Unyango lweentlungu zokubeleka? Masithethe ngale nto!

Ukuba ulindele umntwana, omnye wemibuzo emikhulu onokuba nayo kule mihla kukuba ungamelana njani nentlungu yokubeleka, intlungu eza nokuzalwa komntwana wakho. Kakade ke, amava abantu awafani. Ubungakanani bentlungu ozivayo buxhomekeke kwizinto ezininzi. Umzekelo, ubungakanani bomntwana, indawo ami kuyo umntwana, ukuba ziqine kangakanani izitho zakho zesibeleko, kunye nokukwazi kwakho ukunyamezela iintlungu.

Kutheni ezi ntlungu zokubeleka zisiza? Zivakala njani?

Ngamafutshane, iintlungu zokubeleka zibangelwa kukufinyela kwesibeleko sakho nokuphumla (ukufinyela). Oku kunceda ukutyhala umntwana emjelweni wokuzala. Ngeli xesha, umlomo wesibeleko sakho uqala ukuvuleka (ukuvulwa) nokuncipha (ukucinywa), ukulungiselela ukuba umntwana aphume. Ungaziva neentlungu ngenxa yoxinzelelo lwentloko yomntwana kwisinyi sakho nasemathunjini. Kamva, ungaziva iintlungu njengoko umntwana etyhala isini sakho.

Uninzi lwexesha, eyona ntlungu inzima ngexesha lokubeleka kukubhitya. Indlela le ntlungu evakala ngayo iyahluka kumntu nomntu. Isenokungafani nakwixesha lokukhulelwa elinye njengoko yayinjalo kwixesha elilandelayo. Kwabaninzi, ivakala njengentlungu ebukhali emqolo nakwisisu esisezantsi, kunye noxinzelelo kwilungu lobufazi. Abanye bathi ivakala njengexesha lokuya esikhathini . Kwabanye, ivakala njengegagasi elinamandla lokubhitya ngokungathi isibeleko siza kuqhuma.

Ngamanye amaxesha , abantu baxhalabele kakhulu ukuphelisa iintlungu kunokuba intlungu inzima kangakanani, ihlala ixesha elide kangakanani, kwaye ihlala ixesha elide kangakanani. Kukho iindlela ezimbini eziphambili zokunciphisa iintlungu zokubeleka: amayeza kunye nokungasebenzisi amayeza.

Eyona nto ibalulekileyo kukuthetha nomboneleli wakho wokhathalelo lokukhulelwa malunga nezi ndlela zokuphelisa iintlungu. Indlela nganye ineengenelo kunye neengxaki zayo. Ukuthetha ngezi zinto ngaphambi kokuba ube nomntwana wakho kuya kwenza kube lula ukwenza isigqibo xa ixesha lifika.

Ngaba ukuba nomntwana kuyabuhlungu ngokwenene?

Abantu abaninzi baziva iintlungu ngexesha lokubeleka, nokuba basebenzisa amayeza okudambisa iintlungu. Indlela ezivakala ngayo ezi ntlungu, ixesha ezihlala ngalo, kunye nokuba zibuhlungu phi zinokuhluka ukusuka kumntu ukuya komnye kwaye ukusuka ekukhulelweni komnye ukuya komnye.

Ziziphi iindlela zokunciphisa iintlungu ngexesha lokubeleka?

Kubalulekile ukwazi ukuba zeziphi iindlela zokuphelisa iintlungu ezikhoyo ngexesha lokubeleka. Nceda uxoxe ngale nto nogqirha wakho ngaphambi kokuba umntwana wakho afike. Ukwazi into onokuyilindela kunye neengenelo kunye neengxaki zesixhobo ngasinye sokuphelisa iintlungu kuya kukunceda wenze isigqibo esinolwazi xa ixesha lifika.

Khumbula, iindlela zokuphelisa iintlungu onokukhetha kuzo zinokwahluka ngokuxhomekeke kwiimeko ezithile zokuzala kwakho. Ngexesha lonke lokuzala kwakho, ugqirha wakho uya kukunceda ukhethe indlela yokuphelisa iintlungu efanelekileyo kuwe, ngokusekwe kwimeko yakho kunye nendlela okhululeke ngayo.

Ugqirha wakho angakuthumela kwi-anesthesiologist (ugqirha ochwephesha ekulawuleni iintlungu) ukuze akuchazele iindlela zokuphelisa iintlungu, ezifana ne-epidural okanye i-spinal anesthesia. I-anesthesiologist iya kukuvuyela ukuphendula nayiphi na imibuzo onokuba nayo.

Nazi ezinye zezona pilisi zokuthomalalisa iintlungu ezisetyenziswa kakhulu ngexesha lokubeleka:

1. Ii-analgesics

Oogqirha banika ezi pilisi zokuphelisa iintlungu, ezibizwa ngokuba yi-"Analgesics," nokuba kukusebenzisa i-IV (intravenous line) okanye kwimisipha ukunceda ukunciphisa iintlungu zokubeleka. La mayeza awayisusi ngokupheleleyo intlungu, kodwa anokuyinciphisa kakhulu. Ngenxa yokuba ezi "Analgesics" zichaphazela umzimba wakho wonke kwaye zinokwenza wena nomntwana wakho nilale, zisetyenziswa kakhulu kwizigaba zokuqala zokubeleka ukukunceda uphumle kwaye wonge amandla.

Zisetyenziswa njani ezi (Analgesics) ngexesha lokubeleka?

Ezi zinikwa njengeyeza elinikwa ngemithambo yegazi okanye njengenaliti kwisihlunu. Zithintela impendulo yakho kwiintlungu, aziyisusi. Ii-analgesics luhlobo lweyeza elibizwa ngokuba yi-opioid.

Zithini iingozi zokusebenzisa ii-opioid ngexesha lokubeleka?

Ukusebenzisa ii-opioids xa usana lusentlungwini yokubeleka kunokubangela ubunzima bokuphefumla kumntwana emva nje kokuzalwa, kwaye kunokwenza umntwana azive ediniwe okanye "engazi nto." Ngoko ke, qiniseka ukuba ubuza ugqirha wakho okanye ingcali ye-anesthesiologist malunga neenzuzo kunye neengxaki zokusebenzisa ii-analgesics.

2. I-Anesthesia Yasekuhlaleni

I-anesthesia yendawo iyenza buthathaka indawo encinci yomzimba wakho, njengelungu lakho lobufazi kunye nendawo engqongileyo. Oogqirha bakunika oku xa uza kubeleka (okanye ukuba kufuneka uthungwe emva kokuba umntwana ezelwe).

Yintoni i-anesthesia yendawo yokuzala?

Oku kusetyenziselwa ukutyumza indawo encinci yomzimba wakho ngexesha lokubeleka. Ingcali yokubulala iintlungu iza kufaka isixhobo sokudumba kwimithambo-luvo ethwala imvakalelo kuloo ndawo. Umzekelo, inokubangela ukuba i-vagina, i-vulva kunye nendawo ephakathi kwe-vagina kunye ne-anus (perineum). Iluncedo kakhulu ukuba ufuna ukwenza i-episiotomy okanye ukuba ufuna ukulungisa ukukrazuka kwi-vagina emva kokubeleka. Iziphumo ebezingalindelekanga ezivela kwi-anesthetic yendawo azifumaneki rhoqo.

Yintoni iPudendal Block?

I-pudendal block ikwaluhlobo lwe-local anesthesia. Oku kubandakanya ukufaka inaliti kwi-pudendal nerve yakho. Oogqirha bakunika oku kwangoko nje ukuba umntwana wakho afike. Oku kunciphisa iintlungu ezijikeleze i-vagina yakho kunye ne-anus njengoko umntwana wakho ehla ngomjelo wokuzalwa aze aphume kwi-vagina yakho. Oogqirha badla ngokuthanda ukusebenzisa iyeza elibizwa ngokuba yi-lidocaine kwi-pudendal block kuba lisebenza ixesha elide kunezinye iyeza.

3. I-Anesthesia yeSithili

I-anesthesia yengingqi yeyona ndlela ixhaphakileyo nesebenzayo yokuphelisa iintlungu ngexesha lokubeleka. Inganciphisa kakhulu okanye isuse ngokupheleleyo iintlungu ezisezantsi komqolo wakho. Ingasetyenziswa nokuba une-C-section, okanye i-cesarean section. Kukho iintlobo ezintathu ze-anesthesia yengingqi: i-spinal, i-epidural, kunye nokudibanisa kwezi zimbini (i-spinal/epidural edibeneyo). Kwindlela nganye kwezi, i-anesthesiologist ifaka iyeza kwimithambo-luvo esezantsi komqolo wakho ukuze "ithintele" iintlungu kwindawo enkulu yomzimba wakho ngelixa uvukile.

Ziziphi iintlobo ezintathu ze-anesthesia yengingqi ezisetyenziswa ngexesha lokuzala?

• I-Epidural Block: Ingcali yakho yokubulala iintlungu ifaka ityhubhu yeplastiki ebhityileyo, ebizwa ngokuba yi-catheter, emqolo wakho. Le tyhubhu ishiywa endaweni yayo de kube sekupheleni kokubeletha kwaye iqhagamshelwe kwipompo. Oku kukuvumela ukuba uthathe amayeza amancinci njengoko kufuneka ngexesha lokubeletha. Ukuba kufuneka wenze utyando lwe-C-section, ugqirha wakho angakunika idosi enamandla yamayeza ngale tyhubhu. I-epidural yeyona ndlela idumileyo yokuphelisa iintlungu kumazwe afana ne-United States. Iyenza buhlungu umqolo wakho ongezantsi nemilenze. Kuthatha malunga nemizuzu eli-15 ukuba i-epidural iqale ukusebenza. Usenako ukuhambahamba ebhedini kwaye utshintshe izikhundla nge-epidural.
• Ukuvimba komqolo: Ukuvimba komqolo kudla ngokusetyenziswa emva kotyando olucwangcisiweyo. Ingcali yokubulala iintlungu isebenzisa inaliti encinci ukuvala indawo ejikeleze umqolo wakho (umjelo womqolo). Le ndlela isebenza ngokukhawuleza kwaye ingakugcina ungenantlungu kangangeeyure ezimbini. Ngokungafaniyo ne-epidural, ukuvimba komqolo akuniki ncedo oluqhubekayo.
• I-Combined Spinal-Epidural (CSE): Le yindibaniselwano ye-epidural kunye ne-spinal. I-spinal yenza ukuba ndindisholo kube nzima kwaye ingasetyenziswa kunye namayeza ongezelelweyo ukuba kuyimfuneko.

Inikwa nini i-anesthesia yengingqi?

Ixesha elifanelekileyo lokufumana i-anesthesia yengingqi lixhomekeke kwindlela wena nomntwana wakho enisabela ngayo ekubelekeni. Ukuba ucela i-anesthesia yengingqi ngexesha lokubeleka, ugqirha wakho uza kubiza i-anesthesiologist. I-anesthesiologist iza kuza kwigumbi lakho ize ikunike i-anesthesia. Amandla e-anesthesia yengingqi ayaphela ngokuhamba kwexesha, ngoko ke ixesha libalulekile. Ugqirha uya kuqinisekisa ukuba ukubeletha kwakho kukwinqanaba elifanelekileyo le-anesthesia. Nangona kunjalo, ukuba ulibazisa ukufumana i-epidural, usenokungakwazi ukuyifumana. Yiyo loo nto kuyingcinga elungileyo ukufunda ngeendlela zokuncedisa ngaphambi kokuba umntwana wakho azalwe. Akukho mithetho inzima nekhawulezayo, kwaye ukuba utshintsha ingqondo yakho ngequbuliso, i-epidural isoloko iyindlela.

Ukuba ucela i-anesthesia yengingqi, unokufumana i-epidural okanye i-spinal anesthesia, okanye zombini ezi zinto zimbini. Oogqirha baya kukhetha uhlobo lwe-anesthesia ngokusekelwe kwimpilo yakho ngokubanzi kunye nenkqubela phambili yokuzala kwakho.

Isebenza njani i-epidural?

Ingcali yokubulala iintlungu ikunika i-epidural ngelixa uhleli okanye ulele ngecala. Okokuqala, ikhupha i-anesthetic kwindawo engaphantsi komqolo wakho nge-anesthetic yendawo. Emva koko, kufakwa inaliti ekhethekileyo kwindawo eneentloko ukuze kufunyanwe indawo efanelekileyo yokufaka i-anesthetic. Emva kokuba i-anesthetic ifakiwe, ingcali yokubulala iintlungu isusa inaliti. Ityhubhu encinci yeplastiki ebizwa ngokuba yi-epidural catheter ishiywe endaweni yayo emva kokuba inaliti isusiwe, ukuze ikunike amayeza entlungu njengoko kufuneka de kube kuphelile ukuzala.

Ngaba i-anesthesia yengingqi iya kuyichaphazela umntwana wam?

Uphando oluninzi lubonise ukuba i-anesthesia yengingqi ikhuselekile kuwe nakumntwana wakho.

Isebenza ngokukhawuleza kangakanani i-anesthesia yengingqi kwaye ihlala ixesha elingakanani?

I-anesthesia ye-epidural iqala ukusebenza kwimizuzu eli-10 ukuya kwengama-20 emva kokufakwa inaliti. Ukunciphisa iintlungu kwi-epidural kuhlala kude kube sekupheleni kokuzala kwakho, kuba amayeza amaninzi anokunikwa nge-catheter nangaliphi na ixesha.

I-anesthesia yomqolo iqala ukusebenza kwangoko emva kokufakwa inaliti. Ukuphelisa iintlungu kuthatha malunga neeyure ezimbini. Ukuba kulindeleke ukuba ukuzala kwakho kuthathe ixesha elide, ugqirha wakho uza kufaka i-epidural catheter aze akunike amayeza okuqhubeka nokuphelisa iintlungu ixesha elide kangangoko kufuneka.

Ndiza kuva iintlungu ezingakanani xa ndisebenzisa i-anesthesia yengingqi?

Nangona uziva ukhululekile kakhulu kwiintlungu, usenokuziva uxinzelelo oluthile ngenxa yokusikwa kwesibeleko sakho. Usenokuziva uxinzelelo xa ugqirha ekuxilonga. Usenokungakwazi ukuhamba ixesha elininzi. Kufuneka uvuke, uphapheme, kwaye ukwazi ukuliva xa kufika ixesha lokutyhala.

Ngaba kuya kufuneka ndilale ebhedini emva kokufumana i-anesthesia yendawo?

Akunjalo ngokuyimfuneko. Ingcali yakho yokubulala iintlungu ingalungisa i-anesthesia ukuze uhlale esitulweni okanye uhambe. Ukuhamba okanye ukuhlala phantsi kunokunceda ekukhawuleziseni ukuzala. Ukuba ukhetha, buza ingcali yakho yokubulala iintlungu malunga "ne-walking epidural."

Ngaba i-epidural iya kuyilibazisa ukuzala kwam?

Kwabanye abantu, ukushwabana kwesibeleko kunokucotha ixesha elifutshane emva kokusetyenziswa kwe-anesthesia yengingqi. Kodwa kubantu abaninzi, i-anesthesia yengingqi ibanceda baphumle, kwaye ngokubavumela ukuba baphumle, indlela yabo yokushwabana iyaphucuka.

Ukuba ndifumana i-epidural, ndiza kukwazi na ukutyhala?

Ewe. I-anesthesia yengingqi ikuvumela ukuba uphumle kamnandi ude umlomo wesibeleko sakho uvuleke. Xa umlomo wesibeleko sakho uvuleke ngokupheleleyo kwaye lixesha lokutyhala, uya kuba namandla angakumbi aseleyo. I-anesthesia yengingqi akufanele ichaphazele amandla akho okutyhala. Ifanele yenze kube lula kuwe ukutyhala.

Ngaba kukho naziphi na iziphumo ebezingalindelekanga ze-anesthesia yengingqi?

Ingcali yakho yokubulala iintlungu iza kuthatha amanyathelo akhethekileyo okuthintela iingxaki. Nangona iingxaki zinqabile, ezinye iziphumo ebezingalindelekanga zingabandakanya:

• Uxinzelelo lwegazi oluphantsi: Uza kunikwa ulwelo olufakwa emthanjeni (ii-IV fluids), kwaye ugqirha wakho uza kujonga uxinzelelo lwakho lwegazi ukuze angalubeki phantsi kakhulu.
• Ukurhawuzelela okuncinci ngexesha lokubeleka: Ukuba ukurhawuzelela kuba yinto ekhathazayo, ingcali yokudambisa iintlungu inokuyinyanga.
• Intloko ebuhlungu: Ukusela ulwelo kunye nokusela i-painkiller emva kwe-anesthesia yengingqi kunokunceda kwiintloko ezibuhlungu. Ukuba intloko ebuhlungu iyaqhubeka, xelela ugqirha wakho.
• I-Allergic reaction: Nangona i-allergic reactions kwi-anesthetics yendawo inqabile, inokuba yingozi kakhulu.

Ukuba ukhe wenziwa utyando olukhulu kumqolo wakho ongezantsi ngaphambili, okanye ukuba uneengxaki ezithile zempilo, usenokungakwazi ukuba ne-epidural okanye i-spinal block. Thetha nogqirha wakho malunga neengozi ze-epidural okanye i-spinal block ngokusekelwe kwimbali yakho yempilo.

4. I-Anesthesia Jikelele

I-anesthesia eqhelekileyo ikwenza ulale ngokupheleleyo. Nangona ikhuselekile, i-anesthesia eqhelekileyo ithetha ukuba awuyi kukwazi ukubona umntwana wakho emva nje kokuzalwa. Ihlala isetyenziswa kwiimeko ezingxamisekileyo.

Isetyenziswa nini i-anesthesia jikelele ngexesha lokubeleka?

I-anesthesia eqhelekileyo ithetha ukuba ulele ngokupheleleyo ngexesha lokuzalwa komntwana wakho. Isebenza ngokukhawuleza, kodwa idla ngokuba yindlela yokukhetha kuphela xa usenza utyando lwe-C-section olungxamisekileyo okanye ezinye iimeko ezingxamisekileyo, njengokuphuma kwegazi elininzi ngexesha lokubeleka.

Zithini iingozi zokulalisa umntwana ngexesha lokubeleka?

Omnye umngcipheko we-anesthesia ngokubanzi kukungena kokutya emiphungeni yakho (`(aspiring)`). Oku kuthetha ukuba ngelixa ulele, ukutya okuvela esiswini sakho kuphuma emlonyeni wakho kuze kuphefumlwe. Le yeyona mngcipheko uphambili we-anesthesia ngokubanzi, kungekuphela nje ekubelekeni, kodwa nakulo naluphi na utyando.

5. I-Nitrous Oxide

I-nitrous oxide, okanye "igesi ehlekayo," yigesi engenavumba okanye incasa. Uyiphefumla ngemaski. Inceda ekunciphiseni ixhala ngexesha lokubeleka, kodwa ayizisusi ngokupheleleyo iintlungu.

Ziziphi iingenelo kunye neengxaki zegesi ehlekisayo?

I-nitrous oxide ayisetyenziswa kakhulu eMelika njengakwamanye amazwe. Yigesi ophefumla ngayo ngomlomo xa sele uza kuba nokushwabana. Isebenza ngokukhawuleza, kodwa ikwaphela ngokukhawuleza. Abaphandi bezempilo basafunda ngemiphumo yexesha elide ye-nitrous oxide. I-nitrous oxide inokuchaphazela ukuphefumla kwakho, kwaye inokubangela isicaphucaphu, ukuhlanza, kunye nesiyezi.

Ziziphi iindlela zendalo zokunciphisa iintlungu zokubeleka?

Zininzi iindlela zokulawula iintlungu zakho ngexesha lokubeleka ngaphandle kwamayeza. Ukuzalwa komntwana ngokwendalo akudli ngokusetyenziswa kwamayeza. Endaweni yoko, abantu basebenzisa umthambo wokuphefumla kunye neendlela zokuphumla ukuze babancede bamelane nokubeleka.

Eminye imizekelo yeendlela zokunciphisa iintlungu ngaphandle kwamayeza:

• Ukufumana umasaji.
• Kulungile ukuhlamba okanye ukuhlamba ngamanzi ashushu.
• Ukumamela umculo ozolileyo nolula.
• Ukujija ibhola yokuzilolonga (`(ibhola yokuzala)`).
• Ukuziqhelanisa nokuzilolonga ngokuphefumla nzulu.
• Ukucamngca okanye ukusebenzisa i-hypnosis / hypnobirthing.
• Ukuziqhelanisa nezinye iindlela zokuphumla.
• Unyango lwe-Acupuncture (`(Acupressure)`).

Amaxesha amaninzi, ukuba nomyeni okanye iqabane lakho, i-birth doula, okanye umhlobo okufutshane ngexesha lokubeleka kunokubonelela ngenkxaso enkulu kunye nokhuthazo oluhle. Oku kubizwa ngokuba yi -continuous learning support . Abanye abantu bade bakhethe ukusebenzisa ezi ndlela zendalo kunye namayeza.

Loluphi uhlobo lokuzala olubuhlungu kakhulu?

Lo ngumbuzo onzima ukuwuphendula kuba zininzi izinto ekufuneka ziqwalaselwe. Ezinye zezi zinto ziquka ukuba umntwana wakho mkhulu kangakanani, ukuba i-pelvis yakho ibanzi kangakanani, nokuba ukhe waba nabantwana ngaphambili, kunye nokuba ufuna uhlobo luni lwendlela yokubeleka.

Nangona kulungile ukwazi iindlela zokuphelisa iintlungu zakho ngaphambi kokuba ube nomntwana, ukuzala umntwana akunakuqikelelwa. Thetha nogqirha wakho malunga neenkxalabo zakho kwaye baya kukunceda ukhethe ukuba yeyiphi ekulungeleyo.

Ngaba zikhona izithomalalisi zentlungu zokubeleka?

Ezinye iintlobo zeziyobisi (ii-narcotics / ii-opioids) zinokunceda ukunciphisa intlungu ozivayo ngexesha lokubeleka. Nangona zingayisusi ngokupheleleyo intlungu, zinokukunceda ukulawula indlela osabela ngayo kwiintlungu. Ugqirha wakho uza kukunika ezi ngemithambo yegazi (IV) okanye ngenaliti, ngokuqhelekileyo ekuqaleni kokubeleka (le yeyona ikhuselekileyo). Thetha nogqirha wakho malunga nemiphumo emibi ye-opioids, njengoko kubonisiwe ukuba ibangela iziphumo ebezingalindelekanga ezifana nokozela kunye notshintsho kwindlela yokuphefumla.

Ndingafumana umntwana ngaphandle kwentlungu?

Ukuzalwa ngaphandle kwentlungu ngokupheleleyo akunakwenzeka. Nangona kunjalo, kukho iindlela ezininzi zokunceda ukunciphisa okanye ukulawula iintlungu zakho ngexesha lokubeleka. Wonke umntu ufumana iintlungu zokubeleka ngokwahlukileyo. Eyona nto ingcono onokuyenza kukuthetha nogqirha wakho wokubeletha okanye ingcali yokubulala iintlungu malunga neendlela onokukhetha kuzo. Ukuzala nokubeleka kudla ngokungalindelekanga, kwaye kunokufuneka ube bhetyebhetye, kodwa kuyanceda ukwazi into onokuyidinga ngaphambi kokuba umntwana wakho afike.

Ziziphi ezinye iindlela ezingasetyenziswayo endaweni ye-epidural?

I-epidural yeyona ndlela ithethwa kakhulu nethandwayo yokuphelisa iintlungu xa ubeleka. Ukuba awucingi ukuba uyayidinga i-epidural, kukho ezinye iindlela ezinokukunceda ukunciphisa iintlungu zakho. I-pudendal nerve block okanye i-acetaminophen (paracetamol) inokuba luncedo ukuba awuyithandi ingcamango ye-epidural. Okanye, ungajonga iindlela ezingezizo iziyobisi, ezifana neeklasi zokuzala.

Izinto ezibalulekileyo ekufuneka uzikhumbule (Umyalezo Wokuya Ekhaya)

Ukuzala umntwana kunokuba ngamava abuhlungu. Ngoko ke, ukufunda ngazo zonke iindlela ezikhoyo zokunciphisa iintlungu kuya kukunceda wenze isigqibo esinolwazi malunga nokuba yintoni efanelekileyo kuwe. Cela ugqirha wakho ukuba akuchazele indlela esebenza ngayo indlela nganye kunye nento ayicebisayo ngokusekelwe kwimbali yakho yempilo. Ukuba nesicwangciso engqondweni malunga nokuba ungalindela ntoni kunye nendlela ongathanda ukulawula ngayo iintlungu kunye nokungonwabi kokubeletha yindlela elungileyo yokuzilungiselela oku. Ungakhathazeki, awuwedwa, kukho oogqirha kunye nabahlengikazi abanokukunceda. Sikunqwenelela ukuzalwa okumnandi!

Intlungu yokubeleka, ukuzala, ukuphelisa iintlungu, i-epidural, i-spinal block, ukuzala kwendalo, ukukhulelwa