Analgesia, numbness, pain relief
There are a number of possibilities for pain therapy to accompany the birth process (relieve birth pains)
In the Sedation (Relieve birth pains) is a dampening of wakefulness and arousal through certain drugs. Through the central nervous (in brain and Spinal cord) Mechanisms work by some drugs anxiety-relieving (anxiolytic), muscle relaxing (relaxing) and dampen and make you tired (Sedation). However, medication for sedation does not have an analgesic or pain-eliminating effect (relieve birth pains)
Can be used for sedation Benzodiazepines, Propofol or Ketamine (Relieve birth pains). These drugs can also affect the unborn or newborn child; possible side effects can be serious in some cases (e.g. temporary Muscle weakness in children by benzodiazepines), so they should only be used in certain cases by experienced staff.
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Under systemic pain therapy in obstetrics means the administration of painkillers via the vein (intravenous) or in the form of tablets (orally). In this context, systemic means that the whole body comes into contact with the medication, as opposed to regional or local pain therapy (relieving birth pains).
The problem of systemic pain therapy (relieving birth pains) is that Permeability of the placenta (Placenta) for most medications. In this way, the unborn child also gets to feel the effects of the medication, which can be problematic with some medications, as babies in particular react more sensitively due to their not yet mature metabolism and are less able to break down medication.
Various medications are used in obstetrics (relieve birth pains)
It is possible Opioids to be administered (e.g. morphine, sufentanil or Pethidine). Especially with severe pain (relieve birth pains) such as B. at the birth of the child's head they can fight severe pain quickly and effectively. However, when giving opioids, one should always anesthetist be present as it becomes a Respiratory depression (Suppression of breathing) can occur in the mother and, after the birth, also in the child, so that short-term ventilation may be necessary.
In the Spinal anesthesia is a topical pain reliever (Local anesthetic) into the cavity containing nerve water (liquor) (Subarachnoid space) in which the spinal cord lies. The injection (injection) takes place at the level of the Lumbar spine (Vertebral bodies L3 / L4 or L2 / L3), the spinal cord itself ends a little higher so that it cannot be injured during the injection.
The pain reliever switches one by one autonomic nervous system, the sensation of temperature, the sensation of pain, the sensation of touch, the movement (motor skills) and the sensation of vibrations and position sensation.
With operations like one Caesarean section (Caesarean section) can therefore already be started when the patient can still move her legs, since the pain sensation is switched off relatively earlier.
The Spinal anesthesia is the procedure of choice for planned or urgent caesarean sections or also for necessary ones Operations during the pregnancy below the thoracic vertebrae 4 - 6.
Spinal anesthesia should not be performed if the patient refuses, or in emergencies before and during the birth (Emergency caesarean section or caesarean section), Coagulation disorders, certain pre-existing diseases and Allergies on Local anesthetics.
Common side effects are severe a headache after spinal anesthesia (Root cause: Leakage of nerve water from the spinal canal and thus different pressure ratios), difficult urination and sensory disturbances.
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$config[ads_text3] not foundSynonym: epidural)
Epidural anesthesia (PDA) is the most effective method for eliminating pain in obstetrics. A local anesthetic (local anesthetic) can be injected by inserting a catheter, more rarely by a single injection (injection) into the space outside the skin surrounding the spinal cord (meninges or dura), the so-called epidural space.
As a result, the nerve tracts that transmit the pain are temporarily and locally switched off. Epidural anesthesia (PDA) is possible in both the thoracic vertebrae (thoracic PDA) and lumbar vertebrae (lumbar PDA); in obstetrics, the lumbar PDA is preferred.
In addition to the local anesthetic, opioids (strong painkillers that work on the opiate receptors) can be injected; in Germany only the opioid sufentanil is approved for this. With this method, local anesthetics can be saved, making it possible to eliminate pain, but to leave the movement (motor skills) relatively unrestricted. Ideally, the patient can still walk with complete elimination of pain.
Another advantage of epidural anesthesia (PDA) with leaving a catheter in place is the so-called patient-controlled anesthesia. The patient can use a button to determine for herself whether more painkillers are injected through the catheter (limited per hour, thus preventing overdosing).
A PDA is an option for all patients with an unremarkable birth process and an unremarkable CTG. The epidural does not lead to an increased rate of caesarean sections. If the epidural catheter is in place, however, in the event of an unplanned course of the birth (if an urgent caesarean section is necessary), this can be used to eliminate pain, a very effective and time-saving option. Epidural anesthesia should not be performed if the patient refuses, emergencies before and during childbirth (emergency caesarean section), coagulation disorders, certain pre-existing diseases and allergies to local anesthetics.
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Of the Pudendal nerve (Pubic nerve) is available twice and supplies the genital area from Pubic mound up to the anus. It transmits sensations and pain, but it is also for some Muscles responsible. In the case of pain during childbirth (expulsion phase) or difficult births (Forceps or suction bell delivery) the nerve can be injected with a local pain reliever (local anesthetic) in several places and thus temporarily switched off, d. H. the transmission of pain is interrupted in this area. However, a pudendal block is a local anesthetic that only involves the vagina and the perineal area; the pain in labor is still felt.
A pudendal block should not be performed if the patient refuses, infections in the area of the injection, allergies to local anesthetics and coagulation disorders. In contrast to spinal or epidural anesthesia (purely medical activity), the pudendal block can be carried out by obstetricians themselves.
Intubation anesthesia
With an intubation anesthesia, pain sensation and consciousness are completely switched off by medication, and a tube is still inserted into the windpipe introduced to ventilate the patient on the one hand and on the other hand before inhaling stomach contents (aspiration) to protect.
Intubation is at advanced pregnancy Always necessary (after the 12th week of pregnancy) to protect against aspiration, pure mask ventilation or the use of so-called laryngeal masks for ventilation are absolutely contraindicated as these Forms of ventilation do not provide adequate protection.
During the intubation itself, it may also be necessary to relax the muscles with medication.
Before the intubation anesthesia, no food must be ingested at least 6 hours beforehand and no liquid must be ingested at least 2 hours beforehand.
After anesthesia should also not breastfeed for at least 24 hours, as the anesthetic drugs can pass to the newborn through breast milk.
Intubation anesthesia should only be performed if there are no alternatives, e.g. B. in emergencies such as emergency caesarean sections or heavy bleeding, as well as in diagnostic or therapeutic interventions during pregnancy and childbirththat cannot be performed under a local or regional anesthetic.
Before the birth in the opening phase of the cervix, relaxation techniques are particularly useful to reduce pain. These can be warm baths (also with water birth), relaxation or breathing techniques or massages. Aromatherapy can also be used for relaxation. A calm and relaxed atmosphere in which the woman giving birth feels comfortable and secure is also important.
Relaxation techniques lower the tone (tension) of the body muscles. The autonomic nervous system (lowering of the sympathetic tone) is calmed, which also leads to the body and mind coming to rest and tensions to be released. The physical relaxation also reduces anxiety, both of which ensure that pain is perceived less intensely. Movement, e.g. For example, walking around slowly helps many women by reducing tension.
Of the alternative methods, only acupuncture, psychoanalgesia and hypnosis have so far been able to prove their effectiveness in facilitating childbirth in studies.
Read more on the topic: Breathing at birth
Alternative methods of analgesia how hypnosis or the Psychoanalgesia can also be used in obstetrics. However, the prerequisite for both is learning these techniques from specially trained staff before the birth.
In the Psychoanalgesia the pregnant women z. B. trained in certain anti-anxiety (anxiolytic) techniques to use during childbirth. In studies, at least 20% of users did not need any further pain therapy during childbirth.
In the Hypnotherapy the patients are trained by a therapist specially trained in hypnosis hypnotic state of relaxation offset. Self-hypnosis can also be learned and used during childbirth.
If the pregnant woman is in hypnosis, the body sensation and thus also the pain can be influenced by the hypnotist or by herself (Suggestion or autosuggestion). In studies, some hypnotically trained patients needed less pain medication than the patients in the comparison group. However, like psychoanalgesia, this method must be learned and practiced regularly before birth in order to be effective.
The acupuncture is a method of traditional chinese medicine (TCM). During treatment, the acupuncturist inserts special needles into the skin pricked and remain there for different lengths of time. Acupuncture is designed to influence the flow of energy in certain pathways in the body that flow through these points.
A Acupuncture treatment should only be performed by specially trained medical personnel. Birth preparation should be carried out before the birth so that the pregnant woman is not afraid of the needles during the birth and has confidence in the user. Sterile disposable needles should always be used to prevent infection.
Studies have shown that acupuncture is very effective for pain therapy in obstetrics, so that it can be recommended to interested women.
As with all other pain therapies, the prerequisites for acupuncture are acceptance by the pregnant woman and healthy, infection-free skin in the area of the punctures. When used correctly, no side effects are known.
Acupuncture can not only be used for pain management but also to combat it nausea and Vomit, for faster opening of the cervix and for an improved regression of the uterus after birth.
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The basic principle of homeopathy (Greek: to suffer similarly) is the use of active ingredients which, in healthy people, can cause symptoms in the body that are similar to those of the disease to be treated. There are different active ingredients for pain therapy during childbirth, but there are still others relaxing, antispasmodic and anti-anxiety homeopathic Active ingredients that can all be used before and after birth. It is important to have intensive homeopathic advice from those trained in this before the birth Midwives, Naturopath or homeopathically trained doctors takes place. The homeopathic therapy is based on a holistic aspect that is individually tailored to the patient. The respective active ingredients depend on the patient's state of health and the general condition of the patient; they should be selected and used by experienced homeopaths. As with other healing methods, it is not advisable to try it yourself.
In homeopathy, a positive attitude and conviction are important to support the effect. Homeopathic medicines usually have no side effects and are well tolerated.
In the Aromatherapy essential herbal fragrances are used. It is supposed that essential oils at the level of the autonomic nervous system work. For some patients, they are therefore suitable for relaxation and anxiety relief, which in turn can have a positive effect on the intensity of the pain.
In many clinics and birthing centers it is now possible to use essential oils with the help of fragrance lamps or vaporizers. The pregnant woman can decide for herself which aromas are pleasant to her at the moment, which can have a positive influence on the birth process.
