Obstetrics and Gynecology - A. M. Gromova 2000

Pain Relief in Childbirth
Non-pharmacological methods of anesthesia in labor

In addition to psychoprophylactic preparation for childbirth and pharmacological pain relief, various non-pharmacological Methods of obstetric anesthesia are also available, including acupuncture, electropuncture, abdominal decompression, and electroanalgesia, among others.

Acupuncture is used to prepare pregnant women for labor by reducing tension, anxiety, and pain, as well as for pain relief and The regulation of uterine activity. An acupuncture session typically lasts from 15 to 40 minutes and is performed daily or every 1–2 days, for a total of up to 4–8 sessions.

Electroacupuncture involves applying electrical impulses of varying duration and polarity to needles inserted into acupuncture points. Two paired and two unpaired points located on the inner surface of the body are typically used:

- NEIGUAN (PC-6), a paired point located on the inner aspect of the forearm;

- SANYINJIAO (SP-6), a paired point located on the inner aspect of the lower leg;

- GUANYUAN (VC-4) and ZHONGJI (VC-3), points located along the midline of the abdomen.

Abdominal decompression is used for pain relief and to accelerate labor. It gained international recognition in the 1960s. The application of this method During the first stage of labor reduces or completely eliminates pain in 75–86% of laboring women. M.A. Petrov-Maslakov and V.A. Ryndin developed a specialized chamber that closely matched the contour of a pregnant woman's abdomen. The decompression technique is performed as follows: with the edges slightly stretched, the chamber is placed on the woman's abdomen. A compressor then evacuates air from the space between the chamber walls and the abdominal surface during each contraction, reducing the pressure inside the chamber by 50 mmHg and maintaining it at 20 mmHg between contractions. Air evacuation can be performed using a "Herana" surgical suction unit, which creates a negative pressure of up to 50 mmHg in the chamber within 6–8 seconds. The maximum duration of decompression, with short intervals, is up to 3 hours. Uterine contractility is enhanced in the majority of patients. Abdominal decompression has no adverse effects on the intrauterine condition of the fetus, the newborn, or the subsequent Development of the child.

Electroanalgesia. In 1968, L.S. Persianinov and E.M. Kastrubin developed a technique for intrapartum electroanalgesia utilizing fronto-occipital electrode placement. The therapeutic effect of electroanalgesia is achieved by gradually increasing the current intensity during the session, tailored to the patient's sensory threshold (averaging up to 1 mA). The duration of a session is approximately 1–1.5 hours. After 40–60 minutes of using this technique between contractions, a drowsy state is typically observed, along with a reduced pain response during contractions. If the patient is restless, initiating electroanalgesia is recommended following the preliminary administration of Pipolfen, Diphenhydramine (Dimedrol), or Promedol.

Despite the wide array of methods mentioned above, it must be remembered that the approach to pain relief should be individualized in every case, taking into account the mother's physiological characteristics (such as extragenital pathology, Pregnancy complications, and psychological profile) as well as fetal factors (gestational age and intrauterine development).

Review Questions.

1. What factors necessitate pain relief during labor?

2. Where and by whom was the psychoprophylactic method of preparing pregnant women for childbirth originated?

3. What components make up psychoprophylactic preparation for childbirth?

4. What are the Specific characteristics of pharmacological pain relief in obstetrics?

5. Name the methods of pharmacological pain relief categorized by the stages of labor.

6. What non-pharmacological methods of obstetric anesthesia are you familiar with?