How painful is childbirth? Anesthesiologists will help you understand painless childbirth!

Childbirth is an important stage that most women cannot avoid in their lives. Before their babies are born, mothers have to go through a "world-shaking" baptism. Some mothers describe the pain of childbirth as "unforgettable pain, pain that makes them lose their dignity." Fortunately, with the improvement of medical conditions, more and more people can choose painless childbirth.

The emergence of painless childbirth has brought hope and help to mothers who choose natural childbirth. So, is painless childbirth really painless? Will painless childbirth have any adverse effects on the baby? With these questions, let's talk about painless childbirth today~

01 What is the principle of painless childbirth?

Pain is first transmitted from sensory fibers to the brain, which then reacts to pain, and the brain then issues instructions. The anesthesiologist punctures the spine with a needle and injects anesthetics and analgesics to reduce or completely block the conduction of sensory nerves, so that the brain is not stimulated and does not feel pain. Of course, this process is reversible, which means that once the drug metabolism is gone, the pain mechanism will be restored and will not affect health.

02 Is painless childbirth really “painless”?

First of all, painlessness is achievable, but it may be achieved by sacrificing motor function. Temporarily sacrificing motor function will prevent pregnant women from getting out of bed and moving around, which is not conducive to childbirth. In addition, pregnant women cannot feel the pain of uterine contractions, and their psychological sense of childbirth disappears, and they cannot get psychological support. At the same time, the second stage of labor requires the fetal head to press on the perineum to produce the urge to defecate, prompting pregnant women to hold their breath and increase abdominal pressure, creating a feeling of pulling down. Therefore, complete painlessness is not conducive to childbirth.

After nearly 10 years of cooperation between the Department of Anesthesiology and the Department of Obstetrics, the pain level of pregnant women during labor is controlled as follows: the VAS score of the first stage of labor is 3 points (0 points means no pain, 10 points means unbearable pain, and 3 points means tolerable uterine contraction pain), and the VAS score of the second stage of labor is kept at 5-7 points, in order to restore the perineal reflex and not affect the breathing effort of pregnant women. Therefore, painlessness is actually analgesia, and the professional term for "painless delivery" is "labor analgesia."

03 Does painless childbirth have any impact on the labor process?

The labor process refers to the whole process of a woman giving birth to a baby, which includes four stages of labor. The first three stages are mainly experienced in the delivery room (delivery waiting room and delivery room). Whether the delivery can be completed smoothly depends on the three basic elements of labor force, birth canal and fetus.

The first stage of labor refers to the period from the onset of regular uterine contractions to full cervical dilation (10 cm), which takes 11 to 12 hours for primiparas and 6 to 8 hours for multiparas. The first stage of labor can be divided into two stages: the latent stage and the active stage. (1) Latent stage: Uterine contractions gradually intensify, the cervical canal disappears, and the cervix dilates to 3 cm. The duration of this stage varies, but generally takes 8 to 16 hours. If the first stage of labor lasts for more than 20 hours, it is considered abnormal. (2) Active stage: The cervix dilates from 3 cm to full dilation, and the fetal presenting part enters the mid-pelvis.

[Note: Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University has adopted a new partograph, which considers a 6-cm cervical dilation as a sign of entering the active phase, and a prolonged latent phase (>20 hours for primiparas and >14 hours for multiparas) is not an indication for cesarean section.]

The second stage of labor refers to the period from full dilation of the cervix to delivery of the fetus, which lasts about 2 hours. At this time, the mother will feel the pain of uterine contractions relieved, but she will have an involuntary defecation sensation during contractions, which is caused by the compression of the rectum by the fetal head. Many mothers do not know how to push, and the reasons may include unclear guidance from the midwife and the mother's inability to understand the key points of the movements. Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University has opened a childbirth experience program, which will be more helpful for mothers to understand the childbirth process in advance. (Note: The second stage of labor in the new labor process is prolonged, more than 4 hours for painless delivery and more than 3 hours for no analgesia.)

The third stage of labor begins with the delivery of the fetus and ends with the delivery of the placenta. After the fetus is delivered, the placenta begins to separate after 1 to 2 uterine contractions, and there will be a small amount of bleeding. At this time, under the guidance of medical staff, the mother holds her breath to assist in the delivery of the placenta. Usually the placenta will be delivered completely within 30 minutes. If the placenta is not delivered 45 to 60 minutes after the delivery of the fetus, it needs to be separated manually. After separation, the doctor will check whether the placenta is complete, because residual placental tissue in the uterine cavity can cause postpartum bleeding and even infection. If the placenta is incomplete, the uterine cavity needs to be explored.

After the midwife sucks the amniotic fluid and wipes the baby, you can start breastfeeding and put the baby in your arms to promote emotional communication with the child. After the doctor sutures the perineal wound, the mother and the baby go to the postpartum observation room to observe the mother's bleeding, blood pressure and general condition. After about 1 hour, she can be transferred to the general ward.

Many studies at home and abroad have shown that labor analgesia can significantly shorten the first stage of labor. Labor analgesia during the latent period will not prolong the labor process.

04 Does painless childbirth have any impact on the baby?

Domestic and foreign studies have repeatedly confirmed that epidural analgesia used by mothers during labor has no effect on the Apgar score of the baby born. The Apgar score (muscle tone, pulse, frowning action (response to stimulation), appearance/skin color, breathing) is the most commonly used method to assess the overall health level of newborns. After the child is born, the score is based on five physical signs: skin color, heart rate, breathing, muscle tone and movement, and reflexes.

A full 10 points is a normal newborn, a newborn with a score of 7 or less is considered to have mild asphyxia, and a newborn with a score of 4 or less is considered to have severe asphyxia. Most newborns have a score between 7 and 10. Newborns will be scored at 1 minute, 5 minutes, and 10 minutes after birth, and the doctor will give the child appropriate treatment based on the score.

Epidural analgesics are generally made of a small dose of local anesthetics and a small amount of opioid analgesics that are highly diluted. These drugs are pumped into the epidural space (not directly into the blood) to act on the nerve roots and spinal cord, thereby producing an analgesic effect. Under normal circumstances, only a very small amount of drugs will be absorbed into the blood, and the amount of drugs that enter the fetus is even smaller, so the impact on the fetus is even smaller.

As we all know, Europe and the United States have very strict medical supervision, and the use of drugs for pregnant women and fetuses is even stricter, but they have long popularized painless delivery technology. According to public information, Britain began to implement painless delivery in the 18th century, and the painless delivery rate in the United States and Europe is as high as 98%. Their analgesics and anesthesia methods are the same as those in China.

To sum up, painless childbirth has minimal impact on the delivery process and the baby, so you can choose it with confidence.