Sun. Jul 14th, 2024
About Pain Control Techniques
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During pregnancy, many doubts assail us about the type of delivery we want. Some women want to give birth without anaesthesia and resort to other analgesic techniques for pain relief. Others, on the other hand, prefer the epidural when the time comes.

Anaesthesia 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. Anaesthesia, however, refers to the complete loss of sensory perception, including loss of consciousness.

In other words, analgesia is used to modulate the intensity of the pain that we perceive, while anaesthesia completely cancels any sensation of pain.

As we mentioned at the beginning, it is normal for doubts to arise during pregnancy about what to do at the delivery time. We consider whether to resort to analgesia to minimise pain or opt for anaesthesia to eliminate it.

It is essential to be adequately informed and clarify all our 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 assessment based on our physical condition, history, or illnesses/ complications related to pregnancy, will define the best strategy to follow.

Several types of pain relief can be used during labour. 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 and Australia, use nitrous oxide or laughing gas in many childbirths to relieve women’s pain without interfering with the process.

This gas is inhaled through a mask and neutralises nerve transmission at the brain level; that is to say, it does not eliminate the pain but makes it live differently. Its effect is speedy, and as soon as the mask is removed, it begins to decrease until it disappears.

Laughing gas must be administered under medical supervision and continuously mixed with oxygen at a concentration of 50 per cent to mitigate the toxic and hallucinogenic effects of nitrogen at higher concentrations.

Opioid medications

It is explained that the risks and benefits of using opioid medications to ease the pain of labour contractions. In addition, it makes a list of the primary medicines used, explaining each of them in detail.

Butorphanol, phenol (which we told you about a while ago ), nalbuphine and pethidine are the most widely used narcotics. Among their advantages is the fact that they help women reduce anxiety, relax between contractions and minimise pain, although they do not make it disappear.

But opioids carry risks, both for mother and baby. The American Pregnancy Association lists the following:

Mother: Nausea, vomiting, dizziness, itching, sedation, decreased gastric motility, loss of airway protective reflexes, hypoxia due to respiratory depression.

Infant: central nervous system depression, respiratory depression, impaired early breastfeeding, altered neurological behaviour, decreased ability to regulate body temperature.

The WHO explains the following about opioid medications used in childbirth:

“The findings indicated that parenteral opioids provided pain relief and reasonable satisfaction with analgesia during labour. However, two-thirds of women receiving 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 insufficient evidence 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 peridural. The absorption, its maximum peak of action and the duration of its effect will depend on the route of administration. 

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 are going to remember them again:

water birth

More and more maternity hospitals, centres and hospitals are incorporating dilatation tubs due to the excellent reception they have had among the parturients. The use of hot water during dilation induces relaxation in women, reduces anxiety by stimulating the production of endorphins, improves uterine perfusion and shortens the dilation period, increasing the sensation of pain control and satisfaction.

Specialized accompaniment

Some studies have found that being accompanied at all times by a person of your choice increases well-being, improves health outcomes and considerably decreases the rate of interventions.

Among the main options for 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 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 the woman considers most comfortable at all times is essential to cope with the pain of contractions. Lying down and immobilised in a bed is not the most natural position in labour, and unless we want it, it will not help us relieve the sensation of pain.

Sitting on a fitness ball, rocking your pelvis, walking around the room, or dancing are some techniques preferred by pregnant women to face the moment of dilation. 

Massages during childbirth

Massages provided by a person you trust 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 lumbosacral 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 essential things in the labour process. 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 tense muscles helps relax them.

Deep, relaxed breathing during labour also helps your baby get plenty of oxygen, helping him better cope with the stress of birth.

Experts recommend practising yoga during pregnancy, as they consider it an ideal preparation exercise for the moment of childbirth and also to cope with the typical discomforts of pregnancy.

Among the childbirth preparation techniques that use relaxation and conscious 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 women to give birth confidently and live this great moment consciously. This method relies on tactile (massage), visual (relaxation through visualisation), and auditory stimuli (words of encouragement) to help mothers relax and keep them away from the painful sensations caused by contractions.

The philosophy of the Dick-Read method is based on childbirth without fear, that is, trying to reduce and eliminate anxiety, tension and pain as much as possible through adequate education and emotional support. To achieve this, a series of breathing exercises and breath control, muscle relaxation, information on 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 in relieving the pain of childbirth, but some studies suggest that the ancient technique may not be as effective as some belief.

However, the El Parto es Nuestro Association explains how in some hospitals in Sweden, acupuncture is offered as one more technique to relieve tension and the pain of contractions.

Reiki

Reiki is an ancient Japanese technique of energetic 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 hospital centres 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, as the Ministry of Health stated in a document published in 2011, the fact that it lacks scientific evidence is not synonymous with inefficiency since some patients claim to feel improvement after receiving it; receiving Reiki during pregnancy is beneficial because 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 labour.

If you are interested in learning more about these analgesic techniques for childbirth, do not hesitate to ask your doctor or midwife. They will clarify all your doubts.

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