RU2506964C2 - Method for obstetric aid - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to obstetrics, and may be used in obstetric practice during an act of delivery for elimination of apprehension, pain management and control of parturient's behaviour. The obstetric aid accompanies the period of the act of delivery. A parturient is visually and verbally contacted by establishing the stable positive psychological interrelation during the contractions. Suggestion techniques are used for the psychotherapeutic effect on the parturient with creating cognitive attitudes to concentrate the parturient's attention on a baby and to form an active delivery position, to form a sense of confidence in the favourable delivery outcome. Then, the parturient is brought into the altered state of consciousness by intrusion of the intensive cohesive breathing; for this purpose each following contraction in the parturient is accompanied by operator's suggestions to breath together by a calm, mild yet directive voice, and the operators starts breathing together with the parturient by a maximum deep breathing and a calm breathing out without breath holding. Between the contractions, the operators intensifies the suggestive directive effect on the formation of the parturient's internal active position by creating the cognitive attitudes at the nonconscious level. A consequence of the psychotherapeutic effect is repeated until the parturient starts breathing adequately and behaving stably that are controlled by the operator and maintained by the respective actions until the act of delivery completed.

EFFECT: method enables eliminating the apprehension, reducing pain senses, as well as provides a complete conscious behaviour control by the parturient.

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Description

The invention relates to medicine, namely to obstetrics, and relates to a method of psychotherapeutic intervention using somatic techniques and can be used in obstetric practice during the birth act to eliminate feelings of fear, anesthetize labor and control the behavior of the woman in labor.

Childbirth, as a rule, is accompanied by pain sensations of varying severity. Under the influence of labor pain, the function of the cardiovascular system changes significantly: tachycardia occurs, cardiac output increases, arterial and central venous pressure rises. Perhaps the development of heart rhythm disturbances, a decrease in coronary blood flow, a change in pressure in the cavities of the heart, an increase in total peripheral resistance. As a result of the lack of controlled breathing, tachypnea develops, the tidal volume decreases, while the minute volume of breathing increases significantly, which can lead to severe hypocapnia and disorders of the uteroplacental circulation, and lead to fetal hypoxia. The pain can disrupt the function of the gastrointestinal tract, bladder, cause reflex spasm of the muscles of the pelvic floor, nausea and vomiting.

Pain in childbirth leads to psychoemotional stress, fatigue of the woman in childbirth, impaired contractile activity of the uterus and intrauterine suffering of the fetus, in particular in the form of hypoxia of the fetus and newborn, which ultimately increases the injuries of the mother and newborn and increases the frequency of cesarean section.

At the same time, the following requirements are imposed on methods for pain relief of labor: removal of negative emotions, fear; good analgesic effect; lack of inhibitory effect on labor; complete safety of anesthesia method for mother and fetus; maintaining the consciousness of the woman in childbirth, her ability to actively participate in the birth certificate; the absence of negative adverse reactions for the mother and fetus, a harmful effect on lactation and the course of the postpartum period; simplicity and accessibility for obstetric institutions of any type.

A patent search revealed the following. Known methods of psycho-prophylactic preparation of pregnant women for childbirth with the goal of pain relief of childbirth (application No. 96111343/14, 06/18/1996; application No. 98121424/14, 02/02/1998; application No. 2006116952/14, 05/17/2006), in accordance with which the preparation of pregnant women women for childbirth by conducting sessions of psychotherapy and simultaneous massage; by teaching pregnant women diaphragmatic breathing using biological feedback; by conducting sessions of psychophysical relaxation using viewing a pregnant video sequence containing verbal information consisting on the 25th frame. The disadvantages of these methods is that they use very time-consuming for the patient and therapist and long-term methods of psychological examination and psychological exposure, conducted courses, and also require the use of special equipment. Moreover, the effectiveness of these methods is not stable, and, most importantly, they are intended only for preparing pregnant women for childbirth and it is impossible to use these methods directly in the process of delivery.

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, and also natural factors are used in a certain sequence ( 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 it is necessary x conditional rfleksov.

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 to consciously manage their autonomic functions and affect their 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 are completely ineffective, 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 use in childbirth of any non-drug methods of pain relief. 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.Lane from English .-- M .: Logosphere, 2010 .-- 440 p.)

Medicinal painkillers used in childbirth include sedatives, analgesics, antispasmodics, tranquilizers, benzodiazepam derivatives, drugs. The method of their administration is injection, which carries the risk of infection of the body, this reduces the safety of the method and can have a negative effect on the organisms of both the mother and the fetus. The effectiveness of drugs is often insufficient or even absent. These drugs can cause disorders of the uterine contractility, have a negative effect on the woman in labor (drowsiness, loss of self-control) and on the fetus, especially narcotic analgesics, and acidosis and inhibition of activity can occur cardiovascular system and breathing in the fetus and newborn until the development of drug depression of the child. In particular, the use of epidural anesthesia does not allow a woman to take an active part in the laborious period of labor, since the desire to push is practically eliminated. In addition, fetal suffering and serious neurological complications can often occur. Medication painkillers may have contraindications (severe hypertension, increased tone of the bronchioles, etc.) and restrictions on the appointment (the pronounced inhibitory effect of promedol on the fetal center of respiration prevents its administration less than 2-3 hours before the birth of the baby), can cause complications in the mother (dysfunctions of the cardiovascular system, respiratory system, gastrointestinal tract, histamine-like reactions, allergic reactions).

Closest to the proposed is the method of obstetric care (RF patent No. 2075979, A61B 21/00, 03/27/1997), in accordance with which, at the beginning of the session, a massage is carried out simultaneously with the psychotherapeutic effect, the zones of the most pronounced muscle rigidity are identified and their relaxation is achieved . Then they search for psychologically disturbing episodes and initiate their consistent living in the imagination, repeat the living of each alarming episode until the emotional tension in it is removed. After that, using the methods of dianetics, they cause an imaginary return of the patient during her own birth. With the help of verbal reinforcement, they create a figurative sensation of fetal movement and correct the tension of individual muscle groups, change their position and find the optimal position for convenient passage of the fetus. The mental residence of childbirth is repeated until the development of the necessary bodily sensations and the creation of a sensual image of successful childbirth.

The disadvantage of this method, as well as the previous ones, is that it is used only for preparing a pregnant woman for childbirth, which does not allow using it directly for conducting childbirth.

Thus, the known methods of obstetric aid in the implementation do not allow to achieve a technical result, consisting in the possibility of using them directly during the delivery of the birth certificate to relieve feelings of fear, reduce pain and, as a result, the possibility of providing complete conscious control of the woman in labor over her behavior, which consists the ability to fully control it during childbirth, control breathing, and focus on the baby.

The proposed method of obstetric aid solves the problem of creating an appropriate method, the implementation of which allows to achieve a technical result, which consists in the possibility of using the method directly during the delivery period to relieve fear, reduce pain without negatively affecting the mother and fetus, and, as a result, the possibility of ensuring complete conscious control of the woman in labor over her behavior, which consists in the ability to fully control him in the process of childbirth c, control breathing, focus on the child.

The essence of the claimed invention lies in the fact that in the method of obstetrics, including the use of psychotechnics aimed at eliminating fear, reducing pain and developing the ability to consciously and actively control one’s behavior, it is new that obstetrics is performed directly during the period of delivery, while at the beginning of labor pain a lasting positive psychological relationship is established with the woman in labor through visual and verbal contact, after which, by questioning the woman in labor, assess the anamnestic and clinical data, while assessing the presence and nature of clinically manifest emotional disorders and the level of pain according to the method of the visual-analogue scale, then, using suggestions, they perform a psychotherapeutic effect on the woman in labor with the creation of cognitive attitudes to concentrate the attention of the woman in labor and the formation her active position in childbirth, on the formation of a sense of confidence in a favorable outcome of childbirth with the simultaneous creation of an attitude towards the woman giving birth to controlled hyperventilation of the lungs, as well as to exercising the ability to completely control and manage her behavior until the end of the birth act, the psychotherapeutic effect on the woman in labor is carried out until the woman is able to enter the active and confident image of a successful woman in labor, and the appearance of stability of her rational breathing and behavior, which are strictly controlled by the operator until the end of the birth certificate.

The technical result is achieved as follows. In the last decade, natural “liquidators of pain” —endorphins and enkephalins that produce chromaffinocytes of the brain, adrenal glands, and intestines — have been especially important in the genesis, strength, and stability of pain.

The experience of modern theoretical, experimental and clinical obstetrics confirms the main role of the central nervous system in preparing a woman’s body for childbirth and during the childbirth process (Abramchenko VV Active management of childbirth: A guide for doctors. - SP: SpetsLit, 2003). The full functioning of the central nervous system provides the physiological course of the birth act itself. In this case, the most important element of the mechanism for ensuring the normal course of the birth process is the formation and stable functioning of the birth dominant, a stagnant focus of excitement that regulates the full preparation for childbirth and the birth process itself. The generated focus of excitation by the law of induction inhibits others, less necessary for the body during this reaction period. Reflexes, which provide the physiological course of the birth act, come to the fore. Reactions to external stimuli (stimuli) become more economical and selective. The most active and stable response occurs to stimuli that are significant and contribute to the optimal course of the birth act. Inhibition of response to other stimuli occurs, including a decrease in the response to pain stimuli as a result of an increase in the threshold of pain sensitivity.

In the event of various stressful situations (strong emotional experiences, fear, pain, and others) in the central nervous system of the woman in labor, other foci of persistent excitement may occur along with the generic dominant. In these cases, a weakening of the action of the generic dominant can occur, which will be accompanied by a pathological course of childbirth and an increase in the perception of pain in the parturient woman. The pain itself can be accompanied by the formation of a focus of persistent arousal, inhibiting the influence of the birth dominant and, as a result, worsening the course of labor and the condition of the fetus.

To understand the mechanisms of functioning of regulatory mental processes in the central nervous system, it is necessary to turn to the concept of the unconscious, which in the broad sense includes all mental phenomena outside the realm of consciousness and, in addition to the conscious field, actively affects all systems and physiological functions of the human body, including consciousness. Influence on the sphere of the unconscious opens up serious possibilities for controlling the motivation, focus and degree of activity of a person, however, the impact on the field of the unconscious is an extremely difficult task.

Unconscious phenomena of the external environment play a very significant role in the mental life of a person in cases when they are associated with the emotional or motivational dominant of the subject, and also due to the formation of psychological attitudes that significantly determine the perception of the external environment, its assessment and decision-making.

In 1986, the English scientist N. Dixon proposed the condition necessary to influence the sphere of the unconscious: the parameters of the stimulus (effect) should be significantly lower than the threshold of awareness. At the same time, weak external stimuli, which are not recognized in a calm state and do not affect a person in any way, can change certain functions of the body against the background of emotional excitement. A lot of data has been accumulated indicating that emotionally colored unconscious words influence the subject's impression and perception of subsequent consciously perceived images.

For the maximum effect of unconscious words to manifest, it is necessary that:

1) they were emotionally significant in a given period of time for the subject;

2) the level of motivation or emotional stress of the person was quite high.

The greatest subthreshold (unconscious) effect is observed when these two variable factors coincide (EA Kostandov, Psychophysiology of consciousness and the unconscious. St. Petersburg: Peter, 2004, 167 pp.)

Another form of the unconscious is cognitive attitudes. As a result of the interaction of the subject with the environment, a certain “internal” state is formed in the higher frontal parts of the cerebral cortex of the brain, which dominates the function of perception of external objects and, as a result, the organization of an integral behavioral act. According to the psychologist D.N. Uznadze (1886-1950), the installation should be understood as the state of a person’s readiness for a certain activity, which occurs at an unconscious level in the presence of 2 basic and necessary conditions: 1) the needs that are currently acting in the given organism and 2) the objective situation of its satisfaction. In other words, in the interaction of the subject with the situation of satisfying his needs, an attitude arises. The latter is formed in humans as a result of repeated exposure to the same external stimuli in a certain situation. (Uznadze D.N. Experimental Foundations Psychology // Experimental Studies in Installation Psychology / Ed. By A.S. Prangishvili, Z.I. Khodzhava. Tbilisi: Publishing House of the Georgian Academy of Sciences, 1958. P.5-126).

An important area of psychophysiology is knowledge of the concept of altered states of consciousness. Altered states of consciousness (ASC) are qualitative changes in subjective experiences or psychological functioning from certain generalized norms for a given subject, reflected by the person himself or noted by observers (classical definition by A. Ludwig). The experience of ASC is a characteristic property of the consciousness and psyche of healthy people. Altered states can be triggered by completely different triggers and may or may not be related to pathology. ASC can be used for training, recovery, treatment, all this happens at the level of the unconscious and therefore has a huge impact on a person, his condition and functions. It is known from ancient times that a person who is in an altered state of consciousness perceives sensations from the side of his own body in a different way, including, at all, not feeling pain.

The most physiological, and most importantly, purposeful and conscious way to achieve altered states of consciousness is breathing. (Abramchenko V.V., Kovalenko N.P. Perinatal Psychology: Theory, Methodology, Experience. - Petrozavodsk: IntelTek, 2004. - 350 p.). With the help of the so-called intensive cohesive breathing, which is based on controlled hyperventilation of the lungs, an expanded state of consciousness (RCC) arises - a special state related to altered states of consciousness. RCC is characterized by the maximum mobilization of the reserve capabilities of the human psyche, when a person with the help of conscious coherent breathing and maximum relaxation receives enhanced control capabilities of the central and peripheral nervous systems, the body as a whole.

The process of coherent breathing as a way to achieve RCC has such qualities as awareness, controllability, controllability, the presence of will and the possibility of realizing one’s intentions, the possibility of returning to a normal state of consciousness at any time. RCC has a specific phenomenology and is distinguished by autization of the sensory sphere, distortion of time perception, hypermnesia, an increase in the perception threshold of some sensations, in particular pain, and some other qualitative changes in mental processes (Kozlov V.V. Sources of awareness: Theory and practice of integrative psychotechnologies. Minsk , 1995).

The effects of intensive breathing are based on hyperventilation of the lungs, which leads to an increase in oxygen content in the blood, and in general to a significant increase in the oxygen capacity of the blood of the mother and fetus, which in turn leads to optimization of metabolic and trophic processes, activation of the functions of the nervous, cardiovascular and endocrine systems. As a result, the use in the claimed method to achieve an altered state of consciousness of the woman in labor of intensive coherent breathing allows two functions to be performed: the possibility of psychosomatic effects on the woman in labor and oxygen enrichment of the blood of the mother and the fetus, which reduces the possibility of fetal hypoxia and promotes successful childbirth.

In the claimed method, the basis for assessing the pain of the woman in labor is: the subjective sensations of the woman during childbirth, which are recorded as a result of her interrogation during the birth act, and the doctor’s observation of her behavior during childbirth. The strength of labor transmitted during labor is assessed using a visual analogue scale (VAS) (Brevik H., Borchgrevink P.C., Allen S.M. et al. Assessment of pain. British Journal of Anaesthesia 2008; 101 (1): 17-24). YOUR is a piece of paper with a drawn straight line 10 cm long with marks every centimeter on which a woman notes, at the request of a doctor, the intensity of pain during childbirth. The beginning of the line corresponds to the absence of pain, and the end of the line corresponds to the feeling of intolerable pain. As a result, the doctor has an objective result of pain assessment.

From the foregoing, it follows that in the claimed method, immediately during the passage of the birth act, a psychological and somatic effect is simultaneously exerted on the woman in labor, which leads to minimization of pain. In this case, the psychosomatic effect includes the formation of: a persistent positive psychological relationship between the obstetrician-gynecologist and the woman in labor through visual and verbal contact; the formation of an active position in childbirth (generic dominant) using suggestion techniques and cognitive attitudes; concentration of the parturient woman on the child; management of breathing and childbirth behavior. Simultaneously with the creation of psychological contact between the operator and the woman in labor, the woman in labor is taught the techniques of rational breathing and behavior. The use of the psychosomatic pain relief technique for childbirth continues until the birth of the woman in the active and confident image of the successful woman in labor, the appearance of stability of her rational breathing and behavior that the operator strictly controls until the end of the birth act.

Thus, the proposed method of obstetric care allows you to optimize the mental state of the woman in childbirth, eliminate fear, minimize pain, reducing their level to insignificant, regardless of the psychotype and motivation of the woman. As a result, due to the complex psychosomatic effect on the psyche of the woman in labor and her basic life support systems, it is possible to control the behavior of the woman in labor, as well as optimize the state of the mother and child, increase the level of life and functional performance of the mother-fetus system. The proposed method is an effective, relatively uncomplicated way of correcting the psychological state of a person, eliminates the need to introduce the patient into a hypnotic and trance state, the need to encode and eliminate the associated danger of negative consequences for the patient; reduces the time required to implement an effective psychological impact.

From the foregoing, it follows that the proposed method of obstetrics during implementation ensures the achievement of a technical result consisting in the possibility of using the method directly during the delivery period to relieve fear, reduce pain without negatively affecting the mother and fetus, and, as a result, the possibility ensuring full conscious control of the woman in labor over her behavior, which consists in the ability to completely control him during childbirth, to control the respiratory system focus on the child.

The claimed method of obstetrics is as follows. Obstetrics is performed directly during the passage of the birth certificate. At the beginning of labor pain, a lasting positive psychological relationship is established with the woman in labor through visual and verbal contact. Then, by questioning the woman in childbirth, anamnestic and clinical data are evaluated, while assessing the presence and nature of clinically manifest emotional disorders and the level of pain according to the method of visual-analogue scale. Then, with the help of suggestions, they carry out a psychotherapeutic effect on the woman in childbirth with the creation of cognitive attitudes to concentrate the attention of the woman in childbirth and the formation of her active position in childbirth, to form a feeling of confidence in a favorable outcome of childbirth and at the same time to create an attitude for the childbearing to manage controlled hyperventilation of the lungs, and and on the exercise of the ability to completely control their behavior and manage it until the end of the birth act.

The psychotherapeutic effect on the woman in childbirth is carried out until the childbirth is stable in entering the active and confident image of a successful woman in labor, the stability of her rational breathing and behavior, which are strictly controlled by the operator until the end of the birth act.

At the first stage of the implementation of the claimed method, the medical documentation is studied (an exchange card of the pregnant woman and the history of childbirth), and additional information is obtained from medical personnel. As a result, the somatic status of the woman in labor and the obstetric situation in childbirth are determined.

At the second stage, a stable positive relationship with the woman in labor is established through visual and verbal contact, for which the patient forms the maximum concentration of attention on the doctor, his face and his speech, suggesting to her the possibility of providing quick and effective help, which will provide a significant reduction in pain , increased oxygen supply to the fetus, accelerated cervical dilatation and accelerated labor, followed by the successful birth of a healthy baby.

Active fixing of a woman in childbirth on the doctor’s words is carried out by repeatedly repeating certain keywords and phrases, namely: "Now you are very ill, unbearably bad and you think that the situation is hopeless. If you want me to help you, listen to me carefully and follow everything that I will tell you. If you accurately and actively perform everything, it will become easier for you, the pain will decrease and go away completely. You and your child will feel better, the contractions will be active, but if you follow my advice exactly, you’ll hardly feel any pain and give birth quickly. " It is necessary to achieve the answer: "Yes, I want to"

Then, in a calm, mildly prescriptive tone, the doctor says: “Let's breathe together. Breathe like me” and begin to breathe, taking the deepest breath possible and calm without holding your breath - exhale. In this case, the ratio of the duration of inspiration and expiration refers to 3: 1, with a respiratory rate of 10-11-12 in 1 minute (the frequency is selected individually, while taking a breath that is as deep as possible takes 4.5 seconds, while exhaling - 1, 5 seconds).

Then he repeats again: “You really want me to help you? Do everything I tell you, and you will give birth quickly and well. The pain gradually goes away. You feel much better. Gradually, you will not feel any pain at all.” Then the doctor again carries out joint breathing with the woman in labor during contractions and re-pronounces the formulations of suggestion to strengthen the suggestive directive effect and form the internal active position of the woman in labor by means of speech influence on the subconscious.

In the intervals between contractions, the doctor carries out a detailed survey of the woman and a thorough assessment of anamnestic and clinical data. Then she performs an external obstetric examination of a woman, assesses the clinical course of childbirth, determines the presence and nature of clinically manifest emotional disorders, and determines the level of pain by self-assessment using the visual analogue scale (VAS).

Having achieved full contact with the woman in labor and control her behavior, after the woman in labor has followed all the instructions of the operator, she is invited to stand up and standing to continue the recommended breathing in the right rhythm.

A woman in labor should be standing in the birth hall, bending slightly to reduce the tension of the anterior abdominal wall during the contractions, bending her legs a little and be sure to focus on the arms (on the elbows) with clenched hands, for which it is necessary to firmly hold hands for some support: the edge of the birth table, horizontal headboard. This position, in contrast to the lying position, is the most physiological, provides the deepest breathing, the free arrangement of parts of the woman’s body and the optimal state of the fetal circulation. In this position, the load is removed from the muscles of the pelvis and the anterior abdominal wall and these muscles relax.

The vertical position of the woman in childbirth is maintained until the moment of attempts.

At the third stage, by continuing to apply the methodology of psychosomatic anesthesia for childbirth, the woman in labor is removed from the affective state and her attention, respiration and behavior are controlled, followed by the woman's transition to a state of complete self-control to maintain these functions.

At the fourth stage (throughout the entire period of contractions), actions are taken to monitor the state and behavior of the woman in labor and supportive actions are taken to preserve her full self-control and fulfillment of all mental and somatic functions.

At the fifth stage, informational and psychological preparation for the rest period is carried out, and then it is followed by psychological and somatic management.

At the final stage after childbirth, the mental and somatic state of the puerperance is assessed by means of a survey, visual observation, and standard objective examination.

Negative consequences or complications during or after the use of psychosomatic pain relief for labor were not observed. Clinical example N 1. The patient G.D.M., 23 years old. This is the first pregnancy, the first birth is coming.

From the anamnesis: in childhood, she had chickenpox, had an allergic reaction to iodine and potassium permanganate. Menses from 14 years, after 25 days to 5 days, were established immediately, regular, moderate, painless. Sexual life since 18 years. Married. Husband - 23 years old, healthy.

There are no occupational hazards for the woman and her husband, both spouses do not smoke, alcohol abuse is absent. This is the first pregnancy, occurred 3 months after marriage.

The last menstruation of January 25-30, 2011, without features. Registered in the urban antenatal clinic from 8 weeks of pregnancy. Height 165 cm., Weight - 62.8 kg at the first appearance at 11 weeks of pregnancy. HELL within 120/70 - 110/70. Blood Rh (-) without antibody titer. The dimensions of the pelvis are normal. In the period of 37-38 weeks of pregnancy, edema of pregnant women was identified. The total weight gain during pregnancy is 10 kg. In a general blood test, hemoglobin is 125 g / l (normal) from 09/06/2011.

Received in the maternity ward of the maternity hospital No. 10 of the City Perinatal Center of Yekaterinburg on 10/29/2011 at 2 hours 10 minutes, indicating contractions from 23 hours on 10/28/2011

Upon admission to the hospital at 2 hours 10 minutes 10/29/2011: General condition is satisfactory. There are no complaints. The skin and visible mucous membranes are clean, normal in color. Pulse 76 beats in 1 minute rhythmic, satisfactory filling and tension. HELL - 120/80 on both hands. The abdomen is soft, painless on palpation. Physiological administration is normal. The uterus is in normotone. Contractions after 5-6 minutes for 30-35 seconds of moderate strength. The position of the fetus is longitudinal, the head is presented, pressed to the entrance to the small pelvis. The fetal heartbeat is clear, rhythmic 140 beats in 1 minute.

At 2 hours and 30 minutes, a vaginal examination was performed: the cervix is smoothed, opening of the external uterine pharynx 3 cm, the edges of the pharynx are thin, extensible. The fetal bladder is intact. The fetal head is pressed to the entrance to the pelvis. Diagnosis: I period of urgent delivery. Edema of pregnant women. Rh (-) blood without antibody titer. Mixed neuro-circulatory dystonia. Varicose disease of the lower extremities. Delivery is 3 hours 30 minutes.

At 5 hours 30 minutes the general condition is satisfactory. There are no complaints. HELL 120/80 mm. Hg Contractions after 3 min. 30-35 sec. medium strength. The fetal head is pressed to the entrance to the pelvis. Fetal heart beat 144 beats per 1 min. clear, rhythmic. The water did not leave.

At 6.30 a.m. general condition is satisfactory. There are no complaints. HELL -120/80 mm. Hg Pulse 80 beats in 1 min. The uterus is in normotone. Contractions after 3 min. 30-35 sec. medium strength. The fetal head is pressed to the entrance to the pelvis. Fetal heart rate 144 beats in 1 min. clear, rhythmic. Light amniotic fluid began to leak. A vaginal examination was performed: the cervix is smoothed, the opening of the external pharynx is 5 cm. The fetal head is pressed to the entrance to the small pelvis. There is no fetal bladder. Delivery is 7 hours and 30 minutes.

At 9.30 a.m. General condition is satisfactory. HELL - 120/80 mm. Hg Contractions after 4-5 minutes. 25-30 sec. strong. Over the past hour, a woman has expressed anxiety, complains of painful contractions, rushing about, asks for a painkiller or a caesarean section. The fetal head is pressed to the entrance to the pelvis. Fetal heartbeat 136 beats in 1 min. clear, rhythmic. The waters are leaking bright.

At 10 o’clock. The patient is on the verge of collapse, behaves hysterically, screams, that is, there is a pronounced stress state. Work has begun on the methodology of psychosomatic pain relief for childbirth, in accordance with the claimed method of obstetric care. A woman in labor is invited to note the power of pain on a visual analogue scale. The mark on the scale corresponded to 10 points. Within 15 minutes, the pregnant woman gradually calmed down, began to breathe correctly, between the contractions adequately answers questions, a smile appeared on her face. The woman says that there was an unaccountable fear and an inner confidence that she really started thinking about the baby, that she really feels herself as a defender of the interests of the baby and is confident in the successful outcome of childbirth for him. At 10 hours 30 minutes, the woman in labor is again asked to make an assessment of the pain experienced on a visual-analogue scale. The mark on the scale corresponded to 3 points.

At 11 o’clock. contractions continue active after 2.5-3 minutes for 45-50 seconds. The woman in labor behaves absolutely calmly, confidently, while breathing deeply she breathes. The fetal heartbeat is clear, rhythmic 136 beats per 1 minute.

At 12 o’clock. 20 minutes. contractions acquired a restrained nature after 1.5-2 minutes. 50-55 sec. Fetal head on the pelvic floor. The fetal heartbeat is clear, rhythmic 130 beats. in 1 min., the woman is fully pushing, behaving completely adequately.

At 12 o’clock. 40 minutes a live full-term boy was born with an APGAR rating of 7/8 points (normal), weighing 3335.0 g, 53 cm long. A woman happily hugs a child, communicates with him, her condition is calm, satisfied. After 15 minutes, the placenta, whole, shells separated and stood out on their own. Blood loss 200.0 ml. The birth canal is intact.

Clinical example N 2. Patient N.S.A. 35 years. Real pregnancy 4th, 2nd birth ahead.

History: in the past suffered measles, ARI. Menses from 16 years, established immediately, regular, moderate, painless after 28 days for 5 days. Sexual life since 20 years, in a registered marriage. There were 3 pregnancies in total, the real pregnancy is 4th. The first pregnancy ended in 1997 with a miscarriage in 8–9 weeks; The second pregnancy ended in 1998 with an urgent delivery without complications; The 3rd pregnancy in 2003 ended in medical abortion. Real Pregnancy - 4th.

The first appearance at the antenatal clinic for a period of 7-8 weeks was observed regularly. Pregnancy proceeded without complications; the total increase in body weight was 11 kg.

Contractions began at 4 a.m. on September 30, 2011 and arrived at the maternity hospital on September 30, 2011 at 6 hours and 10 minutes with regular vigorous labor.

An objective examination of organs and systems revealed no pathology. Height - 173 cm, weight - 68.8 kg. HELL - 110/80 mm Hg Moderate swelling of the legs. Obstetric status is normal.

At 8 o'clock - for 40 minutes, the contractions are strong after 3-4 minutes for 40-45 seconds. The woman is extremely restless, screaming, asking to anesthetize childbirth. The introduction of baralgin 2.0 ml and the antispasmodic no-shpa 2.0 v / m does not give an effect.

8 hours 30 minutes. The puerperan stands in the delivery room near the delivery table and screams loudly at each fight, crying out for help, her face is distorted by a grimace of pain and suffering, her look is absent, meaninglessly wandering. During contractions, she frantically grabs the edge of the birth table, squeezing it with her hands, literally wriggling from pain and choking with a cry.

Psychosomatic pain relief for labor has begun. A woman in labor is invited to note the power of pain on a visual analogue scale. The mark on the scale corresponded to 10 points.

After the end of the first fight, during which the puerperan carried out all the instructions of the perinatal psychologist, the woman indicated that she felt noticeably lighter. A woman in childbirth is invited to re-note the strength of pain on a visual analogue scale. The mark on the scale corresponded to 5 points. The expression on her face became calmer and in the future she more clearly and correctly carried out all the instructions. After 10 minutes, she did not make not only screams, but even groans. Sensing a clear improvement, she already without any special commands performed all the necessary actions. The puerpera subsequently behaved completely confidently, breathed correctly, a calm smile even appeared on her face.

At 9.30 a.m. labor activity intensified: contractions became stronger after 2.5-3.0 minutes for 55-60 seconds. The fetal heartbeat is clear, rhythmic 148 beats in 1 minute. The fetal head is located in a small segment at the entrance to the pelvis. There are no discharge from the genital tract. The puerperan behaves calmly, during the fight concentrates her thoughts on the child, on the desire to help him as much as possible. After the fight, he relaxes, breathes in the usual, natural mode, in a friendly form, talks about his well-being, about the child, smiles.

At 10 o’clock. labor activity is active: contractions are strong after 1.5-2.0 minutes for 55-60 seconds. The fetal heartbeat is clear, rhythmic 154 beats per 1 minute. The fetal head is located in the pelvic cavity. There are no discharge from the genital tract. The puerperan behaves calmly, during the fight concentrates her thoughts on the child, on the desire to help him as much as possible. After the fight, he relaxes, breathes in the usual, natural mode, in a friendly form, talks about his well-being, about the child, smiles.

At 10 hours 10 minutes. attempts began. The woman is on the birth table, behaves completely calmly, appropriately perceives all the instructions and accurately fulfills them. During the fights, he actively pushes, in between the fights he rests calmly.

At 10 a.m. 20 min. a live full-term boy was born weighing 3210.0 grams, height - 51 cm. (34/34). There was an entanglement of the umbilical cord around the neck 2, not tight. The scream is loud, right away. The state of the child on the Apgar scale: 7/8 points. After birth, the baby was placed on the mother’s chest and then attached to the chest. A woman hugs a child, speaks affectionate words to him, expresses gratitude to the perinatal psychologist who carried out the methodology for psychosomatic pain relief for childbirth.

Clinical example N 3.

Patient P.I.G., 28 years old. This is the third pregnancy, the second birth is coming. She has had a medical abortion and an urgent delivery in the past. During pregnancy was observed in a commercial medical center.

08/25/2010 11:00 a.m. The birth block. The perinatal psychologist went into the birth, located next to the medical post, attracted by the heart-rending cries of the woman in labor. The woman was on the birth table, literally could not find a place for herself from the pain, screaming, trying to attract attention to herself. Next to her was a bewildered husband, who hugged her and said something inaudibly, trying to calm her and alleviate her suffering. There was no effect from attempts to help her husband. In this situation, the nursing staff could not help. The screams continued, the woman screamed angrily.

A perinatal psychologist - an obstetrician-gynecologist who owns the method of obstetric care according to the declared election, turned to a woman and work began on the method of psychosomatic pain relief for childbirth. The specialist concentrated on herself the attention of the woman in childbirth, asked the question if she would like to get rid of these painful sensations, and, having received an emotional positive answer, began to teach her the maximum concentration of attention on the child and proper breathing. After 8-9 minutes, the woman in labor began to follow the recommendations and breathe correctly. After another fight, she was asked the question: "How are you feeling now? Is it easier for you to endure contractions with such breathing?" She replied: "Yes, easier." The pregnant woman gradually calmed down, breathed deeply and actively, behaved much calmer and more obediently, and ceased to react sharply to contractions. A woman in labor was asked to note the power of pain on a visual analogue scale. The mark on the scale corresponded to 6 points. Between contractions, she adequately answered questions, her face acquired a calm expression, as the sensations of pain in the contractions significantly decreased. The husband also perked up and cheered up. Listening to the work of the fetal heart showed that the fetal heartbeat is clear, rhythmic 134 beats in 1 minute.

In the future, the woman in labor continued to comply with all recommendations on concentration, respiration and behavior. Her condition was calm, she made no complaints.

30 minutes after the start of measures by the method of psychosomatic pain relief for childbirth, the fetal head sank to the pelvic floor, contractions became more active and acquired a strenuous character. At 11 hours 45 minutes a live full-term boy was born weighing 3150.0 g, 50 cm long. With an Apgar rating of 8/9 points, the scream was loud, right away. The woman has a joyful mood, she hugs the child, who was laid on her chest, and expresses words of gratitude for the help provided. After 10 minutes, the placenta, whole, shells separated and stood out on their own. Blood loss 280.0 g. The uterus was reduced, dense. The birth canal is examined, intact.

After childbirth, it was possible to find out that the woman was regularly observed in a private medical center, where she underwent a full course (10 lessons) of psycho-preventive preparation for childbirth with the participation of a psychologist, which consisted in group listening to information, learning methods of self-pain relief in childbirth and learning practical breathing skills during contractions. Classes were held in full accordance with the currently accepted principles for conducting studies on preparing pregnant women for childbirth. During childbirth, the woman tried to use the knowledge on pain management received in the course, but received no effect.

In this case, an expectant mother was provided with urgent psychological assistance with a positive result in the absence of time and opportunities to receive additional medical history and clinical information.

The proposed method of psychosomatic anesthesia and control of the woman’s behavior in childbirth has the following advantages compared to the known ones, including the prototype:

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

- accessibility of implementation and the possibility of use without preliminary preparation of the woman in childbirth, in almost any conditions (outpatient and inpatient conditions);

- 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).

Claims (1)

A method of obstetric care, including the use of psycho-technology aimed at eliminating fear, reducing pain and developing the ability to consciously and actively control one’s behavior, characterized in that obstetrics is performed directly during the period of labor, and during this time, during pregnancy, a lasting positive psychological relationship is established with parturient woman through visual and verbal contact, while the operator forms the patient’s maximum concentration of attention on himself, on his I have a face and speech, then, using suggestion techniques, they carry out a psychotherapeutic effect on the woman in labor with the creation of cognitive attitudes aimed at concentrating the attention of the woman in labor on the child and the formation of her active position in childbirth, on the formation of a feeling of confidence in a favorable outcome of labor, after which the woman in labor is changed state of consciousness by imposing intense coherent breathing on her, for which, during the next bout at the woman in labor, the operator offers a calm, mildly prescriptive tone to the woman in labor together and begins to breathe along with it, taking the deepest breath possible and calm without holding the breath - exhale, while the duration of inhalation and exhalation are 3: 1, with a respiratory rate of 10 to 12 in 1 min, while in the interval between contractions, the operator enhances the suggestive directive effect on the formation of the internal active position of the woman in labor by creating cognitive attitudes at an unconscious level by repeated speech impact on the subconscious, pronouncing the suggestion formulas, during the next contractions mothers operator again performs together with giving birth and in the next breath interval between contractions repeatedly utters the wording suggestion, then the sequence of psychotherapeutic influence is repeated until the stability in mothers efficient breathing and behavior that the operator controls and supports appropriate action until after childbirth.