Produced by | Tiger Sniff Medical Group
Author | Chen Guangjing
Edit | Chen Yifan
Head Figure | Visual China
There is a kind of "human light" that has been used for nearly 200 years, painless childbirth, which is used by only 30% of Chinese mothers.
This data has rushed to the recent hot search. According to the "2022 World Analgesia Day Survey Report" released by the Physician's Daily in conjunction with Zhejiang Women's and Children's Fund and Babycare, 36% of respondents "did not know or only heard of" painless childbirth.
Although 82 per cent have hospitals to support painless childbirth, only 54 per cent of families have adopted painless delivery in real life.
In addition to economic reasons, the reasons for not using painless are also - the fear that painless hitting will affect the health and growth and development of the fetus, and the painless will leave sequelae for pregnant women, accounting for 21% of the respondents.
In today's increasingly high status of women, the embarrassment and pain in the process of giving birth to a child is no longer a secret.
Many people have given the image analogy: breaking 20 ribs, a truck running back and forth on the stomach... Another objective fact is that most of the men who experience grade 10 birth pain can only endure to level 6 to 7, and there is also the tragedy that the mother eventually develops to suicide due to birth pain. Many people change their minds as a result.
According to a study by New York University School of Medicine, the proportion of people who agreed to painless immunity increased by 20% after painful contractions began. After all, painless childbirth has long been hailed as the "light of man," and most people who have experienced it lament that going from hell to heaven could have been achieved in a matter of minutes.
Why do only 30% of people in China use painless childbirth? Is birth pain really necessary? Does a painless birth really make a child stupid? What is the root cause of the "light of mankind" that prevents most Chinese mothers from enjoying the "light of mankind"?
It got rid of "fate" 180 years ago
For a relatively long time, pain during childbirth was once considered the fate of the woman; In religious stories, the pain of childbirth is seen as a punishment for the "sin" committed by women.
With the transformation of tradition to modernity, medical technology has become more and more involved in childbirth, and labor pain has inevitably been involved in disputes, and painless childbirth has also begun.
According to Yu Lianshi, a history department at Mokpo National University in South Korea, the first person to try "painless childbirth" was Simpson, a British. In 1847, he tried to use ether and gorofen to relieve maternal analgesia, which was the first anesthetic in obstetric medicine.
Six years later, Queen Victoria gave birth to Prince Leoppert through "painless childbirth" and later Princess Bradlis. Grophon was also known as the "Queen's Anesthesia".
In the early 1890s, China introduced this anesthesia technique at the theoretical level. By the 1910s, painless childbirth had been fully introduced. However, at this time, the use of anesthetics in the obstetric department was not for the purpose of analgesia.
Today's most widely used spinal anaesthesia, in the 1930s appeared in the prototype, by the 1940s began to popularize, gradually emerging for the spinal cord injection anesthetics and other new technologies.
During this period, Western societies associated painless childbirth with science, which also allowed it to develop rapidly.
Unfortunately, however, anesthetics were soon discovered to be dangerous. The early selection of anesthetics is mainly a combination of morphine, atropine , chloraldehyde, scopolamine and the like.
Clinical practice has found that ether can cause maternal bleeding, stimulate the lungs, damage the kidneys, and slow down contractions, causing suffocation in children; Chloral can damage the heart and liver; The popular "twilight sleep method", that is, the method of subcutaneous injection of scopolamine/morphine combination to "erase the painful memory of the mother", will not only inhibit fetal breathing, leading to maternal delirium, but also may lead to maternal and infant death.
At the same time, it has also begun to be believed that this method deprives women of their dominance in childbirth and promotes natural production.
Interestingly, the UK, the birthplace of painless childbirth, was the most noisy, because of the natural childbirth movement against anesthetics, and the use of painless childbirth in the UK was once relatively low in developed countries.
But even so, the fire of painless childbirth development has been lit. In the two or three decades since, as hospital deliveries have become mainstream, painless deliveries have rapidly become more widespread in developed countries, especially after epidural anesthesia technology matured in the mid-1980s.
According to researchers at the National Center for Scientific Research and the Center for Social and Movement Studies in Paris, France, the chance of using epidural anesthesia in France in 1981 was only 4%, compared with 22% in the United States. Today, France leads the world in the world with 82.4% of the use of epidural analgesia.
In China, the first painless delivery surgery was performed in 1963 by Zhang Guangbo, an obstetrician-gynecologist at Peking University First Hospital, and by March 1964, she had performed labor analgesia for 67 women. However, the technology was rolled out in China until after 2000, and progress was slow, and by 2018, when the National Health Commission issued a document encouraging pilot labor analgesia, the use rate was less than 10%.
During this period, some women in order to pursue the "painless" delivery of labor, would rather give up a normal birth and embrace "caesarean section". This also makes the probability of caesarean section in China all the way up. According to Xinhua News Agency, the caesarean section rate in China was as high as 46% in 2011, more than three times the 15% "warning line" set by the World Health Organization (WHO), and the abuse problem is serious. Later, it was controlled after many appeals from clinical experts.
Why is painless childbirth, which took place two hundred years ago, still not widely accepted? All the worries and avoidances point to one question – is painless childbirth really safe and harmless?
Is a painless birth really harmless?
The "painless delivery" that rushed to the hot search is actually a drug-based analgesic method in labor analgesia. The most common and widely recognized method is spinal anesthesia, in addition to the aforementioned epidural block, there is also a combination of subarachnoid metadural block, which is a classic analgesic method.
The principle is local anesthesia. During the procedure, the doctor inserts a long needle into the lumbar spine, places a hose in a specific location – the epidural or subarachnoid space – and then withdraws it. In labour progression, the mother can self-administer the drug by pressing the pump on the catheter.
The anesthetic acts directly on the dura membrane, temporarily blocking this nerve signaling pathway.
In this process, the anesthetic does not enter the blood circulation, and in childbirth, because the mother also needs to use the contraction force to complete the delivery, it will not be completely "numb", but retain a certain pain. Therefore, the amount of anesthetics is also very small, generally only 1/5 to 1/10 of the caesarean section, which mainly plays an analgesic role.
Xiao Jinfeng and others from the Affiliated Hospital of Southwest Medical University further pointed out that the anesthetics used in epidural analgesia are mainly ropivacaine and fentanyl. Among them, ropivacaine is a drug that women can supplement themselves during childbirth, which has low toxicity to the cardiovascular and central nervous systems, and has a high protein binding rate and is not easy to pass through the placental barrier.
These reduce the harm to a relatively low level.
"[Painless delivery] is a local anesthesia that acts only in the maternal spinal canal and does not pass through the placenta, and has no effect on the intelligence of the fetus." Professor Kemi Weidong, head of the National Health Commission's pilot expert working group on labor analgesia and the First Medical Center of the PLA General Hospital, pointed out in an interview with the Physician Daily.
As for whether the sequelae of low back pain will be left after anesthesia in the lumbar spine, many domestic experts clearly pointed out that there is no direct connection.
The objective fact is that many women have low back pain, which has a lot to do with not resting well after childbirth.
This is not to say that painless childbirth is completely risk-free.
As mentioned in the above-mentioned articles by Xiao Fengying and others, there have been reports of epidural anesthesia that have prolonged labor, increased urinary retention, and lower limb movement block. There are also a few reports of excessive use of epidural anesthesia analgesia, which may affect the fetus through the placenta.
In the specific application, there are also many unsatisfactory places, such as: anesthesiologists are too busy, and they are almost born when they come; According to the regulations, opening three fingers can relieve pain, but opening one finger is already painful; As well as having to insert a urinary tube and carry a urine bag because of anesthesia on the lower extremities, causing psychological and physical discomfort to the mother.
In addition, a small number of people will have vomiting and itching problems with anesthetic allergies, and analgesia is not effective for 3% of pregnant women.
Of course, a lot of discomfort is negligible compared to birth pain, and statistically speaking, the proportion of problems is minimal.
However, the smallest probability of implementation to a specific person is 100%. Because of this, not everyone in Europe and the United States has chosen painless childbirth. After all, everyone's situation is different, and you need to make judgments and choices according to your own situation.
For Chinese mothers, the reasons for not being able to enjoy painless childbirth are very complicated. In addition to the lack of understanding and misunderstanding of painless childbirth, the small number of hospitals that can provide painless birth services, the insufficient manpower of anesthesiologists, the high cost, and the lack of medical insurance are all constraints.
For example, under the requirements of the National Health Commission, the country has carried out a pilot project for 4 years, and only more than 900 hospitals have set up pilot bases for labor analgesia, accounting for only about 1/4,000 of the more than 36,000 hospitals in the country, which is a dime.
Another example: the cost of this service of 1,000 yuan to 5,000 yuan is completely paid at your own expense, which is also unacceptable to many families. This is also reflected in the World Analgesia Day 2022 study report – 15% of respondents believe that affordability is important for the popularization of painless childbirth.
And the disparity between the cost of caesarean section and the cost of caesarean section also makes many people feel the gap. "After the reimbursement of the caesarean section, I only need to pay about two thousand yuan to three thousand yuan, and if the vaginal birth is painless, the cost is higher than the caesarean section." There is a new mother who told Tiger Sniff.
"World Analgesia Day 2022 Research Report" (excerpt)
From: Doctor's Daily
In fact, painless childbirth is not just a method of spinal anesthesia, or even more than just drug analgesia. In terms of non-pharmacological analgesia, there are also many ways to relieve pain by adjusting the rhythm of breathing, as well as giving birth in warm water.
No matter what kind of means, its core is the need for more humanistic care.
Non-pharmacological analgesic methods are difficult in the current situation of prominent supply and demand contradictions in the medical field, and in contrast, rapid advancement of intraspinal anesthesia is indeed a more realistic means.
However, anesthesia is a highly professional service project, and it is difficult for women and families to make independent judgments, and it is still in a very urgent situation. Therefore, in order to make more people accept the technology itself, it is still inseparable from the full communication between doctors and patients, and doctors need to give personalized advice.
If you do not communicate until you need to sign a family, and you change "informed consent" into "informed notification", it is still inevitable that there will be misunderstandings.
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