Whether childbirth is painful or not depends not only on the doctor's skills, but also on the individual situation of the mother.

In the past, when I was on duty, I had to worry about orthopedic emergencies, appendicitis emergencies, or major car accident emergencies. Today, the emergency room has an additional labor analgesia "out of thin air."

Faced with this new thing, many anesthesiologists are in a state of headache. The reason is that they were confident in all kinds of anesthesia before, but they dare not challenge labor analgesia.

Today, let’s talk about this topic~

Let's first talk about what labor analgesia is:

Labor analgesia, also known as analgesic labor, is usually called "painless labor." Generally speaking, "painless" is just an idealized state. In other words, medical staff can only use various methods to reduce the pain during labor.

At present, the commonly used methods include psychological comfort analgesia during labor, acupuncture anesthesia, transcutaneous electrical nerve stimulation, underwater labor, analgesics, and spinal analgesia. The specific implementation process can be broken down into many forms, such as prenatal education, family companionship, and doula labor. In short, as long as it can relieve pain, it belongs to the category of labor analgesia.

However, despite the numerous schools of thought, the only one that has been proven to be effective is spinal analgesia performed by anesthesiologists.

When obstetrics departments in various hospitals found that spinal analgesia was effective, they regarded it as a "magic skill". When communicating with mothers, they were very open about it. As a result, mothers and their families all thought that "it won't hurt after the injection". It is also because of this that the anesthesiology department is in a difficult position as soon as it comes on the scene. If the injection is not good, it seems to be purely due to poor skills.

Today we will discuss this: Is it because of poor technology, or are there other reasons?

In essence, spinal analgesia is nerve block. The key is whether it can be blocked accurately. If the analgesic accurately blocks the target nerve, there will be no pain. Therefore, it is crucial to understand which nerve conducts labor pain.

Having said this, I believe that this is also a knowledge point that many anesthesiologists are concerned about. After all, this part of the anatomy is too detailed and may be a little vague or uncertain.

Labor pain is obviously related to the uterus, so let's take a look at how the nerves of the uterus are distributed: the uterus is innervated by the sympathetic and parasympathetic nerves, while the uterine body and cervix are innervated by different nerves.

The movement of the uterine body comes from the control of the sympathetic motor nerve fibers from T5 to T10 in the spinal cord. The preganglionic fibers exchange neurons in the adjacent sympathetic ganglia, and the postganglionic fibers participate in the formation of the anterior aortic plexus and hypogastric plexus in the celiac cavity, and finally form the pelvic nerves next to the cervix.

The sympathetic sensory fibers of the uterine body pass through the pelvic plexus, hypogastric plexus, and aortic plexus into the lumbar and lower thoracic sympathetic trunks, and finally enter the spinal cord along the T11-L1 spinal nerves.

The movement and sensation of the cervix are mainly transmitted by the S2-S4 parasympathetic nerves. On both sides and behind the uterus, the posterior branches merge with the sympathetic nerves from the pelvic plexus to form the uterovaginal plexus and the greater cervical nerve. The sensation of the upper part of the vagina is transmitted by the S4 parasympathetic nerve, while the sensation of the lower part of the vagina is composed of the anterior branches of the S2-S4 spinal nerves.

Obviously, a good labor analgesia should control the pain of T10-S4 nerve conduction. However, the best block range of neuraxial analgesia is three segments above and below the location of the catheter tip. And T10-S4 is exactly six segments. In other words, the catheter tip must be placed accurately at the midpoint of L1.

If you are not an anesthesiologist, you may not understand what this question means. This is related to the operation of spinal puncture: spinal puncture is a blind operation. Although some hospitals currently use ultrasound guidance, they are very few after all. Blind operation may be inaccurate. Another objective reason is that the positioning of the puncture point is completely based on the feel, and this error is completely forgivable if it is within one segment.

However, labor analgesia does not give you the opportunity to make a single mistake. Therefore, some incomplete blockage is objectively unavoidable.

Some people say that it was fine at first, but then it became very painful.

This is related to the labor process. The first stage of labor is mainly uterine contraction pain transmitted from T10 to L1.

The pain at this time is often located higher up in the abdomen. If the catheter happens to be located higher up, the pain will be gone or significantly improved.

However, once the second stage of labor arrives, the analgesic effect is not enough because the pain in the second stage of labor is mainly caused by the pressure of the fetal presenting part transmitted from S2 to S4.

At this point, increasing the dosage may not be helpful.

If the mother is intolerant to pain, has mood swings, or the fetus is suffering from hypoxia, it is very likely that the fetal heart rate will be abnormal. Because of this, this process often becomes a high-incidence period for failed normal delivery.

At this point, sharp-eyed friends seem to have noticed the word "emotion". Is pain related to emotions?

Of course it is related, and it is very important.

Let's look at the definition of pain: it is an unpleasant sensory and emotional experience associated with tissue damage, or the potential for tissue damage, or a description of similar damage.

To put it bluntly, it hurts as much as you feel it.

If you still don't understand, let me give you an example: suppose a person is singing in a dance hall and is accidentally scratched by a bottle, he will not feel much pain. At that time, because he is very excited, his focus is not on the wound; for another example, if a soldier is charging into battle, will he be sensitive to pain? No, because he is focusing on the battle.

Therefore, what we want to say is that we must learn to distract ourselves. In practice, we have found that those who complain about pain and cannot hold on to a natural birth and switch to a cesarean section are usually afraid of pain. The reason is that they are too focused on giving birth.

In conclusion, don't take labor analgesia so seriously. The higher your expectations, the worse it is. You should treat it with a normal attitude. As long as the pain is relieved a little, you will be happier than before. If the effect is very good, it means that the anesthesiologist is accurate and you have adjusted well.

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