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Hypnosis is a frame of deep mind and physical relaxation that allows the pregnant mother to focus intensely on a thought or feeling, preventing outside disturbances. In this state  the mind is more open to positive suggestions that change our beliefs . When a woman gets ready for childbirth with hypnotherapy, these suggestions aim to replace anxiety and expectations of pain with positive expectations of a secure, soft – even comfortable – birth.

Women learn to hypnotize themselves, using skills such as deep breathing, visualization, and positive affirmations or hypnosis strategies. For example, a woman using this skill may pay deep inner attention on the sound of her deep shallow breathing, taking her  into a hypnotic state, and imagine her newborn descending  downward with each expiration.

The idea of experiencing  an altered mental state makes some people goose bumps, hypnotherapists say we all experience this state in our everyday lives. Daydreaming, being deeply engrossed in a book or movie, or driving someplace and having no memory of the journey when you arrive are described as examples of the hypnotic state.

How can Hypnotherapy  help you, in your childbirth journey?

One thought explains that when a mother feels anxious during childbirth, her body releases stress  chemicals that stimulates the body’s “fight or flight” response. This leads to muscles being tighten and disturbs with the birthing journey. By conditioning the subconscious mind to expect a safe, gentle birth,  women can prevent going into this adrenaline rush state, allowing for a smoother birth experience.

The theory that hypnosis can lessen labor by aiding  women prevent the fight-or-flight state has been supported in research. It makes sense based on experts’ understanding of how the body works, says William Camann, director of obstetric anesthesia at Brigham and Women’s Hospital in Boston, Massachusetts, and author of Easy Labor: Every Woman’s Guide to Choosing Less Pain and More Joy During Childbirth. ” 

Labour Analgesia From Anesthesiologist View Point

Childbirth may be the most painful experience many women ever faced. The experience is unique for each woman. methods of labour pain relieve chosen  depends upon the techniques available locally and the personal choice of the individual.

Non-pharmacological Methods
Benefit of non-pharmacological mode of pain relieve for labour pain:ease of
administration with minimal negative unwanted effects.; however there is insufficient evidence to support the
effectiveness of some of these modalities and some may be expensive and time consuming.

A possible list of non-pharmacological techniques are mentioned as below:

• Transcutaneous electrical nerve stimulation (TENS)
• Relaxation/breathing skills
• Temperature adjustment: hot or cold packs, water immersion
• Hypnotherapy
• Massage
• Acupuncture
• Aromatherapy

Pharmacological agent : inhalation agents and systemic analgesics.

Inhalation Methods : Nitrous oxide:
Nitrous oxide has been  in obstetric practice for maternal analgesia for many years
Entonox (50 % nitrous oxide with 50% oxygen ) provides pain relieve within 20-30 seconds of
inhalation with a maximum effect after about 45 seconds.

Benefit  include:
• ease of use
• physician supervision not needed for administration
• minimal drug accumulation with intermittent use in patient’s body
• self-administration gives self control.
​​
Negative side effects include:
• drowsiness
disorientation
nausea
• does not provide absolute pain relieve.

The effectiveness of inhaled nitrous oxide for labour pain is controversial. Current
clinical research suggest it relieves labour pain to a certain degree in most delivering mothers ,however
does not gives complete pain relieve for many. Nitrous oxide still being used as  a useful analgesic
tool for childbirth pain and is especially beneficial in centers where other analgesic modes are limited.

Systemic analgesics
Pethidine is usually administered
intramuscular (IM) . Despite commonly use, its effectiveness has been
debated and it has been suggested that it gives only sedation rather than
pain relieve in childbirth.

Pethdine, like other opioids, delays gastric emptying and  increases
gastric volumes in labour. It also leads to sedation,  respiratory depression
and its active metabolite component  has seizures like components.

Pethdine crosses the placenta and its effects on the fetus are directly in proportion to dose and timing of administration; the peak fetal plasma concentration occurs 2-3 h after maternal intra-muscular administration. Neonatal effects are compounded by production of norpethidine which leads to further sedation and respiratory depression. Neonates of women administered norpethidne in labour have been shown to be sleepier, less attentive and less able to establish breast feeding despite normal APGAR scores.

Despite these side effects, Pethidine still is the commonly used medication in many maternal childbirth units, is simple
to administer and may be a useful analgesic tool where other methods are not
available or not suitable for the patients.

Fentanyl
has a fast onset. repeated dosing may result in medications accumulation in both the fetus and the mother. Benefit include absence of active by-product and immediately onset of action making it useful for patient-controlled pain relieve drugs. side effects are just as same to all other opiods ill effects.

Patient-controlled analgesia (PCA)

If regional pain-relieve is not available or contraindicated, PCA is a useful mode of
pain management as long as the equipment and staffing are available. PCA gives some
control to the woman, and this in itself is related with significant satisfaction; however it
is important that women are directed in how to use the machine properly.
Most opioids have been used in PCA devices; drugs routinely used include fentanyl and
more newly added remifentanil.

However,
close observation is important and additional oxygen may be needed.
Regional techniques options for labour analgesia
Regional techniques is the “gold standard” for labour analgesia.

Lumbar Epidural Analgesia

Epidural analgesia effectively provides childbirth pain relieve; however debate exists as to the effect of epidurals on the progression of labour, mode of delivery and effects on the newborn.

1. Effect on caesarean section rate

• Various research have attempted to establish the effect of epidural analgesia on
progress of labour and mode of delivery. When combined these research clearly
shows that epidural analgesia does not increase the risk of caesarean section.

2. Epidurals and long term backache.

• Back pain is common after child birth . studies have confirm that epidural analgesia is not linked with an increased prevalence of backache after child birth.

3. Effect on length of labour and operative vaginal delivery.

• Many research have highlighted a  prolongation of the  labour
and an increase in the operative vaginal delivery rate (forceps or vacuum deliveries)
of delivering mothers taken up epidural analgesia for childbirth.

• It should be remembered that pregnant mothers with complicated, painful labours may ask for epidural analgesia more often and the prolongation of labour caused by epidural analgesia might cause obstetricians to perform an operative delivery more often in order to shorten this stage off labour.

4. Effect on the fetus and neonate.
• No  differences have been shown in neonatal arterial pH or APGAR
scale in babies who are born to mothers with epidurals.

5. Effect of epidurals on maternal temperature.
• Several researches have demonstrated a  raised in the temperature of mothers
receiving epidural analgesia. The reason of this raised  temperature and significance for
the neonate still unknown.

Epidural Technique
Low dose vs. traditional epidural analgesia.
• Low dose techniques provides the best of spontaneous vaginal delivery should
epidural analgesia be needed.

Decision of epidural drugs for labour and delivery.

Epidural bupivacaine gives good sensory block and has been used for labour
analgesia for many years.

Ropivacaine was designed to reduce the prevelance of cardiac toxicity in the event of
accidental intravenous medication error.

Epidural Opioids

The addition of epidural opioids to local anaesthetic solutions has been the standard practise over  the years.

Summary

The pain of childbirth is severe and many mothers seek ways to reduce it. Non-regional
modalities include supportive measures, inhalation of nitrous oxide and parenteral opioid administration. Epidural analgesia gives excellent quality analgesia in labour. Well
performed researches confirmed there is no influence on the rate of caesarean delivery or long term back ache. epidural analgesia is linked with increased duration of
labour and increased prevelance of operative vaginal delivery.