Obstetric psychoprophylaxis what it is for and exercises

The obstetric psychoprophylaxis is a tool used for the comprehensive preparation (theoretical, physical and psycho-affective) that is provided during pregnancy, delivery and / or postpartum, to achieve an optimal, positive and healthy obstetric journey for the mother and her baby, guaranteeing them a satisfactory and happy, while the participation and active role of the father is strengthened. It is what has been publicly disseminated as "labor without pain". 

The objective of obstetric psychoprophylaxis (PPO) is to train a pregnant woman fully prepared for before, during and after childbirth, while serving as a strategy to reduce maternal and perinatal morbidity and mortality from achieving a mother and a baby. healthy children, considering education as an important instrument for health promotion.

The current concept of obstetric psychoprophylaxis implies that it will always be positive that the pregnant woman receives the preparation even at the end of her pregnancy, since she will receive advice and training that will allow her to respond in a better way and collaborate at the time of delivery, which is called emergency obstetric psychoprophylaxis.

Article index

• 1 What does? 
  • 1.1 Theoretical preparation (or cognitive dimension)
  • 1.2 Physical preparation (or behavioral dimension)
  • 1.3 Psycho-affective preparation (or attitudinal and emotional dimension)
• 2 What is it for? 
  • 2.1 Advantages for the mother
  • 2.2 Advantages for the newborn
  • 2.3 Advantages for the healthcare team
• 3 Exercises 
  • 3.1 -Session 1
  • 3.2 -Session 2
  • 3.3 -Session 3
  • 3.4 -Session 4
  • 3.5 -Session 5
  • 3.6 -Session 6
  • 3.7 -Other
• 4 References

What does it consist of?

It consists of achieving an adequate theoretical, physical and psycho-affective preparation that will lead to the happy culmination of pregnancy and childbirth..

Each element contemplated has specific objectives to meet in the three dimensions involved:

Theoretical preparation (or cognitive dimension)

Provide real and timely information to the pregnant woman and her partner so that they know and understand the aspects related to their obstetric journey.

Information related to the birth process and its implications in the different stages is provided here: pregnancy, childbirth and postpartum.

Physical preparation (or behavioral dimension)

Give physical training to the pregnant woman with the support of her partner so that she obtains physical and mental benefits.

This is achieved through respiratory activity techniques, calisthenics, obstetric gymnastics, neuromuscular relaxation techniques, analgesic positions and / or localized massages, among others..

Psycho-affective preparation (or attitudinal and emotional dimension)

Provide emotional support to the pregnant woman and her partner that allow them to enjoy the arrival of the newborn without fear or negative ideas. Renal stimulation is circumscribed here. This dimension is related to each phase of the birthing process.

What is it for?

It serves to:

• Empower the pregnant woman and her partner regarding health care, generating in them a culture of prevention.
• Give knowledge of the warning signs, special care, signs of the beginning of labor, childcare, postnatal recovery, birth plan, among other components.
• Prepare the pregnant woman and her partner to achieve a better pregnancy, delivery and recovery.
• Develop skills that allow to competently face the process of pregnancy, childbirth and postpartum; strategies for fears and annoyances (pains), relaxation techniques, relationship and communication skills.
• Achieve permanent tranquility, security and well-being in the pregnant woman and her partner.
• Generate predisposition to accept changes in one's own body, sexuality and relationship with the partner.
• Contribute to the disposition to help the newborn to establish an affective bond, as well as to attend to their needs within a positive emotional climate.
• Acceptance of the emotional implications regarding the type of delivery and feeding of the baby.

Additionally, it has a whole series of advantages for the mother, the newborn and for the health team involved in its care..

Advantages for the mother

• Lower degree of anxiety.
• Adequate response during uterine contractions.
• Avoid unnecessary and repeated evaluations prior to admission for the care of your delivery.
• Shorter duration of total labor time.
• Less drug use overall.
• Lower risk of obstetric complications.
• Better bond with the baby, being able to enjoy it in a natural and positive way.
• Less chance of a cesarean delivery.
• Faster and more comfortable recovery.
• Total suitability for natural lactation.
• Lower risk of postpartum depression.

Advantages for the newborn

• Better intrauterine growth curve.
• Lower rate of fetal distress.
• Lower rate of perinatal complications.
• Lower rate of prematurity.
• Better birth weight.
• Best state (apgar).
• Greater success with breastfeeding.
• Better growth and development.

Advantages for the health team

• I work in a climate with greater harmony.
• Greater trust, understanding and collaboration of the pregnant couple.
• Better distribution of work.
• Saving of human resources, materials and time.
• Encourages institutionalized childbirth in safe conditions.

Training

There is a whole series of techniques and exercises that have been designed to meet the objectives and enjoy the advantages mentioned above..

Before starting the obstetric psychoprophylaxis session, it is recommended to evaluate the pregnant woman to reduce any risk in her physical activity.

The possibility that the pregnant woman presents some sign or symptom that motivates the interruption of physical exercises should be considered.

The exercises will be distributed over six sessions, increasing their intensity, frequency and duration as they progress..

Each session deals with the 3 dimensions. Here we will reflect only the information concerning the behavioral dimension.

-Session 1

Breathing exercises

• Sighs and yawns.

Calisthenics

• Walk and march with music.
• Dance.
• Rotation of the head, trunk and limbs.
• Shoulder rotation.
• Hip mobilization.
• Foot mobilization.
• Postural changes in daily activities.

Obstetric gymnastics

• 26-beat stretching and balancing exercise.
• Pelvic swing exercise.
• Foot rotation exercise.
• Adductor stretch exercise.

Relaxation

• Relaxation positions
  • Standing with companion.
  • Sitting in chair or sphere.
• Ideal Relaxation Position (PIR)
  • Lying on your left side with appropriate material (mats, chairs, spheres, cushions, pillows) and soft music.

-Session 2

Breathing exercises and relaxation

• Same as Session One.

Calisthenics

• Arm circles.
• Tin Soldier.
• Lateral rotation.

Obstetric gymnastics

• Squatting (Exercise to make the spine more flexible, improve balance and posture, make the hip and lower limb joints more flexible and improve return circulation)
  • Initial Position: Standing straight spine, hands resting on the back of a chair, feet hip-width apart.
  • Movement: 1. Steep up until you are resting on your toes (Keep your spine erect). 2. Lower by bending your knees to a squat, it is important to keep your knees wide apart. 3. Swing your hips back and forth twice. 4. Swing your hips from left to right twice. 5. Rise with both legs at the same time until you are back on your toes. 6. Lower the heels and stay in the initial position (PI).
  • The two movements back and forth, make 4 times.
• Lateral spine stretch (Exercise to make the spine and lower abdominal area more flexible and improve return circulation. Reduces back pain or low back pain)
  • Initial Position: Standing straight spine, feet wide apart, arms extended to the sides at shoulder height.
  • Movement: Extend the spine to the right and then to the left, as if trying to touch the wall with the hand. Try not to bend your knees.
• Cat Exercise (Makes the spine and lower abdominal wall more flexible)
  • Initial Position: Leaning on hands and knees on the mat, spine straight, head upright looking straight ahead.
  • Movement: 1. Bend the spine upwards as if trying to touch the ceiling with the back, simultaneously inhale and turn the head downwards until it is between the shoulders. 2. Bend the spine down as if trying to touch the mat with the abdomen, inhale and exhale turning the head down and up. The elbows should not be bent.
• Seated localized stretch (For localized relaxation, relief and a feeling of rest. Makes the spine and lower abdominal wall more flexible)
  • Initial Position: Sitting on the mat in semi-pilot (legs crossed), straight spine, arms towards the body.
  • Movement: 1. Turn the head backwards, then forward, left and right, breathing harmoniously with the movements. 2. Rest the right hand on the head and the left hand on the shoulder on the same side, letting the head fall on the right shoulder. Do the same with the opposite side. 3. Raise the shoulders at the same time, as if meeting them with the ears and then release (2 or 3 times). 4. Rest the right hand on the left knee and the right hand behind the hip on the mat. Inhale and with the impulse of the arms turn to the left slowly, as if trying to look at the wall behind. Then repeat the same with the opposite side.
• These exercises are accompanied by pleasant and motivating melodies or sounds.

-Session 3

Breathing exercises, calisthenics and relaxation

• Same as Session Two.

Obstetric gymnastics

• Worship (To make the spine more flexible; it provides a sensation of rest especially in the back and pelvic floor. It reduces pelvic pressure and improves return circulation)
  • Starting position: Sitting on the feet, knees wide apart, spine straight, arms extended towards the body.
  • Movement: 1. Rotate the arms by the sides upwards, until they are well stretched as if trying to touch the ceiling. 2. Lower your arms in front of you until you rest your hands on the mat between your knees. 3. Extend yourself by sliding your hands forward until you are fully lying on the mat. 4. Bend your elbows and support your head on your hands. Mentally count to 5 and rest in this position, the hips should be kept as low as possible. 5. Extend the arms again and return to the IP walking backwards with the hands.
• Hip lift (To make the spine and abdominal wall more flexible. Medium rectus abdominis reinforcement. Reduces pelvic pressure)
  • Initial Position: Lying on your back, legs bent, knees apart, feet apart and resting on the mat, arms towards the body.
  • Movement: 1. Raise the hips slowly. You can use the support and impulse with the hands and elbows. 2. Lower slowly to PI, it can also be with the help of the hands and elbows.
• Kegel (Strengthens the perineal muscles. Improve control over this area. Prevents posterior prolapse)
  • Initial Position: Lying in supine position, legs extended, arms towards the body. Use pillows to support the head and lower limbs.
  • Movement: 1. Contract the muscles of the vagina (as if trying to hold the urine) progressively in 5 seconds. 2. Relax progressively at the same time.
  • In this exercise you can intersperse by contracting glutes, with and without vaginal muscles.

-Session 4

Breathing exercises and calisthenics

• Same as Session Three.

Obstetric gymnastics

• Twist with spinal flexion (Makes the spine more flexible, improves blood circulation, strengthens the back muscles and improves posture)
  • Initial Position: Sitting in a chair or semi-pilot, straight spine, hands clasped behind the neck, elbows wide apart, knees wide apart.
  • Movement: Turn the spine to the right and then to the left, with impulse of the elbows in four beats, each side is one beat. On the fifth beat, lower the right elbow to the knee on the same side slowly trying to touch it.
• Lateral stretch of lower limbs with garter (It makes the joints in the hip and lower limbs more flexible and facilitates return circulation)
  • Starting Position: Lying on your right side on the mat, right knee bent, right thigh towards the spine, right leg leaning back, left leg extended holding a garter or tape with the heel, right elbow bent to support the head with the hand, left hand holding the ends of the tape.
  • Movement: Pull on the garter or strap to facilitate lateral leg elevation as high as possible, then slowly drop the leg holding the garter (8 times each side with rest).
• Pelvic swing (sphere variant) (Makes the spine more flexible, reduces the sensation of pelvic pressure, improves balance)
  • Initial Position: Sitting on the sphere, straight spine slightly bent forward, hands resting on the knees, feet apart resting on the floor.
  • Movement: Swing your hips back and forth 8 times, keeping your hands on your knees for balance. Then swing it from right to left 8 times, finally make circles 4 to 8 times each side.
• Abdominal reinforcement with garter or tape (Strengthens the rectus abdominis while making lower limbs more flexible and facilitating return circulation)
  • Initial Position: Lying on your back, legs extended and together, arms towards the body holding the garter that is hooked on the foot as an aid to movements.
  • Movement: 1. Bend the knee, pulling the garter slightly outwards so as not to press the abdomen. 2. Extend the leg upwards with the help of the rubber band. 3. Go down to the side of the same side until you touch the floor, with the help of the rubber band. 4. Return to the starting position preferably without touching the ground, always with the help of the league.
• Squatting:
  • Postures for childbirth.
  • Positions for the second period.

Relaxation

• Shallow or deep relaxation
  • Relaxation in Ideal Position (PIR)
• Jacobson's progressive relaxation (used to control stress or anxiety)
  • Visit this link for details: https://psicologiaymente.com/clinica/relajacion-progresiva-jacobson

-Session 5

Breathing exercises

• Deep, gasping, and sustained breathing.

Calisthenics and relaxation

• Same as Session Four.

Obstetric gymnastics

• Abdominal reinforcement (Strengthens the rectus abdominis. It makes lower limbs more flexible and facilitates return circulation)
  • Initial Position: Lying on your back, legs extended and together, arms in the direction of the body, preferably with the hands under the hips.
  • Movement:
    • (First part) 1. Bend the right knee. 2. Extend the knee bringing the foot towards the ceiling. 3. Lower to starting position keeping knee extended. 4. Repeat on the opposite side.
    • (Second part): 1. Bend both knees keeping them apart so as not to put pressure on the abdomen. 2. Extend both knees bringing the feet towards the ceiling. 3. Extend the thighs to the sides, bringing the feet from side to side without lowering them. 4. Bring both knees closer together (without bringing them together) bringing the feet towards the ceiling. 5. Re-bend both knees, keeping them apart so as not to put pressure on the abdomen. 6. Extend both knees until you are back in the starting position.
• Neuromuscular control exercises: upper limbs, pectorals, perineal circulation (worship, cat).
• Breastfeeding technique and posture.
• Postpartum exercises: perineum, pectorals and abdominals.

-Session 6

• All the same as in Session Five.

-Others

Some alternative auxiliary techniques are used as a complement to all of the above.

• Aromatherapy. Alternative method through the use of fragrances through aromatic essential oils (oils extracted from leaves, flowers, trunks and roots), in order to promote the health and well-being of the body, mind and emotions.
• Spherodynamics. Physical training modality with the use of a sphere or plastic ball inflated with air, in order to facilitate some movements and postures that facilitate prenatal and postnatal physical preparation in the mother.
• Chromotherapy. Treatment of different pathologies using the interaction of wavelengths in selected regions of the electromagnetic spectrum with biological systems as a physical therapeutic agent..
• Masotherapy. Alternative method through the use of manipulations of the soft tissues of the body exerted especially with the hands, as the most effective way, whose purpose is to achieve mainly the relief of discomfort, relaxation, improve circulation and oxygenation, in addition to favoring adequate rest, the emotional state and the reduction of both physical and emotional fatigue in pregnant or puerperal women.
• Prenatal midwifery. The use of water as a resource to facilitate prenatal preparation, especially in the physical area, and that due to its characteristics and benefits, such as the reduction of gravity, facilitates movements, flexibility and reduces physical effort; Likewise, due to the homogeneous hydromassage effect throughout the pregnant woman's body, it reduces discomfort and generates a feeling of comprehensive well-being, among many other benefits..
• Music therapy. It is an alternative therapeutic method through the use of musical structures, tones, sounds, melodies and others, in order to achieve motivation, relaxation, meditation and stimulation during the obstetric psychoprophylaxis session, thus achieving a better psychophysical state, optimizing the emotional state , cognitive and spiritual in the pregnant or puerperal woman and her partner during their preparation.
• Hypnosis. Hypnosis is an altered state of consciousness that involves a reduction in awareness of the external environment. Hypnosis and self-hypnosis have been used in pregnant women to reduce pain with variable results..

References

1. 1. Morales A, Sabrina; Guibovich M, Alex; Yábar P, Maribel. Obstetric Psychoprophylaxis: Update, definitions and concepts. Horiz Med 2014; 14 (4): 53-57.
   2. Yábar P, Maribel. Obstetric Psychoprophylaxis in pregnant adolescents: Characteristics and comprehensive benefits. Horiz Med 2014; 14 (2): 39-44
   3. Aguinaga, Gabriela and Ponce, Roberto. Technical standard for obstetric psychoprophylaxis and prenatal stimulation. Ministry of Public Health of Ecuador. September, 2014.
   4. Ntella, Georgia. Psychoprophylaxis, Labor Outcome and Breastfeeding. Intern Journal of Caring Sciences 2017; 10 (1): 185-190.
   5. Madden K, Middleton P, Cyna AM, Matthewson M, Jones L. Hypnosis for pain management during labor and childbirth (Review). The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. 2012.
   6. Rubio P., Flor M. Emergency obstetric psychoprophylaxis in first-pregnancy labor without prenatal control at Cayetano Heredia hospital. Lima Peru. 2018. The Degree Project of Nobert Weiner University.