Preparation for Childbirth

Preparation for Childbirth

Previously, the term natural childbirth was used to describe one approach to giving birth. To some, natural childbirth meant delivery without analgesic or anesthesia, whereas to those who had developed the approach it simply meant being prepared for childbirth through prenatal education and training. This preparation gave the woman a method of coping with the discomforts of labor and delivery. To avoid the suggestion that analgesia or anesthesia is unavailable to the woman during labor and delivery should she need it, the term prepared childbirth is now used instead of natural childbirth.

Method of Grantly Dick-Read

• This method is based on the idea that fear and anticipation of pain arouse natural protective tensions in the body, psychic as well as muscular.
• Fear stimulates the sympathetic nervous system and causes the circular muscle of the cervix to contract.
• The longitudinal muscles of the uterus then have to act against increased cervical resistance, causing tension and pain.
• Tension and pain aggravate fear, which produces a vicious cycle of tension, pain, and fear.
• A minor degree of pain, magnified by fear, becomes unbearable.
• According to Dick-Read, prenatal courses and training reduce fear, overcome ignorance, and build a woman's self-confidence. Included in this method are:
• Explanations of fetal development and childbirth.
• Descriptions of methods available to relieve pain.
• Exercises that strengthen certain muscles and relax others.
• Breathing techniques that will enable the woman to relax in the first stage of labor and work effectively with muscles used during delivery.
• Explanations of the value of improved physical health and emotional stability for childbirth.
• The woman is not told that labor and delivery will be painless; analgesia and anesthesia are available if needed or desired.
• The woman is given empathic understanding and support during labor by her partner, the nurse, and the health care provider.

Psychoprophylactic or Lamaze Method

• Psychoprophylactic childbirth has a rationale based on Pavlov's concept of pain perception and his theory of conditioned reflexes (the substitution of favorable conditioned reflexes for unfavorable ones). The Lamaze method is an example of this technique.
• The woman is taught to replace responses of restlessness, fear, and the loss of control with more useful activity. A high level of activity can excite the cerebral cortex efficiently to inhibit other stimuli such as pain in labor
• The mother-to-be is taught exercises that strengthen the abdominal muscles and relax the perineum.
• Breathing techniques to help the process of labor are practiced.
• The woman is conditioned to respond with respiratory activity and disassociation or relaxation of the uninvolved muscles, while controlling her perception of the stimuli associated with labor.
• One method of control consists of breathing normally while silently mouthing the words to a song and simultaneously tapping the rhythm with the fingers.
• Similarity between the Dick-Read and Lamaze methods:
• Fear, which enhances the perception of pain, may diminish or disappear when the woman understands the physiology of labor.
• Because psychic tension enhances perception of pain, relaxation is achieved more easily in a calm, agreeable atmosphere with supportive people nearby.
• Muscular relaxation and a specific type of breathing diminish or abolish the pains of labor.

The Bradley Method of Delivery/ Husband-Coached Childbirth

• Commonly referred to as husband-coached childbirth, although the coach is not necessarily the husband of the woman.
• Involves the concepts of leading, guiding, supporting, caring, and fostering specific skills and confidence.
• Coaches attend classes and learn to help the woman long before labor begins.
• The coach serves as a conditioned stimulus using the sound of his or her voice, use of particular words, and repetition of practice.
• Medications are not encouraged for pain relief. Relaxation is the core component. Increased tolerance to pain is accomplished by decreased mental anxiety and fear, which ultimately decreases the awareness of the pain stimulus. Occurs with cognitive and physical rehearsal.