Rus Articles Journal

It is not sick at all?

It is known that pain at the time of delivery - the phenomenon absolutely natural. But there are situations when doctors nevertheless have to resort to the anesthetizing preparations. When it occurs and what ways of fight against pain the modern medicine has?

for anybody not a secret that childbirth is quite serious test for an organism of future mother. In - the first, this process takes a lot of time. At the woman who for the first time is going to become mother, childbirth lasts on average 12 hours. For repeatedly giving birth this time is reduced a little - usually it is 6 - 8 hours; however a lot of things depend on an interval between the last childbirth, and also on features of a course of this patrimonial process, weight of the kid, age and a state of health of future mother.

In - the second, patrimonial activity is connected with a considerable expense of physical forces. For example, attempts in the second period of childbirth which are any (that is operated) by physical effort of the woman in labor, on expense of physical energy are comparable with occupations on power simulators or agricultural works within several hours.

B - the third, in the course of childbirth sokratitelny activity of a uterus, or fight, is connected with pain. This factor forces most of pregnant women to be afraid of the forthcoming childbirth, to doubt own forces and patience. The fear of pain prevents to get ready fully for childbirth, does not allow future mother to be adjusted on a positive harmony, to set to itself the correct emotional installation on childbirth.

A a lot of things depend on the relation to the process of the birth of the child, on a condition of mentality of the woman in labor, on the level of psychoemotional comfort. The matter is that all mechanism of childbirth, all this difficult sequence of the physiological processes promoting the birth of the kid entirely are operated by the central nervous system of the woman in labor. When we are afraid or, even worse, we panic, our nervous system is in the overexcited state. The fear will paralyze will, prevents to concentrate on process of childbirth, adequately to follow recommendations of medical personnel of maternity hospital. It becomes very frequent fear the main reason for mistrust to doctors. At last, the fear causes decrease of a natural threshold of painful sensitivity. In other words, the more terribly - the more painfully. Thus, at the woman in labor feeling strong fear of pain, pain during fights is much stronger. Some kind of vicious circle is formed of pain and fear. Unfortunately, such change of the mental status very often is the main reason for development of various violations of patrimonial activity. For the purpose of creation of the most comfortable conditions in the majority of modern maternity hospitals modernize delivery rooms. The woman in labor is tried to be placed in separate spacious chamber - “maternity boxing“. In this room there is all necessary for the forthcoming childbirth that gives the chance not to move the patient from prenatal to the delivery room as it was earlier. Considerable significance is attached today also to registration of an interior patrimonial. The separate chamber in the minimum degree reminding of stay in walls of medical institution allows to adapt to conditions of maternity hospital better.

for the purpose of increase of psychological comfort of the woman in labor and trust to medical personnel so-called “partner childbirth“ practices in many maternity hospitals. Future father or someone other of relatives or the woman in labor friends can become the partner in childbirth. Sometimes for partner childbirth the professional - the psychologist or the obstetrician is invited. In the presence of the loved, native one many women feel more surely and more quietly.

Considerable significance is attached by

also to prenatal psychological preparation. The professional psychologists practicing at the centers of planning of a family and also in some state and commercial female consultations are engaged in creation of optimum psychological image of future mother. Besides, a large number of courses for future parents on whom surely give individual and collective classes in preparation for childbirth functions now. On occupations doctors tell about the mechanism of childbirth, change of feelings of the woman in labor at various stages of patrimonial activity, teach rules of conduct and methods of self-anesthesia during fights, explain sense of medical manipulations in the course of childbirth. However there are various specific features of a state of health of the woman in labor or the course of patrimonial activity aggravating pain of future mother during fights. Sometimes physicians should face so-called pathologically low threshold of painful sensitivity of the woman in labor. Such term designate high reactivity of the central nervous system in response to the minimum painful irritants. Owners of a low pain threshold begin to feel pain in labor, at the same time discomfort degree at them much more intensively much earlier, than at women with usual painful sensitivity. Those women who extremely hard (before loss of consciousness) transfer even insignificant painful irritants have the right to suspect a low pain threshold at themselves (for example, need of injection anesthesia in days of monthly). In certain cases intensity of pain during fights is so considerable that the woman in labor cannot suffer it. In such cases of one psychological preparation for childbirth and skills of self-anesthesia it can appear insufficiently. In those situations when application of physiological measures of anesthesia is ineffective, obstetricians offer medicamentous methods of labor pain relief.

Narcotic analgetics

Until recently these preparations were the most popular means of anesthesia in practice of obstetric aid. Treats the narcotic analgetics which are applied to labor pain relief in our country promedol. This preparation is chosen from a large number of various drugs thanks to limited time of action.

It is important that the preparation is used in labor in very small dosage. Introduction of medicine is carried out intramuscularly (in a buttock) or intravenously. Action of a preparation comes as doctors speak, “on a needle tip“: practically at the time of introduction of medicine pain recedes. Along with anesthesia promedol possesses sedative action: soon after introduction of a preparation the woman in labor feels drowsiness and begins to doze. This effect of a narcotic analgetic is also considered favorable: thanks to it the woman in labor not only is anesthetized, but also has an opportunity to have a rest, gain strength before the potuzhny period.

the Sedative and anesthetizing effects of a promedol are not equally expressed to

at all patients: sensitivity to drugs considerably differs, and it is in advance almost impossible to guess effect for 100%. Someone after introduction of anesthetic sleeps “the sleep of the just“, at all without feeling fights up to approach of attempts. Some women continue to feel tension during fights, however the painful factor is absent or is considerably lowered. In this case between fights the woman in labor usually dozes, and during reduction of a uterus - wakes up.

promedol works with

within 2,5 - 3 hours; proceeding from it, a clear boundary for use of a preparation in labor is defined. Usually promedol do not appoint before 4 cm of disclosure of a neck of a uterus: otherwise there is a risk of development of weakness of patrimonial forces. Besides, at early stages of patrimonial activity of fight short, rare and not painful - therefore, the question of anesthesia is irrelevant. Narcotic analgetics are never appointed late 6 cm of disclosure of a neck of a uterus. Such restriction is caused by what promedol, getting with a blood-groove to an organism of the kid, affects it the same as the woman in labor. Under the influence of a promedol the kid sleeps a narcotic dream. Naturally, by the time of the birth effect of drug has to end: otherwise the baby will not be able to carry out the first breath. Future mother also has to wake up by the beginning of attempts: this process assumes active participation of the woman in labor.

promedoly any complications for mother and the fruit is not observed by

At observance of the specified time frames for anesthesia. In 3 - 3,5 hours from the moment of anesthesia the preparation is completely brought out of an organism through kidneys and easy mothers. During childbirth perhaps single use of a promedol. During action of a preparation side effects can be observed:

Besides actually anesthesia, promedol is appointed also for treatment of various pathologies of patrimonial activity. For example, it is used as a premedikation (for mitigation of effect) before introduction of rodostimuliruyushchy substance of oxytocin at correction of weak patrimonial activity. With the same purpose apply promedol before a rodovozbuzhdeniye - initiation of patrimonial activity at its absence. Premedikation with use of a promedol softens the moment of introduction of rodostimuliruyushchy substance, allowing to bring closer its effect to natural development of patrimonial activity as much as possible.

of Epiduralnaya anesthesia

method Following and most popular today is epiduralny anesthesia. As well as in a case with narcotic analgetics, there is a number of situations in which epiduralny anesthesia - only the correct decision. So, this type of anesthesia is applied to treatment of a diskoordination of patrimonial activity - pathology at which the uterus is reduced painfully and irregularly, and dynamics of patrimonial activity - disclosure of a neck of a uterus - is absent. Epiduralny anesthesia is used for artificial maintenance of normal level of arterial pressure in labor at the women suffering from various forms of arterial hypertension (increase of arterial pressure). Besides, “epiduralka“ is absolutely irreplaceable in cases when it is required to minimize potuzhny the period. That is future mother can give birth itself, but full participation in process of attempts can do much harm to her health. An example of such situation is heart disease of the woman in labor, some changes from eyes, arterial hypertension. In this case, to facilitate to the woman potuzhny the period, action of epiduralny anesthesia lasts practically to a head vrezyvaniye stage (emergence of a head in a crotch gleam during fight). Then the epiziotomiya (a crotch section) is made, and the kid is born at the minimum physical efforts from mother. Childbirth with epiduralny anesthesia without indications is possible within the contract on voluntary medical insurance.


For this type of anesthesia use the preparations similar to those that are used in stomatologic practice. Anesthetic (the anesthetizing substance) is entered into epiduralny space, around a firm brain cover of a spinal cord. The technology of carrying out epiduralny anesthesia is more difficult, than anesthesia promedoly. Epiduralny anesthesia is made by the anesthesiologist. Before acceptance of a final decision on an anesthesia method the anesthesiologist holds preliminary consultation. During survey and conversation with the woman in labor the doctor reveals indications and contraindications to epiduralny anesthesia at this patient, predicts risk of development of these or those complications, defines tolerance of the medicines used for this method of anesthesia.

Procedure of anesthesia is made by

in the conditions of maternity boxing or the small operating room. Future mother ask to reach the position facilitating to the doctor carrying out manipulation. There are two versions of the provision of the patient, depending on her condition, a stage of patrimonial activity and anatomic features of a structure of a backbone. In the first case the woman in labor is put a back to the doctor and ask to incline the head to knees. In the second option future mother accepts the same “pose of an embryo“ in a prone position on one side a back to the doctor. After superficial anesthesia of skin (a prick in skin) in the field of intervention the doctor carries out a puncture between vertebras by means of a special needle. Then into the place of a puncture (at the level of 3 - 4 - go a lumbar vertebra) enter a soft flexible tubule - a catheter on which medicine is entered into the spinal canal. The external part of a catheter fastens to skin a sticky plaster; to the place of a puncture the aseptic bandage is applied. During childbirth as necessary the doctor can add an anesthetic dose on a catheter.


as a result of such anesthesia cut off“ painful signals from a uterus to a brain. That is the “signal of disaster“ sent by pain receptors does not reach the painful center of a brain as as a result of introduction of anesthetic to the spinal channel transfer of a nervous impulse is blocked.

the Health of future mother anesthetized thus significantly differs in

from effect of a promedol. In it there are pluses and the minuses. Lack of negative influence on the central nervous system belongs to pluses. The drugs used for anesthesia have no somnolent effect, do not change consciousness of future mother in any way, do not cause an emetic reflex. During anesthesia action the woman in labor still feels fights but only as muscular contraction; painful sensitivity at the same time is absent. The compelled position of the woman in labor belongs to minuses - after introduction of medicine in most cases she cannot get up; sensitivity below the place of a prick vanishes. It is important that by the time of attempts the woman could act. Of course, about free behavior in labor out of the question. Psychoemotional contact with the kid is lost too, and it is not known yet, how sharply the child feels it. However the main problem of this method consists that the preparations used at epiduralny anesthesia for simplification of a condition of the woman in labor do not get to the kid and do not cause emission of endorphins. In other words, it is the only method of anesthesia operating only on mother. The kid in this case remains without anesthesia. And in that case when mother does not get medicamentous support in childbirth, in response to pain it has a small production of endorphins which, getting with a blood-groove to a fruit, anesthetize it in the second period of childbirth.

headaches (sometimes - long) carry back pains, various neurologic violations To rare complications of this way of anesthesia, in the early and late postnatal period.

Nitrous oxide

One more type of anesthesia earlier popular and extremely seldom applied now, - nitrous oxide use. It is gaseous mix which to the woman in labor is suggested to be inhaled during painful contractions. In response to inhalation of nitrous oxide in an organism of future mother there is an allocation of a high dose of endorphins - so-called “hormones of happiness“. These biologically active agents raise a threshold of painful sensitivity of the woman in labor, reducing pain during fights (just the same mechanism of anesthesia operates at introduction of a promedol). Refusal of this method of anesthesia is caused by lack of an opportunity to control a dose of the inhaled mix and connected with this risk of development of complications for mother and a fruit (for example, respiratory standstill).

in conclusion would like to pay attention of future mothers to one very important fact. No medical intervention can do much harm to mother and the kid if his use is really necessary. Therefore before deciding on the choice of this or that way of anesthesia, it is necessary to weigh seriously together with the doctor all pros and cons.