For over a century and a half, the search has been on to find ways to make labor awake and pain-free. Many factors influence the level of pain experienced during labor: the woman’s psychological preparation, emotional support during labor, her experience with labor, abnormal fetal position, and the use of contractions. Childbirth and severe pain go hand in hand, often more than expected, and labor pain is the most intense pain a woman can experience, and typically worse than toothache, back pain, and pain from deep lacerations. A survey reported that 60% of first-time mothers described contraction pain during the first stage of labor as “unbearable, unbearable and extremely painful”. The implementation of labor analgesia solves the problem of pain, increases the courage and confidence of mothers, improves the rate of vaginal delivery, and helps to improve the quality of the perinatal period and the physical and mental health of mothers through the correct implementation of analgesia during labor.
1. Is painless delivery really painless?
Ropivacaine has good “separation anesthesia”, which only blocks your pain sensation and does not affect muscle strength, so you can move normally; sufentanil is the strongest analgesic drug with the least side effects. We recommend that the best way to have a painless delivery is to preserve the sensation of mild contractions. According to statistics, 85% of mothers have no pain at all after a painless delivery, and 12% of mothers have an appropriate degree of relief.
2. Can all mothers in normal labor choose labor analgesia?
Not all mothers who want to have a normal delivery are suitable for labor analgesia, for example, some mothers have skin infection on their backs, or suffer from sepsis or blood clotting disorders, or have had back injury or spinal surgery, which are not suitable for labor analgesia. There are also mothers with obstetric anomalies such as abnormal birth canal, fetal malposition, placenta praevia, poor fetal heartbeat, abnormal amniotic fluid, heart disease and cardiac insufficiency, persistent weak contractions and no significant change even after using oxytocin drip, etc., who can be considered for cesarean section. Therefore, labor analgesia is required to meet the conditions of anesthesia, and everything is aimed at ensuring the safety of you and your baby.
3.Does painless delivery affect the baby’s health?
The local anesthesia technique used for labor analgesia is only a few milligrams and micrograms of drugs injected into the spinal canal, which anesthetizes the area below the mother’s navel, not directly through the mother’s vein, and the amount of drugs absorbed into the mother’s circulation and then absorbed through the placenta is minimal and has no adverse effect on the fetus. Clinical studies have now found that labor analgesia is safe and effective and can have beneficial effects on the mother and baby. Studies focusing on placental-fetal endocrine function have shown that labor analgesia decreases maternal peripheral blood cortisol hormone, thereby reducing maternal stress during labor, and that cortisol concentrations in maternal cord blood and amniotic fluid do not change after analgesia. It was also demonstrated that the secretion of estrogen/progesterone and plasma prostaglandin E2 (PGE2) was not affected by labor analgesia. Other studies have shown that the level of nitric oxide increases after labor analgesia, which is conducive to the relative stability of maternal hemodynamics.
4.What are the reasons why labor analgesia is not popular in China?
The reasons for such a low rate of labor analgesia in China are mainly non-technical factors.
①The degree of maternal and family awareness of labor analgesia and the level of relevant education received. Most pregnant women are not aware of the availability of advanced methods of labor analgesia. From July to September 2006, a questionnaire survey was conducted among pregnant women in different levels of hospitals in Guangzhou, 1000 questionnaires were distributed and 982 valid questionnaires were returned. Most of the pregnant women who were very clear about labor analgesia wanted to give birth by labor analgesia, and the rest wanted to give birth naturally without any analgesia or surgery, and most of the pregnant women said they could be frank about labor analgesia or had no fear of it, but some of the pregnant women who had never heard of labor analgesia or only heard of it had great fear of labor analgesia.
②The degree of recognition and acceptance of labor analgesia by obstetricians and midwives. Medical personnel are relatively backward, especially obstetricians and midwives, who are still stuck in the old concept of epidural analgesia, believing that analgesia will inevitably affect contractions, labor, and labor force. In addition, the situation after analgesia is very different from that of normal labor, midwives need to observe the labor process and the opening of the uterus more carefully, and cannot judge according to their previous experience, and must adapt to the “quiet” labor as soon as possible. A questionnaire survey on labor analgesia was conducted in the anesthesia department, delivery room, obstetrics department and other departments of Beijing Maternity Hospital. A total of 530 questionnaires were distributed, and 504 (95.1%) of them were returned. Among all medical personnel, 93.3% had heard of intralesional labor analgesia, of which 14.4% knew it clearly. 48.8% of medical personnel thought that intralesional labor analgesia was suitable only for women whose other analgesic measures were ineffective, 32.2% thought that non-pharmacological methods were the best method of labor analgesia at present, 42.4% were in favor of intralesional labor analgesia, and 57.4% were neither in favor nor against it. attitude.
(3) The enthusiasm and sense of participation of the anesthesia department in actively developing new business. Many hospitals are short of staff in anesthesiology departments, and they are too tired to deal with daily operations to take care of labor analgesia. In the questionnaire survey mentioned above, 55.3%, or the first, of the reasons for the greatest obstacle to the development of labor analgesia were the lack of sufficient anesthesiologists. According to the current national pricing for public hospitals, the benefits of cesarean delivery are much higher than the benefits of natural delivery. The application of painless delivery for natural delivery only increases the charges by about several hundred dollars, and the popularization of painless delivery will reduce the hospital revenue instead in the case of exponential increase in workload and medical risks. This largely restricts the popularization of painless delivery in China.
5.Can I choose my own anesthesia for cesarean delivery?
Cesarean delivery is an unnatural delivery method. Only those who meet the indications: breech position, fetal distress, placenta praevia, etc. can choose it, and the decision must be made by obstetricians. Cesarean delivery is the most important and common surgical intervention in obstetrics, and as an effective means of solving difficult labor and some high-risk pregnancies, its rational application has saved the lives of numerous mothers and children. However, the abuse of cesarean delivery can also lead to increased maternal complications and mortality. The World Heahh Organization (WHO) survey report on cesarean section worldwide pointed out that the serious complications and mortality rate of pregnant women in the vaginal assisted delivery group and the cesarean section group were significantly higher than those in the natural vaginal delivery group, so mothers should pay attention to prenatal education and recognize the pros and cons of cesarean section.
6.What is the most common type of anesthesia currently used?
At present, the most mature anesthesia and labor analgesia technique in China and abroad is intrathecal analgesia, which is a drug injection tube placed by the anesthesiologist in the lumbar area of the mother, and the concentration of anesthesia drugs in the tube is only about 1/5 of that in a cesarean delivery, so it is very safe. The pain will start to decrease after about 10 minutes of anesthesia. Our hospital is operated by experienced anesthesiologists, which has a high safety factor and is widely recognized by mothers, and is also the standard way of painless delivery at present.
7.What preparations do expectant mothers need to make before surgery?
If mothers-to-be want to be brave enough to give birth by themselves, they must consider having labor analgesia. Labor pain is unbearable, which you can get confirmation from the media and friends, if you want to have labor analgesia, please be prepared: avoid skin infection on your back, exercise properly and often, it takes strength to give birth by yourself, I have my own website on it, communicate and exchange more with us online, improve your knowledge about labor analgesia, and we will help you. We will provide you with help.
8.It is said that it is crucial to have anesthesia in place during cesarean delivery.
Does it mean whether the level of anesthesia is appropriate or not? If the plane is too high, the mother will have low blood pressure, nausea and vomiting, and the baby will be deprived of oxygen; if the plane of anesthesia is too low, the pain will be felt if the pain sensation is not completely blocked, and the muscle contraction will be strong, making it difficult to get out the fetal head, which often poses a threat to the baby’s life. Only the right plane can let the baby come into the world without discomfort.
9.Many mothers feel that their memory will be worse after cesarean delivery, is there any medical basis for this?
There is no scientific basis for this. Any visual and auditory information that stimulates our sensory organs can constitute an extremely short term memory of less than 1 second. If not transferred to short term memory storage it fades quickly, this is sensory memory. You often hear people introduce their last name, and if you don’t put it into your mind, you immediately forget it. If you put a piece of information into your attention, after some thinking and connection, it becomes a short-term memory that can be maintained for a few seconds to a few minutes. This process is related to the temporal lobe of the brain, which is only the initial processing of the brain. If this information is further processed, encoded in some way or used repeatedly, it is stored in multiple parts of the brain and becomes long-term memory, which can last for hours, days, months or even a lifetime. After a mother’s pregnancy, her life experience changes a lot, especially the physiological and psychological changes. During pregnancy and for a long time after delivery, she is relatively separated from her previous social relationships and is relatively closed. Whether or not the attention is focused and whether or not there is enough normal emotion in contact with a certain thing is very relevant to the length of the memory retention interval. If paranoid and anxious emotions, inattentiveness and inability to build a solid memory indicate that memory is related to high attention and emotions rather than brain damage leading to memory loss, which can be gradually improved with proper treatment and correction.