Why is painless childbirth difficult to popularize in China? Why is painless childbirth difficult to popularize in China?

Why is painless childbirth not popular? Today, let's explain why it is difficult to promote painless childbirth in China. Painless childbirth is a good way to reduce the pain of childbirth for pregnant women. So, when can painless childbirth be promoted in China during childbirth? Please see the detailed introduction below.

The main reasons why painless childbirth cannot be implemented are the lack of anesthesiologists and the traditional concern about the side effects of anesthetics.

Medicine has been trying to relieve pain for mothers through physical or drug methods, such as water birth, doula, acupuncture, massage, etc. "The best effect is still drug method, especially spinal block analgesia, analgesia through spinal anesthesia or epidural analgesia." Nan Xingdong, director of the anesthesiology department of a private women and children's hospital in Beijing, introduced that this is the most commonly used, safest and most effective painless delivery method at home and abroad.

Painless childbirth is medically known as "labor analgesia". In fact, it is to intervene when the cervix is ​​opened to about two fingers, and puncture the space between the lumbar spinous processes. The doctor will insert a very thin hose after reaching the epidural space. The hose is connected to a pain pump to continuously administer drugs to the spinal cord and nerve roots. Under the action of the drug, the pain signal generated by uterine contraction is inhibited from being transmitted to the brain, reducing the pain and fear of childbirth.

It was not until 6 o'clock in the morning on August 5 that Wang Fang's cervix was finally dilated to three fingers. She was lucky enough to wait for the anesthesiologist to perform the painless delivery. "It's a bit like an IV drip. The needle is injected into the spine in the back, and the anesthetic is injected little by little through the tube at the back." A few minutes after the anesthetic was applied, she no longer felt pain.

"Using painless delivery can reduce the pain when the cervix dilates, and allow the mother to rest during the first stage of labor, which is the longest time. When the cervix is ​​fully dilated, she can gather enough strength to complete the delivery. At the same time, it can reduce unnecessary oxygen consumption and avoid a decrease in uterine and placental blood flow, which is also beneficial to the fetus." Nan Xingdong said.

Shortage of anesthesiologists

Lu Yuren recalled to reporters that before she retired in 2012, the hospital's painless delivery rate could basically reach more than 80%, but now it is "almost gone because there are not enough people in the anesthesiology department."

Lv Yuren admitted that in terms of capability, all tertiary hospitals in Beijing can provide painless childbirth, but in reality many do not. "It's not that we don't have the capability, it's that we don't have the manpower."

Even when the popularity rate was high at that time, "doctors would not take the initiative to offer painless delivery injections, because the anesthesiology department is very busy and medical operations are risky. It is usually the mother who makes the choice." Lu Yuren said that usually the mother makes the request, the obstetrics and gynecology department contacts the anesthesiology department, and the anesthesiology department sends someone to evaluate whether it is necessary.

An obstetrician and gynecologist who resigned from a tertiary hospital in Beijing last year told reporters that although the hospital offers painless delivery, the penetration rate is only 10%. She requested painless delivery during delivery, but was unsuccessful because the anesthesiologists had patients undergoing surgery to continue to manage. "It depends on the arrangement of the operating room at the time. If you are lucky enough, there will be an anesthesiologist who can arrange it."

The shortage of anesthesiologists is the most obvious reason for the low penetration rate of painless childbirth. Duan Tao analyzed that from the perspective of clinical data, the number of anesthesiologists cannot match the number of pregnant women who need painless childbirth. In comprehensive hospitals, anesthesiologists are mainly assigned to surgeries in various departments of the hospital, and are not specifically assigned to obstetrics and gynecology departments.

Guo Xuesong, an anesthesiologist at a Class II general hospital in Guangzhou, told reporters that there are only three anesthesiologists in their department, who have to perform anesthesia for various surgical operations, painless abortions, painless gastroscopy, etc. every day. "One operation takes an average of 2 hours, and one painless abortion takes 15 minutes. There are about 15 painless abortions a day... Everyone is so busy that where is the time for painless delivery? Even if they wait until they have time to go for the operation, the mother may not be able to wait to give birth."

There is a huge shortage of anesthesiologists in the country. Huang Wenqi, vice president of the Anesthesiology Branch of the Chinese Medical Doctor Association, mentioned in an interview in 2016 that "there are currently more than 85,000 anesthesiologists in the country, and there is a shortage of about 300,000."

At the same time, the number of students enrolled in anesthesia majors nationwide is still decreasing, but the huge shortage of anesthesiologists is shrinking. The two seem contradictory but reflect the embarrassment of domestic anesthesiologists.

Therefore, when a pregnant woman asks for an epidural, it is usually not easy to satisfy her request. The reason is often that the anesthesiologist is too busy or he uses various side effects to persuade the pregnant woman to give up.

People usually worry about labor analgesia that it will prolong labor and increase the risk of cesarean section. Not only expectant mothers have such concerns, but even many obstetric professionals have concerns. In fact, a large amount of data shows that the effect of labor analgesia on the first stage of labor (from labor to full cervical dilation) is unpredictable. Some women may have prolonged labor and need to use oxytocin to promote uterine contractions; some women's labor is completely unaffected; and for those women with slow labor and uncoordinated uterine contractions, labor analgesia may play a role in accelerating labor. After labor analgesia, the sense of rectal pressure during uterine contractions is weakened, which may affect the mother's active use of abdominal pressure, resulting in a slight extension of the second stage of labor (full cervical dilation to fetal delivery), but there is no evidence that this will harm the health of mother and child. It is recognized by international and domestic academic circles that labor analgesia will not increase the rate of cesarean section. Anesthetic drugs used for intrathecal labor analgesia generally do not cause respiratory depression in newborns or affect their feeding after birth.

There are three misconceptions about painless childbirth: The first is that painless childbirth has an impact on the fetus. In fact, the dosage of painless childbirth is extremely low, only 1/5 to 1/10 of that of cesarean section, so the chance of entering the mother's blood and passing through the placenta is very small, and it will hardly have any impact on the fetus.

Some people also say that after using painless anesthesia for childbirth, the waist and legs will hurt after delivery. This is also nonsense. Many pregnant mothers suffer from waist and leg pain after delivery, which is mainly caused by excessive burden during pregnancy. Think about it, for ten months, carrying a fetus weighing several kilograms in the belly, the burden on the waist and legs is too heavy. Postpartum discomfort is also normal, and generally the mother can recover well.

Finally, it should be said that painless childbirth is not suitable for all pregnant women. Painless childbirth may not be suitable for all pregnant women, so pregnant women should undergo multiple examinations before using this technology, and undergo examinations and evaluations by obstetricians and anesthesiologists. The doctor will decide whether it is suitable for painless childbirth. If there are complications such as heart disease during pregnancy, history of drug allergies, and history of waist trauma, these situations should be reported to the doctor in time. Only those who meet the conditions for painless childbirth can use this technology. If one of the conditions is not met, the doctor will not recommend painless childbirth for safety reasons.