Analgesics to comparison, for childbirth

This article is also available in Italian.

This is what you can choose when it comes to alleviating pain.
A quick comparison of painkillers that are available at the time of childbirth, and can be applied for before the baby is born.

Epidural

This is a local anesthetic, performed in the area surrounding the spinal cord. The mixture of liquid anesthetic with a drug similar to morphine is inserted through a needle or catheter between two vertebrae in the spinal canal.

Epidural anesthesia prevents to feel pain in the uterus, the pelvic floor, vagina and spine. Although I think the disadvantages outweigh the advantages, each of you will choose consciously. In the article, Epidural analgesia, you’ll find discussed in greater detail the epidural anesthesia.

Advantage:

• Pain in the opening phase is very small, therefore its effectiveness is proven.

• Although generally recommended in cases of multiple births, or early preeclampsia almost everywhere now can you request.
• Sometimes the epidural leads to an increase in blood flow in the placenta, giving more oxygen to the baby.

Versus:

• The second stage of labor is significantly longer and may be necessary to stimulate the birth.

• With the epidural is more frequent use of forceps or suction.
• When the anesthesiologist, incidentally, puts a needle a little deeper, after the birth the mother may have a nagging headache.
• Only a doctor can perform an epidural anesthesia and possible problems or risks to mother and baby are usually attributed to errors in the execution of anesthesia. For this reason, the doctor must be well prepared and have some experience.

Spinal

The anesthesiologist proposes spinal anesthesia, instead of the epidural, when the time of labor are too long, or when, conversely, it’s all very fast.

In this case, the anesthesiologist uses a very fine needle which is inserted directly into the spinal canal.

Also this is a mixture of a small dose of anesthetic and morphine-like substances. With this method anesthetic substances mix with the cerebrospinal fluid. This is the method anelgesico, most often used for cesarean delivery.

Advantage:

• It works very quickly and is effective at the end of childbirth.

• Provides pain relief for a maximum of two hours.

Versus:

• This method can sometimes cause unpleasant headaches during the period after birth.

Pudendal nerve block

This is an anesthetic that is inserted with a syringe into two sites around the vagina. It works as a local anesthetic, and feel less pressure of the baby’s head coming out. It is only used during childbirth, not in labor.

Advantage:

• You feel the pressure of the baby coming out, but the sensation of pain is gone.

• It is an alternative to epidural, with a childbirth fast.
• Can be performed by midwives.

Versus:

• For the woman will be more difficult to know when it’s time to push.

• The contractions can be inhibited or interrupted, for this may be necessary to stimulate again.
• May cause a transient decrease of sensation in the legs.
• Not very often relieves the pain.

Morphine-like substances

This type of painkillers are made as intramuscular injection, or directly into blood vessels, and can be combined with nitrous oxide. It is generally not recommended and is little used in Italy.

Advantage:

• It acts quickly and can be used when the contractions are too painful and there is no time to do the epidural or spinal.

• Can be used by those who, for medical reasons, may not have the epidural.
• It has a relaxing effect that may be useful in the period preceding the active birth.

Versus:

• It works well especially as a sedative, relieves pain but only minimally.

• The morphine-like substances pass from the placenta to the fetus, and this may affect more or less on the child. The Petidina is particularly harmful, and often must be used as an antidote to invalidate the effect of morphine-like substances on the child after birth.

Nitrous oxide

It breathes through a mask. The gas makes you relax and reduce pain during contractions. The best thing is to inhale laughing gas just before and during contractions. This is used very little, in some regions of Italy is not never even been used.

Advantage:

• Acts quickly but the effect disappears in the same way, very quickly.

• It hasn’t significant side effects, doesn’t affect on the child and hasn’t side effects after birth.

Versus:

• It is not offered in all delivery rooms because the gas seeps out of the room causing danger to the midwives. Essendo un gas, esso ha una certa tossicità e può dare problemi a persone asmatiche.

• Only 30-50% of women had pain relief with nitrous oxide.

Warm clothes and bags of rice

A simple way to alleviate the pain of childbirth is to add warm cloths or bags of rice on your back and your stomach during the opening phase. During childbirth is however useful to add them around the vagina.

Advantage:

• It is a simple method without side effects.

Versus:

• Pain relief is rather limited.

Bath or/and shower

Be in a bathtub or a shower can have a calming effect and thus reduce the feeling of pain.

Many hospitals now have baths or showers. The water should not be too hot because it could increase the baby’s heartbeat.

After several experiments to alleviate the pain, it seems that this is the most recommended. It has no side effect and reduces much of the pain.

Advantage:

• It works as soothing and makes you feel less pain.

Versus:

• If you enter the water too soon, can inhibit the birth. Your doctor or midwife will assess the status of the cervix, and they will wait at least 4 cm opening before that you enter in the water.

• There is an increased risk of infection if the water breaking took place over 24 before entering the water.

Sterile water papules

Put a small amount of sterile water (or saline) just under the skin with a syringe.

This is perceived as intensely painful for the first 20 seconds and subsequently provide pain relief for an extended period.
This is a technique that can act as a painkiller against back pain during childbirth, in the opening phase.

Advantage:

• There is no side effect and can be repeated several times.

Versus:

• Many women have difficulties with syringes.

• Often the effect lasts a very short and for this reason is used very little.

Acupuncture

Acupuncture is increasingly used during childbirth, in the nordic countries. Midwives are trained so that they themselves practice the technique of acupuncture. Even in Italy it is used, though not everywhere, but is performed by an acupuncturist who is also usually the anesthesiologist.

The needles are inserted into different body parts, depending if you want pain relief, strength or relaxation.

Advantage:

• Recent research has shown that acupuncture has a calming effect of pain during labor.

• It is completely safe and has no side effects.

Versus:

• It is not offered everywhere.

• Often it is insufficient as an analgesic.

Partly taken from www.klikk.no and translated by Tamara De Zotti with the help of midwives Pia