Where does the pain of childbirth come from?

During the first stage of labor, pain comes primarily from uterine contractions and cervical dilation. Pain impulses are transmitted to the spinal cord via visceral afferent fibers and sympathetic nerves in the T10-L1 segments. Its nature belongs to "visceral pain" and its location is very unclear.

The pain is mainly in the lower abdomen, waist, and sometimes there is a pulling sensation in the hips and sacrum. The pain is most severe when the cervix dilates to 7 to 8 cm. The pain decreases during the deceleration period.

During the second stage of labor, the pain comes from the stretching, expansion, and pulling of the vaginal and perineal muscles, fascia, skin, and subcutaneous tissue, which is transmitted by the perineal nerve to the sacral 2-4 spinal segments. The pain is sharp and clearly located, and is a typical "body pain." The mother will experience a strong, involuntary "feeding sensation".

History of labor analgesia

As early as in ancient times, people used methods such as chanting mantras and hanging talismans to relieve the pain during childbirth;

In 1660, Wake first reported the use of alcohol during labor to relieve labor pain;

In 1857, 38-year-old Queen Victoria of England received chloroform for pain relief during labor, which led to its recognition and promotion.

In 1880, Crickewitz used laughing gas for labor analgesia, which became popular due to its obvious effect. However, due to the large individual differences, it gradually became an auxiliary means.

In 1885, Soviet scholars first described labor analgesia in a textbook;

In 1901, Germans used spinal anesthesia for childbirth for the first time;

In 1906, in Austria, morphine was used for obstetric labor analgesia;

In 1920, low epidural anesthesia was used for childbirth;

In 1933, Dick Reid, a British obstetrician and gynecologist, advocated "natural childbirth" or "physiological childbirth" and opposed the use of drugs. He pointed out that labor pain is a syndrome of fear, tension, and pain, which can be controlled by the mother herself.

In the early 1950s, the former Soviet Union pioneered "spiritual preventive painless childbirth", the main contents of which included: pregnancy education, training of midwifery movements, guidance in various stages of delivery, and spiritual encouragement and support.

Since the 1980s, the use of epidural anesthesia for painless childbirth has been recognized by more and more doctors and mothers. By the end of the 1990s, the usage rate in countries such as the United States, Canada, and France had reached or exceeded 50%.

The current status of labor analgesia in my country

There is great disagreement about the technology of painless childbirth in China. Some people believe that childbirth is a natural process, anesthesia itself has risks, and unnecessary medical intervention should be reduced as much as possible to return to nature. Some people believe that labor pain ranks second only to burning pain in the medical pain index. According to a medical statistic, regarding labor pain, about 6% of first-time mothers feel mild pain, 50% feel significant pain, and 44% feel unbearable pain, or even "unbearable pain."

According to statistics from the health department, more than 98% of pregnant women in China are afraid of childbirth, and more than 90% of pregnant women hope to give birth naturally. However, about 60% to 70% of pregnant women voluntarily give up natural childbirth and request a cesarean section because they are afraid of pain. Therefore, some scholars believe that labor analgesia is the use of modern medical technology to support natural childbirth. Its essence is a kind of humanistic care, which is a reflection of the progress of medical care concepts.

In our country, the general practice of medical staff is to provide professional guidance to mothers, offer various types of help (vaginal delivery with pain/painless delivery, medicated/non-medicated painless delivery, analgesia after cesarean section, etc.), and help mothers choose the appropriate delivery method for them. For example, for those who do not have obvious labor pain, natural delivery is allowed without too much medical intervention; for those who have slight labor pain, non-drug analgesia can be given to assist natural delivery; for those who have severe pain, necessary drug analgesia is provided to help them reduce pain.