Anesthesia of childbirth

The desire to alleviate the suffering of women during childbirth arose long ago. The desire to anesthetize the birth act was expressed in accordance with the era in various events, often primitive. It is known that in ancient India, for inhalation anesthesia, smoke was inhaled from the combustion of charcoal. In the future, anesthesia of the birth act was not widely spread, as many representatives of medical science put forward the proposition that the mother loves her child because she experiences torment during childbirth, without which there would be no maternal love. This old point of view has long been forgotten. Birth pain is not only not necessary and not necessary, but harmful. With birth pain, as with all pain in general, it is necessary to fight, the victory over it is a matter of honor of every doctor. It is proved that the birth pain causes the exhaustion of the nervous and muscular system, in addition, frightens the woman, causing fear of the impending birth act. It is also known that in the normal course of the birth act, the occurrence of pain in a woman is not necessary. Approximately 20% of women have childbirth with insignificant soreness, and women of some nationalities do not know what pain at birth is.

The issue of anesthesia during surgery and childbirth was scientifically developed in the 19th century. The first scientific experience with the use of chloroform and ether for the reduction of labor pain was produced by Simpson on Nov. 8, 1847.

The Soviet health system contributes to the widespread work on the anesthesia of labor due to the fact that

every pregnant woman in the city and in the village since the beginning of pregnancy is under observationdoctor or midwife.

Since 1935 in our country, widespread anesthesia of labor with the help of various drugs. From the same time, the study of the influence of various painkillers on the generic activity of women, on the condition of the fetus and the newborn began.

At present, with anesthetic delivery, ether, nitrous oxide, analgin and a number of other agents are used.

Widespread use in the practice of analgesia of labor has also found promedol, isopromedol, anadol, aprofen. Along with pain relief, these drugs have a so-called antispasmodic property, accelerating the opening of the cervix.

At present, with a good analgesic effect, a new drug, trilenum, has been used.

However, all medications used in a harmless dosage for the mother and fetus have only a very short-term effect. This is the imperfection of medical anesthesia of childbirth. Nevertheless, they give, if not complete, then a partial anesthetic effect, and the childbirths proceed quite normally and end with the birth of a healthy child.

It should be emphasized that the use of these drugs is relatively rarely an independent method of anesthetizing labor.

In most cases, the medication for anesthesia in childbirth complements the method of psycho-prophylaxis of pain in childbirth that has become the main method in the USSR since 1951.

Only in cases when this method was not used for the purposes of psycho-preventive preparation of pregnant women for childbirth or when it was not effective enough, different medications are used.

The method of psycho-prophylactic anesthesia of childbirth was developed in the Soviet Union and is now used worldwide. It is based on the teachings of IP Pavlov, on the laws of higher human nervous activity.

Under the higher nervous activity, formerly called "mental", one should understand the activity of the nervous system, which provides the complex, subtle interrelations of the living organism with the external world.

Man, like an animal, is born with certain instincts, or, according to the definition of IP Pavlov, innate unconditioned reflexes. So, for example, a newborn soon after birth produces sucking movements. This is one of the innate reflexes.

Along with congenital there are so-called conditioned reflexes. Thus, when eating food in humans and animals, gastric juice is secreted. If before the meal each time the bell rings, then after a while the gastric juice begins to stand out and without food, only when the bell rings. This phenomenon refers to conditioned reflexes, that is, to body reactions that occur under certain conditions in response to stimulation.

All the irritations from the outside world we receive with the help of five senses: sight, hearing, smell, touch and taste. Consequently, these senses are punches, through which the external world is perceived. Then irritations along sensitive nerves are transferred to the central nervous system, from which the corresponding reactions come.

These ways of perception are inherent in both animals and man. But man, in addition to these ways, perceives the outside world also with the help of speech.

A word for a person is not just a sound signal. Filled with a certain content, it is for him the strongest irritant, which can cause a violation of both the general state of a person and his various physiological functions. Under the influence of a stimulus such as a word, blood pressure, the amount of urine released, and various substances in the blood can change.

For a long time there is a folk saying: "You can kill a word." This folk wisdom, based on centuries of observations, has, as we now know, the scientific justification: verbal stimuli can be stronger for a person than all the others.combined with the impact of other factors at the present time and based on the study of the anesthesia of childbirth by the so-called psycho prophylactic preparation of a pregnant woman.

The same painful irritation in different conditions is tolerated by man

Despite the fact that the initial irritations during the birth act occur in the neuromuscular, vascular and ligamentous apparatus of the uterus, the final formation of the birth pain occurs in the brain

Severe mental injuries and experiences contribute to a more acuteThe idea of ​​the possibility of pain during childbirth is partly due to the reactionary nature of the social ideas of the past, as well as to religion. God allegedly instructed the first woman in the words: "In torment you will bear your children."

Along with this, with the appropriate preparation of women, the strongest pain can be so inhibited that they will be perceived very weakly or their perception will be absent altogether.

Numerous searches by Soviet doctors in the field of birth anesthesia have been crowned with success. At present, the most physiologic psychophysical method of anesthesia is widely used throughout the family act.

This method is based on the fact that painful sensations during normal births are not necessary, that when certain techniques that are used by pregnant women during pre-treatment are used, they may not occur. This method represents a unified system, part of which is carried out in the women's consultation, and the other part - in the maternity hospital. Of great importance in this system is the so-called antenatal preparation of a woman in consultation, which basically boils down to acquainting her with the generic process as a physiological act requiring neuromuscular work.

During the exercises, the woman creates new conditioned reflexes in perception of the birth act as a normal phenomenon, in which the woman herself takes an active part. During childbirth, a woman applies a set of certain techniques, mastered by her in the women's consultation during special preparation for childbirth. This helps to fix the elaborated reflexes. Old, misconceptions about childbirth as an act associated with severe suffering can be inhibited.

Preparation for childbirth without pain is spent with pregnant women in consultation for 5-6 sessions. The last session is usually held no later than 7 days before the birth. If the child does not come after 7 days after the last session on psycho-preventive preparation, the woman should come to the doctor for a re-occupation.

Usually, as a result of the first conversation, the pregnant woman creates a new idea of ​​childbirth, and in subsequent sessions she "fixes" the consciousness that delivery is a natural act to which the woman and the fetus are adapted.

As a result, the pregnant woman expects the forthcoming births confidently, calmly, realizing that the outcome depends largely on herself. It forms the right attitude to the generic act as a labor process in which it is an active participant.

Experience shows that a woman prepared in such a way behaves during childbirth, as a rule, in a disciplined manner, performing all techniques mastered in consultation.

All preliminary psycho-preventive work of a doctor with a pregnant woman is like a school of preparation for the forthcoming birth.

In the first lesson, a woman is told about the anatomical and physiological characteristics of her body and, in particular, of reproductive organs, and about the advisability of changing in the body during pregnancy.

The second lesson is dedicated to the generic act as a natural process of expelling the fetus from the mother's body. In this lesson, a woman learns about the different periods of childbirth.

The third lesson focuses on the behavior of a woman during the first stage of childbirth. This period is the longest and requires a special calmness from the woman.

In the third lesson, a woman is trained in special so-called anesthesia techniques, which she must well master and train in their application at home. Their significance in the behavior of the parturient woman during childbirth, in her sensations and even in the nature of the course of labor is exceptionally great.

What are these methods of anesthesia expressed in?

The first method is that, during regular bouts, the maternity during them takes a deep breath, slightly holds her breath and then makes a deep exhalation.

This technique she repeats several times. Such breathing during labor provides a large influx of oxygen into the body of a woman. If the intervals between contractions are shortened to 4-5 minutes, as well as in case of painful feelings, the mother can move to the second method: lying on her back, she palms both hands facing the front wall of the abdomen( fingertips touch and stand at right angles to the middleline directly above the pubis), produces a stroking of the lateral surface of the abdomen. Such stroking should be combined with a deep breath. Similar movements produce smoothly, without tension, 10-12 times during each contraction.

The third method is stroking the skin of the sacro-lumbar region in combination with a deep breath and exhalation. This method takes the woman in the position on her side. The stroking of these parts of the skin is not accidental: here the nerve endings are located internally, which correspond to the reflection of the pain sensitivity of the uterus. Easy stroking of this area in combination with proper breathing improves local blood supply and eliminates discomfort. The second and third methods of the woman in childbirth apply until the end of the first period. In the case of more painful sensations, at the end of the first stage of labor, when the contractions are repeated after 1.5-2 minutes , the woman in labor takes the fourth and fifth methods of anesthesia.

The fourth method is to press the thumbs on the inner surface of the pelvic bones of the pelvis.

The last, fifth, method consists in pressing "anesthesia points" in the lumbar region. Pressing is performed by hands, folded into fists and placed under the rump

The fourth occupation of a woman in a consultation is dedicated to the second period of labor - the period of exile.

In this period, attempts are added to the fights. When their mother arrives from the prenatal room, she transfers the delivery room, where her landlords go to a special bed( high).

What are attempts? This combination of fights with the tension of the muscles of the abdominal press, respiratory muscles, grubopryryushnoy barrier( diaphragm) and other muscles. The effectiveness of attempts depends on the woman in her maternity: her skills, chewing, organization, the strength of the

and the exercise of tension.

The tour is conducted as follows. At the beginning of the onset of labor in the second stage of labor, the mother gives a deep breath, so that the air does not linger in the mouth, then grasps the edges of the bed or the ends of the towel attached to the bed and pulls them, pulling them, pulling the neck muscles, slightly lifting the head andpressing his chin to his chest.

If the mother is not able to breathe more, not breathing, she should calmly exhale the air, then take a deep breath again, hold her breath and continue the attempt. This is repeated 3 times during each bout. An energetic, correctly executed stratum removes painful sensations and accelerates childbirth.

In between the attempts, the mother is resting from stress, breathing freely, putting her hands on her chest.

Tighten this way until the midwife instructs you to stop trying: it usually occurs after the birth of most of the fetal head. At this time, the woman in childbirth should itself help relax the muscles of the abdominal press: do not push, open your mouth or count aloud, putting your hands down or putting them on your chest. The midwife at this point "takes out" the head of the fetus. After deducing the head, the midwife asks the woman once again to strain,

in order for her shoulders to be born. The rest of the trunk of the fetus is born without tension from the woman.

The woman learns about all this in the fourth lesson. In this lesson, she is taught behavior in the second stage of labor. She, in advance, even during pregnancy, almost like mastering the technique of attempts. In the fifth lesson, the latter, the woman is introduced in detail to the situation that awaits her in the maternity hospital upon admission to it, with the manipulations that usually produce the maternity leave. This is done with the goal that for a pregnant woman on admission to the maternity home there should be no surprises that can disturb her. A woman should be sure that she has nothing to fear in a maternity hospital, that people who are ready to come to help at any moment are waiting for her there.