From conception to breastfeeding, the mother’s pain for us, science is solidifying it

Mother, give us life.It wasn’t until we grew up and even old. We gradually realized what it meant.In the time of creating a new life, all the pain that the mother is forced to bear should be seen, recognized, and changed.

Written article | Xiaoye

Throughout the ages, people did not hesitate to dedicate the most beautiful eulogy to their mother, but women suffered the long pain that women suffered from pregnancy to postpartum breastfeeding, but they could be carried by paper and pen.It is science, silently supporting the mother of the world, and trying to ease the pain they have to endure.

Conceive: Under the blessing, the suffering is unpredictable

Most of the pregnant women can’t escape the discomfort during pregnancy, and many discomforts have entered the category of pain.As the level of hormone changes, the fetus continues to grow, there is always a pain from head to toe, there is always a pain that may be stared at pregnant women: headache, sore shoulder, swelling of breasts, burn pain, back pain, pelvic pain, legs, legs, leg pain, leg pain, legsThe muscle is stiff and painful, the end of the limbs is swollen and painful … These are common pain during pregnancy [1, 2].

Everyone’s physique is different, and the severity of pregnancy pain varies from person to person.So far, the study of epidemiological diseases of pain during pregnancy is still scarce, but the existing results still show that back pain and pelvic pain are the most likely to affect the normal life of pregnant women, and they often make them have to seek medical treatment.

According to three studies from Nepal (2019), Norway (2012), and Sweden (2005) [3-5], waist and back pain related to pregnancy and/or pelvic pain are generally ranging from 34%to 72%.In Nepal, the 1284 pregnant women participating in the survey reported that the back and pelvic pain in the back and pelvic pain reached level 6 (Figure 1), that is, "unbearable and obvious moderate pain, sleep is disturbed, and analgesic drugs need to be taken."

Figure 1. Use the digital rating method (NRS) to measure the pain.Level 4 pain can affect sleep, and level 7 pain cannot fall asleep.[10]

Today, more and more pregnant women no longer choose to endure silently and ask doctors to prescribe painkillers.Common analgesic drugs include non -steroidal anti -inflammatory drugs (such as ibuprofen), acetaminol (also known as acetamidol, heating and polygami), and opioids. Unfortunately, they have an impact on the development of the fetus.FDA (US Food and Drug Administration) does not recommend that women who have been pregnant for more than 20 weeks take non -steroidal anti -inflammatory drugs because they may cause severe rare liver disease before they are born. [7]A review in 2021 states that acetaminol may interfere with the fetal brain, reproduction and urinary system development, which brings a negative impact [8, 9].

In Europe and the United States, there are more and more pregnant women using opioids.The queue study of the University of Montreal University in Canada found that from 1998 to 2005, the penetration rate of opioid drugs during pregnancy increased by 40.3%. Specifically, it was 16-28 weeks of pregnancy and 28 weeks of pregnancy.The number of women’s medicines increased significantly [10].In the United States, from 2010 to 2017, the number of women with opioids related diagnostic records during pregnancy increased by 131%. At the same time, the number of babies suffering from newborn abstinence syndrome at the same time increased by 82%, 12]; and a self -report in 2019 shows that 6.6%of the interviewed women (total number of 20,643 people) acknowledged taking opioid prescription drugs during pregnancy.[13]

Therefore, although the number of pregnant women taking painkillers is increasing, in view of the adverse effects of drugs on mothers and fetuses, expectant mothers must strictly abide by the doctor’s advice, maintain safety, and ensure the health of themselves and the baby.

Figure 2. Pregnant woman with low back pain.丨 source: UNSPLASH

Childbirth: The light of analgesic technology brings hope of hope

In October, the pregnant mothers will usher in the peak challenge of physical pain.With the digital rating method, starting from the initial contraction, the continuous pain can reach level 2-3, and the most intensive level can be as high as 7-8 [14].However, simple numbers do not make people really feel the same. The descriptions given by each mother are different: "Returning like a tide, and retreating and rising up."I feel that the belly and waist are hammering with a hammer with a hammer, and the knife is stabbed "" Just like the waist is folded.

There is pain, and naturally you have to try to give an analgesic.In the history of East and West, it has been recorded in the use of opium and folk herbs to relieve childbirth pain, as well as various prescriptions such as olive oil massage and eel gallbladder [16].However, under the guidance of strong traditional concepts and religious creeds, endurance of childbirth has always been regarded as the responsibility of women’s natural righteousness, and alleviating the maternal pain is never the primary task in the process of birth.For thousands of years, women have silently endured the pain caused by natural childbirth.

However, medicine did not give up women who suffered, and shortly after the birth of modern anesthesia, the analgesic of childbirth was benefited.In 1846, the American dentist William Morton successfully demonstrated the effect of inhaling ether anesthesia surgery at the MIT of the General Hospital of Harvard University and created a new era of surgery.One year later, Dr. Nathan Cooley Keep, another American dentist, published an article in Boston Medical Surgical Journal ("Boston Medical Surgery Journal") to report to use ether gas in the process of assisting a maternal delivery and success. Successfully succeeded.Reduce childbirth pain.The first female in the world was named Fanny Appleton Longfellow, the second wife of Henry Wadsworth Longfellow, a famous American poet. With the help of Keep, she successfully gave birth to her first.Three children [18].

Figure 3. (Left) Nathan Cooley Keep

At the same time, on the other side of the Atlantic Ocean, James Simpson, a professor of gap at the University of Edinburgh, also used ether as anesthesia for the first time to help pregnant women take delivery of dead babies who failed in their bodies [21].Later, he began to look for other anesthesia similar to the function of ether, and soon cooperated with his colleagues to discover chloroform. He successfully helped a female produced two weeks earlier than the due date., Then buckle on the mother’s mouth and nose.According to his own records: "The mother gave birth to a baby in 25 minutes after inhaling the chloroform." [22] Of course, the most famous chlorine childbirth and analgesic case is the Queen Victoria (1819-1901) in 1853Prince Leopold, the queen kept awake during childbirth, but did not feel pain.

As the gospel of a mother, the analgesics of delivery are popular.In 1848, a case of 2000 cases used to use anesthesia during childbirth at a meeting of the American Medical Society, and the number of complications was not large, and it was not serious.Nevertheless, the voices of opposition still exist. On the one hand, from the dogma of the Bible, on the other hand, from the inside of the medical community -many people think that the pain of the mother during childbirth is a meaningful clinical indicator. Elimination of pain may may be possible.Inhibit delivery and cut off the emotional bond between mothers and babies.In this regard, Simpson and their colleagues insist on defending the need to defend the analgesic of childbirth, promote the positive significance of anesthesia, coupled with the queen’s endorsement. By 1862, obstetric anesthesia is quite common, but doctors in different places have the choice of anesthesia choices in different places.My preference [16].

Figure 4. (Left) James Simpson (1811-1870) (right) Queen Victoria (1819-1901) had 9 children, and Prince Lion was her eighth child.

In addition to the ether and chloroform, it was found in the 18th century nitrogen dioxide

It has also been applied more and more from the early 20th century in the analgesic of delivery. Different doctors have tried to mix the laughter and oxygen, and strive to overcome the problem of hypoxia that can cause low oxygen.So far [16].

There are two different technologies that develop in parallel with inhaling childbirth analgesics.The first name is "Gastrointestinal External Technology", which became a conventional operation of a nursing nurse in the 1920s, but the process is relatively cumbersome: when the maternal cervix expands to 2-3 cm, or the pain of contractions becomesLaw, when the interval is 5 minutes, the midwife will continue to enter the enema first, and the interval is injected with morphine and magnesium sulfate according to the specific dose for a certain period of time.Then help the mother to lie down, clean the perineum, apply Vaselin in the rectal area to relieve the stimulus, then insert the gastrointestinal catheter, and slowly drip the olive oil-ether mixed solution in the next 30 to 60 minutes.The use of extra -gastrointestinal technology can effectively reduce pain without affecting the delivery process.However, this method also has disadvantages: pregnant women are easy to sleep due to the effect of drugs during childbirth, so midwives need to be vigilant throughout the process.Secondly, this technology is easy to anesthesia and stimulate the rectum. Sometimes it may be used to pull out the baby to pull the baby out [23].

The second method is a local anesthesia method.In 1921, the Spanish military medicine and surgeon Fidel Pages reported on the ductal anesthesia. The anesthetic drug was injected to the outer gap of the lumbar duct. The drug blocked near the spinal nerve signal nearby, which temporarily lost the pain.More than 20 years later, American anesthetic physician John Bonica began to promote using epidural anesthesia during women’s delivery.His wife implemented a ether analgesic when childbirth first tires, which produced complications of life -threatening. Therefore, when giving birth to a second child, Bonica uses a hard spinal anesthesia to give his wife analgesic.The first maternal successfully undergone epidoirus drunk.By the 1970s and 1980s, the analgesic of childbirth in the form of hard spinal anesthesia had become popular in the United States.According to statistics, from 1981 to 1997, the proportion of extra -town pain delivery in major hospitals in the United States was close to 70%[24].

Figure 5. (Left) Fidel Pagés (1886-1923); (right) John J. Bonica (1917-994) [25]

The analgesic technologies mentioned above use anesthesia or calf drugs, but some women are always unable to use these drugs, or they are worried that drugs may have adverse effects on maternal and infants.Therefore, in obstetric practice, you can also choose non -drug analgesic methods.For example, in recent decades, European countries have prevailed in water.This method can be traced back to 1805. After a French woman suffered for a few hours of childbirth, her doctor decided to let her lie in the bathtub filled with hot water. As a result, the child was born smoothly, and the mother and child were safe.[26].The birth of the first medical report was American Jeremy Lighthouse, which was born in a warm bathtub water in 1980.In the 1970s, delivery in water was widely spread and welcomed. After observing nearly thousands of cases of delivery in water, doctors found that women with childbirth did prefer the water environment.process.[27]

By 1993, all maternal and infant centers in England and Wales in England were equipped with water delivery equipment to help more women achieve water delivery., 29].In sharp contrast to the British enthusiasm is the cautious attitude of the United States.In 2014, the American College of Obstetricians and Gynecologists published an article on the official website [26]. At presentTherefore, the delivery of water should still be used as an experimental method, which must be performed and supervised in the experiment.

Children’s analgesic technology has developed in Europe and the United States for more than 150 years, and is now quite mature.It helps women solve the greatest difficulties facing childbirth, and make women no longer have particularly fear of childbirth.According to statistics, the analgesic rate of childbirth in Western developed countries has reached 85-98%, which fully shows that accepting analgesia during natural delivery is a normal and widely accepted concept.

China’s painless childbirth studies were not launching late.As early as 1963, Professor Zhang Guangbo, an obstetrician and gynecologist of Peking University Hospital and the first painless childbirth in China, used low -concentrations of Pruca because of 67 maternal implementation of childbirth analgesics, and recorded 50 cases of clinical samples in detail, and then held in Nanjing in Nanjing.At the first National Anesthesia Academic Conference, the papers "Continuous Discovering Discovering for Painless Childbirth" confirmed the feasibility of painless delivery [17].

Figure 6. (Left) The original version of Zhang Guangbo’s thesis.Photo by Zhang Lingyun [30]; (Right) Zhang Guangbo, the first person in painless delivery in China [31]

Unfortunately, Zhang Guangbo’s research was stranded in the tide of history.Fortunately, we are catching up -by the 1990s, Yao Shanglong, anesthesiologist at Wuhan Union Hospital, went abroad to participate in the Annual Meeting of the American Anesthesiologist Association (ASA), exposed to childbirth analgesic technology, and actively launched clinical attempts and published articles after returning to China.In 2000, Nanjing Maternal and Child Health Hospital tried to promote the analgesics of childbirth. In August 2001, the Peking University Hospital launched an analgesic in large -scale delivery, and started training classes from February of the following year to promote childbirth analgesic technology to the country.In 2008, Hu Lingqun, an associate professor of anesthesiology at the Fenburg Medical College of Northwestern University of the United States, launched the "Painless During Sub -China Division", leading nearly a thousand American medical staff to cooperate with more than one hundred domestic hospitals to promote childbirth analgesics.In the same year, Xu Mingjun, a professor at the Department of Anesthesiology of Beijing Obstetrics and Gynecology Hospital, also launched the "Kangle Children’s National Exploration National Promotion Project".In 2018, the National Committee of Health and Health issued the "Plan for Piloting the Analing Aurement".In 2022, the assessment of the Health Commission showed that 912 pilot hospitals in the country rose from 27.52%in 2017 to 53.21%in 2020 [32].However, at present, the penetration rate of giving birth in my country as a whole is about 30%. To benefit more Chinese women in the analgesic of childbirth, the road is still long.

Postpartum: What is the end of pain trip?

After "unloading", the body’s pain will not disappear immediately.The type, strength, and duration of postpartum pain varies from person to person.Clinically, there are more uterine spasm, neck, back or joint pain, perineal swelling and pain, wound pain, breast swelling, urination pain, hemorrhoids, etc. [33].In addition to physiological pain, postpartum hormone changes make women’s emotional ups and downs stronger, and it is easy to cause mental "pain" -the postpartum depression.(Do not detail here here.) However, in general, with the recovery of the body postpartum, the pain will gradually fade away. For a few days, the long may be half a year.

In the past ten years, there have been more and more postpartum women’s reports of continuous pain, which has attracted the attention of the government, medical institutions and the public.In 2016, a study published in the EUROPEAN JOURNAL of ANAESTHESIOLOGY ("European Anesthesiology Journal") showed that 11%of sustainable pain experienced 12 months after childbirth. [34]

In 2020, a team from the University of Washington, USA revealed that factors related to continuous pain (more than 6 months) after childbirth [35]: The first is the way of childbirth, such as cesarean section may leave scar pain; second, vagina and perineal sustainabilityPain is related to surgical vaginal delivery and perineal trauma; finally, the medical history and weight of back pain before and during pregnancy are also related to continuous pain on the back of the birth.

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