Obstetrics and Gynecology - A.M. Gromova 2000

Pain management in labor
The method of psychoprophylactic preparation of pregnant women for childbirth

The method was developed in 1948 by a team of Kharkiv researchers led by Professor K.K. Platonov. To this day, it remains widely used in healthcare institutions across our country and several European nations, including Romania, the Czech Republic, Italy, and France.

It comprises three main components. The first involves individual and group counseling, tailored to the woman's psychological state and a thorough medical history. The second consists of group exercise classes led by an instructor and supervised by an obstetrician-gynecologist. The third utilizes natural factors—light, air, and Water—to strengthen and condition the body, alongside physical therapy modalities.

Prenatal psychoprophylactic preparation is conducted in antenatal clinics and consists of six sessions.

Session 1 (individual).

An Introduction to the pregnant woman's personal profile (family circumstances, education, medical history, employment, and the course of the current Pregnancy), her attitude toward childbirth, and The history of previous labors or abortions.

All subsequent sessions are conducted in groups.

Session 2: Pregnancy and Childbirth as a Physiological Process.

Hygiene during pregnancy. The Anatomy of the FEMALE REPRODUCTIVE Organs and the physiological changes they undergo during gestation. A General Overview of the stages of labor.

Session 3: Preparation for The First stage of Labor.

Signs of the onset of labor, The Nature of uterine contractions, and The Mechanism of cervical dilation. Instruction in self-pain relief techniques:

- deep breathing;

- abdominal stroking and lower back rubbing;

- stimulation of pain-relief pressure points (the inner surface of the anterior superior iliac spines or the outer corners of Michaelis rhombus).

Session 4: Preparation for الولادة (Second Stage of Labor).

Signs of the onset of the second stage of labor and the mechanism of delivery. Expectant mothers are instructed on proper behavior during this stage, including practicing pushing techniques (lying on the back, pressing the lower jaw to the chest, pulling thighs toward the abdomen, and breath-holding). They also learn behavioral guidelines for the crowning of the fetal HEAD (deep breathing, releasing bearing-down efforts). Finally, An Overview of the Third Stage of labor and maternal behaviors that facilitate its normal progression is provided.

Sessions 5 and 6: The Joy of Motherhood.

These sessions focus on the postpartum period and neonatal care.

During home patronage visits by the midwife and at routine check-ups, the knowledge gained during psychoprophylactic preparation is reinforced.

Psychological preparation should be combined with physical conditioning. This includes a specialized set of gymnastic exercises led by a trained midwife or physician. Additionally, combining this with general ultraviolet (UV) irradiation is beneficial, particularly during the winter and spring months, as it enhances the functional state of The Nervous system and Endocrine glands, boosts the body's resistance to infections, and promotes vitamin METABOLISM. UV therapy is administered According to the method proposed by A.A. Lebedev: up to 16 weeks—10 sessions at an intensity of 0.25–1.25 biodoses; at 16–31 weeks of gestation—10 sessions at 1.25–1.3 biodoses; at 32–40 weeks—20 sessions at 1.5–2.5 biodoses.

Psychoprophylactic preparation for childbirth must be integrated with physical exercises recommended from early pregnancy. Their purpose is to improve Blood Circulation and oxygenation for both the fetus and the mother. The exercise regimen depends on the gestational age. Physical activities are recommended in the morning before meals or 1–2 hours after breakfast, wearing special non-restrictive clothing. Sessions should not exceed 15–20 minutes. If exercises cause fatigue, shortness of breath, or palpitations, they should be moderated and a physician consulted. Jumping, heavy straining, and sudden movements must be excluded from the routine. Physical exercises are recommended solely for healthy women experiencing an uncomplicated pregnancy.

Additionally, pregnant women should incorporate other conditioning practices, such as outdoor walks, river and sea swimming, and graduated air baths.

Stays in rest homes and sanatoriums are of great significance. Childbirth preparation initiated in the antenatal clinic is subsequently continued in the inpatient Setting.