Gynecology And Obstetrics-

Pain during childbirth

introduction

Emotional support from companions can make the birth pains more bearable.

The pain that occurs during childbirth is often referred to as the worst pain possible. However, pain perception can vary greatly from woman to woman, so that every woman experiences childbirth as differently painful. In general, birth pains cannot be compared with other pains that result from damage to the body (injury, accident), as they represent a desired reaction of the body to expel the unborn child.

Birth pain also has a protective function. Pain of all kinds should warn the body of tissue damage so that the person affected shows a corresponding reaction that reduces the pain and thus the risk of injury (e.g. pulling the hand away from the hot stove). It is similar for birth pains. The pain signals potential tissue damage from the pressure the child puts on the pelvic floor. The woman instinctively takes positions in which the pain is most bearable. As a rule, these are also positions in which the pressure on the mother's organs or the child's body is the least, so that the birth takes place in the gentlest way possible. According to this, birth pain has a certain protective effect.

causes

Birth pains are primary muscular pain, as they are caused by strong contractions of the uterus to be triggered. These pressing movements serve on the one hand Opening of the cervix, on the other hand the Positioning the child Towards the pool exit. During childbirth there is a release of Prostaglandins. These are pain messenger substances that irritate free nerve endings and thus lead to the development of pain.

In addition to the muscular pain, however, also play Stretching pain a major role. The cervix is enormously widened by the entering child. Same goes for the whole small pelvis, the dam region, the connective tissue and the skin. The surrounding muscles are also strongly stretched. This also leads to the development of pain. Due to the strong stretching, it can also become a during childbirth Perineal tear come.

The pain is intensified by severe tension in the woman giving birth. fear Before childbirth and also fear of the pain in childbirth lead to being subconscious Cramping of the muscles and thus increase the pain additionally. This usually makes the birth longer and the breaks between each one Labor painsthat are actually used for short-term recovery provide less relief.

The Intensity of pain also depends on the woman's individual pain perception. Every woman has her own pain threshold and is accordingly either more or less sensitive to pain than other women.

Natural ways to get pain relief

Various techniques can help you cope with labor pains. A pleasant environment for the woman, emotional and loving support from accompanying persons, motivation from clinic staff, but also conscious breathing and relaxation techniques have a supportive effect. It is often helpful when the woman tries to look forward to and work towards the goal, namely the birth of her child. If possible, the birth should not only be seen as a painful and bad event, but also as a positive, joyful experience. This can have a very positive effect on the woman's pain perception. The euphoria about the birth of the child makes many women forget the terrible pain even after the birth.

Breathing techniques: Regular breathing is very important for both mother and child during childbirth. This is the only way to ensure the baby's optimal oxygen supply. In addition, irregular breathing leads to premature exhaustion of the mother. The pain in childbirth and exhaustion from long labor processes can quickly lead to hyperventilation, with the woman breathing in too quickly and for too long, but only exhaling briefly. This leads to dizziness, headaches and exhaustion. The woman should therefore concentrate on her breathing and make sure that the exhalation phase lasts about three times as long as the inhalation. It is often helpful to use your voice as you exhale. Breathing becomes more conscious. A short pause can be inserted between inhalation and exhalation in order to consciously separate the two phases. Breath should not be held during the expulsion phase. This is sometimes recommended, but quickly leads to a lack of oxygen in the child's circulation. Instead, the woman should take a deep breath at the beginning of the contraction and then slowly let the air out during the act of contraction.This also reduces the pressure in the dam region, which is very relieving.
When the baby's head is born, no more active pressing is allowed. In this phase, a panting breathing technique is recommended, which serves to reduce the pressure in the abdomen as much as possible and not to exert any additional pressure on the child. Announcements by the obstetrician can be helpful for many women if the excitement and pain make it impossible for them to find a regular breathing rhythm.

Read more on the topic: Breathing at birth

Birth position: A comfortable birth position for the woman is very important for a bearable birth. It is best for the woman to find out for herself in which position she can best cope with the pain. Many women find it pleasant to give birth in the bath, as the warm water has a relaxing and relieving effect on the muscles. This can make the pain more bearable. A lying position can be comfortable as this position allows you to relax well in the pauses between contractions. While sitting, gravity helps bring the child into the birth canal earlier, but sometimes this position is more painful than other positions because the pressure on the pelvic floor is higher.
Movement: Movement at the beginning of the labor process can relieve pain. Many pregnant women are encouraged to walk around or let their pelvis rotate. This promotes muscle relaxation, but at the same time helps the baby to find entry into the birth canal.
The body's own endorphins: the body releases endorphins during childbirth. These act as the body's own pain relievers, so to speak. They ensure that the pain in childbirth remains bearable for the woman, especially between labor. In addition, towards the end of the birth, they trigger a trance-like state in the woman, which resembles an expansion of consciousness. This enables the woman to complete the labor and to endure the pain of labor. The euphoria at first sight of the child is also attributed to the effect of the endorphins. The hormone oxytocin is also released during childbirth. It is particularly important for the bond between mother and child and also promotes the formation of endorphins so that they are released into the woman's circulation in sufficient quantities.
Acupuncture: Some women choose acupuncture to prepare for birth. However, this method does not help every woman to the same extent. However, it can stimulate the production of the body's own endorphins and thereby naturally help to relieve pain. A massage of the neck and shoulders by an accompanying person can also relieve a woman of some of her tension during childbirth. This can do particularly well to very excited and tense women

You might also be interested in: Epidural anesthesia at birth

Medicinal pain relief

On medical side There are also means available for natural childbirth that can make the pain more bearable for women. For example, it is possible to create a epidural (also Epidural anesthesia = PDA) or one Spinal anesthesia. However, many women can manage without pain medication at all. In general, every woman should initially approach the birth as impartially as possible and first see how she is coping with the labor. On medicinal agents can still be used at a later point in time.

Epidural anesthesia: The PDA should make the severe labor pains more bearable for the woman giving birth. It is born naturally not to complete painlessness because the woman still has to feel the contractions so that she can actively help with the birth process by pressing in good time. The amount of anesthetic must not be too high, otherwise not only the pain in labor, but also the Labor is inhibited. When creating the PDA, the Cervix already opened wide enough his and the Have used contractions sufficiently.
During the procedure, the pregnant woman lies or sits with a curved back so that the Vertebral bodies Stand as far apart as possible. The doctor then selects the desired puncture height (usually between the 3rd and 4th Lumbar vertebrae), since there no spinal cord more runs. However, there are the nerves for the abdomen and legs, which can thus be reached by the anesthetic. A local anesthetic is injected directly under the skin with a syringe (so-called wheal) so that the thicker PDA needle does not become too uncomfortable for the patient later. After Numbing the skin then the actual PDA can be made. If the needle is correctly positioned, the anesthetic can be injected, which then numbs the nerves running there. Until full anesthesia is achieved, about 15-20 minutesbecause the anesthetic must first migrate through the hard meninges until it reaches the nerve pathways to be anesthetized. The needle can then be removed again. Alternatively, a small Plastic catheter be introduced through the needle, which can remain there for a long time. This can be used to subsequently administer further anesthetics or painkillers. This is also in the form of a self-dosing pump possible, which the pregnant woman can activate herself if necessary. With a single administration of anesthetic, the effect lasts for about 4 hours on.
A normal birth can be achieved by the PDA more complicated become, for example through the Inhibition of labor. Then an additional contraceptive drop may be necessary and the birth will be artificially prolonged. Often pregnant women with an epidural have more problems pushing the child out than women without an epidural. Hence the PDA actually should only with unbearable pain can be used.
Spinal anesthesia: The only difference between epidural and spinal anesthesia is the exact location where the anesthetic is injected. While it is injected into the so-called epidural space (space outside the meninges) with epidural anesthesia, it is injected with spinal anesthesia directly to the nerves injected. The effect is ultimately the same. In general, epidural anesthesia is the preferred method of pain therapy during childbirth. Under epidural and spinal anesthesia is also a Caesarean section possible.
Antispasmodics: Are antispasmodics anticonvulsant medicinesthat can be given to the woman giving birth by infusion. Due to the relaxing effect, the Supports opening of the cervixso that the birth can be made easier overall. Antispasmodics are also available in suppository form. They can be re-dosed several times if necessary.
Pain injection: The pregnant woman can too painkillers injected directly into the gluteal muscle become. This can be especially true at the beginning of childbirth pain relieving and relaxing Act. The downside is that the Spainkillers can pass to the child and reduce their respiratory drive. However, these complications are usually easy to manage and by the Administration of an opposing drug easy to pick up.