a. Relaxation and Psychological Control of Pain.

Several methods of relaxation and psychological control of pain during labor are listed below:

(1) Lamaze method (Psychoprophylactic method-PPM). This method is the most widely taught. It deals with combating the fears associated with pregnancy by teaching relaxation and breathing techniques.

(a) The patient is taught to replace responses of restlessness and loss of control with more useful activity.

(b) The patient is taught to respond to pain with respiratory activity and relaxation of uninvolved muscles.

(c) The patient is taught controlled breathing and mind-focusing techniques.

(d) The partner is taught to help the patient stay in control.

(2) Bradley method (husband-coached childbirth). This is similar to the Lamaze method. Emphasis is placed on slow, deep breathing along with complete relaxation. Women using this practice often appear to be asleep during labor. However, they are not asleep, but are simply in a state of deep mental relaxation.

(3) Hypnosis. This is an induced state of extreme suggestibility in which the patient is insensible to outside impressions except the suggestion of her attendant.

b. Signs of Approaching Labor.

These signs of approaching labor are taught to all patients. When the patient notices them, she is aware that labor will be forthcoming. The signs are:

(1) Lightening. This is the descent of the fetus into the brim of the pelvis (dropping). Lightening occurs in the last 10 to 14 days of pregnancy in a primigravida. It may not occur until actual onset of labor in multigravidas. The patient identifies it as being able to breathe easier.

(2) False labor (Braxton-Hicks Contractions). This is intermittent uterine contractions occurring at irregular intervals, which serve to tone the uterus.

(3) “Show.” This is when the blood-tinged mucoid vaginal discharge becomes more pronounced and red as cervical dilatation increases during labor.

(4) “Burst of energy.” This is an increase in energy level. It occurs approximately 24 hours before onset of labor. The patient should be advised to relax during this time since labor will be starting soon.

(5) Rupture of membranes. This occasionally may be the first sign. Due to the risk of the prolapse cord, the patient needs to be aware that she should come to the hospital immediately even if she is not having contractions. If the membranes rupture prematurely, it then becomes a complication.

(6) Frequent urination. This, again, becomes a problem in the last stages of pregnancy. Pressure on the bladder is due to the enlarging uterus and the head settling back into the pelvis.