What Are the Pros and Cons of Birth With No Epidural?

The so-called "painless delivery", which is medically called "birth analgesia", is the use of various methods to reduce or even eliminate pain during delivery. Childbirth analgesia can prevent expectant mothers from experiencing painful torture, reduce fear during childbirth and fatigue after childbirth, and allow them to rest during the longest first parturition period. Have enough strength to complete the delivery.

Basic Information

nickname: Labor analgesia
English name: painlesslabour

Visiting department: Obstetrics and Gynecology
Contagious: no

Anatomy of Painless Childbirth

Natural vaginal delivery is divided into three stages (the birth process). Childbirth pain occurs mainly during the first and second stages of labor. The neural conduction pathways of pain in different births are different ^[1] .

1. The first stage of labor is from the beginning of the regular uterine contraction to the opening of the cervix, during which the uterine body, cervix and vagina and other tissues have undergone huge changes, and the decline of the fetal head promotes the progressive widening and shortening of the lower uterine segment, cervical canal and cervix. , Thinning and enlargement, uterine muscle fiber elongation and tearing, round ligament is stretched by strong stretch. The rapid changes in these anatomical structures constitute a strong stimulus signal. The stimulus impulses pass from the pelvic visceral afferent nerve fibers and the accompanying sympathetic nerves to the thoracic 10, 11, 12, and lumbar 1 spinal cord segments, and then rapidly through the dorsal tract of the spinal cord. Upload to the brain and cause pain. The pain is mainly in the lower abdomen, waist and palate. The first part of the pain is characterized by: the pain range is diffuse, the lower abdomen, waist and back appear tightness and soreness, which can be radiated to the hip.

2. The second stage of labor is from the opening of the cervix to the delivery of the fetus. At this stage, in addition to the contraction of the uterus and the expansion of the lower uterus, the fetal compression of the pelvic tissue and the expansion of the perineum are the main causes of pain. Pain impulses pass through the genital nerves into the sacral 2, 3, and 4 spinal cord segments and upload to the brain, forming a typical "body pain". Its pain properties are completely different from the first stage of labor, manifested as sharp and sharp pain. The pain area is clear, concentrated in the vagina, rectum and perineum.

3. In the third stage of labor, the placenta is delivered, the uterine volume is reduced, the intrauterine pressure is reduced, and the perineal pulling sensation disappears. The mother suddenly feels relaxed, and the labor pain is significantly reduced.

Painless delivery

"Painless childbirth" originated from abroad and has a history of more than 100 years. At present, it has been widely used abroad. The analgesia rate of childbirth in the United States is> 85%, and the UK is> 90%. Many domestic hospitals have started painless delivery, and some of them have accounted for 30% to 40% of normal births. Expectant mothers can safely choose painless delivery, which is a simple, easy, safe and mature technology.

Current analgesia methods for childbirth include non-drug analgesia and pharmacological analgesia. Non-drug analgesia includes mental comfort, breathing, and water delivery. Its advantages are that it has no effect on the labor process and the fetus, but the analgesic effect is poor. Drug analgesia includes laughing gas inhalation and intramuscular analgesic drugs. , Spinal canal delivery analgesia and so on.

Spinal canal delivery analgesia is by far the most accurate method of analgesia of all delivery analgesia methods. This procedure is performed by an experienced anesthesiologist. After the anesthesiologist successfully punctured the lumbar intervertebral space, a small amount of local anesthetic or opioid was injected into the subarachnoid space, and a thin catheter was placed in the epidural space. One end of the catheter was connected to an electronic analgesia pump. The degree of self-administration (the anesthesiologist has set an hourly limit, do not have to worry about overdose), the analgesic pump can continue to be used until the end of delivery. During the whole process, the concentration of anesthetic is low, which is equivalent to 1/5 1/10 of that during cesarean section anesthesia. It is highly controllable and highly safe, and it hardly affects the maternal movement. The maternal consciousness can be active. Cooperate and actively participate in the entire delivery process. This painless delivery method is currently the most widely used and ideal effect in major hospitals ^[2] .

When giving birth analgesia to the mother, it is necessary to consider the principle of not affecting the birth process and the safety of the fetus. By strictly giving analgesics without affecting the regular contraction of the uterus, the painful nerve transmission during delivery can be blocked, thereby achieving The purpose of avoiding or reducing the pain of childbirth is to minimize the pain of childbirth, but keep the uterus contracted and have a slight pain.

"Painless delivery" is not painless throughout the delivery process. Due to safety considerations, at present, most hospitals in China provide intra-vertebral block for delivery analgesia when the cervix is opened to 2 to 3 cm. If the mother's mental state is in tension, fear, anxiety, or lack of confidence, she will also increase sensitivity to pain. Therefore, mental preparation is also a good way to reduce pain. It is difficult to be absolutely painless no matter what method is used, and its application is to make the unbearable uterine contraction pain intolerable, or just feel the uterine contraction without pain.

Painless labor advantages

Although painless delivery is not widely used in China, it has been widely used abroad. Expectant mothers can safely apply painless delivery, which is a simple, easy, safe and mature technology.

Safety

Intraperitoneal block is used for painless delivery. The doctor places a catheter in the epidural cavity of the mother's waist. The concentration of anesthetic in the analgesia pump is equivalent to 1/5 to 1/10 of cesarean section. It's safe.

There are very detailed studies confirming that spinal canal analgesia is safe for women and fetuses. The dosage for painless delivery is very low, only 1/5 to 1/10 of cesarean section. Therefore, the probability of entering the mother's blood and passing through the placenta is very small, and it will hardly affect the fetus. When the human body feels severe pain, it releases a substance called catecholamine. This substance has adverse effects on the mother and fetus, and the blood and oxygen supply of the newborn may be affected. Therefore, painless delivery can also reduce the risk of fetal hypoxia.

2. Convenient

Because the concentration of anesthetic is very low, it hardly affects the maternal motor function, so the mother can get out of bed with the permission of the doctor; In addition, the mother can self-administer medication according to the degree of pain, which is truly individualized, which is very convenient. .

3. Lasting effect

About 10 minutes after the administration, the mother will not feel the intense contractions of the contractions, and the pain that can be felt is like a slight abdominal pain during menstruation. Give a medicine, the effect lasts about one and a half hours, or even longer. After the pain is felt, the mother should continue to administer the analgesia pump. The analgesia can be controlled by self-control. This is repeated until the end of labor.

4. Suitable for a wide range of people

Most women are suitable for painless delivery, but if they are complicated by diseases such as coagulopathy, drug allergies, and a history of trauma to the waist, the woman should consult a doctor and the doctor will decide whether a painless delivery can be performed.

5. No need to enter the operating room

The whole process of painless delivery is completed by the cooperation of anesthesiologist and obstetrician and gynaecologist. Normal painless delivery can be performed in the delivery room without the need to enter the operating room ^[3] .

Advantages of painless delivery over cesarean section

Natural childbirth should be regarded as the most natural thing for a healthy, full-term pregnancy, normal childbearing age and women of childbearing age to be mature and well established. This is a normal physiological process of human reproduction. A mother should believe that she and her fetus are born with the ability to accomplish this sacred mission. Cesarean section is just a last resort alternative to childbirth, which is bad for both mother and child.

Caesarean section surgery is usually a remedial measure taken due to the patient's obstetric pathological conditions. It is an artificial and unnatural state of delivery. For mothers, it increases the chance of intestinal adhesions, attachment inflammation, wound infections, and endometriosis. For newborns, due to lack of compression of the vaginal wall and lack of ability to gradually adapt to the external environment, the elimination of amniotic fluid is not Thoroughly adverse to the respiratory function of the newborn.

Contraindications to painless delivery

Women with contraindications to vaginal birth, contraindications to spinal canal anesthesia, and abnormal blood coagulation should not use this method.

Painless labor complications

Hypotension

Intraspinal analgesia (epidural, subarachnoid block, or combined epidural-subarachnoid block) during labor analgesia, if the systolic blood pressure drops to <90mmHg, or 20% lower than the basic value 30% is called hypotension. The mechanism is that after the lower thoracolumbar spinal nerve block, the abdominal muscles relax, the uterine compression of the inferior vena cava during pregnancy causes venous reflux disorder, and the cardiac output suddenly decreases; in addition, after sympathetic nerve block, peripheral vasodilation also causes blood pressure to drop one of the reasons. If the hypotension is too long, it may lead to reduced perfusion of placental blood, fetal hypoxemia and acidemia. Therefore, when using painless delivery, first open the intravenous infusion, closely monitor the maternal blood pressure, heart rate and breathing, and at the same time monitor the fetal heart rate to avoid too wide the block plane. When hypotension occurs, the mother needs to be placed in the left lying position, and if necessary, intravenous blood pressure raising drugs are injected.

Headache

Some women with cerebrospinal fluid leakage after dura mater puncture may cause a headache after puncture. After the occurrence, the mother needs bed rest and fluid replacement therapy. This headache is self-limiting and can resolve on its own within 1 week.

3. Local anesthetic poisoning

The main reason is that local anesthetics are injected into blood vessels by mistake or due to the large amount of local anesthetics, which are quickly absorbed by local blood vessels.

4. Total spinal anesthesia

If the catheter penetrates the dura mater and is not found during the puncture process, a large number of local anesthetics will be continuously infused into the subarachnoid space for total spinal anesthesia. Due to the low concentration of local anesthetics used for continuous epidural infusion or self-controlled delivery analgesia, it is not easy to cause total spinal anesthesia in a short time. As long as the changes in the block plane are closely observed, and vital signs such as blood pressure and breathing are monitored, they can be detected and processed in time.

5. Nerve injury

The main causes are caused by the compression of the peripheral nerves behind the pelvic birth canal during the decline of the fetal head or fetus during the birth canal, or excessive flexion of the lower limbs during the second stage of delivery, and improper posture, which can generally recover automatically within 3 months.

6. Prolonged labor

It is inferred from some indirect research results that the first stage of labor changes little in the case of analgesia in the spinal canal, and the second stage of labor may be prolonged by 15-20 minutes. Therefore, the dose should be reduced when the uterine cavity is almost full.

7. Other

Such as drowsiness, dizziness, nausea, vomiting, itching of the skin, urine retention, etc. are also more common ^[4] .

Precautions for painless delivery

1. Forced labor is required after painless delivery

The analgesic currently used is a "separation of sensory and motor" nerve blocker, which selectively blocks the transmission of maternal pain without leaving the motor nerves affected. During childbirth, the mother was completely free and her abdominal muscle contraction and uterine contraction remained normal. On the contrary, after the maternal pain is relieved, the spirit is completely relaxed, and the whole body no longer rolls and twists, which is conducive to the maternal exertion under the doctor's guidance, and the opening of the uterine opening is easier, thus accelerating the progress of the labor process.

2. Slight discomfort during spinal cannula placement

The puncture and placement of the catheter is performed under local anesthesia, and the woman feels only slight discomfort, which is not comparable to the pain caused by uterine contraction.

3. The delivery method during painless delivery may be changed to cesarean section

Whether natural birth is changed to cesarean section is not necessarily related to whether or not painless delivery. It depends on whether the fetal head and pelvis are commensurate, whether there is an abnormal fetal position, the umbilical cord around the neck, and intrauterine distress. Some factors can only It gradually appears during the delivery process. If a cesarean section is required during the labor analgesia process, the mother can enter the operating room in time to perform the operation. If the analgesic effect of the labor is accurate, the administration of the tube can eliminate the need for a spinal canal. The puncture process saves preparation time before surgery.

References

1.Wu Xinmin, Chen Qian. Analgesia during delivery [M]. Beijing: People's Military Medical Press, 2006.65-69.

2.SharmaSK, McIntireDD, WileyJ, etal.Laboranalgesiaandcesareandelivery: anindlidualpatientmeta-analysisofnulliparouswomen.Anesthesiology, 2004; 100; 142-148.

3 Liu Yujie, Qu Yuan, Zhang Xiaosong, et al.Effects of subarachnoid block and epidural block on prognosis of mother and child and delivery mode [J] .Chinese Journal of Obstetrics and Gynecology, 2005, 40: 372-375.

4.MoenV, IrestedtL. Neurologicalcomplicationsfollowingcentralneuraxialblockadesinobstetrics.Currentopinioninanaesthesiology2008; 21: 275-80.

Painless labor

In November 2018, the National Health and Medical Commission issued a notice to launch a pilot program for labor analgesia. A number of hospitals will be selected nationwide to conduct pilot labor analgesia diagnosis and treatment. A list of pilot hospitals will be announced in January 2019. The scope of the pilot project is general hospitals, maternal and child health hospitals, or obstetrics and gynaecology hospitals with obstetrics and anesthesia diagnosis and treatment departments.