Painless Birth

Looking at the historical development of painless childbirth, it has been described as a painful, life-threatening, and frightening event since the earliest written records, and retained this characteristic until the last century. After the discovery of the anesthetic effects of ether and chloroform in the mid-1800s, British religious authorities claimed that this human invention was a sin against God's will in the miracle of childbirth. Three months after Morton's historic demonstration of ether's anesthetic properties at Massachusetts General Hospital in Boston in 1846, modern anesthetics were used for the first time in childbirth. Queen Victoria preferred to use anesthetics for childbirth. The first painless birth using a method called regional anesthesia was performed in July 1900. In subsequent years, as a result of advancements in childbirth anesthesia, it is increasingly applied safely in pregnant women who desire painless childbirth.

During labor, when the uterus contracts, pain travels from the uterus through nerves to the spinal cord and then to the brain, causing discomfort. Many non-medical techniques can help control pain during labor. These include breathing and relaxation techniques, warm baths, massage, supportive nursing care, position changes (standing, sitting, walking, rocking), and the use of a birthing ball. However, these methods are often insufficient on their own. Painless childbirth methods include systemic pain management, regional anesthesia, general anesthesia, and alternative non-pharmacological methods.

Systemic Pain Treatment: These are medications administered by injection into the bloodstream that reduce, but do not completely eliminate, pain during labor. Narcotic drugs (opioids) are the most effective drugs in making labor pain more bearable. These drugs are administered intravenously or intramuscularly. This method is used in patients who do not prefer regional anesthesia for childbirth. They are usually administered by obstetricians and nurses. Sometimes, they can also be administered by anesthesiologists using intravenous infusion pumps, a method called patient-controlled analgesia.

The pump is programmed to deliver a specific amount of medication, and the patient will reduce their pain by pressing the button when needed, depending on the pain they perceive. The most significant disadvantages of narcotic drugs are that they cause drowsiness and lethargy. Other side effects may include nausea, vomiting, decreased respiration, itching, constipation, and urinary retention. If breastfeeding is planned, initial efforts may be more difficult. Another side effect of narcotics is that they all cross the placenta and enter the baby's circulation, which can cause slight changes in the baby's heart rate and mild drowsiness after birth. Ultimately, these drugs, given in low doses to the mother, are not expected to negatively affect the baby.

Regional Anesthesia: Regional anesthesia involves blocking painful stimuli within the spinal cord, preventing their transmission to the brain. Epidural, spinal, and combined spinal-epidural anesthesia are called regional anesthesia because they anesthetize a specific area of ​​the body. In these methods, the area of ​​the body under injection becomes numb, allowing the mother to remain awake during contractions, feeling pain-free and more comfortable. Regional anesthesia is administered by anesthesiologists and is popular in childbirth because it provides excellent pain control and very little medication passes to the baby. The spinal cord and nerves are located in a sac containing cerebrospinal fluid. The epidural space surrounds this sac. The medications used in regional anesthesia (local anesthetics and narcotics) block the nerves that carry pain signals from the uterus and cervix to the spinal cord and brain. Spinal anesthesia is performed by injecting anesthetic drugs into the fluid-filled sac (cerebrospinal fluid). A small amount of local anesthetic provides immobility during a cesarean section, while the narcotic provides pain relief for 12-24 hours after surgery. In epidural anesthesia, a thin catheter (a plastic tube) is placed in the space outside the amniotic sac (epidural space), and the necessary medications are administered through this catheter. The aim is to relieve pain without restricting leg movement or pushing during labor. Spinal and epidural anesthesia have the same effect (numbing a wide area of ​​the body) because in both techniques, the nerves are numbed where they branch off from the spinal cord. Spinal anesthesia is preferred for women who are not in labor but need a cesarean section, while epidural anesthesia is preferred for women who want a painless vaginal delivery to relieve pain. In combined spinal-epidural anesthesia, the spinal injection is followed by the placement of the epidural catheter. The onset of effect is quicker because the spinal injection is given first. The anesthesia is maintained through the epidural catheter. After both epidural and combined spinal-epidural anesthesia, pain relief can be maintained with patient-controlled epidural analgesia, which provides continuous medication delivery through the epidural catheter using a pump. Some rare side effects and complications may develop, which can be avoided with various precautions. These include tremors, low blood pressure, itching, local anesthetic reaction, intravenous injection, persistent pain in some areas, and headache. Serious complications such as nerve damage, bleeding into the epidural or spinal space, paralysis, and infection are quite rare.

General Anesthesia: With intravenous administration of medication, rapid loss of consciousness develops, and a tube is placed in the airway to support breathing. It is one of the anesthesia methods used to relieve labor pains during cesarean section. The medications used to put the baby to sleep in general anesthesia are not harmful to the baby because they have a minimal anesthetic effect on the baby. This is because these drugs do not reach sufficient amounts in the baby's brain to put the baby to sleep. Although the mothers are asleep, babies are usually born active and cry. After waking up, pain relievers are administered intravenously. One of the most important concerns regarding general anesthesia is the possibility of the mother's stomach contents rising up into the esophagus and into the lungs (aspiration) following loss of consciousness. However, the anesthesiologist takes extra precautions to protect the mother's lungs from this serious complication.

Alternative Methods: In situations where mothers do not want medication or regional anesthesia during childbirth, or where these options are not available, non-pharmacological analgesic methods to help mothers cope with labor pain include aromatherapy, hypnotherapy, Lamaz technique, water birth, acupuncture, Transcutaneous Electrical Stimulation (TENS), touch and massage, and the mother's movements and position during labor.

Can an epidural, used in vaginal delivery, be used in cesarean delivery?

If the mother requires a cesarean section and the epidural catheter is functioning, the anesthesiologist administers additional medication through the catheter to achieve a sufficient level of numbness for surgery. If the epidural is not functioning, it is reinserted, or spinal or general anesthesia is administered.

How long does the block last when regional anesthesia is administered?

Epidural analgesia can be extended for as long as needed.

Is anesthesia safe for babies?

Both general and regional anesthesia are safe and have no significant effect on the baby. Regional anesthesia is preferred whenever possible because it minimizes airway complications. During both anesthesia methods, safety monitors are used to track the mother's vital signs and ensure they are within safe limits for the baby's health.

When can I get regional anesthesia?

Epidural analgesia is administered at the onset of active labor, which is usually characterized by regular uterine contractions. Consulting with an anesthesiologist before delivery allows for the selection of the most suitable method for the mother.

Can I strain when regional anesthesia is administered?

Regional anesthesia does not eliminate your ability to strain; it makes it easier.

Are there any situations where epidural analgesia is advantageous compared to natural childbirth?

Epidural analgesia may be more beneficial in mothers with heart or lung problems or pregnancy toxemia.

If I stay awake during a Cesarean section, will I feel anything?

With spinal or epidural anesthesia, no pain is felt during surgery. You may feel movement in the lower body. You may feel pulling or tugging as the obstetrician separates the abdominal muscles and tissues. You may feel pressure in your chest as the baby presses on your abdomen during delivery.

What is the approach to pain management after a cesarean section?

Pain management during a cesarean section depends on the type of anesthesia used. If regional anesthesia was used, medications given into the spinal or epidural space can last up to 18 hours after surgery without causing dizziness. After general anesthesia, intravenous patient-controlled analgesia may be administered. Oral medication can be used after the first day.