During labor activity Sometimes there is a need for drug pain relief. This happens when anomalies develop, when the process of giving birth to a child is delayed. Deviations include premature discharge of amniotic fluid, weak labor, and dysregulation. Promedol is used during childbirth so that the woman can rest and gain strength before the decisive breakthrough.
Promedol is considered a regional anesthesia drug. It is prescribed more often than other drugs. The medicine belongs to the group of narcotic analgesics. The composition contains promedol 20 mg per 1 ml ampoule, the rest is water for injection.
It is administered intravenously, intramuscularly. The second option is preferable. If Promedol is administered during childbirth, the woman will rest for 30 minutes to 2 hours. The mother can completely relax and sleep.
The drug enters the mother's body and passes through the placenta.
During the action of Promedol, the child also sleeps. Therefore, the medicine must be administered no later than 2 hours before the start. birth process. When the uterus is dilated by 8 cm, the product is not used. The born child must take his first breath on his own; under the influence of the drug he will sleep. If inserted before the cervix is 4 cm dilated, labor will weaken.
Promedol during childbirth has the following effects:
- anti-shock;
- antispasmodic;
- analgesic;
- mild sleeping pill.
Principle of influence:
- changes the emotional side of pain;
- makes the endogenous system active;
- disrupts the interneuron transmission of pain impulses;
- increases tone;
- strengthens contractions.
Compared to morphine, it has less effect on the respiratory system. Helps dilate the cervix during labor. When injected, the effect begins after 10-20 minutes, reaches its peak after 40 minutes, and lasts for 4 hours. If taken orally through the gastrointestinal tract, the effect will be 2 times weaker.
Indications and contraindications
The drug is administered to stimulate the dilatation of the cervix, which provides pain relief during childbirth. Included in general anesthesia as an analgesic component.
Promedol is prescribed during childbirth:
- for pain of moderate to severe intensity;
- before, during, after surgery;
- with spasms of smooth muscles;
- for pain relief during labor.
Contraindications:
- depressed breathing;
- with caution in patients addicted to opioids;
- hypersensitivity;
- blood clotting disorder;
- infections;
- diarrhea.
Treat the drug with caution when bronchial asthma, renal, liver failure, arrhythmia. It is undesirable to use Promedol for inflammatory bowel diseases if there is a history of drug addiction. When the body is weakened, the drug is not administered.
Side effects:
- constipation, flatulence, gag reflexes;
- weakness, drowsiness;
- confusion;
- nervousness;
- discomfort;
- decreased blood pressure;
- skin rash;
- swelling.
Rarely, pain in the head area and blurred conscious perception may occur. Sometimes involuntary muscle twitching occurs. There may be ringing in the ears and slower reactions.
Effect on mother and child
In its structure, Promedol is similar to Morphine. In the UK the drug is called Meperidine, in America it is Demerol.
This drug is selected because of the licensing permission for its use. A dose of 150 mg is considered safe. An obstetrician-gynecologist who often uses the drug claims that 25 mg is enough to obtain the desired effect.
Impact on the baby. Promedol easily passes through the placenta. When the baby is due to be born within an hour, Demerol is not administered. Studies have shown that the drug produces the most depressing effect after administration 2–3 hours before the onset of labor.
If you administer Promedol during childbirth in a large dose, the effect on the fetus will be stronger. The dependence here is directly proportional. The baby’s liver is still immature, so the medicine is eliminated within 18 to 24 hours.
Demerol affects breast-feeding. It makes the process very difficult. After introduction into the woman’s body, the drug enters the milk, with which an additional dose is passed on to the baby. The baby is drowsy and has problems attaching to the breast. The mother does not associate these symptoms with the drug.
The consequences for the child when using Promedol during childbirth are observed within 6 weeks. During the doctor's examination, the baby screams, often wakes up, and shows anxiety. Doesn't calm down on its own.
Impact on mother. Anesthesia with drugs is administered according to strict indications. If the woman in labor has used drugs in the past, the doctor will refuse pain relief with Promedol. The result will not be effective.
Women are wary of this type of anesthesia, fearing drug addiction, serious consequences, and the impact on the child. The drug is administered once, so there is no reason for concern. It is used in the first stage of labor, when uterine contractions are painful. Any addiction develops with repeated use over a short period of time.
Demerol is administered through the thigh, buttock, and shoulder. The maximum concentration occurs 1 - 2 hours after injection. The cervix relaxes, dilates faster, and pain spasms are eliminated. The woman's consciousness is completely preserved. Despite side effects, the drug is considered absolutely safe for women in labor. If Promedol does not work during childbirth, other medications with similar properties are used.
Analogs
Sensations during labor are associated with mental state women in labor. Pain, excitement, fear intensify the sensations. The muscles of the uterus tense, causing pain. Some women cope with its manifestation on their own using various breathing techniques, relaxation, and massage. Others need medication to dull the nervous system's response to pain.
Requirements for painkillers:
- fast-onset effect;
- suppression of fear and other emotions for a long period;
- do not have a negative impact on the body of the mother and baby;
- do not deprive women of the opportunity to participate in the birth process;
- do not cause drug addiction.
For pain relief, along with Promedol, the following are used:
- Fentanyl;
- Omnopon;
- Gomk;
- nitrous oxide.
The first three relate to narcotic analgesics. Their action is based on communication with opiate receptors. They are safe for mother and baby. Calms, relaxes, maintains consciousness. The drugs have an antispasmodic and analgesic effect, correct uterine contractions, and promote dilation of the cervix.
Fentanyl begins to act after 1 – 2 minutes. Active for half an hour. The rapid, strong effect is explained by its easy permeability and high lipophilicity. Gives a powerful calming effect, loss of pain while maintaining consciousness.
Omnopon is available in the form of powder and solution. Active analgesic, suppresses painful sensations, slows down conditioned reflexes. The main properties are due to the morphine it contains. When administered subcutaneously, the effect lasts for 3–5 hours.
Gomk is used if a woman in labor needs rest. Drowsiness occurs 10–15 minutes after administration. Relaxation lasts 3 – 5 hours.
Nitrous oxide. Inhalation anesthesia is widely used during childbirth. It is used when the cervix is dilated by 3–4 cm, if the pain of contractions is pronounced. Nitrous oxide is considered the main remedy. The advantage lies in safety for the mother and child. The action comes quickly and also ends. No negative effects were noticed, there is no smell.
Oxide is given through a mask using a special apparatus. The woman in labor inhales nitrogen and feels slightly dizzy. The effect of the gas begins within a minute, so a couple of deep breaths are taken at the beginning of the contraction.
Promedol refers to synthetic drugs, weaker than Morphine. Has a moderate antispasmodic effect. Promedol during childbirth rarely causes nausea, vomiting, less depresses the respiratory system, and its consequences are mild. The drug allows you to rest during the birth process, the pain is dulled, but does not go away at all.
1 tablet includes 25 mg trimeperidine .
1 ml injection solution includes 10 mg or 20 mg trimeperidine .
Release form
The drug Promedol is available in the form of tablets of 10 or 20 pieces per package, as well as in the form of a 1% or 2% injection solution in ampoules of 5, 10, 100, 150, 200, 250 or 500 pieces per package.
pharmachologic effect
Analgesic, antishock, antispasmodic, uterotonic, hypnotic.
Pharmacodynamics and pharmacokinetics
The drug Promedol belongs to the pharmacological group narcotic (opioid ), with the main analgesic effect. Active substance Promedol according to INN classification – trimeperidine , exhibits an agonistic effect on opioid receptors . Activates endogenous painkiller (antinociceptive ) system , thereby violating different levels CNS, transportation pain impulses between neurons . Trimeperidine also influences higher departments brain , modifying the emotional coloring pain syndrome .
The pharmacological effects of Promedol are similar to those and are expressed by an increase pain threshold for symptoms of pain of various origins, inhibition, as well as mild hypnotic effect .Suppression respiratory center , when using Promedol, manifests itself to a lesser extent compared with Morphine . The drug is less likely to cause symptoms such as nausea And vomit , somewhat enhances contractile function And myometrial tone , has moderate antispasmodic effectiveness in relation to ureters And bronchi, as well as a spasmogenic effect, inferior to the action Morphine , towards intestines And biliary tract .
The development of the analgesic effect of Promedol, when administered parenterally, is observed after 10-20 minutes, rapidly increases and reaches its maximum value after 40 minutes. High analgesic effects last for 2-4 hours, when carried out - more than 8 hours.
Oral administration provides an analgesic effect of the drug, which is 1.5-2 times less than when administered parenterally.
For any delivery method trimeperidine into the body, its absorption proceeds quite quickly. TCmax when taken orally is observed after 60-120 minutes. When administered intravenously, the contents trimeperidine in plasma decreases rapidly and after 2 hours only trace concentrations are detected.
With plasma proteins trimeperidine binds by 40%. Basic metabolism passes into liver through a hydrolysis process releasing normeperidine And meperidic acid and further conjugation. T1/2 takes from 2.4 to 4 hours, increasing slightly.
Excreted kidneys in small quantities, including 5% unchanged.
Indications for use
Cupping pain syndrome medium and strong intensity with:
- pain after surgery surgical intervention ;
- pain in patients;
- unstable angina ;
- delaminating aortic aneurysm ;
- renal artery ;
- acute pericarditis ;
- pulmonary artery and arteries of the limbs;
- air;
- acute pleurisy ;
- heart attack lung ;
- spontaneous pneumothorax ;
- perforation of the esophagus;
- chronic;
- paranephritis ;
- acute dysuria ;
- renal and hepatic colic ;
- acute attack;
- priapism ;
- acute;
- lumbosacral radiculitis;
- causalgia ;
- acute vesiculitis ;
- thalamic syndrome;
- acute neuritis ;
- injuries and burns;
- protrusion intervertebral disc;
- foreign bodies in urethra, rectum, bladder.
Promedol is prescribed in obstetric practice with the aim of labor pain relief and as a lung stimulant labor activity.
IN surgical practice the drug is indicated for premedication and in the composition as an analgesic component (for example, conducting neuroleptanalgesia in combination with antipsychotics ).
Pulmonary edema , spicy left ventricular failure And cardiogenic shock , are also among the indications for the use of Promedol.
Contraindications
Absolute contraindications to taking Promedol are:
- patient to trimeperidine ;
- age up to 2 years;
- painful conditions in which there is respiratory depression ;
- parallel therapy using MAO inhibitors , as well as up to 21 days after their cancellation.
There are also a number of relative contraindications in which the use of Promedol is possible only with extreme caution, these are:
- respiratory failure ;
- and/or liver;
- chronic heart failure ;
- adrenal insufficiency ;
- traumatic brain injury;
- CNS depression ;
- myxedema ;
- urethral stricture ;
- surgical manipulations on the urinary system or gastrointestinal tract;
- convulsions ;
- obstructive pulmonary disease , chronic course;
- arterial hypotension ;
- emotional lability;
- cachexia ;
- elderly age;
- weakened patients;
- inflammatory in nature;
- (including history).
Side effects
- blurred vision;
- diplopia ;
- convulsions ;
- involuntary muscle contractions;
- weakness;
- confusion ;
- unusual or nightmares;
- anxiety;
- paradoxical arousal;
- muscle stiffness (especially respiratory);
- retardation of psychomotor reactions ;
- tinnitus.
Promedol at prescribed for And stimulation of labor . Injections are carried out intramuscularly or subcutaneously in doses of 20-40 mg, with a positive assessment of the condition of the fetus and dilatation of the cervix by 3-4 cm. Promedol promotes relaxation of the cervical muscles , thereby speeding up the process of its disclosure. The last injection should be given 30-60 minutes before the intended delivery , to avoid negative consequences during childbirth associated with suppression of fetal breathing .
The maximum parenteral dose for adult patients is 40 mg, and the maximum daily dose is 160 mg.
For children over 2 years of age, the dose of Promedol is from 0.1 to 0.5 mg/kg, with subcutaneous, intramuscular and rarely intravenous administration. Repeated injections to relieve pain can be carried out after 4-6 hours.
When carrying out, as its component, Promedol is administered intravenously at 0.5-2.0 mg/kg/hour. Maximum dose throughout the entire duration of treatment operations , should be no more than 2 mg/kg/hour.
It is carried out in a dose of 0.1-0.15 mg/kg, pre-diluted Promedol in 2-4 ml of sodium chloride for injection. The onset of the effect of the procedure is observed after 15-20 minutes, the peak of action occurs after approximately 40 minutes, with a gradual decrease in effectiveness over 8 hours or more.
Overdose
In case of an overdose of Promedol, the main negative effect is depression of consciousness And respiratory suppression , up to state . Various enhanced side effects. A characteristic sign of diagnosing an overdose may be miosis (constriction of the pupils).
Interaction
During parallel use of Promedol with sleeping pills And sedatives , anxiolytics, antipsychotics , muscle relaxants , ethanol, means general anesthesia and others narcotic analgesics , intensifies CNS and respiratory depression .
When taken systematically barbiturates , especially Phenobarbital , observed a decrease in analgesic effect trimeperidine .
Promedol can increase effectiveness antihypertensive drugs (diuretics , ganglion blockers etc.).
Antidiarrheal And anticholinergic means can lead to urinary retention , heavy constipation , intestinal obstruction .
Trimeperidine enhances the effects medicines With anticoagulant activity, in connection with which, with their joint use control needed plasma prothrombin .
Therapy using , currently available or carried out previously, reduces the effect of Promedol.
Combined treatment with MAO inhibitors may cause serious consequences associated with braking or overexcitation of the central nervous system and lead to development hypotensive or hypertensive crises .
The effects are reduced when taken together with Promedol.
Naloxone , being an antidote trimeperidine , eliminates its side effects: suppression of breathing , analgesia, CNS depression . At drug addiction accelerates the development of symptoms " withdrawal syndrome «.
Also affects the acceleration of symptoms " withdrawal syndrome " at drug addiction . After administration of the drug, persistent and difficult to eliminate symptoms appear quite quickly, sometimes within 5 minutes, and are observed for 2 days.
Terms of sale
To purchase this drug, you need a correctly completed Promedol prescription for Latin, on the form established by the rules, with all the attached details and seals.
Storage conditions
Both the injection solution and Promedol tablets belong to list A. The storage temperature of the drug is 8-15°C.
Best before date
For tablets and solution – 5 years.
special instructions
During therapy with Promedol, it is better to refrain from thin and hazardous work, as well as from driving a car.
At systematic application Promedola may develop drug-like addiction .
For children
Prescribed to children over 2 years of age, strictly according to indications, in exactly recommended doses, with extreme caution and under the supervision of a doctor.
With alcohol
Treatment with Promedol should not be combined with drinking alcoholic beverages.
During pregnancy (and lactation)
During periods (except for cases of onset of labor, in which the drug is indicated as an analgesic and stimulant), as well as during periods, Promedol is prescribed with extreme caution, taking into account all possible negative effects of therapy for the mother, fetus or newborn.
Beverly Lawrence Beach, UK
(Excerpt from article Drug therapy in childbirth: how will she respond 20 years later?)
Midwifery today, 1999
Demerol ( promedol)
One of the drugs most often used in childbirth is pethidine, a synthetic narcotic substance similar in structure to morphine. In the UK it is known as “meperidine”, in America – “Demerol” (and in Russia – “Promedol”. - Translator’s note)
It has become the drug of choice for most English midwives, mainly because it is the only narcotic drug that their license allows.
Typically, women are prescribed a dose of 150 mg, but those midwives who use small doses prescribe, for example, 25 mg and claim that this dose is also effective.
Demerol easily crosses the placenta. A child may have a very high sensitivity to it due to the immaturity of the blood-brain barrier (BBB - what separates blood vessels and brain cells - Translator's note) and due to the presence of a hepatic shunt (due to which the fetal blood is distributed bypassing the liver, neutralizing toxic substances - Translator's note (Burt, 1971). If the baby is expected to be born within an hour, most midwives will try to avoid using Demerol because there is a risk that the medicine will enter the baby's body. However, studies show that Demerol has the greatest depressant effect on the child’s respiratory system when administered 2-3 hours before birth. The higher the dose administered to the mother, the greater the effect on the fetus (Yerby, 1996).
Due to the immaturity of the child’s liver, it takes him much longer to remove the medicine from the body - from 18 to 23 hours.
Despite the fact that 95% of the drug dose is eliminated from the body within 2-3 days, this has great importance for breastfeeding. Rajan showed that "Demerol is the drug that most interferes with breastfeeding." While breastfeeding, the mother often unwittingly gives the baby an extra dose of Demerol, since this medicine passes into the milk. She may not know what is causing the baby's sleepiness. and also the cause of her problems with putting it to her breast is Demerol.
Long-term effects of Demerol little studied. However, in children who received a large dose of Demerol during labor, these effects continued to be detected for 6 weeks: they cried more often during the examination, were more restless and, upon awakening, were less likely to calm down on their own. The effect of Demerol was most noticeable in children aged 7 days, especially in those who received a large dose (Belsey, 1981). Interestingly, researchers consider the effect of the drug for 6 weeks to be long-term effects. We would call long-term an effect that affects itself over many years.
Translation by V.A. Maslova
Pain relief for childbirth
Drug pain relief for childbirth
Popular medicinal pain relief for childbirth
Undoubtedly, childbirth is greatest event in a woman's life. But we will need a lot of strength, patience and diligence before meeting the baby. However, this is not what usually frightens pregnant women. The most common fear before childbirth is the fear of pain. Many women ask doctors for drug pain relief during labor. But are these procedures as “harmless” as some expectant mothers think?
Women's perception of pain during childbirth varies significantly. This process is entirely controlled by the nervous system, and it is fear that reduces the threshold of pain sensitivity. It turns out to be a kind of vicious circle: we hurt because we are afraid of pain.
When is drug pain relief necessary?
Sometimes during labor there is a need for additional drug pain relief. For example, medication assistance necessary in the event of the development of certain anomalies of labor that increase the duration of labor. Such deviations include: weakness of labor, incoordination (dysregulation) of labor, premature rupture of amniotic fluid (occurring before the onset of contractions or simultaneously with them).
These conditions really lengthen and complicate labor and take away the strength of the woman in labor. But the expectant mother really needs strength: at the end of the second stage of labor, she will have a big physical labor- push! In order for a woman to rest and gain strength for the decisive event, painkillers are used during childbirth.
In addition, some women in labor have a pathologically low pain sensitivity threshold. In other words, these women feel pain much earlier and much stronger than it should normally be. Of course, in this case, women also need additional drug pain relief during labor. It also happens that the use of drug pain relief is determined by the woman’s desire; this, as a rule, is possible when conducting childbirth under a voluntary health insurance contract.
Pain relievers
We will tell you about the most commonly used pain medications in the arsenal of obstetricians and anesthesiologists. These include narcotic analgesics and regional anesthesia drugs such as: Promedol, Epidural anesthesia and Nitrous oxide.
Promedol
Most often, promedol is prescribed for pain relief during labor. This drug belongs to the group of narcotic analgesics, in other words - this is dope. It can be administered intramuscularly (which is preferable) or intravenously.
It is assumed that under the influence of the medicine you will be able to get a break from 30 minutes to two hours: relax and even sleep. In reality, it is quite difficult to predict in advance how a woman will react to the introduction of promedol.
There are women who, after such anesthesia, sleep peacefully until the birth of the baby, while others only get the opportunity to take a nap in between contractions. Promedol penetrates the placental barrier, and the baby also sleeps during the period of action of the drug. Associated with this feature is the upper time limit pain relief with promedol- no later than two hours before the baby is born.
Therefore, after dilation of the cervix by 8 cm, insertion promedola is not produced. After all, having been born, the child must take his first breath on his own, which means he should not be sleepy. It is also not customary to prescribe narcotic analgesics before the cervix is dilated by 4-5 cm, as this may contribute to the development of weak labor forces.
In addition to the actual pain relief of labor, promedol is also prescribed for the treatment of various pathologies of labor. For example, it is always used as an application (to mitigate the effect) before the introduction of a labor-stimulating substance - Oxytocin - when correcting weak labor.
Possible complications when administering narcotic analgesics during childbirth include nausea, vomiting, drowsiness, lethargy, confusion in the mother and “congestion” (the residual effect of the narcotic substance, manifested in sluggishness of vital reflexes and functions, primarily breathing) at the time of birth in a baby - if pain relief was performed late.
Nitrous oxide
There is another method of medication labor pain relief. until recently, widely used in domestic and foreign obstetric practice. We are talking about the use of nitrous oxide, a gas that, when inhaled, reduces pain sensitivity. Currently, this method is practically not used due to low efficiency and a large number of complications (respiratory depression in the woman in labor).
In conclusion, I would like to draw the attention of expectant mothers to this fact. None medical intervention cannot harm - if it is justified. Therefore, before deciding to choose one or another method of labor pain relief, you need to seriously weigh the pros and cons together with your doctor.
Remember that pregnancy and childbirth are not a disease, but the most natural thing for female body state. This means that nature has provided everything in order to successfully cope with this task - so difficult and so happy on your own!
On my own behalf, I would like to add, remember - promendol is a drug, the effect of which on the child’s body has been poorly studied, and long-term effects have not been studied by anyone at all. So draw your own conclusions...
As you know, pain during childbirth is a completely natural phenomenon. But there are situations when doctors still have to resort to painkillers. When does this happen and what methods does modern medicine have to combat pain?
It's no secret that childbirth is a rather serious test for the body. expectant mother. Firstly, this process takes quite a long time. For a woman preparing to become a mother for the first time, labor lasts an average of 12 hours. For those giving birth again, this time is slightly reduced - usually 6-8 hours; however, a lot depends on the interval between last birth, as well as on the characteristics of the course of this birth process, the weight of the baby, the age and health status of the expectant mother.
Secondly, labor activity is associated with significant expenses physical strength. For example, in the second stage of labor, which is a voluntary (that is, controlled) physical effort of the woman in labor, the expenditure of physical energy is comparable to training on weight machines or agricultural work for several hours.
Thirdly, during childbirth, the contractile activity of the uterus, or contractions, is associated with pain. It is this factor that makes most pregnant women afraid of the upcoming birth, doubting their own strength and patience. Fear of pain interferes with full preparation for childbirth, does not allow the expectant mother to tune in to a positive mood, and to set herself the correct emotional attitude towards childbirth.
But a lot depends on the attitude towards the very process of giving birth to a child, on the state of the mother’s psyche, and on the level of psycho-emotional comfort. The fact is that the entire mechanism of childbirth, this entire complex sequence of physiological processes that contribute to the birth of a baby, is entirely controlled by the central nervous system of the woman in labor. When we are afraid or, even worse, panic, our nervous system is in an overexcited state. Fear paralyzes the will, prevents you from concentrating on the process of childbirth and adequately following the recommendations of the medical staff of the maternity hospital. Very often, fear becomes the main reason for distrust of doctors. Finally, fear causes a decrease in the natural threshold of pain sensitivity. In other words, the scarier the more painful it is. Thus, a woman in labor who experiences a strong fear of pain experiences much more pain during labor. A kind of vicious circle of pain and fear is formed. Unfortunately, such a change in mental status is very often the main cause of the development of various labor disorders. In order to create the most comfortable conditions, maternity wards are being modernized in most modern maternity hospitals. They try to place the woman in labor in a separate spacious room - a “maternity ward”. This room contains everything necessary for the upcoming birth, which makes it possible not to move the patient from the prenatal to the delivery room, as was the case before. Today, considerable importance is attached to the design of the family’s interior. A separate room, minimally reminiscent of being within the walls medical institution, allows you to better adapt to the conditions of the maternity hospital.
In order to increase the psychological comfort of the mother in labor and confidence in medical personnel In many maternity hospitals, so-called “partner births” are practiced. The birth partner can be the future dad or one of the other relatives or friends of the woman in labor. Sometimes a professional is invited for a partner birth - a psychologist or an obstetrician. In the presence of a loved one, many women feel more confident and calm.
Considerable importance is also attached to prenatal psychological preparation. Professional psychologists practicing at family planning centers, as well as in some government and commercial organizations, are engaged in creating an optimal psychological image of the expectant mother. antenatal clinics. In addition, there are currently a large number of courses for expectant parents, which require individual and group classes to prepare for childbirth. During classes, doctors talk about the mechanism of childbirth, changes in the mother's feelings at various stages of labor, teach rules of behavior and methods of self-anesthesia during contractions, and explain the meaning of medical manipulations during childbirth. However, there are various individual characteristics health conditions of the mother in labor or the course of labor, aggravating the pain of the expectant mother during labor. Sometimes doctors have to deal with the so-called pathologically low threshold of pain sensitivity of a woman in labor. This term refers to the high reactivity of the central nervous system in response to minimal painful stimuli. Women with a low pain threshold begin to experience pain during childbirth much earlier, and their degree of discomfort is much more intense than in women with normal pain sensitivity. Those women who have an extremely difficult time (to the point of loss of consciousness) tolerate even minor painful stimuli (for example, the need for injection pain relief on menstruation) have the right to suspect that they have a low pain threshold. In some cases, the intensity of pain during contractions is so significant that the woman in labor cannot tolerate it. In such cases, psychological preparation for childbirth and self-anesthesia skills may not be enough. In situations where the use of physiological pain relief measures is ineffective, obstetricians offer medicinal methods.
Narcotic analgesics
Until recently, these drugs were the most popular means of pain relief in obstetric practice. The narcotic analgesics used to relieve pain during childbirth in our country include promedol. This drug was selected from a large number of different narcotic drugs due to limited duration.
It is important that the drug is used during childbirth in a very small dosage. The medication is administered intramuscularly (into the buttock) or intravenously. The effect of the drug occurs, as doctors say, “at the tip of the needle”: almost at the moment the medicine is administered, the pain recedes. Along with pain relief, promedol has a sedative effect: soon after administration of the drug, the woman in labor feels drowsy and begins to doze. This effect of the narcotic analgesic is also considered beneficial: thanks to it, the woman in labor is not only relieved of pain, but also has the opportunity to rest and gain strength before the beginning of the pushing period.
The sedative and analgesic effects of promedol are not equally pronounced in all patients: sensitivity to drugs varies significantly, and it is almost impossible to predict the effect 100% in advance. Someone, after the administration of an anesthetic, sleeps “the sleep of the righteous,” without feeling contractions at all until the onset of pushing. Some women continue to feel tension during contractions, but the pain factor is absent or significantly reduced. In this case, the woman in labor usually dozes between contractions, and wakes up during uterine contractions.
promedol acts for 2.5-3 hours; Based on this, clear boundaries have been defined for the use of the drug during childbirth. Usually, promedol is not prescribed before 4cm of cervical dilatation: otherwise there is a risk of developing weakness of labor forces. In addition, in the early stages of labor, contractions are short, infrequent and painless - therefore, the issue of pain relief is irrelevant. Narcotic analgesics never prescribe later than 6 cm of cervical dilatation. This limitation is due to the fact that promedol, entering the baby’s body through the bloodstream, affects him in the same way as it does on a woman in labor. Under the influence of promedol, the baby sleeps in a narcotic sleep. Naturally, by the time of birth the effect of the drug must end: otherwise the baby will not be able to take his first breath. The expectant mother should also wake up when pushing begins: this process requires the active participation of the woman in labor.
If the specified time frame for pain relief with promedol is observed, no complications for the mother and fetus are observed. After 3-3.5 hours from the moment of anesthesia, the drug is completely eliminated from the body through the kidneys and lungs of the mother. During childbirth, a single use of promedol is possible. During the action of the drug, side effects may occur:
- nausea, vomiting;
- increased/decreased heart rate;
- confusion;
- increased perception of sound, light, touch, and smell.
In addition to pain relief itself, promedol is also prescribed for the treatment of various pathologies of labor. For example, it is used as a premedication (to soften the effect) before the introduction of a labor-stimulating substance when correcting weak labor. For the same purpose, promedol is used before the onset of labor induction - initiating labor in its absence. Premedication using promedol softens the moment of administration of the labor-stimulating substance, allowing its effect to be as close as possible to the natural development of labor.
Epidural anesthesia
The next and most popular method today is epidural anesthesia. As with narcotic analgesics, there are a number of situations in which epidural anesthesia is the only correct solution. Thus, this type of anesthesia is used to treat incoordination of labor - a pathology in which contractions are painful and unsystematic, and the dynamics of labor - dilatation of the cervix - is absent. Epidural anesthesia is used for artificial maintenance normal level blood pressure during childbirth in women suffering various forms arterial hypertension (increased blood pressure). In addition, an epidural is absolutely irreplaceable in cases where it is necessary to minimize the period of pushing. That is, the expectant mother can give birth herself, but full participation in the pushing process can harm her health. An example of such a situation is a heart defect in a woman in labor, some changes in the eyes, and arterial hypertension. In this case, in order to make it easier for the woman to push, the effect of epidural anesthesia is extended almost until the stage of the head cutting in (the appearance of the head in the lumen of the perineum during a contraction). Then an episiotomy (an incision in the perineum) is made, and the baby is born with minimal physical effort on the part of the mother. Unindicated childbirth is possible within the framework of a voluntary health insurance contract.
This type of pain relief uses drugs similar to those used in dental practice. An anesthetic (substance) is injected into the epidural space, around the hard meninges spinal cord. The technique of epidural anesthesia is more complicated than pain relief with promedol. Epidural anesthesia is performed by an anesthesiologist. Before acceptance final decision The anesthesiologist will conduct a preliminary consultation about the method of pain relief. During the examination and conversation with the woman in labor, the doctor identifies indications and contraindications for epidural anesthesia in this patient, predicts the risk of developing certain complications, determines the tolerability of medications used for this method pain relief.
The anesthesia procedure is performed in a maternity ward or a small operating room. The expectant mother is asked to take a position that makes it easier for the doctor to carry out the manipulation. There are two options for the position of the patient, depending on her condition, stage of labor and anatomical features structure of the spine. In the first case, the woman in labor is seated with her back to the doctor and asked to tilt her head to her knees. In the second option, the expectant mother takes the same “fetal position” while lying on her side with her back to the doctor. After superficial anesthesia of the skin (injection into the skin) in the intervention area, the doctor makes a puncture between the vertebrae using a special needle. Then a soft flexible tube is inserted into the puncture site (at the level of the 3rd-4th lumbar vertebra) - a catheter through which the medicine is injected into the spinal canal. The outer part of the catheter is attached to the skin with an adhesive tape; An aseptic bandage is applied to the puncture site. During labor, the doctor may add a dose of anesthetic through the catheter as needed.
As a result of such anesthesia, they are “cut off” pain signals from the uterus to the brain. That is, the “distress signal” sent by pain receptors does not reach the pain center of the brain, since the transmission of the nerve impulse is blocked as a result of the introduction of an anesthetic into the spinal canal.
The state of health of the expectant mother, anesthetized in this way, differs significantly from the effect of promedol. This has its pros and cons. The advantages include the absence of a negative effect on the central nervous system. Medicines used for anesthesia do not have a hypnotic effect, do not change the consciousness of the expectant mother in any way, and do not cause a gag reflex. During the period of anesthesia, the woman in labor still feels contractions, but only as muscle contractions; there is no pain sensitivity. The disadvantages include the forced position of the woman in labor - after the administration of the medicine, in most cases she cannot get up; Sensitivity disappears below the injection site. It is important that by the time the woman begins to push, she can act on her own. Of course, free behavior during childbirth is out of the question. Psycho-emotional contact with the baby is also lost, and it is not yet known how acutely the child feels this. However, the main problem with this method is that the drugs used during epidural anesthesia to alleviate the condition of the mother in labor do not reach the baby and do not cause the release of endorphins. In other words, this is the only pain relief method that affects only the mother. In this case, the baby remains without pain relief. And in the case when the mother does not receive medicinal support during childbirth, in response to pain she produces a small amount of endorphins, which, entering the bloodstream to the fetus, anesthetize it in the second stage of labor.
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Childbirth are a natural physiological process that completes the pregnancy of any woman. As a physiological process, childbirth has certain characteristics and is accompanied by a number of specific manifestations. One of the most well-known manifestations of labor is pain. It is the pain syndrome that accompanies every childbirth that is the subject of numerous discussions, both among pregnant women themselves and doctors, since this characteristic The birth act seems to be the most powerfully emotionally charged and deeply affecting the psyche.Any pain has a very specific effect on the human psyche, causing deep emotional experiences and creating a stable memory of an event or factor accompanied by pain. Since pain accompanies almost the entire labor act, which normally can last from 8 to 18 hours, any woman remembers this process for the rest of her life. Pain during childbirth has a bright emotional coloring, which, depending on individual psychological characteristics personality, as well as the specific circumstances that surround the birth act, can be easily tolerated or, on the contrary, very difficult.
Women for whom the pain of childbirth was tolerated relatively easily or, in the terminology of the mothers themselves, “was tolerable”, have absolutely no idea what other representatives of the fair sex experienced and felt, who, due to the will of circumstances, felt terrible, unbearable pain.
Based on their sensory experience, two radical positions arise in relation to pain relief during childbirth - some women believe that it is better to “be patient” for the sake of healthy baby, and the latter are ready for any drug, even one that is very “harmful” for the child, that will save them from hellish, unbearable torment. Of course, both positions are radical and therefore cannot be true. The truth lies somewhere in the area of the classical “golden mean”. Let's consider various aspects related to pain relief during labor, relying, first of all, on common sense and data from serious, reliable research.
Pain relief for childbirth - definition, essence and general characteristics of medical manipulation
Childbirth anesthesia is a medical manipulation that allows a woman giving birth to be provided with the most comfortable conditions, thereby minimizing stress, eliminating inevitable fear and without creating a negative image of the birth act for the future. Relieving pain and removing the strong, subconscious fear associated with it effectively prevents labor disturbances in many impressionable women who have a pronounced emotional perception of reality.Childbirth pain relief is based on the use of various medicinal and non-medicinal techniques that reduce the level of mental anxiety, relieve tension and stop the conduction of pain impulses. To relieve labor pain, you cannot use the entire range of currently available medications and non-drug methods, since many of them, along with analgesia (pain relief), cause complete loss of sensitivity and muscle relaxation. A woman during childbirth should remain sensitive, and the muscles should not relax, as this will lead to a stop in labor and the need to use stimulant drugs.
All currently used methods of labor pain relief are not ideal, since each method has pros and cons, and therefore, in a particular case, the method of relieving the pain of labor must be selected individually, taking into account the psychological and physical condition women, as well as the obstetric situation (position, fetal weight, pelvic width, repeat or first birth, etc.). The choice of the optimal method of labor anesthesia for each individual woman is carried out jointly by an obstetrician-gynecologist and an anesthesiologist. The effectiveness of various methods of labor anesthesia is not the same, therefore for best effect you can use combinations of them.
Pain relief for childbirth in the presence of severe chronic diseases in a woman is not only desirable, but necessary procedure, because it alleviates her suffering, relieves emotional stress and fear for her own health and the life of the child. Labor anesthesia not only relieves pain, but at the same time interrupts the functioning of adrenaline stimulation that occurs with any pain syndrome. Stopping the production of adrenaline allows you to reduce the load on the heart of a woman giving birth, dilate blood vessels and, thereby, ensure good placental blood flow, and therefore better nutrition and oxygen delivery for the child. Effective relief of pain during childbirth allows you to reduce the energy costs of a woman’s body and her stress. respiratory system, as well as reduce the amount of oxygen she needs and, thereby, prevent fetal hypoxia.
However, not all women need pain relief during labor, since they tolerate this physiological act normally. But you shouldn’t draw the opposite conclusion that everyone can “endure it.” In other words, labor pain relief is a medical procedure that should be performed and used if necessary. In each case, the doctor decides which method to use.
Pain relief during childbirth - pros and cons (should I have pain relief during childbirth?)
Unfortunately, at present, the issue of pain relief in childbirth is dividing society into two radically opposed camps. Followers natural birth They believe that pain relief is unacceptable, and even if the pain is unbearable, you need to, figuratively speaking, grit your teeth and endure, sacrificing yourself to the future baby. Women with the described position are representatives of one, radical part of the population. They are very vehemently opposed by representatives of another part of women who adhere to the exact opposite, but equally radical position, which can be conventionally designated as an “adherent” of pain relief during childbirth. Adherents of pain relief believe that this medical procedure is necessary for all women, regardless of the risks, the condition of the child, the obstetric situation and other objective indicators of a particular situation. Both radical camps argue fiercely with each other, trying to prove their absolute rightness, justifying possible complications pain and pain relief with the most incredible arguments. However, no radical position is correct, since neither the consequences can be ignored severe pain, nor the possible side effects of various pain relief methods. It should be recognized that labor anesthesia is an effective medical procedure that can reduce pain, relieve associated stress and prevent fetal hypoxia. Thus, the benefits of pain relief are obvious. But, like any other medical procedure, labor anesthesia can provoke a number of side effects on the part of the mother and child. These side effects, as a rule, are transient, that is, temporary, but their presence has a very unpleasant effect on the woman’s psyche. That is, pain relief is an effective procedure that has possible side effects, so you cannot use it as you would like. Childbirth should be anesthetized only when a specific situation requires it, and not according to instructions or some standard averaged for everyone.
Therefore, the solution to the question “Should I perform labor anesthesia?” must be taken separately for each specific situation, based on the condition of the woman and fetus, the presence concomitant pathology and the course of labor. That is, pain relief must be performed if the woman does not tolerate labor pains well, or the child suffers from hypoxia, since in such a situation there is no benefit medical manipulation far exceeds possible risks side effects. If labor proceeds normally, the woman tolerates contractions calmly, and the child does not suffer from hypoxia, then you can do without anesthesia, since additional risks in the form of possible side effects from the manipulation are not justified. In other words, to make a decision on labor pain relief, you need to take into account the possible risks from not using this manipulation and from its use. The risks are then compared, and an option is selected in which the likelihood of cumulative adverse consequences (psychological, physical, emotional, etc.) for the fetus and woman will be minimal.
Thus, the issue of pain relief in childbirth cannot be approached from a position of faith, trying to classify this manipulation as, figuratively speaking, unconditionally “positive” or “negative”. Indeed, in one situation, pain relief will be a positive and correct decision, but in another it will not, since there are no indications for this. Therefore, whether to give pain relief must be decided when labor begins, and the doctor will be able to assess the specific situation and the woman in labor, and make a balanced, sensible, meaningful, and not an emotional decision. And an attempt to decide in advance, before the onset of childbirth, how to relate to pain relief - positively or negatively - is a reflection of the emotional perception of reality and youthful maximalism, when the world is presented in black and white, and all events and actions are either unconditionally good or such definitely bad. In reality, this does not happen, so labor pain relief can be both a blessing and a disaster, like any other medicine. If the medicine is used as directed, it is beneficial, but if it is used without indication, it can cause serious harm to health. The same can be fully applied to pain relief during childbirth.
Therefore, we can draw a simple conclusion that pain relief during childbirth is necessary when there are indications for this on the part of the woman or child. If there are no such indications, then there is no need to anesthetize labor. In other words, the position on pain relief in each specific case should be rational, based on taking into account the risks and condition of the mother and child, and not on an emotional attitude to this manipulation.
Indications for the use of labor anesthesia
Currently, labor pain relief is indicated in the following cases: - Hypertension in a woman in labor;
- Increased blood pressure in a woman during childbirth;
- Childbirth due to gestosis or preeclampsia;
- Severe diseases of the cardiovascular and respiratory systems;
- Severe somatic diseases in women, for example, diabetes, etc.;
- Cervical dystocia;
- Discoordination of labor;
- Severe pain during childbirth, felt by the woman as unbearable (individual pain intolerance);
- Severe fear, emotional and mental stress in a woman;
- Delivery of a large fetus;
- Breech presentation of the fetus;
- Young age of the woman in labor.
Methods (methods) for pain relief during labor
The entire set of methods for pain relief during labor is divided into three large groups:1. Non-drug methods;
2. Medication methods;
3. Regional analgesia (epidural anesthesia).
Non-drug methods of pain relief include various psychological techniques, physiotherapeutic procedures, proper deep breathing and other methods based on distraction from pain.
Medicinal methods of labor pain relief, as the name implies, are based on the use of various medications that have the ability to reduce or stop pain.
Regional anesthesia, in principle, can be classified as a medical method, since it is produced using modern powerful painkillers that are administered into the space between the third and fourth lumbar vertebrae. Regional anesthesia is the most effective method pain relief during childbirth, and therefore is currently used very widely.
Methods of pain relief during childbirth: medicinal and non-medicinal - video
Non-drug (natural) labor pain relief
The most secure, but also the least in effective ways labor pain relief are non-drug, which include a combination of various methods based on distraction from pain, the ability to relax, creating a pleasant atmosphere, etc. The following currently apply non-drug methods labor pain relief: - Psychoprophylaxis before childbirth (attending special courses where a woman gets acquainted with the process of childbirth, learns to breathe correctly, relax, push, etc.);
- Massage of the lumbar and sacral regions spine;
- Proper deep breathing;
- Hypnosis;
- Acupuncture (acupuncture). Needles are placed on the following points - on the stomach (VC4 - guan-yuan), hand (C14 - hegu) and lower leg (E36 - tzu-san-li and R6 - san-yin-jiao), in the lower third of the lower leg;
- Transcutaneous electrical nerve stimulation;
- Electroanalgesia;
- Warm baths.
The most common methods of non-drug pain relief during labor are massage of the lower back and sacrum, being in water during contractions, correct breathing and the ability to relax. All these methods can be used by a woman in labor independently, without the help of a doctor or midwife.
Pain-relieving massage and birth positions - video
Drug pain relief for childbirth
Medicinal methods of labor pain relief are highly effective, but their use is limited by the condition of the woman and possible consequences for the fetus. All currently used analgesics are capable of penetrating the placenta, and therefore for pain relief during labor they can be used in limited quantities (dosages) and in strictly defined phases of labor. The entire range of medicinal methods of labor pain relief, depending on the method of drug use, can be divided into the following types: - Intravenous or intramuscular injection drugs that relieve pain and eliminate anxiety (for example, Promedol, Fentanyl, Tramadol, Butorphanol, Nalbuphine, Ketamine, Trioxazine, Elenium, Seduxen, etc.);
- Inhalation administration of drugs (for example, nitrous oxide, Trilene, Methoxyflurane);
- Injection of local anesthetics into the area of the pudendal nerve or tissue birth canal(for example, Novocaine, Lidocaine, etc.).
In recent years, there has been a tendency to replace narcotic analgesics with non-narcotic ones, such as Tramadol, Butorphanol, Nalbuphine, Ketamine, etc. Non-narcotic opioids, synthesized in recent years, have a good analgesic effect and at the same time cause less pronounced biological reactions.
Inhalational anesthetics have a number of advantages over other drugs, since they do not affect the contractile activity of the uterus, do not penetrate the placenta, do not impair sensitivity, allow the woman to fully participate in the birth act and independently resort to the next dose of laughing gas when she deems it necessary. Currently, nitrous oxide (N 2 O, “laughing gas”) is most often used for inhalational anesthesia during childbirth. The effect occurs a few minutes after inhaling the gas, and after stopping the supply of the drug, its complete elimination occurs within 3 to 5 minutes. The midwife can teach the woman to inhale nitrous oxide on her own as needed. For example, breathe during contractions, and do not use gas in between. The undoubted advantage of nitrous oxide is its ability to be used for pain relief during the period of expulsion of the fetus, that is, the actual birth of the child. Let us remind you that narcotic and non-narcotic analgesics cannot be used during the period of expulsion of the fetus, as this may negatively affect its condition.
During the expulsion period, especially during childbirth with a large fetus, you can use anesthesia with local anesthetics (Novocaine, Lidocaine, Bupivacaine, etc.), which are injected into the area of the pudendal nerve, perineum and vaginal tissue located next to the cervix.
Drug methods of pain relief are currently widely used in obstetric practice in most maternity hospitals in the CIS countries and are quite effective.
General application scheme medications for labor pain relief can be described as follows:
1.
At the very beginning of labor, it is useful to administer tranquilizers (for example, Elenium, Seduxen, Diazepam, etc.), which relieve fear and reduce the pronounced emotional coloring of pain;
2.
When the cervix is dilated by 3–4 cm and painful contractions appear, narcotic (Promedol, Fentanyl, etc.) and non-narcotic (Tramadol, Butorphanol, Nalbufin, Ketamine, etc.) opioid painkillers can be administered in combination with antispasmodics (No-shpa, Papaverine, etc.). It is during this period that non-drug methods of labor pain relief can be very effective;
3.
When the cervix is dilated by 3–4 cm, instead of administering painkillers and antispasmodics, you can use nitrous oxide, teaching the woman in labor to inhale the gas independently as needed;
4.
Two hours before the expected expulsion of the fetus, the administration of narcotic and non-narcotic painkillers should be stopped. To relieve pain in the second stage of labor, either nitrous oxide or local anesthetics can be injected into the area of the pudendal nerve (pudendal block).
Epidural pain relief during childbirth (epidural anesthesia)
Regional analgesia (epidural anesthesia) has become increasingly widespread in recent years due to its high efficiency, accessibility and harmlessness to the fetus. These methods make it possible to provide maximum comfort to a woman with minimal impact on the fetus and the course of labor. The essence of regional methods of labor pain relief is the introduction of local anesthetics (Bupivacaine, Ropivacaine, Lidocaine) into the area between two adjacent vertebrae (third and fourth) lumbar region(epidural space). As a result, the transmission of pain impulses along the nerve branches is stopped, and the woman does not feel pain. Drugs are administered to that department spinal column, where there is no spinal cord, so there is no need to worry about damaging it. Epidural anesthesia has the following effects on the course of labor:
- Does not increase the need for delivery by emergency caesarean section;
- Increases the frequency of applying a vacuum extractor or obstetric forceps due to the incorrect behavior of the woman in labor, who does not feel well when and how to push;
- The period of fetal expulsion with epidural anesthesia is slightly longer than without labor anesthesia;
- It can cause acute fetal hypoxia due to a sharp decrease in the mother's blood pressure, which is relieved by sublingual use of nitroglycerin spray. Hypoxia can last a maximum of 10 minutes.
Currently, the following indications are available for epidural anesthesia during childbirth:
- Preeclampsia;
- Premature birth;
- Young age of the woman in labor;
- Severe somatic pathology (for example, diabetes mellitus, arterial hypertension, etc.);
- Low pain threshold of women.
Painkillers for epidural anesthesia (as well as narcotic analgesics) can begin to be administered no earlier than the dilatation of the cervix by 3–4 cm. However, the catheter is inserted into the epidural space in advance, when the woman’s contractions are still rare and less painful, and the woman can lie in the fetal position 20 – 30 minutes without moving.
Labor pain relief medications can be given as a continuous infusion (like an IV) or in fractions (boluses). With continuous infusion, a certain number of drops of the drug enter the epidural space over an hour, which provides effective pain relief. With fractional administration, drugs are injected in a certain amount at clearly defined intervals.
The following local anesthetics are used for epidural anesthesia:
- Bupivacaine - 5 - 10 ml of 0.125 - 0.375% solution is administered fractionally after 90 - 120 minutes, and infusion - 0.0625 - 0.25% solution at 8 - 12 ml/h;
- Lidocaine - 5 - 10 ml of 0.75 - 1.5% solution is administered fractionally after 60 - 90 minutes, and infusion - 0.5 - 1.0% solution at 8 - 15 ml/h;
- Ropivacaine - fractionally administered 5 - 10 ml of 0.2% solution after 90 minutes, and infusion - 0.2% solution 10 - 12 ml/hour.
If for some reason local anesthetics cannot be used for epidural anesthesia (for example, a woman is allergic to drugs of this group, or she suffers from heart defects, etc.), then they are replaced with narcotic analgesics - Morphine or Trimeperedine. These narcotic analgesics are also fractionally or infused into the epidural space and effectively relieve pain. Unfortunately, narcotic analgesics can provoke unpleasant side effects, such as nausea, itching of the skin and vomiting, which, however, can be easily controlled by the administration of special drugs.
Currently, it is common practice to use a mixture of a narcotic analgesic and a local anesthetic to produce epidural anesthesia during childbirth. This combination allows you to significantly reduce the dosage of each drug and relieve pain with the greatest possible efficiency. A low dose of narcotic analgesic and local anesthetic reduces the risk of lowering blood pressure and developing toxic side effects.
If an emergency caesarean section is necessary, epidural anesthesia can be enhanced by introducing a larger dose of anesthetic, which is very convenient both for the doctor and for the woman in labor, who will remain conscious and will see her baby immediately after removal from the uterus.
Today, epidural anesthesia in many maternity hospitals is considered standard procedure obstetric benefits, accessible and not contraindicated for most women.
Means (drugs) for pain relief during childbirth
Currently used for pain relief during labor medications from the following pharmacological groups: 1. Narcotic analgesics (Promedol, Fentanyl, etc.);
2. Non-narcotic analgesics (Tramadol, Butorphanol, Nalbuphine, Ketamine, Pentazocine, etc.);
3. Nitrous oxide (laughing gas);
4. Local anesthetics (Ropivacaine, Bupivacaine, Lidocaine) - used for epidural anesthesia or injection into the pudendal nerve area;
5. Tranquilizers (Diazepam, Relanium, Seduxen, etc.) - are used to relieve anxiety, fear and reduce the emotional coloring of pain. Introduced at the very beginning of labor;
6. Antispasmodics (No-shpa, Papaverine, etc.) – are used to accelerate the dilatation of the cervix. They are inserted after the uterine os is dilated by 3–4 cm.
The best analgesic effect is achieved with epidural anesthesia and intravenous administration narcotic analgesics in combination with antispasmodics or tranquilizers.
Promedol for pain relief during childbirth
Promedol is a narcotic analgesic, which is currently widely used for pain relief in childbirth in most specialized institutions in the CIS countries. As a rule, Promedol is administered in combination with antispasmodics, has a pronounced analgesic effect and significantly shortens the duration of cervical dilatation. This drug is affordable and very effective.Promedol is administered intramuscularly and begins to act within 10 to 15 minutes. Moreover, the duration of the analgesic effect of one dose of Promedol is from 2 to 4 hours, depending on the individual sensitivity of the woman. However, the drug penetrates perfectly through the placenta to the fetus, so when using Promedol, you should definitely monitor the child’s condition using CTG. But Promedol is relatively safe for the fetus, since it does not cause any irreversible disorders or damage to it. Under the influence of the drug, the child may be born lethargic and drowsy, will have difficulty latching on the breast and will not immediately be out of breath. However, all these short-term disturbances are functional, and therefore will quickly pass, after which the child’s condition is completely normalized.
If epidural analgesia is unavailable, Promedol is practically the only available and effective analgesic that relieves pain during childbirth. In addition, during induced labor, which accounts for up to 80% of the total number in the CIS countries, Promedol is literally a “saving” drug for a woman, since in such cases contractions are extremely painful.
