How painful is it to give birth? Let's see what the anesthesiologist says~

As the saying goes, there are eight sufferings in life, namely: birth, aging, sickness, death, separation from loved ones, long-lasting resentment, failure to obtain what one desires, and inability to let go. These eight sufferings, whether we have faith or not, are what we must face and overcome in life.

Birth is suffering. Every mortal is born from the mother's womb. The mother endures the danger and pain of losing her life to give birth to us. If misfortune occurs, both mother and child may die.

On August 31, 2017, a pregnant woman named Ma fell to her death from the 5th floor of the Obstetrics and Gynecology Department II at the Suide Branch of the Yulin First Hospital in Shaanxi Province, which attracted widespread public attention.

Who has the final say on how to have children?

Natural birth or cesarean section, who should you listen to?

On September 7, 2017, the National Health and Family Planning Commission responded: Regarding the Yulin maternity incident that has attracted much attention from the public. This is a very sad situation and is something no one wants to see. Here, we express our deepest condolences to the family of the pregnant woman.

In order to prevent tragedies from happening again, in this fast-paced and warm era, every expectant mother longs for more tenderness and less pain when welcoming a new life. On November 15, 2018, the National Health Commission issued the "Notice on Carrying out a Pilot Program for Labor Analgesia".

Through the pilot project, the labor analgesia rate was increased, the labor analgesia management was strengthened, and the quality of perinatal medical services was improved. The rate of intrathecal labor analgesia in pilot hospitals increased from 27.52% in 2017 to 53.21% in 2020.

In recent years, thanks to the vigorous promotion of the National Health Commission, the rate of painless childbirth in my country has increased year by year. The rate of spinal analgesia in pilot hospitals in some regions is as high as 40%-60%. However, there is still a big gap compared with the 80%-90% penetration rate of painless childbirth in developed countries such as Europe and the United States.

Among them, there is a shortage of labor analgesia professionals, and the job is not attractive. Anesthesia and obstetric medical staff are fully loaded or overloaded with medical work, the time of vaginal delivery is uncertain, labor analgesia requires medical staff to invest more time and energy, the staffing is not enough to meet the full implementation of labor analgesia, and the performance distribution related policies cannot fully mobilize the enthusiasm of medical staff, etc., but more is the lack of awareness of painless delivery by patients and their families, there is information asymmetry between doctors and patients, they know nothing about medical knowledge, have their own anxiety, and even distrust and misunderstanding of medical staff.

Therefore, as an anesthesiologist, health popularization is an important responsibility of ours. It is urgent to help the public understand and master health knowledge, prevent diseases, and improve their quality of life through the transfer of scientific knowledge.

How painful is it to give birth to a child?

Clinically, pain severity is usually graded from 0 to 10.

0 points: No pain.

0-3 points: mild pain.

4-6 points: moderate pain.

7 points or above: severe pain.

10 points: The most severe pain imaginable.

1. What is “painless childbirth”?

Painless childbirth, also known as labor analgesia, is a method to reduce the pain of natural childbirth for women and improve the quality of childbirth and the comfort of mothers.

The most commonly used method of labor analgesia is spinal anesthesia.

Intraneurial anesthesia refers to the injection of anesthetic drugs into the subarachnoid space or epidural space in the spinal canal. The spinal nerve roots are blocked, causing anesthesia in the corresponding area innervated by the nerve roots.

2. Applicable groups and contraindicated groups?

Applicable people: women who can give birth vaginally.

Contraindications: women who cannot give birth vaginally, or those with intracranial hypertension, abnormal coagulation function, puncture site infection or systemic infection.

3. Will labor analgesia affect the child’s intelligence and breastfeeding?

No. The dosage and concentration of labor analgesia are only 1/10-1/20 of that of cesarean section. Painless labor is to inject anesthetic drugs into the subarachnoid space or epidural space in the spinal canal. The spinal nerve roots are blocked, causing anesthesia in the corresponding area innervated by the nerve roots. The anesthetic drugs will hardly enter the child's body and will not affect the child's intelligence. Before choosing labor analgesia, the obstetrician and anesthesiologist will conduct a series of assessments on the parturient, including medical history, physical condition, blood routine, coagulation function, etc. Only those with normal assessment results can undergo labor analgesia. The principle of labor analgesia: maintain the safety of the mother and fetus. The drugs for epidural labor analgesia act locally, and the dose of drugs that enter the mother's blood and are secreted with breast milk is negligible, which will not have any effect on the baby.

4. Will labor analgesia cause postpartum back pain?

There is no obvious connection. Most of the postpartum back pain in mothers is caused by the stretching of ligaments during pregnancy, the drop in hormone levels after delivery, the incomplete recovery of ligaments, and the incorrect posture of holding the baby and fatigue.

5. Will labor analgesia prolong the labor process?

No. On the contrary, after taking labor analgesia, the muscles relax and the cervix will open faster.

6. When does labor analgesia begin?

The old practice was that labor analgesia could only be implemented when the mother's cervix was 2-3cm dilated.

The new practice is that after the mother enters the delivery room, analgesia can be started at any time if requested. In order to achieve the best analgesic effect, labor analgesia should be started "early rather than late".

Currently, there is an extreme shortage of anesthesiologists, and anesthesiologists in almost every hospital are severely overloaded. However, in order to reduce the pain of childbirth for mothers, everyone is working hard to persevere.

I hope that one day, anesthesia work will be given enough attention, and the sense of professional achievement and treatment of anesthesiologists will change qualitatively. At that time, more and more outstanding talents will join the anesthesiologist team. Just for labor analgesia, the labor analgesia rate will be further improved and more women will benefit.

Dongxing People's Hospital (Dongxing Branch of the First Affiliated Hospital of Guangxi Medical University)

Department of Anesthesiology Chen Yunmin (attending physician)

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