During pregnancy there are many doubts that assail us about the type of delivery we want. Some women are clear that they want to give birth without anesthesia, and resort to other analgesic techniques for pain relief . 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 labor , because they are not the same, nor do they have the same effect. However, we recommend that you consult all your doubts with your doctor or midwife in order to make the decision that makes you feel calmer. We start with analgesia in labor: what is it and how many types are there?
Anesthesia and analgesia: is it the same?
Analgesia refers to the modulation of the perception of pain that we reach 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.
As we 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 to opt for anesthesia to eliminate it.
It is important to inform yourself correctly and clarify all your doubts with the specialist , since even if we state our preferences in our birth plan, the final decision will always be made by the doctor, who after an evaluation based on our physical condition, history, or diseases / complications related to pregnancy, will define the best strategy to follow.
There are several types of pain relievers that can be used during labor. In some cases it is pharmacological analgesia, but not in others. 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 the woman’s pain without interfering with the process.
This gas is inhaled through a mask , and neutralizes nerve transmission at the brain level; that is, it does not eliminate pain but it makes you live differently. Its effect is very fast, and as soon as the mask is removed, it begins to diminish until it disappears.
Laughing gas must 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 reduce anxiety and tension during contractions,” he says.
Opioid medications
The American Pregnancy Association explains the risks and benefits of using opioid medications to ease the pain of contractions during labor. In addition, it makes a list of the main drugs used, explaining each of them in detail.
Butorphanol, fenatol (which we talked about a while ago), nalbuphine and pethidine are the most widely used narcotic medications. Its advantages include the fact that they help women reduce anxiety, relax between contractions and minimize pain , although they do not make it disappear.
But opiates carry risks for both mother and baby . The American Pregnancy Association lists the following:
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Mother: nausea, vomiting, dizziness, itching, sedation, decreased gastric motility, loss of protective airway reflexes, hypoxia due to respiratory depression.
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Baby: central nervous system depression, respiratory depression, early disturbance of breastfeeding, altered neurological behavior, decreased ability to regulate body temperature.
WHO explains the following about opioid drugs 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 opioids reported moderate or severe pain or mild or moderate pain relief once or twice. 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 adverse effects of opioids in newborns. There was no evidence enough to assess which opioid drug provided the best pain relief with the fewest adverse effects “
Opioids can be administered orally, subcutaneously, intramuscularly, intravenously, intrathecally, and epidurally. The route of administration will depend on the absorption, its maximum peak of action and the duration of its effect.
Non-pharmacological 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 water
More and more maternity wards, centers and hospitals are incorporating dilatation bathtubs due to the good reception they have had among women in labor. The use of hot water during dilation induces a woman to relax , reduces anxiety by stimulating the production of endorphins, improves uterine perfusion and shortens the period of dilation, increasing the sensation of pain control and satisfaction.
Specialized accompaniment
Studies have shown that being accompanied at all times by a person of your choice increases well-being, improves health outcomes and considerably reduces the rate of interventions .
Among the main options for continuous support during childbirth are accompaniment by midwives, doulas (professionals who and accompany the woman during pregnancy and childbirth, providing emotional and physical support, and offering advice to face the moment in a good 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
Having the freedom to choose the position that the woman considers most comfortable at all times is essential to cope with the pain of contractions . Lying down and immobilized in a bed is not the most natural position in labor, and unless we want it to, it will not help us relieve pain.
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 moment of dilation.
Massages during labor
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, reducing 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 into the body and sending air to tight muscles helps relax them.
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 labor preparation techniques that use relaxation and mindful breathing to help control the pain of contractions, we also find the Lamaze method and the Grantly Dick-Read method.
The Lamaze method, also called the psychoprophylactic method, maintains that childbirth is a normal, natural and perfect physiological process, and teaches a woman to give birth with confidence and to live that great moment consciously. This method relies on tactile (massage), visual (relaxation through visualization) and auditory (words of encouragement) stimuli to help mothers relax and keep them away from the painful sensations caused by contractions.
As for the philosophy of the Dick-Read method, it is based on a fearless delivery, that is, trying to reduce and eliminate fear , tension and pain as much as possible through adequate education and emotional support. To achieve this, a series of breathing exercises and breathing control, muscle relaxation, information on what should happen in a normal situation and on what you can do to help yourself at the time of delivery are carried out.
Acupuncture
The benefits of acupuncture for relieving labor pain are also discussed, but some studies suggest that the age-old technique may not be as effective as some people believe.
However, from the Parto es Nuestro Association they explain to us how acupuncture is offered in some hospitals in Sweden as one more technique to relieve tension and pain from contractions.
Reiki
Reiki is an ancient Japanese technique of energetic massages, performed through the imposition 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 Midwives Associations of Spain, receiving reiki during pregnancy is beneficial as it provides the mother with a state of relaxation and comprehensive well-being that also affects the baby, and prepares her physically and mentally for labor.
If you are interested in learning 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
In Babies and More | “Doulas are at the service of the mother.” Interview with the doula Carolina Cerro, To have a happy delivery: seven things you should avoid during labor, How will I know that I am in labor? Unmistakable symptoms that the day has come, They recommend dilating, but not giving birth in water
