RU2515763C1 - Method for complex psychotherapeutic preparation of pregnant women for delivery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: what is involved is psychodiagnostics that provides a basis for a short-term positive and rational psychotherapy. Then, three types of breathing are trained: diaphragm breathing technique; pre-labour breathing technique that provides a deep chestful breath-in alternated with a deep breath-out every time labour arrives, in a relation of breath-in : breath-out - pause 4:6, repeated for at least 5 times. The breathing technique for the period of intensive labours is trained to provide a deep mouth breath-out, a chestful breath-in, in the relation of breath-in : breath-out 4:4; and a shallow breathing is trained. After the breathing types are trained, a pregnant woman is subject to a positive non-conscious exposure for 30 minutes according to SOMVI technique for the purpose of the desensitisation of negative expectations of the forthcoming delivery and the correction of the psychosomatovegetative state; the preparation course is 8-10 sessions.

EFFECT: method enables provides the more effective psychotherapeutic preparation of the women at the late pregnancy by normalising the high anxiety level and reducing the subjective feeling of the labour pain, that in turn leads to reducing the drug-induced load accompanying the labour, and reduces a probability of obstetric and perinatal complications in birth and after-birth periods.

Description

The method relates to medicine, namely to the psychophysiological method in obstetrics, and is intended for psychotherapeutic preparation of pregnant women for childbirth.

Medical and preventive and psychotherapeutic preparation of pregnant women for childbirth remains an urgent problem not only in the practice of an obstetrician-gynecologist, but also in general medical practice, since the health of the mother and child depends on the outcome of the pregnancy, which determines the quality of life in general. Anxiety has a negative effect on the health of the fetus, obstetric and perinatal outcomes. Pregnancy anxiety disorders occur in 54% of women (Faisal-Cury A., Rossi Menezes P., 2007; Lee A.M., Lam S.K., Sze Mun Lau S.M. et al., 2007). However, anxiety during pregnancy often remains unrecognized (Alder J., Fink N., Bitzer J. et al., 2007; Coleman VH, Carter MM, Morgan MA et al., 2008), which is a significant factor for complications in neonatal period (Zelkowitz P., Papageorgiou A., 2005). In addition, anxiety disorders during pregnancy are one of the main risk factors for emotional stress after childbirth, leading to maladaptation (Korotkova N.A., 2011).

Today, there are many programs for preparing pregnant women for childbirth, which combine various psychotherapeutic approaches (psychoanalytic, suggestive, art therapy, etc.) adapted for working with pregnant women; respiratory and physical exercises, acupuncture, biological feedback method, acupressure and other methods of non-drug preparation. These methods require a sufficient period of time in order to train a pregnant woman to consciously use them during childbirth. That is why it is recommended that training begin in the early stages of pregnancy and, often, are carried out individually, which leads to an increase in the economic and time costs of providing medical care. However, the acquired skills of psycho-prophylactic preparation in connection with stress, as well as insufficient mastery of skills, are often not reproduced in conditions of labor activity, which makes many methods of preparation ineffective.

There is a method of preparing for childbirth, when a pregnant woman is taught diaphragmatic breathing using biological feedback (BFB) according to the heart rate under the control of the maximum heart rate during inspiration and training in the use of this breath (RU 2134542, 1999).

The pregnant woman breathes diaphragmically at first with an exhal equal to inhalation, then with a breath hold on inhalation. Periods of such breathing alternate with periods of rest, the duration of the periods of respiration and rest is regulated depending on the periods of labor. The method allows to objectify control over the preparation of a pregnant woman for childbirth. The training is aimed at alternating various skills in the proposed time modes.

However, for this method of preparation, as a rule, training of specialists and special equipment are necessary.

The well-known program of psychophysiological adaptation and psychological support "Prepared birth", which offers a combination of techniques: "work in small groups, positive psychotherapy with elements of autogenic training and joint creativity (Shirinyan L.V." The role of psychophysiological adaptation during pregnancy in the prevention of gestational and perinatal complications. ”Abstract of the dissertation for the degree of candidate of medical sciences, Blagoveshchensk, 2006) It was proved that the maximum efficiency (66.7%) after testing ennoy psycho program was observed in women who were trained in the early stages of gestation (28 weeks). This was manifested in a decrease in anxiety, normalization of the autonomic balance and the creation of a positive attitude towards pregnancy and childbirth.

However, pregnant women after 28 weeks were difficult to respond to psychocorrectional effects, in 50% of cases, anxiety remained at the same high level.

Known psycho-preventive preparation (SPP) for the program “Prepared birth (Kovalenko-Madzhuga N.P., 2001), which includes the methodology of individual support in childbirth in combination with non-drug methods of pain relief (relaxation between contractions, pressure on painful points, acupressure and regular massage , change of body position, self-regulation of breathing, audiotherapy).

However, prenatal psychoprophylactic preparation proved to be ineffective: every second remained at a high level of anxiety during childbirth. In the main group of 51.2%, emergency epidural analgesia was required due to discoordinated labor, accompanied by severe pain in labor and fetal hypoxia.

The known method, which is taken as a prototype "Method of psychoprophylactic preparation of pregnant women for childbirth" (RU 2308299, 2006.05.17). It includes thematic conversations, relaxation sessions and special video therapy sessions. Video therapy includes viewing a pregnant video sequence, on the 25th frame of which there is verbal information containing a thematic and ongoing attitude towards positive motherhood.

However, this method requires the constant inclusion of the active attention of the patient for the perception of visual information, which eliminates the possibility of complete relaxation. In addition, the authors emphasize that for the application of this method only high-quality equipment should be used, and the screen on which the video sequence will be projected should be large enough. This eliminates the possibility of using this method in an outpatient setting.

The objective of the invention is to normalize the increased level of anxiety and reduce the subjective experiences of birth pain, which in turn will reduce the drug load during childbirth and the likelihood of obstetric and perinatal complications in the birth and postpartum periods.

The problem is solved by the method of complex psychotherapeutic preparation of pregnant women for childbirth, which consists in the fact that in addition to conducting 8-10 sessions of 1.5-2 hours of short-term positive, rational psychotherapy and breathing techniques, they also include 8-10 sessions of positive unconscious effects during 30 minutes.

The inclusion in the method of psychotherapeutic preparation of pregnant women for childbirth for short-term positive psychotherapy, rational psychotherapy, based on the development of a conscious attitude of the pregnant woman to all the processes that occur in her body, breathing techniques and positive unconscious effects using modern technical means, will normalize the increased level of anxiety and reduce subjective experiences of labor pain, which will optimize labor activity, reduce medication the burden during labor and the likelihood of obstetric and perinatal complications. Medical information is recorded on CDs, which offer to listen at each lesson. The duration of listening to medical information is 30 minutes.

The theme of the method of audio psychocorrection remains constant and is aimed at reducing the level of anxiety and tension (anxiolytic effect), increasing self-confidence (assertive effect), desensitizing the negative expectations of the upcoming birth, and correcting the psychosomatic vegetative state.

CD audio recording format.

APK programs contain three recording levels:

- 1st level - background sound carrier - audible sound (fully perceived by the patient at an awareness level), into which an unconscious sound effect is sewn (in these APK programs, the background sound is music);

- 2nd level - pre-threshold masked recording - sound effect sewn into the background sound at the border of the perception threshold. The patient perceives it as a hiss (crackling), not recognizing the content of the impact at a conscious level (sometimes patients with good hearing can isolate individual words, which does not negatively affect the overall suggestive effect);

- 3rd level - subthreshold masked recording - sound effect sewn into the background sound below the threshold of conscious perception - absolutely not perceived at the level of consciousness. Recording is made precisely under the threshold of masking, and not under the threshold of physiological perception. The acting sound information in its physical parameters is not subthreshold (the volume level is 10-20% of the background sound or more), while maintaining the effect of inaccessibility to conscious perception.

Unconscious sound effects include:

- Unrecognizable suggestive attitudes (NSOs) - short phrases consisting of keywords (individually meaningful semantics), the sound of which is automatically looped and constantly repeated throughout the psycho-correction session. The number of repetitions, taking into account the reverberation effect, depending on the duration of the program and the size of the NSI, ranges from 630 to 1260 in each channel (different, but complementary in meaning, NSIs were used in the right and left channels).

Unconscious influence is aimed at a gradual change in the significance of semantic elements of memory (according to the mechanism of psychosemantic conditioning) and, as a result, a modification of mental functions in accordance with the purpose of the audio-psychocorrection program.

Playback time is 30'04 ".

The agro-industrial program includes 2 parts: 1st part - with a duration of 21 '04 ".

Semantics of NSU left channel (main suggestive installation):

"I am pregnant -

Childbirth will be easy -

Soft, painless childbirth -

Childbirth will be easy

NSU semantics right channel (contextual suggestive installation):

"I'm sure -

I am healthy -

I'm happy -

I'm sure"

A form of suggestive exposure is autosuggestion.

The purpose of the suggestive effect is relaxation and desensitization of negative expectations of the upcoming birth, the formation and strengthening of positive motivation for the state of pregnancy, an assertive effect.

Part 2 - 09'00 ".

Semantics of the NSU left and right channel:

"The head is clean -

Eyes are bright -

Thoughts are clear -

The body is free

The form of suggestive exposure is heterosuggestion.

The purpose of the suggestive effect is the correction of the psychosomatic vegetative state.

To use this method, any equipment that allows you to listen to music CDs is used, which makes this method available for use both in a medical institution and at home.

In practice, the method is as follows.

First, they hold a conversation with pregnant women about the goals of preparation and expectations from the course of psychotherapeutic preparation for childbirth. Then the pregnant women undergo psycho-diagnostics using psychometric tests (Spilberger-Khanin test, SAN questionnaire), an assessment of expectation of labor pain on a visual analogue scale (VAS) is revealed. Classes include topics of three periods of childbirth, precursors of childbirth, the biomechanism of childbirth, the concept of “pain” in childbirth, explain its protective function during childbirth, introduce the psychological characteristics of a child under one year of age and the characteristics of parent-child relationships, explain the importance of breastfeeding, and highlight issues postpartum contraception; then they teach three types of breathing, one of which is the technique of diaphragmatic breathing, when a pregnant woman puts her hands on her stomach to control the “correctness” of the process, the exercise begins with a maximum exhalation, after that they take a deep breath - the stomach sticks forward, fingers extend on the stomach, lower departments of the lungs passively filled with air, perform the exercise 5 times; Having mastered the technique of diaphragmatic breathing, they switch to the type of breathing, which is suitable for the onset of contractions, when each time at the beginning of the contractions you need to make a deep cleansing exhalation, then take a deep breath with full chest, after a deep exhalation in the ratio of inspiration: expiration (pause) 4: 6 ( 2), this exercise must be performed at least 5 times during the classes; then the woman is taught the type of breathing when contractions become more intense, the intervals between them become shorter, there is a need to breathe more often and shorter, the breathing pattern is as follows: deep exhalation through the mouth, then full inhalation, inspiratory: expiratory ratio 4: 4; prolonged exhalation for 20-30 seconds to avoid hyperventilation; to make the woman feel better when it’s impossible to push, and the baby’s head goes down, we teach superficial breathing, starting with a deep exhalation, then taking a deep deep breath, then superficial rapid breathing, which must be completed with a deep intensive exhalation, and then breathing a calm type of breathing in the ratio of inspiration : exhale (pause) 4: 6 (2); we conduct a demonstration of breathing when the child’s head sank to the pelvic floor: deep exhalation - take a full breath, hold our breath and squeeze with the entire diaphragm, with the whole volume of the lungs, if there is not enough breathing, take a deep exhalation without giving up, and squeeze again; after breathing techniques, we give instructions to take a comfortable position, close your eyes, relax, imagine yourself in a safe place and turn on a music disc with an unconscious effect for 30 minutes, after listening to which we suggest making several active movements; after classes, we give instructions for re-passing the Spilberger-Khanin test and SAN questionnaire, when it is necessary to cross out the number in the corresponding column, depending on how the patient feels at the moment; the instruction for assessing the expectation of labor pain on a visual analogue scale (UA8) is as follows: mark on the scale that figure that corresponds to the expected assessment of pain during childbirth.

The following example illustrates the method according to the invention: The patient is 28 years old, gestational age is 32 weeks, the first birth. During a psychological interview, before using the method of psychotherapeutic preparation of pregnant women for childbirth, the Spilberger questionnaire revealed an increased level of situational anxiety (47 points), the SAN questionnaire indicators were 4.1–3.8–4.5, and the patient expected birth pain by 8 points. During 8 lessons of 1.5-2 hours for the pregnant woman, short-term positive psychotherapy, rational psychotherapy was carried out, topics of three periods of childbirth, precursors of childbirth, the biomechanism of childbirth, the concept of “pain” in childbirth were included, their protective function during childbirth was explained, they were introduced to psychological the features of a child under one year of age and the characteristics of parent-child relationships, explained the importance of breastfeeding, highlighted issues of postpartum contraception; then the patient was taught three types of breathing, one of which is the technique of diaphragmatic breathing, when the pregnant woman laid her hands on her stomach to control the “correctness” of the process, the exercise was started with the maximum exhalation, then a deep breath was taken - the stomach was protruding forward, fingers were apart on the stomach, the lower parts of the lungs were passively filled with air, performed the exercise 5 times; having mastered the technique of diaphragmatic breathing, we went on to learn the type of breathing that is suitable for the start of contractions, when each time at the beginning of the contractions you need to take a deep cleansing exhalation, then take a deep breath with full chest, then a deep exhalation in the ratio of inhalation: exhalation (pause) 4: 6 (2), performed this exercise 5-7 times during classes; then they taught the woman the type of breathing, when contractions become more intense, the intervals between them become shorter, there is a need to breathe more often and shorter, the breathing pattern is as follows: deep exhalation through the mouth, then full inhalation, inspiratory: expiratory ratio 4: 4; prolonged exhalation for 20-30 seconds to avoid hyperventilation; performed this exercise 5-7 times during classes; the patient was taught superficial breathing, starting with a deep exhalation, then a deep full breath, then a superficial rapid breathing, which must be completed with a deep intensive exhalation, and then breathing a calm type of breathing in the ratio of inspiration: expiration (pause) 4: 6 (2), exercise 5-7 times during classes; demonstrated the following type of breathing: deep exhalation - full breath, held their breath and strained, with the entire diaphragm, with the entire volume of the lungs, explained that if breathing is not enough, we take a deep exhalation without giving up, and again straining; after breathing techniques, they gave instructions to take a comfortable position, close their eyes, relax, imagine themselves in a safe place and turn on a music disc with a positive unconscious effect - 8 sessions for 30 minutes, after listening to which they suggested making several active movements; after all the classes, they gave instructions for re-passing the Spilberger-Khanin test and the SAN questionnaire, when it is necessary to cross out the figure in the corresponding column, depending on how the patient felt at the moment; The instruction for estimating the expectation of labor pain by the vivisual-analogue uiKane (VAS) is as follows: mark on the scale that figure that corresponds to the expected assessment of pain during childbirth. As a result of preparation for childbirth, the level of increased anxiety decreased (35 points), the problem of pain in childbirth was deactivated (the assessment of expectation of labor pain decreased by 3 points on the VAS scale). Childbirth passed without complications for the mother and the child (the state of the child on the Apgar scale is 8–9 points, weight 3500 g, height 52 cm). After delivery, the assessment of pain in childbirth remained at the expected level (5 points). The subjective attitude towards childbirth and satisfaction with the behavior in childbirth by the woman herself was rated on a 5-point scale of 4.

The claimed method was used to increase the effectiveness of psychoprophylactic preparation for childbirth, not only in individual lessons, but also in group sessions, by normalizing the increased level of anxiety and reducing the subjective experiences of labor pain, which allowed to reduce the drug load and complications in the labor and postpartum periods in 50 women . The results of the study showed that the anxiety level in 82.5% significantly decreased, the expectation of labor pain decreased from 7-8 points to 5-6 with a maximum score of 10 points. According to the SAN questionnaire, the indicators were 5-5.5-5.1.

Claims (1)

A method of comprehensive psychotherapeutic preparation of pregnant women for childbirth, which consists in conducting psychodiagnostics, based on the results of which they carry out short-term positive and rational psychotherapy, after which they are subsequently taught the following types of breathing: diaphragmatic breathing technique; breathing technique for the onset of contractions, according to which each time a contraction occurs, alternating deep exhalation, deep inspiration with full breasts should be performed, and breathing should be carried out in the ratio inspiration: expiration - pause 4: 6, and repeated at least 5 times; then they teach the breathing technique for a period of intense contractions, according to which they perform a deep exhalation through the mouth, then a full breath, with a ratio of inhalation: exhalation 4: 4, then they teach surface breathing; after learning the types of breathing, a pregnant woman has a positive unconscious effect for 30 minutes using the SOMVI method, aimed at desensitizing the negative expectations of the upcoming birth and correcting the psychosomato-vegetative state, the training course includes 8-10 sessions.