In the medical community, reducing labor pain has become a hot topic, but for many anesthesia experts, it is a difficult problem.

Many anesthetists who excel in other specialties appear to lack confidence when it comes to managing pain during childbirth. There are many complex reasons behind this situation.

Labor analgesia exists to relieve maternal pain during childbirth and includes a variety of methods.

Various methods such as mental comfort, analgesia, and acupuncture anesthesia are within its scope.

In order to alleviate pain, the hospital has taken various measures, such as using transcutaneous electrical nerve stimulators to assist in relieving pain during delivery, and also promoting underwater delivery methods.

Among the many methods, the most proven and effective method is the neuraxial analgesia performed by an anesthesiologist.

This method is very popular in the obstetrics departments of many hospitals. Women and their families have high expectations for it and generally believe that it can be completely painless after use.

The reality is that "painless" is only an ideal state, not an absolute.

Medical staff can only try their best to reduce the pain level.

Measures such as prenatal education and family companionship have the same goals, but the actual results are different. Moreover, it is not easy to realize the desire to be completely painless.

Neuraxial analgesia is essentially a nerve block.

To do this well, you must know which nerves conduct labor pain.

It is particularly important to understand the innervation of the uterus.

The uterus is regulated by sympathetic nerves and parasympathetic nerves, and the uterine body and cervix have different neural regulation.

The sympathetic sensory fibers in the uterus travel through multiple nerve plexuses and finally reach the spinal cord along the spinal nerves from T11 to L1.

The nerve conduction of the cervix is ​​mainly carried out by the parasympathetic nerves in the S2 to S4 segments. These nerves are distributed on both sides and rear of the uterus. Here, the parasympathetic nerves meet the sympathetic nerves, and together they form the corresponding nerve plexus.

The catheter tip is located in the three adjacent vertebrae areas above and below. The analgesic effect is most significant in this area, so it is necessary to ensure that the catheter tip is accurately placed in the middle of the L1 vertebral body.

It is indeed quite challenging, because although some hospitals are now beginning to adopt ultrasound guidance technology, most doctors still mainly rely on touch to locate the puncture point. Although this error is tolerable within a small range, it may still adversely affect the treatment effect.

In the second stage of labor, the effect of neuraxial analgesia is sometimes less than ideal.

At this time, if the mother encounters unbearable severe pain, mood swings, or insufficient fetal oxygen, her fetal heart rate may be abnormal.

This finding is relevant to the understanding of pain as fundamentally linked to the painful sensations and emotional experiences caused by tissue being or potentially being harmed. Women who decide to switch from natural delivery to caesarean section because of unbearable pain during childbirth usually have a strong fear of pain.

It plays a vital role in easing the pain of childbirth, but that doesn’t mean it solves every problem. Especially during childbirth, there can be a lot of uncertainty. If these adverse factors continue to accumulate, various adverse consequences may occur.

Women and their families may think that neuraxial analgesia can provide quick relief from pain, but this is wrong.

This misunderstanding comes from the fact that many hospital obstetrics departments have exaggerated the effects of neuraxial analgesia.

In clinical practice, neuraxial analgesia does make a difference, however, not everyone enjoys complete pain-free feeling.

This wrong idea not only makes the mother feel psychologically disappointed, but also puts the anesthesiologist under great pressure.

If the mother feels that the actual pain relief has not achieved the effect she expected, she will often feel dissatisfied with the anesthesiologist. But in fact, anesthesiologists have done their best within the limits of existing technology and conditions.

The anesthesiologist's understanding of the anatomy of the uterine nerve is not clear enough, and some details are not precise enough. This knowledge is so complex that even experienced doctors can be confused.

This affects the performance of neuraxial analgesia.

If the nerve conduction route is not clearly understood, it will be difficult to place the catheter accurately, which will naturally affect the analgesic effect.

When locating puncture points, they generally lack precise equipment support and can only rely on touch to locate, which can easily lead to errors.

Under the influence of various factors, even if the operation is very accurate, the analgesic effect may still be unsatisfactory during delivery. This situation makes it very difficult for anesthesiologists to deal with labor analgesia.

During the delivery process, if the mother feels that her pain has been relieved, her sense of well-being will be significantly improved compared to when she had not used any analgesic measures.

The analgesic effect is very obvious, which often reflects the anesthetist's operation and adjustment is quite precise, however this is not common.

Don’t overestimate labor analgesia, it still has many limitations.

The mother, her family, and the hospital should all view pain relief during childbirth rationally and should not have unrealistically high expectations.

Understanding how it works and possible problems can help you better handle the birthing process.

What new insights do you have on the difficulty of anesthesiologists’ work in labor analgesia?