הרצאה בסין 1999 תקציר
Lecture to the Nurses Congress Dalian – Aug
Ladies and gentlemen
President of Chinese nursing association . Ms. Zeng Xiyuan
Ms. Wu Liang
I want to bless you and happy to be here and give lecture you in this special event.
At a meeting with Prof. Wu Liang a year ago, I indicated
my desire to present a system for preparing couples for childbirth. Therefore, with great pleasure I accepted this invitation to present a lecture about prenatal preparation for women before birth. I am optimistic that this lecture will motivate you to use this system for the benefit of Chinese
This is my fourth visit to China since first visiting here as a tourist in March 1993. In November 1997 I once again returned to China and deepened my ties with and knowledge of Chinese women. I concluded that there is a need to encourage the subject of pre-natal preparation in China. Chinese women give birth only once and it is important that this should be a positive experience for them. I have arrived at Delian with Prof. Wu Liang’s generous ג'נורוס help, and I want all to know how pleased and excited I am to be here.
I personally have four children aged between 17 and 27 all of whom had natural births without help of relieving medication. My confinement was wonderful and I want to transfer my experiences as a mother and midwife to every women.
I believe that all women are capable of enjoying natural childbirth if this is what they believe for themselves.
I have a private Clinic in which I offer pre-natal and postnatal treatment. I am a Midwife and a holistic healer and prepare couples for birth from the 26th week of pregnancy.
I Israel Childbirth Education Center (ICEC) has been training educators for 15 years.
It is customary to take courses on childbirth public or private sectors, there is a great demand for these services. If woman wishing to be educator she has first to pass a special educator’s course. The ICEC believes that qualified instructors who come from a variety of disciplines can provide quality prenatal education.
Good prenatal education must include the following topic:
*The physiology of pregnancy and birth.
*Prenatal nutrition, and effects on pregnancy of smoking, drugs, alcohol, environmental and occupational risk.
• Coping techniques for labor such as relaxation, breathing techniques, and other psychological and physical methods the teacher finds valuable.
• Support methods for the use of the laboring woman’s companion.
• Role of the health – care provider in maternity care.
• The use of medical technology in pregnancy and labor.
• Caesarian and other high risk birth.
• Obstetrical analgesia and anesthesia.
• Preparing for parenting, including baby care, infant development, sexual relation postpartum.
• Tour of labor and delivery ward.
Childbirth educators keep contact with local hospital and keep themselves informed of change in policy.
Childbirth Educators aware of community support which provide support to a new families such breastfeeding – counselling organisations, parenting class, psycholocgical services, and post- natal support group.
Women experiencing their first pregnancy undertake the prenatal preparation course. On an average, women bear three children. The positive affects of the prenatal course experienced during their first labor are extremely important for later confinements.
Each birth and each women-giving birth is unique. Rigid regulations to woman and her companion , Stifle individuality can give negative effect on progress of her labor. The focus of attention must shift from the birth procedures surrounding birth to the women giving birth.
Many experts believe that minimizes interference in normal process of labor and birth foster early interaction between parent and infant. The routine use of intravenous fluids, continuous electronic fetal monitoring, with hold food and drink, perennial shaving, enema, and Episiotomy are all routine practices have not give benefit to low risk mother and baby.
The ICEC believes that the freedom of the healthy woman with healthy fetus to adopt a position of her choosing during labor and birth.
The physiological benefits of maternal ambulatory and upright position in labor have been reported in a number studies. These include increased tolerance to labor pain, increased intensity and frequency of contraction increased the diameters of pelvic and shorter labor.
An Outline of the Lecture Program
1. A history of prenatal preparation (including methods of preparation).
2. Why is prenatal preparation important? Active or passive woman?
3. What recommendations are made by WHO?
4. What is natural childbirth and who are the women suitable for it?
5. Contractions – physiological and psychological reasons and managing pain.
6. Hormonal effects during confinement.
7. Breathing and relaxation methods.
8. Pushing reflex and pushing with prolonged expiration.
9. The maternity ward as the 21st century approaches.
1. A History of Prenatal Preparation
At the beginning of this century childbirth moved from the home to hospitals. It was believed that a confinement in a hospital was safer. Since it was believed that the labor- room had to be sterile it became an emergency- word, a strange place, in which the woman was left alone, without the presence of family. A feeling of discomfort developed between the woman and the medical staff. “The doctor knew everything” and the woman’s desires were not) importance. There was more interference during the confinement, relaxant medication was given, the woman was seen as being “ill” and childbirth as being a “medical complication.”
Since the middle of the century start to seek pleasure and satisfaction from childbirth. The centrality of women in confinement has developed and start to give attention the woman’s special needs
About 40 years ago saw the introduction of the Monitor that made a close watch on the fetus’ condition possible. However this prevented the woman’s freedom of movement at birth.
About 20 years ago husbands began to be admitted into labor rooms. Before, the husbands were forced to wait outside while their wives faced birth alone. The husband’s presence in the labor room generated a sense of cooperation and encouraged the woman emotionally. The husband was the only person, which close her and can help to keep connection to her daily life.
For as long as can be remembered birth has been a subject confined to women. Until the 17th century only women acted as midwives.
In 16 century the Church resistance to midwives and compare them to “Witches” and they encouraged the male doctor to take them place.
With the introduction of the use of forceps male doctors also entered this field, as there was a need for strength. The Neonatal Doctors also desire to knew every moment health condition of the fetus and also control the women in confinement, and then start to be conflict between women and men in confinement.
The function of Midwife change and she was one from medical- team.
Childbirth is referred to in the Bible, and the text “… In sadness you will bear sons…” be recorded in there mind and all woman from childhood they believe that childbirth is a distressing and unpleasant event.
The explanation the meaning of grief at childbirth (flows) stems from the difficulty spiritual of woman to separating herself from her baby and give him an independent existence outside of the womb. There is also the crisis of separation bound in the physical separation of baby from mother in the process cutting the umbilical chord.
During the middle 19 century had start development a systems to prepare the woman to confinement.
The purpose was to return her a confidence and believe she capable bear without fear in foreign place. All the system emphasis the importance of privacy, intimacy, quiet room, and movement ,to help women to be relaxation to encourages the progress procedure of birth.
French gynecologist Fidrique Laboye, in his book “Birth without Violence,” was the first to champion providing women with natural conditions in the labor room. He suggested:
1. A darkened, quiet room with freedom of movement for the woman during her confinement in order to prevent delays during the birth process.
2. To ease the transition from fetus to baby by making it possible for the baby to face his first moments outside of his mother’s womb under conditions similar to the atmosphere within the womb.
He stressed the importance of a gradual cutting of the umbilical chord so that the baby’s first natural breath would take while still connected without pressure and violent action. He claimed that most human problems are connected to the first breath.
Birth should be as if awakening from a peaceful sleep. He stated, “We have to place extreme importance on this fragile moment of birth in which the baby is balanced between two worlds”. This is a uniquely special moment.” The “babies –laboye” was more relaxed, less crying, they except to receive love and pleasant from the world, satisfied, without fear, and have more ability.
Psychoanalysis deals with the myth of “childbirth trauma.” This myth states that the fetus has a wonderful life within the womb and that birth is likened to the expulsion from Paradise. Birth is described as a horrific experience. accompanied by sensations of contact with an strange and frightening world. This idea developed in Sigmund Freud’s school.
Herman Hessa attempts to explode this myth and claims that not all confinements are traumatic. Birth could be far easier if the expectant mother prepares for it properly from both mental and physical aspects. With the knowledge that babies are extremely sensitive to their physical surroundings and the presence of people around them at birth, if birth were natural it would be possible to save the baby from much suffering.
He relates to the importance of privacy, silence, and a darkened room as well as to the importance of a gradual cutting of the umbilical chord in order to avoid trauma.
French gynecologist Michelle Audent who allowed women to behave according to their desires discovered the positive effect that water has on easing pain and developed water births. The childbirth education include singing of childhood song to be more connected to her tradition and also good exercise for breath .He motivate them to dance with these sound music from childhood.
English birth educator, Sheila Kitzinger saw birth as a psychosexual event connected to the couple’s sex life and. She places emphasis on breathing and relaxation during birth.
American gynecologist, Robert Bradley was the first to admit husbands into the labor room so that they could assist their wives during birth.
Ayna May Guskin, in her book “Spiritual Midwifery,” states that there usually isn’t any need for “preparing” a woman for her confinement. She stressed the atmosphere of the confinement that should be spiritual charged with energy resulting from love and positive thinking.
The Paula method is based on techniques of Kegal exercises and helps in easing pain for women during childbirth. She believes that healthy women are capable of painless childbirth if the sphincter muscles in their bodies function correctly the birth come natural. To this purpose women must exercise and strengthen the sphincter muscles found around all the body’s orifices.
Suggestion Therapy – The woman is hypnotized during her confinement while receiving encouragement from the doctor ,and massaged in order to ease her suffer pain.
The Dick – Reed Method is based on the” triangular theory”: Fear→ increases tension→ generates pain→ and increases fear. His concept was on natural birth procedure and he taught about confinement procedure, breathing and relaxation and exercises for maintaining stability and suppleness. He concentrated on discussing the fear of birth, claiming that pain stems from an mistaken conditioning influenced by Bible stories and folklore.
The Lamarge Method – Painless Birth – A psychoprophylactic method dealing essentially with psychological and physiological preparation in preventing or reducing pain. This method, using psychological and physical means, aimed at preventing or reducing pain while giving birth without the use of drugs.
He relates to birth as an great effort requiring energy and teaches women methods of keep energy to preventing exhaustion and enabling them to deal with their contractions. Women learn to react to contractions by breathing in a manner that diverts her attention from the pain.
Russian doctors who believed that birth could be painless since pain is a controlled reflex developed the psycoprophylacsis method. They taught women breathing and massage techniques. They learned how to trace their negative thinking towards birth and correct them in order to avoid fear.
The philosophy Chinese medicine.
In pregnant have to keep about the balance between yin& yang energy and Qi & blood in body, for keep the health fetus and woman. It is necessary to build the yin energy in pregnancy woman, and for painless labor have to stress the yang energy to move the fetus out quickly. They use in Herbs, Acupuncture, and diet according five elements to support the function of internal organ.
2. Why is Prenatal Preparation Important
During confinement we can define both active and passive women.
The active women have preparing her self during pregnant, she keep eat balance diet, to do exercise to be elastic, keep going every day at least half hour, all these improvement ability to born quickly.
How does a passive woman behave?
She has a negative reaction to a contraction, as she is startled and afraid due to her lack of knowledge and not understanding. She is hysterical, doesn’t concentrate on breathing and doesn’t relax between contractions. Tension causing an increased adrenaline discharge into the blood stream is generated. This causes a contraction of blood vessels reducing the flow of blood and oxygen to the uterus and fetus. The uterus muscle is damaged and doesn’t function optimally. Discharge collects in the muscle cells and this increases pain. All this leads to irregular uterine contractions, to a lack of progress and to a prolonged, painful and suffering confinement.
How does an active woman behave?
When a contraction occurs there is a positive response from the brain to the contraction. The woman breathes, relaxes herself between contractions; is focused on the birth procedure. Her uterine muscles receive oxygen and there are proper regular contractions. The confinement progresses quickly, the woman doesn’t tire and thus there isn’t any suffering.
A prenatal preparation course influences behavior during a confinement. It prepares a woman for an event of which she knows mainly through her mother’s, friends’ and neighbors’ experiences. This course is given by specially trained professionals and provides detailed information on correct birth process. It provides information on a balanced diet in order to prevent the development of a large fetus and an overweight woman. It encourages the woman to physical activity in order to maintain a physical health and suppleness as her confinement nears. A body has a natural physiological program for birth. The preparation is principally psychological in order to reduce doubt and fears and to understand that the process can be simple.
Women learn relaxation techniques that include meditation that help them to relate to their willpower and to travel within themselves during birth. They learn the use of breathing during contractions, to flow with the contractions, to relax themselves and make the fetus’ explosion(emergence) possible without interruptions by using the pushing reflex.
Husbands learn how to help using massage during contractions in order to release tension, to ease and to pamper, to generate an sympathetic atmosphere and to be partners in childbirth.
3. Main Points of the Recommendations made by WHO
This organization has emphasized the social, emotional and psychological aspects that constitute the prenatal treatment.
1. Policy for applying midwifery technology in health services has to be determined.
2. Each woman has to be free to choose the confinement treatment she prefers.
3. There must be cooperation between the medical organization treating the woman and communal support groups.
4. Mother and baby must be allowed to be together after the birth.
5. Breast-feeding should be encouraged in the maternity ward.
6. Medical procedures such as enemas, shaving, inducement, rupturing the amniotic fluid, electronic monitoring and Episiotomy rather than procedural Episiotomy should be examined.
7. Husbands should be allowed to be present at Caesarian sections and should encourage breast-feeding after the operation.
8. The use of pain relievers and relaxant drugs should be avoided during the confinement.
9. The woman should be encouraged to move during contractions and allowed to choose the most suitable position for birth.
4. What is Natural Childbirth?
Today more women want to give birth naturally and in many instances at home.
Epidural local anesthesia is still used especially amongst women who arrive for confinement without any prenatal preparation and who fear birth.
Women wish to experience birth without any interference and with a minimum of risk.
In Holland, the most advanced nation on the subject of birth, there is a possibility to give birth at home under the supervision of a midwife who accompanies the woman from the beginning of her pregnancy. A warm relationship, develops between both parties.
In England the Domino birth method exists. The woman begins labor at home. The midwife comes to her home and transfers her to the maternity ward as the birth approaches and six hours after the birth she returns home with her baby.
Who is suitable for natural childbirth? – A full-term pregnant woman between the 37th and 42nd week, healthy with a single fetus with vertex presentation and no suspicion of C. P. D.
What conditions are necessary for natural childbirth?
1. Suitable conditions such as privacy, intimacy, dim lighting, silence that enable the woman to relax and to focus on the birth.
2. Encouraging and confident the woman to allow the natural processes in her body without outside intervention. To encourage mobility, massage and the use of breathing.
3. Giving chance to management the birth process to the woman and her partner with support from a midwife. Checking on the fetus’ health as necessary with the help of monitoring in first stage every half an hour for five minutes and later every fifteen minutes for a period of one minute.
4. Rupturing the amniotic fluid according to necessity and not as procedure.
5. Allowing light food and drink until 4cm dilation, and thereafter only drink. Eating at the outset of labor doesn’t increase the risk of aspiration.
6. Avoiding using infusions as procedure as their very penetration stresses the woman and implies that she faces a risk even when none is present. The introduction of the solution into the vein changes the blood’s electrolytic balance and could effect the fetus.
Methods of Easing Pain at Birth
Does birth really hurt? What are the reasons for pain at birth?
There are six physical reasons for pain.
1. A lack of oxygen in the uterine muscle. Pain is more acute when there isn’t proper relaxation between contractions.
2. Straining the cervix and pressing on the cervix nerves by the fetus’ head.
3. Straining the fallopian tubes and ovaries and peritoneum.
4. Tension and contraction of uterine ligaments.
5. Pressure on the urethra, urinary bladder and rectum.
6. Straining the pelvic floor muscles.
There are 6 factors influencing progress of birth.
1. The contraction frequency, intensity and duration.
2. The speed of cervix dilation also effects the duration and pain of birth.
3. The extent of perineum expansion and relaxation.
4. The age of the woman , exhaustion and anemia have effect on the body’s resistance.
5. The baby’s position and size.
6. Fear at birth effects adrenaline discharge that disturbs regular contractions at the start of birth.
It is possible to control a large number of these factors as I have already explained.
Pain is a messenger informing us that there are changes in the body and that birth is commencing. Usually pain is a danger and causes fear. Attitude to a pain differs for all of us. Personal factors and social perception and culture influence these reactions.
Painless childbirth is an ancient problem. The question, “How to have painless childbirth is old.” Clergymen have always stressed the existence of pain at childbirth. In contrast to this Dr. Lusomme believed in human consciousness and managed thousands of painless confinements. This is a method of conscious cooperation. The mother enter to deep meditation. She is aware of the birth’s procedure. Welcomes it readily and makes no attempt at resistance. He claims that the struggle during birth generates pain. She fears birth and her resistance is concentrated in fear and thus she prevents the child from being born, while the fetus try to born there is conflict between mother and baby and this confrontation causes pain.
There are two ways of calming the mother. First mother will give birth under the influence of a drug and will never be able to be a “complete mother” because when the baby is born, also mother is born together with him.
The mother has to be aware to birth process in this awareness she is also born. The mother’s awareness has to be prepared towards the birth. She has to receive it in the deep of meditation. She doesn’t have to resist or struggle but should cooperate. Only then will painless birth occur.
It is possible to influence these factors during pregnancy and birth with the aid of the knowledge that a woman receives in a prenatal preparation course.
The use of relaxation with the aid of: breathing, guided imagination, meditation, self-hypnosis. The woman should be encouraged to be intuitive and connect with her natural instincts.
• She has to inhale into the contraction and flow with it, to inflate her Hara with air and energy and exhale and contract the Hara muscles by expelling air. This fills the pelvis with energy and accelerates the birth process.
• She has to concentrate her thinking on the cervix and imagine it opening like a flower or expanding spiral and give direction to baby into descending the birth canal on its way out.
• Use of positive expressions such as:
“I accept each contraction with love.”
“My body knows how to give birth simply and with confidence.”
“Each contraction brings me closer to my baby.”
• To encourage movement of the pelvis by means of a rocking chair or by standing and dancing like “dance- belly”, massaging or a hot shower.
6. Hormonal Effects during Confinement (labor)
The hormones that participate in birth and their effect on progress
The hormone Adrenaline
This is discharged during emotional tension and is a disturbing factor that delays regular contractions and causes an extension of the first stage of birth. This hormone is necessary during the second stage of birth in order to energize the woman to assist in extracting the baby.
Stimulating the neo cortex also encourages Adrenaline discharge and therefore it is important to avoid discussions with the woman during confinement and to enable her to totally concentrate on her inward journey into the birth process. It is therefore important to darken the room and provide her with silence and privacy.
Adrenaline effects the baby in opening its eyes during the first postnatal hour, which assists in establishing a bond with the mother.
The hormone Oxytocin
This hormone is discharged during birth and effects the contraction of the uterine muscle. It keep an effective level of contractions, which enables dilation of the cervix and lowering the fetus into the birth canal without the woman’s aid. The woman should be kept warm in order to insure that this hormone is discharged correctly.
This hormone is discharged in any love bond. At the end of the birth its level rises. It effects the mother’s behavior and her desire to take care of her baby. Under its influence the milk flow reflex is generated.
The Endorphins = hormones similar to morphine
These hormones are discharged during the confinement and have a narcotic effect. They relax and soothe pain. After birth both mother and baby are have high level. This enables them a sense of pleasure happiness and a deep bond.
According to the French Dr. De Gasca a body has a natural physiological program for birth. She believes that it is unnecessary to know how to push and that she doesn’t have to push at all. She is referring to the pushing reflex that appears spontaneously at every normal birth.
She states that contractions of the uterus cause the disappearance and dilation of the cervix and at a second stage of birth the feeling of contractions is change to strong sense of the need to push .At that moment, the transverse abdomens and oblique abdomens muscles contract together with and parallel to uterine contractions in a contraction similar to vomiting. This is an” explosive reflex “through which concentric pressure is generated and is similar to pressure on a toothpaste tube and causes the baby to emerge. The pressure is applied during expiration like inflating a balloon or vomiting.
She protest against strenuous pushing methods using pressure that generate a pressure of approximately 20-Kg on the sacra-uterine ligaments. This pressure causes postnatal damage: damage to sphincter muscles and causes problems of urine leakage and a dropping of the uterus and damage to the anal sphincter.
According to her there is no need for pushing during the second stage but she should wait for an” explosive reflex” that occurs naturally if the woman is not encouraged to push before it appears. The woman is help by prolonged expiration that occurs spontaneously. Once this reflex occurs pushing while inhaling is possible for only a few seconds as the diaphragm rises under the effect of the reflex.
“Concentric pushing” is possible due to the three layers of uterine muscles and transverse abdominus and obliquus abdominus that push the diaphragm upwards causing a desire to vomit or shout. The same process occurs when there is a regular intestinal activity generated by stimulating the reflex and there is a need to defecate..
The muscles are:
1. The longitudinal layer that pulls the baby towards the cervix.
2. The circular layer – contracts concentrically (stronger in fundus but not as strong in the lower uterine section).
3. The spiral layer with flexiform muscle fibers that generate pressure including “a circular movement” and this, in effect guides the fetus toward the vagina.
4. Above all the transverse abdominus and obliquus abdominus muscles contract and push the diaphragm upwards and cause the woman to vomit or shout.
If the reflex doesn’t occur one should wait and not push too early. One should use a prolonged expiration (as if inflating a balloon) lie down with a straight back and not raise the head or one should sit down. In this position it is possible to use the transverse abdomen muscles with the aid of prolonged expiration. Using prolonged inhalation during pushing causes the baby hypoxia and acidosis and then the baby has to be delivered quickly with violent means such as forceps or vacuum.
I believe that in 21 century we will witness more women having natural confinements, under medical supervision and the support of midwives.
These women will know the natural strength of their bodies to give birth by being aware and attentive to birth process.
The aims of prenatal preparation course for are to provide her with the "tool" with which she will approach birth confidently.
Every women is capable of easy childbirth and our assignment is to show her the way.