RU2389464C2 - Method of preparation for childbirth and postnatal period in pregnant women of risk groups at sanatorium stage - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine and can be used to improve adaptation of an organism of pregnant women to incremental pregnancy loads, to prevent pain and various parturient complications, especially in pregnant women of risk groups at the sanatorium stage. It involves respiratory gymnastics and therapeutic exercises according to a pregnancy trimester. Psychoprophylaxis is ensured by preliminary individual interview and testing of pregnant women to detect their anxiety, and keeping them informed on pregnancy and labour behaviour and body effect to form motivation for respiratory gymnastics, therapeutic exercises, psychoprophylaxis and postpartum gymnastics. The training is performed in 4 cycles during 4 days. On the first day therapeutic exercises are performed. On the second day therapeutic exercises involve fitball gymnastics. On the third day psychoprophylaxis is performed once again in group training to relaxation techniques, respiratory gymnastics within various delivery periods and intrapartum pain relief techniques, with making "a delivery rehearsal" exercise, including training to tension and relaxation of separate groups of muscles involved in birth activity, training to motor habits in intrapartum body position, training to the exercises between labours. On the fourth day there is performed gymnastics to be made after delivery, including daily walks in the morning and in the evening for 60-90 minutes.

EFFECT: method allows for effective correction of psychoemotional condition of the pregnant women, a stable positive effect after the sanatorium stage of the pregnant women, and also for positive effect on the foetus development.

24 dwg, 4 tbl, 5 ex

Description

The invention relates to medicine and can be used to improve the adaptation of the body of pregnant women to increasing loads during pregnancy, for the prevention of pain and various complications in childbirth, especially in pregnant women at risk at the sanatorium stage.

Pregnancy and childbirth have always been an extremely serious test for a woman, both physical and psychological. Currently, the average age of pregnant women has increased significantly compared to previous years. A few years ago, a woman older than 30 years, expecting a baby, was "late primogenous", and only this situation was enough to classify the pregnant woman as a risk group. Special physical exercises (FU) should help the expectant mother to optimally prepare for childbirth.

Pregnancy causes great changes both in the appearance of a woman and in her emotional status. Therefore, it is especially important that a woman is aware of the changes that her body will undergo during pregnancy, and accept them calmly as a natural, temporary condition.

However, the undeniable companion of the good psychophysical state of the future mother should be FU throughout the entire period of pregnancy. The positive effect of FU on the functional state of the cardiovascular, respiratory, and muscular systems, and the ability to increase the body's resistance and create a favorable emotional mood, make it possible to use FU in a pregnant woman as a powerful therapeutic and prophylactic agent.

It is especially important to systematically deal with those who are not particularly young, since the older the expectant mother, the more likely the deterioration of her physical status as a result of a long period of decreased physical activity during pregnancy. It is necessary to pay attention to special exercises that affect the morphological and functional changes that occur during pregnancy. It is known that during pregnancy the position of various parts of the body, the center of gravity changes, the lumbar lordosis increases, the abdominal and pelvic floor muscles weaken and stretch. With an additional load, the functions of blood circulation and respiration, metabolism, stagnation in the veins of the lower extremities and pelvis, flattened longitudinal and transverse arches of the feet, etc.

FU will help the expectant mother to develop a calm and positive attitude during the nine months of pregnancy, allowing you to maintain control over your body, transfer the most critical moments of pregnancy and childbirth. With the help of FU, a young mother after childbirth can regain that physical form that she had before pregnancy.

The issues of rehabilitation treatment and prevention of various pathologies in pregnant women during their stay at the resort are of great interest. Aftercare of this category of women in a sanatorium is relevant, because continuity in treatment is maintained, additional therapeutic factors are included with their strengthening and training effect.

The birth of a child in the modern conditions of our life has become a certain problem. In this regard, the provision of full assistance to a pregnant woman is one of the important medical, social and ethical components of medicine. Improving the health of pregnant women, reducing perinatal and maternal morbidity and mortality is a priority area of medicine in all countries of the world.

One of the most common causes of maternal and perinatal mortality is extragenital pathology, against which every third pregnancy proceeds. To reduce it, society is making significant efforts aimed at both increasing the birth rate and improving the health of pregnant women.

In this regard, on the basis of the sanatoriums of Russia, pregnant rehabilitation units are opened, which allows for 180 mothers to improve their health status and reduce perinatal and maternal morbidity and mortality in a short period of time. A significant role in this belongs to therapeutic physical factors.

An important role was given to physical therapy, but over the past 10 years there have been significant changes in the ideas about many aspects of preparing pregnant women for childbirth. All this requires an evolutionary correction of the methods traditionally established in the domestic service of physiotherapy exercises. Pregnancy and childbirth have always been an extremely serious test for a woman, both physical and psychological, and physical exercises throughout the entire period of pregnancy should be an indispensable companion to the good psychophysical state of the expectant mother.

In this regard, it became necessary to develop a comprehensive program of physiotherapy exercises for pregnant women at risk at the sanatorium stage.

There is a method of preparing a pregnant woman for childbirth, aimed at preventing pain in childbirth, IZ Velvovsky and others. Psychoprophylaxis of pain in childbirth as a complex system. Pediatrics, Obstetrics and Gynecology, 1951, No. 3. At the same time, a pregnant woman, starting from 30-32 weeks, is taught deep breathing with a long breath with a frequency of 16-18 times per minute, and also she is taught methods of analgesic massage. In addition, a pregnant woman is taught breathing with a pause by closing the glottis on inspiration, which she will use during the attempt. The method increases the flow of oxygen due to deep breathing, helps to supply the uterus with oxygen, reduce pain, activate the cerebral cortex.

However, the analgesic effect itself is low, the emotional state of the pregnant woman is not taken into account. Under stressful conditions of labor, a pregnant woman cannot fully utilize the skills she was trained during the preparation for childbirth.

The closest is a method of physiotherapy exercises for pregnant women (Physiotherapy exercises. Handbook edited by V. Epifanov, M .: Medicine, 1987, S.298-314).

The first trimester - week 1-16 is characterized by a complex restructuring of the body due to conception, so caution is required in the dosage of the load and the use of exercises. When constructing classes, static and dynamic breathing exercises, relaxation exercises are used to train the abdominal and chest type of breathing, pelvic floor muscles and abdominal muscles.

In the second trimester - 17-28 weeks, the level and nature of the exercises is changing. Along with the general effect and a gradual increase in the total load, it is necessary to pay special attention to the mobility of the joints of the small pelvis, develop flexibility of the spine and begin training long muscles of the back.

In the third trimester - 29-40 weeks, pregnant women exercise in deep rhythmic breathing with an emphasis on his chest type, complete psycho-preventive preparation for childbirth. This technique involves medical exercises in outpatient or home settings.

The disadvantages of the method.

Women are not always able to visit polyclinics or centers to conduct physical therapy classes there because of employment at work, due to health reasons or because of difficulties with transportation, especially in the third trimester. At home, without appropriate control, women perform classes in bad faith and therefore the skills acquired by them are not persistent. The constant and continuous implementation of physical exercises requires a woman to have a certain discipline and culture of behavior in relation to her own health. With such organization of classes, it is impossible to achieve such a level of training when automatism is achieved in the transition to a particular type of breathing that will be effective at the right time of delivery.

In addition, physical therapy exercises should be playful in nature and diverse to provide not only physical, but also emotional effects on women.

The objective of our invention is the effective assistance to pregnant women at risk in the form of an integrated method of healing their body, including exposure to a natural factor, psychological training with the formation of motivation for respiratory gymnastics and physiotherapy exercises during pregnancy trimesters, as an alternative to contraindicated drugs during pregnancy, and achieving stability in the process of preparing behavior skills in childbirth by bringing their implementation to automatism, th helping to reduce the number of complications, the number of maternal and perinatal morbidity and mortality.

The problem is achieved by the method of preparing for childbirth and the postpartum period of pregnant women at risk at the sanatorium stage, including psychological preparation for childbirth by talking, conducting respiratory gymnastics and therapeutic exercises in accordance with the trimester of pregnancy.

Psychological preparation for childbirth is carried out by a preliminary individual interview with testing pregnant women to identify their anxiety. They inform about the course of pregnancy and childbirth in women and the effect of these factors on the body. The interview is aimed at creating motivation for performing respiratory gymnastics, medical gymnastics, preparation for childbirth and gymnastics after the birth of a child.

Classes are held in 4 cycles of 4 days.

On the first day they perform therapeutic exercises.

On the second day, therapeutic exercises on fitballs.

On the third day, psychological preparation for childbirth is repeated by conducting group exercises to teach relaxation techniques, breathing exercises are taught at different periods of childbirth and anesthesia during childbirth, exercises are performed “childbirth rehearsal”, including: training in tension and relaxation of certain muscle groups associated with labor, training in motor skills in body position during childbirth, training in exercises performed between attempts.

On the fourth day they perform gymnastics, which the woman will do after childbirth.

On the first day of the cycle in the first trimester, therapeutic exercises are performed, consisting of exercises aimed at activating the work of the cardiovascular and bronchopulmonary systems, improving blood supply to organs and tissues, normalizing the function of the nervous system, increasing the general and psychoemotional tone of the body. In the second trimester, they perform exercises that improve the utero-placental blood flow, increase the tone of the muscles involved in labor: the abdominal press and the pelvic floor, preventing the violation of the venous system of the lower extremities and the development of flat feet. In the third trimester, they perform exercises that improve blood circulation and reduce congestion, stimulate the function of the gastrointestinal tract, intestinal motility, and strengthen the pelvic floor muscles.

On the second day of the cycle, physiotherapy exercises on fitballs are performed. In the first trimester, they perform: exercises to increase the mobility of the cervical spine, relax the muscles of the neck, increase mobility in the shoulder joints, lumbosacral spine, relax the muscles of the lumbar, improve venous outflow, to prevent swelling of the ankle joints. In the second trimester, they perform exercises of the first trimester and additionally exercises to increase the mobility of the lumbosacral spine, strengthen the abdominal muscles and exercise the diaphragm, to strengthen the muscles of the hips and buttocks, unload the lumbar spine, exhale training, to strengthen the oblique and rectus muscles of the abdomen, square muscles of the lower back and buttocks, strengthening the muscles of the pelvic floor and abdominals, the development of coordination of movements, to increase the mobility of the shoulder girdle, correction of chest kyphosis and lumbar lordosis, strengthening the extensor back, to increase lateral mobility of the trunk, spine, stretching the oblique muscles of the stomach, training the square muscle of the lower back, improving coordination of movements, to increase the mobility of the hip joint with stretching of the adductor of the thigh. In the third trimester, exercises of the first and second trimesters are repeated and additionally exercises for self-extension and general relaxation, relaxation of the pelvic diaphragm, increase in the mobility of the hip joint, strengthening of the muscles of the buttocks and hips, massage of the spine, increase in the mobility of the hip joints, lumbosacral spine, stretching of the pectoral muscles , maintaining muscle tone of the hips, buttocks and adductors of the thigh, relaxing the diaphragm of the pelvis, strengthening the muscles of the abdomen, back, increased mobility of the shoulder oyasa and hip joints, unloading the lumbar spine, the spine relaxation, stretching long muscles of the back, removing the load from the lumbar spine, stretching muscles of the foot and calf muscles, strengthening the pelvic floor muscles and legs, slow breath to relax the lumbar simulating the expulsion of the fetus.

On the third day of the class cycle, they repeat the psychological preparation for childbirth through group exercises to consolidate the result. They teach breathing exercises and anesthesia during childbirth, which include taking deep breaths and exhalations from the beginning to the end of each bout, or simultaneously with a deep breath and exhale, stroke the lower abdomen with the hands of both hands, or with the thumbs of both hands, press the skin to the inner surface of the comb ilium in the area of both anteroposterior spines, or stroking the skin in the sacro-lumbar region. Perform exercises "rehearsal of childbirth", including: training in tension and relaxation of certain muscle groups associated with labor, namely the muscles of the abdominal wall, pelvis and lower limbs. They teach motor skills in the position of the body during childbirth on the back, the legs are bent: alternately bending and extending the legs in the knee joints, breeding and flattening the legs bent at the knee joints, alternately pulling the bent leg to the stomach. They teach the exercises performed between attempts: deep breathing with the arms extended to the sides or lifting them up, squeezing and unclenching the fingers of the hand, flexing and extending the legs in the ankle joints, alternately bending and unbending the legs in the knee joints, relaxing the muscles of the abdominal wall, shoulder belts, legs.

On the fourth day of the exercise cycle, exercises are performed for the postpartum period, which help to restore diaphragmatic breathing, stretched muscles, fiber, skin of the abdominal wall and perineum, restore the tone of ligaments and muscles, activate the intestines and bladder.

The novelty of the invention:

- Conduct psychological preparation for childbirth through a preliminary individual interview with testing pregnant women to identify anxiety. Comparison of personal and situational anxiety allows the psychologist to identify a condition that is characterized by the experience of gloomy presentiments, nervousness, anxiety. Then, through conversation, they try to achieve the emancipation of the pregnant woman by increasing self-confidence, relieving fears and worries, helping to look into one’s inner world, helping to find marital understanding and strengthen marital relations.

- Inform about the course of pregnancy and childbirth in women and the impact of these factors on the body. This is necessary for the patient to recognize the problem, with the formation of positive emotional-volitional motivation to perform respiratory gymnastics, therapeutic exercises, preparation for childbirth and gymnastics after the birth of a child.

- Classes are held in 4 cycles of 4 days. This sequence helps to better master the exercises and remember their sequence. Therapeutic physical factors are most appropriate for pregnant women. They are an alternative to medicines contraindicated during pregnancy, since they do not have a teratogenic effect, do not cause allergies and side effects on other organs and tissues.

- On the first day they perform therapeutic exercises. The sequence of performing exercises of therapeutic gymnastics was selected, the most favorable for the recovery and impact on the body of a pregnant woman.

- On the second day they perform therapeutic exercises on fitballs. Exercise also favorably affects the physical condition of the pregnant woman’s body, develops coordination of movements, stresses the lumbar spine during pregnancy, unloads the pelvic angle, improves posture, but further adjusts the emotional sphere.

- On the third day, they repeat the psychological preparation for childbirth by conducting group exercises to teach relaxation techniques, teach breathing exercises at different periods of childbirth and pain management during childbirth, and perform the exercises “rehearsal of childbirth”. The use of psychological training allows you to increase the effectiveness of the impact and configure pregnant women to use the acquired skills during childbirth and continue to prepare for childbirth, performing physiotherapy exercises at home. Half an hour of skillful relaxation will provide the body with much more rest than sleeping for an hour. At the same time, the tension that accumulates in the body unknowingly completely decreases. You need to learn to relax from the first weeks of pregnancy. During relaxation, blood circulation improves in relaxed muscles and surrounding tissues, and metabolic products are better evacuated.

During childbirth, the ability to relax skeletal muscles in the pauses between contractions and attempts is of particular importance, since it slows the development of fatigue and contributes to a more perfect contractile activity of the rested muscles, the uterus, including the muscular organ. If a woman in labor will be able to skillfully relax between contractions, then in the second period of childbirth she will find that the process of childbirth is almost painless.

Pregnant women are given an idea of how she should breathe during pregnancy and at different stages of childbirth. Mastering the skills of proper breathing and daily training will help ensure that at the right time they can automatically switch to the right type of breathing.

- On the fourth day they perform gymnastics, which the woman will do after childbirth. Performing these exercises is necessary to restore diaphragmatic breathing, stretched muscles, fiber, skin of the abdominal wall and perineum, restore the tone of ligaments and muscles, activate the intestines and bladder.

This helps a woman to quickly restore the body's strength, so necessary for her to care for the newborn.

- Every day, pregnant women take walks in the morning and in the evening for 60-90 minutes across the territory of the sanatorium, at a slow pace with stops for exploring the surroundings and the lake. At stops, they offer to listen to the sounds, silence, birdsong, enjoy the smells of moist earth, forest, freshness and feel that the body is recovering, health is improving, calm is coming, calmness is becoming even.

The implementation of the program for the rehabilitation of pregnant women without taking into account the psychological aspects is not effective enough, neither physical exercise, nor training in proper breathing alone can provide a positive result of treatment.

Only an integrated approach combining the factor of sanatorium treatment, psychotherapy, physiotherapy exercises and training in proper breathing and pain relief in childbirth is a reliable way by which you can effectively correct the psycho-emotional state of pregnant women, conduct prenatal physical training, teach behavior and breathing during childbirth, and physical education carried out in the postpartum period, which allows to achieve a lasting positive effect after the stage of sanatorium treatment of pregnant women, positive to influence the development of the fetus.

For the first time, an integrated method of healing pregnant women at risk is used, designed for the entire course of stay of expectant mothers in a sanatorium. The risk group included women with the following diseases: preeclampsia, arterial hypertension, neurocirculatory dystonia, kidney disease, digestive and respiratory diseases, diabetes mellitus, obesity, habitual miscarriage, pregnancy in primiparous children aged 28 years and older, multiple pregnancy, scar on the uterus hormonal disorders, etc.

The method is as follows.

Upon admission to the sanatorium, a pregnant woman gets an initial appointment with a doctor. At the same time, the pregnant woman’s sanatorium card from the place of residence is studied, the medical history of the disease, according to which the pregnant woman is classified as a risk group, is clarified, then, if there are no contraindications, a treatment course is prescribed according to the proposed method with the corresponding entries in the spa book. Classes are not held on the first day, as it is necessary to create a mood for the perception of recovery, relax, adapt to the new situation, it is recommended to take a walk through the territory of the sanatorium.

A preliminary individual interview is conducted with testing of pregnant women to identify the level of anxiety of women on the Spielberg scale. They inform about the course of pregnancy and childbirth in women and the influence of these factors on the body to form motivation for performing respiratory gymnastics, therapeutic exercises, preparation for childbirth and gymnastics after the birth of a child. They say that pregnancy in women lasts a long time - about 270-275 days and such a long stay in a special condition cannot but affect all aspects of a woman's life, as well as all the systems of her body and their functions. Changes that occur in a woman’s body during pregnancy can be divided into two groups: changes aimed at preserving the well-being of the fetus, and changes aimed at maintaining the well-being of the mother. Delivery is not easy, in particular, they are inevitably associated with significant risk. The body must be ready to cope with such a load. By the time of childbirth, the load on the body increases by leaps and bounds: the function of the endocrine glands - the pituitary, adrenal glands, and thyroid gland - changes. To ensure the growing fetal needs for nutrients and oxygen in the mother's body, blood volume is increased, and the function of the respiratory system is activated. Under the influence of placental hormones, the bronchi expand, the air permeability through them increases. A double burden also falls on the kidneys: they remove the woman and her own “waste” and metabolic products of the growing fetus from the body of the woman. During pregnancy, especially in its second half, significant changes occur in the location of the abdominal organs. They are mechanically compressed, which partially disrupts blood circulation and causes stagnation of blood in the vessels of the pelvis. This affects the function of the intestines, primarily - the promotion of food along the gastrointestinal tract. During the conversation inspire positive emotions, calm and peace.

It is no exaggeration to say that it is possible to adapt to increasing loads in the only way - by doing physical exercises.

In addition, along with the expectant mother, the unborn child is also engaged in physical education.

Classes are held in 4 cycles of 4 days. Women are grouped according to their gestational age or engaged individually. They begin physical therapy exercises using the gymnastics complex corresponding to each trimester.

1 day of classes - A differentiated complex of therapeutic exercises depending on the trimester of pregnancy of a woman.

2nd day of classes - Therapeutic gymnastics on fitballs, which have long been successfully carried out in medical institutions of the country and have become an important part of prenatal physical and psychological preparation.

3rd day of classes - Repeat psychological preparation for childbirth by conducting group exercises to teach relaxation techniques, teach respiratory gymnastics at different periods of childbirth and pain management during childbirth, perform exercises "rehearsal of childbirth", including: training in tension and relaxation of certain muscle groups associated with labor activities, training in motor skills in body position during childbirth, training in exercises performed between attempts. Repeat the suggestion of calm, tranquility and positive emotions associated with the birth of a child.

4th day of classes - Perform gymnastics, which a woman will do after childbirth.

1 day of classes. Physiotherapy.

The complex of therapeutic exercises is designed so that:

1. To intensify the work of the cardiovascular and bronchopulmonary systems, improve blood supply to organs and tissues;

2. Normalize the functions of the nervous system.

An approximate set of physical exercises of therapeutic gymnastics for 1 lesson in 1 trimester:

1 exercise Starting position (I.P.): main stance. Walk around the room - on toes and on heels.

2 exercise I.P .: the same. To spread your arms to the sides - inhale, cross on your chest - exhale. Repeat 6-8 times.

3 exercise I.P .: the same. Raise one hand up, take the other back - inhale, return to I.P. - exhale. Repeat 6-8 times.

4 exercise I.P .: the same. Take your hands back - inhale, return to I.P. - exhale. Repeat 6-8 times

5 exercise I.P .: the same. Perform circular movements of the hands forward and backward. 4 times in each direction (voluntary breathing). Repeat 3-4 times.

6 exercise I.P: standing, hands on the belt. Take your foot to the side - inhale, return to I.P. - exhale. Repeat 3-4 times.

7 exercise I.P: standing, feet shoulder-width apart. Lean forward - inhale, return to I.P. - exhale. Repeat 4-6 times.

8 exercise I.P: the main stand. Perform relaxed left and right movements around the lower back with a “lash”. The breath is arbitrary. Repeat 4-6 times.

9 exercise I.P: standing at the support. Take your hand to the side and the foot of the same name forward - inhale, return to I.P. - exhale. Repeat 4-6 times.

10 exercise I.P: the main stand. Perform 4-6 half-squats.

11 exercise I.P: lying on his back. Bring the legs to the stomach with your hands - exhale, return to I.P. - a breath. Repeat 4-6 times.

12 exercise I.P: sitting on the floor, arms extended forward. Bend over, reach the floor with your fingers, exhale, return to I.P. - a breath. Repeat 4-6 times

13 exercise I.P: lying on your back, legs bent at the knees. Leaning on the feet, arms and shoulders, raise the pelvis up - inhale, return to I.P. - exhale. Repeat 6-8 times.

14 exercise I.P: lying on his back. Raise a straight leg - exhale, lower - inhale. Repeat 4-6 times.

15 exercise I.P: the main stand. Take your leg back, raise your hands up - inhale, return to I.P. - exhale. Repeat 6-8 times.

16 exercise Walk around the room.

In the II trimester of pregnancy, the complex of physical exercises of therapeutic gymnastics is composed so that:

1. To influence the formation and consolidation of deep and rhythmic breathing skills, which ensures full utero-placental blood flow during and after classes;

2. Train the abdominal and pelvic muscles involved in labor;

3. Increase tone and improve the functioning of the cardiovascular and respiratory systems;

4. To carry out the prevention of violations of the functioning of the venous system and the prevention of possible expansion of the veins of the lower extremities;

5. To carry out prophylaxis of flat feet;

6. Create a positive emotional attitude. Table 2 proposes a scheme of occupational gymnastics in the 2nd trimester

An approximate set of physical exercises of therapeutic gymnastics on the first day of classes in the second trimester of pregnancy:

1 exercise I.P: I.P: standing, hands along the body. For 1-2 minutes, walk around the room on toes, on heels.

2 exercise I.P: the main stand. Spreading your arms to the sides - inhale, turn left, right, return to I.P. - exhale. Repeat 4-6 times.

3 exercise I.P: kneeling, arms to shoulders. Crouch (pelvis between the heels), lower your hands to the waist - exhale, return to I.P. Repeat 4-6 times.

4 exercise I.P: standing, hands on the belt, legs shoulder-width apart. Lean forward, then to the sides. The breath is arbitrary. Repeat 4-6 times.

5 exercise I.P: sitting on the floor, hands behind his back. Alternately bend and unbend legs by sliding the sole on the floor. The breath is arbitrary. Repeat 4-6 times.

6 exercise I.P: sitting on the floor, hands behind his back, legs bent at the knees. Perform exercise "bike" (exhale).

7 exercise I.P: sitting on the floor, legs spread apart shoulder width apart, arms spread apart. Touch with your left hands, then the right foot - exhale, return to I.P. - a breath. Repeat 4-6 times.

8 exercise I.P: lying on its side, one arm under the head, the other - extended along the body. At the same time, raise the “upper” arm and leg — inhale, return to I.P. - exhale. Repeat 4-6 times.

9 exercise I.P: standing on all fours. Take your leg up, back - inhale, return to I.P. - exhale. Repeat 4-6 times.

10 exercise I.P: lying on the back, hands lie along the body, legs are extended. Bend your knees, spread them apart - inhale, return to I.P. - exhale. Repeat 4-6 times.

11 exercise I.P: the main stand. Raise your hand to shoulder level - inhale, return to I.P. - exhale.

12 exercise I.P: lying on your back, arms bent at the elbows, legs straightened. Bend the leg at the knee - exhale, do the same with the other leg. Repeat 4-6 times.

13 exercise I.P .: sitting with an emphasis on hands behind his back. At the same time bend your knees - exhale, return to I.P. - a breath. Repeat 4-6 times.

14 exercise Walk around the room.

The complex of physical exercises of therapeutic gymnastics in the III trimester of pregnancy is composed so that:

1. Improve blood circulation in organs and systems, reduce congestion;

2. Stimulate the function of the gastrointestinal tract, intestinal motility;

3. Expand the bony pelvic ring as much as possible.

4. To instill skills in muscle tension without holding your breath.

Table 3 shows the scheme of exercises during pregnancy in the 3rd trimester.

An approximate set of physical exercises for physiotherapy exercises on the first day of classes in the third trimester:

1 exercise Walk around the room.

2 exercise I.P: the main stand. Turn right, spread your arms to the sides - inhale, return to I.P. - exhale. Repeat 6-8 times.

3 exercise I.P: standing, legs together, hands on the belt. Take your foot to the side - inhale, return to I.P. - exhale. Repeat 6-8 times.

4 exercise I.P: standing, feet shoulder-width apart. Make a half squat - exhale, get up - inhale. Repeat 4-6 times.

5 exercise I.P: standing, arms along the body. To rise on socks, to spread hands apart - inhale, to return to I.P. - exhale. Repeat 4-6 times.

6 exercise I.P: lying on his back. Imitate walking.

7 exercise I.P: lying on your back, legs bent at the knees. Dilute knees to the sides - inhale, return to I.P. - exhale. Repeat 4-6 times.

8 exercise I.P: lying on his back, hands on his stomach. Breathe with a diaphragm: on inhalation, the stomach rises, on exhalation, it falls.

9 exercise Sitting on a chair, one arm is laid aside. Bring the leg to the lateral surface of the abdomen, helping with the other hand - exhale, return to I.P. - a breath. Repeat 4-6 times.

10 exercise I.P .: sitting on a chair, arms and legs stretched forward. Clutch your fingers into a fist, pull the feet towards you. The breath is arbitrary. Repeat 6-8 times.

11 exercise I.P: sitting on a chair. Bring a foot to the stomach, helping with both hands - inhale, return to I.P. - exhale. Repeat 6-8 times. 12. Walk around the room.

2 day classes. Gymnastics on fitballs.

Classes with pregnant women on special gymnastic balls - fitballs have long and successfully been held abroad - in Italy, Germany, Switzerland, Japan, the USA and have become an important part of the constant exercises of prenatal physical and psychological preparation.

Fitball can withstand weight up to 300 kg, has great strength, perfectly trains the muscles of the abdominal and pelvic floor, develops coordination of movements, balancing. In addition, the lumbar spine, strained during pregnancy, is unloaded, the angle of inclination of the pelvis decreases, and posture improves.

Exercises in I.P. lying on the floor, legs on the fitball, improve venous outflow from the lower extremities, improve blood circulation in the pelvic area. Undoubtedly, there is also a great emotional effect of exercises with the use of fitball on the pregnant woman's body.

All this served as the basis for the development of a set of physical exercises for pregnant women on fitballs.

Some preliminary recommendations:

1. It is necessary to choose a fitball of such a size that, when landing on it, the hips are 8-10 cm above the knees.

2. Avoid contact with sharp objects so as not to damage the fitball.

3. Do not inflate the fitball larger than the set diameter.

4. Keep it away from heat sources, direct sunlight, radiator, lamp.

5. Wipe the fitball with a neutral detergent and a soft cloth.

2 day classes, gymnastics on fitballs in the 1st trimester of pregnancy

Exercise 1.

It is aimed at increasing the mobility of the cervical spine; relaxation of the neck muscles.

I.P: sitting on a fitball, forearms and shoulders are relaxed, hands on hips; legs bent and divorced, pelvis slightly tilted back. Tilting the head to the right and left with slow, continuous movements without holding your breath. Exercise to perform 8-10 times. If the cervical region is excessively tense, it is necessary to repeat the exercise several times a day.

Exercise 2.

I.P. sitting on the fitball; forearms and shoulders relaxed; hands are on hips; the legs are bent and divorced, the pelvis is slightly tilted back (position as in exercise 1). Turning the head left and right with slow, continuous movements without holding your breath. The exercise is aimed at increasing the mobility of the cervical spine, relaxing the muscles of the neck.

Exercise to perform 8-10 times. If necessary, with excessive tension of the cervical spine, repeat the exercise several times a day.

Exercise 3.

I.P: sitting on a fitball; forearms and shoulders relaxed, hands on hips;

legs bent and divorced, feet on the floor; the pelvis is slightly tilted back (position as in exercise 1). Flexion and extension of the head back and forth with slow, continuous movements without holding your breath. Training of the cervical spine, relaxation of the neck muscles.

Exercise to perform 8-10 times. If necessary, with excessive tension of the cervical spine, repeat the exercise several times a day.

Exercise 4.

I.P: sitting on a fitball; forearms and shoulders relaxed, hands on hips;

the legs are bent and divorced, the pelvis is slightly tilted back (position as in exercise 1). Circular rotation in the shoulder joints back and forth without holding your breath. Increased mobility in the shoulder joints.

Exercise to perform 8-10 times. If necessary, then with excessive tension of the muscles of the shoulder girdle, you can repeat the exercise several times a day.

Exercise 5.

I.P: sitting on a fitball; forearms and shoulders relaxed, hands on hips; the legs are bent and divorced, the pelvis is slightly tilted back (position as in exercise 1). Roll from the heel to the toe so that with smooth movements take the pelvis first back, then forward. Increased mobility of the lumbosacral spine, relaxation of the muscles of the lumbar.

Repeat exercise 8-10 times.

Exercise 6.

I.P: sitting on a fitball; hands to the side; legs bent and slightly divorced, feet on the floor; take the pelvis to the right, then to the left. Perform the exercise with slow, smooth movements. Increased mobility of the lumbosacral spine; muscle relaxation of the lumbar.

Repeat 10-12 times. Gradually, the exercise can be complicated: by short repetitions of movement on the fitball left - right, right-left.

Exercise 7.

I.P: sitting on a fitball; hands are relaxed and lie on top of the fitball; legs bent and divorced, feet on the floor. Take the right hand to the side, slowly raise it up and place it behind the head with the body tilted to the left, then return to I.P. The same with the other hand. Breathing in time with the movement of the hand and return to I.P. Training weakened muscles of the shoulder girdle; increased spinal mobility. Repeat 8-10 times.

Exercise 8.

I.P: lying on the floor; to spread the arms to the side below shoulder level; legs slightly divorced and bent, lower leg on top of the fitball. Raise your left leg up - inhale; stay in that position for a few seconds. Return to PI with exhalation. Improvement of venous outflow, prevention of ankle swelling.

Repeat the exercise 8-10 times with each leg. Perform the exercise slowly at first, then - with an increase in pace.

Gradually, you can perform a more complex exercise: bend and stretch the elongated leg, just touching the fitball. Then, stretching out the leg, perform circular rotations left and right.

2 day of classes, gymnastics on fitballs in the II trimester of pregnancy.

- Repeat the exercises described in the first trimester of pregnancy.

- Perform exercises for the abdominal muscles and pelvic floor. Exercises are carried out lying on the floor, legs are relaxed and lie on the fitball.

Exercise 9.

I.P: lying on your back; arms spread apart below shoulder level; legs bent, slightly divorced, lower leg on top of the fitball. Straighten your legs as you exhale and slowly raise your pelvis. Hold this position for several seconds, return to I.P., taking a slow breath. Increased mobility of the lumbosacral spine; strengthening the abdominal muscles, training the diaphragm.

Repeat exercise 6-8 times.

Exercise 10.

I.P: lying on your back; arms to the sides below shoulder level; legs extended, slightly divorced, heels on the fitball. Slowly raise the pelvis as you exhale. Hold in this position for a few seconds. Return to I.P. performing a breath. Strengthening the muscles of the thighs and buttocks, unloading the lumbar spine, exhaling training. Repeat the exercise slowly 6-8 times.

Exercise 11.

I.P: lying on your back; hands to the side, palms on the floor; legs bent and slightly divorced, feet on fitball. Rolling the fitball with legs and pelvis from I.P. left and right. Exhale while moving, inhale when returning to I.P.

Strengthening the oblique and rectus muscles of the abdomen, square muscle of the lower back and buttocks.

Repeat the exercise slowly 6-8 times, according to the rhythm of breathing.

Exercise 12.

I.P: lying on your back; arms bent at the elbows, behind the head; the legs on the fitball are bent and slightly divorced. Raise your head and shoulders as you exhale, while squeezing your feet on the fitball. Hold in this position for several seconds. Return to I.P. on a breath. Strengthening the muscles of the pelvic floor and abdominal muscles, the development of coordination of movements.

Repeat the exercise slowly 6-8 times.

Exercise 13.

I.P: Sitting on the heels, the knees are slightly divorced; arms extended forward, touch the fingers of the fitball; shoulders and forearms are relaxed. Roll the fitball forward, tilting the body forward, without tearing the buttocks off the heels. Hold in this position for several seconds without touching the stomach with the floor, and return to the PI. Exhale while moving forward. Inhale when moving back. Increased mobility of the shoulder girdle; correction of chest kyphosis and lumbar lordosis, strengthening of the extensors of the back.

Repeat the exercise slowly 8-10 times.

Exercise 14.

I.P: sitting on the heels; knees slightly divorced; arms extended forward clasp a fitball. Keeping your position while sitting on your heels, roll the fitball forward. From this position, slowly turn right and left. Exhale during a turn, inhale when returning to I.P. Increased lateral mobility of the torso, extension of the oblique muscles of the abdomen, improved coordination of movements.

Repeat exercise 6-8 times.

Exercise 15.

I.P: sitting on the floor; the back is straight, head straight; one hand lies on the floor; the other hand lies on the fitball; legs extended and divorced. Tilt towards outstretched arms. Run the other way, with the other hand. Exhale when tilted to the side. Inhale upon returning to I.P. Increased lateral mobility of the spine, training square muscles of the lower back.

Repeat exercise 6-8 times.

Exercise 16.

I.P. - on all fours; one leg is set aside and lies on the fitball at an angle of 90 ° to the other leg; the head and spine are in a straight line; With gentle movements, roll the fitball to the side with your foot so that you feel the extension of the hip adductors. Repeat movement with the other leg. Exhale when moving to the side. Inhale upon returning to I.P. Increased mobility of the hip joint with extension of the hip adductors.

Repeat the exercise slowly 6-8 times.

2 day classes, gymnastics on fitballs in the III trimester of pregnancy

- Repeat all exercises described in the first and second trimesters of pregnancy.

- Turn on self-stretching exercises.

- Include exercises for general relaxation and relaxation of the diaphragm of the pelvis.

Exercise 17.

I.P: lying on the left or right side. Bend the right or left leg, move the knee towards the fitball with the foot fixed on the fitball. Return to I.P. Inhale while bending the leg. Exhale upon returning to I.P. Increased mobility of the hip joint and strengthening of the buttocks and hips.

Repeat exercise 6 times. First on the right, then on the left side.

Exercise 18.

I.P: Pair exercise. I.P: the partner is standing; legs at shoulder level, slightly bent and divorced; hands on the shoulders of the pregnant woman; the stomach is tightened; lumbar relaxed. Pregnant in I.P. sitting, leaning back on fitball; legs bent and slightly divorced; hands behind your head. The partner helps the expectant mother to make movements back and forth, lowering the pelvis to the floor and increasing bending of the legs. Spinal massage; increased mobility of the hip joints and lumbosacral spine; stretching of the pectoral muscles; maintaining muscle tone of the thighs, buttocks and adductors of the thigh; relaxation of the diaphragm of the pelvis.

Repeat exercise 8 times.

Exercise 19.

I.P: squat; legs bent and divorced; the back rests on a fitball; hands are lowered. On inspiration, the movement of the pelvis forward and up. Hold this pose for several seconds by reducing the buttocks. On the exhale, lower the pelvis and slowly return to I.P. Spinal massage; increased mobility of the hip joints; stretching of the pectoral muscles; strengthening the muscles of the abdomen, back, buttocks; relaxation of the diaphragm of the pelvis.

Repeat the exercise slowly 6-8 times.

Exercise 20.

I.P: standing; legs slightly bent and divorced; arms extended forward on a fitball; push the fitball forward, bending the knees. Arms outstretched and lie on the fitball. Return to I.P. Exhale when moving forward. Inhale upon returning to I.P. Increased mobility of the shoulder girdle and hip joints; unloading of the lumbar spine.

Repeat the exercise slowly 6 times.

Exercise 21.

I.P: standing; press the fitball back against the wall with a little pressure; legs slightly bent and divorced; bend the knees slowly and keep them at the level of the feet, without lowering the pelvis below the knees. Hold this pose for a few seconds. Return to I.P. with the help of legs, unbending them and pressing the fitball with the spine to the back. Exhale while bending the legs. Inhale upon returning to I.P. Spinal massage; relaxation of the diaphragm of the pelvis; increased mobility of the hip joints.

Repeat the exercise slowly 8 times.

Exercise 22.

I.P: sitting on a fitball; arms and shoulders relaxed, hands on hips; legs are divorced and bent; the pelvis is slightly laid back. Slowly lean forward, starting from the upper parts of the spine and ending with the middle and lower. Return to I.P., lifting the lower sections of the spine first, then the middle and upper sections. The last to be raised is the head. Exhale when leaning forward. Inhale upon returning to I.P. Spinal relaxation; stretching the long muscles of the back; unloading from the lumbar spine.

Repeat exercise 6 times.

Exercise 23.

I.P: sitting on a fitball; the left hand holds a loop that captures the toe of the left leg. Gently wiggle on the fitball, while one leg remains bent, and the second leg straightens. In this case, the loop is pulled and lifts the toe of the leg. Hold the extended position for 20-30 seconds, then relax. Repeat the same with the other leg. The breath is arbitrary. Stretching the muscles of the foot and calf muscles.

Exercise 24.

I.P: lying on your back; hands spread apart, palms on the floor; legs bent and divorced, feet clasp fitball. Raise the fitball by bending your legs and pulling your pelvis down until your knees are above your stomach. Hold the fitball in this position for several seconds until you feel full exhalation. Inhale when lifting the fitball with your feet. On exhalation, return to I.P. Hold this position for several seconds.

Stimulation of the period of expulsion of the fetus (this exercise teaches slow inspiration with relaxation of the lumbar).

3 day classes. For all trimesters of pregnancy.

Rehearsal of childbirth.

Repeat psychological preparation for childbirth by conducting group exercises to teach relaxation techniques during pregnancy to relax. Information on the course of pregnancy and childbirth in women and the effect of these factors on the body are repeated. They say to women that it is possible to reduce the pain of childbirth, if you prepare for them correctly. They tell in detail about the birth process so that the pregnant woman can imagine how this happens and mentally lose it and remember her actions during the birth process until it becomes organic.

Thought is the readiness of the whole body for future action. When a person is just getting ready to do something, a certain muscle group is contracting, an appropriate amount of hormones, nutrients necessary for a given action is secreted. It is known that positive emotions and thoughts have a beneficial effect, causing corresponding changes in the body. At the same time, the woman is not only well informed about what awaits her, but is also able to apply new ways to control physiology in order to actively help the process of childbirth. A woman should be convinced that the birth process is inevitable, that she is ready to suffer the physical and psychological inconveniences associated with pregnancy. After completing the training, a woman will be able to further reproduce the acquired skills in order to independently adjust her behavior in childbirth.

Half an hour of skillful relaxation will provide the woman’s body with much more rest than sleeping for an hour. At the same time, the tension that accumulates in the body unknowingly completely decreases. You need to learn to relax from the first weeks of pregnancy. During relaxation, blood and lymph circulation in relaxed muscles and surrounding tissues improves, metabolic products are better evacuated,

During childbirth, the ability to relax skeletal muscles in the pauses between contractions and attempts is of particular importance, because slows down the development of fatigue and contributes to a more perfect contractile activity of the rested muscles, uterus as a muscular organ. If a woman in labor will be able to skillfully relax between contractions, then in the second period of childbirth she will find that the process of childbirth is almost painless.

They give women an idea of how she should breathe during pregnancy and at different times of childbirth. Mastering the skills of proper breathing and daily training will help ensure that at the right time they can automatically switch to the right type of breathing. They conduct training in various breathing methods: chest, diaphragmatic, mixed.

“Rehearsal of childbirth” includes the following steps.

Stage 1. Training in different ways of breathing.

First technique: take deep breaths from the beginning to the end of each bout.

The second method: simultaneously with a deep breath and exhale, stroke the lower abdomen with the hands of both hands. Movement should be directed outward and upward.

Third method: with the thumbs of both hands, press the skin to the inner surface of the iliac crest in the area of both anteroposterior spines.

Fourth technique: stroking the skin in the sacro-lumbar region; breathe deeply.

2 stage. Training in tension and relaxation of individual muscle groups.

1 exercise Squat with arms resting on the bed. Run 6 times.

2 exercise Raising the shoulders, followed by relaxation. Run 6-8 times.

3 exercise Alternately raising the legs with the support of the hand on the bed. Run with each foot 6 times.

4 exercise Shaking hands with hands to relax the muscles of the shoulder girdle. Run 6-8 times.

3 stage. The development of motor skills in such positions of the body that will have to be taken in childbirth.

1 exercise Alternate flexion and extension of the legs in the knee joints. Run each leg 4 times.

2 exercise Breeding and mixing of legs bent at the knee joints. Run 6 times.

3 exercise Alternately pulling the bent leg to the stomach. Run each leg 4 times.

4th stage. Performing exercises that a pregnant woman will perform in the period between attempts:

1 exercise Deep breathing with arms spread to the sides or lifting them up. Run 4 times.

2 exercise Squeezing and unclenching the fingers of the brush. Run 8-10 times.

3 exercise Flexion and extension of the legs in the ankle joints. Run 8-10 times.

4 exercise Alternating bending of the legs in the knee joints with their subsequent extension. Run 4 times with each foot.

5 exercise Relaxation of the muscles of the abdominal wall, shoulder girdle, legs.

4th day of classes.

Learning the exercises that a woman will perform after giving birth. Carried out in all trimesters of pregnancy.

Serious changes occur in the body after childbirth. All ligaments of the internal genital organs are stretched, the abdominal press, pelvic floor and vagina are excessively mobile. The muscle tone of the anterior abdominal wall is reduced, the abdomen sags, the internal organs are still not in place. Slow movement of blood through the vessels. Blood runs slowly through the vessels, causing blood clots to form in large vessels; the intestine makes lazy, sluggish movements, which leads to constipation, the bladder does not want to contract, which leads to a delay in urination. It is necessary to restore the normal functioning of the body.

1. Breathing exercises, static and dynamic, will help restore normal full breathing with the full participation of the diaphragm, which did not have such an opportunity during pregnancy. Diaphragmatic breathing, in turn, will eliminate stagnation in the abdominal cavity, accelerate venous circulation, increase the flow of venous blood to the heart and contribute to strengthening the abdominal wall.

2. Exercises for the abdominal press and pelvic floor will help more quickly restore the stretched muscles, fiber, skin of the abdominal wall and perineum, and thanks to this, the organs of the abdominal cavity and pelvis will snap into place faster.

3. Exercises involving the transverse and internal oblique muscles of the abdomen will contribute to a more rapid reduction in the muscles of the uterus, which means a stop in postpartum hemorrhage, and restoration of the tone of the ligaments and muscles.

4. Exercise will make both the intestines and the bladder work as expected; and even lactation in puerperas will increase - due to the fact that the muscle elements of the mammary glands will contract together with all the muscles reflexively.

An approximate set of exercises in the postpartum period.

1 exercise I.P. - lying on the back, the right hand on the stomach, the left - on the chest. Calm inhalation through the nose, exhale through the lips through the lips; exhalation gradually lengthens. Run 3-4 times.

2 exercise I.P. - also. Bend your arms at the elbow, rest against the bed. Lift the chest - inhale, return to I.P., relax all muscles - exhale. Run 3-4 times.

3 exercise I.P. - lying on your back, arms along the torso. Raise your head, touch your chest with your chin, unbend your feet, pull yourself toward you, and reach your left foot with your right hand. Return to I.P. Repeat the exercise, with your left hand reach for the right foot. Returning to I.P., relax all muscles, do not hold your breath. Run 2-3 times with each hand.

4 exercise I.P. - lying on the right or left side. Bend the left or right leg in the knee and hip joints and press it to the stomach using the arm of the corresponding side - exhale. Return to I.P. - a breath. Run 3-4 times.

5 exercise I.P. - lying on your back, arms along the torso. In turn, bend the right, then the left leg in the knee and hip joint, sliding your feet on the bed. Run 3-4 times.

6 exercise I.P. - lying on your back. To spread your arms to the sides and up - inhale, lower down - exhale. Run 6-8 times.

A pregnant woman takes 4 cycles of 4 days at the sanatorium stage.

Pregnant women take walks around the resort and along the lake in the morning and evening. The duration of walks is 60-90 minutes.

Fresh air of the forest pine massif, beautiful landscape, lake, create a feeling of peace, relieve tension and anxiety.

In the study - the first group included 69 pregnant women who received a comprehensive rehabilitation program in a sanatorium, the control group included 67 pregnant women without such treatment.

The following criteria were used as objective criteria in assessing the effectiveness of rehabilitation treatment at the end of the sanatorium course:

1. Immediate results. Questioning among expectant mothers after treatment.

2. Long-term results:

2.1 According to the outcome of childbirth.

2.2 Upon the birth of a child with a rating of Apgar.

2.3 According to the incidence of children after birth.

2.4. Attached to the breast of children in the first days after birth.

2.5. In cases of perinatal death.

The results of the study are shown in table 4.

Table 4
Research results Indicators Study group N-200 (204 children, 4 twins) Control group N-136 Immediate Results 1. Questioning: 200 136 BUT). significant improvement 166 80 93 24% B) improvement thirty fifteen 33 7% Remote results 1. according to the outcome of childbirth: - on time 190 95.3% 126 92.4% - premature birth 10 4.7% 10 7.6% 2. assessment of the child at birth with a score of points and above 200 95.6% 115 87.2% 3. applied to the breasts of newborns in the first 30 minutes 184 88% 96 71% 4. incidence of postpartum morbidity 22 10.5% 41 thirty% 5. Perinatal mortality 0 0 8 per 1000 births

From table 4 it is seen that the health status of pregnant women according to their assessment has improved, a decrease in the number of preterm births is noted by 3%, which significantly reduces the number of hospital days in the hospital, as well as the financial costs of the institution for nursing premature babies. The health status of newborns in the study group is much better than in the control. Attached to the chest in the delivery room is 4.4% more than in the control group. Newborns fell ill by 20% less than in the control group.

Example 1

Patient Z. 39 years old. Re-pregnant, multiparous woman was admitted to the sanatorium after treatment in the maternity ward. Diagnosis at admission: pregnancy 28 weeks-III trimester. The threat of miscarriage in re-pregnant at 39 years. A burdened obstetric and gynecological history (OASA).

From the anamnesis: the first delivery was urgent, complicated by the weakness of labor 17 years ago. Abortions - 4, in the early stages without complications. Registered in the antenatal clinic from 6 weeks of pregnancy. Pregnancy proceeds against the background of the threat of termination of pregnancy. Upon receipt of a complaint of periodic, pulling pains in the lower abdomen, weakness, fatigue.

Appointed: exercise therapy, psychotherapy from the second day of stay. After the treatment, already on 3-4 days the woman completely disappeared pain in the lower abdomen, the general condition improved.

Childbirth occurred on time, without complications. At birth I used breathing exercises, relaxation techniques. A full-term boy was born 8/9 points in Apgar, weighing 4200 g, was applied to the chest in the maternity room, was discharged home with a diagnosis of “Healthy”. After childbirth, I applied the proposed method of therapeutic exercises, which helped to improve the contraction of the uterus muscle, and reduce the length of stay in a hospital bed. Breastfeeding continues. Mother feels well. Discharged on the 4th day after birth.

Example 2

Patient M., 28 years old. Re-pregnant, multiparous woman was admitted to the sanatorium after treatment in the maternity ward. Diagnosis at admission: pregnancy 27-28 weeks. III trimester. Gestational anemia. OASA.

From the anamnesis: the first delivery is urgent, without complications. Abortion - one, in the period of 6 weeks, without complications. Registered in the antenatal clinic from 9-10 weeks of pregnancy. Pregnancy proceeds against the background of the threat of termination of pregnancy, anemia. Stress during pregnancy: a husband died in a mine. Upon receipt of a complaint of periodic, pulling pains in the lower abdomen, weakness, fatigue.

Prescribed: exercise therapy, psychotherapy, anemia and stress therapy. After the treatment, already in 4-5 days the woman completely disappeared pain in the lower abdomen, the general condition improved. Significantly decreased the level of anxiety.

Childbirth occurred on time, without complications. At birth I used breathing exercises, relaxation techniques. A full-term boy was born 8/9 points in Apgar, weighing 3,750 g, was applied to the chest in the delivery room, was discharged home with a diagnosis of "Healthy." After childbirth, I applied the proposed method of therapeutic exercises, which helped to improve the contraction of the uterus muscle, and reduce the length of stay in a hospital bed. Breastfeeding continues.

Discharged on the 5th day after birth.

Example 3

Patient F., 27 years old. Re-pregnant, multiparous woman was admitted to the sanatorium after treatment in the maternity ward. Diagnosis at admission: Pregnancy 23 weeks. II trimester. Gestational anemia. OASA.

From the anamnesis: the first delivery is urgent, without complications. Abortion alone in the period of 6 weeks., Without complications. Registered in the antenatal clinic from 11-12 weeks of pregnancy. Pregnancy proceeds against the background of the threat of termination of pregnancy. Upon receipt of a complaint about an increased tone of the uterus, pain in the lower abdomen, weakness, fatigue.

Appointed: exercise therapy, psychotherapy. After the treatment, already in 2-3 days the woman completely disappeared pain in the lower abdomen, the general condition improved.

Childbirth occurred on time, in childbirth she used breathing exercises. Childbirth without complications by a full-term girl of 8/9 points according to Apgar, weighing 3,500 g, was applied to the breast in the delivery room, the child was discharged home with a diagnosis of "Healthy."

After childbirth, I applied the proposed method of therapeutic exercises, which helped to improve the contraction of the uterus muscle, and reduce the length of stay in a hospital bed. Breastfeeding continues.

Example 4

Patient G., 23 years old. The first pregnant woman was admitted to the sanatorium after treatment in the maternity ward. Diagnosis at admission: pregnancy 18 weeks., II trimester. OASA. Infertility 1. Lumbosacral osteochondrosis.

From the anamnesis: childbirth - no; abortion - no. Primary infertility was treated on an outpatient basis. Registered in the antenatal clinic from 11-12 weeks of pregnancy. Pregnancy proceeds against the background of anemia, the threat of abortion. Complaints of pain in the lumbosacral spine, lower abdomen. Appointed: exercise therapy, psychotherapy. I attended classes regularly. After the treatment and recovery according to the proposed method, the woman’s lower abdominal pain completely disappeared for 3-4 days, the general condition improved.

Childbirth occurred on time, without complications. In childbirth I used a relaxation technique. Breathing exercises. A full-term girl was born 8/9 points in Apgar, a girl of 3950 g, was applied to the breast in the maternity room, was discharged home with a diagnosis of “Healthy”. Breastfeeding continues. She continued physical therapy at home, which helped to improve uterine muscle contraction and reduce the length of stay in a hospital bed. The psychological state before childbirth was calm, because she knew what awaited her and was ready for childbirth. Discharged on the 5th day after birth.

Example 5

Patient R. 23 years. Re-pregnant, primiparous woman entered the sanatorium after treatment in the maternity ward. Diagnosis at admission: pregnancy 14 weeks. I trimester. OASA. Infertility 2. From the anamnesis: childbirth - no; abortion - 1 in 7 weeks of pregnancy. Primary infertility was treated on an outpatient basis. Registered in the antenatal clinic from 11-12 weeks of pregnancy. Pregnancy proceeds against the background of the threat of termination of pregnancy. Complaints of periodic pain in the lower abdomen.

Appointed: exercise therapy, psychotherapy.

After the treatment, already in 3-4 days the woman completely disappeared pain in the lower abdomen, the general condition improved.

Childbirth occurred at term, the full-term girl 8/9 points for Apgar, weight 3950 g, used the proposed methods of breathing and relaxation during childbirth. The girl was attached to her breast in the delivery room, was discharged home with a diagnosis of “Healthy”. Breastfeeding continues. The condition of the pregnant woman before childbirth was calm, as she well understood what awaited her during childbirth. I tried to do therapeutic exercises at home, which helped to improve uterine muscle contraction.

The positive impact of exercises on the functional state of the cardiovascular, respiratory, muscle systems, the ability to increase the body's resistance and create a favorable emotional mood, allow them to be used in pregnant women as a powerful therapeutic and prophylactic agent. In addition to the beneficial effect on the condition of a pregnant woman, the regular use of a therapeutic gymnastics complex affects the development of the fetus. The proposed complex allows you to successfully prepare pregnant women for childbirth without complications in the postpartum period, reduces the level of maternal and perinatal morbidity and mortality.

All types of preparation are combined into a single complex, which includes all aspects of prenatal preparation and is therefore more effective than previously known methods.

The method allows to achieve the stability of the skills developed in the preparation process, which the pregnant woman can apply in the stressful conditions of labor due to psychotherapeutic methods of exposure, when the need to acquire and play these skills becomes conscious.

Claims (1)

A method of preparing for delivery and the postpartum period of pregnant women at risk at the sanatorium stage, including conducting respiratory gymnastics and medical gymnastics, in accordance with the trimester of pregnancy, characterized in that they conduct psychological preparation for childbirth by preliminary individual interviews with testing pregnant women to identify their anxiety , inform about the course of pregnancy and childbirth in women and the influence of these factors on the body, to form motivation for the respirator oh gymnastics, medical gymnastics, preparation for childbirth, and gymnastics after birth; classes are carried out in 4 cycles of 4 days: on the first day they perform medical gymnastics, on the second day medical gymnastics on fitballs, on the third day they repeat psychological preparation for childbirth by conducting group exercises to teach relaxation techniques, they teach respiratory gymnastics at different periods of childbirth and anesthesia methods in the process of childbirth, perform exercises "rehearsal of childbirth", including: training in tension and relaxation of certain muscle groups associated with labor, training in motor skills in position body during childbirth, training in exercises performed between attempts; on the fourth day they perform gymnastics, which the woman will do after childbirth, daily walks in the morning and in the evening for 60-90 minutes.

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