don't resist,” instead of, “Oh my God, another contraction!”

Practice relaxing with your partner. Make yourself comfortable. Bring a bunch of pillows and teach the main pillow placement person (your partner) where to put them. Perform these exercises in various positions: standing, leaning on a partner, wall or furniture, as well as sitting, lying on your side and even standing on all fours.

EXERCISE 1. Check to see if any muscles in your body are tense. The easiest things to notice are furrowed brows, clenched fists, and pursed lips. Then practice consistently relaxing all muscle groups - from the top of your head to your toes. Tighten and then relax each muscle group to feel the difference between the two states. When your partner gives you the “contraction” signal, think: “Relax and don’t resist.” Feel how tense muscles relax.

EXERCISE 2. In the last month of pregnancy, practice relaxing touch more often. Such touches prepare you for the fact that tension is followed not by pain, but by pleasure. Determine what kind of touch and what type of massage relaxes you best. Relax the muscles of your entire body as described above. Tighten each muscle group, and then ask your partner to gently touch the area while relaxing the muscles. This eliminates the need for the verbal command to “relax,” which can become irritating over time. Another goal of this exercise is to learn how to relax tense muscles from one touch of a partner to a sore spot. Training: “I have pain here and there - press hard on this place (stroke, touch).”

Music for childbirth. Music can be a significant aid in relaxation. Carefully choose tunes that you enjoy and that help you relax. Play this music during home workouts so that you develop a reflex and during labor you automatically relax at the sounds of a familiar melody.

Mental images. A clear mind filled with soothing images helps the body relax during labor - at least between contractions. In addition, it enhances the production of endorphins that accelerate labor. Sports psychologists use mental imagery to train athletes.

Determine in advance which thoughts and images best contribute to your relaxation, and several times a day - especially in the last month of pregnancy - practice focusing on them. This way, by the time you give birth, you will have collected a mental library of short images that you can switch to between contractions. Most women in labor are helped by the following images: the sea surf, a waterfall, a winding stream, a walk on the beach with her husband. In addition, you can prepare several “pictures” with pleasant memories: meeting your husband, a memorable date, making love, a vacation.

Imagine what happens during childbirth. When contractions begin, draw a mental picture of the uterus “grabbing” the baby and trying to pull itself onto his little head. During the dilatation stage, imagine that the cervix becomes thinner, and after each contraction the opening widens even more. Some women in labor successfully use visualization during the next stage of labor, imagining their vagina opening up like a flower.

You need to switch from pain to pleasant sensations. Try a technique called “packaging the pain.” Imagine the pain as a piece of modeling clay that you need to take, roll into a small ball, wrap in paper and place in a balloon that comes off your body and floats into the sky. You need to do the same with unpleasant thoughts: pack them up, and then imagine how they float away. This exercise is especially useful in combination with cleansing breathing during a contraction: take a deep breath, and then exhale the air along with the pain.

During and between particularly intense contractions, focus on the reward ahead rather than the pain you must endure. Imagine that you are bending down to help the assistant accept the baby and place it on your stomach, that you are giving the baby the breast.

Mental images do not relate to techniques for controlling the body through consciousness - in this case, consciousness simply helps the body act more efficiently. Make sure mental imagery is a relaxation tool and not a distraction.

If you are convinced that you can move your consciousness to another planet and distract yourself from what is happening to your body, then you are in for a big surprise: contractions can be so strong that attempts to mentally escape will not yield any results. It is much more realistic to hope that during childbirth the consciousness will help the birth process, rather than hide from it.

I've found that it's best to completely eliminate the word "pain" from my thoughts. When I started having contractions, instead of expecting pain, I imagined that I would experience pleasure.

I imagined my favorite dessert and it helped me relax.

Pain during childbirth

One day, after speaking at a meeting of the International Childbirth Association, we had the opportunity to talk about pain in childbirth with experienced mothers who were also childbirth educators. We realized that they have a completely different attitude towards pain than women with their first pregnancy, frightened by the terrible stories of their friends. During the first birth, a woman is programmed to expect that the pain she will endure will be greater than any pain she has ever experienced. She doesn't know what the pain will be like, but she knows it will be terrible. An experienced childbirth instructor - and especially if this woman has given birth several times herself - perceives the pain of childbirth very differently. This is not to say that this pain is stronger than any other - it’s just different. Understanding these differences makes childbirth less painful for an experienced woman than for someone giving birth for the first time.

Think back for a moment to the worst pain you've ever experienced in your life, such as a toothache. It took you by surprise and lasted for several days. She immediately became strong, and no remedies helped. She didn't pass. You were ready to give everything up for a few minutes of respite. The pain of childbirth is completely different:

You know what's going to happen, but you just don't know what you'll feel about it.

The pain is not continuous. There are blessed pauses between contractions, which can be longer than the contractions themselves - at least in the initial stages. The pause is followed by a contraction lasting from sixty to ninety seconds.

The pain is predictable. You know that in a minute or two there will be another contraction.

After a while, you already know what your feelings will be like during the next contraction. Perhaps the fight will be a little stronger or weaker than the previous one, but overall similar.

Labor pains gradually intensify, signaling you to get ready for the reward - the birth of your baby.

You know this all has to end.

When it's all over, the most valuable reward in the world awaits you.

When you consider the pain of childbirth from a broad perspective, it becomes clear that Mother Nature has made it so that labor pains can be endured. Otherwise, would women give birth to children?