RU2711999C1 - Method for pregnant women preparation for childbirth and the puerperal period - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely obstetrics, and can be used in preparing pregnant women for childbirth. That is ensured by a course of eight sessions. First "Trial" session involves informing on the length of childbirth, the physiological and psychological component of childbirth. Second lesson is "Psychology of childbirth", including information on physiology of woman and physiology of childbirth. Third lesson is "Breathing During Contractions", including performing the exercises to obtain practical breathing skills during contractions and informing about the physiological characteristics of the organism at the beginning of childbirth. Fourth lesson is "Entering the maternity hospital", including performing the exercises "Bridge" and exercises for the birth table. Fifth session "Prevention of birth injury in newborns", including performance of breathing exercises on the birth table, performance of reception to accelerate movement of the child through the birth canal. Exercise, imitating attempts, "Hanging" reception – standing with its back to the window sill or the bed backrest or bedside table, rest on the elbows surface, supporting themselves under the breast, with legs on shoulder width, female sags down, knees bent, legs should stand at such distance that turned right angle under knees in moment of "sagging", in this position, there live is a tense contraction, after which they descend to the fitball for rest. Sixth lesson – "Positions in childbirth", including execution of 5 blocks poses: 1 – poses from the position "on all fours", 2 – poses "lying", 3 – poses "sitting", 4 – poses "standing", 5 – poses for the pressure period. Seventh session is "Breathing on the birth table", including repetition of breathing exercises on the birth table and exercises with the ball. Eighth lesson is "Childbirth rehearsal", including simulating the childbirth process and the woman's actions at different stages of childbirth.EFFECT: method provides reducing the risk of the birth injury to a newborn that the child can get before birth with maternal wrong behavior in the process of childbirth contractions and attempts, as well as reducing the risk of female traumatism during childbirth.7 cl

Description

The method relates to medicine, namely to the psychophysiological method in obstetrics, and is intended for the psychotherapeutic preparation of pregnant women for childbirth and the early postpartum period (the first two hours after childbirth).

Today, there are many programs for preparing pregnant women for childbirth, which combine various psychotherapeutic approaches (psychoanalytic, suggestive, art therapy, etc.) adapted to work 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 training is recommended to begin in the early stages of pregnancy and, often, carried out individually, which leads to increased economic and time costs for the provision of 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.

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 the 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. However, anxiety during pregnancy often remains unrecognized, which is a significant factor for complications in the neonatal period. 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).

There is a method of preparing for childbirth according to the patent for IZO RU No. 2134542, when a pregnant woman is taught diaphragmatic breathing using biological feedback (BFB) in terms of heart rate under the control of the maximum heart rate on inspiration and training in the use of this breath.

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 monitoring of the preparation of a pregnant woman for childbirth. Training is aimed at alternating different 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 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 the level of 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 NP, 2001), which includes a 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.

A known method of psycho-prophylactic preparation of pregnant women for childbirth according to the patent for IZO RU No. 2308299. 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 verbal information is placed containing thematic and ongoing orientation towards positive motherhood.

However, this method requires the constant inclusion of active patient attention 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.

There is a method of physiopsychoprophylactic preparation of pregnant women for childbirth (Abramchenko V.V. Physiopsychoprophylactic preparation of pregnant women for childbirth. - St. Petersburg, 1992), in which individual and group conversations and lectures, special gymnastic exercises in groups, as well as natural factors (air, water, light), which contributes to the development of an internally conscious attitude of the pregnant woman to the processes and changes occurring in her body and the fetus, by creating and fixing is necessary of conditioned reflexes.

There is also known a method of autogenous preparation of a pregnant woman for childbirth (VV Abramchenko. Modern methods of preparing pregnant women for childbirth. - St. Petersburg, 1991), in which the woman herself is actively involved in psychotherapeutic work during the training process while fully preserving the initiative, self-control and learning consciously manage your autonomic functions and influence your emotional state.

The disadvantages of these methods are low efficiency, which largely depends on the psychotype and motivation of the woman, the need for long classes and the inability to use them directly in childbirth.

Of the non-drug methods of labor anesthesia that are used directly in childbirth, psychological and physical relaxation, self-massage and relaxing massage, music therapy, singing, hydrotherapy, thermal procedures, aromatherapy, acupuncture, skin electrical stimulation and electroanalgesia are used. These methods have completely insufficient effectiveness, most often the analgesic effect is minimal or nonexistent. In addition, to obtain a real analgesic result, a woman must be fully prepared before childbirth, that is, undergo preliminary psychological training, which creates a positive psychological attitude and builds up the pregnant woman's skills for using any non-drug methods of pain relief in childbirth. If a woman was not previously prepared for the use of non-drug methods of pain relief, then their effectiveness in childbirth is significantly reduced (Cochrane Manual: Pregnancy and Childbirth / D.Yu. Hofmeyr, D.P. Neilson, Z. Alfirevich et al. / Under the general ed. G.T. Sukhikh, Translated from English .-- M .: Logosphere, 2010 .-- 440 p.).

The purpose of the invention is to increase the responsibility of pregnant women for the result of their childbirth, to teach them the correct actions during childbirth and thereby reduce the risk of birth injury and asphyxiation of the newborn. We are talking about the injury that happens due to the fault of the woman, because of her wrong actions during contractions and during the busy period.

The technical result of the proposed method is to reduce the risk of birth injury to a newborn, which a child can get before birth if the mother does not behave properly during labor and labor, and also reduces the risk of female injuries during childbirth.

The specified technical result is achieved by the fact that pregnant women take a course of classes, built on the principle of the natural development of labor in the body of a woman. So that they do not just learn to endure pain during childbirth, and that their actions do not contradict the natural "program" of the course of childbirth, so that their adequacy does not cause doubts among physicians, and that obstetricians do not have reasons for serious medical interventions during childbirth.

The course consists of eight lessons and, as in natural childbirth, it all starts with precursors and weak fights, are also built on an increasing and lesson course.

To obtain a result in the work, psychological techniques affect various structures of a woman’s personality.

At the personal level, work is underway with the value of the child and motivation for behavior in childbirth, contributing to the birth of a healthy child.

At the emotional level - teaching the empathic attitude to the child “before” and “during” childbirth, which allows the mother to psychologically more comfortably survive childbirth.

At the cognitive level, women are introduced to obstetric features of the course of childbirth in certain cases. Women gain knowledge about the various actions of the medical staff and, accordingly, are trained in appropriate ways of responding and behavior (medical teams at the delivery table, rules of conduct when examined on an obstetric chair during admission to childbirth and during childbirth). Information is given on how a child in the mother’s body can be injured due to her improper behavior.

At the operational level, behavioral skills are being developed at various stages of childbirth (breathing methods, body postures, methods of natural anesthesia), women are learning techniques for preventing birth injury in a newborn at the stage of labor and at the strenuous stage.

At the psychophysical level - methods of self-regulation during pregnancy, at different stages of childbirth during contractions and between them.

The course is built on the basis of knowledge of obstetrics and physiology, but is presented to women in an understandable language with examples from practice.

It is no secret that many women tend to blame doctors that childbirth was unsuccessful for themselves or for the baby. We do not exclude this. But taking into account the fact that the main character in childbirth is a woman who is the guide of her child to this world, during the extrauterine period of life, it is she who first of all needs to know about the features of actions for a good result.

During childbirth, doctors are next to the woman situationally, at those moments when you need control over the condition of the mother and fetus. The woman is, if I may say so, next to the baby throughout pregnancy and all births from the first contractions until his birth.

Even if for some reason a woman will give birth alone, the birth will still end, i.e. it means that without a woman in this matter can not do. And she, like doctors, must be taught adequate actions at different stages of childbirth, taking into account her individual characteristics during childbirth.

A feature of the course is that each stage of childbirth is considered from several positions:

1. What a woman will feel physically,

2. How long will this phase last,

3. What will happen in her body at this time,

4. What emotional states and thoughts will arise at this moment,

5. At what stage of his birth will the child be at this moment.

First lesson "Trial"

The purpose of the lesson is to make women think about how, using special knowledge, they can reduce the risk of asphyxiation and trauma for their own child during his birth. And also provide information on the key requests of women in childbirth. To begin to build confidence that every woman can give birth to her baby well (under conditions that do not contradict the natural birth).

For clarity, a target is drawn, where in the center the child is interrupted, as the goal of pregnancy and childbirth. A scheme (composition) is built up, where it is shown that in the actions of a woman, doctors and relatives, it leads to a successful result of childbirth - a safe birth of a child.

Then, in turn, theoretical and visual information is given for each of the requests of women: without breaks, quickly, without pain, a healthy child.

1. Using logical examples of physiological processes in the human body, information is given on why the tendency to rupture of soft tissues of the birth canal increases. The emphasis is on the fact that a woman can prepare her body so that the risk of tearing is reduced. Already in this lesson, every woman does a test exercise, in which, given the anatomical features, she can understand if she has a risk of breaks.

2. It tells what the duration of labor, the physiological and psychological component depends on. Why do some women say that "gave birth to a day." How is the duration of childbirth calculated by doctors and what can a woman do to prevent childbirth?

3. Most women do not want to face pain in childbirth. For those who have this first birth, pain is generally from the category of the unknown and even frightening. Those who already have experience of previous births, physically cannot remember the level of pain that they had to endure. They remember pain only on a psychological level: "It was painful ... It was terrible ..." etc.

In this lesson, you need to give truthful information about what the pain will be. But at the same time, give confidence that a woman can cope with this pain using safe methods of pain relief for the baby.

4. A healthy child. This is the most important thing, for which the whole process of pregnancy and childbirth is for. It is told what is a birth injury of a newborn. What are the three groups of reasons for the formation of birth trauma. Who directly provokes the onset of such an injury by their actions. The mechanism of some injuries is shown clearly with the help of a doll and how these injuries can arise due to illiterate actions of a woman.

Women are tested for proper breathing for the birth table and whether they can make the body an accelerating element if obstetricians ask for it.

As a result, a woman should not only understand that childbirth is a painful process for both the mother and the child, find out that childbirth has a risk of injuries for the child and breaks in the mother, but also believe that every woman can reduce this risk, having realized and learning the right actions during childbirth.

The second lesson "Psychology of childbirth"

The purpose of the lesson is to increase the confidence of women that they will cope with their births.

1. It is necessary to obtain information from women, which for them is still incomprehensible in childbirth, which is frightening, causing doubt. Each must say that in the birth process for her the most important thing. This will allow in the process of training to place emphasis on certain fears or sides that are not yet clear to them. And during the lesson, when this or that fear will be explained, visually contact with the woman who voiced this fear (this topic).

2. In a fascinating way, the physiology of women and the physiology of childbirth are described. It is drawn “schematically” how the uterus is located in the body, showing how prudently and wisely Nature has arranged the organ necessary for bearing offspring. Make you think about how women gave birth when there were no doctors, how they understood that they gave birth, how they coped with pain. Here we are trying to imagine how primitive women gave birth (the moderator clearly depicts the poses that these women could get up ... breathing, etc.), logically leading to the fact that if childbirth were a dangerous process, then Evolution would change the birth for the better and would find another way for the birth of offspring. It is said that Nature has thought through this process so that regardless of skin color, time of day, season, political situation in the world, whether there are assistants next to a woman or not, she can always give birth (we are talking about physiological births, when the state of health of the woman does not involve delivery by surgery). We emphasize that during the life of mankind, millions and billions of women have already given birth to their children. Thus, we form the idea of a woman that she, as a woman, can also give birth to her child, obeying the laws of Nature, because this process has been happening on Earth for many years, thousands and even millions of years.

3. We show childbirth not from the position of obstetricians, but from the position of the woman herself, and a woman always focuses only on how she feels, that is for pain and the strength of pain at different stages of childbirth. It is necessary to tell the truth about birth pain so that women do not have a false impression that childbirth can be completely painless. Pain in childbirth is normal, it should be. Emotions are described in relation to this pain at the beginning of labor and during the development of labor. We bring women to the fact that women, through logical conclusions, came to the conclusion that pain in childbirth is an ally, it is a hint to the body what to do now.

4. Graphically depict contractions, as they are reflected on the monitor’s tape during childbirth, the level of pain and emotional state, as well as voice the thoughts that a woman may encounter at these stages of childbirth. Here, on the square of the blackboard, the whole process of childbirth is clearly shown in stages and an integral picture is formed. Thus, the answer is given to the question "what follows, how long it will be, that I will experience emotionally." A peculiar algorithm of the development of labor activity in the classical obstetric sense is drawn.

5. Show how closely the body and the psyche are connected, and how wrong thoughts about childbirth can affect the body, the process of childbirth. Without going deeper into the physiological process of the formation of the generic dominant and the child’s readiness for birth, a connection is shown between the child - the subcortex - the cerebral cortex. To simplify the perception, the brain is drawn in the form of an apple, the example of which shows how the normal birth process can be disturbed if there is no harmony between the cerebral cortex and the subcortex.

6. Explain why it is not profitable to be afraid of childbirth, and that a woman in the process of preparing for childbirth will have all the “tools” - skills in the presence of which not only the number of fears decreases, but also working moments of childbirth, such as correct breathing, correct behavior, are solved during fights and correct attempts.

7. Compare the birth process for mom and baby. Who is harder? To whom longer? Show what the child experiences during fetal life (the mother is portrayed as a kind of "spaceship" that provides the vital functions of the child). Showing what happens to the baby during labor and delivery, form the “I will think about the baby” setting - which is one of the most important elements for managing my own pain and my behavior in childbirth, and thereby preventing complications for the baby that occur when mom’s actions. All this should form the dominant - "I am strong, I help my baby be born."

8. Show what happens to the child during an attempt, what mechanisms are needed for an independent prenatal life, will be included in the birth canal. At the same time, it is necessary to show that at this stage the child is completely dependent on the actions of the mother. To simulate the process of a child passing through the birth canal using a doll. Show how his head is compressed, how the chest is compressed, how the umbilical cord is compressed. The whole point of this “show” is to make women think about the danger of ineffective mother’s efforts for the child. And how important is it that the mother understands this and does everything so that it is easier and safer for the child to go through this stage, because Without the correct actions of the mother, doctors are forced to use obstetric techniques that can injure the child.

9. It is necessary to emotionally describe (“lose”) what will happen to the mother immediately after the birth of the baby as a result of a change in hormonal levels in the first minutes after childbirth. Emotionally bring her to this climax, so that now she is moved and experienced the future pleasure of the result of childbirth. This will allow her to further establish herself in the thought that she will be able to live her birth correctly and receive a well-deserved reward for this.

10. Describe the condition of the baby immediately after birth. Against the background of physical relief of the mother and her emotional euphoria, talk about the "stress of birth" that the child is experiencing at the level of all body systems. Explain not only the need for this from a physiological point of view, but also from the position of “attachment” to the mother, imprinting (imprinting).

11. Explain how the mother is sealed and attached to the child. Show that this is a mechanism thought out by nature, and it is included in all women.

12. In the summary, it is necessary to get an answer from women to questions: who is the most important in childbirth, what does the mother do, what are the doctors, what is the partner. Putting the emphasis in childbirth correctly (which is most difficult in childbirth for a small child and without the help of a mother it is difficult for him to be born) and correctly distributing functions between participants in childbirth, a woman should take responsibility for her behavior in childbirth and for the result of these births.

Third lesson "Breathing during contractions"

The purpose of the lesson is to give women practical breathing skills during labor and the necessary obstetric knowledge on the onset of labor and the physiological characteristics of the body at the beginning of labor.

Lesson plan.

1. To learn the first breath for contractions, explaining what are its advantages.

2. “Acquaint” with relaxation and tension in the body based on the exercise “arms and legs”. Explain how this will help in childbirth.

3. Work out the general relaxation of the body to music.

4. Pelvic floor training for learning to relax on the birth table.

5. Provide information on the signs of an approaching birth and different options for the onset of labor.

In the process of labor for several hours, when a woman is experiencing contractions, she will have to breathe in special breathing methods that will not only ease her condition, her pain, but, above all, will provide the fetus with the necessary oxygen. Given that in any birth the fetus is more or less experiencing a fluctuation in oxygen in the blood, i.e. hypoxia, maternal breathing becomes the key to an adequate child's birth process, as only a mother can provide him with oxygen through her breathing.

For women, a specific “8” breathing method is given for development. It is recommended to use this breath from the moment when the contractions are already noticeable and require some kind of relief.

To begin with, mastering this method of breathing, women breathe at the expense of:

- 1-2 - a breath in the stomach;

- 3-4 - continue breathing into the chest;

- 5-6 - pause;

- 7-8 - exhale through the mouth.

For control, one woman’s hand is placed on her stomach, the other on her chest, thereby paying attention to whether it is possible to inhale successively into the stomach and chest, observe which hand is raised.

This method of breathing allows you to simultaneously use the abdominal type of breathing and chest. Abdominal breathing - includes relaxation mechanisms, and thereby control the release of adrenaline (it is known that excessive adrenaline inhibits the birth process). Thus, this breath is involved in reducing birth stress. Thoracic breathing stage - makes it possible to stock up on oxygen for ourselves and the child for the duration of the bout, i.e. make the maximum amount of inspiration. At the same time, focusing on counting breaths psychologically switches a woman from pain to counting.

In the process of performing the training cycle of this breath, women realize and feel that the body is becoming more relaxed and there is a desire to sleep. And relaxation, as you know, is one of the main ways of pain relief.

To connect a special effect for better disclosure of the cervix during contractions in such breathing, we learn to exhale “horse” through relaxed vibrating lips. Because at birth, some organs are functionally in the same condition, it is necessary to use this feature. Relaxing the vocal cords (special vocal exercises) or relaxing the lips, we relax the cervix. Obstetricians have the expression "what lips - such a cervix", which is why they do not recommend clamping lips and clenching teeth.

Breathing should be worked out and become habitual so that confusion from the rhythm does not occur during childbirth.

The second skill that you need to master in this lesson is the ability to relax the body as much as possible. Given the formula “fear = tension = pain”, it is necessary to teach women to be aware of the stressed parts of the body and be able to relax with the willpower in order to reduce pain during contractions, as well as save strength for attempts.

In the same lesson, women work out relaxation techniques to calm music. But in order to make women better aware and subsequently able to relax their body as much as possible, the “Hands and Feet” exercise is carried out first.

In the exercise “Hands and Feet”, women lie on their backs and, on command, strain one arm first, then one leg. The instructor checks at this time how relaxed the opposite arm and leg are. If the opposite arm and leg are tense, it means that the woman has difficulty with relaxation, and thereby deprives herself of the opportunity to receive natural pain relief during childbirth.

The course of the exercise.

On command:

We strain only the right hand, the rest of the body is relaxed.

We strain only the left hand, the rest of the body is relaxed.

We strain only the right leg, the rest of the body is relaxed.

We strain only the left leg, the rest of the body is relaxed.

Straining both hands, legs relaxed.

Straining both legs, arms relaxed.

We strain the right arm and the right leg (i.e., the right side of the body), the left side of the body is relaxed.

Straining the left hand and left foot (i.e. the left side of the body), the right side is relaxed.

We strain the right arm and left leg, the left arm and right leg are relaxed.

It strains the left arm and right leg, the right arm and left leg are relaxed.

This exercise teaches women not only to recognize the tension and relaxation in their body, which contributes to a deeper overall relaxation, but also prepares the body for work on the birth table, when at the command of the midwife it will be necessary to strain some parts of the body (these will be arms, legs, back, stomach, neck), and other parts of the body to relax (face and pelvic floor).

With such a training, the body remembers that, on command, it can strain some of the muscles and leave some relaxed.

In addition, the ability to relax the face and pelvic floor during attempts is prevention of capillary ruptures in the skin of the face and prevention of perineal ruptures.

After the exercise "Hands and Feet" a session of general relaxation. Prior to this, women are shown the manual “Penfield Scheme”, which clearly shows how much different muscle groups of the body in the cerebral cortex occupy in volume. The largest area is occupied by the hands and face. It is by relaxing the effort of the will of the hands and face that the reflex signal goes into the cerebral cortex, thereby stimulating the inclusion of processes for analgesia as a result of the release of endorphins, which reduce sensitivity to pain (Physiological Foundations of Psychophysiology, p. 181). Women are clearly explained that in their body, in their body, there are mechanisms of pain relief. The main thing is to learn how to use them before delivery. Those. learn to consciously include pain relief mechanisms.

General relaxation is carried out to calm music. The host announces which muscles need to be relaxed in turn, starting with the toes and ending with the face. At the end of this exercise, the women are still in a state of relaxation, the facilitator asks them to introduce their child and say positive attitudes: “I will give birth well, with an understanding of what is happening”, “My body can give birth”, “I will think about you and help you be born "," I have enough strength to force you "," I love you and I will be your best mom. "

Upon completion, the facilitator interviews all participants how they felt, whether they managed to relax the muscles, what they felt in the body when they imagined the child and whether it was possible to imagine him. If a woman says that during the presentation of the child and “communication” with her, she did not feel her body, this shows her that concentrating thoughts on the child will help in childbirth not to feel pain (or, at least, reduce these feelings).

The next Pillow exercise is aimed at training the pelvic floor of women. Women sit on the floor with support on fitball. Legs stretched straight ahead. The woman between the feet clamps the pillow, while the pelvic day should be relaxed. When a woman is on the birth table at the end of labor, in her feet she will rest against special supports, and the pelvis should be relaxed in order to miss the baby.

Then, the lesson provides information on what signs indicate an approaching birth. How to understand what "water leakage" is. How to distinguish labor from precursors. It is explained what a “mucous plug” is, what it looks like, and how long before birth it can go away in primiparous and multiparous women. The optimal interval between contractions is indicated, when it is best to go to the hospital. Explains why it is necessary to go to the hospital without delay if amniotic fluid leaves. The concept of two variants of the onset of labor is formed. Knowledge of these options and a prepared algorithm of actions will reduce labor stress, which in turn can prolong labor activity.

The fourth lesson "We arrive at the hospital"

The purpose of the lesson is to form an idea of what happens after admission to the hospital for childbirth. How much the woman’s actions help doctors make a picture of the obstetric situation and the birth plan. Teach the correct position on the obstetric chair when entering the hospital. Give exercises, using which at home a woman can prepare a pelvis for childbirth. Give breathing techniques to relieve pain during childbirth in combination with anesthesia.

Lesson plan.

"Bridge" - for inspection on the chair upon admission to the hospital + scheme with an explanation on the board.

Gymnastic exercises that are useful for the birth table:

- "in Turkish";

- “the frog”;

- "Squat with a transfer of body weight";

- "circular rotation sitting on the fitball +" back and forth ";

- “arching the back against the wall”;

- "namaste" behind the back + deep breath ";

- "obstetric breathing" with your nose inhale - exhale with your mouth "+ reception" ballerina ";

- "breathing with the sound" sigh "," hugging ".

At the beginning of the lesson, we once again draw the attention of women to the fact that physical labor of the body occurs in childbirth. In the first birth, this is also due to the novelty of sensations. It is required to prepare the body, especially the pelvic area for such work. Contraindications for gymnastics are necessarily voiced for women: the threat of premature birth, ischemic cervical insufficiency, low placenta location, placenta previa, installation of a pessary.

The first exercise is "sitting in Turkish" with swaying hips. It is necessary for stretching the muscles and ligaments of the inner surface of the thigh, so that while you are on the birth table, do not pinch the baby’s head with the legs brought together.

The duration of the exercise is 30 seconds. For one lesson, you need to repeat the exercise 5-7 times.

The second exercise - the "frog" - women sit on the mat so that the pelvis is placed between the heels. In this position, the distance between the tubercles of the ischial bones stretches between which the child’s head will go. Under the pressure of your own body weight, an increase in the distance between these bones occurs. At the same time, the Kegel exercise (tension and relaxation of the muscles of the pelvic floor) is done in this position, which contributes to a rush of blood to this area and improves tissue elasticity. Thus, by stretching the pelvic floor during this exercise and training the bones to move apart, we prevent the ruptures of the soft birth canal (perineum) and prevent the fetal head from getting stuck at the exit from the pelvis.

The duration of the exercise is 30 seconds. For one lesson, you need to repeat the exercise 5-7 times.

The third exercise - “Squat with the transfer of body weight to the heels”, is done with a partner. A woman holds her hands on her partner, legs shoulder-width apart, crouches to the end and throws the body back. In this case, the back is rounded, the body weight is transferred to the back of the foot, to prepare the legs for work on the birth table.

In this position, the lower back is stretched and the body is in a bend, most favorable for childbirth, when the sacral protrusion is “smoothed out”. And also in this position, the pelvic floor stretches and relaxes, which will be necessary for the busy period. The body remembers the correct position necessary for childbirth. The duration of the exercise is 30 seconds.

For one lesson, you need to repeat the exercise 5-7 times.

The fourth exercise - “Circular rotation, sitting on the fitball” - the exercise stimulates a rush of blood to the pelvis, improve mobility of the lumbosacral region, relieve stress from the lumbar region, as well as a gentle massage of the pelvic floor, which is the prevention of perineal ruptures. The exercise is done within 2-3 minutes, 5 sets.

The fifth exercise - “Bending the back against the wall” - a woman stands against the wall. Three points of contact: shoulders, pelvis, heels. Feet shoulder width apart. Hands along the body. On inspiration, tilts his head forward so as to try to touch the chin of his chest. At the same time, it is necessary to bend the lower back so that it rests against the wall. On the exhale, it straightens. The woman starts one palm behind her back and controls whether she managed to get a wall with her lower back. This exercise simulates the position on the birth canal so that the body remembers this position and in the process of childbirth, despite the fatigue and pain, was able to perform this action. Only in the vertical version. Lying on your back, we do not perform the exercise so as not to overstrain the uterus in the early stages of pregnancy.

The sixth exercise - “Namaste behind the back” - A woman sitting, folds her palms together behind her back, fingers up. In this case, the chest is maximally revealed. Holding her hands like this, a woman cannot squeeze her chest back. As soon as the arms are folded on the namaste, we take a deep breath into the chest. Hold the breath for 10 seconds and exhale smoothly. In this exercise, the chest is trained for a volume inhalation on the birth table, which will contribute to more effective attempts and prevention of newborn asphyxiation.

Further in the lesson, we proceed directly to the topic “We arrive at the hospital”. Each woman, upon admission to childbirth, must undergo a procedure such as a gynecological examination by an obstetrician-gynecologist to assess the internal obstetric situation.

Often women complain of severe pain during this examination. It should be borne in mind that the inspection is carried out at the time of the bout. Thus, the pain doubles. Knowing the obstetric technique of this examination, we can conclude that the pain occurs only in those women who lie incorrectly on the gynecological chair during the examination. It is necessary to explain to women the causes of discomfort and pain, and also to teach them the correct position for this procedure.

Women lie on their backs, imitating the position on the chair. An exercise is done: to press hands near the body and back, then put your palms on your chest and bend your back with a "bridge". Women should feel in which of these positions she is more relaxed. In which of them I want to push off from the surface and crawl up. By analyzing their own feelings, women should come to the conclusion that, with their backs pressed, they are more strained and the pelvic floor area is strained, moreover, in this position, pushing your arms and legs off the surface, it is easier to crawl up (and this will complicate the examination by the doctor and add discomfort to the woman herself).

Then women, for clarity, on the anatomical diagram (see Fig. 2.19 Vaginal examination. Measurement of the diagonal conjugates. Akunts KB, Atlas on Obstetrics - M .: Medical News Agency, 1998. - 215 pages) shows how the examination is carried out a doctor. Visibility allows women to realize that their correct position on the chair will help the doctor draw up a more detailed and correct picture of the obstetric internal study. We focus women on a coordinated interaction with the doctor. Women are told what the difficulty may be for the doctor during the examination. The doctor must determine not only the pre-existing part of the fetus (head, buttocks, or transverse presentation), but also determine the position of the presentation (first or second), view (front or rear), insertion (flexor or extensor). The doctor must also assess the condition of the cervix and its readiness for childbirth. And also to determine the presence of the fetal bladder and evaluate the effectiveness of its work in the birth process. At the same time, the dynamics of labor is assessed. The doctor “receives” all this information not through the eyes (although this procedure is called “examination on the chair”), but from the fingertips with which he examines the woman. And in the interest of women to provide the doctor with the best conditions for examination, i.e. to lie correctly. It is based on the information obtained during this procedure that the doctor draws up a birth plan. Those. whether any medical manipulations will be carried out, whether labor will be strengthened or weakened, or is it necessary to give birth to a woman through cesarean section.

Further in the lesson, a deep traditional “obstetric” breathing is worked out - “exhale through the nose - exhale through the mouth”. The emphasis is that the breath should be long in order to increase the amount of oxygen for the working uterus and baby. A typical error in such breathing is shown in strong contractions. The mistake is that women take a short rhythmic breath and short exhale. The volume of such a short breath is not enough to provide oxygen to the child.

On exhalation, women are invited to relax their lips, exhale through vibrating lips - i.e. it turns out exhalation "horse".

In addition to this breathing, anesthesia is given under the code name “Ballerina”. It can be useful to those women who have fights while standing. Women stand and exhale making a light half-squat. Due to this, the pelvis and the lower part of the birth canal are relaxed and thereby the pain is reduced. In addition, this technique helps women determine the moment when attempts appear. At the moment of approach, the woman will want to sit down deeper, because the body begins to push the child down and according to the command of the body, the woman wants to do such a squat to help.

For women who assume that they will not be able to endure the fight “without a voice”, i.e. without screaming, it is proposed to master the “vocal” techniques that do not interfere with the flow of oxygen to the child. It is known that during a sharp loud cry of a high tone, the vocal cords are compressed, the whole body is tensed, and thereby the pain intensifies (according to the fear-stress-pain hypothesis). In addition, if a woman screams during a fight (and, as a rule, this happens, because the pain is during a fight), then this blocks the flow of oxygen to the baby and to the uterus. The uterus without oxygen experiences great pain, and the baby is hypoxic (lack of oxygen), which can affect his condition after birth.

Women are invited to “voice” the fight on the exhale: Take a deep breath with your nose - on the exhale we pronounce, we sing in a whisper the word “pop-o-o-o-o-o-o-o-o-x”. The second option: Take a deep breath with your nose - on the exhale we sing in a whisper the word “hug-me-me-me-me-me”, trying to pronounce so that there is vibration in the throat. All this allows you to: provide the child with oxygen, reduce pain due to relaxation, focus not on pain, but on proper breathing and satisfy the woman's need for sounds.

Fifth lesson “Prevention of birth injury of a newborn”

The purpose of the lesson is to show the whole drama of the birth process for the child and mother if the woman does not know what to do at the most difficult stage of childbirth and form a motivation for the correct behavior during labor and labor.

Tasks:

1. It is necessary to form a woman’s understanding that without her understanding of the process and adequate behavior, doctors with all their knowledge may be powerless in their assistance in childbirth.

2. Set up a woman for time and patience in childbirth, so that there are no vain expectations of a quick birth and, subsequently, disappointments.

3. Show how a woman, as a result of ignorance, can injure her child before birth.

4. To study the elements of prevention of childbirth trauma of the child.

5. Show in practice that their body can create conditions for the soft birth of a baby.

6. To teach techniques that anesthetize, accelerate the birth process, but do not injure the child.

7. Encourage women to engage in special “obstetric gymnastics” so that they have enough strength during childbirth.

8. Give assessment criteria when exactly you need to go (ask) on the birth table. Explain how doctors understand that a woman is "time to give birth."

9. To teach women to act in different situations at the stage of "time for the table or is it too early?"

10. It is logical to bring women to a lesson in breathing at the birth table.

Lesson plan:

- “legs up” (elbows to the sides);

- “the diagrams on the board“ why all this should be done in this way ”4.25, then 4.17 and 4.18”;

- "video" Prevention of birth injury ";

- "when do attempts appear?";

- "third breath (like a dog in the heat) when to breathe";

- “breathing pattern and contractions, sounds“ A ”,“ O ”,“ U ”,“ E ”;

- “the meaning of the third breath (for the child, for the mother)”;

- reception at the windowsill to facilitate and accelerate: above the ball (rear, front);

- “when it’s time for the birth table, as doctors understand, how women understand it”;

- "showing the" crotch-ball in panties. "

The lesson begins with developing skills for the birth table. This technique is necessary to accelerate the progress of the child through the birth canal. It is often used if the baby’s heartbeat is suffering and it is necessary to quickly complete the delivery so that the baby does not suffer. T.O. this technique is the prevention of asphyxia of the newborn, which can occur in the last minutes before birth. Working off reception: women lie on their backs, as on a birth table. They are given the command "raise their legs under the knees up." Each woman in turn should be helped to pull her knees as close to her shoulders as possible. In this case, the knees should be wide apart so as not to squeeze the stomach and elbows are bent apart. We repeat the exercise several times so that the women themselves feel that they are not just raising their legs, but thereby raising their pelvis up.

Then the instructor leading the lesson explains and shows on his body what will happen on the birth table if during this technique the elbows are not divorced and the knees are not close enough to the shoulders.

It is for a better understanding (analysis of one’s own mistakes in execution) and in subsequent execution already in childbirth, the exercise is worked out just like this: first we do, then we look. The instructor also shows the typical mistakes that women can make (legs are not wide enough, hands do not hold legs under the knees, but on the top for the knees, insufficient back bending to accelerate the birth of a child).

After the demonstration on the body, the instructor shows anatomical diagrams 4.25 (see page 124), then 4.17 and 4.18 (see page 121) Akunts B. B. Atlas on Obstetrics - M.: Medical News Agency, 1998. - 215 p. Here it is shown how the bones of the pelvis of the mother and the head of the newborn at the stage of the effort are anatomically related.

The meaning of all these visual aids is for women to understand that in the birth process they have every chance to help their child. And sometimes only a woman can accelerate the process of childbirth, properly controlling her body and changing the curvature of the pelvis.

Next, we show a video story about how a child passes through the birth canal. How many movements of the head and body he makes during this period of time. Women are explained that the child has no other options for “behavior”, that he is in a forced state and cannot accelerate his birth. In contrast, a woman, owning the body and understanding the process, can affect the rate of birth.

Further in the lesson, those types of breathing for contractions that women have already studied are repeated. And move on to the next stage of childbirth - the approximation of attempts. Women should speak out about how they understand attempts and how they differ from fights. This will debunk the "myths" of attempts. Such as “it’s easier in attempts”, “fights go away, and then attempts come”.

Women are given information that attempts appear in the form of specific sensations at the peak of one of the contractions. This happens even before the cervix is fully opened. Using a dummy doll, it is shown what happens to the baby at this stage of delivery. What neck and head injury can occur if a woman pushes herself at the wrong time.

Initial attempts appear when the opening of the cervix is not yet complete (only 7-8 cm.). Through such a discovery, a full-term child cannot pass, he needs 10 cm. the diameter of the fetal head when passing through the birth canal is approximately 10 cm. To the questions of women why the attempts do not yet begin at full opening, information is given that when opening 7-8 cm, the crown of the baby already enters the birth canal and presses, hence attempts. But it’s too early to push on such attempts. Because in this case, the entire mass of the female body presses on the child from above, but there is still no sufficient way out. And yet, with early attempts, the muscles of the pelvic floor are compressed and press on the head of the child from below. It turns out that the child shrinks “like an accordion” between the mother above and the pelvic floor muscles from below. This injures the baby’s neck before birth. And also a birth injury such as a geophalogem is provoked.

Women do a test exercise that simulates attempts: after inhaling, they clench their hands in fists, lean toward their stomach, and strain their legs. It is here that women should track how the pelvic floor muscles behave under general stress. Women should realize that if they push early, then the birth canal closes (because everything is straining) and does not allow the child to lower to the exit. Those. there is a squeezing of the child himself.

To restrain early attempts, it is necessary to master superficial breathing of the type "like a dog in the heat."

In order for women to realize how the body works during this breath, we ask you to put one hand on your stomach and watch what happens to your stomach. During such breathing, the stomach vibrates. Due to this vibration, the muscles of the pelvic floor are relaxed, the woman concentrates on the correct execution of breathing, she does not put pressure on the child with all its mass, the uterus does this for her with the force that the child has from nature.

For a better understanding, what is the difference between regular contractions and contractions enriched by attempts, a diagram with two contractions is drawn on the board, where one does not yet have an attempt, and in the other fight there are already attempts. Above these sketchy contractions, a breathing pattern is drawn. Women breathe one after another two contractions with different types of breathing.

Because this is the most difficult stage of childbirth, on which it depends on how easily and quickly it turns out on the birth table, it is necessary to concentrate women on the fact that the duration of this period in the first and second births is different. That in the first birth it can take 1.5-2 hours before the moment when they call on the birth table and allow to push. In repeated birth, this time is reduced by 2-3 times.

Understanding that women begin to push at the wrong time (that is, early) because of fatigue and a desire to give birth faster, we give women the “Hangman” technique. This technique has three main advantages: it speeds up, relieves pain and does not give mom the opportunity to injure (pinch) the baby in the birth canal. But, since this technique requires some physical effort, women should train before childbirth in order to have enough strength.

Reception - a woman standing with her back to the windowsill (headboard, bedside table, etc.) rests on this surface with her elbows, supporting herself under the breast. In this case, the legs are shoulder width apart. The woman sags down, her knees bend. Feet should be at such a distance that you get a right angle under the knees at the time of "sagging". A woman in this position is living an intense battle. After the bout, he lowers himself onto the fitball to rest. If a woman has a partner in childbirth, then this partner supports the woman, and she can only breathe correctly.

Since the woman in this case is in an upright position, this contributes to a faster lowering of the child to the exit. When the support no longer goes to the feet, but to the hands in the “sagging” position, the lower part of the birth canal is more relaxed, which does not allow compressing the baby’s head. A woman feels less pain when relaxing.

Women test their body, how relaxation occurs with this technique. Each must make sure that in this position, even if he wants to squeeze the child, the body will not obey this desire.

For a larger selection of actions at this stage, it is proposed to diversify the breathing with the “dog” with different sounds. Women breathe on "O", "A", "E", "U". Breathing on the sound "U" most of all restrains attempts. At the same time, the throat is the least dry. And if a woman has the thought “I can’t take it anymore,” she is advised to breathe on “U”.

Next, it is necessary to answer the question “When can I push?”, Obstetricians have a medical criterion - “when the head is on the pelvic floor”, “when the head crashes”. Women should push only on the birth table. But women are not obstetricians and they need to be given a criterion so that they can determine on their own the moment when they ask for a table. For this, a “crotch” dummy is shown and what will happen to the crotch at the time of an attempt. Women should know that they themselves can understand when it is time for the birth table. They can put their hand in the pelvic floor and feel the head pushing the external genitalia (for obstetricians, this is called the “head crashes”). If a woman at this stage is on the birth table, then for the birth of a child she will only take 10-15 minutes to push. This is one of the elements for the prevention of asphyxia of the newborn, as well as the prevention of obstetric interventions such as Christeller’s reception. "Kristeller's reception" is an obstetric technique that contributes to the rapid completion of the second stage of labor; consists in artificially squeezing the fetus from the birth canal by pressure on the uterus through the anterior abdominal wall of the mother in the direction from top to bottom with the hand of the obstetrician.

Christeller, who proposed this technique, used it only during the period of expulsion of the fetus with weak labor. At present, Christeller’s administration is not recommended, as it is considered dangerous for the fetus (trauma) and for the mother (premature detachment of the child’s place, rupture of the uterus, shock) and vacuum extraction of the fetus by the head. In addition, due to the smooth lowering of the baby's head to the exit, the tissues of the pelvic floor of the mother also smoothly stretch and the risk of ruptures is reduced.

Despite the fact that Christeller’s technique is not recommended, it is used quite often in practice. And only effective hard work of the woman herself helps to avoid this intervention. And accordingly, a woman for this must be able to determine when to push.

Further, women are given information when the surface breathing (“dog”) is useful on the birth table. This will happen when half of the head is born, and the crotch will stretch by its largest size. To relax the perineum and reduce the risk of rupture, the woman will have to not breathe on the command of obstetricians, but breathe this breath. And the uterus will smoothly push the baby out.

Sixth lesson "Poses in childbirth"

The purpose of the lesson is to teach a woman to trust her body in childbirth and use its anatomical features to facilitate and accelerate childbirth at different stages and with different pains.

Tasks.

1. Show options for body position and movement during labor for pain relief.

2. Combine the “postures” and breathing methods during the contractions in the ward.

3. To teach to use the ball-fitball and other improvised means for the adoption of facilitating poses.

4. Highlight the category of special poses for "the most difficult period in childbirth."

5. Show the poses for the situation when a woman gives birth on the system.

6. To teach with the help of the “universal” pose to accelerate the child’s progress towards the exit.

7. Identify the elements that can help partners in childbirth or close women when she is still at home.

As is known from the anatomy, with a different angle of inclination of the pelvis (i.e., with different poses), a woman can expand the entrance to the pelvis or expand the exit from the pelvis. This is true at different stages of childbirth.

Lesson Plan “Learning and Making Poses”:

- on all fours + rocking;

- on all fours + massage;

- on all fours + unwinding with the knees resting in the pelvis + pressure on the sacrum between contractions;

- with a set foot, we unwind the pelvis;

- a mill lying on its back;

- slide;

- relying on the ball + swinging;

- based on the ball + rotation;

- sitting + rotation or swinging;

- sitting + partner help from the back;

- sitting, relying on a partner (very suitable for the system);

- sitting, the partner holds, the woman rolls down;

- standing facing the ball;

- relying on the ball with his back (at different levels);

- relying on the ball, relying on a partner;

- standing, one leg above the other + rotation;

- poses for living an early labor period (the most difficult period of childbirth);

- flattened "frog";

- “frog” resting on the ball + breathing + massage of the sacrococcygeal zone;

- in a squat with elbows resting on the edge of the bed or on the partner’s knees;

- in a squat facing the ball, hugging the ball;

- crouching, holding hands on any surface or holding the partner’s hands, feet shoulder width apart, feet in parallel (standing on the full foot), the pelvis moves forward, the face is tilted down, nose on the stomach + breathing;

- sitting on the bed, resting his back on the ball "universal";

- lying on its side with a leg raised to the shoulder;

- standing at the surface and shaking the pelvis.

The position of the woman’s body during labor and during the second (cramped) period can affect both the level of pain in a woman and the speed of the child’s advancement through the birth canal, and therefore the prevention of trauma and asphyxiation of the newborn.

In the lesson, 5 blocks of posture are disassembled and practiced - on all fours, lying, sitting, standing and posture for the most difficult period of labor “laborious”. And also "partner" poses are studied, i.e. poses in which the assistant helps the woman. Refining these poses even before childbirth will allow women in childbirth to instinctively choose those poses that will be adequate to her birth process. Poses at the time of birth should be clear, tested and should be performed taking into account the anatomical features of the ratio of the pelvis of the mother and the fetal head. Because a woman in labor concentrates on pain, she just needs to remember the correct execution of the poses. The partner, for his part, is mastering the help options, learns the permissible amplitude and force of influence on the woman during the fights. This builds confidence and reduces anxiety before childbirth.

The first block - postures from the "on all fours" position. Given that in this position, the stomach sags down as much as possible, which means it relaxes and an analgesic effect appears. At the same time, in this position, the uterus with the fetus located in it does not squeeze large vessels that provide blood supply to the uterus and the baby. And this is the prevention of fetal hypoxia. This block of poses is most popular among women.

1. A woman stands on all fours and sways back and forth in the rhythm of her breathing - inhale forward - backward - exhale. A partner can do back massage to relieve pain.

2. A woman stands on all fours, the partner holds her side by the pelvis, rests her knees on the pelvis and helps her spin the pelvis during the bout. Between contractions, the partner presses his palms on the sacral region.

3. A woman stands on all fours, the partner presses on the sacral region with the entire plane of the palms during the bout. Squeezing the nerve endings creates conditions for "numbness" of the sacrum, which is anesthesia if the pain of the contractions is localized in the back.

4. A woman stands on all fours, puts one leg to the side at an angle of 90 degrees to the body and spins the pelvis. In this position, the entrance to the pelvis expands and facilitates the insertion of the fetal head.

5. Standing on all fours, feet shoulder-width apart, the woman lowers her head and upper body down (the pelvis rises above her head) and rests her head against her folded arms - "Hill". This pose is used only if water has not receded. In this position, the severity of the fetus is shifted to the upper part of the uterus. And it becomes easier for a woman to bear the pain. If the water has not diverged, then the fetal bladder, despite this position of the woman and the displacement of the center of gravity in the upper part of the uterus, continues to fulfill its opening function. If the water has departed, then this position is not recommended to be used in order to avoid delaying childbirth.

6. A woman stands on all fours and rests her chest on a large ball (fitball) and swings in the rhythm of her breathing. It sways back - inhale, sways forward - exhale (because the ball presses on the chest and it is more logical to exhale). The weight of the body is held by the ball and the woman does not spend force on the support using her hands. With a free hand, a woman can massage the abdomen or use other methods of anesthesia (for example, pain points). The partner can do back massage with a massager or spiky balls.

7. A woman stands on all fours and rests her chest on a large ball (fitball) while doing rotational movements of the body in a circle. The second block is the lying posture. Because It is known that the supine position is not the most beneficial for quick and easy childbirth (blood flow is disturbed, pain intensifies, the preceding part of the fetus slows down), it is better to try not to lie down during contractions. Or lie on your side. But there are times when this is inevitable. For example, during hardware monitoring of the fetal heartbeat or during childbirth on the system.

If the back hurts and the woman is forced to be lying on her back, she puts the heels close to the pelvis, puts a massager or spiky balls under the sacrum and rubs her back and sacrum in circular movements in the horizontal plane (the “mill” pose).

The woman is lying on her side, slightly bending and lifting her legs to her. This position is more favorable in comparison with the supine position. A partner can swing it slightly to help relax and thereby reduce pain during contractions.

The third block is the sitting posture. Women are not recommended to sit during contractions and especially during attempts on a hard surface. Thus, the pelvic floor is strained and the progress of the head is slowed down. But you can sit on a big ball (fitball). To do this, the fitball is not inflated very tightly so as not to press heavily on the pelvic floor:

- sitting on the fitball, spinning the pelvis in a circle "left-right" and "forward-backward";

- swinging (bouncing) - “up and down” on the fitball (if there is a partner, he gets up from the woman’s back and, supporting her armpits, lifts above the ball and lowers back; when the woman lifts the partner, her pelvis relaxes and pain decreases );

- sitting on a fitball, with a back against a partner - it is very suitable for childbirth, when a woman has a system and she can not move freely and is forced to lie. In this position, the woman is sitting on the fitball, and the partner is sitting on the back of the chair. A woman leans back against a partner who holds her and sways slightly. At the same time, the partner holds his hand with the system.

- sitting on the fitball, the partner stands behind him and holds the woman by the shoulders. During initial labor fights, when you already want to push, but you still can’t do this, the woman really wants to speed up this process. The partner, holding her by the shoulders, helps to roll off the ball and rise back. This movement not only facilitates the fight, but also accelerates the process of moving the baby’s head down to the exit from the uterus.

The fourth block is the standing posture. The vertical position of the body during labor and effort accelerates the whole process. In this position, the force of gravity helps and the baby moves down to the exit from the birth canal faster, overcoming the resistance of the birth canal tissues. Given that walking tires a woman during childbirth, you can use other options for an upright position with a big ball.

- a woman stands against the wall, resting her face and chest on a fitball, leaning against the wall at face level. In this case, you can slightly spring on the ball. Legs are recommended to be slightly bent at the knees to relax the pelvic floor to reduce pain. Hands a woman can do a massage of the abdomen or use the point of pain on the body. If a woman has an assistant, then he smoothes her back or stomach with her hands or massage balls.

- a woman stands against the wall, leaning her back on a ball leaning against the wall. The ball can be placed at different heights from the floor, depending on the convenience of the woman. A woman is leaning on a ball and swinging. Due to the fact that the ball holds the weight of the woman’s body, the body relaxes more and the anesthesia mechanism is activated. If a woman has an assistant, then he stands with his back to the ball, and the woman leans against her partner. And this partner is already rocking a woman in this position. A partner can also help with abdominal massage or pain points. A woman can only breathe, which saves strength for the birth table.

- a woman stands by a bed or chair, one leg is raised and rests on this surface (chair, bed). Pelvis woman makes rotational movements. In this position, the woman not only uses the vertical position of the body for faster passage of the child through the birth canal, with this position of the legs, the transverse size of the entrance to the pelvis expands.

The fifth block is the posture "for a busy period." At the effort stage, the ratio of the baby’s head and the mother’s pelvis becomes key, because the baby’s head contracts and must pass through the bony ring of the mother’s pelvis. The obstetric conjugate can be increased by 0.5-1 cm due to a change in the position of the woman's body (Fig. 2.29 p. 85). Akunts K.B. Atlas on Obstetrics - M.: Medical News Agency, 1998. - 215 p.). Those. more space appears for the child so that the head can lower into the pelvis.

It is known that if you start pushing ahead of time, it can injure the child (cervical trauma), in addition, it makes it difficult for doctors to diagnose the internal obstetric situation due to the fact that edema occurs on the adjacent part of the fetus, covering the anatomical landmarks for diagnosis.

In order to reduce these risks, it is necessary not only to breathe correctly. You can use the anatomical features of the body, which help to survive this period easier and even accelerate the progress of the child, without the risk of injury. A woman can change the inclination of the pelvis and expand the distance between the tubercles of the ischial bones, between which the head of the child will pass, changing the position of the body.

If a woman chooses a pose on all fours as the main posture for living the contractions, then at the time of the desire to push to ease this and expand the pelvis for a more safe and quick passage of the fetus to the exit from the pelvis, the “flattened frog” pose is recommended. From the position on all fours, the woman at the time of the appearance of the attempt lowers the pelvis back between the legs, folds her hands in front of her and lowers her head on them. An important point is that the legs are parallel, i.e. heels are not reduced. This is necessary for greater stretching of the pelvic floor. At the same time, the woman breathes special breathing (“dog”) to restrain the effort, which relaxes the pelvic floor and does not impede the child’s progress to the exit.

Pose "frog with chest resting on the ball" - a woman stands on all fours and rests her chest on the ball, at the time of the appearance of an attempt, the pelvis lowers between the legs and the pelvis hangs over the surface on which the woman is standing. It is important that the legs are parallel to each other and the heels do not come together. And we add a special breath to restrain attempts ("dog"). The partner can massage the sacrococcygeal zone, which enhances the relaxation of the pelvic floor.

Half-squat pose (squatting). All squatting poses have great advantages compared to others: - the child moves down to the exit from the pelvis faster, because this vertical posture and the force of gravity helps; - Pelvic floor muscles are stretched and the risk of ruptures is reduced; - the distance between the ischial tubercles expands, which increases the place for the child’s head, the angle of the pelvis changes and conditions are created for easier and faster advancement of the child to the exit; - due to stretching of the lumbosacral region of the pelvis, back pain is reduced.

A woman squats facing the ball or to a surface that you can hold onto. The legs are wide, the feet parallel to each other. In this position, there is a fight with attempts and breathes breathing to restrain the attempts ("dog"). It is important that the woman crouches in this position before the start of the bout. Because if she begins to squat already during the bout, when there is a desire to push, she will put pressure on the child from top to down by the movement of her body, and this increases the risk of injury in the cervical spine and cephalohematomas.

To accelerate the baby’s advancement through the birth canal without risk of injury, the woman can be in a “squatting” position, leaning with her bent hands on the edge of the bed or on her partner’s knees (if it’s a partner’s birth), the body is upright, the pelvis is advanced. In this position, the sacral protrusion moves posteriorly, and the sacrum rises, approaching the head of the child and the child quickly sinks to the pelvic floor. At the same time, special breathing is performed.

If a woman chooses the position of lying on the bed for the first period of childbirth (contractions), then for the period of attempts she can, without getting out of bed, facilitate this period. Lying on a side convenient for her, a woman picks up her leg, which is above the knee and pulls it up to the shoulder. Thus, the pelvic floor stretches, increasing the exit from the pelvis for the child. At the same time, special breathing is performed.

A woman is in a crouched position, holding her hands on any surface or holding the hands of a partner. The legs are shoulder-width apart, the feet parallel (standing on the full foot), the pelvis moves forward, the face leans down - the nose on the stomach (i.e. the back is rounded). In this position, the exit from the pelvis is maximally expanded. And even if a woman involuntarily wants to pinch the baby in the birth canal, then in this position with the maximum extension of the pelvis, she will not be able to do this. Those. she will not be able to injure the child. At the same time, special breathing is performed.

A woman sits on a bed, puts a fitball under her back. The body is tilted, the pelvis is advanced, the legs are bent and shoulder width apart, the heels are close to the pelvis, and the knees are apart. Hands of a woman holding on to her ankles. During a tight fight, a woman lowers her head to her stomach and breathes special breathing. In this position, the pelvic floor is stretched and provides more opportunities for the child to exit. Clutching a child in the birth canal even through negligence, out of ignorance, a woman will not succeed due to the purely physical characteristics of this pose. In addition, a woman, while sitting, saves energy for the birth table. At the same time, special breathing is performed. This pose can be called "universal", because it is easy for a woman to perform, despite the accumulated fatigue at this time of birth, the pelvis is located so that the baby passes easier to exit, it is easy for doctors to diagnose the obstetric situation.

Standing by the bed, window sill, etc., the woman clings to this surface and, slightly bending her legs, during a contractions of an arduous nature, shakes her pelvis up and down, as if "shaking out" the baby. At the same time, special breathing is performed.

A woman should be able to determine the moment when you can already push. This is necessary in order to adequately interact with doctors in the process of childbirth. And also in order to restrain the desire of doctors to speed up attempts for biased reasons (tired, they want to deliver a woman faster and go home), i.e. thereby contribute to the prevention of obstetric birth injury to the newborn. To do this, a dummy of the perineum and the moment of cutting the head are shown, which the woman should recognize and check by palpation.

Seventh lesson "Breathing on the birth table"

The purpose of the lesson is to teach breathing at the birth table and show a key psychological moment at the end of the first stage of labor.

Tasks:

- repeat the exercise against the wall, simulating a birth table;

- talk about the key psychological moment for primiparous women at the end of the first period of childbirth;

- give a solution to the question "what to do if I can no longer";

- test the idea of breathing on the birth canal;

- show typical errors in breathing and tell what it can lead to for the child and for the mother;

- explain why an ineffective breath leads to cracking of the capillaries in the face and eyes of the mother;

- give associations to breathing on the birth table;

- show and train an increase in the volume of each breath;

- Demonstrate different types of contractions and the effect of breathing in certain contractions;

- why breathing training becomes a prevention of newborn asphyxiation, as well as prevention of cervical trauma;

- to focus the attention of women on the fact that even in order to get breathing there is still no birth, no pain and no energy has been expended, it takes time. Get an answer from them that “there’s no time at the birth table for training”;

- to simulate the breathing and work of the body on the birth table, so that "I breathe, but the body works" in the mind. This is the answer to the team of doctors: “push as you were taught”;

- conduct an exercise test for the body to show how all the muscles of the body will work on the birth table. To teach to relax the perineum with the stress of the whole body;

- explain when and how to train breathing for attempts. Talk about the possible reactions of loved ones.

Lesson plan:

- “disturbing moment” for primiparas;

- breath on the birth table:

- testing;

- all one at a time;

- errors;

- associations (like a swimmer, noisy, greedy, enthusiastic, pinching his nose, waving his hands);

- an increase in the volume of breaths (the second is larger than the first, the third is larger than the second);

- The scheme of different types of contractions on the birth table;

- breathing options on the birth canal;

- why do you need 30 seconds, "it may come in handy in the last fight";

- reception with hands;

- exercise against the wall with the ball;

At the beginning of the lesson, it is necessary to talk about the psychological state during the active stage of labor, when several hours have passed from the beginning of the birth, and the woman is already tired. The essence of this condition is that the woman’s physical and mental fatigue provokes the thought that “it will never end ...”, “I can’t put up with it anymore ...”. At this moment, if a woman succumbs to such panic thoughts, then she forgets about the correct behavior and spends energy on a tantrum. Most often, women do not realize that it is this moment that shows that it will all be over soon and that it is necessary to endure and save strength for the birth table. As practice shows, if a woman "goes into hysteria", then in the future she will not have the strength to push, and this can lead to trauma and asphyxiation of the newborn.

It is at this stage that most women begin to ask for a cesarean section or anesthesia. Therefore, here only the correct motivation of a woman allows her, forgetting about fatigue, to adequately wait until the doctors take her to the birth table and allow her to push.

Women should know that almost all primiparous experience this. In multiparous, this condition is much less common. To cope with this, it is necessary to use the psychological method “Thinking about a child”. If a woman begins to think not about her fatigue and pain, but about the fact that with it all this passes her little child, that he is in more difficult conditions, then it becomes easier for her to live these minutes. Having retained strength, she gets the opportunity to faster and easier to pull the baby on the birth table. And this in turn reduces the risk of injury and asphyxiation of the newborn.

Next, go directly to the breath training for the birth table.

At the birth table, it is necessary to create additional muscle effort to help the baby get through the birth canal quickly enough. A woman must push three times in one fight. Thus, she takes a breath, then, while holding her breath, squeezes (presses the uterus with the muscles of the abdomen with the baby), then exhales smoothly. And so for the match three times.

The breath should be fast enough and voluminous so that it is possible to push longer with one breath and push the baby more efficiently. And the exhalation should be smooth and fast. If you exhale sharply, then the child rises sharply a certain distance up from the point at which he has already lowered. The speed of inhalation and exhalation is necessary in order to use the main time of the contractions for extrusion.

First you need to determine how much women already get such a breath. We simulate the situation of the birth table, give the command as well as the doctor or midwife commands the woman during the attempts: “Inhale - push up - exhale ... Inhale - push down - exhale ... Inhale - push down - exhale ...”. This is done in one minute, about as long as a good fight lasts on the birth table. Holding the breath every time for 15-20 seconds.

It is necessary to get feedback from women, i.e. they should tell how comfortable it is for them to breathe, whether there is enough air to hold for 15-20 seconds, whether their heads are spinning.

To get a good breath, you need to do it with your mouth quickly and actively. In this case, a specific sound may occur. Inhaling through the mouth allows air to enter the lungs faster.

The instructor shows how to inhale, so that it is easy to hold your breath for attempts.

Then all women again inhale everything together. Next, each inhales separately from the others, so that you can evaluate the correctness of the execution. It also prepares the woman not to be shy about breathing on the birth table.

It is necessary to describe and show how proper breathing works, what typical mistakes can be, and how this can affect the child and the mother herself.

Common mistakes.

The first mistake is a small breath.

The progress of the child is not accelerated. A small amount of oxygen for the child (the threat of hypoxia and, as a consequence, asphyxia of the newborn is growing);

It seems to women that, filled with lungs, they press on the diaphragm, and she, in turn, presses on the uterus with the fetus. Thus, air works like a piston in a syringe; the more air, the stronger the pressure.

The second mistake is that women who are not familiar with panting often after the first inhalation do not expect the midwife to not give out some time, and exhale ahead of time and start asking questions “When to exhale?”

Here it is necessary for women to explain that while the battle is on, it is necessary to push and be silent. All questions only after the fight, so as not to delay the laborious process.

The third mistake - after the first exhalation, an untrained woman does not inhale. Even on the command “Breathe big!” With the mouth! ”Women often only open their mouths, but do not inhale. Without inhalation, the child does not receive oxygen. The uterus continues to push the baby, but the woman cannot make every effort to help the uterus and the baby’s progress slows down. In the absence of inhalation or with a small inhalation of the attempt, the capillary “breaks” into the woman’s face and skin, in the eyes, on the neck and in the skin of the chest, and there may be ruptures of capillaries.

The fourth mistake is a very sharp exhale when the midwife gives the command "Exhale!". During an attempt, the uterus and the woman push the baby forward with their breath. The baby's head is already rigidly fixed in the bones of the pelvis, the body is higher - in the uterus. If you exhale sharply, then the lungs empty and the diaphragm, and after it the uterus rises sharply. And the child, along with the uterus, as if "twitches" up. The child’s body rises along with the uterus, and the head is fixed and due to a sharp exhalation, the neck is stretched, which can lead to neck injury. The exhalation should be quick, but smooth, as if blowing out candles.

For a better understanding and implementation of this breath, we give women associations what this breath might look like:

- a greedy breath, like a swimmer when he emerges.

- a volumetric breath, enthusiastically, noisy.

- a breath with simultaneous raising of the arms to the sides to open the chest and increase the volume of inhaled air.

- try to inhale, holding your nose. With this technique, the glottis opens wider and more air passes into the lungs per unit of time.

Each woman should choose for herself the most suitable option for association. Again, we simulate one stiff fight, when women, on a team, inhale three times, as it will be on the birth table.

The task is given to train this breath. You can not train breathing hungry and on a full stomach. In the first case, so that there is no fainting state. In the second, so that the hypochondrium does not hurt.

It is better if a woman will train this breath every day, so that, being on the birth table, a woman could use it spontaneously.

Training starts with 10 seconds of holding your breath. Those. three times in a row for 10 seconds. Gradually, you need to train for a delay of up to 30 seconds. So that even in the most difficult attempts to advance, the woman had the strength to hold this breath and push with the help of his child the way out.

Further, when the women have already practiced a little and become familiar with this type of breathing, we focus on the fact that the second breath for the fight should be greater than the first, and the third should be greater than the second. This is necessary so that in any case (even if there is weakness), the woman’s work would be effective.

An example is given that if a tight fight is strong: it quickly gains strength, lasts a long time and quickly decreases, then in this case three breaths of the same volume will suffice. But, if the fight gains strength for a long time, lasts a little and quickly decreases, then only the second and third breaths will push the child through. Because it is not known what the contractions on the birth table of each particular woman will be, we must prepare them for the weakest option of contractions. If the contractions are good, then the ability to make each breath more voluminous will help a woman give birth to her child even faster.

One more fundamental remark. Usually a fight lasts a minute or a little longer. And a breath for 20 seconds is enough. But we ask women to train for 30 seconds. This is necessary so that in the case when the baby begins to quickly move forward from the birth canal out, if this happens at the end of 20 seconds, so that the woman has a breathing reserve and she continues to push. If she exhales, then in this case two oppositely directed forces act on the child’s neck - the force of nature pulls the child forward, and the woman pulls him back with her exhale. Given that the head is fixed, all the power falls on the neck and there may be a neck injury in the last minute before birth.

It is difficult for many women to imagine how she will need to combine this breath and effort. To do this, we simulate the work of the body in combination with this breath.

Women with palms folded in the solar plexus imitate the bottom of the uterus. After inhalation, women look at the hands (which depict the bottom of the uterus) and hold their breath. Hands at this time smoothly straighten, pointing down, simulating the pressure of the uterus on the fetus. Those. we form the model "I breathe so - the body pushes the child down." We cannot force women to push in order not to disturb the course of pregnancy. But to create a mental way of working on the birth canal is necessary.

The final exercise is done while standing. Women stand with their backs against the wall, pressing the fitball with their lower back against the wall, their legs are slightly bent and shoulder-width or slightly wider (about the same as on the birth table), hands are bent, palms are clenched into fists (we hold palms in the area of the ilium), elbows to the sides. The pose should maximally resemble the position on the birth canal (only vertically). Women take a breath and are grouped to the stomach, with an emphasis on the fact that the pelvic floor should be relaxed. Arms, legs, back, neck, abs - everything is tensed and only the face and pelvic floor should be relaxed.

Women should train this so that everything happens spontaneously on the birth table.

The eighth lesson "Rehearsal of childbirth"

The purpose of the lesson is to simulate the birth process and actions of a woman at different stages of childbirth.

Objectives of the lesson:

- Remind about the duration of the different stages of childbirth and how a woman should determine when she should go to the hospital;

- talk about the benefits of traveling to the hospital by car, on an ambulance, on foot;

- remind key points in the process of labor (relaxation, thoughts about the child, you can close your eyes);

- to study the four classic methods of self-help in childbirth with pain in the lower abdomen and with back pain;

- do all the poses for the most difficult period of childbirth in the ward in combination with breathing;

- show how a woman should correctly rise to the birth table if she goes to the table herself and how to do it if she was brought to the table on a gurney;

- explain the rules of position on the birth table;

- work out the position on the birth table and the woman’s behavior during the contractions (breathing-arms-legs-gaze-exhale), three options - herself, with an assistant who supports her head, with legs raised up above her knees;

- find out from women what is most difficult at this stage to refine these points;

- show on the body what points on the pelvic floor will need to push;

- talk about the terms that doctors use when describing attempts;

- show and model the tricks that doctors use to strengthen attempts (safe tricks, dangerous tricks).

- Get feedback from women about dangerous practices;

- obtain confirmation of the intention of women to make the main element for the prevention of medical interventions (obstetric aggression) in front of the birth table and show this element;

- give information about the only case when you can push in the ward, work out this body position, so that women are convinced of the effectiveness and necessity of an upright position at the stage in front of the birth table;

- practice switching from panting to breathing “dog” on the command of the midwife at the final stage on the birth table;

- talk about what they will do with the woman after birth at the birth table, as well as during 2 hours in the maternity ward;

- tell why you need to be careful and how to act when transferred to the postpartum unit (in the early postpartum period), how obstetric complications are “masked”;

- give homework to work on the birth table.

Wish a good birth. Hand out forms of postpartum profiles.

Lesson plan:

- two plans for the onset of labor: the beginning with labor, the beginning with the discharge of water.

- remind you when to go to the hospital;

- practicing breathing and relaxation during contractions.

The study of classic methods of pain relief pains:

- calm breathing;

- smoothing the lower abdomen in combination with rhythmic breathing (three ways of smoothing: palms, thumbs, all fingers);

- pressing the points in front at the corners of the ilium, behind at the outer corners of the lumbar rhombus (Michaelis rhombus). + use of massage balls instead of your own palms;

- repeat the "hangers" - poses to accelerate and facilitate childbirth;

- repeat all the poses for the first part of the busy period, when you still can not push;

- we study the correct position on the birth table, which will not injure the child during promotion;

- we model attempts.

At the very beginning of the session, we again remind women that childbirth has two options for starting: from the discharge of amniotic fluid and from labor. In order to reduce possible anxiety and adrenaline in the case of the discharge of water, women are invited to draw up two step-by-step plans for childbirth. The first - if the contractions began, the second - if the water has moved. Then none of the options will become stressful.

Then, once again, a diagram of the development of labor activity is drawn on the board with an emphasis on how much time each stage can take.

Then the lesson is set so that behavior during fights is modeled, and further explanations are given between the “fights”. For example, like this: there is a “fight” - women breathe relaxation breath for 1 minute, then a break of 5 minutes. During the break, the facilitator gives feedback to women, talks about who got relaxation (that is, “get into a fight”) and who doesn’t, suggests what is best done in each case (change posture or take a longer one) exhale or close your eyes, etc.). Women “lose” such fights in a sitting pose with their backs resting on the fitball. So 5-6 fights are lost in the first 30-40 minutes of a lesson. The main time of the lesson is planned to practice the behavior of a woman at the birth table.

Further “contractions” are set more often as it will be in real birth: after 4 minutes, after 3 minutes, so that there is less time for rest. Everything should “resemble” childbirth.

Women are given four classic methods of pain relief.

In 1949, in the USSR I.Z. Velvsky, V.A. Ploticher and A.E. Sugom, in consultation with Professor K.I. Platonov, proposed a new, psychoprophylactic system for preparing for childbirth and anesthetizing them. The authors of the system believed that normal childbirth is a painless or slightly painful physiological process, and only false ideas inspired by the environment about the inevitability of pain during childbirth evoke “emotions of fear” in the mother and determine her increased painful reactions during childbirth. The purpose of psycho-preventive preparation is to remove the emotions of fear and increase the joyful expectation of the mother to give birth to a healthy baby, to remove the psychogenic components of pain, and to promote calm and active behavior in childbirth.

Methods of anesthesia.

1. Proper uniform and deep breathing during labor.

2. Inhalation and exhalation during contractions are combined with stroking the anterolateral surfaces of the abdomen. Stroking the skin of the sacro-lumbar region.

3. Thumb pressing of the front-upper bones of the ilium. Pressing fists of the points that correspond to the outer corners of the Michaelis rhombus (the last two tricks are recommended for frequent contractions).

4. Calm breathing between contractions.

In view of the often incorrect presentation of these techniques in antenatal clinics (without taking into account the particular psychological state of a woman during childbirth), women who gave birth were disappointed in these methods of pain relief. But in fact, the methods are really effective and useful. The fact is that it is not enough for pregnant women to simply talk about these massages and pressing points. In order for a woman in childbirth during pain to be able to remember them and press with the necessary force, it is necessary to do all this in practice before giving birth.

Therefore, the instructor approaches each woman and first shows her with his hand what and how to massage and crush, and then puts the woman’s hands on the right points and asks to do the same.

A new item is added to each trick.

1. In a calm breath during the contractions, an exhalation with relaxed lips is added.

2. During the massage of the lower abdomen, women are invited to try not just to massage with their palms, but to smooth out (as if “scribble”) this area with their thumbs or with all five fingers. It is necessary to try, because feelings during labor pains with increased labor will change. And we must give tricks that a woman can use to increase pain.

3. Pressing the points "in front of the superior awns of the ilium." It is especially important here to put women their fingers to put pressure on the right place. Because if they will only press on the outer surface of the awns, then the proper effect will not be. It is necessary to deepen the fingers into the abdomen and click on the "edge" of the bone. This pressure of the dots causes pain. And here we must include the correct behavior of the woman "it hurts you, but you breathe." And be sure to say that the fight is much more painful than this pain. By training the breath at this time, we reinforce the correct behavior.

When rubbing the points "at the outer corners of the lumbar rhombus", women should feel how inconvenient it is to do. Therefore, we suggest using spiky balls that can be placed between your body and the wall (if the woman chooses an upright position) or between yourself and the bed if the woman has to lie. Moving your body and clutching balls, you can anesthetize it in that place of the pelvis, where it hurts the most. In this case, the hands are free and a woman can massage her stomach.

4. Calm breathing in between contractions. At this time, a woman can independently switch her attention from pain to calm breathing, to the visualization of a child or paintings that enhance relaxation (sea views, etc.).

The instructor teaches women how to use these techniques in different positions of the body. If partner birth is planned, then the partners are trained with what force you need to massage or press.

Next, you need to repeat all the poses in combination with breathing "dog" for the most difficult period of childbirth, when attempts to join the contractions, but you still can not push, because incomplete opening of the cervix and the precursor of the fetus (usually the head) has not yet descended to the pelvic floor.

Women are encouraged to remember which poses they trained at home. And in turn we work out all the poses with breathing and partner techniques at the same time (massages, pain points, etc.) with an interval of 3 minutes. Here, the entire block of poses for the "busy period" is repeated:

- “flattened frog” + breathing “dog”.

- “frog” resting on the ball + breath “dog” + massage of the sacrococcygeal zone;

- in a squat with elbows resting on the edge of the bed or on the partner’s knees + breathing “dog”;

- in a squat facing the ball, hugging the ball + breath "dog";

- crouching, holding hands on any surface or holding the partner’s hands + breathing with the “dog”, legs shoulder-width apart, feet parallel (standing on the full foot), the pelvis moves forward, the face is tilted down, nose on the stomach + breathing with the “dog” ";

- sitting on the bed, resting his back on the ball "universal" + breathing "dog";

- lying on its side with a leg raised to the shoulder + breathing "dog";

- standing at the surface and shaking the pelvis + breathing "dog";

- sitting on the partner’s lap when the partner shakes the woman in the rhythm of breathing with the “dog”.

Next, after practicing all these poses with a frequency of 1 pose in 3 minutes, we go to the birth table. Here, women are shown how to lie on the table correctly so as not to disturb the obstetric sterile zone, depending on whether I shift it to the table from a gurney or it rises by itself. A woman should not touch the sterile area with her hands. It is necessary to put a basin or sit on an absorbent napkin, throwing your legs through the sterile zone to special supports for stopping the legs.

The main rules of the situation on the birth canal.

It is necessary to lie flat, without bending or tilting the head to one or the other shoulder, because in this position, the exit from the pelvis bends. A woman is looking at a man who is standing on his right thigh. There is a midwife who takes birth. It is she who sees the situation outside, like everything in the birth hall and at the same time from the inside, carrying out an internal examination. Eyes during attempts should not be closed so that there is no rush of blood to the face and there are no ruptures of capillaries in the skin of the face, neck and chest. During the fight, the woman is pushing at the command of the midwife, after the fight, she is resting.

Women lie down on the birth table. Hands hold on to the ankles. At the “breath” command, they take a deep volume breath, raise their heads, press their lower back, spread their elbows to the side and hold themselves in this position (pause for 15 seconds) - exhale (at the command of the instructor). The woman will hear the same commands lying on the birth table from the midwife. In this case, the face and pelvic floor should be relaxed. On command, women exhale smoothly and lower their heads. Again comes the command "inhale-pause-exhale." And so three times. At the same time, women do not bother !! But women can appreciate their strength.

The question is asked “what was easy in this situation, what I didn’t like, what I would like to change”. Women should analyze how comfortable or not this position is, whether they have the strength to hold their body in it, whether it turns out to hold their breath and be in that position at the same time. There is a parsing of errors, which can interfere with women in this.

Then the second approach is done on the birth table. In this case, we are already changing the position of the body. We ask women to raise their legs under the knees and pull them to the shoulders. And again we do “inhale-pause-exhale” three times, as during one fight. Then again, you need to get feedback from women - “Is it more convenient or not, is it possible to hold your breath for the right number of seconds, is it easier to hold your head in this position”. If women say that it is easier in this position, then it is recommended to tell the midwife or doctor about it directly during childbirth in order to use the power of this position.

After this second position, women are asked the question: "Is it clear where (in what place) you need to push?" Women are sitting on the floor, on the rug, resting their backs on the fitball, the body is at an angle to the floor. The instructor puts the fingers of women on the tubercles of the ischial bones so that they feel and have an idea of what points the child will need to be pushed to. The child’s head will press precisely on these points. Only we put our hands on the outer surfaces of these bones, and the head will press on the inner surfaces of the ischial bones. Women are invited, holding their fingers at these points, take a breath as for an attempt and imagine that with this air they press on them through the body.

Further, the instructor shows women techniques that doctors can use when a woman is pushing. Women try these tricks:

- pinching the upper abdomen (doctors do this between contractions). This is a safe technique, but it allows the uterus to respond to irritation and start the fight. This technique is used if the baby’s head has already lowered, but contractions become rare and fetal hypoxia may develop just a few minutes before the end of labor.

- applying the forearm to the upper abdomen. A woman puts her hand on her upper abdomen, takes a breath and grouped into the abdomen, as with attempts. In this case, the uterus gets a platform above itself, resting against which, it pushes the baby down with more force. If doctors use this technique, this suggests that the woman can’t cope with the attempts and she wants to accelerate the advancement of the child. Often, using this technique, obstetricians do not just hold their hands to support the uterus, there is a temptation to push down (which can injure a child who is still in the birth canal).

- "Christeller's reception" - pressure on the bottom of the uterus. Officially, this benefit is not applicable in Russia. However, according to numerous complaints to the “League of Patients”, we can conclude the opposite - in Russia this technique is used and leads to such terrible consequences as rupture of the uterus in a woman in labor and birth injury in newborns. Thus, a definite role in the genesis of birth injuries undoubtedly belongs to the use of the ancient obstetric technique described in very old textbooks on obstetrics and known as the “Christeller technique”, or pressure on the stomach. "Kristeller's reception" was officially banned in the Russian Federation back in 1992. But, as practice shows, this technique is carried out everywhere and, of course, leads to injuries of newborns.

Women, seeing from the side how it looks, themselves conclude that it is quite dangerous. The instructor shows a technique in which women can avoid such interventions by obstetricians. This technique is "head tapping." Those. On the crotch model, women are shown how much the head should appear from the inside, so that you can ask for a delivery table. Here, the instructor says that in this case, even if the woman does not manage to breathe correctly on the birth table, even if there is not enough muscle strength, then the attempts will be spontaneous. Because the child’s head is already crushing with maximum force and, the woman’s body itself will perform the necessary work.

Then attempts are simulated again, only now women are half-sitting with their backs resting on the fitball. All other actions remain the same: we press the chin in to the chest - hold on to the ankles with our hands - we pull our bodies with our hands, as if “grouping”, while we move our elbows to the sides.

After such an intake of attempts, women give feedback - they say whether it was easier for them to hold their breath and it is easier to simulate attempts. As practice shows, 100% of women evaluate this option as the easiest to perform and more effective for attempts. Thus, women themselves prove that attempts to upright will be easier for them to do. Provided that vertical delivery is allowed in the maternity hospital, a woman can immediately say that she prefers this option. If in the maternity hospital the traditional approach is when the woman is lying on her back, then the woman must conclude that she needs to be upright as long as possible while she is in the ward. This will allow the baby to lower lower and then, lying on his back, less time will be spent on attempts.

Women are given information that they can bother once in the ward before going to the birth table while in a sitting position with their backs on the ball. But this can only be done under the supervision of a doctor or midwife, who will monitor whether the baby’s head is moving or not. Obstetricians using Piskachek’s technique will be able to determine whether it’s really time to take the woman to the birth table.

The next stage of development is when, during one of the attempts, the midwife will ask you not to push and go to breathe "dog." At this time, she will conduct obstetric allowance so that her crotch will not break. And with such breathing, the perineal tissues relax and the risk of tearing is reduced.

In the final part of the lesson, women receive information about how the early postpartum period will take place (the first two hours after childbirth) and what signals in the body should be paid attention to. This knowledge is necessary in order not to miss the obstetric complications of childbirth in the early postpartum period, such as “preeclampsia”, external bleeding and internal bleeding in the suture area.

Women are given homework to work out what they went through in this lesson at home every day in the most difficult way - lying on their back, because it is emphasized that on the birth table it will have to do everything after many hours of labor, i.e. against the background of fatigue.

Those women who note difficulties in modeling attempts are recommended to come to the “rehearsal of childbirth” again after completing homework.

The proposed method of preparation for childbirth and the postpartum period has compared with the known following advantages:

- has complex functional capabilities, removing a sense of fear, having a positive impact on the emotional state of a woman in labor, reducing pain and the ability to fully control the behavior of a woman in childbirth;

- high impact effectiveness and the absence of negative side effects and complications;

- the possibility of use in the presence of contraindications to the use of medical methods of pain relief or in case of their inefficiency;

- a decrease in the frequency of obstetric complications for a woman and a newborn (a decrease in the frequency of violations of the contractile function of the uterus, injuries to women and children, fetal hypoxia and asphyxiation of the newborn);

- the ability to drastically reduce or completely avoid the introduction of medications during childbirth;

- can be used in emergency situations during childbirth with inadequate and uncontrolled behavior of the woman in labor;

- can be used as an effective means of emergency psychotherapeutic assistance in emergency situations during childbirth with inadequate and uncontrolled behavior of the woman in labor, associated with the severity of the pain syndrome;

- virtually no contraindications (contraindications are various types of impaired consciousness, intoxication or drug sleep).

The proposed method of preparation for childbirth and the postpartum period of pregnant women is available for implementation and is possible to use in almost any conditions (outpatient and inpatient conditions).

Claims (19)

1. The way to prepare for childbirth of pregnant women, which consists in taking a course of eight lessons: the first "Trial" lesson, which includes informing about the duration of the birth, the physiological and psychological component of the birth; the second lesson "Psychology of childbirth", which includes informing about the physiology of women and the physiology of childbirth; the third lesson, "Breathing during labor," including exercises to obtain practical breathing skills during labor and informing about the physiological characteristics of the body at the beginning of labor; the fourth lesson, “Entering the Maternity Hospital,” including the implementation of exercises such as the Bridge and exercises for the birth table; the fifth lesson “Prevention of birth injury in a newborn”, including performing breathing exercises on the birth table, performing a technique to accelerate the child’s progression through the birth canal, an exercise that simulates attempts, taking the Hangman - with your back to the windowsill or headboard, or bedside table, lean on the surface with elbows, supporting herself under the chest, while the legs are shoulder-width apart, the woman sags down, her knees bend, her legs should be at such a distance that a right angle under the knees is obtained at the time of “sagging” , in this position there is a tight fight, after which they are lowered onto the fitball for relaxation; the sixth lesson "Poses in childbirth", including the implementation of 5 blocks of poses: 1 - poses from the "on all fours" position, 2 - lying poses, 3 - sitting poses, 4 - standing poses, 5 - poses for a busy period; the seventh lesson, "Breathing at the birth table," including the repetition of breathing exercises on the birth table and exercises with the ball; the eighth lesson "Rehearsal of childbirth", which includes modeling the process of childbirth and the actions of women at different stages of childbirth. 2. The method according to p. 1, which consists in the fact that as exercises to obtain practical breathing skills during contractions, breathing is performed using: - 1-2 - a breath in the stomach; - 3-4 - inhalation into the chest; - 5-6 - pause; - 7-8 - exhale through the mouth, while one woman’s hand is placed on her stomach, the other on her chest, to control the sequence of breaths; exhalation "horse" - through relaxed lips; exercise "arms and legs"; Pillow exercise - sitting on the floor with support on a fitball, legs are stretched directly in front of you, a pillow is clamped between the feet, while the pelvic floor area is relaxed. 3. The method according to p. 2, which consists in the fact that the exercise “Hands and Feet” is performed lying on the back and, on command, first strain one arm, then one leg in the following sequence: strain only the right arm, strain only the left arm, strain only the right leg, strain only the left leg, strain both hands, strain both legs, strain the right arm and right leg, strain the left arm and left leg, strain the right arm and left leg, strain the left arm and right leg. 4. The method according to p. 1, which consists in the fact that as exercises for the birth table carry out the following exercises: - “we sit in Turkish” perform for 30 seconds 5-7 times; - “frog” is performed for 30 seconds 5-7 times; - Squat with weight transfer carry out 30 seconds 5-7 times; - circular rotation sitting on the fitball + "back and forth" perform 2-3 minutes for at least 5 approaches; - arching the back against the wall; - “namaste” behind the back + deep breath; - breathing “nose inhale - mouth exhale” + “ballerina”; - breathing with the sound of "sigh", "hugging". 5. The method according to p. 1, which consists in the fact that the exercise to accelerate the progress of the baby through the birth canal is performed while lying on the back, legs are lifted up, the knees are pulled as close to the shoulders as possible, while the knees are wide apart, elbows are spread apart. 6. The method according to p. 1, which consists in the fact that as breathing exercises on the birth table, breathing is used by the "dog" with the sounds "O", "A", "E", "U". 7. The method according to p. 1, which consists in the fact that as exercises "Poses in childbirth" perform the following exercises: on all fours + rocking; on all fours + massage; on all fours + unwinding with the knees resting in the pelvis + pressure on the sacrum between contractions; with the leg set aside, spin the pelvis; "Mill" lying on his back; "Hill"; relying on the ball + swinging; relying on the ball + rotation; sitting + rotation or rocking; sitting + partner help from the back; sitting, relying on a partner; sitting, the partner holds, the woman rolls down; standing facing the ball; resting on the ball with his back at different levels; relying on the ball, relying on a partner; standing, one leg above the other + rotation; flattened "frog"; "Frog" resting on the ball + breathing + sacrococcygeal zone; in a squat with elbows resting on the edge of the bed or on the partner's knees; in a squat, facing the ball, hugging the ball; crouching, holding hands on any surface or holding the partner’s hands, feet shoulder width apart, feet parallel, standing on a full foot, the pelvis moves forward, the face is tilted down, nose on the stomach + breathing; sitting on the bed, resting his back on the ball.