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RELATIVE RISK AND CLINICAL FEATURES OF PERINATAL COMPLICATIONS UNDER PSYCHO-EMOTIONAL STRESS DURING MEANING OF PSYCHOLOGICAL RIGIDITY AT PSYCHOEMOTIONAL STRESSES OF PREGNANT WOMEN
Vetchanina E.G., Zalevsky G.V., Malgina G.B. (Ekaterinburg, Russia)
There are 47,3% pregnant women living in industrial centres who experience chronic psychoemotional stresses. It>
Purpose of the study: to determinate differential-diagnostic meaning of rigidity during the psycho-emotional stresses of pregnant women.
Background and numbers: 254 pregnant women under emotional stress with different gestational age were assessed using specially designed programme. After analyzing the results of psychological tests two types of psychological reactions to chronic stress were brought out. First type of reactions to chronic stress factors reveals high levels of score meaning in basic tests, whilst second type is characterized by closeness, lack of communication abilities, asthenia of pregnant women and low scores of basic tests.
Setting: “Tomsky Questionnaire of Rigidity” by Zalevsky was used. It includes six columns with certain numbers of questions/statements in each of them. These questions/statements cover all personality substructures: dynamic, practical, cognitive, emotional- affected and psychosocial.
Findings: Study of psychological rigidity showed that women from the studied group have high level of rigidity. At the same time indices of the first type reactions group were much higher than norm, whilst pregnant women with second type of reactions to stress factor had indices slightly higher or norm levels.
Most changes were noticed in the RAC scale (Rigidity As Condition). Normal score values are 13,2. group with second type of reactions had 12,3, and group with first type –15,8 (2nd-and 3rd trimesters having more than 16). That shows the high level of psychological rigidity, anxiety, fatigue, low mood in pregnant women with first type of reactions to various stress factors. Lower values of rigidity in pregnant women with second type of reactions give them better abilities to compensate distress situations.
Women from first group are more rigid, stubborn, determined, than women from control group and from the group of second type. They are more susceptible to effects of stress factors.
Interpretation: It's seem reasonable to suggest that pregnant woman under chronic psycho-emotional stress needs some psychological help if high level of rigidity was revealed during the test.
Conclusion: Psycho-correction should be performed with certain differentiation depending on types of stress reactions and stress factors, involving different methods. Individualized approach to the problems of pregnant women under psycho-emotional stress allows improving psychological and somatic condition of pregnant woman and prevent perinatal complications.
MODERN VIEWS ON PSYSIOLOGICAL ASPECTS OF PAIN IN LABOUR
Kiselyov A.G. (St-Petersburg, Russia)
Two types of pain are caused by birthing process (Cromford M.J., 1965):
- Visceral – pain caused by uterus contractions and uterus structural changes and dilatation
- Somatic – pain caused by stretching of the perineum and pressure applied to muscles, blood vessels, nerves and pelvic bones.
Various studies reports that the pain in the first stage of labour is due mainly to dilatation of the cervix as well as to distension and stretching of the lower segment of the uterus. (Bonica, 1990; Nicolayev, 1959-64; Bodyajina, 1979; Bumm, 1908; Persianinov, 1975; Reynolds, 1949; Lampe, 1979; Moir, 1985, Shnider, Levinson, 1981; Manevitch, 1994).
It is also suggested that pain is caused by ‘contraction of the uterus under isometric pressure, that is, against the obstruction presented by the cervix and perineum, which is the “adequate stimulus” for provoking pain in hollow viscera..
Other suggestions include ischaemic changes of the myometrium and cervix, pressure on the sensory nociceptors of the body of the uterus, and also inflammatory changes in the muscles of the uterus.
Nociceptive nerve fibres from the uterus and cervix pass to the spinal cord through the uterine and cervical nerve plexuses, the pelvic plexus, the middle and then the superior hypogastric plexuses.
These nociceptive nerve fibres then pass through the posterior roots of spinal nerves T10, T11, T12 and L1, to synapse at the interneurons in the posterior horn of the spinal cord. Nerve fibres also travel from perineal structures through the pudendal nerve to the spinal cord through spinal root nerves S2, S3 and S4.
Pain in the first stage of labour sometimes could have abnormal traits. Emotional reaction is determined by the character of the labour dominant, somatic pathology, medicaments influence, abnormal progress of pregnancy and labour, woman’s attitude, social background, individual pain threshold, occupational background. Therefore the issue of indications for pain relief and the level of analgesia needed is quite complex and could not be solved in a straightforward manner.
In this view Baksheev N.S offered an interesting conception based on study of structure of nerve fibres and nerve endings in different segments of pregnant and non-pregnant uterus. According to this research it seems that at the end of pregnancy part of nerve fibres is damaged, which means that physiological partial deinnervation of the uterus is occurring. That has positive influence on the labour process and could prevent labouring woman from abundant/profuse pain information flow.
SPECIAL FEATURES of WOMEN’S PSYCHOLOGICAL STATUS DURING THE PHYSIOLOGICAL AND COMPLICATED PREGNANCY
Vasilyeva V.V., Cagamonova K.Y., Kovpyi Y.V., Bogdasarova A.A. (Rostov-na-Donu, Russia)
Background: The psychological status of the pregnant woman is the essential factor influencing optimum performance of system “mother – placenta - foetus”.
Purpose and numbers: Study the psychological features of 58 women with physiological pregnancy – group "norm" and 52 pregnant women with risk of spontaneous abortion – group "risk" at 8-15 weeks gestation.
Methods: The diagnostic complex included the following techniques: Spilberger C.D.–Hanin Y.L. reactive and personal anxiety score; Kettle R questionnaire; Lusher M. colour test; Dobryakov I.V. psychological component of a gestational dominant determination, Nemtchin T.A. neuro-psychological stress questionnaire.
Primary outcome studied: – The analysis of study results using Kettle method has revealed authentic distinctions between the allocated groups under the following factors: L (trustfulness – suspiciousness), Q (self-confidence – anxiety), Q1 (conservatism – aptitude for experiment), Q3 (indiscipline – steadiness), Q4 (slackness – intensity). Besides both groups had the reduced meanings under the factor C (emotional instability - emotional stability).
– The analysis of situation induced anxiety study results using Spilberger C.D.–Hanin Y.L. Score has shown, that on the average this parameter has made 58,2 +-6,5 fixed units in the “norm” group, whilst for “risk” group – 60,3 +-4,8 fixed units. The received meanings allow to consider high level (according to existing classification) of situation induced anxiety of pregnant women in both groups.
The comparison of average parameters of personal anxiety, received with the use of the same test, demonstrates statistically significant distinctions. In "«norm" group the parameter personal anxiety was 43,8 +-5,1 (average level of anxiety), and in "risk" group - 55,2 +-3,0 (high level of anxiety).
– The use of Lusher M. multicolour test has allowed to perform quantitative evaluation of the level of psycho-emotional tension of pregnant in both groups. In contrast to “norm” group the pregnant women in “risk” group had high level of emotional tension.
– During the psychological component of a gestational dominant determination the following regularity was revealed. In control group: 58% of women had optimal type of psychological component; 9% – euphoric; and 33% – mixed type (anxiety, hypogestosis, euphoric, optimal). “Risk” group: 31% – anxiety type; 4% – euphoric; 65% – mixed type. In both groups depressive type was absent.
– The index of a neuro-psychological stress (Nemtchin T.A) in control (“norm”) group was 39,1 +-1,1, and for "risk" group - 50,0 +-2,7.
Conclusion: The further study in this area will enable to create " norms of pregnancy " score concerning mental processes and will help to develop a complex of measures allowing prediction of a possible deviations from norm from the very beginning of gestation.
EVALUTION OF THE PSYCHOMOTOR DEVELOPMENT
OF CHILDREN BORN BY CAESAREAN SECTION
Alikimovitch B.G., Kulitchkin Y.V., Kiselyov A.G., Klipina L.V., Shishkov V.V.
(St-Petersburg, Russia)
Caesarean section is a major surgical operation and considered by the authors as a risk factor to the health and development of the baby. The increased numbers of the babies who are now being delivered by Caesarean section calls for a need of psychomotor development evaluation of children born this way.
Research methods: The study used practical diagnostic system designed by Arnold Gesell in the beginning of the 20th century. The Gesell’s Score is based on systematic comparative studies of coarse and fine motor activity age changes, speech, adaptive reactions and child’s social communications, and behaviour patterns dynamics assessment. Assessment was carried out with equal time scale limits: during first year of child’s life – every four weeks, during second year – every three months, then – once in every six months.
Subjects: Authors assessed 13 babies born by Caesarean section at Ott’s SRI using psychomotor evaluation and development quotient. In 7 cases the endotracheal anesthesia, in 6 cases – regional analgesia was used during the Caesarean section. Age of participants: from 4 weeks to 18 months.
Findings: Psychomotor development of 4 babies was far ahead of their passport age. Others demonstrated slowing down of speech development and social reactions.
Interpretation: According to these findings babies born by Caesarean section have definite retardation in psychomotor development and lower development quotient than babies born physiologically.
UNDESIRED CHILDBEARING AS ONE OF RISK FACTORS OF AN ABANDONED CHILD PSYCHOLOGICAL PATHOLOGY
V.I Brutman, A.A. Severnyi.
Association of the children's psychiatrists and psychologists.
12306, Moscow, Gruzinsky Val, 18/15, 23.
Background: The high frequency of mental disorders of the babies rejected by the mothers immediately after birth and kept in orphaned establishments is well known. Usually it connected with antenatal and intrapartum foetal trauma, as well as with abnormal postnatal development due to early deprivation. At the same time, the aspects of abnormal antenatal interactions in the system "pregnant woman - foetus" are not less essential. One of the most powerful psychotraumatic factors for the future mother is – going through undesired pregnancy.
Subjects: Our research experience of 25 women-"refuseniks" show the large prevalence of the psychopathic type persons among them, as well as mentally immature, intellectually limited, with the low social status, unstable, inclined to neurotic and aggressive reactions. There is a significance of frequency of such behavioural features as attempts to get rid of not desired pregnancy, high frequency of migrations, autoaggressive tendencies (malignant nicotine smoking, alcohol abuse, sexual extremes). The hysteric reactions, marred chronic depression, psycho-vegetative disorders, aggravation of psychosomatic and physical disorders, gestosis of pregnancy were marked in the majority of "refuseniks" during pregnancy. In its majority the pregnant women form the studied group have appeared not to be ready for birth, that was confirmed by level of premature delivery, which was considerably higher, than in a rest of population, (37,5 % and 4,7 % accordingly). Pathology of labour activity also was extremely high in these cases (59,2 %).
Findings: All this could have some influence on the well-being of a baby. 65,6 % of the babies had birth weight below than 3 kg. The attributes of morphofunctional immaturity were marked at 45,0 % babies born at term. Clinically manifistated brain circulation disorders and signs of encephalopathy were found in 43,7 % of cases. 46,9 % of the babies required intensive therapy and resuscitation immediately after birth due to severe distress of the newborn. For comparison: only 14,8 % of the babies born to mothers with wanted pregnancies need some treatment immediately after birth due to somatic and neurological complications.
Interpretation: It is possible to allocate mental pathology risk factors in abandoned children:
1. Genetic-constitutional (presence of parental mental diseases and personality disorders);
2. Woman’s psychological immaturity in relation to motherhood (animosities towards the foetus and sensory and humoral interrelation disorders in antenatal period, connected to it);
3. Mental, behavioral, somatic disorders of the future mother during pregnancy;
4. Growth retardation and prematurety of the foetus.
5. Superearly disconnection in the system "mother - baby" (destruction of psycho-biological system of mother-child interactions).
PREBIRTH MEMORY THERAPY
INCLUDING PREMATURELY DELIVERED PATIENTS
Turner J.R.G., Turner T.
Editor’s Note: Jon and Troya Turner are Co-Founders of the Whole-Self Discovery and Development Institute, Inc., International. For a quarter century they have been leading workshops around the world on a unique way of approaching pre- and perinatal trauma. Jon has served as Vice-President of the International Society of Prenatal and Perinatal Psychology and Medicine (ISPPM) and Troya has served as a specialized nurse, a psychiatric nurse, and a social nurse. This article is republished, with permission, from the Pre- and Perinatal Psychology Journal, 7(4), Summer 1993.
Questions and comments to the authors can be sent via email. The Turners live in Grootebroek, The Netherlands. More Information about their work is available on their website.
Abstract: This paper focuses on the psychological aspects of prebirth and perinatal memories encoded for full term and premature infants and activated as possible pathology during adult life. It presents a brief recapitulation of the basic hypothesis that not only do human beings inherit the genetic coding of their mother and father, but also the mental and emotional states of their parents in the form of non-conscious emotional reaction patterns from the nine months of gestation including birth and post birth circumstances. The anxiety and stress of full-term delivery or premature labor for the mother, and the heightened emotional levels of the midwife or delivery team, contribute to an emotional reservoir from which the baby draws as it grows and develops in life. By recognizing the source of this reservoir, persons can stop blaming themselves, parents, governments, and/or God, and assume responsibility for their own lives.
Introduction
The Whole-Self method discussed in this paper"the means by which data are elicited from the client--incorporates the Prebirth Analysis Matrix (PAM) used to help people re-experience twenty-two specific moments during the prenatal and perinatal period, including time in the crib or incubator.
Each point in what we call the emotional DNA is related to specific mental, emotional and physical reactions synthesized from the parents. We will each begin with a comment, and then jointly discuss the method.
Jon Turner:
I am terribly lonely and most of all feel fear! My hands are wet and I can hardly breathe. There is fear I will die if the incubator is not there. I think I cannot live alone. The fear of living! My breathing goes faster and faster high in the chest. I am seized with panic! I will die! I am imprisoned!
Pat used these words to describe her feelings as a premature infant lying in her incubator. When she retrieved and re-experienced these feelings, she realized that these words were not just those of a little baby. She also was describing feelings that had followed her throughout life.
In my practice, I started getting referrals from therapists who had given up on certain patients. The inspiration came to me that these patients might heal rapidly if I were to regress them back to experience the emotional patterns of their father and mother during the nine months of gestation. By focusing on the 22 specific moments in the gestation, these patients discovered that they were not guilty; they had done nothing wrong. They were able to recognize that the unresolved, nonproductive and diminishing emotional patterns they were experiencing were actually synthesized from the patterns of their parents during the period of gestation. In other words, they discovered that not only do we synthesize the genetic coding of our parents but their emotional DNA as well.
Troya Turner:
Trying to project back to my birth, I suddenly saw my mother sitting in her doctor's office. And I heard the doctor saying: "Because of this problem with your tipped uterus, expect that this first baby could be born dead!" At that moment, I realized that my expectation was that I would be born dead. I experienced my mother's reaction to his words. Her feelings of fear, panic and disaster became a very familiar reaction in my own life.
Most startling of all, in this recollection was the realization of the cause of my tendency to sabotage good things about to happen in my life. For 12 years, anorexia and bulimia eating disorders were my nonconscious way of fulfilling the expectation that I should be dead.
Fifteen years later, when I told this story to Jon, he asked me if I had ever discussed my vision with my mother. I admitted that I had not. So, the next time we went to visit my parents, I told them what I had seen in my imagination. My father immediately denied it. But my mother calmly asked: "How did you find out what the doctor told me? I never even told your father what the doctor said." So it was confirmed. The thought that created my pathology and my mother's reaction to those words had been generated before I was born. Seven years ago I was attending a psychology conference in England when I heard Jon Turner lecturing. He was teaching the same ideas that I had used to heal myself! Two years later we started working together.
Whole-Self Hypothesis
The basis of our whole-self therapy is that each child is the synthesis not only of the genetic DNA coding of parents but also of their mental and emotional states during the nine months of gestation. In other words, whatever the mother and father experienced at that time becomes part of the emotional repertoire of the baby. As the child's body is gestating, so too, are emotions being developed and practiced so that by the time of birth there is a range of emotions that the baby can feel. These feelings may not be expressed in words by the newborn, but that does not mean they are not there.
In 1990, we attended a meeting of the Forum on Maternity and the New Born at the Royal Society of Medicine in London (Zander 1990). We saw videotapes of three-day-old infants expressing obvious emotions in interactions with their mothers. These emotional reactions not only are experienced by very young infants, but can also be experienced and remembered from the nine months of gestation, using various methods.
The whole-self format is called the Prebirth Analysis Matrix (PAM). The PAM helps any person to discover specific emotional patterns synthesized from their parents. In effect, through the twenty-two PAM questions, each person is able to decode and (when they wish to) change their emotional DNA.
Prebirth Memories
There is an obvious question to ask at the outset: Is it possible that most infants are aware of the intra-psychic and interpersonal activities taking place during their gestation? Mr. David Boadella (1986) of the London Centre for Biosynthesis has acknowledged that in the field of prenatal and perinatal work, there is a significant problem because of our inability to elicit verbal testimony from babies. Nevertheless, he believes that there is a nonverbal language in the body that can be recovered and expressed. This is what we have been doing with the Prebirth Analysis Matrix with
thousands of people since 1970. They have meaningfully re-experienced and verbalized information from the prenatal period and have been able to use this information as a significant source of life-long feelings and emotional and reactive patterns.
Psychologist David Chamberlain, Ph.D., in his landmark book, The Mind of Your Newborn Baby (1998), offers a clarion apologia for newborns as real persons:
Now science confirms that infants are social beings who can form close relationships, express themselves forcefully, exhibit preferences, and begin influencing people from the start. They are capable of integrating complex information from many sources and with a little help from their friends, begin regulating themselves and their environment.
Do these capacities for a "warm start" suddenly turn on like a computer when we take our first breath? Obviously not! Just as gestation is the period for my little body to develop and grow, this nine months is for my emotional capacities to develop, grow, and be practiced. In other words, my body and my emotions were in parallel development to work in synchrony at birth.