MEDICAL CARE FOR PREGNANCY: PARTICIPATION OF THE MOTHER-TO-BE

In recent years, more and more attention is being focused onto the natural aspect of the entire procedure of pregnancy. Although set routines are carried out in most obstetrics hospitals, many large women's hospitals now encourage active participation in the confine­ment by the mother herself. By sensible, simple training beforehand, much can be done to alleviate the fears and phobias that many women harbour.

A system which goes by the name of "Psychoprophylaxis" is becoming more and more widely used. It is mentioned here not with the intent of replacing normal obstetrics practice with it, but because it is such a sensible system that many women are now anxious to try it.

In many instances it finally allows delivery of the baby with the minimum use of drugs. In fact, the proponents claim that 45 per cent of patients using the system do not need any injections of the usual pain-killing drugs (such as pethidine). About 45 per cent may require one single shot (or at most two). The remaining 10 per cent do not seem to receive much assistance from the method.

As we all know, many women are still plagued with the basic conception that pregnancy is an illness, and that the confinement must be painful. For this reason, because they expect it to hurt, it will hurt. It becomes a "conditioned reflex." This has been a well-established physiological theory for many years, and is nothing new. So the unlucky woman becomes pregnant; she anticipates the worst, and pain and suffering become her lot forthwith.

But, with sensible training, this conditioned reflex can be removed, and successfully replaced by a new one. So, when the chips are ultimately down, sensations which would normally be interpreted by the brain as pain, are no longer given this interpretation. The sensations are automatically converted into "motor activity."

In other words, action supplants fear and pain. From the practical view-point, this is briefly how the system is put into operation:

(1)  The Conditioned Reflex. The expectant mother attends a series of simple lectures. These clearly describe the process of childbirth and what will happen at the time of her confinement.

In words she can understand, the "con­ditioned reflex" idea is presented. It is shown how her response to stimuli can be increased, reduced or altered.

She is taught that the "Pains" that herald the onset of labour are really a signal for her to start playing her part in the act. She immediately starts to follow a series of specially taught breathing exercises. In this manner, by concentrating on her breathing, her pain threshold is immediately raised. The cycle continues, so that she becomes a trained participant in a situation, rather than a passive, frightened acceptor who fears the worst and probably will end up experiencing the worst.

In this manner, the need for drug therapy to quell pain is usually markedly reduced. Experience shows this is frequently what takes place.

(2)  Breathing Exercises. This is a key routine that the patient learns during the second half of pregnancy. The exercises come in two forms. The first type of breathing is designed for the early stages of labour. The second type is scheduled for the latter part of labour and the delivery.

Breathing is first slow and relatively light. It increases in depth and rate as the contractions increase and the "Pains" become more severe. Quick, shallow breathing is interspersed with the breath being blown out at certain intervals. These breathing exercises are interspersed with light, stroking movements with the fingertips over the abdomen or sacral areas. The idea is to further increase mental stimulation.

She is also taught to give her utmost in physical co-operation, particularly in the later stages.

(3)  Neuro-muscular Control. The patient is taught during the prenatal classes that stimuli must travel from the brain to the muscles. While one set of muscles is contracting, she is told, other sets are relaxing. In this way, it is possible for her to gear herself so that specific sets of muscles are either in a contracted or relaxed state.

Certainly this requires a considerable amount of education. But in a well-trained person, the results can be very gratifying. In later labour, a proficient person may be actively assisting by contracting her abdominal muscles, and at the same time actively relaxing her pelvic floor muscles, so assisting the birth of the baby.

The net effect can be extremely rewarding. But the patient needs assistance and tender co-operation throughout the procedure. Those who have undertaken this system claim it is an exhilarating sensation. Most claim the best part is when the baby gives its first lusty yells, and the mother is fully aware, in a happy state of drug-free consciousness, and can appreciate this tender moment. Indeed, many claim it is a situation which is etched indelibly on their mind, and can be fondly remembered.

Of course, it is essential that adequate drug therapy and the usual forms of standard obstetric practice be readily available in case the mother suddenly finds she cannot cope. An attentive staff, trained to both systems, are well aware of these possibilities.

However, the system is worth considering, as more and more obstetricians all over the world are starting to phase the system in. Some doctors will not have anything to do with the relatively new ideas (although they have now been around for quite a few years).

At least, it offers women another form of obstetric care, and can easily be slotted in with normal procedures.

It seems to fit in so well with a natural approach to baby care, and a relaxed mind that is so important.

In some large city hospitals, the methods are taught in classes, and this is perhaps the best way to approach the matter. But following psycho-prophylaxis in no way invalidates the other recommendations already made about general care of the body, regular medical attendances and so forth, for the prospective mother. These are vital, irrespective of the method finally used in the labour ward.

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GENERAL HEALTH