The objective of this thesis centers around enhancing the standard of obstetric care, with a particular emphasis on investigating the effects of different analgesic techniques employed during vaginal childbirth. The aim is to evaluate how these methods influence women's contentment with the care they receive throughout the process of labor and delivery, ultimately aiming to safeguard the health and welfare of both women and their offspring. The research endeavors to establish a concept of pain relief firmly based on scientific principles. Its primary goal is to cultivate a favorable childbirth experience while mitigating the adverse long-term psychological consequences, specifically focusing on reducing the risk of postpartum depression.
Adequate analgesia during vaginal childbirth is a crucial component of women's satisfaction with care during labour and birth. Insufficient control of labour pain can lead to short- and long-term mental outcomes. 13% of women suffer from postpartum depression (PPD), and 4-6% from post-traumatic stress disorder. Postpartum psychological disorders in women increase the risk of suicide and infanticide and lead to cognitive-behavioral disorders in children.
Women who choose nitrous oxide (50:50) for childbirth report high satisfaction due to reduced pain and anxiety caused by its effects, however, they also report a medium-to-low analgesic effectiveness, which may prompt a change in decision regarding the method of pain relief.
Due to conservative views in society, women often choose childbirth with non- pharmacological methods of pain relief or without pharmacological pain relief at all. Such situations frequently occur during hospital and non-hospital births that closely resemble home environments. Some women manage labour pain well without any intervention, while others require pharmacological and/or non- pharmacological methods of pain relief.
In Ukraine, there is a degree of uncertainty and inconsistency in elevating the level of analgesia within the interdisciplinary team during vaginal childbirth, considering the intensity of labour pain, to achieve adequate pain relief and minimize the use of invasive pain relief methods. Problems also increase with the methods of evaluating and documenting the intensity of labour pain.
In Ukraine, nitrous oxide (50:50) for labour pain relief is limited, mostly used in private hospitals [165]. Alternative methods of pain relief are primarily utilized, the variation of which depends on the specific birth center. If alternative methods of pain relief prove insufficiently effective, opioid or non- opioid systemic analgesics may be added.
The indication for neuraxial methods is the desire of the labouring woman, assuming there are no contraindications. However, it is not necessarily associated with satisfaction after the usage of epidural analgesia.
Implementing neuraxial techniques at a later stage in labour does not significantly alleviate the suffering, but rather, can contribute to a negative childbirth experience. The notable lack of information among pregnant regarding pain management methods and their sequence of application calls for additional exploration. These issues emphasize the importance of our study.
Due to the individuality of each woman's childbirth experience, employing a standardized approach to pain relief may prove ineffective or potentially detrimental for certain individuals.
The research aims to utilize women's satisfaction with the care they receive during labor and delivery as a basis for selecting the most suitable pharmacological and non- pharmacological analgesia techniques. The objective is to improve the effectiveness and safety of pain management specifically for women undergoing vaginal childbirth.
During the research, the following tasks were accomplished:
1. Local protocols for pain management during vaginal childbirth in various public maternity units in Kyiv were studied;
2. Predictors of severe labour pain were identified and studied;
3. The effectiveness and safety of patient-controlled epidural analgesia during vaginal childbirth was examined, considering the woman's satisfaction with care during labour and childbirth;
4. The effectiveness and safety of pain relief using nitrous oxide (50:50) during vaginal childbirth was examined, considering the woman's satisfaction with care during labour and childbirth;
5. The effectiveness and safety of alternative pain relief methods during vaginal childbirth were researched, considering the woman's satisfaction with care during labour and childbirth;
6. The level of the woman's satisfaction with care during vaginal childbirth in standard conditions without pharmacological analgesia was studied;
7. The impact of various pain relief methods on the risk of developing postpartum depression in mothers was investigated
