The classic preparation for childbirth, also known as the "preparation for childbirth without pain," has long been proven to be effective. Combining useful information, relaxing and breathing exercises, it will help relieve stress during childbirth.

Do not be afraid

This technique, which originated in Russia and was finalized in France by Dr. Lamaz, is based on several points. On the one hand, fears are born of ignorance, and by explaining to a woman what happens at the time of childbirth, most of them can be overcome. On the other hand, the belief that childbirth is a painful process confuses women. Prepared for this in advance, they, of course, will not forget about the pain, but will accept it as something inevitable.

Remember that all the difficulties that you experience during pregnancy and childbirth are temporary. They will soon be forgotten, and the wonderful moments of the first contacts with the baby will be remembered.

Many mothers can cope with pain with the realization that everything that happens to you is aimed at fulfilling the highest goal - to give life to your child.

When and with whom to start?

Classes are held in small groups, by midwives or doctors. Usually you are invited to them when you are in your seventh month of pregnancy. Some women are unhappy that these courses are not individual. Others regret that they did not start their visit earlier.

First lessons

The first classes are informative; they can sometimes be accompanied by slides: about your body, about pregnancy and the changes that it causes in the body of a woman. You can also be told about childbirth and various types of medical intervention (epidural anesthesia, episiotomy, cesarean section, placement of forceps, etc.).

A place

If the sessions are held in a clinic in which you have to give birth, you can get acquainted in advance with the medical team that will assist you, visit the maternity room and rooms of the baby’s material. You will also receive detailed information on the course of childbirth.

Learning to breathe and relax.

It is known that when we feel pain, whatever it may be, breathing is interrupted, the body and muscles are tensed. This chain reaction creates intense physical and mental stress, and the pain as a result is felt even more acutely.

Relaxation and breathing techniques will allow you to remain calm, “filled with oxygen” as soon as possible at the time of the first labor pains.

Relaxation

Exercises aimed at relaxation are performed most often in the supine position. They consist in the fact that you alternately relax all parts of the body. Performing these exercises also allows you to learn how to strain a certain muscle, which will "work" later, at the time of the fight.

Breath

During pregnancy, oxygen demand increases. During childbirth itself, when a period of active contraction of the muscles of the body begins, oxygen saturation becomes an even more important factor: a sufficient amount of oxygen allows you to relax tense muscles.

Respiratory techniques are physical exercises that help to saturate every cell in the body with oxygen. You learn to breathe deeply, inhaling through your nose and exhaling slowly through your mouth, pushing air out of your lungs to the end. The shallow and quick breathing of the "little dog" is no longer practiced. It can cause hyperventilation of the lungs and, as a result, a headache.

Caution, slippery surfaces

If you regularly perform exercises for relaxation or do prenatal gymnastics at home, take care of a special rug or karemat to make training as comfortable and safe as possible. Never practice in socks or on a slippery floor without a non-slip coating; avoid shoes with slippery soles.

Learning to push hard

Breathing plays an important role at the time of attempts. In the last moments before the birth of the child, you will help him move along the birth canal. Push three times in each bout while exhaling or holding your breath. This exercise is advisable to do after the "half-bridge", the implementation of which helps to straighten the spine.

• Lie on your back, the legs of the slang are spread apart and pulled up to the stomach.
• Grasp your feet. Inhale deeply, filling the stomach with air first, then the chest. Exhale. Take a deep breath again while raising your head and upper back. Hold your breath (the diaphragm presses on the bottom of the uterus), then push, lifting your legs to your shoulders. The organs of the abdominal cavity will press down on the uterus, thereby helping the child to go down.

You can also push, releasing air with short exhalations.

Perineal gymnastics

To better prepare for the exile phase, you can strengthen your perineal muscles. To do this, start doing exercises from the fourth month of pregnancy and continue classes until childbirth.

• Stand on all fours, put your head on your hands, perineum muscles are relaxed.
• Lie on your back, put your legs on a chair. As you exhale, turn your left foot outward. Then, on inspiration, turn it in the opposite direction so that you get a vertical angle, straining the muscles of the perineum.

Sophrology and Yoga: Learning to Relax

Sofrology, which became widespread in the 1960s in Spain, is based on relaxation using the technique of hypnosis and auto-hypnosis, borrowed from yoga. As for yoga itself - this is philosophy, it is a search and knowledge of oneself. However, we are not going to make you a real “yoga” and force you to master difficult poses.

Sophrology: rest and trust

Preparation begins around the fifth month of pregnancy. You will need to find the mental strength and time. If you want to apply this technique after childbirth, you will do it once a week for 20 minutes, listening to the voice of the sophrologist and performing a set of exercises.

On the threshold of sleep

In a standing, sitting or lying position, you listen to a calm and measured voice and enter a state of drowsiness. This condition is similar to the one that occurs when you are almost asleep or have just woken up.

In other words, you are neither in a trance, nor under hypnosis. Moreover, you do not sleep, you are just completely relaxed. You also learn to breathe and relax various parts of the body.

During pregnancy, this technique will help you imagine the process of childbirth, stop being afraid of this moment and look at it from a positive point of view. After several weeks of regular exercise, it will be enough for you to close your eyes to remember a familiar voice and enter the desired state.

Fatigue Remedy

Half an hour in a half-awake state can compensate for two hours of full sleep, which is especially important in your current state. On the day the birth comes, you will use these techniques to breathe correctly and slowly and create the right atmosphere for the normal course of the process.

After childbirth

Sophrology will come in handy even after childbirth, during sleepless nights, when it will be necessary to compensate for the precious hours of sleep and restore emotional balance.
Yoga: for better balance

According to Dr. Frederick Lebuyer, who has widely used this technique in pregnant women, yoga is not just a system of exercises or a sport. This is a method; finding your own self.

Harmony of body and soul

Even if you have never done yoga before, pregnancy is a great opportunity to find out what it is. Taking certain poses and concentrating attention, you are trying to find or maintain harmony of soul and body. By moving different muscles and joints, you can ease your physical condition and find inner peace. Yoga classes help improve blood circulation, improve fetal oxygen saturation, and breathing exercises help you deal with stress.

Performing asanas has a beneficial effect on the perineum, preparing it for childbirth and helping to tidy the muscle of the tour after them.

In what rhythm?

Yoga sessions for pregnant women usually last one and a half to two hours and are held 1-2 times a week. You can also practice at home for 15-20 minutes every day.

Which center to choose?

When choosing a place to study, pay attention to the following factors.

Teaching Staff

You can choose who will conduct yoga sessions: an obstetrician with a special education, or a yoga teacher who adapts his classes for pregnant women. In any case, when choosing an instructor, pay attention to the availability of certificates confirming his qualifications, listen to the reviews of those who have already studied in his group. When meeting with the teacher, do not hesitate to ask him what direction of yoga he represents, and how it differs from everyone else.

What to bring to class?

• Comfortable, easily stretching, non-limiting clothing made of natural material (cotton, knitwear). The so-called alladin pants are great for practicing. Familiar fitness clothing is also suitable.
• As a rule, yoga instructors recommend doing barefoot, but if you prefer, you can wear socks.
• Replaceable shoes (in it you will walk around the territory of the fitness center).

There is no finished model

Yoga and the ability to relax are inseparable concepts. In a state of relaxation, you better feel your body and breathe correctly. Yoga is an individual path to self-awareness, and you should not blindly follow ready-made positions and formulas. You can change them according to your desires and sensations.

Adapted Poses

These are special postures designed to strengthen the muscles that work during childbirth. You will learn to go to bed, stand up and turn around without effort and pain. Recent sessions are focused on the period of labor and the period of expulsion of the fetus. These poses do not pose a danger to the fetus, but if you are not comfortable when performing this or that position, abandon it.

Three principles of relaxation

• Here are three basic principles of “dynamic relaxation.”
• Concentration. Focus on a single object inside or outside your body. For example, you can concentrate on your own breath or say a mantra to yourself. Listen to yourself. Such activities help cleanse the mind and help you take your body that changes during pregnancy for granted.
• Contemplation. Try to find your place among other people, be prepared for future changes and look forward to the birth of your baby.
• Meditation. By meditating and taking certain poses, you learn to concentrate and relax. This will help you a lot during childbirth, when increasing contractions will upset your inner balance.

Pregnant yoga poses help strengthen the muscles involved in childbirth.

Alternative techniques

Whatever methods you choose (classes in the pool, prenatal singing, music therapy, acupuncture), they will certainly benefit you and improve your physical and mental state. Classes can be held individually or in a group, the choice is up to you.

Preparation for childbirth in the pool: ease and well-being

In water, the body loses its weight, and you feel light, despite the weight gained. Exercises are easy and calm. In addition, water has a draining effect, removes heaviness in the legs and promotes better blood circulation. Water procedures will have a positive effect if you complain of sciatica, insomnia, and constipation. Finally, you will see other pregnant women around you and stop being embarrassed when you see your own body.

Learning to breathe deeply

The duration of the lesson is usually 1 hour, the group usually consists of 10 people. The main goal of these trainings is to acquire the right breathing skill, which will be needed at the end of the term and during childbirth. You will strengthen the muscles of the perineum and prepare them for work during the period of expulsion of the fetus. Also in the process of training you can learn various exercises for stretching and relaxation.

In complete safety

In order to engage in such groups, you do not have to be able to swim. Sessions are held in a specially designated place, the water temperature in the pool is 30 ° C. Particular attention is paid to compliance with hygiene rules. Before starting classes, you should get a medical certificate that there are no contraindications to water procedures.

Classes are held by a swimming coach or an obstetrician with a special education. When and in what rhythm to start is up to you.

Childbirth in the water?

Immersion in water can significantly alleviate pain from contractions, help to relax and even out breathing. Childbirth in water is practiced in some maternity hospitals and clinics - there are special rooms equipped with a bath or pool. The future father can be in the water with his wife: he sits down behind and helps the woman in the process of childbirth, supporting her under the armpits.

When to start preparing for childbirth?

• Classical training: from the 7th month.
• Yoga: from the 5-6th month or earlier, if you feel tired.
• Sofrology: closer to 5 months or earlier if you are worried about anxiety.
• Bonapas method: you can start in 6 months (4 sessions of 2 hours or 6 sessions of 1.5 hours).
• Pool: during the entire period of pregnancy.
• Prenatal singing: from the 1st trimester, when the fetus is able to pick up sounds through bone conduction. From the 5th month he begins to hear with his ears.
• Music therapy: you can start at any time, but best from the 6th month.
• Haptonomia: from the 4th month, that is, shortly before the expectant mother begins to feel the first movements of the fetus.
• Acupuncture: you can start at any time, but it is especially important to go through the sessions in the last three weeks. This will help restore the energy balance in the body, gain confidence and calm before childbirth.

Prenatal singing: vocalises in a close circle

Impact on mom and baby

Prenatal singing has a beneficial effect on breathing, tone of the abdominal muscles, muscles of the perineum and pelvis. It allows you to express your feelings of anxiety and anxiety not through words, but through sounds. A child surrounded by these sounds is able to perceive them well. First, he hears the mother’s voice thanks to bone conduction, then, starting from the 5th month, through the ears, he reacts differently to different sounds: it depends on their timbre, melody and pitch. During the session, the child sways gently from the movements of your body, your voice “envelops” it and soothes.

How do the sessions go

You can start at any time and engage in a group. Classes begin with light pats on the body to warm it up and open all areas. This is followed by several exercises to warm up the voice, and then the singing begins. Unfortunately, in France there are few antenatal clinics organizing prenatal singing sessions. If you are unable to attend such classes, you can enroll in a choir or find a singing teacher specializing in psychophony.

After the birth of a baby, you can continue to sing to him the melodies that you sang when he was still in his stomach. This is a great way to calm him down.

Acupuncture: We Energy Saving

Despite the fact that acupuncture cannot be called a prenatal technique in its purest form, it can be perfectly combined with other techniques. Acupuncture is used during pregnancy, but so far it is rarely used to relieve pain during childbirth.

In short, acupuncture should support and restore the energy flow in the body.

According to Chinese medicine, our body has 14 so-called "meridians", through which the energy of "qi" flows. Eastern healers divide the meridians into two systems - yin and yang - 7 meridians each. In total, there are more than 800 biologically active points. If the meridians are in integrity, the qi energy flows freely along them, which means that a person is healthy and feels cheerful, full of vitality. If the meridians are damaged, the qi energy stagnates and cannot flow easily through the channels, then the person feels tired, and chronic diseases may appear in him. Acupuncture sessions activate energy production and contribute to its proper distribution.

With the help of acupuncture, you can restore the proper functioning of all internal organs. A properly conducted acupuncture session raises the mood, helps to cope with pain and aches in the body, improves blood circulation and stimulates metabolism.

The use of acupuncture during pregnancy carries a special meaning. During childbirth, the energy balance in a woman’s body changes: the yang energy collected in the gas region turns into yin. This transition is very important. Everything will go better, the more harmonious a woman felt before and during pregnancy.

Preparation of muscles of the perineum and cervix

The ideal option would be to use acupuncture at the stage of pregnancy planning, but you can start at any time. Preparation for childbirth is carried out in the last three weeks, at the rate of one session per week.

In two weeks, the preparation of the perineal muscles begins, and one week before the deadline, the maturation of the cervix can be accelerated.

There are other indications for the use of acupuncture in obstetrics. For example, if you need to change the position of the fetus and reduce pain during childbirth. But this practice is rarely used in Russia.

What do the doctor do?

A doctor (obstetrician-gynecologist) inserts thin needles into different parts of the body, except for the abdominal region. Needles are left in energetically active points for 15-20 minutes.

This is an almost painless procedure. The first sensations may seem a little strange, but your fears will soon pass, only the feeling of complete relaxation will remain.

Music Therapy: Preparing with Music

Music can have the same deep relaxing effect as yoga. Low sounds, for example, the sound of double bass, have a relaxing and soporific effect on the fetus. Therefore, music is sometimes combined with other types of preparation for childbirth - sophrologist Ney and singing.

Low and high sounds

The method consists in a combination of listening to various musical passages by a mother, in recording or “live”, and playing sounds of various heights in her own voice.

Low sounds train your breath and saturate the blood with oxygen; high - strengthen the muscles of the perineum. The purpose of such sessions is not only to learn! relax, but also develop a child’s hearing.

Classes begin around the sixth month, but you can start earlier. It all depends on desire. You can study alone, with family or in a group.

Technique Julie Bonapas: active dad

In developing her approach, Julie Bonapas resorted to methods of acupuncture and studied the effect of stimulation of certain points of the body on the state of the body. Her own method appeared in the early 1990s. It can be useful as a complement to the classic preparation for childbirth. However, the technique is still little known in the world, and you may encounter a situation where there will be no specialist in this method in your city.

What is its originality? The future dad is actively involved in the birth process.

The technique is based on the following principle: you can reduce the intensity of pain by pressing with your fingers on certain points located on our body (something like acupuncture without the use of needles), as well as using massage and relaxation.

Massage and finger pressure

Your husband can learn to find what are called “trigger zones”.

These eight points are located on the arms, legs, sacrum and buttocks; your partner will click on them during childbirth to help you deal with the pain. The goal of the Bonapas method is to create a second sensitive place and act on it so that the brain produces endorphins.

Your partner can also learn how to massage the lumbar region so that during childbirth you can help relax your tense back muscles after each bout.

I read many books about pregnancy, and I had a clear opinion about how the birth process itself should proceed. But in fact, I'm afraid at some point to lose control over myself due to pain and miss something, after which everything will go wrong as planned

Learn to let go of the situation

Of course, you would like the team of doctors to carefully deal with you and your baby. And if you are used to always and in everything controlling the situation, you will want to maintain this control here, preparing yourself for childbirth in advance, building trust with a doctor and obstetrician even before childbirth.

But you need to accept the fact that during childbirth you will not be in charge of the process: you will not make the decision to conduct an episiotomy, if there is a risk of rupture, you will not decide whether or not to give you epidural anesthesia - these questions should be decided by a team of doctors: obstetrician, anesthetist and other representatives of medical personnel.

You must “let go of the occasion” at the right time — it will be better for you and your child. This is a very important point, and you need to prepare yourself for it in advance. Calm down and accept this fact, trust professionals who have more experience.

Singing has a beneficial effect on breathing, strengthens the muscles of the abdominal cavity, and this is a great way to get rid of fears and anxieties.

The health of the unborn child depends not only on how the pregnancy progressed, but also on the course childbirth. The birth act is for the fetus a certain test of endurance. The less the fetus suffered during pregnancy, the easier it is to cope with this test.

Every woman is interested in giving birth to her normally, quickly and painlessly. In our country, a system has been developed for preparing a pregnant woman for childbirth. Preparation should begin with exercise.

To this end, in a antenatal clinic, a methodologist of physiotherapy exercises conducts classes according to a special program. If a woman before pregnancy is accustomed to doing exercises in the morning, then she needs to continue classes, excluding exercises associated with jumping, considerable straining, and sudden movements. You can apply the set of exercises developed by prof. K.K. Skrobansky. These exercises are recommended at any stage of pregnancy. You need to start the lesson with lighter exercises and perform 3-4 complex exercises daily. The duration of physical education should not be more than 15-20 minutes.

The main task of the physical preparation of a pregnant woman is to teach her how to control her breathing. Deep Breathing, the ability to hold out exhalation makes it easier for a woman to give birth. In addition, exercises to strengthen the muscles of the abdominal wall and pelvic floor are very useful. Well-developed elastic muscles of the abdomen contribute to the correct location of the fetus in the uterine cavity, provide sufficient strength of attempts at the birth of the fetus and prevent sagging abdomen after childbirth.

Exercise 1

Starting position: lying on your back without a pillow, arms freely along the body.

Execution: alternately slowly raise one leg or the other and slowly lower them. When raising - a deep exhale, when lowering - a breath. Raise and lower each leg 3 times. The exercise ends with a three-fold lifting of both legs simultaneously. When raising legs - exhale, when lowering - inhale.

Exercise 2

Starting position   also.

Execution: raise both straight legs - exhale; push them apart - inhale; connect legs - exhale; lower them to the starting position - inhale.

The exercise is repeated 3-4 times. Between exercises, calm breathing.

Exercise 3

Starting position   also.

Fulfillment: slowly bend the knees, the feet remain on the floor; pull the legs to the stomach; straighten your legs and spread to the sides; to connect the raised legs together; lower to the starting position. The breath is arbitrary.

Exercise with rest is repeated 3-4 times.

Exercise 4

Starting positionalso.

Execution: raise your head, sit down without the help of your hands - exhale; slowly lower the body - inhale.

The exercise is repeated 2-3 times

Exercise 5

Starting position: lying on his back, legs bent at the knees, bunches folded on his chest.

Fulfillment: slowly straighten the legs, take your hands to the sides - inhale; return to starting position - exhale.

The exercise is repeated 3-4 times.

Exercise 6

Starting position: lying on your back, arms extended along the torso.

Fulfillment: bend the legs to the knees - inhale; straighten your legs - exhale.

The exercise is repeated 4-5 times.

Exercise 7

Starting position: lying on his back with legs bent at the knees, arms along the body.

Execution: when inhaling, slowly raise the pelvis and torso; when exhaling - lower to its original position.

Exercise 8

Starting position: sitting on the edge of the bed, on a small pillow.

Fulfillment: slowly deviate backwards, holding the edge of the bed with your hands and without raising your legs - inhale; return to starting position - exhale.

The exercise is repeated 3-4 times.

After completing each exercise - short-term complete rest with relaxation of all muscles.

The described physical exercises are especially useful for those women who, by the nature of their work, spend most of the day sitting.

Clothing in time   physical education should not constrain movements.

Sports games and competitions are prohibited even with very short gestation periods. In addition to possible shocks, bruises, falls and other injuries, any competition is accompanied by great nervous tension, which can complicate the course of pregnancy.

If a pregnant woman in the past has never been involved in physical education, then she must choose a set of exercises with a doctor. Gymnastics should not cause women feelings of fatigue, shortness of breath, heart palpitations. When such sensations appear, it is necessary to facilitate exercises and consult a doctor.

Systematic gymnastic exercises cause vigor, vitality in pregnant women, increase efficiency and contribute to the rapid and normal course of childbirth.

At the end of pregnancy, most women look forward to giving birth. Each woman carries this expectation in her own way. Some experience a sense of fear. Especially often, fear of childbirth is observed among women who are about to give birth for the first time. This is due to ignorance of what constitutes childbirth, and a false idea of \u200b\u200bthe inevitability of pain in childbirth.

About how the uterus is arranged, what changes occur with it during childbirth, and much more, every pregnant woman learns in the classes on psychoprophylactic preparation for childbirth, held in the antenatal clinic. The knowledge gained helps a woman consciously perceive the sensations that she experiences, as well as actively participate in the birth act.

At present, there is no doubt that some women do not feel pain at all during childbirth. For other women in childbirth, pain can be eliminated with the help of various medications.

The great physiologist Academician I.P. Pavlov proved that the perception of pain depends on the state of the central nervous system: a sense of fear, fear of something makes a person extremely sensitive even to minor pain. For example, everyone is well aware that pricking a finger with a needle when sewing is perceived more easily than when donating blood for analysis. Therefore, the main purpose of the classes conducted by the doctor in the antenatal clinic is to rid the pregnant woman of fear, to teach some techniques that will help the woman and her child to give birth. Active woman behavior during childbirth and the use of painkillers can eliminate pain. Childbirth can begin in different ways. Most women initially have rare, and then all the more frequent contractions of the muscles of the uterus, called contractions. Gradually, contractions become stronger and longer. They lead to the opening of the cervix. Amniotic fluid leaves at the height of one of the contractions, after which attempts soon begin at the women in labor, and then the baby is born. In some women, water flows at the very beginning of labor pains or even before they occur. In this case, the woman should immediately go to the maternity hospital, not expecting the appearance of labor, as sometimes the water can leave several days and weeks before the birth. This condition, called "dry birth", is dangerous for the fetus and mother in the first place because pathogenic microbes can enter the uterine cavity, which will lead to the development of infection. Therefore, from the moment of discharge of the waters, a constant medical supervision is necessary to prevent complications.

During each fight, perceived by a woman as tension and tightening of the abdomen, as a result of contraction of the uterine muscles, a slight compression of the blood vessels of the uterus occurs, their lumen decreases. As a result, the placenta, through which metabolism occurs between the mother and the fetus, receives a slightly smaller amount of blood, and therefore a smaller amount of oxygen. In order for the fetus not to lack oxygen, the woman in labor during the contractions must breathe deeply and rhythmically. Proper deep breathing promotes better oxygenation of the mother’s blood. Sometimes for this purpose a woman in labor is allowed to breathe pure oxygen. The future mother should remember that, following these tips, she helps her child.

Childbirth is a long process that continues in primiparous women for about 16-18 hours. During this time, the woman in labor expends a lot of mental and physical strength, especially at the last stage of childbirth, when attempts are added to the contractions. If the power of contractions does not depend on the will and consciousness of a woman, then she actively participates in attempts. The stronger the woman is pushing, the faster the baby is born. In order for the woman’s efforts during the attempts not to be in vain, she must be able to push hard and must save enough strength by this time. The ability to push, to properly use your energy when trying, is taught to a woman in the classroom during pregnancy in antenatal clinics and during childbirth.

To make up for the labor expended in childbirth, each woman in labor can take fruits and chocolate with her to the maternity ward. Some women refuse to eat during childbirth. You should know that if a woman in childbirth does not eat anything for a long time, then by the time of the expulsion of the fetus, when the attempts begin and when the woman in labor is especially needed, they are not. As a result, childbirth at the very last stage is unnecessarily delayed and a fetus and even his life may be threatened. In such situations, the doctor leading the birth is forced to resort to the help of some obstetric surgery to save the child. And if a woman took care of her strength - she ate in a timely manner, in the intervals between contractions and attempts to achieve complete relaxation of the muscles of the body, breathed deeply, and sometimes dozing, childbirth could end without any operation. After all, childbirth for a healthy woman is a normal physiological process, which should not be accompanied by surgical intervention!

From the foregoing, one should not conclude that obstetric surgery. dangerous to the child. There are many operations that accelerate the birth of the fetus. All of them have strict indications for their use. The lives of many children born were saved only due to one or another operation applied in time. But, of course, children endure even the same operation in different ways. This may depend on many reasons, but the main one is how well the intrauterine development of the child proceeded at all stages. In their practice, obstetricians have the opportunity to very often be convinced of the truth of what has been said. If the development of the fetus during pregnancy was satisfactory, it easily tolerates any, even severe obstetric surgery, and it does not affect the health of the child in the future. In other cases, normal birth can be an unbearable test.

Currently, great importance is attached to the diagnosis of a woman’s readiness for childbirth. The latter can be detected by changes in the female reproductive system in the form of increased tone, excitability and contractile activity of the uterus, as well as in the form of the onset of cervical maturity and changes in the cytological picture of vaginal smears. The most clear idea of \u200b\u200bthe severity of the readiness of the body for childbirth gives a thorough palpation assessment of the maturity of the cervix. The revealed structural and functional changes in the reproductive system indicate the possibility of a spontaneous onset and physiological course of the birth act.

Currently, methods have been developed for both drug and non-drug exposure in order to form a woman’s readiness for childbirth.

Skillful selection and comprehensive application of methods of preparation for childbirth in combination with the psychoprophylactic preparation of pregnant women will achieve optimally expressed biological readiness, significantly reduce perinatal and maternal morbidity and mortality.

Physiopsychoprophylactic preparation. It should include three components of exposure to create a favorable emotional state, to ensure a conscious attitude to pregnancy and active participation in childbirth:

Individual conversations and lectures - psychoprophylactic preparation;

Group exercises in special gymnastics;

The use of natural factors (light, air, water) to promote health and the use of physical therapy.

Psychoprophylactic preparation. It is aimed at eliminating negative emotions and forming positive conditioned reflex connections - removing a pregnant woman’s fear of childbirth and labor pains, attracting her to actively participate in the birth act.

Psychoprophylactic preparation significantly reduces labor pains, has a multilateral, in particular organizing, effect on a woman, contributes to a favorable course of pregnancy and childbirth.

The method is absolutely harmless to the mother and the fetus, and therefore there are no contraindications to mass use. Its disadvantage is the need for painstaking, lengthy, individual work with the patient.

The method of psychoprophylactic preparation was proposed in our country by I.Z. Velvovsky and K.I. Platonov (1940). Later, the method was improved by G. D. Read (1944), F. Lamaze (1970) and was widely used in many countries of the world.

The main goal of the psychophysiological preparation of pregnant women for childbirth is as follows:

Develop a woman's conscious attitude to pregnancy, teach to perceive childbirth as a physiological process;

Create a good emotional background and confidence in the favorable course of pregnancy and the completion of childbirth;

To educate the pregnant woman in the ability to mobilize her will to overcome the fear of childbirth.

At the first contact with a pregnant woman, it is necessary to find out her attitude to pregnancy, the nature of relationships in the family, education, profession, the presence of mental injuries, to establish the pregnant woman's idea of \u200b\u200bchildbirth, the peculiarity of fear of them, fear of pain. It is important to find out the characterological features of the pregnant woman, her emotional and volitional qualities. It is advisable to distinguish a group of pregnant women with psychological problems, in the presence of which the patient can be referred for consultation with a medical psychologist or psychotherapist.

Along with the individual psychoprophylactic work that the obstetrician-gynecologist carries out at each visit to the pregnant woman, it is recommended to conduct group exercises on the psychoprophylactic preparation for childbirth.

The interior of the office for group classes should create psychological comfort for the patient. It is necessary to have a couch or comfortable chairs, a set of drawings and tables showing the anatomical and physiological characteristics of the birth act, it is recommended to have a slideoscope, tape recorder or installation for showing films about the birth process.

To conduct classes on psycho-preventive preparation, it is advisable to form groups of 6-8 people, preferably taking into account the psycho-emotional status of patients, determined on the basis of the clinical experience of the doctor.

It is advisable to start classes from 33-34 weeks of pregnancy, to conduct them weekly for a month (4 lessons), each lasting 25-30 minutes. The first lesson can last about an hour.

First lessonconsists of introductory and main parts. In the introductory part, they focus on the possibility of training pregnant women to manage their will and activity in childbirth. One form of such training is autogenic training. Self-massage of certain biologically active points also contributes to strengthening the will and relieving psychoemotional stress: the sacral region, the lower abdomen, the inner surface of the upper edge of the ilium. The use of finger self-massage elements in childbirth helps to reduce labor pain, normalize contractions, and immobilize labor efforts.

The main part provides brief information about the anatomical structure of the female genital organs, the development of the fetus, the unified mother-placenta-fetus system, it is emphasized that the mother is the environment for the fetus. It is necessary to present childbirth as a natural physiological act, to characterize all periods of childbirth, to stop the attention of pregnant women on the ability to distribute their strength in childbirth, to follow the instructions of medical personnel.

To consolidate the acquired skills, pregnant women are recommended to repeat classes at home, lasting 7-10 minutes.

On the second lessonthe doctor explains the physiology of the first stage of labor. The mechanism of contractions, which contribute to the opening of the cervix, is described. Techniques are suggested to reduce the pain of contractions; it explains how to breathe properly during contractions and relieve muscle tension between contractions. A woman in labor should apply relaxation techniques and pain relief methods: stroking the lower abdomen with the movements of the palms from the midline to the side; when standing on the side by pressing with thumbs on the sacrum; when positioned on the back, thumbs are raised in front of the crests of the pelvis.

On the third lessonpregnant women are introduced to the course of the second stage of labor. They explain what attempts are and how to promote the correct birth of a child. They inform about the subsequent and early postpartum period, about blood loss in childbirth. They persuade how important it is to follow the recommendations of the midwife during childbirth, conduct training with holding the breath and, conversely, with frequent shallow breathing. They tell how to push.

On the fourth lessonbriefly repeat the entire course of previous classes and consolidate the acquired skills and techniques recommended in childbirth.

Physical exercise. Recommended for early pregnancy. These exercises are aimed at training breathing and muscle groups that have especially hard work to do during childbirth: the abdominals, pelvic floor muscles. Physical training classes are conducted under the guidance of a physiotherapy instructor.

UV exposure. It is carried out for 10 days in the I, II and III trimester, which increases the functional state of the nervous system and endocrine glands, increases immunological activity and normalizes metabolism in the body. Ultraviolet irradiation is especially useful when there is insufficient natural exposure, depending on the climate and seasonal variations.

Mothers who have undergone physioprophylactic preparation for childbirth require a lower dose of drugs to anesthetize labor.

Non-drug methods of exposure.They include intranasal electrical stimulation, electrical stimulation of the nipples of the mammary glands, acupuncture.

Intranasal electrical stimulation is based on the reflex relationship of the upper respiratory tract ("nasogenital zones" of the nasal mucosa) and internal genital organs. The method involves irritation of reflexogenic zones (the tuberculum septi region and the anterior part of the lower shell) with pulsed currents of variable frequency. The duration of each session is 1 hour. The method is effective in terms of cervical maturation in 87% of pregnant women, probably due to the appearance of a large number of uterine contractions of the Brexton-Hicks type, instead of small uterine contractions of the Alvarez type.

Electrical stimulation of the nipples of the mammary glands is carried out in order to accelerate the maturation of the cervix and is based on the fact that the emerging impulses affect the supraoptic region and paraventricular nuclei of the hypothalamus, which in turn leads to the release of oxytocin from the posterior pituitary gland, the appearance of uterine contractions and the maturation of the cervix. There is literature evidence that mechanical irritation of the nipples and areola of the mammary glands leads to the development of regular labor in 45.5% of pregnant women.

Acupuncture is used to relieve fear and tension before childbirth, to anesthetize the latter and regulate labor. The effect of this method is explained by the fact that an artificially induced flow of afferent impulses triggers a reflex reaction.

When choosing exposure points, the recommendations of classical Chinese acupuncture and the principle of segmental innervation of organs are taken into account.

Currently, preference is given to electroacupuncture (ELAP), which provides for the electrical effect of using pulse generators on the needles. Indications for the use of ELA are both insufficient readiness for delivery of the birth canal, and delivery during premature discharge of amniotic fluid.

4.5. ANTENATAL DIAGNOSTICS OF THE FETAL STATE

At the present stage of knowledge and technical capabilities, the most optimal antenatal tests for assessing the condition of the fetus are ultrasound scanning, examination of the fetal cardiac activity, determination of the biophysical profile of the fetus, Doppler blood flow in the mother-placenta-fetus system, and investigation of the gas composition of umbilical cord blood. Some of them (ultrasound fetometry) allow us to assess the physical development of the fetus, its compliance with the expected gestational age, and to exclude the presence of fetal malformations; others (ultrasound placentography, examination of uteroplacental blood flow) - get indirect signs of placental insufficiency; third (the study of the biophysical profile of the fetus and fetal blood flow, cardiotocography, the study of cord blood) - to evaluate the functional state of the fetus.

Ultrasonic fetometry is the most reliable objective method for assessing fetal growth and development, allowing each exact gestational age to accurately determine the conformity of fetal size to gestational age, as well as their degree of deviation from normal values. When studying the development of the fetus in the II and III trimesters of pregnancy, the main attention is paid to measuring the biparietal size of the head (BDP), the size of the abdomen, and the length of the thigh, which increase as pregnancy progresses. Towards the end of pregnancy, the growth rate of fetal biometric indicators gradually decreases: the growth rate of the BDP head decreases from 4 mm / week at 14-15 weeks of pregnancy to 1.3 mm / week at 39-40 weeks; thigh lengths - from 4.8 to 1.7 mm / week. The ratio of the size of the head and abdomen of the fetus is normal in the second trimester of pregnancy exceeds 1, but after 36 weeks of gestation it changes due to the prevalence of the size of the abdomen of the fetus. This indicator is of great clinical importance for the diagnosis of fetal growth disorders.

Valuable information on the condition of the fetoplacental system is provided by a direct study of the placenta: determining its location, structure, and placentometry. Most often, the placenta is located on the anterior or posterior surface of the uterus with a transition to one of the lateral, less often localized at the bottom of the uterus. Data on the effect of localization of the placenta on the growth and development of the fetus is very contradictory, but most studies have shown that the location of the placenta does not significantly affect the intrauterine development of the fetus.

The localization of the placenta at different stages of pregnancy is unstable. It has been established that in most cases, as pregnancy progresses, its “migration” occurs from the lower segment to the bottom of the uterus. Therefore, the final conclusion about the location of the placenta should be done only at the end of pregnancy. It is believed that the displacement of the placenta is due to both a higher growth rate of the uterine body compared to that of its lower segment, and also apparently arising under the influence of specific proteolytic enzymes secreted by the cervix from partial atrophy of the placental tissue located in the lower segment.

The thickness of the placenta during physiologically ongoing pregnancy is constantly increasing in a linear relationship from 10.9 mm at 7 weeks to 35.6 mm at 36 weeks (Table 4.6). Depending on the pathology of pregnancy, a decrease or increase in the thickness of the placenta may be observed.

The placenta changes as pregnancy progresses, providing ever-increasing fetal needs. Morphological features of its development at different stages of pregnancy are reflected in echograms. With an uncomplicated pregnancy, the boundaries of the transitional period of maturity from 0 to I correspond to 27-30 weeks of pregnancy, from I to II degree - 32-34 weeks, from II to III degree - 35-37 weeks of pregnancy. The development time of a certain degree of placental maturity is not always constant. In some cases, I or II, the degree of maturity of the placenta may persist until the end of pregnancy and not be accompanied by a violation of the fetus. However, premature occurrence of changes of the III degree of placental maturity (up to 36-37 weeks of pregnancy), i.e. its "aging" serves as a marker of chronic fetal suffering (Fig. 4.39).

Table 4.6. The thickness of the placenta during physiological pregnancy

Pregnancy, weeks	The thickness of the placenta, mm	Pregnancy, weeks	The thickness of the placenta, mm
	10,89		25,37
	11,74		26,22
	12,59		27,07
	13,44		27,92
	14,29		28,78
	15,14		29,63
	16,00		30,48
	16,85		31,33
	17,70		32,18
	18,55		33,04
	19,40		33,89
	20,26		34,74
	21,11		35,60
	21,98		34,35
	22,81		34,07
	23,66		33,78
	24,52		33,50

Much attention in assessing the condition of the fetus should be given to the amount of amniotic fluid. As you know, amniotic fluid is a biologically active environment surrounding the fetus, a product of metabolic processes occurring in the mother and fetus. The amount of amniotic fluid with increasing pregnancy progressively increases from 500 ml in 30 weeks to 1500 ml at the end of pregnancy.

Ultrasound examines the amniotic fluid index. For a normal pregnancy, an index of 8.1 to 18.0 cm is characteristic.

A clear relationship was found between a change in the amount of amniotic fluid and an increase in negative perinatal outcomes. Currently, the determination of the amount of amniotic fluid is widely used as one of the most informative parameters in the study of the biophysical profile of the fetus.

In addition to studying the anatomical features of the fetoplacental system, in clinical practice, it is important to assess the functional state of the fetus, primarily its cardiac activity. With auscultation, the normal heart rate of the fetus is 120-160 beats / min. More accurate information about the nature of the cardiac activity of the fetus can be obtained on the basis of ECG, FCG, CTG.

With antenatal electrocardiography, in addition to the heart rate, it is possible to determine the ventricular complex QRS.Normal tooth Rit is pointed, the duration of the ventricular complex is 0.03-0.07 s, the voltage ranges from 9 to 65 μV, with an increase in the duration of pregnancy, a gradual increase is noted.

With phonocardiography, fluctuations in the duration and amplitude of the fetal heart tones are very variable in the III trimester, averaging: I tone - 0.09 s, II tone - 0.07 s; III and IV tones are rarely recorded. It is possible to conduct a phase analysis of cardiac activity while simultaneously registering the ECG and FKG of the fetus. With a physiologically ongoing pregnancy, the duration of the asynchronous contraction phase is 0.02-0.05 s, mechanical systole lasts 0.15-0.22 s, total diastole 0.17-0.26 s, ventricular diastole 0.15-0 , 25 p. The ratio of the duration of total systole to the duration of total diastole at the end of an uncomplicated pregnancy averages 1.23.

In modern obstetrics, cardiomonitor observation, or cardiotocography (CTG), is widely used to assess the condition of the fetus during pregnancy. During pregnancy, CTG allows you to dynamically monitor the condition of the fetus, evaluate the effectiveness of the therapy, predict the course of the upcoming birth and choose the optimal method of delivery. With a normal pregnancy, the basal heart rate is 120-160 beats / min, the amplitude of instant changes in heart rate is from 10 to 25 beats / min and their frequency is 7-12 oscillations per minute. In the physiological course of pregnancy, slightly undulating (5-10 beats / min) and undulating (10-25 beats / min) types of basal rhythm variability are most often observed. Particular attention should be paid to the appearance of silent and saltatory types of variability, especially in combination with tachycardia or bradycardia. With a physiologically ongoing pregnancy, a mute type of basal rhythm variability (0-5 beats / min) may be due to exposure to drugs and sedatives.

In an uncomplicated pregnancy, acceleration is observed almost constantly with a frequency of 4-5 or more over a 30-minute interval, no deceleration. Sporadic acceleration is most often associated with motor activity of the fetus. A decrease in the frequency of acceleration or their absence, the appearance of deceleration are an unfavorable prognostic sign.

Functional tests are of great help in assessing the condition of the fetus. In the normal course of pregnancy, in response to fetal movement, the heart rate increases on average by 10 per minute or more - a positive non-stress test. In more than 99% of cases, a positive non-stress test is a reliable criterion for a healthy fetus. The absence of a reaction of the cardiac activity of the fetus in response to movements indicates intrauterine suffering. The test can be false negative during the period of physiological rest of the fetus, in this case, a second study is required.

To assess the condition of the fetus during pregnancy, it is advisable to take into account the motor activity of the fetus. Counting the most pregnant number of fetal movements for 30 minutes in the morning and evening hours allows you to assess the condition of the fetus. Normally, the average frequency of fetal movements is about 3 in 10 minutes; their increase and amplification, as well as a sharp decrease in the frequency of fetal movements, may indicate fetal suffering and serve as the basis for a more detailed examination of the pregnant woman. Along with a subjective assessment of the movements of the fetus of the pregnant woman, their assessment by ultrasound is possible.

Respiratory movements of the fetus (DDP), determined by ultrasound, are albeit indirect, but quite valuable information about the state of the central nervous system of the fetus, whose role in the regulation of respiratory activity has been convincingly proven. It is believed that respiratory movements are one of the factors supporting the fetal blood circulation and thereby regulating the amount of blood flowing per unit time through the vessels of the placenta. Hemodynamic changes are associated with DDP: increased blood pressure, increased heart rate, increased blood flow in the umbilical cord vessels, as well as blood flow in the aorta and inferior vena cava. Some authors perceive the physiological significance of intrauterine DDP in the preparation of the respiratory apparatus for the implementation of respiratory function in the future; it is believed that DDP is necessary for the normal development of the lungs in the fetus.

The fact of the presence or absence of respiratory movements within 15-30 minutes is considered to be the main parameter of DDP. By the end of an uncomplicated pregnancy, the fetal respiratory rate is about 50 in 1 min. Normally, DDPs are combined with periods of apnea, the duration of which is more than Bay. The duration of DDP in the physiological course of pregnancy is on average 50-90% of the study time. A significant decrease in respiratory activity in the fetus was established in the complicated course of pregnancy.

The combined registration of several biophysical indicators of the fetus (BFPP) allows for reliable diagnosis and significantly improves antenatal monitoring. A combined determination of the respiratory and motor activity of the fetus, its cardiac activity and muscle tone, i.e. indicators under the regulatory influence of the central nervous system of the fetus, with greater reliability reflect its functional state. At the same time, the frequency of false positive and false negative results is reduced in comparison with the study of each of these parameters separately. Normally, the fetal BFPP score is 8-12 points.

Since BFPP is a valuable diagnostic criterion for the intrauterine state of the fetus, his study has found widespread use in a number of pregnancy complications. At the same time, the degree of decrease in BFFP assessment does not depend on the nature, but on the severity of pregnancy complications.

One of the most promising diagnostic methods used to assess hemodynamics in the mother-placenta-fetus system is dopplerometry. The blood flow in the arterial vessels of the fetus and uterine artery in uncomplicated pregnancy is characterized by continuous curves that reflect the translational blood flow throughout the cardiac cycle, without zero and negative values \u200b\u200bin the diastole phase. A qualitative analysis of blood flow in the umbilical artery, fetal aorta, and uterine artery during the third trimester of uncomplicated pregnancy revealed a gradual decrease in peripheral vascular resistance, which is manifested by a decrease in blood flow indices (Table 4.7).

With an uncomplicated pregnancy, the values \u200b\u200bof the systolodiastolic ratio (SDS) in the uterine arteries after 18-20 weeks should not exceed 2.4. A decrease in the indices of vascular resistance in the umbilical artery during the II and III trimesters of pregnancy indicates a decrease in the vascular resistance of the placenta, which is caused by the intensive growth of its terminal bed, associated with the processes of development and vascularization of the terminal villi of the placenta.

Table 4.7. Blood flow in the aorta of the fetus, umbilical artery and uterine artery in the third trimester of uncomplicated pregnancy

For a comprehensive assessment of blood flow in the mother-placenta-fetus system, it is necessary, in addition to the umbilical artery, fetal aorta, and uterine artery, to study the blood flow in the fetal brain vessels. When comparing the blood circulation in the fetal-placental unit and the cerebral blood flow of the fetus, the relative stability of the cerebro-placental relationship in uncomplicated pregnancy was established, which indicates the preservation of a constant level of blood supply to the fetal brain.

To assess the condition of the fetus allows the study of fetal blood obtained by cordocentesis.

Normally, as pregnancy progresses in the fetus, P about in the artery, umbilical cord vein, and intervillous vessels gradually decrease. Despite the decrease in P about, the oxygen content in the umbilical vein remains constant due to a compensatory increase in hemoglobin concentration. The content of CO 2, bicarbonates, bases and lactate in the umbilical cord vein increases as the gestational age of the fetus increases. The pH value of the blood of the fetus during physiologically ongoing pregnancy does not significantly change (7.38 ± 0.04).

Indirect information on the condition of the fetus is given by the study of amniotic fluid during pregnancy. With uncomplicated pregnancy during amnioscopy, a sufficient amount of bright, transparent opalescent amniotic fluid with the presence of a white cheese-like lubricant is determined. In full-term pregnancy, the pH of amniotic fluid is from 6.98 to 7.23; P about varies from 120 to 78 mm RT. Art.

1 1 kcal \u003d 4187 10 3 J (4187 kJ).

Prenatal preparation of pregnant women for childbirth.

Preparation of a pregnant woman for childbirth should begin from the moment a pregnancy is diagnosed.

The essence of all activities is reduced mainly to the following:

Psychoprophylactic or physioprophylactic preparation,

The establishment of an individual diet and labor regime,

Obtaining general and special hygienic knowledge necessary to ensure the health of the matter of the unborn child.

Psychoprophylactic preparation of pregnant women for childbirth is a complex of measures, including physiotherapy exercises, ultraviolet radiation and special classes.

The method of psychoprophylactic preparation of pregnant women for childbirth is based on the doctrine of the essence of labor pain, in the formation of which not only irritation of the nerve endings from the uterus and other genital organs, but also the conditioned-reflex component associated with the effect on the second signaling system takes part. It is recognized that the leading role in the occurrence of pain belongs to the cerebral cortex.

The essence of the method is to verbally reduce excitation in the subcortical centers and balance the processes of excitation and inhibition in the cerebral cortex.

The purpose of psycho-preventive preparation is to eliminate the fear of childbirth and other negative emotions that arise during pregnancy, to develop and consolidate the idea of \u200b\u200bthe birth act as a physiological and painless process, in the upbringing of a new positive feeling associated with upcoming motherhood.

Psychoprophylactic preparation for childbirth begins with the first visit by a woman to a antenatal clinic. The doctor finds out the social and living conditions of the pregnant woman, her attitude to pregnancy and the upcoming birth, the presence of bad habits. A woman is introduced to the rights of pregnant and lactating mothers and their benefits. The doctor finds out whether the woman has a fear of childbirth, convinces the pregnant woman of the need for special preparation for childbirth, which helps to eliminate pain. The doctor should strive to have a beneficial effect on the psyche of the pregnant woman, constantly emphasizing that childbirth is a physiological act and their course largely depends on the woman’s preparedness for childbirth and motherhood.

From the 30th week (the beginning of the antenatal maternity leave), classes are held especially thoroughly. With good preliminary preparation, they are limited to 4-5 classes so that the latter takes place 6-7 days before delivery. With late registration, the pathological course of pregnancy, a burdened obstetric history, extragenital pathology, the number of classes increases to 6-9, they are carried out individually 2 basics per week. Healthy pregnant women are engaged in groups of 8 to 10 people, which, if possible, are composed of women of the same emotional type.

First lesson.Brief information is given to pregnant women about the anatomical structure of the female genital organs, about the uterus as a fetus, and the organ of nutrition of the fetus. Information is given on the development of the fetus, its position in the mat, the role of the placenta, amniotic fluid. The essence of the changes in the body of the pregnant woman, providing the physiological course of pregnancy and childbirth, is explained.

The second lesson.The idea of \u200b\u200bchildbirth as a physiological act, of those periods of childbirth is given. The features of the right period of childbirth, the subjective sensations of the woman giving birth are explained, the concept of contractions, their duration and regularity is given. It describes the mechanism of smoothing and opening the cervix, the role of the fetal bladder and amniotic fluid.

The third lesson.Explains how to behave with the appearance of contractions and throughout the first period of childbirth. It is indicated that pain and contractions should not be identified; in many women, contractions are completely painless. Women are taught special techniques with which to reduce pain: proper, uniform and deep breathing during contractions; light stroking the anterolateral surfaces of the abdomen on inhalation and exhalation; stroking the skin of the lumbar region; pressing the skin with the thumbs to the inner surface of the iliac scallop in both anteroposterior awns; punching the points corresponding to the outer corners of the Michaelis rhombus; bout scoring; rest and, if possible, an attempt to nap between contractions. Pregnant women should learn these techniques well and perform them accurately. At the end of the lesson, reasons that can aggravate the pain during childbirth (fear, restless behavior, and a full bladder) are explained. It must be emphasized that these causes are easily eliminated in childbirth by the correct behavior of a woman.

The fourth lesson.An idea of \u200b\u200bthe course of the second and third periods of childbirth, the nature of the sensations of the woman in labor at this time is given. Rational positions are recommended at the beginning and at the end of the period of exile, when the woman in labor should exert maximum physical and mental efforts, be able to hold her breath to increase the effectiveness of attempts and relax the muscles at the time of birth of the fetal head. It is emphasized that the duration of the second period of childbirth depends not only on the correct use of techniques, but also on sufficient physical fitness. It is recommended at home to repeat the proposed techniques for their full assimilation. It tells about the course and content of the last period, its duration, the nature of fights. Women learn the correct behavior at the birth of the afterbirth.

The fifth lesson.As a rule, this is the final lesson, which controls the assimilation of the material of past classes. It tells about the order and situation in the maternity hospital, about the rules of asepsis and antiseptics. It gives an idea of \u200b\u200bmandatory and possible treatment and diagnostic measures (external and vaginal examination, opening of the fetal bladder, intravenous and intramuscular injections, inhalation of oxygen, etc.). Their validity and necessity for a successful course and completion of childbirth are explained.

It is useful to combine the psychoprophylactic preparation of pregnant women for childbirth with ultraviolet radiation (UV), which improves the functional state of the nervous system of the endocrine glands, increases the body's resistance to infections, and helps normalize the metabolism of vitamins. Ural federal district is carried out according to the method proposed by A.A. Lebedev. Up to 16 weeks of pregnancy, 10 sessions of total ultraviolet irradiation with an intensity of 0.25 - 1.25 biodoses are prescribed, during pregnancy 16 - 31 weeks - 10 sessions with an intensity of 1.25 - 1.5 biodoses and at 32-40 weeks - 20 sessions with an intensity of 1, 5 - 2.5 biodoses.

Psychoprophylactic preparation of pregnant women for childbirth should be combined with physical exercises, which are recommended from the very beginning of pregnancy. Systematic physical education increases the body's resistance to infection, strengthens the nervous system, gives a sense of vitality, improves general condition, appetite, sleep, the work of the cardiovascular system, respiration, and the gastrointestinal tract. Exercise strengthens the muscles of the pelvic floor, anterior abdominal wall, eliminates congestion in the pelvis and lower extremities, contributing to the normal course of the birth act and the postpartum period.

Physical education classes are conducted more often in groups led by an instructor and physiotherapy exercises or a specially trained midwife. It is allowed to perform exercises at home after appropriate training, while the correctness of the exercises is checked every 10 days.

It is recommended to engage in physical education in the morning before meals or after 1 - 2 hours after breakfast in a well-ventilated area, in loose, non-restrictive clothing. The duration of classes should not exceed 15-20 minutes. The complex of exercises should not cause pregnant fatigue, shortness of breath, palpitations, shortness of breath, etc. Jumps, considerable straining, sharp movements are excluded.

Contraindications for classes:

Acute infectious diseases

Decompensated diseases of the cardiovascular system,

Liver and kidney disease

Pregnancy complications (gestosis, threat of miscarriage, bleeding during

pregnancy).

In addition to physical education, other means of hardening are also used: walks in the fresh air, air dosed baths, vitamin therapy, a rational diet, etc.

Drug preparation for childbirth.

Drug preparation for childbirth can be carried out in cases where there is no natural readiness of the body for childbirth to prevent overtaking and anomalies of labor, as well as to prevent fetal hypoxia in childbirth.

Anesthesia for childbirth.

Since pain depletes the body of the woman in labor and disrupts the normal course of labor, it must be eliminated.

The following requirements are imposed on drug anesthesia for childbirth:

The complete safety of the anesthesia method for both the mother and the fetus;

The absence of a depressing effect on labor;

Shortening the birth certificate;

Prevention and elimination of spasm of the muscles of the cervix and lower uterine segment;

Adequate analgesic effect;

Preservation of consciousness of the woman in childbirth;

No harmful effects on lactation and the postpartum period;

Availability of anesthesia method.

Schematic sequence of action for labor pain relief.

1. At the beginning of labor during relatively painless contractions, tranquilizers are prescribed to relieve stress and fear (trioxazine –0.6 g, seduxen 0.01 g).

2. With the development of regular labor and the appearance of severe pain in contractions, combined or independent use of inhaled or narcotic analgesics in combination with sedatives and antispasmodics (nitrous oxide inhalation, intravenous injection of analgin, baralgin, no-shpa, papaverine) is used. Perhaps the use of acupuncture, electroanalgesia.

3. In the absence of effect or the presence of special indications, prolonged epidural analgesia (DPA) is used.

DPA has a number of advantages, which include high efficiency (full anesthesia is achieved in 90-95% of cases), the simplicity of the instruments used, the ability to preserve the patient’s consciousness, the presence of sympathetic blockade that improves blood supply to the uterus and kidneys, the absence of a depressing effect on labor and intrauterine state fetus and newborn. DPA is indicated for pain relief in both normal births (in the absence of the effect of other methods of pain relief) and pathological births (complicated by gestosis, diseases of the parenchymal organs, and cardiovascular system).

4. Inhalation anesthesia methods. In order to anesthetize labor, nitric oxide, trilene, methoxyflurane mixed with oxygen are currently used with anesthesia devices such as NAPP. In addition, triylene and methoxyflurane can be used mixed with air using portable analgesics.

5. Anesthesia with narcotic analgesics. The only drug related to narcotic analgesics that have found use in childbirth is promedol. It should be remembered that promedol inhibits the respiratory centers of the fetus, so you can use it no later than two hours before the birth of the fetus. Promedol is administered intravenously or intramuscularly, alone or in combination with other drugs. For example: promedol 20 - 40 mg, relanium (or seduxen) - 10 mg, isoverine - 50 mg; promedol - 20 - 40 mg, diphenhydramine - 20 m, no-spa - 40 mg.

6. Therapeutic obstetric anesthesia. Indications for treated anesthesia are prolonged childbirth, discoordination of labor, fatigue of the woman in childbirth. After intramuscular premedication with promedol (10-20 mg), diphenhydramine (10 mg) and atropine (0.5-1 mg), GHB in a dose of 50-60 mg / kg is administered intravenously. It is possible to use seduxen (10 mg) and barbiturates in a dose of 3-5 mg / kg.

The main participant in the birth process is a pregnant woman, it will depend on her how the birth will take place. It is very important to prepare for them physically and psychologically in advance in order to come to give birth and not be afraid of anything. Of course, you won’t be able to completely get rid of pain and fear, especially for those who are waiting for the first-born, but to gather all their will into a fist, tune in and give birth to a healthy and strong baby will definitely come out. In this article, we will tell women what you need to know about childbirth and how to prepare for them correctly.

Pregnancy and childbirth - this is a very big burden on the female body, to cope with which the future mother will help only good physical preparation. Every woman must always pay attention to sports in her life, not only in order to have a beautiful and fit figure, but also to make it easier for her in childbirth.

Of course, during pregnancy, a woman cannot afford to go to the gym, pump the press and perform heavy physical exertion, but she needs to do as much as possible to move, walk, swim in the pool and perform special exercises to prepare for childbirth. You can learn how to do them at home yourself, because a huge number of relevant video lessons are published on the Internet, or you can sign up at the fitness center, where pregnant women are given courses for childbirth.

If you decide to study at home yourself, then we will tell you a set of training classes that you need to perform every day. All of them are aimed at preparing the muscles of the intimate area for childbirth. In medicine, they received the name "Kegel gymnastics":

1. First you need to learn how to strain and relax the vaginal and anus muscles. It is very simple - imagine that you specifically retain urine while urinating. To do this, you need to either lie on your side or sit in any position convenient for you and try to perform the exercise. Doctors recommend starting to practice it from the 15th week of pregnancy, when the placenta has fully formed, and there is no threat of abortion. It is advisable to perform this exercise at least 30 times a day. They will help the woman prepare the cervix for childbirth and the perineum to avoid tears during natural childbirth. After such an exercise, you can lubricate the perineum with Weleda oil, an excellent remedy that is recommended for all women preparing for childbirth (it is a prophylactic for tears).

Important! Closer to the date of delivery, the doctor may prescribe you to take special pills that prepare the cervix for childbirth (they will have a softening effect on it). In no case should they be taken earlier so that the pregnancy does not end.

1. It is also very important to perform exercises for stretching the muscles of the perineum. It will be enough if you are within 10 minutes. every day you will do one of the following:

• stand with your back to the chair, grip it firmly with your hands to firmly stand on your feet, and then do not sharp, but smooth lifts with each leg first to the side and then forward - when you raise the leg forward, you can bend it a little in the knee (try while raising your legs as high as possible);
• spread your legs as wide as possible, and then do a slow deep squat (while springing for a few seconds), and then slowly rise to its original position;
• squat down, stretch your arms forward to maintain balance, and then first put one foot to the side, swaying a little on it and transferring all its weight to it, and then do the same thing on the other leg;
• stand straight, firmly pressing the heels to each other - in this position you need to try to sit down without lifting your heels off the floor, keeping your back straight;
• squat down and just walk around the room in gander for 5-10 minutes;
• during the day when you will do some homework, sit in the pose of a butterfly or a frog.

If you correctly perform all the exercises that we have described to you, then you will only benefit yourself from this:

• strengthen your cardiovascular system
• help your baby develop in the womb
• help boost your own immunity
• prepare your body for the physical stresses that you will have to go through during childbirth
• reduce the likelihood of complications during labor
• can recover quickly after you give birth

Just be sure to keep in mind that you should not overwork and get tired. If you feel that it’s already very hard for you, then just stop and go outside to get some air, just walk around slowly. In general, it is advisable if you are not sure that you can cope with the exercises at home, to be led by a trainer who will take into account your preliminary physical preparation, especially the course of pregnancy and your state of health. At any moment, a professional will provide you with qualified assistance so that you avoid the negative consequences of training.

In addition to special gymnastics, a pregnant woman must attend massage sessions that:

• relieve muscle tension in her lower back and legs
• contribute to the prevention of edema
• improve blood circulation so that the child does not suffer from a lack of oxygen
• give energy to the expectant mother and add good mood

In addition, you must prepare your breasts for breastfeeding yourself. To prevent mastitis during lactation and cracks on the nipples, you need to do the following beforehand:

• take a contrast shower more often - it perfectly massages the nipples;
• rub your nipples with ice cubes;
• rub your breasts gently with a bath towel;
• walk around the house with your chest open as often as possible so that it breathes;
• ask your husband, although you can completely cope on your own, pull the nipples so that they get an elongated shape.

By the way, in the process of preparing for childbirth and breastfeeding, you can also use special oil. Just go to the pharmacy and find out which remedy will help you on your due date.

Respiratory preparation for childbirth

Every person should have the ability to breathe correctly. It is important not only to inhale and exhale air, but also to fill them with all internal organs, every cell of your body, in order to feel good. It is especially important to be able to do it for pregnant women who are responsible for the supply of oxygen to the body not only for themselves, but also for the man growing in their tummy.

According to the reviews of women who have been trained for childbirth, you need to learn how to breathe correctly in order to alleviate your pain during labor. Do breathing exercises very carefully, because dizziness and nausea may occur. What you can learn to do on your own at home:

• Place your hands on the ribs, and then take a deep breath with your nose, and then exhale as deeply, but through your mouth. So you will train chest breathing.
• To develop diaphragmatic breathing, you need to learn how to breathe air through the diaphragm, and exhale, redirecting the entire load on the stomach. Inhalation should occur within 5 seconds, and exhale within 7 seconds.
• It is equally important to train rhythmic breathing. Everything is simple here: inhale deeply the air with your chest, hold it for 3 seconds, and then take a deep breath.
• It is very important to learn how to breathe correctly in a doglike manner. Get on all fours, stick out your tongue and breathe often. If you do this during the birth process (meaning during the longest and most painful stage), then it will be much easier for you to survive this difficult stage.

Childbirth: psychological preparation

Pregnancy is not only a physical burden on the body, but also a psychological one. In women, hormones that affect the non-psycho-emotional system constantly make themselves felt. The expectant mother can cause her to cry, get nervous, act up, and then calm down dramatically. But if in the process of bearing a child this is not very scary, then during childbirth it will be necessary to reorganize and calm down. Therefore, psychologists recommend that for every 9 months every woman who expects the birth of a baby take psychological training for childbirth. They help a woman not only put her nervous system in order, but also realize that she will soon become a mother.

What else can help a pregnant woman to prepare for childbirth before she gets to the hospital:

1. Sign up for a group for pregnant women, which conducts classes on various topics related to childbirth and caring for the baby. Talking with women who are in the same position as you will benefit you.
2. Read as many different books as possible, participate in forums and discussions. Engage in self-education to feel more confident when you give birth. Of course, because of stress, you can forget something, but after you see your baby on your chest, you will immediately remember everything.
3. Go to yoga. It will help you to properly adjust to childbirth, imagine them, visualize the moment when your baby appears, who with its tiny arms will hug you.
4. Relax more often. Go for a walk, listen to pleasant music, relax, get positive emotions in order to always feel balanced and calm.

Try to prepare for childbirth comprehensively during pregnancy, but if something does not work out, do not be discouraged. All knowledge will come to you with experience in the process of educating a little man. The main thing is to take care of your health, because the well-being of the child, which counts on you, depends on you.

Video: “Preparation for childbirth through the eyes of a pediatrician”