Childbirth is a natural process of human reproduction, but this painful labor, caused by uterine contractions and nervousness and fear, is extremely painful for most mothers, especially first-time mothers. In the medical pain index, labor pain is close to third degree burn pain, and it should be said that it is the most painful thing that most women experience in their lifetime. This makes more mothers-to-be fearful of it and give up on natural childbirth in favor of the risky cesarean section.
Even if some “brave” women choose natural childbirth, they still suffer a lot during the labor process. Whenever the pain comes, they will do everything they can to reduce the pain even a little bit, such as shouting, irritability, uncooperative and other actions that lose their dignity. And because labor pains increase the basal metabolic rate of pregnant women, increase oxygen demand, increase catecholamines and psychological impact on the mother and fetus, maternal respiratory alkalosis, increased blood pressure, increased heart rate and a series of clinical manifestations, which directly affect the safety of the fetus, so that the placental blood flow is reduced, fetal oxygenation is reduced, resulting in fetal acidosis.
It has always been the wish of people to have a pain-free and sober delivery and a new life. Effective relief of labor pain can reduce the adverse physiological reactions to labor pain to the minimum, avoid the reduction of blood flow to the uteroplacenta, improve the oxygen supply to the fetus, improve the phenomenon of uterine contraction disorder, increase the probability of normal delivery, avoid unnecessary cesarean section due to excessive pain, so that the mother no longer suffers from pain during delivery, but really enjoys the joy and happiness of giving birth to a child.
There are various types of labor analgesia: psychological comfort, acupuncture analgesia, inhalation analgesia (N2O), intravenous analgesia, epidural analgesia and so on.
Epidural labor analgesia is the most reliable, widely used and feasible method of analgesia recognized by the domestic and foreign anesthesia community, with an analgesic efficiency of more than 95%, and it also best meets the conditions of ideal labor analgesia (ideal labor analgesia: 1.
1.Low impact on mother and child.
2, reliable analgesic effect, fast onset, easy to administer, and can meet the needs of the entire labor process.
3, avoiding motor block, not affecting contractions and maternal movement.
4.The mother is awake and can participate in the birth process.
5, can meet the needs of surgery when necessary).
Now I will give you an introduction to the knowledge related to epidural labor analgesia.
Indications for epidural labor analgesia
1. No contraindications to obstetric vaginal delivery (excluding pelvic abnormalities, cephalopelvic disproportion and fetal distress).
2.No contraindications related to anesthesia (excluding platelets below 100×109/L, neurological disorders, post-polio, spinal deformity, etc., and skin infection at the puncture site of the mother’s back).
3. Maternal voluntary.
Advantages of epidural labor analgesia
1.Good analgesia effect, can be completely painless, especially suitable for women with severe labor pain.
2, the mother is awake, can eat and drink, and can participate in the whole process of labor.
3.No motor obstruction, can walk on the floor.
4.It can flexibly meet the anesthesia needs of forceps and cesarean section, and buy time for early termination of labor.
5.Birth analgesia may have protective effect on children’s intellectual development.
6.The choice of labor analgesia during labor can reduce the incidence of maternal postpartum depression.
7. Labor analgesia increases the incidence of active arrest, but overall it reduces the rate of cesarean section, while it has no significant effect on the rate of instrumental delivery.
Epidural labor analgesia process
1.The patient applies for it, and the midwife informs the anesthesiologist if there is no contraindication after examination (obstetrics is the main aspect).
2. After the anesthesiologist has checked that there are no contraindications (mainly in anesthesia), he/she will talk with the family and sign the anesthesia consent form.
3. Before anesthesia, ask the mother to urinate and open intravenous access.
4. When the opening of the uterus is 2-75px or regular contractions start, you can go to the sterile operation room specializing in labor analgesia to carry out anesthesia operation. The operation room is fully equipped with oxygen, anesthesia machine (can be pressurized oxygen), suction device, monitor (including ECG, BP, SPO2), common anesthetic drugs, anesthetic emergency drugs and common emergency drugs; anesthetic emergency equipment: laryngoscope, tracheal tube, dental cushion, breathing bag under pressure, sputum tube, etc. Laryngoscope, tracheal tube, dental pad, pressurized breathing bag, suction tube, etc.; anesthesia equipment (puncture kit, analgesic pump, gloves, etc.). In case of emergency, Caesarean section can be carried out directly in the operating room of the delivery room.
5. The midwife will assist in the positioning, check the analgesic drugs and fix the epidural catheter together with the anesthesiologist. After successful puncture, the midwife will be responsible for escorting the pregnant woman back to the waiting room.
After the anesthesia, the anesthesiologist and midwife are responsible for monitoring the blood pressure, heart rate and respiration and dealing with the problems in time. After the implementation of labor analgesia, the anesthesiologist observes the patient for 30 minutes without any abnormality before leaving, and later the obstetrics department notifies the anesthesiologist of the abnormal analgesia.
7.Obstetricians and midwives observe the labor process closely and record it in detail.
8.Anesthesia analgesia continues until after delivery, and epidural analgesia can be suspended if the labor force is insufficient at the end of the first stage of labor.
9.The anesthesia department will send someone to visit the patient within 24 hours after delivery.
Epidural labor analgesia method
After the epidural cavity is opened to 2-75px, epidural puncture can be performed in the L2-3 or L3-4 gap, and after the epidural cavity is reached, the head of the epidural tube is injected 3-100px with a trial amount of 1% lidocaine 3ml, and after 5 minutes of observation, no abnormality, 6-8ml of the configured solution (0.1% ropivacaine + 0.25ug/ml sufentanil) is given to establish the analgesic plane (below T10). The epidural catheter is then connected to an analgesic pump loaded with the above drugs. The analgesic pump is an electronic pump with a continuous infusion of 5-8 ml/h, which can reduce the pain level by 80-90%. If the pain is most severe between 7-250px, PCA can be added with 2ml/time, and local anesthetics can not be used during lateral incision. The epidural catheter is withdrawn when the mother returns to the ward after delivery.
The implementation of labor analgesia not only reduces labor pain during labor and improves the rate of vaginal labor analgesia, but also significantly reduces the rate of cesarean section and reduces the occurrence of maternal and neonatal complications.
Pain-free medical treatment is to return a patient’s dignity, a dignified medical treatment, a graceful delivery and a happy motherhood!