In clinical practice, it has been found that labor analgesia is closely related to the mental and psychological state of the mother. Factors such as fear, anxiety, fatigue, lack of self-confidence, and adverse stimulation from the surrounding environment will all lower the pain threshold of the mother. This pain relief regimen includes:
l) Prenatal education: Correct the misconception that childbirth must be painful.
2) Practice midwifery movements: abdominal breathing and massage.
3) Care and support: door-to-door delivery, childbirth accompaniment, etc.
4) Doula birth method: A woman who has experienced natural childbirth is accompanied by a woman who is giving birth.
2. Acupuncture anesthesia
3. Transcutaneous Electrical Nerve Stimulator
Principle of action: It distracts the mother\’s attention, and the analgesic effectiveness is only 25%.
4. Water birth
That is, the mother sits in a hot tub during the first stage of labor and the early stage of the second stage of labor, relying on the hot water and the buoyancy of the water to relieve labor pain, but the analgesic effect is not exact.
Advantages of non-drug analgesia: no impact on labor and fetus.
Disadvantages of non-drug analgesia: poor analgesic effect.
2. Commonly used drugs for labor analgesia
Laughing gas (N2O) inhalation method
Instructions for use: After mixing N2O:O2=50%50% with an anesthesia machine, the mother holds an anesthesia mask in her mouth and nose, and takes a deep breath through the mask 20-30 seconds before contractions. When labor pains subside, a mask will suffice. Intermittent inhalation during the first and second stages of labor.
Advantage:
1). The effect is more reliable, and about 50% of pregnant women have effective analgesia.
2).It works fast and fails fast.
3).Does not irritate the respiratory tract.
shortcoming:
1).N2O has a latency period of 30-45 seconds, and uterine contractions appear before labor pains, so it should be inhaled intermittently at least 50 seconds before contractions. Intermittent contractions into a light sleep state, accompanied by varying degrees of dizziness and nausea.
2). If inhaled too deeply, it will produce a general anesthetic effect and there is a possibility of aspiration.
3). Laughing gas is an inhalable gas that can cause indoor air pollution.
2. Demerol
Instructions for use: The usual dose is 50-150mg, intramuscular injection, it takes effect 15-20 minutes after administration, reaches the peak in 1-1.5 hours, and gradually decreases after 2 hours.
Advantage:
1).Simple management.
2). 40%-60% of maternal analgesia is effective.
shortcoming:
1).InjectionIt can quickly pass through the placental barrier, appear in the fetal blood within seconds after maternal intravenous injection, and reach drug equilibrium between maternal blood and fetal blood within 6 minutes. Fetal blood concentration reaches its peak 2 hours after intramuscular injection, which can inhibit the newborn\’s respiratory center.
2). Dizziness, nausea, vomiting, and irritability, mostly manifested by apathy, slow reaction, and often drowsiness between contractions.
3. Stability
Usage: The usual dosage is 0.2-0.3mg/kg iv.
Advantages: Convenient administration, suitable for pregnant women who are stressed.
shortcoming:
1). No analgesic effect.
2). It can cause severe hypotension and prolonged hypothermia in newborns, especially premature infants.
4. Regional block: This method is performed by an obstetrician.
1) Perineal local infiltration block
2) Parauterine block
3. Neuraxial injection analgesia
It is currently recognized by the anesthesia community at home and abroad as the most reliable, widely used and feasible analgesic method, with an analgesic effectiveness of over 95%.
Advantage:
1. It has good analgesic effect and can be completely painless, especially suitable for mothers with severe labor pain.
2. The mother is awake, able to eat and drink, and can participate in the entire delivery process.
3. No motor block, can walk on flat ground.
4. It can flexibly meet the anesthesia needs for forceps and cesarean section, and gain time to end labor early.
5. With the emergence of new administration methods of CSEA and PCEA technology and the emergence of the new drug ropivacaine, the effect of labor analgesia has been improved, with almost no impact on the mother, baby and the delivery process.
shortcoming:
1. It is highly technical, requires an anesthesiologist with professional anesthesia skills, and is difficult to administer;
2. There are technical risks, with a 3% analgesia failure rate;
3. Improper selection of drug dosage and concentration will have adverse effects on motor block, delivery process, and mother and baby. Neuraxial labor analgesia is invasive and carries certain operational and technical risks.