Take care of maternal love and give birth happily.
"Caring for maternal love and giving birth happily" is the initiation theme of "Global Mothers' Public Welfare Delivers Happy Childbirth", and it is also the pursuit of humanistic care for women's childbirth all over the world. It hopes to reduce the physical exertion of women during childbirth, alleviate the pain in the whole childbirth process and fully enjoy the happiness of being a mother. In developed countries, parturients have already enjoyed labor analgesia, but in China, the labor analgesia rate is less than 1%. Therefore, there is still a lot of work to be done to widely carry out labor analgesia in China and better serve pregnant women.
"Global Public Welfare Sending Happy Mothers" is a public welfare international project initiated by Amic public consulting company in September 2009. Mr. Tao Wei, the general planner of the project, proposed that with the support of the World Health Organization (WHO) Breastfeeding Promotion Association, the American Association for Analgesic Delivery and Beijing Antai Maternity Hospital, the activity aims to fully understand and care for the great maternal love through the popularization and application of cutting-edge clinical means such as underwater delivery, hypnosis and analgesia, so that more people can understand and benefit from the new academic concept of obstetrics and mothers all over the world can share happy delivery moments.
Labor analgesia
Non-drug analgesia
1. Psychological comfort and analgesic delivery methods
In clinical practice, it is found that labor analgesia is closely related to the mental and psychological state of the parturient, such as fear, anxiety, fatigue, lack of self-confidence and bad stimulation of the surrounding environment, which can reduce the pain threshold of the parturient. The analgesic method comprises:
L) Prenatal education: correct the wrong idea that "childbirth must be painful".
2) Sports midwifery actions: abdominal breathing and massage.
3) Care and support: home delivery, accompanying delivery, etc.
4) "Doula" delivery method: the parturient who has had natural delivery experience accompanies the parturient.
2. Acupuncture anesthesia
3. Percutaneous electrical nerve stimulator
Principle of action: Distract the attention of lying-in women, and the effective rate of analgesia is only 25%.
4. Underwater transportation
That is, the parturient sits in the hot tub at the beginning of the first stage of labor and the second stage of labor, and relies on the buoyancy of hot water and water to relieve labor pain, but the analgesic effect is not exact.
Advantages of non-drug analgesia: no effect on labor and fetus.
Disadvantages of non-drug analgesia: poor analgesic effect.
Commonly used drugs induce labor and relieve pain
Nitrous oxide inhalation method
Usage: After mixing N2O: O2 = 50% and 50% with an anesthesia machine, the parturient puts an anesthesia mask on the nose and mouth, and takes several deep breaths through the mask 20-30 seconds before the contraction. When the labor pain disappears, you can take off the mask. Inhale intermittently during the first and second stages of labor.
Advantages:
1)。 The effect is reliable, and about 50% of parturients have effective analgesia.
2)。 Quick effect, quick failure.
3)。 Does not irritate the respiratory tract.
Disadvantages:
1).N2O incubation period is 30-45 seconds, and uterine contraction occurs before labor pains. Therefore, intermittent inhalation should be used at least 50 seconds before uterine contraction. If you inhale when you feel pain, it will not only have no analgesic effect, but will intermittently enter a shallow sleep state during contractions, accompanied by different degrees of dizziness and nausea.
2)。 If inhaled too deeply, it will produce general anesthesia effect and the possibility of aspiration.
3)。 Nitrous oxide is an inhalable gas, which will cause indoor air pollution. ? [ 1]?
2. Demero
Usage: The usual dosage is 50- 150mg, which takes effect in15-20min after taking the medicine, reaches the peak in1-1.5h, and gradually fades after 2h.
Advantages:
1)。 Management is simple.
2).40%-60% of parturients have effective analgesia.
Disadvantages:
1)。 After injection, it can quickly pass through the placental barrier, and it will appear in fetal blood in a few seconds after maternal intravenous injection, and reach the drug balance between maternal blood and fetal blood in 6 minutes. The concentration of fetal blood reached its peak at 2 hours after intramuscular injection, which inhibited the respiratory center of newborns. 2)。 Dizziness, nausea, vomiting, irritability, mostly manifested as indifference, unresponsiveness, and frequent drowsiness during contractions.
3. Diazepam
Usage: The usual dosage is 0.2-0.3 mg/kg for intravenous injection.
Advantages: It is simple to take and suitable for nervous parturient.
Disadvantages:
1)。 No analgesic effect.
2)。 It can lead to severe hypotension and long-term hypothermia in newborns, especially premature infants.
4. Regional block: This method is performed by obstetricians.
1) perineal local infiltration block
2) Paracervical block? [ 1]?
Intraspinal injection for analgesia
It is the most reliable, extensive and feasible analgesic method recognized by anesthesia circles at home and abroad at present, and the effective rate of analgesia is over 95%.
Advantages:
1. Good analgesic effect, completely painless, especially suitable for parturient with severe labor pain.
2. The parturient is awake, can eat and drink, and can participate in the whole process of delivery.
3. You can walk on the ground without movement disorder.
4. It can flexibly meet the anesthesia needs of forceps and cesarean section, and win time for ending the labor process as soon as possible.
5. With the emergence of new drug delivery methods-CSEA and PCEA technology and the emergence of new drug-ropivacaine, the analgesic effect of labor has been improved, with little impact on mother and baby and labor process.
Disadvantages:
1. The high technical content requires the operation of an anesthesiologist with professional anesthesia skills, which means that administration is not very simple;
2. There are technical risks, and there is a 3% failure rate of analgesia;
3. Improper selection of drug dosage and concentration will have adverse effects on movement block, labor process, mother and baby. Intraspinal injection for labor analgesia is invasive and has certain operational and technical risks. ? [ 1]?