Shengmen: labor pain witnessed by an anesthesiologist

Childbirth is the struggle of the mother alone. In the medical pain index, labor pain is the second pain after burn pain. After the Yulin maternal jump event in 2017, the state promulgated relevant policies in 2018 to popularize painless childbirth throughout the country and set up a number of pilot hospitals. That year, China’s labor analgesia rate was only 16.45%.

Wang Xiaolin is an anesthesiologist in a 3A hospital in Shenzhen. One of the major tasks of his daily work is to provide painless delivery for pregnant women. After carrying out painless childbirth, Wang Xiaolin saw that many unnecessary pains were eliminated. But she still points out that women’s contributions are not fully known.

I need to stay in the delivery room all day when I am on duty for painless delivery. The delivery room is divided into waiting room and delivery room. Maternal from abdominal pain to the birth of a baby, still need a long time of pain. Therefore, every time I go to work, I can hear one after another shouting inside when I go to the door. There are more than ten or twenty lying in women who are ready to give birth and go to bed. Whenever this time, I would like to give them painless, let them have a quiet rest.

we’ve seen a lot. We all know what it’s like to have a baby. I have seen too many puerpera, hit painless before childbirth, facial features twisted together, completely different. Several times they came out after giving birth to a child, and after they had a peaceful face, I couldn’t recognize her at all.

during painless labor, we need the lying in woman’s side, puncture her lumbar intervertebral space, and inject a small amount of drugs to reduce the pain before the formal delivery. Painless childbirth will not affect the consciousness of the pregnant women, just let them comfortable through the previous labor process, save physical strength to face the final delivery. Under the existing conditions, not everyone can have painless childbirth at any time. Because of the worry that too early hit painless will affect the labor process, we stipulate that generally wait for the maternal palace mouth to open three fingers to have painless delivery.

I was on the night shift that day. It was late at night when I got the call from the delivery room. At that time, my obstetric colleagues did not tell me that she had been in pain for so long, only that there was a woman who needed painless childbirth.

in the labor room, I met the woman. Her head was covered with sweat, her hair was completely scattered, her clothes were completely soaked with sweat, and she was very embarrassed. As soon as we met, she said to me, “you are finally here. Come and help me.” He was hoarse and his voice was shaking.

I checked her condition. Her clothes and skin were stained with blood, vomit and secretions. She stayed in such bad conditions for two or three days until she could fight painlessly. The whole person was shaking. After the examination, I told her that she would first go to her spouse for signature and give her a retention needle before painless delivery.

I asked her medical history before she had no pain. She told me it was her third day of pain. I saw a bag next to the bed, full of her vomit. Because it was so painful, when she pulled the paper towel, she scratched it in a mess, and vomit and tissue were scattered on the floor.

before painless labor, she talked to me. In obstetrics, very few pregnant women will feel weak when they speak. It is not because their pain is not painful. It is precisely the pain that forces them to stay in a high position all the time. Even if their physical strength is overdrawn, they can’t breathe peacefully.

during the two or three days of waiting for painless delivery, the woman was completely unable to sleep under the stimulation of continuous pain. After giving birth to her, I told her to ask her aunt to help her change into clean clothes. When the pain is not so bad, eat something, and then have a good sleep, because when the second stage of labor is about to give birth to a baby, the puerpera has to work hard, and also needs to fight against the pain and save energy in advance.

after that, I went to the office to help her improve the information. After only 10 minutes, when she returned to the ward, she was already asleep and had no time to change her clothes.

all of us who have worked in our department know what people will look like in childbirth pain. Even female anesthesiologists can’t avoid this mess. Colleagues as long as the birth of children, all played painless childbirth, childbirth is not so painful, but still very embarrassed.

a person who is usually clean and clean, regardless of his occupation and social status, when you lie in the bed for delivery or delivery, everyone can’t help lying with his or her excreta, secretions, blood, sweat and vomit, so his sense of dignity disappears.

in 2017, the family members of Yulin disagreed with the parturient who jumped from a building after painless childbirth. My colleagues and I understood her very well. We see too much. It’s no exaggeration to say that we want to jump out of a building because of the pain. Really.

the most difficult thing is to change people’s existing ideas. Family members, including the maternal themselves, often feel that pain is a must for childbirth. The puerpera will also feel that my mother and mother-in-law are the same. This is a normal situation, and I should bear it.

more often than not, it is the mother-in-law who does not recommend painless childbirth. Family members of the older generation do not have painless childbirth at all, but they also have children, so they may feel that painless childbirth is unnecessary. Some people will worry about the impact on the baby, or worry about maternal low back pain, nerve damage, and do not let them have painless childbirth. A little bit extreme, will think this is the thing that the hospital makes out to cheat them money.

if the older generation doesn’t have any opinions, the general spouse will agree. Many husbands listen to their mothers because they feel that their parents have had several children and believe in their experience. But in fact, no one knows whether they need painless childbirth or not.

there are two doors between the waiting room and the family members. The mother-in-law, her husband and her mother-in-law do not know how painful it is for her to be inside. She is not a vegetable and she has not lost her mind. In fact, she can make this judgment on her own.

as an anesthesiologist, there is a saying that I think is ridiculous: how to give birth to a child without pain and lie comfortably there?

in fact, painless childbirth has a history of more than 100 years in the world. Labor analgesia rate reached 85% in the United States and 90% in the United Kingdom. However, according to the statistics in 2018, the implementation rate of anesthesia labor analgesia in China was only 16.45%

. The other is that the fear of painless childbirth will bring physical damage to the baby and maternal. In fact, painless childbirth drugs do not pass through maternal blood, so will not pass through the placenta, acting on the baby, generally no problem. The real risk is nerve damage. We will communicate with the pregnant women and their families clearly. There is a risk, but the risk is relatively low.

usually, the outcome of the negotiation is that the pregnant woman also said that she would not fight. She will be convinced by her family members: “bear with it again.” But when the mouth of the palace opened wider and the pain became more severe, they would say: we must fight, no matter who is against her.

as an anesthesiologist, I think she has suffered pain for two or three hours in vain, but the mother will think that she has persisted for another two or three hours. It’s very painful.

anesthesiologists can control the degree of analgesia through drug deployment. For example, your pain is 10 points, I can help you reduce to 3 points, if maternal physical conditions allow, can completely reduce the pain to 0. However, the status quo is that most people can not separate “production” from “pain”. Some people will always look up at the fetal monitor because they can’t feel the contractions. They are afraid that the fetal heart rate is gone and the uterine contraction is gone, and they are constantly anxious.

the purpose of painless childbirth is to make the parturient spend the process of childbirth more comfortable, at least to give them enough rest before delivery. If completely painless will let the maternal anxiety, but can not achieve the goal. In China, because of such and other concerns, our medication will be conservative, generally will not reduce maternal pain to 0 – that is, there is no pain at all, will retain some pain, so that the maternal feel contractions. In other countries and regions, active medication will make the puerpera feel no pain at all, until the mouth of the uterus is opened, they will guide the puerpera to exert force.

because of the difference of human body, some of my parturient women still can’t feel contractions after painless delivery. At this time, we will comfort the lying in women and say that the midwife actually has a screen that can see all of you’s fetal monitors. As long as one of the fetal monitors gives an alarm, it will be handled immediately.

the local anesthetics used for painless labor are basically the same as those for cesarean section, but the dose concentration will be much smaller than that for cesarean section. However, before the state attaches importance to the science popularization of painless childbirth, only half of the parturients entering the delivery room proposed to have painless childbirth. The rest, some people finally choose cesarean section, in fact, to avoid the pain of labor.

the cesarean section rate in China has always been at a high level, in part because of the non-medical necessity of cesarean section. According to the World Health Organization’s warning line year, China’s cesarean section rate once reached 46.5%, ranking first in the world. In recent years, the number has been declining, and it will still be 36.7% in 2018.

although the process of cesarean section is not painful, there are many things to face after the operation. The biggest risk comes from the scarred uterus. If the fetus is implanted on the scar during re delivery, it will cause fatal risks such as uterine rupture. In addition, postoperative pain and healing, urinary retention and other adverse reactions, is also a * risk of cesarean section.

the promotion of painless delivery reduces the number of cesarean section operations. After the pilot policy of promoting painless childbirth has come down, although the puerpera will still be afraid of childbirth, we can comfort her by saying that you can have a painless look first. If you feel comfortable, you can continue to be comfortable until the mouth of the uterus is fully opened. Many people can still accept it. Up to now, in my hospital, of the 10 parturient women entering the delivery room, seven or eight will choose painless childbirth.

a senior sister in the same department was born very tall. She was very popular in the hospital. We all thought that she could give birth naturally. But when I went to see her, she was sweating in the pregnant woman, sitting on a yoga ball, trying to turn the baby’s position. No one around her can take care of her, even if someone is difficult to help, only she and the baby can turn around.

especially in natural labor, expectant mothers need to bear more on their own. Before the baby arrives at the door, the midwife will verbally instruct the mother to exert herself and breathe, but she can’t help the expectant mother to pull the baby out of her belly. Only when the baby arrives at the door, the midwife can help pull it. If the process is smooth, it only takes a minute or two. If the baby is entangled in the umbilical cord, it can not take too long.

they know why a girl lying in the delivery bed is so hoarse. Therefore, they will never dislike the presence of secretions and excreta on the parturient’s body. They will also try to make other colleagues who have not given birth understand the situation of the pregnant woman.

when I first started, I suddenly entered the last night shift and had to do 20 or 30 painless childbirth. When I was very tired, I sometimes couldn’t take into account my emotions. When the puerpera is very painful, can’t cooperate to put out to play painless posture, sometimes can’t help but the mentality starts to be impatient. These senior sisters will tell you in advance:“