Physio-psychoprophylactic preparation of pregnant women for delivery of high-risk groups

Older primiparous women. A clinical analysis of the course of pregnancy and childbirth was conducted in 400 older women who had undergone physiopsychoprophylactic training. This method makes it possible to significantly reduce:

• the frequency of late toxicosis during pregnancy and childbirth;
• frequency of birth of children with large birth weight (more than 4000 g);
• 3 times the incidence of threatened and incipient fetal hypoxia;
• frequency of operative deliveries;
• total duration of labor;
• volume of blood loss in the afterbirth and early postpartum periods;
• perinatal mortality and morbidity.

It is important to take into account the characteristic features of their condition and physical development that we have identified:

• the presence of an excited, anxious neuropsychic state; an acute desire to have a child, fear of the possibility of losing it during childbirth, fear of childbirth, insomnia, restless sleep;
• manifestation of age-related involutional changes in the body: impaired speed of perception, assimilation, slow development of motor skills, movement stereotypes, insufficient coordination of movement, limited mobility in the joint articulations, in particular, in the hip;
• increased sensitivity and resentment to comments and jokes;
• vegetative neuroses with peripheral circulatory disorders;
• metabolic disorder;
• significant frequency of the presence of concomitant diseases;
• Along with the possible presence of the indicated deviations from the norm, in the general condition of primiparous women over 30 years of age, very good endurance is noted.

Pregnant women suffering from obesity. Characteristic features of their health condition:

• overweight;
• metabolic disorders;
• often the presence of diseases of various organs and systems of the body that are the cause of obesity or arise as a result of obesity;
• disruption of external respiration function (shallow, asynchronous, uncoordinated - chest inhalation with simultaneous diaphragmatic exhalation);
• tendency to hypoxia and hypoxemia;
• slow progression of inhibitory-excitatory processes in the central nervous system;
• tendency to vascular dystonia (hypertension, hypotension);
• violation of rational nutrition;
• tendency to develop late toxicosis of pregnancy;
• birth of large children weighing 4000 g and above. Arterial hypotension of pregnant women. Characteristic features of their condition:
• low blood pressure (not higher than 100 mm Hg);
• rapid fatigue;
• decreased endurance;
• lability of vasomotor reaction, tendency to vascular dystonia;
• lability and instability of heart rate, tendency to tachycardia;
• frequent headaches;
• dizziness;
• restless sleep;
• lethargy and apathy;
• relatively weakly expressed sense of motherhood.

Pregnant women with inflammatory diseases of the internal genital organs. This group of pregnant women is characterized by:

• absence of subjective complaints;
• tendency to spontaneous miscarriages and premature births;
• high percentage of placental attachment anomalies.

The specifics of preparation for childbirth are as follows:

• significant limitation of physical activity in the early stages of pregnancy. Activities that include elements of sports and swimming in natural bodies of water are absolutely contraindicated. Sportswomen should stop training and participating in competitions;
• from the 14th week of pregnancy, special gymnastics classes of the therapeutic type. Mainly breathing exercises and exercises that improve blood and lymph circulation in the pelvic organs and uteroplacental circulation;
• at the first signs of a threatened miscarriage, immediate hospitalization;
• after persistent elimination of the threat of termination of pregnancy, continuation of the FPPP until childbirth in a special group;
• Pregnant women with a history of previous inflammatory diseases of the internal genital organs are recommended to take general light and air baths and ultraviolet irradiation in a light room or aerophotorium, undergo hydrotherapy, but with warm or indifferent temperature water, undergo hydroaeroionization, and undergo oxygen therapy.

Varicose disease in pregnant women. Characteristic features of the general condition of pregnant women with varicose disease are:

• vascular system deficiency;
• phlebectasis, due to stretching of the venous system;
• blood stagnation in the nodes of dilated veins;
• pain in the lower limbs and impairment of their function;
• abnormalities of placental attachment and premature detachment;
• frequent and significant postpartum and early postpartum bleeding.

Preparation for childbirth for pregnant women with other extragenital diseases and deviations from the norm in health.

These conditions either do not require allocation to special groups, or are subject to preparation by combining them into groups consisting of 3-6 people (heart defects, hypertension stage I-II, myocarditic cardiosclerosis with circulatory disorder stage I, neurocirculatory dystonia, etc.).

According to the clinical picture, these pregnant women have much in common with those suffering from arterial hypotension: rapid fatigue, decreased performance, greater sensitivity to changes in meteorological conditions, sleep disorders, emotional lability, headaches.

We prepare these pregnant women for childbirth in the same way as we prepare pregnant women suffering from arterial hypotension.

Physical factors in the FPPP system.

The specifics of preparation for childbirth are as follows:

• physical education of pregnant women with the definition of goals, objectives, and means;
• familiarization with general provisions on preparing pregnant women for childbirth based on the principles of physical education;
• regulation of lifestyle and daily routine;
• regulation of the physical activity of pregnant women;
• special gymnastics classes;
• lectures and discussions by an obstetrician-gynecologist and a methodologist-instructor;
• group implementation of all major events.

Method of autogenic preparation of pregnant women for childbirth.It seems possible to use autogenic training in obstetrics in 3 variants:

• 1 - as a form of psychotherapeutic intervention for certain concomitant diseases or diseases that arise during pregnancy (functional disorders of the nervous system, early stages of hypertension, etc.);
• 2 - as an element in the general system of preparing pregnant women for childbirth using the method of psychoprophylactic or FPPP of pregnant women for childbirth;
• 3 - as an independent form of preparing pregnant women for childbirth.

Autogenic training is fundamentally different from what forms the basis of psychoprophylactic preparation for childbirth, the main goal of which is to eliminate fear and established ideas about the presence of pain during childbirth.

Autogenic training combined with elements of physical training should be considered as a method of comprehensive preparation of a woman for childbirth, teaching her to mobilize all systems of her body for childbirth. Elimination of the pain component is included in the general system of preparation, but it should not be the only or main element of the classes. Pain cannot be considered in isolation from all processes occurring in a woman's body during pregnancy and childbirth.

Consequently, the essence of training pregnant women according to the recommended methodology should be reduced to the pregnant women mastering self-regulation techniques and the ability to self-hypnosis.

Practice has shown that this can be achieved, however, the method of autogenic training, its mechanism of action, the effect on the body of a pregnant woman and a woman in labor, the antinociceptive system, endogenous opiates, and the method of application require further study.