Childbirth and pain forever together?
B the fact that patrimonial pain - the damnation sent by God to mankind for an original sin it is possible to trust or not to trust, but the word “childbirth“ strongly are associated with the word “pain“. So was always. Also will be still very long.
But why? Behind a window the 21st century. Doctors are able even to replace heart, and at the same time the patient does not die on the operating table of pain! Why still women suffer, giving birth to children? Why doctors do not want or cannot facilitate already heavy female share? There are special drugs, there are anesthesiologists, there are women who gave birth and will give birth, the earth while spins. What disturbs?
we Will try to understand together. It seems, everything is simple. But it only seems.
Yes, anesthesiologists exist. Yes, there is a mass of special preparations which reliably block pain. BUT!!! “BUT“ give these together and we will discuss.
At first we will understand terms and we will describe the elementary scheme of impact of such preparations on a human body.
of Analgeziya in translation from Greek - “absence of pain“. Analgeziruyushchy means are the medicinal substances eliminating or reducing pain. Analgetiki happen narcotic (for example, promedol) and not narcotic (analginum). The Greek word “anesthesia“ is meant by “sensitivity loss“. Respectively, the medicinal substances applied to artificial anesthesia belong to anesthetics. Such means oppress different types of sensitivity, including (and first of all) - painful.
So, “BUT“ the first . Let`s remember that the fruit is connected with mother through an umbilical cord. Anesthetics, circulating on mother`s organism, will inevitably get to a fruit, and what is good for mother, is not always good for a fruit. Why? The child has to be protected from pain too! The matter is that anesthetics, besides the main action - blockings of pain, possess also side effect - block a respiratory reflex! And in a varying degree - almost all anesthetics! Imagine a situation: we provided to mother childbirth without pain, but completely paralyzed breath of the been born kid. He does not breathe - it should be done for him. The crew of neonatolog - resuscitators will be engaged in it. Unattractive prospect, isn`t that so?
“BUT“ the second . All anesthetics and analgetik in a varying degree reduce sokratitelny ability of a uterus. In a uterus there are several types of muscles. Their coordinated reductions are necessary for happy end of childbirth. This mechanism is put by the nature and fulfilled throughout the millennia not only at the person, but also at all mammals. Both anesthetics, and analgetik break the coordinated uterus muscle work that results in weakness of patrimonial activity, and it is fraught with grave consequences for the kid. In such cases it is necessary to impose obstetric nippers or to do urgent Cesarean section.
B it is that and the main paradox of labor pain relief consists - helping mother, we harm a fruit. “Golden mean“ is necessary. The science obstetric anesthesiology is also engaged in search of this middle.
What the modern obstetric anesthesiology is able? A lot of things! But not all that it would be desirable...
we will make a reservation At once that not only the moment of appearance of the kid, and everything that happens to the pregnant woman after one of three events enters the medical concept “childbirth“: beginnings of fights, izlitiya of amniotic waters or otkhozhdeniye of a mucous stopper. It is the process borrowing 12 - 18, and sometimes and more, hours. And for all this time the anesthesiologist wants to protect future mother from pain.
What can be offered the pregnant woman in usual maternity hospital?
numerous methods of labor pain relief Exist, let`s stop on the most effective and widespread of them, without concerning exotic, like, for example, anesthesia by music.
First and the oldest method - an autoanalgeziya nitrous oxide . Heard about “the amusing gas“? It is also nitrous oxide. He is obliged by the name to curious property: mixed with oxygen in concentration of 50 - 70%, nitrous oxide causes euphoria, laughter, confusion of consciousness (the woman in labor inhales mix of the amusing gas with oxygen in a proportion 1:1). In some maternity hospitals the special devices giving nitrous oxide mix with oxygen still hang on walls of prenatal chambers near each bed. The woman in labor independently, in process of increase of pain, takes a mask of the device and breathes this mix - it is and is called an autoanalgeziya, i.e. self-anesthesia.
Of course, it is good that future mother herself regulates extent of anesthesia. But there is also a danger of overdose of mix. Nitrous oxide absolutely gets through a placenta to a fruit, affecting it as well as mother, but without suppressing the respiratory center. Therefore it is quite possible that right after the birth the kid will be sluggish and sleepy, however will independently breathe.also the fact that supply of nitrous oxide causes some shortage of oxygen in an organism Is bad
. Therefore patients after this type of an anesthesia usually have to breathe within 5 - 7 minutes 100% oxygen. The same concerns also the been born kid. He needs “to recover the breath“. Besides in labor nitrous oxide can relax a uterus considerably.by
What it is dangerous, we already spoke. Nevertheless, this method is still very widespread in Russia, especially on the periphery.
the Second method - a method of labor pain relief opiate, or narcotic analgetika , known in the people under the name “drugs“. Due to them there is very popular belief: many consider that if anesthesia in labor was carried out by narcotic analgetika, then the kid will be obviously predisposed to drug addiction. It is necessary to notice that the doses appointed by doctors and duration of use of these preparations are so small that cannot cause steady accustoming in the kid, and in his mother.
the Main narcotic analgetik used for labor pain relief is promedol. It oppresses less fellows the respiratory center, has less than other side effects, but at the same time and has less expressed analgesic effect.by
during childbirth promedol it is usually entered intramuscularly once at 2 - 3 o`clock. It too absolutely gets through a placenta to a fruit. Therefore, considering duration of action of a promedol, the last injection it try to make not later than 2 hours before alleged appearance of the kid on light.This method is rather effective, simple and available to
in any maternity hospital. However it is necessary to tell that degree of analgesic effect of a promedol is very individual. At someone it almost completely kills patrimonial pain, practically does not affect others. Approximately in 35 - 40% of cases promedol has very weak anesthetizing effect. And if future mother in the past had bitter experience of close communication with drugs, it is not necessary to wait for effect and doctors, having learned about such experience, for certain will refuse this method of anesthesia.
should refer possibility of vomiting at the woman in labor To side effects of a promedol. It occurs not always, but the probability such exists. Even more individually action of a promedol on a fruit. Very often, especially if fast and between the last injection and the birth of the kid passed childbirth less than two - three hours, the newborn has a breath depression. It is very dangerous situation. At this moment near the kid there has to be an expert - neonatolog, possessing skills of reanimation of newborns. In his hands there is now life of the child who will need an artificial respiration. Through some time promedol in an organism of the newborn will stop the action, and the kid will begin to breathe. But when it will be able to do it itself, it is unknown.Promedol also rasslablyayushche affects with
a uterus, especially in high doses.
you See - again paradox! Helped mother, did much harm to the kid. And the main precept of the doctor - “do not do much harm!“ . whetherSo everything is hopeless
? There is exit!
exist drugs which have only local effect, without getting into blood. And whether there are such anesthetics? Is! Also they are called - local anesthetics. Means, it is necessary to find a way to deliver these drugs to that place where they could have the effect. And such way is found and exists!
The matter is that all painful impulses before getting into a brain, pass on nervous backs of a spinal cord. Here and solution. To block these nervous backs. Figuratively speaking to break off an electric chain. Though it is not so figurative. In an organism impulses on nervous cages extend in the form of weak positive electric charges.the method of epiduralny anesthesia So was born
. The essence of a method is that the doctor introduces a needle through openings in the vertebral channel directly over a firm cover of a spinal cord, in epiduralny space, just there where there pass nervous backs. Then through a needle strong local anesthetic is entered. If long anesthesia is necessary, then through a needle the thin silicone tubule (catheter) is inserted in the beginning, the needle is removed, and the catheter remains in epiduralny space. And through it anesthetics are already as required entered.
At the correct performance it is the most reliable and effective method. In - the first, pain is blocked completely at all women. In - the second, it is possible to prolong analgesic effect till 24 - 36 o`clock. In - the third, blockade of painful nervous backs does not influence reductions of a uterus - childbirth happens as usual. And most important: local anesthetic does not get to mother`s blood at all and therefore it is harmless to a fruit!
Eureka?! Yes and no. Why “yes“ - it is clear! And why “no“?
As any method in medicine, whether it be operation, anesthesia and even the usual prick, a method of epiduralny anesthesia is fraught with complications, sometimes very terrible.
the simplest - anesthetic got not there, and blockade of pain incomplete, or full, but only on the one hand bodies. Quite often there is a casual puncture a needle of a firm brain cover. At the first moment the woman of it will not feel. Childbirth will take place without pain. But next day it will begin headaches, and very strong which will proceed about two weeks. More difficult the situation is in case the needle incidentally wounds even a small vein near epiduralny space. It is impossible to guarantee even that it will be possible to do without operation. There is an inflammation of brain covers which is subject to long-term treatment. The list of complications can and be continued, but we will not frighten future mothers! This method in skilled hands is rather safe. For example, 75 - 80% of all childbirth take place in Great Britain with epiduralny anesthesia, and it is a little complications.
Here we in brief also got acquainted with the main arsenal of obstetric anesthesiology. Once again we will emphasize that any method is good in skilled hands. The main thing that these skilled hands were near!
Therefore, choosing medical institution in which your kid should be born, learn not only what there doctors are obstetricians (though it is very important), but also how there the anesteziologichesky service is put. Wellbeing - and yours, and your kid in no small measure depends on it.
Unfortunately, today we cannot tell that pain is completely won. But pain is not the evil, and absolutely on the contrary. Pain - the immemorial satellite of our life, the sentry protecting our organism and signaling about danger. To win against pain completely - means in some measure to lose “the security alarm system“. And you will leave the car on the street with the switched-off alarm system?
Having come to maternity hospital, be ready that childbirth is always pain, to a greater or lesser extent. Remember that any method of labor pain relief can be applied only with the consent of the woman in labor. The anesthesiologist is obliged to tell it what features of influence and a consequence of application of this or that preparation. And let near you in it the moment will appear the skilled and knowing anesthesiologist who if necessary will be able to help you to pass through childbirth.
of Good luck to you!