Childbirth Preparation and Concerns

Education for expectant parents has played an increasingly important role in recent years. In many obstetrical clinics throughout the country a series of six to eight sessions is given, usually at weekly intervals. These generally begin when the pregnancy is six to seven months along. Much of the mystery of the experience to come is cleared away by comforting understanding of the development of the fetus, body changes related to pregnancy, and the mechanism of labor. These courses are given by the American Red Cross, the Child Study Association of America, the Maternity Center Association of New York, and by most of the large teaching centers.

The expectant mother immediately gets heartening assurance that the risk of childbirth is scarcely greater than the risks of living without pregnancy. A half-hour trip by car on a congested highway is a distinctly greater hazard. The achievements of modern obstetrics are of course closely related to advances in all fields of medicine.
Concerns

The concerns regarding child birth preparaion are:

Exercises

Exercises which develop muscles important in labor (principally of the abdomen, back, and pelvic floor) are practiced. Breathing exercises are particularly stressed as an aid during labor. The rhythmic activity of breathing has a calming effect, gives the woman in labor something to concentrate on, and helps to disassociate uterine contractions from overall tensions of the entire body. The first stage of labor is that during which contractions gradually increase in frequency and intensity. Slow, long, deep breathing is practiced for application in the early and middle parts of the first stage. Shallow, rapid breathing is substituted when first stage contractions become strong, on the verge of transition to the second stage of labor which terminates with expulsion of the baby. During the transition from first to second stage, a “pant, pant, blow” rhythm of breathing prevents pushing or bearing-down effort before the neck of the uterus is fully dilated. The “blow” part is exhalation through parted lips without contracting the abdomen.

Finally, in the second stage of labor, long “pushing” similar to that practiced with a bowel movement is substituted. As the baby’s head is born, rapid panting breaths begun at the obstetrician’s command help to prevent injury to the mother’s tissues as the head emerges.

These well known special breathing rhythms are excellent for lessening the pain in labor by giving the mother a distracting and useful activity with assurance that everything is proceeding normally. Constant attention of an obstetrician or obstetrical nurse is necessary for best results with these techniques that the patient has practiced.

A great advantage of “training for childbirth” is that the need for sedatives at delivery is almost always reduced. High or even moderate doses of pain relieving drugs may depress the onset of breathing in the newborn. Small amounts of sedation are necessary in most labors, but large or frequent doses are practically always unnecessary in the “educated” patient.

A woman may not desire or be able to attend formal preparation classes. The gap can be bridged very satisfactorily by conversations with the obstetrician and a “learn as you go” course guided by the obstetrical nurse during the actual progress of labor.
Hypnosis

True hypnosis goes far beyond suggestibility, distraction and reassurance instilled in preparation for childbirth classes. The obstetrician must spend a great deal of time in inducing and releasing the patient from the hypnotic state, and his almost constant attendance is necessary. Patients suitable for and desirous of hypnosis are usually rather carefully selected. Hypnosis, although dramatic in its relief of pain, is not a routine technique but one useful in particular circumstances. There is a tendency for a patient prepared for a normal delivery to be taken by surprise by complications. She may wish and expect events to continue normally although some complication may compel a departure from her expectations. Thus, childbirth preparation courses stress that there are particular considerations which may require anesthesia, forceps delivery, or even cesarean section, which are unpredictable but which the obstetrician will recognize and deal with effectively.