As the saying goes, there are eight sufferings in life, namely: birth, old age, sickness and death, love and separation, resentment for a long time, can't ask for it, and can't let go. These eight sufferings, whether we have faith or not, must be faced and overcome in life.
Bitterness. Every mortal is born from the mother's body, and the mother endures the danger and pain of losing her life to give birth to us, and if unlucky, both mother and child have the possibility of death.
On August 31, 2017, Ma Moumou, a pregnant woman, fell to her death in the second ward (5th floor) of the Department of Obstetrics and Gynecology of the Suide Branch of the First Hospital of Yulin City, Shaanxi Province, which aroused widespread public attention.
Who has the final say on how to have a baby?
Vaginal birth or cesarean section, who should be listened to.
On September 7, 2017, the National Health and Family Planning Commission responded: about the Yulin maternal incident that the society is very concerned about. It is very sad that such a situation occurs, and it is also a situation that no one wants to see. Here, we would like to express our deepest condolences to the families of the mothers.
In order to avoid the tragedy from happening again, in this fast-paced and warm era, every expectant mother is eager to be more gentle and less painful when welcoming a new life. On November 15, 2018, the National Health Commission issued the Notice on Carrying out the Pilot Work of Labor Analgesia.
Through the pilot project, the rate of labor analgesia will be improved, the management of labor analgesia will be strengthened, and the quality of perinatal medical services will be improved. The rate of neuraxial labor analgesia in the 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 painless delivery rate in mainland China has increased year by year, and the analgesia rate of neuraxial labor in pilot hospitals in some regions is as high as 40%-60%, but there is still a big gap with the penetration rate of painless delivery in developed countries such as Europe and the United States (80%-90%).
Among them, the allocation of labor analgesia professionals is insufficient, and the job attractiveness is low. Anesthesia and obstetric medical staff are overloaded 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 can not meet the comprehensive development of labor analgesia, and the relevant policies of performance distribution can not fully mobilize the enthusiasm of medical staff, etc., but more is the lack of awareness of patients and their families on painless delivery, the problem of information asymmetry between doctors and patients, their ignorance of medical knowledge, their own anxiety, and even distrust of medical staff. Lack of understanding is caused.
Therefore, as an anesthesiologist, health science popularization is an important responsibility for us, and it is urgent to help the public understand and master health knowledge, prevent diseases, and improve the quality of life through scientific knowledge transfer.
How painful is it to have a baby?
Clinically, pain is usually graded on a scale of 0 to 10.
0 points: no pain.
Score 0-3: mild pain.
Score 4-6: moderate pain.
Score 7 or more: severe pain.
10 points: The most severe pain imaginable.
1. What is "painless delivery"?
Painless delivery, also called labor analgesia. It is a method to reduce the pain of natural childbirth and improve the quality of childbirth and maternal comfort.
The most commonly used method of labor analgesia is neuraxial anesthesia.
Neuraxial anesthesia refers to the injection of anesthetic drugs into the subarachnoid or epidural space within the spinal canal, and the spinal nerve root is blocked to produce an anesthetic effect on the corresponding area innervated by this nerve root.
2. Who is suitable for and who is contraindicated?
Applicable population: women who can give birth vaginally.
Contraindications: Women who cannot give birth vaginally, or who have intracranial hypertension, coagulation abnormalities, 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 the caesarean section. Painless delivery is the injection of anesthetic into the subarachnoid or epidural space in the spinal canal, and the blockade of the spinal nerve root causes the corresponding area innervated by the nerve root to produce an anesthetic effect, and the anesthetic drug hardly enters the child's body and does not affect the child's intelligence. Before choosing labor analgesia, obstetricians and anesthesiologists will conduct a series of evaluations of the mother, including medical history, physical condition, blood routine, coagulation function, etc., and labor analgesia can only be performed if the evaluation results are normal. Principles of labor analgesia: to maintain the safety of the mother and fetus. The drug for epidural birth analgesia acts locally, and the dose of the drug that enters the mother's bloodstream and is secreted with the milk is minimal, and it will have no effect on the baby.
4. Can labor analgesia cause postpartum low back pain?
There is no obvious connection. Most postpartum low back pain is caused by the ligaments being stretched out during pregnancy, the postpartum hormone level drops, the ligaments are not fully recovered, and the posture of holding the child is wrong, fatigue and other reasons.
5. Will labor analgesia prolong the labor process?
No. On the contrary, after labor analgesia, the muscles are relaxed, and the uterine opening will open faster.
6. When does labor analgesia start?
The old practice is that the uterine opening of the mother is 2-3cm before labor analgesia can be implemented.
The new practice is that at any time after the woman enters the delivery room, analgesia can be initiated. In order to achieve the best analgesic effect in childbirth, "sooner rather than later".
Currently, there is an extreme shortage of anesthesiologists, and anesthesiologists in almost every hospital are severely overloaded. But in order to reduce the pain of childbirth, everyone is trying to persevere.
I hope that one day, anesthesia work will be paid enough attention, and anesthesiologists' professional sense of achievement and treatment will change qualitatively. At that time, there will be more and more talented people joining the ranks of anesthesiologists. Labor analgesia alone will further increase the rate of labor analgesia and benefit more mothers.
Dongxing People's Hospital (Dongxing Branch of the First Affiliated Hospital of Guangxi Medical University)
Department of Anesthesiology, Chen Yunmin (Attending Physician)
【Tips】Pay attention, there are a large number of professional medical science popularization, revealing those things about surgical anesthesia for you~