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Hippocrates had already subjected childbirth pains to detailed examination and analysis and he had concluded that it is more definite and frequent in case of primagravidas. Childbirth pain had been considered as divine origin until the middle of 19th century, so as it was naturally related to delivery they didn’t even try to reduce it.

The first case of childbirth analgesia (1847) is connected to the name of James Young Simpson, Scottish obstetrician, who had used ether for this purpose (10). John Snow administered chloroform in 1853 at the childbirth of queen Victoria, when she had given birth to prince Leopold. Then chloroform had been the most often administered method of childbirth analgesia for almost 100 years, later it was replaced with nitrous oxide, then opiates and epidural analgesia.

Childbirth analgesia has undergone significant development in the past 150 years, but due to its special position it is continuously in the crossfire of disputes.

Due to the fact that childbirth analgesia is performed with pregnants the methods always affect two persons, the pregnant and the fetus. The examination of fetal consequences of the different analgetic techniques is still the preferred topic of the scientific issues. Apgar scoring system – which is widespreadly used even today – was elaborated by Virginia Apgar (who was an anaesthetist) for the purpose of objective assessing of the impact of analgesia to the fetus.

Childbirths had been performed without any pain relief for thousands of years, so childbirth analgesia is considered to be a „luxury” intervention in many parts of the world even now.

Childbirth analgesia must meet several criteria:

  1. It must be safe both for the pregnant and the fetus!
  2. Administration should be simple!
  3. It must have quick, predictable and calculable effect!
  4. The pregnant must be cooperative during labour and delivery!
  5. Pain relief should prevail in each stage of childbirth!
  6. It should result in minimum motoric block thus enabling the pregnant to actively participate in the delivery!
  7. It should facilitate delivery, thus avoiding other interventions!
  8. It must not reduce the uterine function; it should not prolong delivery duration, and must not increase the need for finishing operations or the frequency of Caesarean section!
  9. It should be applicable for pain relief in Caesarean section, thus avoiding general anaesthesia!

Good analgesia not only meets the demands of painless delivery of „today’s women” but its several favourable effects contribute to the improvement and stabilization of the condition of both the mothers and the fetuses. Labour pain induces stress reaction of the organism, energy consumption is increased, pulse and blood pressure of the mother are growing. Increased energy consumption leads to quicker fatigue and weakening of uterine contractions. In case of delivery without complication and healthy pregnants this would not affect the course of delivery due to the compensating mechanisms, however in case of prolonged labour and delivery the above changes may be dangerous both for the mother and the fetus.

The techniques and medicines of pain relief applied today have been undergone important development in the past 2 decades.

Labour pains can be most efficiently relieved with the neuraxial methods (epidural, spinal, combined spinal-epidural anaesthesia) out of every pain relieving medicines and techniques. Regional anaesthesiology is efficient, it can be easily applied, it can be repeated, if required and all this is done without intervention in the state of mind of the pregnant and as a result the woman in labour is able to cooperate with her doctor and midwife during the whole period of delivery. By using the above techniques childbirth analgesia achieved that the woman in labour can actively participate in delivery almost painlessly and with minimum side effects. It could not have been imagined decades before that there had been a method by which the women in labour would be able freely walk; but childbirth analgesia has developed to such an artistic level, that it is possible by now.

Epidural pain relief – contrary to the common belief – does not increase the frequency of Caesarean sections according to our experience, but sometimes oxytocin must be administered to support the process of delivery. Benefits of epidural anaesthesiology for the mother and the fetus overshadow the growth of oxytocin demand, so it is not by chance that it became the most popular pain reliving method in the developed countries and 60 % of the women in labour choose epidural or combined spinal-epidural anaesthesia for reducing labour pains.

In case of spinal and epidural anaesthesia the expectant mothers are most afraid of the pin-prick. Writer of these lines experienced these moments not only in the quality of an anaesthetist, but also as a mother. I can tell, together with many other mothers that the intervention required for pain relief is painless. There were some patients who felt some pain, but also they compared these few seconds to the pain caused by a simple injection or vaccination. Deliveries managed with pain relief have several benefits. The mothers do not get tired out, they are not exhausted by a possible prolonged labour, and they can live the first hours after delivery in a very different mental state, when they first meet their babies.

The greatest benefit is that the woman in labour can experience a Caesarean section awake, without general anaesthesia. Previously the Caesarean sections were performed in anaesthesia and the mother could first meet her baby –after wakening up - only hours after the intervention. At Maternity Clinics the father can be present at Caesarean section; we believe his presence gives much help for the mother. The fathers do not have to be afraid of watching the operation in close-up, because they are behind a folding screen, at the head of their partners. In case of delivery or Caesarean section the baby is together with its mother and father in the family room, where the whole family can be happy together with the newcomer.

Dr. Petronella Hupuczi

Dr. Petronella Hupuczi
Head of the anesthesiology service.


Phone number: +36(06)1-213-4222


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