During pregnancy there are many doubts that assail us about the type of delivery we will want. Some women are clear that they want to give birth without anesthesia, and turn to others pain relief analgesic techniques. Others, on the other hand, prefer the epidural when the time comes.
We have prepared two articles to clarify the issues that arise regarding the use of anesthesia or analgesia during childbirth, because they are not the same, nor do they have the same effect. However, we recommend consulting all your questions with the doctor or midwife in order to make the decision that makes you feel calmer. We start with labor analgesia: what is it and how many types are there?
Anesthesia and analgesia: is it the same?
Analgesia refers to the modulation of pain perception to which we arrive through different techniques, which affect either a small and specific area of our body, or the body as a whole. Anesthesia, however, refers to the total loss of sensory perception, which can also include loss of consciousness.
That is, analgesia is used to modulate the intensity of pain that we perceive, while anesthesia completely cancels any pain sensation.As we have mentioned at the beginning, it is normal that during pregnancy doubts arise about what to do at the time of delivery, and we consider whether to resort to analgesia to minimize pain, or opt for anesthesia to eliminate it.
It is important get informed correctly and clarify all our doubts with the specialist, since even if we set our preferences in our birth plan, the final decision will always be the responsibility of the doctor, who after an assessment based on our physical condition, history, or diseases / complications related to pregnancy, will define the best strategy to follow .
There are several types of analgesia that can be used during childbirth. In some cases it is pharmacological analgesia, but in others it is not. We detail it below:
Nitrous oxide or laughing gas
Some countries such as Canada, England, Finland, the United States, Sweden or Australia, use nitrous oxide or laughing gas in a large number of deliveries, with the intention of relieving women's pain without interfering with the process.
This gas it is inhaled through a mask, and neutralizes nerve transmission at the brain level; that is, it does not eliminate pain but makes it live differently. Its effect is very fast, and as soon as the mask is removed, it begins to diminish until it disappears.
The gas of laughter should be administered under medical supervision, and always mixed with oxygen in a concentration of 50 percent, in order to alleviate the toxic and hallucinogenic effects of nitrogen at higher concentrations.
The prestigious Californian hospital, Kern Medical, explains in detail how this drug is used and what the woman feels after inhaling it: "Nitrous oxide helps lower anxiety and tension during contractions", it states.
Opioid medications
The American Pregnancy Association explains the risks and benefits of using opioid medications to relieve the pain of contractions during labor. In addition, it makes a list of the main medications used, explaining each one in detail.
Butorphanol, fenatol (which we talked about a while ago), nalbuphine and pethidine are the most commonly used narcotic medications. Its advantages include the fact that they help women reduce anxiety, to relax between contractions and minimize pain, although they do not disappear.
But opiates carry risks, both for the mother and the baby. The American Pregnancy Association lists the following:
Mother: nausea, vomiting, dizziness, itching, sedation, decreased gastric motility, loss of protective airway reflexes, hypoxia due to respiratory depression.
Baby: central nervous system depression, respiratory depression, early breastfeeding disorder, altered neurological behavior, decreased ability to regulate body temperature.
WHO explains the following about opioid medications used in childbirth:
"The findings indicated that parenteral opioids provided some pain relief and moderate satisfaction with analgesia during labor, although Up to two-thirds of women who received opiates reported moderate or severe pain. or relief of mild or moderate pain one to two hours after administration. Opioid drugs were associated with maternal nausea, vomiting and drowsiness, although different opioid drugs were associated with different adverse effects. There was no positive evidence of the adverse effects of opiates in newborns. There was not enough evidence to assess which opioid drug provided the best relief. of pain with less adverse effects "
Opioids can be administered orally, subcutaneously, intramuscularly, intravenously, intrathecally, and peridurally. The absorption route, its maximum peak of action and the duration of its effect will depend on the route of administration.
Nonpharmacological techniques
There are also non-pharmacological pain relief techniques, which may be beneficial for some women. In Babies and More we have talked about some of them on several occasions, but we will remember them again:
Delivery in the water
More and more maternity hospitals, centers and hospitals that incorporate dilation bathtubs due to the good reception they have had among the parturients. The use of hot water during dilation induces women to relax, reduces anxiety by stimulating the production of endorphins, improves uterine perfusion and shortens the period of dilation, increasing the feeling of pain control and satisfaction.
Specialized accompaniment
There are studies that have found that being accompanied at all times by a person of your choice increases well-being, improves health outcomes and greatly reduces the rate of interventions.
Among the main options of continuous support in childbirth are the accompaniment by midwives, doulas (professionals who accompany women during pregnancy and childbirth, providing them with emotional and physical support, and offering advice to face the moment in a way relaxed and confident) and the assistance of a family member chosen by the woman. These solutions are not incompatible with each other.
Freedom of movement
Being free to choose the position that women consider most comfortable at all times is essential for cope with the pain of contractions. Being lying and immobilized in a bed is not the most natural posture in labor, and unless we want to, it will not help us relieve the pain sensation.
Sitting on a fitness ball, balancing the pelvis, walking around the room or dancing, are some of the techniques preferred by pregnant women to face the time of dilation.
Massages during childbirth
Massages, provided by a trusted person, can help relax the muscles and relieve tension in the dilation phase. However, this is a very personal option, and there will be pregnant women who appreciate a massage, especially in the lumbo-sacral area, and others who, on the contrary, do not notice relief. It is best to ask before acting.
Relaxation and breathing techniques
Relaxation techniques help relieve muscle tension and focus the mind, two very important things in the process of labor. The state of relaxation also releases stress, decreasing the sensation of pain.
On the other hand, deep and conscious breathing is a widely used method for pain control. Controlling the flow of oxygen that enters the body and sending air to muscles that are tense helps to relax them.
Deep and relaxed breathing during childbirth also helps the baby receive a large amount of oxygen, helping it to cope better with the stress of birth.Experts recommend practicing yoga during pregnancy, as they consider it an ideal preparation exercise for the time of delivery, and also to cope with the typical discomforts of pregnancy.
Among the techniques of preparation for childbirth that use relaxation and conscious breathing as an aid in controlling the pain of contractions, we also find the Lamaze method and the Grantly Dick-Read method.
The Lamaze method, also called the psychoprophylactic method, argues that childbirth is a normal, natural and perfect physiological process, and teaches women to give birth with confidence and to consciously live that great moment. This method bets on tactile (massage), visual (relaxation through visualization) and auditory (words of encouragement) stimuli to help mothers in their relaxation and keep them away from painful sensations caused by contractions.
As for the philosophy of the Dick-Read method, it is based on childbirth without fear, that is, on trying to decrease and eliminate fear as much as possible, tension and pain through adequate education and emotional support. To achieve this, a series of breathing exercises and breathing control, muscle relaxation, information about what should happen in a normal situation and what you can do to help yourself at the time of delivery are carried out.
Acupuncture
There is also talk of the benefits of acupuncture to relieve labor pain, but some studies suggest that the ancient technique may not be as effective as some people believe.
However, from the Association El Parto es Nuestro they explain how in some hospitals in Sweden acupuncture is offered as one more technique to relieve tension and the pains of contractions.
Reiki
Reiki is an ancient Japanese technique of energy massages, performed through the laying on of hands. In countries such as the United Kingdom or the United States, this technique is used in more than 1,000 hospitals and is included in the Public Health System. But in our country there are very few hospitals that offer it, since There is no scientific study that supports it.
However, and as stated by the Ministry of Health in a document published in 2011, the fact that it lacks scientific evidence is not synonymous with inefficiency, as some patients claim to feel improvement after receiving it.
According to the Federation of Midwifery Associations of Spain, receiving reiki during pregnancy is beneficial because it provides the mother with a state of relaxation and integral well-being that also affects the baby, and prepares her physically and mentally for labor.
If you are interested in knowing more about any of these analgesic techniques for childbirth, do not hesitate to ask your doctor or midwife. They will clarify all your doubts.
Photos | iStock
