Psychoprophylaxis is part of a rebellion. It defies the age-old premise that pain is a natural part of childbirth. It is a method that all but obliterates sensations of pain from the consciousness during childbirth. Psychoprophylaxis is anintellectual, physical, and emotional preparation for painless childbirth that starts during the last months of pregnancy. It is a method in which both wife and husband participate. The woman is not left alone during labor, and her baby is not taken from her immediately after birth. It supports the social psychological bond between husband and wife, as well as the biological bond between them and the baby.
Psychoprophylaxis allows a moth- er to deliver her baby while awake and alert, with a minimum of discomfort. To do this, she must learn the mechanisms of childbirth so that she can use her mind and body to ease the process, With such training, increasing numbers of women have learned to experience birth, to participate in it actively, but without needless suffering. The idea underlying these methods is that women have the right to participate consciously in the act of giving life, without the intervention of technicians or medications; that the most natural childbirth does least damage to the child and the mother.
Natural childbirth was proposed in the 1930s by Grantly Dick-Read, an English obstetrician. He declared that pain during labor and delivery is not inevitable; that it arises from fear and tension. To dispel the fears that he felt were due to ignorance, he offered a program of systematic instruction on the body and the birth process, designed to remove the mystery and apprehension that had accompanied labor. The program also involves a series of exercises that teach the mother-to-be how to relax her muscles between uterine contractions, and to breathe effciently and to contract her muscles during them. During labor, the physician keeps the mother informed on the progress of the child, and guides her in making use of the techniques she has learned for participating in the birth process.
Although Read asserted that most women prepared in this way managed their deliveries without need of drugs, he specifically stated that when and if the mother requested drugs for pain relief she should never be refused. The Lamaze or the psychoprophylactic method of childbirth proceeds from the same principle that the body and mind can be trained to act together in the process of giving birth. Again, education in the mechanism of birth is basic. The techniques for managing labor and delivery are more precise and more dynamic than those of the Read method.
Based on the Russian Pavlov’s principle of conditioned reflex, spe- cific physical and mental exercises teach the woman to respond automatically to contractions, with particular breathing and muscular techniques that relax her tissues or help her work with the successive events of labor. She learns to modify or suppress certain lifelong conditioned reflexes of anxiety and resistance, and to replace them with responses that aid in the birth. Active participation of the father is essential to this method. He shares in the education on child birth and, more importantly, he helps the wife with her exercises.
Ideally, he is present and active during labor and delivery to support and guide her. The mother becomes conditioned to respond automatically to verbal cues—when to breath, when to bear down. On her own she might falter in maintaining control. Joint participation draws the parents together; they are a team, together with the doctor. The traditional loneliness of the woman in labor is lessened. Unfortunately, however, not all North American hospitals allow the husband into the delivery room. When he cannot be present, the coaching may come from the doctor or from an assistant trained in the technique.
Psychological education has two objectives: first, to remove from the woman s mind the taboos and misconceptions about childbearing that make it a fearsome and mysterious ordeal, and second, to replace them with a positive outlook born of an understanding of the physiology of birth and its naturalness. This process of deconditioning leads the woman away from traditional attitildes of fear and resignation that society has taught her is the inevitable suffering attached to woman’s condition. The word pain” is eliminated from her vocabulary; now she
is educated or conditioned instead to look upon “labor pains” as “uterine contractions”.
She comes to see herself as capable of understanding and controlling her body’s responses to these contractions, of taking an active role in the production that is, making the best use of her human qualities of intelligence, will, energy, and personal responsibility. She is no longer to be merely passive, waiting for the birth to happen to her; she can control it, direct it, and move it ahead. The program includes a film showing a birth by the psychoprophylactic method. The prospective parents can see what to expect, and identify with the woman shown in the birth process. A visit to the hospital acquaints them with the labor rooms and the personnel.
Training and practice for childbirth starts eight weeks before delivery. Instructions are spaced out over a period of time, preferably in late pregnancy, because if the birth date is too far distant, motivation lessens and instruction may have to be repeated. All techniques, as they are mastered, must be practiced daily until labor be-
gins. Because a strong psychological commitment is essential to the process, the choice of the instructor is crucial. So, of course, is the enthusiasm or at least the support of the attending physician.
A woman who decides she wants to have this kind of delivery should seek a doctor is wholeheartedly behind her decision, and if possible, alreadv familiar with the techniques. Furthermore, a hospital whose personnel is encouraging is very helpful. Physical training in breathing and deep-muscle relaxation is crucial to the psychoprophylactic method. Through certain exercises and positions the pregnant woman prepares her body to react effectively to the various stimuli she will encounter during the labor and delivery. She learns to neutralize her body’s resistant reflexes, as well as to relax certain muscles and push with others.
She also practices concentration, to shield herself from distracting stimuli during labor the better to attend to her real business of following and responding to contractions. The first session usually concerns concentration on certain muscle groups, isolating and using them to the exclusion of others. Body building strengthening the abdominal muscles, stretching those in the perineum is also begun. In the next two sessions, the woman learns and practices different styles of transition breathing for the first, al, and second stages of labor. For the first stage of labor, the dilatation of the cervix is accomplished entirely by the involuntary contractions of the uterus.
The laboring woman can only share in it by relaxing her soft tissues, concentrating on deep breathing, replenishing her oxygen and conserving her strength. In training, she conditions herself to respond to the word-cue contraction. In actual labor, an outside person, the husband or an assistant, marks the contraction by giving the same cue “Contraction begins contraction over ” and the conditioned response goes into play. As the contractions grow longer and more intense this cue-and-response help is crucial, as it imposes an orderly control on the overwhelming sensations and helps the mother control her responses.
Training for the first stage also involves abdominal friction massage (effleurage) and the application of back pressure to ease the discomfort of the eon tractions. For labor that has becorne wellestablished, the wonvan starts shallosv breathing, accelerating with the peak of the contraction and decelerating with the diminution. In the third session, the woman learns exercises for the transitional stage when the contractions reach their highest intensity and frequency. The fetus has descended into the pelvis and is pressing against the rectum and perineum.
The automatic reflex to push becomes strong, but pushing is not yet desirable. To resist the impulse, a stronger and more complex breathing technique, demanding a pant and blow pattern, competes with the intense sensations reaching the brain, preoccupies the mother, and makes it impossible for her to bear down. Concentration and control at this point are vital. This is the hardest time to maintain that control, and the guiding reminders of a second person are invaluable. In the fourth session, the mother is taught to concentrate on specific muscle groups for the second or expulsion stage of labor. Here the woman learns to use her abdominal muscles to push down on the uterus and force the infant along the birth canal; at the same time, she learns to relax the muscles of the pelvic floor, or perineum.
Relaxing the lower vaginal tract eases the newborn’s path to the outside. Despite the tremendous stretching, major tears in the perineal tissue are rare with relaxation training, and in most cases there is no need for an episiotomy. “Painless childbirth” by these training methods is not a wholly accurate description, The process is not totally painless, but women who have chosen the rnethod say that the pains they do feel are quite tolerable. Analgesic drugs, perhaps a little meperidine or a tranquilizer, often are adminiqtered in small dosages, to counteract tension from fatigue that may’ build up and interfere with the woman’s ability to apply the techniques she has learned. Patients and doctors agree that these drugs can help rather than hamper control and alertness.
Adapting to the body’s work, and learning effective responses to deal with it, gives a woman a feeling of self control and competence. She can use her energies where they are helpful, and relax to gather strength whenever it is possible. For this reason, many women who do not choose to do entirely without anesthesia have found that training for childbirth is immensely helpful to them in managing the early stages of labor, or for intermittent participation during the course of it. Loss of control and panic can be avoided and with them the nerve and muscle tension that has made childbirth difficult.