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Honors Projects Nursing, School of
1970
One Measure of Success: A Study of the Lamaze Technique of Preparation for Childbirth
Cynthia L. Ketchum Illinois Wesleyan University
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Recommended Citation Ketchum, Cynthia L., "One Measure of Success: A Study of the Lamaze Technique of Preparation for Childbirth" (1970). Honors Projects. 27. https://digitalcommons.iwu.edu/nursing_honproj/27
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G OF A i3TUby ION CHILDPIHTH
SPECIAL COLLECTIONS
Cynthia L. Ketchum II
Hubmitted for Eonors �ork in the 001 of ing Illinois Wesleyan University Rloomio on, Illinois lC,70 With deepest appreclation to husban; and family with- out whose eneOiJrar.-;eruent and assistEIl"lCe this oJ'o!j ect could not; 'Je b en unde!"tai\':-:n a:,d cornpleted. SpeciBl tnank:s also to my adviso:cs W!10se glliCienc(; b8S bee; 80 (3xceI1ex,t.
i1 of Illinois �!esleyan
[;ni ver' ity in fulfi 1.1mellG if the requirement for deDartliJental honoI's.
Accepted by the School of Nursing of Illinois esleyan
University in fulfillment of the raquirement for departmental honors.
ue:;7 iiursing
Accepted by the School of Nursing of Illinois �esleyan
Universit;, in fulfillmer,t of the reclUirement for departmental honors.
---i/JDate 'Ill" h'eader
Accepted by the School of Nursing of Illinois Wesle an ilnivers ity in fulfillment of the r quire!"ent for C1enart,ent!Jl honors.
'!cjA III (Gel ) I / cj 7,1..0,,-) (j !Je:te __
iii IN'].'RODDe'l' ION 1 ...... , ...... 0" ...... e"
PAIt'I' I
Chapter
I...... 9 ......
II...... ,...... 10
PAF1'I' II
39 III. . IV. .. 40 ..o� .....� . ..e •••o •••• "".O." '.'••• ' ••.
If. R .,LJ-2
VI. y,: .. .. . L�() ...... �.o •••• ,,� ......
III
VII...... � ......
nIX ...... ,......
...... so .�.... o ...... �" ...... O •••••
iv 1. l;Jerforme.l1ce }Ii:�_;ures ••••• ...... " ...... " •••11
0" ..
�. :�valuatioG of ords 1�eC0ived •.•••••••••••••13
3. Results Obtained Ur'. I,' rnD. Z,e ..."."" ...... 1 L!.
� . • Ori'Leria for Cl��ssification of rlesul-ts •••••••••••14
5. i88,1 of tl:,.c- GOtlrf3(0 of J(,:,-livfsry, Materni-�y Hospital at Geneva •••••••••16
b. �e·bhoas of Obste-brical Analt�e8iG US8G in the ttern T�ospitD_l at ...... 17
v 1. IJnprepared Mothers ...... , 6
2. Frepared Mothers ...... 7
vi '.�he process of the Fsychoprophylactic I';et]'od of 011ild- birth, Lamaze Techniaue, has been receiving increasing em- phasis during tbe past twenty years. Receiving its original trial and utilization in Hussia in 1949, it WElS modified and introduced to I\iestern society in 1951 by a French physician, 1 Dr. Fernand I.amaze. As a result, the me 1;11od has also spread to the linited States. One such orp;anization which supports the Lamaze Method is the American SOCiety for Fsychoprophy- laxis in Obstetrics, Incorporated. It was founded in 1960 by a group of physicians, physiotherapists, nurses ano par- ents, all of whom maintain that childbirth is a natural, nor- 2 mal process. Other notable organizations founded in recel�
which support Lamaze an(1 other met;: are th,:.; Int8r- nat ional Childbirth ';ducation sociation, the 01")ildbirth iithout Fain 8ducation Organization, and the Maternity Center
soc ion ..
on Pavlov's pri�ciples of conditioned response,
the psychoprophylactic od de-co itions ':lomen from child- birth fears and misconceptions, and then by conditioning,
l "psycho-prophylactic M of Childbirth (Lamaze tech nioue) II (NeVI Jlmeric':}!1 for Psycho prophylaxis in Ob�te'�rics, Inc.) 2
trains her to consci l]Sly conl;rol her activi
pcd:;e in tbe birth of her child. 'I'his
is not ct to a Llst for all women.
not care to know wi nt is durinf tl1e birth process.
For her, �any methods of modern obstetric sedation, analgesia,
and anesthesia are available and appropriate for individual situations. But for the woman wbo is eager to participate
actl.vely and fully and to know the true ,?xperience of child birth, preparation for childbirth training is indispel_sible.4
Psycl�oprophylaxis is verbal analgesia based on the WODian. It is quite different from o\;her methods of obstetric analgesia. It depends
on v!orcls as tilerapeutic agents •••• Its ba.sis is
the use of conditioned reflexes •••• It attempts to equilibrate the brain (cor ex) of the pregnant wo man by cre2�ing durin pregnancy, complex chains of conditioned reflexes w ich will be �plied at the
cortf 8 pI'egnan.t woman learn". to -;�ive birth as the child learns to read or SWill!. She cOYn;::letos 11 is education, so understands the simpl.e mech -ism of childbirth and can adapt her- s31f en her confi arrives. oets rid hf bad influences and me�ories s0e previously accumulated which may. inhibit her in t0e act of birth.?
icall�: re-conditions
. C the tieLt to control her receptio of pl3lr1 •
this, as stated before, lies t:;he Pavl
-"Ibid. 4priseilla Richardson Ulin, '''.�'he iliratin�p jJ,owent of Firth", American ,Journal of ]II1).T'si,,;", Vol. III, No. 6 (June 19(;3), p. bOo
' SUr. ierre Vellay, Chi16birth �ithout in ( .fJ,;';H Vor·1r. "- . '-' ,\ - . ' . F. Duti;Oll Co., Inc., 1960 , p. 21 • 6U1in, lIThe ilirat r p"rcc his enviro i:::nt Gi :1:'0 j\.S s ese or ans, l;!"l cer- ebral cortex of the br'in for interpretation. They cen, however, also translhit 81 Is orir:inat are spoken of as JlpropX'ioceptive signalsll indicating the body I s position and "enterocept i ve signals indicae in;;; flmc- t ionin,;); of various inteynal organs. As the cerebral cortex develops, it acquires the abil to form, group, transform, and extinct links betw(cen s s havin� actual value for t;he life of the org3.llis:i:� and correspo�'citng act�ivtties of this OT'I:';Cl.L'.ism. f[l"ne,y are, however, only temporary liYlJ:cs which last only as long as the si s are maintained. Wt,en the sig s are terminated �tlere re�!ain traces of the links, so tha'� the reflex could be brou�ht back at ffoms later time. Another system of sifmals is derive',' from speech. ','ords act b:,' links to es Hblished fsc s ,rough a �:rocess we �now as This i the process leErns fro� others who have experienced pain associ�lted with contractions of' the uteru.s. also learns thar although ly uncomfortable, is in is neceSSt3 to fully exper- i:Tlce 'the JOY of mot ood. A conGitioned reflex can 0 be developed and maint;ained as Ion,,: as it iE not inhibited by other reflexes. �he - e of conditioned assocla�ions throu!';h ech, c e of inhibit I'ef'lex pain, is due to �he woman1s ignorance of t exact physi- 010 cal nroceus of childbirth for the aEsociation between uterine contraction is oractically 7 Is1dore BonsLein, )'.D. , 5'sychoproohylact1c '(reparation for T-'a.irless Childbirth (I.ondon: I"(c(dical "!il11arn He inemann 20-2 2. oks, Ltd., 1958), pp. Lj. the woman learns about her confine- �ento is i nee nouri s an 811tire series of' (::ffJ.otional manifet3tations, 2:oing from s:ppreJien sian to fear and uusets the 0uilibrium of the cerebral cortex.••• The ;nset of labor increases tnis exhaustion and weakens her yet more. '.1'he wo man is incapable••• of re-establishing the tone of her s corticHl activity, because she can not act. Lamaze pr!,paration attempts to reor;tanize the viO�lan I s cerebral activity. This is done by applying newly learned condi.tioned ref'"! exes and thereby, inhibi.ting pain reflexes from uterine enteroceptions. These newly conditioned re- flexes associate uterine contractions with actions on the wonan's part wilieh permit her active participation.9 :Briefly, during the six weekly sessions of f7i&Ze 1;rain- ing, th, anat and physiology of pregnancy and childbirth, neuro-muscular I'elaxation exercises, efficient of the body, and appJ.ication of breathing 'bechniques to be ap- ied in� childbirth, d.iscussion of thG role of moJern obstetrical techniques, meclicati;;n, and anesttlesia, and the goals of choprophylactic tion eire s- 16 cuss practj.c FoI' a compJ.e!;e :mation of the maze fiethod the is advised to see the follow ildbi.rth Without Pain ( .F. Dutton and ao;, Jnc., 1 ); 'iJlernand Lamaze, D. , ess Childbirth ( n: • .::.c::=.:::.,.,_._. Bonstein, I'! , Fl'3ychoPI'ophylactic FI'"'.... •• Dc\l(';,tion for P",inless Childbirth (London; illi.am lcieinel',ann 8 Ibid., pp. 31-32. a 'IbiCh, p. l °p.SYChO-prophylact1c flethod of ildbirth (Lamaze Technique). 1 r'i,?d ical 01:, Ltd" 1, and !)lfred 'L'anz, r. r). A Practical TraLlin,c; CoU':'se for the FsychoproDhylactic J1ethod of Childbirth (New York , 1 ) • 6 D WHEN LAB� STARTS "M0 mIOl':AJ : ATIOI' 0]' 'H \1, RAIN FmmH []f) /1' ,I AG I'l'A'l' IOr,01\ OF Bi\.LAN"OE OF I.rTIi� INCO- It"ATION N;�RV()U�) E)YSteEI'� t OF PAIN! BAIJ�NGE '1\ NElVOUS SYS'J'Eli ION OF lfJAf:'iF.;.:;; PH\" DUCTS eni' BJ\IJ1NO.t: Oli' BLOOD CIRCULATION ION RECl�} L Isidore Bonstein, I'i. D., Psychoprophylaci; ic ITeTlar;,li,ion for Painless Childbirth. (I,ondon: 'ililliam HcJ,nemann filediccl1 £\001(8 Ltd., 1958), p. 82. 'I RS (ACQ1JImm . + (AC('jliIRED CONDITIONED R:�iI'TER BLOOJ CIRCULATION BlrFEor.f\TV:t,; UTEHINE SHOT{Tf�)l( li'O, ;: 'I'lL, INF iU\'Jl IVERY BY ( :�rr'1ONi:;D L 'ij�Fl?'GcrLlIVE: Sf-tORiF8P ('.IF 2N7D D·lfD,. ,d .. ... L_" I'" p;:/()'" i,:n NO Isidore Bonstein, N , Psychoprophylactic freparation for Painless Ohild.birth. •. (I,ondon: v1il1iam Eeiner:lann !f'ed. ieal Books Ltd., 19,8), p. 83. PART I O.v' 'L\P (:; Chapter II: 8 aT-) I In selecting and analyzing a problem for study, it was decided that an exploration of the ulother's icipation in labor would be most significant and provide more insi�ht in- to the effectiveness of the method. is probleru WB.S also selected because of a felt need of this author for more in- forma t ion amont� those in the medical profession concerning the objectives, goals, and practical application of the La- maz, Metnocl of Childbirth. 'l'hus, the problet: explored was: Do("s the woman ilillO u- tilized the Lamaze Method of Childbirth conclude that it en- abled her to more actively DarticiDate in the la�or p rocess? .. '- - � 9 CW II Although many testimonials can be found praising the at- tributes of prepared childbirth, very little actual research has been done, especially in the [pecific area of the Technioue. The most pertinent of the available research de- rived from a review of the literature is reported here. 1,10yd H. fiiille,' reports in the January 1961 issue of Obstetrics and Gynecolo�y on a ,Ian for childbirth education which he set up in his private practice. \Vas be- 'un on ,January l, 1951; Lj'733 mothers who del i vereo 4'788 babies partlc ted in this pro!,;ram \lUI' the nine year period Dece�ber 31, 19�9. The instruc'bion for e \vornen inc 1 f0ur, two hour classes conducted by rnine(j nurses. Th firs-t three clclsses "Jere attended d�)r tlle second :;r er and s v!ee}�s est eel e of confinement. covered were nl Gxercises alid follo'£in:' :,: r::t"er unstructured pattern, t.;opics of in \v�; :11 iller' s E:unl;r:�Dr:' a::ld conclusions are a:-:; fol1o ll LlO:yd [" 10 11 l. :�:ducation for cnildbir·t;h has jec number of 'l'ouI's in labor. It has 2. resulted in lower morbidity rate of moth- ers. 3. Babies are born alert and seldom need stimula- tion. 4. Deliveries are much less complicated. 5. The average blood loss is less. c. 1 mothe�s were given e opportunity to watch t ,(;ir O\oln deli veries and 75 Der cent did so. 7.. SU1yoort dl1ri lc:;bor by 'oroperly t:rained "person- nel was fou.nd to be essent ial'� , � �" 8. �h8 method appeared heJ.p most patients. Miller also concluded that it is becomi more B:nd more iportant to have a patient satisfied menLall and emotion- ally with her medical care. �motions play a great part, but also a great physical effort is required for delivery. There- fore if mothers are trained for physic effort, the elnotion- al satisfaction will usually follow. rl Tuoper studied over 1,200 wo"en who utilized the IJ Di cl-c-nead, Lldbirth Hiloa"!; Fear (New Yor.'): H arid Brothers, 1959) l? '-1('('1 0 n f' rom l'':;Jj 'CO ):;4· Inc ].USl • ve. He the following results: • �. 1 I?_\�I:; HO Rt:lA1\ Of; -PRI1ViIFARllS l'miT If AEAS i';xcel i ent ...... 19.7 percent .••••A6.5 percent Very Good ...... -22 .,6 II ...... 10.7 II " II Good ...... 7 ..... 1? ,(3 ...... 2/7 Helped ...... 0 ., ., ., •.17., 8 22 c) " ilures ...... 8.. 0 ., ., .,'7 ., .,•c. Carl Tup , "Condition for Childbirthll American Jour- nal of Obstetrics and GynecoloRY 1 1. I, 1"0. Lf (\l)l'il 1956), p. '/36. 12 Carl 'I'upper, "Condition for ildbi.rth", American Jour- nal of' Obstetrics and G'mecnJ on!, Vol. , Ho. 4 (1\.pril 1956) pp '77()r:;:,- r '740 ., 1 labor is used �ot so Duch for its reI f froffi })airl as for its psycholocical effect on ,;he woman, t,endtting ner- GO Q,,- rive greater satisfaction from haviDf:: a baby, and (;:1i8 is a most valuable add ion. This next study is based upon attitudes, feelings, and reactions of doctors nurses and people in many departments who have wor]red with parents Iped to develop the pre-. paration for childbirth program. 'llhe rlJ.ilosophy of natural childbirth was Gxplained and discussed. It 'dab made clear to every patJent that; there was no such thinp; 3,b success or failure. Bach person was treated ac an indi.vidual with cer- tain basic GIDotional charac�eristics. �he function of this IlEltural childbirth 9roF;rar:� HLich tOOi� place at ti,:e odne ospit;>l for women, Has to hel;) each vv'O:-;]cU1 develop strenr;tbs to tbe fullest and teo evaluatioL of success was whether compared almost 300 women who attneded a series of cldsses l'litb 300 who had ',ot. ]\)0 diffee.ences vlere found in blood loss or lengt of labor, but those with preparation needed less medication and arlGSLJlesia and had more slJontaneous doliveries. est differences were shown tn.ose inally requested the classes and attended them. 1 1t 3jCflarion J). ird t; ,rIogan, Elective Fro- i'?:ram of FreparErt�ion for C11i1db at the oane Hospital i'or ['fomeli, fv;ay 1951 to June 1953" American Journal of Ob- ') No. (Beptember 19:)6), stet;rics aml C�vni'1cQ1Qftv, Vol :3 p. 6L13. Obstetricians answered tile following questions: l. 'Nas the mo�her controlled bhroughout her labor? ;:> \\'8.8 she compleTely cooperF·tive throughout? 3. she oleased with her deliver:v� LI_ • ','ias she happy with her baby? Mothers were asked: 1. Are you isfied with your experience� 2. Would you elect natural childbirth next time? 3. When did you experience the greatest degree of pain or discomfort? 4. Are YOU happy with your baby? The physicians listened to personal accounts from Bach mother and evaluated then, on three Doints: physicsl, psycho- logical, and soci OBSII'L:.;TRICIANS Successful ....•....•.•.•• ...... 150 Reasonably Successful .... 46 ...... 2LI- Fairly Successful ...... 32 ...... 2"-, Unsucce sful ••••••••••••• • • • ••.. • ...... 27 .. • 1-10t eva1 uated ...... • .. .. • • •...... 5 IV'tarian Laird,.. and. rV}aI'f,�aret hog:an, II .. • (:jeT::i'Ie on ion Childbirtb et the Sloane Ho ital for \vo- men, 1951 to June 19;:;3, " Americar�_}ournal of Obs-�etrics "rid Cynecolof1;y, Vol. I,XXII, No. ') (f:eptember 19';'6), p. 6LJ-'). The obstetricians scored hi mothers in lL� thirty-five records Bnd lower in 30 recordc! .. following set of fivure an� tables ar's results of psychoprophylactic preperation i: 707 conf c;nts ternity Hospital at In ra'ted excellent, 4��.5 percent !�ood, 11.3 percent fGir, And . 1 1!�.2 percent faIlure. r, / the followinf results in 1.is until October 31, 1955. fL';')'J.• ", :3 Ii D:E:GHTEE NO. OT? J?Alj_,lTJ�;_lY�N3 ,PEri CEI\YC ;;xcellent 89.) 18.1,3 '.:; Very Good 1,097 ce.. . 6·3 Good 1,172 24.17 l' 859 17.73 82.96 lerab1e 595 12.28 J·'8ilure 231 Lj·.76 17. OLj Lf,847 100.00 100.00 P. Hubert De \'Jatteville, '''rhe Use of Obstetric8l Anal gesiEt at; th[::, F!aternity Eospil;al at Geneva, II American Jour nB.l of Gbs .etrics and Gynecoloi2;';, Vol. IXXIII , No. 3 (lV!arch 1 1'j'() , p. 483. The criteria for the cl ssificBtion of the reslllts in these s1;udies is �s follows: 02111' CLASS J?HYSICTAX 0]1 l"iLi)\'\J IF1� Gxcellent No feeling of pain. Fatier,t relaxed, calm with perfect self control, no complaints, smiles. Good Occasional slight pain, No complclints, but some perfect tolerable, no "bemporary tension alle need for 2nal�eeia. viated by massaESint�. Fair Perception of disturbin� OOTIlplains, some rest pain, des for some lessness, occasional analgesia moaning, but responds to ordeTs and encoura�ements. Cl .r" lr_�' "'--"!- '" ,-.C' ]l'ailura IntolerabJ.e oain 0Credml.d1.��, r80 l< l ::: ssne,,::>v '} ps chomotor excitation,' no e to orders and en co ur agEnnerrl,;;-.!- _____ 1 ttevtl1e') nT1he of Oost cal i 11 at the f'-'iaternity Hosrlital a t '} jjJ'f)(;;rican .Jour;�;Bl of Obstet- 1957), Hics and Gynocolo�y, Vol LXXIII, No. 3 (March p. 482. 1 [:1 / Us 'Ghe Rbove cri�er·ia. the rssul-ts in �('0 follo� l:ab12 show tIle 69praisal of the course of livery i· VJomen (primiparas and multioaras) \dth and without psychoprophy- lactic tio:n, ternity Eo it 1 at (�eneva. Ninety-two cases used psychoprophylactic preparstion and fifty- nine did not. J.J1,UJ..I,!..;J J �� APPRAISAL OF' THE COURSE OF DELIVERY HOSPITAL ,-:-.���� HATERNITY AT GENEVA:' �---"----T�-----r __� __ ��. 1 �1�_���vrJIT�,rIT�TrIT�.w . �� �_��nn�n_�-4���R�·i'�rR� +- �MA\T�:,[JWRR�R ______� � p" Ph 1M Do Ph 1M P. Ph 1M p, Ph 1M 66 z 46 37 0 H 41 42 H I r 4; H j 3 '32 H t=l 22 19 I ;- - ,9 8 12 I f n • 1.4 11 �60 z 50 0 56 H I ::3 '-' 0... 35 ><:1 II 30 1%11 I 27 25 22 22 I 13 I r I 2 t n � � ri 62 61 34 2" 19 20 17 17 16 17 'PablG 6 slowS 110W �choprn 8ctic l; ion had in- nevn sia u.sed at t same iYlstj,tutj.on durin� the ti!nes period from 19�O to June 30, 1956. 6 jV: June 30 Yeer 1950 19:;1 1952 1953 195LJ- 1955 1956 Total Number of 1,410 1,406 1,380 1,497 1,534 1,702 922 Deliveries Delivery Under 326 591 726 840 608 170 59 '[lrilcme and Nitrous 32% 42;1, 56c; 39;; 10', 6.4�'c Oxide Delivery Under 63 LJ-8 LW 39 52 49 29 4.4 Delivery Under 81 72 35 2 i"addle Block c: 7'1 5.1 2.5;c 1;!& J .. !(J o .. Delivery Under 17 16 88 152 106 108 48 1.19(, 10�6 Continuous Lumbar 1 • L."""")"i r:O • 6. 10.3/)/ I') 5. idural Analgesia -�- Delivery By Psychoprophylactic 454 250 26.59b3 Preparation of all deliveries P. Hubert v!atteville, "The Use of Obstetrical Anal gasia at the Maternity Hospital of Geneva", Americen Journal of Obstetrics and Gynecology, Vol. LXX III, No. 3 (March 1 Sarn reports on a stud� conducted over an ei G0D month period on 190 patients :from an antenatal clinic in I,eicester General Hospi conclueJed that two improvements were possible in impro psycholop;ical care du,ring ncy. G is the abolition of loneliness and anxi(;;t�v� ich can result in hospit ization. Sec- and, a new and practic01 tool is neeo to eliminate Buffering 18 in childbirth. '1'hese i by a tem based on three fundaf{jt:::)ntals: J. The patient was (�(iuc8.ted in the ele:nentary an atom;;• of childbirth. �. The pain threshold was r!lised by mental concen tration. 3. 'Ihe patient was made aware of a,nalgesic a,:,e(ts and assured that they would be employed if necessary. Forty patients, all of whom had anxiety about childbirth, un- derwent the training, and were compared with 100 who had not fift:f who used Heads method; no differences were found in length of lahor or complications, hut less analgesia was necessary with "arn's group. In brief, the Lraininf; consisted of teaching the patIents to achieve a state of extreme relax- 16 etion hy strained ocular fatigue and sue;gestion. evaluation of a prepared childbirth program was un- dertal<:en the . ,ent of Obstetrics and Gynecolop;;; at Yale. All sixty-two women L the study we'o primiparas who weeK of pregnancy. FrenataJ_ classes were held for -btJGse wo- JD8n with Gt18 content I�e lutual topics of discussion, ex- ercises, and relaxation techniques. This study concludeci of person who utilizes 0 prepared childbirth pro is more irrlportant in deter�i i. its effect thot � orsppration itself� ((lh data from !;!�is s�udy i;id not sup- ort previous ,reports COllC(.jI'ninc effectf?, of preparation and 16, £l..)\. 'Jarn, HIv1ental Concentration--A New and �;::,;ffectiv'H logical Tool for the Abol tion of Suffering in ild- btrth", Amt?T'ican JournaJ of Obst2tri cs cU1d Gynec()logy, 1, \0. ')0 IV"X"r-1I��Aj _, j" 1 anuary ICCjOL )) , PP L7-31" �. (J ' 19 support on the lRn�ttl of labor, reduction of SCd8�;ion, etc. II: was therJ conclllded t�)at the ul'binlai�e contril)ution of pre- pared childbirth programs in thi� country will he to help in reversing the tren6� toward llheav:f sedationll And tile use of amnesia proClucine: drugs. rrl1e dId find, however, dif.ferer,ces hetween tGose who were interested in and attend classes and those who did not in that those \Vho attended were older, better educated, .from a highe� occupational group and had ,- 1 , .fewer fears about childbirth. ' Chertok has cor-rpared the three;e most widely used rnetl10ds of' prepared childbirth, namely the Read method, hypnosis, and psychoprophylaxis. He found that relaxation was utilized in varyinf'� I:lays in a] 1 methods. HoI" some relaxation is pas- sive; others reuuire a more active pproach. Nonetheless, it be thought of as ha ing effects at three levels: mus- cular, central and psychotherapeutic. There seemed to be no accurate practical ins'�run:ents for measurin� '�he de- p:ree of mUf3culElr relax,;rtiol ' Ercb ieved, but centr'l} relaxation VIas brout�bt about b�' the mechanism of attention, or in Fav- lovian l�8rms, by focusinu:: upon a cenLer of' cortical activ- ity. Psychotherapeutic relaxation is accomplished through stiOD. Crhe sian school expresses this in physiologi- cal terms (hypnoidal state with hei�bt tho Americ;�lns in psycholoi>;ical terrns (interpersono.l :s.spects it ()b�j8ctive na-cion of a PI'8Dared Chil J , ilmerican JournE{l of Qbstei�rics Gvnecolo�v, . 0ud .L,!j_,'d_� 'J�I\To' · qA ( f\foveWfJC1""; 1C\h'"..J/'�<-/ ) 'J 'pp 1196-1206. .'� ,,< - "v_ and duri lsbo' theory, t e 81lalgesi,c effec'� occur's AS 0 r sul':� of posthyp- ic ion. R Americacs maintain tne effect resul-I;s lS by intrshypnotic effects. _ a tl'enrptic�l'J basis Jirench proponents of psycho pro- O'n -.. J � , -..' _ = -_ phylaxis maintain that relaxation does not wort the same way as in Read or hypnosis. These methods lead to passivity, inhibitory states, and a lowering of the level of conscious- ness. Psyclloprophylaxis advocates activi-�y that raises and maintains the threshold of cerebral sensitivity. However, some express the view tha� a state of muscular relaxation corresp()nds neurolog:ically to an inhibi ory state. 19 Fizalkowski has levied several strong criticisms iost; loet ods of psychophysical preparation and other methods for the conduct of labor. states: The exclusive concern with the combat of labor be- came the po'nt in psychoprophylaxis as well as in other psycho ical methods. As a result, a hos- tile attitude -�oward ·he me s of pharmacal anesth sia followed. In practice, furthermore, it is difficult to disnense with tlle convichion of tIle necessity of pain, �specially when even its denial is continually tn; spo.Ken of, for the atterr i0 0f' � 20 e pregnant worean is thus concentrated upon 1�. hetho,[ of Obstetrics pp 291--265. 19Ib-d"1 .., p. 26L�. 20 VJtodruimiery Fizalko\'lski, 11 'days of L's;ychoptlysical ion for Childbirth", Americs.I1 Journal of Obstetricg and Gynecolop:y, Vol. XCII., no .. 7 (J\ugust 1965), "po 1U18. ___ 21 He so adv8nces the opinion that o [)J:oph)'laxi:'3 made 0 pal ' ial Uf3a of the :rinciple that labor i:3 the re- ;'lUlt of inBcti.vity and Incl.: of pal,ticipation bv the tient. His contention lies in the b(jlief that the sufferinr; of the labor patient has dealt with, but the complete re-educa- tion which should include both the psyche of the woman and the menical approach of the obstetric1an.21 He cont inues by peine 1n1'; ou that medic ine i I;self has contributed to the exaggeration of the suffering associated with labor by excluding from the oatient's consciousness that import::mt role she can play in protecting her babv :,uring the birth nrocess. '1'his role among the oth'3r inmortcmt top- ics of pronatal instruc1;ion cen best be oresented in a group s1tuat10n. FregnEu::t Vlomen feel better in 3. Group. J11hey form associations with each other and compete in t�e cor rectness of the perforusYlce of (;:X8rcises. c:: The mother who is \'Jell prepare plays a superior• • • IDole 1n �') the process of childbirth . • Carl Fromha�en, hOi:Jever, expresses the opinion that feV! women Can be prepared for childb1rth solely throu�h indoc- trination. contends that a deI,endable �ranouilizer might produce similar results allaying fear and anxiety in preg- nant women \'iho an psycbolo colly unprepared for natural ch11dbirth.L')4 c y) GCTbid. p. 1020. 23Ibid., p. 1021 ':> t I! '- L'Carl J?romhagen, 8il]{0nt of Smot;;ional DisturD;':l.nces Obstetrics and Gynecolo€v J.8TJtSlt 'J IUnericEJ.n Journal of Obstetrics ' OlOi.<' ,VOl , No. 2 (September 1963) p. 184 fhe 8ent81-hy�ipne 3 acl1 e of rograms to re1i�ve 8,nd tension in childb irth .. How- ever, no publ ished re' u1ts h:�,ve demonstrated any s differences in criteria between women who have had spe6i�1 ewot iow"l care tl10se who had not. These studies were the 2 follow ing: He=y, 1937 5, ]'ries,19Lf1, Eries, 194Lf27 C;im- 29 0 Al Y' L' rJ 28 3 In0rman,f l "1"( , Clav'"" 1041"j v, RO"JebyIT '-' "' 1951, Caplan, 1951� _ 3� 3� Caplan, 1954 L Caplan, 1957- J. 25C' J. l,!". Henrv.f, "'li'en" ' v '""Jl,;C;(fl' ene,-t ;Uuring Pref{nancyl!, Pre- veni;,)tive IV1edicine,_', � Vol 1 :209 (l ) ouoted Ricllardson and Guttmacher, p. 26. 2 6/ii • Fries, "IJjental Hygiene in Pregnancy, Deli ver,Y, i;he Puerperium", ii,pntFl,l i-TvfTiene, Vol ,(iipril 1941) pp 1-36. 27 lV1• Fries, "Psychosomat ic Relationsl1i p Between !'other and Infant", Psychosomatic I' 2EiICJ!.. /,immerman, "Iublic Health Nurse and the ions of Pre(i;nancyH, Public Health Nurse, Vol. 39 (19Wl) quoted by Richardson and muttmacher, p. 25. 2c )A.8. Clay, !!Guidance in Maternal and Infant Care 1-1.\'10 ;onths .fore and A:t'tsr' :Hirth of the l?irst-Bornil, FediatI'ic�, Vol. II (194t) p. 200. quoted by Richardson and Gutt- n18.cher, p. 26. 0 3 llS• Boweby, "[,'laternal Gare and ji!ental ,Health" ,I',/orld Health Organization Eono�raph Series, No. 2, (1951), p. 26. As quoted by Richardson and Guttmacher, p. 26. 31 C'T. '�8 '/c:.l� "Ian ";"""en'l-a'l Hygiene Work ith Expectant Eothers- a PsychotherapeuticJ_ Approach", IV!ental llyp�iene, Vol. XXXV :::';:" (1951), p."41. As �uot by If i char ds:';o-"n=a'-',n"'a;;-- ac he 1', p. 26 • -7:G"'u"'"t'"'t;=-n:':.1 -z---' 7"'0. Gaplan, '''Phe j"enta1 Hy[; I.\ole of the Nursa in ternal and Child Care", ,!;i\J.1'J.LJr,"s;;;w.j.un",u_' Vol II, 1\'0. 1 ",C.i.l!'.J.1J.:.1;1..w./o",o",-k, (January 1954), pp. 14-19 • .")3G• Caplan, "Ps:ychologic81 Aspects of ernity C�areIt , American Journal of Fub1ic Health, Vol. XLVII, • 1 (Jan- uary, lS57) pp. 25-31. The use of hy�nosis was st ied by Abramson and Heron. e results reported in �!he ;\merican Journal of (�tstetrics and Gyn�cology, Vol 59, 1950, showed that tho use of hypnosis resulted in an average reduction of time of the firs� stage of labor by two hours ana the difference was even more in primiparae. I'he study used 100 experimental subj ects and controls.;;"ll_ Special programs promoting; "natural childbirth", educat,,,o childbirth, mental concentrat ion, T-'avlovian condit ioning, et cetera, have yielded a great deal of information. laxation is strived for and is accomplished through instruction, ex- ercise, breathing and support by those attending the mother. preparation of Dick-Read emphasizes eliminat which produces muscular tension ultimately pain. , a llev iat ing fear would pro :nce a smoother childbirth 7 ,- both ically and psychologic ly.;;) Iviandy, at al, conducted studies based on Heads metYlod tIl eUl attempt l�o assess tihe vEi,lue of the:: preparation. wi-th 400 con- c ing almost L�O() pa.tients villo par tie i ea troIs who had not, the� found no difference in the len of le.bor or occurence of compllca�ions. y,G ')ll_J.E. Abramson and J Heron, "An Ob,j"ictiv8 Evaluation of J!ypnosis� in Obstetrics!',.• American Journal of Obstetrics and Gvnecology, Vol. IIX (1950) p. 1069. �s cuoted byl{ich ardson and Guttm,gcher, p. 27. l'a1'- (jl1ildbirt;h b'[J t:;ural';' n , ) , p. 1. As Quoted �oberts, et al., conrtucced clusses and c 1000 "10- also concluded that no si�nificant differences were shown in 1 of laljor, ;fiB enance of con�rol the rna her or oc- curence of complications but that there were diffeY'Boces in the de,;ree of relaxation 2.nd amount of' analgflsia needed dur- , 37 i laoor. Van Auken and TOfnlinson also cODlpared two Froups of wo- men, 200 in each group; one group participated in a prepara- �ion for labor (IrOcram a the other did not. found that the prepared tien s needed less analgesia and anesthe- sia, h�d two hours shorter labor, required 17 percent less delivery artificial means, ana 5 percent less perineal tra,uma. T'homs Karlovsky, concluded that after studYing 2000 de- liveries their regime ly decreased the number of' de- sed infants at birth, resulted in shorter labors, few- er nn,r""""'ive deliveries, less blood loss, quicJeer recovery, """"CI more sQ!;isfied, haopier mothers. 37n .. Hoberts, et aI, H'rhe Value of cenatal Preparationll, aournal of Obstetrics and Gyneco10!":y of the British ";maire Vol. LX (1953) p. 404. As quoted by gichardson and Guttmacher, p. �n 'oW D VanAuken and l),R. '�omlinson, 11 AppraisaJ. of tient 'I'raining. . for ahil(lbirt�h\i,i, Arnerican Journal of Obstet- rics nnd Gynecolof�Y, Vol. 19 ( S3 ) p. 100. As quoted by Richardson and Guttmacher, D. 27 . J:'. Kavlovsky, 11111'10 !Jlh.ou j)eliveries Hnder a Childbirth• �FrofJ;ram; a Stattstical Sur- can Journal of' etrics and G,vne- "'1'1"gcESo7; ,;)r,:"::':p"'=p :::'. ' 4 � :2'!9-8# • c.: The accumulat e(! evidence fI'O!!l the prece�iI1� invest i�a- decreased admirristiration of mf::?dic9.t ion wt t;h irJore s.·ontc1neous deliveries , not �l dr8stic reduction in Is compl ications. l:;xcept for the study done at lale by Davis and Morrone , none investigated the motivat ion and psychologi- cal factors which prompted the women to attend classes , and the possibility that their labors might have been better with or without preparation. Differences were found , but none vJ ere of maJor. l'!l. por-Ganc, e.li O "Much more intensive study of the psychological and social chatacteristics of part icipants and non participants is indicated. Unt il a control is used which cons ists of women who would have wished for but have been denied the opportunity of attending classes , the effects of' expectant-pi:jlfent education cannot be conclusively established . - An art icle by l,ee Buxton seems to summarize the preced- ing material . He states that modern prenatal care up to recent time has neglect�d a very influent ial facet in maternal weI fare and labor and d'alivery ;: the mental and emotional at- t itude of the pregnant woman . B.o\'Jever , 'p rogress in anytb ing must come in s·�ages . With the refinGments oi" qute phys- ical cara well established , psychological care can come into 40 Stephen A. gichardson and �lan F. Guttmacher , Child bearinp; -- Its i30ciel end FS·1Cbologi cal ,lSpc:ctS. ('fhe ,!il Iiams and �!illdns Company , 1(67) , p. 29 . 41Ibid . light . �his need is be r 2.1 ized the increas- nur'il eI's of chi ldbiFt;b prep,H':" t; ion el inies in tb is coun- try . �omen are beeoIing better informed and are de22nd inf the prepaY'C} i; ion hopinv to be 8ble to 8cproach the labor and delivery with 8nticipat ion, eaf';erness , and excitement , in- stead of fear and dread . Certainly every technique reports a tr,.lly impressive number of' successful cases . 'l'hree-fourths or more of' the part icipants of any kind of childbirth pre- peration have had a successful delivery . It seems that child- birth preparation of any kind is of great psycholo 1cal va.lue . However , he states two possible objections to prepared chil.d- birth : 1. Time , expense and number of personnel needed . 2. of preparation technioues for emotionally unst Ie individuals . Both points brinG to focus the need for care- ful assessment 0 f the facilities desiring to carry on the also a sensibl evaluation of every . . ".42 Siring n1"pn'''�ClT. lon 'G raIDIng . Natural childbirth is said to "work." tJum;i ci s have been made : anxiety during T) regnancy and [lain during labor and delivery are reduced; a woman 's feelings about her�elf are improved, as are both her feelings toward and actual reactions with her hus- her tl\' 2ct of cllildbirtll il; f is l? -�y; .t 3 much more posltlve ••• L�2 � � p "}' h h 1 In..Inf( ' In J)reparf.l,- 0. Lee ,,)uxt on, .-syc Op_�:yS IC(;i. ,_ .- tion for Childbirth" . as armear's in 1-' eternal IIlc 2ltll Nursinrc edel] I. itt and J Jllliam !i orre ,- (.i rincoton , New •. Jersey : . Van Norstrand C. , Inc., 1962), p. 18. 43 Deborah Tanzer , " Childbirth : 1"" in or Peak f 8rience,?!1 }1sycholon:;r fllo(�,8.:V , :c'epT' int , October 196(3 , p.2. 7 ,[hy e women to effect ive- con ,rol sir own la ors : What psycbolo c forces a:['6 er ent in the tion? Dle promising advan ces have been in the field of teaching and lsarnin� which can explain these quest ions . Spec ial techniques have been de- si[';ned to arl'ange what are called "cont ingenc ies of rein- forcement " wh ich are the relations Wh ich prevail between behavior on one hand and el,e consequences of that behavior on the other , with the result that a mucn more effective control of behavior has been achieved . 4Lj· An organism le!Jrns by ing char!fi;es in his environment . Two recent principles identifying this have been proposed. One is the Law of J';f- fect . is insures that effects do occur and that they oc- cur under con6 itions wh ich are opt imal for produc inc; the c s called learning . Once the reinforcement has been islled , the behavior of the orc;an ism can he shaped a:: A second techni e permi's the maint enance of behavior in iven stat es of strength for long iods of time � Re- inforcements cont inue to be import ant lone; after an nism leerns to do ., thst; 'is Ger it has acquired the behnvior . Reinforc ement ii:; necessary to ma intain the bell vior in 11 L.-4B • Sk inner , 1IThe Sc ience of Learning and the lirt of 1 t rs e;}c hOoi nf;� ., as in .;.!+2:���-+;��;.;!:.:��-,-: T�. h-" ,:::eo�r*,Y,-3;a!:.!D-"J ;!;) .' ctice by W 1 I. ill Moore , Pr ince- tOYl, Neev Jersey : D. Inc ., 1962) , p. 18. Lj'�'Ibid. , p. 19. Lj.6Ibid • Virginia Sendus s·tstes that the behavior attitude of the prepared pat ient in tbe labor and deli very room can be accounted for bv basic psychological prin�iples.LL7 ' To do this one needs to ident ify the primary reinforcement , the responses that are made , and the st imuli that are to func- 4-6 10 ion as seconciary reinfol'cers , plus the cont ingencies present . One basic assumption is needed, that the production o'f a child and the process of birth, with its associated sights and seunds , act as primary rein forc ement for the normal 1IJ O- man . It is 21 rewarding [�oa1 . 'I'hus , previously neutral Bt im ul i will become reinforcing I>lh en repeatedly paired with it.49 FoT' the prc:;pared childbirth PD .ient . there are repeated pairing of a neutral and re inforcing stimuli as she lis�ens to and reads about childbirth . learns the se�)uence of eVetits leadin� to the and the specific res s ex- pected of her. Gach res onse will in its turn produce cer- tain recognizable consequences. T'hysiologic change and the feedbacK from each of her learned res:_,onses will become a discriminative stimulus , telling her what to do next and as a secondary reinfo('cefllent , rewardinB in i·ts own ri;tlt . ']lhe closer each comes to the L�7 Virgil1i a , II An Academic :Fsycl'loloGist LOO.\;;::8 at Naturel Ch ildbirth" , Obstetrics and G:ynecolorz::y , Vol . XIV , No . 6 ( cember 1959) , p. 820. Lj S · Ib lG'... -'._- LI·9 Ibid. "T) J Ibid., pp 820-821. of c1.ctuD.1 [1 8 secession 01" well Y'8- 1 SPODS8S .9 ant ic ted re\'larci s.5 '['hE:- Fluthor has th(3r :;fore s�ated. specific implicat ions for Lraini pared chi1dl irth : 1. detail of t route to the must. be foreseen, anticipat understood by the patient before it can serve as a secondary reinforc 2. ient mUBt aw."re "bhG.t there are alma variat i ons among normal labors (?,B t h ere are , reports of normal labors shoudl be reported . 3 . shOD not be deni These sensations can function as rewards only if they are foreseen . 4. �ovies sho·,ld be used for teachin� aids . Mul "t ir;aras in the class shoulQ discuss 'th eir experiences . 5. Hedico.l personnel must be in attendance to ex plain ci.evil?ction as they occur , so the cient CD.n ad just her expectat ions accord ingly • AlSo , tl ey should 52 ke ep her informed of her pro,',resE . s V ariou as ve heer:. unC1 erta.L:en GO deter:]!ine mothers t reac'c ions to childbirt� classes � A s'�udy of 1 pEl_res babies were -cwo to mO;-i1:;hS 016 . itbout ODG half had ac- t ttl "t heir h usbands . sisted of six to eiBht weekly sessions , some with exercises . The int erviews to evalus"t e the classes were structured, arId lasted about forty-five minutes. \der(� ini ered by carefully but non-medically trained persons .53 l ").' _)lt 1( " 1. , p. 82. c.'::> ·�5';; Il) id ., pp . 822-823 . 53Alfred l� . Bock , �mma L. Ghaffer , and Dorot ��: . , About il{lbearinR Parents 811 , r�ursini2 Outlook , Vol VIII , No . 10 (dctober 19(0 ), p. t2he retlction:3 to the classes ar(; as foI l OVJS .. Fo rty percent of ttlG '::'l oth{�: rs vi110 did no t at Lend uid not �cn o\'i th.st there were classes . Another oncthird saia employment , and �C'tat ion prevent fro:r: c I'nl, Oni? out of THO thirds ttlOught it would have been an advant to attend . In general , the mothers valuea the class experience . �nree fourths of the mothers who attended classes mentioned th,e class as a good source of information about childbirth , ba- by care ? and pregnancy . One half of t11ese r�-,t;ecl it as the si e most; im1' ortont source. 1',ore 'Ghan one , fourth thought all parts were valuable . Sixty five percent were - 1J na hle to narne subjects not covered in C S5 which � been helpful 0 them . One half of the mothers at 't he t; ir:-: _:- of this int;-:;]:,view had <:3_1ready recol:"ill18fld ed the cl,:�j sS to ant mothers and �ll hut t;wo of the sc id t v/ould atd:;end if e. Mothers valued most. t;ho classes 1:;0 the of what , la b car'e \vuld menn to them . 1 u �'j ect e1' of -CrIe currl VC' Ill'''d: y; 0 oppor1Jurli to in a GY i'e;lt; t to oro fit most . t e needed to be to c� oose tlleir own culum discussion. 'Chars is no i icat ion frOGI ��lese nc:-� at� elL",} ;:)es VJ::tI3 r eel to or 's rea�tion to their ild- 31 ,� beari ex i2nces � On tIle ottl r , v cl sses HI possibly have !)rovided those moot not reQuired by those who did not attend . ,-� 4 Inmlicatiol1s 1'rom this study ,�re : 1. Much more needs to be done to relieve women of concerns anxierties in pre�na' ncv" . �his should not be done by lectures vice� but [rroup discussion and expressi and sharin� concerns . 2. Mothers should not be le1't alone while in labor. Pro fessional per onnel shouldbe "ssigned to them and a simple change in visit rules should bemade . 3. Suggestions for classes : te publicity as to where classes are to be held, etc .; 1 should be trained it tile use 01' (Z;roup processes; mothers should choose their OWD topics ore them to the ext needed by thiffi ; they should have a c ance to visit the hospital . )� The purpose of s reported by Koldjeski, was to sent aD analysis Rnd descri tion of content obtained in tients. The us. of unstructured was one appI'oach appl;:,r select al he; h C011- ·,6 ce s in ongo inc£; public health program .- and frustra"Gion wer0 ident�fied as be releven' in war eing bh mothers in the ant HI p<::,riod. h{ursinf'� approaches '!Jere based on the reduction e;lTlQ usc or anxi e unstruct Llrf,) d i�nce was selected as one appro8ch in wh ic:; ·the !':ot;i"ter coul express feel flt1(l t out b c better ahJ e handlE' 3ses GLCOUDT; ered i:J 54 I�bl· ii p r:, )"�4,. --:::-.::..!.. ') . '-' 55 Ibid., p. • C) 6 � Helen oldjeski nConcerns of in l.lleo.ching pe'y i(�nce�; e.nd i\I�A Cl�nic;JJ. c;essiol1s , 1966 , York : fts, lQG7) , p. 117. family liv S V! Gro froln "lhe lo�er socioeconomic class . �� he tour or cl,te ies of expressed concern were : 1. Infornlnt ion concerning ant e- deliver;' 2. Information f:l bout F:!. natomy and io1 3. Feel's and anxi related to labor and delivery . 4. Informat ion rala"t in? to care j" lv rn =a11" CA b7e�On�, L, . v 57 _ • > v • of labor and delivery was IDOst frequently in- troduced topic by mothers . Seventy ei percent of the fifty four to�ic in"c roductions on this subject were initiat ed by the mothers , whilc twenty nine percent were by the nurse. Informa tion rela �in� to care Etnc 11:/ was ini roduced in a 0U8LCY of seventy one percent of forty (mc topic irl'.;rodlJct ions b,'; tile nUl'se nine 0crcent the mothers . Of e forty foul' to c intrO(luctions about Dnt problc:1LS, labor delivery , fj.fty four percer:t were by i;be !11o Lhers B forty six perC911t by t Ie nurse . In- Etol T)(:; rcent nnd fift,\ t: e nurse . exvsr1eDces tend to s ect topics that are self-ori.ented. Po-ch ci:!'\;e Tcries , 1J and anxi 1 bor 1::; ion on ant aJ b1(;; ;.:3 , i'or enG cLelivery!1 included to\ ics rc:l!=:t.ted direc-c GO ex- i(':-!"f1CeS fino. s nat ions in l/!hich mothers \;1ou.ld p:'rtic 'C8 57 TblO" . ,_ " in a perS01101 anci 1 'l ed m£tnner" i Cf>' !� ions IUO L; pat i ent 's fears anxieties , and thet she is �ore concernea about talking about rself than she is about IGarning the techniques of be [; those vlho teach the classes need the knowl and ability to use in- 507 terparsonal relations ips in order to counsel these !U,"n o"I-f� ;I' \'-�r'�O" es oiteD arGl ·bhe ones who ·teach the instruct ion , wh etll'cT it bi3 l.ama/;e , pr c; nata! classes , 's classes , etc., and it is a nurse who has IDost int te con- :.:; act wi the p8.t ient dvr her labor , delivery , aod hos- ni a1 st r':,ince this paper is ori nted toward nUI's ins , .'.:1 discussion of the nurse 's role wj �h the laborin. pat ient who h childbirth preparation is essential . role to pI v iYI eidine the la ient who ut ili�es the Lamaze m�thod" The patil�nt in la- bor is in a stressful sJ.tuEd:; ion . HAny that; dellands Xul pain to s:i. on a speci f' ic BC�l.vi des L u. . 121 . 58J"b 1' -1 , p. _ .59 II) l' Url " , �. Syndrome!! , American J·ournal of lC.--�"" )5 �) ')D '""CiS ...-- ' . sts on c w�! ich lead 1:0 rea sons 61 iz nurs care . s of in s_ re : 1. A feel :::-rLElte it/h ich is OPT/Qst-l- of pleasure . c:.. re of st imul ion of sensory sm . 3. A sensat ion having its own cialized neural mechanisms . !� com f3X D1JGnomenon involvin?: both a i'ES2 l inf�; LI· . . st ease sat ion wi-�h its OWll '- 188 . lost nlent ioned , more complex view of pain exis-I� s nr imari Loday due to t;he infl UI:Jl1C e of other di.scipl il1(::?3 such ,38 sociology , psychology , anthropolo.csY , and pS;jlch iatry . fill are known to have ej irect influenc e on one 's perception and response to ps in. Bender reports on two cOl1secu ;ive and related studies und er-baken to tesi; t 1"8 tionl311 b8 1., ween supportive llurs- labor and the inc idence of ()ne of hey" conc lusions was thf) nurse provia.es " tient , of her ions.l It has been said th natural Cllil ;birth no help that the; nurs in fac 'ehis only 1 s ane reS811tment nU2:'S fectiv8 ( spleton Ibiel. Ibid. l i lt , 1l , Lc-i,bor 1'1'1 Ibid. , p. 172. of th0 pRtienb's havior . Only then C8n 811e help the: i r::Hrt vi or in reJ_at ion to G 1 ,,, bor cess . In natura l i l ei b ecomes 3 11 1 ink to the i it i comes consumHd ith b thus to wi Aynp els_nee , til ss , some; ime:::: tc Lhe po int of' 67 o in[: s who have educated elves in the childbirt ; process are id0-:;11i ic. �hey have lsarn- ed how on:�ls bod_y csn c 11 ch i lcJ.b irth need the f) ainfu] 8LC{:; oJ' otb( T'S . of na d e al I: l'-lord-of-mout'--- 11 [; he iences of future p I'erl-ts wi ll b c ed tllose can h ot: ,:-aYi3 : 1. can t liarize h::J:self v-JiLb cLl1c_!l>irt::l-] ould • find t mct!-;_O( �; s hi1VG' C): 088(1 ::- at Gt; ir I'Y"n;c"";)_-G .:i.0l1F3 ctre . NUT"'se . 7 ll :<: " si ", , ur n I , . 173. ileibirth", [. 1451 . 2. i aCc8ntance 01' the pn ien'i" hush::,:no. ') the me !;hod ,?l. re of r:.'r{,· ·� t i,m�(;OrtDnce . (:�he !".lOPi?;S to be '� eepl' Ived 'lnd p�rtici:/Dtin�' in ,birti.' of 0 7 her child, and nO{c'ds support to accompl ish ner goals. Informa :; ion :.L: to the : ient IS ])ro ,.T'ess should ') • ' be freely give n since lo t, l" Q �� Il'a".r'1 t c '�JO 1101' ..'. hO ,. act bre b,' -c t;;rns . Ir " 4, . ional support c(mt�';{l l cm. o of the " nurse I s role in cb . (L can do this either by supporting the husband , thus i irec:tly sup prating the mother ; or she can 60 i� directly 'oui;h backrubb ing , cO;.:lc i'ling her on !.-:1 ;3SUral1Ce , etc. If nurse has establ ished rappor with the pat ient durim2; .3 dmission lebor , she cen pro- �ide emotionai supi ort even at errupted interval s, if necessar,," , b,;cauiJe she is n porson in Ilhorn th"7l?a- tient feels confidence in Wi om she can trust . 7 Flora Hommel renor'b s on nurses in privat e pract ice as montrices , a professional who is trained ,to �ive support in (" il. method . J , trained about thirty five nurseG the Detroj a,�ea in t Lamaze �ethod. Af'ber train are �hen assigned ·� o ho s to assist t:; Grli t:;s in lE:.bor. 8 training required for ,t aGe wi e and attend pat ients in labor is : 1.. Attendance a�� an ent series of six classes ;}; i ven to cte.nt parents. ')0 . . ---Ibld. , Pp . lL>51-1452 • ?I TbIn.,," " p. 1452. _ 72 Illid . 7 3 --(l)b id. 71>,," }l lora Eommel , "Natural Gh ildbirth--Nurses in rivate t:it.: es ::)8 n'Y'i::esJ! , !'l� ricHn !J ouT'Dal of F!u:,--'sin;>.:, Vol . , 130 . 7(July 1 ) , p. 14W7 . (', .. en':,:. � n;-Y :< \0 f.; S ions , t;;/o c thrr:?(j "8Cn l, our'':.!" t:;; !.:, 1 J � rehese 305810n2- .� _ _ , IncluDe : 2. lGcture the obstetrician on f: ; compl i- cRt ioDS of lsbor . b. J?rincipIes and t echniClU(;S of p8 choproph;vl- Bctic method B� ied to normal, labor. - e. j)i�: cussion of probl'-3rt: In.'bar::i \,oJ i th consiuer- ation of ical and pa- . cholo�ical aapec D Bnd tech- niaues of coaching . d. istor;r of the hod, the [rogro,m , and its development . e. 1Jiscu2sion of statistics collec- tion with analysis of form the monitrice is to fill out; [",nd discussion of e bl ie reI ions role of the monitrice . f. Practice sessions , test monitrice on 7r her performance in subsequent I liveries . :; '!,'hese monitrices have b'[en found to have (;ainecl excel- lent ra,·port ';l ith the patic;nts, husbands , staff. IJ:l he staff especially knows that her presence Assures care for one woman , should th become too busy to the ::tttention they would like to . 76 II Chapt er 3: Chapter Lj. : 1, , ';TFOD Ch'-)pt"-.- r 5: Chapt er 6: ;\1 HY:FOTHEBES 1. �rhe Lama_ze methoc:i provides effective pr�pal'lution for bor in those women who choose to ut ilize it . 2. Each f-determ ined action by the mother is pos- itively reinforcing. 3. lISuccessl! is not cJ pend�ent upon abs6nse of pain, but on the feelinF; of satisfaction vained . It was concluded this author that in order to obt in signific, .nt research data, independent findings should be sought . Three Lamaze teachers were contacted, two in the of Bloomington-Normal areas , and one in Peoria. h I ei@;l1ty six names and addr(;:?sses wps compiled. IJ:hese l1c;unes were of women who had p rticipated in the preparation delivered . The list of bhose in the oomin:;ton- area was complete; however , 1 ist; from 'Feoria WEtS no"c . is was due to tbe fact that some of the �omeD had \ since moved of a �:; trEtin the t mentioned mwstionnaire was then \llritten nue ions � It �as struc ain ci El. , s no an S\rJGl S to ific questions , so subj ctive responses . uestionnaires were in- anonymous ; however , re nts ct ir names. of' e ionna 'd ere scn:rt out in late to be ret:urni-:;;Ci Of these , 1 DeCember I t::/ , I three were due of \/1 it1'1 8i to 8 ;S (1U(3stionnaires 1:J ere ';ctual l"ec(:;tved b�l the VJOHiGn , and of tl is semple, sixty nino i:J ere r":�_; �� urn€-'d . /'. _S 6COD() set of six auestionnaires were 80 Dt- au·t .Ln early J� turned by Janua y 16, 1970 . �his second lnailing was neces- ;::: ClI'Y to aceD iiOd,:) -Le those ",:"ho \-Jere; due to deli vel" , but h not; 8,8 of the t of e initial mailing . Of these six, �hree were rGturned . is gave a total of e three question- naires sent out , a ri.:: l: urn of sevent:y two , a p,-�_'rcent of 86 .7) percent . 5 RESDI.TS 'Jlhe res Its are 8S follows : 1. All resDonden E5 answered the first ouest ion aSI: wa s from 21 to 45 years with 25.85 beinB the mean . 2. All 72 respoD;len' s answered oU8stion 2, Dat e of de- 1 i very . rrho dates of c;, i ver�y ranged from f/i a:cch 16, 1968 to 1969 . It was felt that recerrL experience witl] would yield the clearest most accurate responses. 3. There were 71 res;.:onses, 98 .61 percent of the total , 1; 0 (; ueetion 3, number of prGviol1s PI" ies . cent ) 'flare nrimi -j 8.ras ; 32 (LI-5 .0r; �)erce t) were rnulti 4. There were 71 GS ( .61 pGrcGnt of the total) children . to tion 4 concerning number of 1 had an of 1.Ll-9 1 5 . There was 100 PGrcen� re tI C) the qU8[:;:tion , n 'IC Oll any previous e fore , [lnd 1 (en . ( .61 nnt ) Dover used used the percent of VIi tll 0 IUU Hornen ,} 7 ( percent ) havin never used method other tha! 2 (2. percent) used ot;her LI·2 chere 51 ( w� s 100 nercent resronse. 81"- c said 21 ( .17 p��dent ) did not . b. wh o did not at tend , 19 (86. r(el S onded to t b, "If not all , ich on 's did you attend?" percent ) sessions 1 2 (10.53 �_o (52. i-?t;t; throUL�h 5 . 1 '!'\ rough 3. 2 (10.53 1)8rcent ) issed 2 ses8ions ,} 1 und 6. 1 (5.26 percent ) miss session 2. 1 (5. ) miss session 1. 1 (5. T:H?rCent ) lIli �he sessions were as follows : sian 1: In troduction , objectives , th�ory , of tneor3' of co Giani om'; iolo of i ver;{ , explGxuD, t ion of the stB.; ;es of lat)or , anCl the Mus 's rolo. ions c:. , 3, 4: Neuromuscular exerc ises , reJ.axa- cion sion ): of the Qbst V1(;0 ha��i us the method . eVJ , nractic of 1 dxerc t es , i (;;: c. c. 67 ( -; ou . u I' Ll 1 ( ) t;o the �:: ues·tion , " ou at; t ional se�:3S L�2 (60 s'nt) ent ) id not . (lOu ent ) respoD'Jed to (Iuestion 8, wi-�h 66 (91 . percent ) s that had practiced the oxerC lses they did not . 9. ct. 72 (100 eIlt ) responded to the () uestion , IIDid you use 8101;'1 c est bre_ thing in the begin;- into:; of your labor?" 59 (81 . 9L, percent ) responded to t'tl.eaffirmat ive . 13 (18.06 percent ) sai( they did not ." b. Of' [:; 50/ wno v.." l• d .. chest; breElthi • 4-0 ( .130 perceel; ) combined it Hitb af'fleura[Z'e , 19 ( .20 percent ) (�_ id not . 10. 71 (91 .61 percent ) rersponded to QUG ion 10. ( 92 .92 peI'c ent ) said t did use pant i. , and ' -, l.10I _ not . 11. a. 72 (100 E:: f: t) res-ooD(le(l to tile question ? l! l)id you accelGrat ed dccelerr�_t; 8d breath USF) ElT.:d 55 (76.39 percent ) did cmd 17 (23 .61 percen ;) did not . b. Of' th\3 55 who did use accelerate(] deceler- ( .09 perc ) co;ubined it \'l ith eff1eur- 17 (30.')1 percent ) d. id not . , il 12 . 71 ( P''- rc ) respondec1 to you use i- u tional 9c:." percent ) did and 10 (H.ld pe:c'- ( • not use trans it�ono l breclth (1-( 13. a. '7') U) eel ;; 0 � 1'0:[> YOU to act the pus , reflex un� i] you percent ) found i-� not .. b. Of 37 who found it necessary to act reflex , YI- (e'l . nercent ) were able to do it, 3 (8.l_1 percent ) were not . c. 61 (8Lf.72 percent ) 8_n Sv!ereo_, and 57 ( 44 per- . cent ) said push brollght; relief and LI· (6.�S6 -!.)ercent ) said it not . 14 . 60 (83.33 percent ) responded to, "Gould you relax pelvic floor to aid the delivery? " SO (83. 33 percent ) could and 10 (16.67 percent ) could. not . 1'). t3. 69 (95;. 83 pe i cent ) respondGd to , "Uid you at any t irue: durin1.?; .YOU. labor Qx!)eriell Ce pain'? ,1 0) (91 .30 percent ) iGnced pain , and 6 (8.70 pSl cent ) did not. b. Of the who (t id experience pain , it vIas dur- tj h8 following times : Durin� -tra�sition 29 LI·6 .03 Dercent �ith all contractions 10 ''7 11 IS c) lcbor transition 6 """ • " before 9.52 <'L eliverv 5 7 ,, 9Ll· " stract (pr�nil1[: , chGckin� LI_ 6. " d i lcita-t ion) 35 f i " (en los i control 3 L • 7 _J " " "1h81'1 not br0� the wit� COll'[;r8ction ;; Li- .76 n '_yhen caul;; not r(;lax c 3.1b Before husband 's sup�ort 1 1.59 " r; A c. Of' villa ( "O? percent ) responde me hoels to coun'�er8ct crns 33 .10 er:t axat ion LI O. " I sup art; 15 B 2- - !L'.. S9 � tiOD 7 II.LIB 4 6. sit ion Li- i-, C. -, (co ic t:iOYlf3 ) 1 1. were me;:t; results loned [3 ir� como ion. (1 .. ( to , )l tbcs(; no . 16. 71 ( percent ) resJ,onded to , tJ ere ':ou deter:l1ine the 58 of your 1 the proper activi 57 (80. c:; t; o, perc ) were nOT able to. 17. ,,1 . (9'+ .'1·4· perc ) responded to , " to follow tile directions of your (95. could Elncl 3(4.Lbl percent ) coUld rot. l tJ. 71 (99.61 pe, cent ) resr,onded to , > er,c; ,you able to follo'V] the irectioDs of t: e nu:r-s8s'i :l 61 ( percent ) cou follow the directions , conIc not . cODlbiT1at ion with this answer , 6 45 percent ) LIJ (8 .. irectionsit , cttonstl , !l ed s if c. to, ere yo e ( ) res< on(� ed 11' to follow the directions of our ctor'?1! 67 (97.10'porc could follow the doctor 's directions ; 2 (2 .90 perce h It ) no doctor l! ( to, control of Jour ct :i,:, : ty <, '! .5', perC8Ilt ) cOllld snd could Dot . (II .. 3 oe1"C0[1 ) '11 ( ..61 COJltroJ of ,'l our ernst :; ( en ,) SZJ (11.2',1 , c ould, g Del cer}'c ") re 20 . ( o • (91 coulet res't ; rest be��een contract ..�2 perce L) 6 (E>" percent ) could not . said they could; 1 (1.41 percent ) could not. 22 . 69 ( .63 percent ) responded to , "h}ere you able to consciously relax':''' 63 (91 . 30 percent ) could ; 6 �8.70 per cent ) could not . 23 . 71 (9 .61 percent ) responded to , "'L'hrough ;yours ex- perience with the Lamaze method, do ou conc lude that you were :', ble to act ively poyt icipote i the labor process',,, 100 percent concluded that they were able to actively ])ar- ticipate . 72 (100 percent ) re"'TJon '.d to , II 'I re ou setiE;fied � (8.33 percent ) were not . 25 . 72 (100 pe rcent ) res ad to , f1 Would you reCOI!lm tbe e me'thod to a friend?1! 72 (1(;0 percent; ) anSVJ8recl to the affirljative . Ouest ion 26 pr ovided the res; ,onu ent \'l i l: ' an oppor- Guni iance. Some very pror�inel] � in these responses . from thG ic 1:; C ;:crl1 i. ber 13- t z..1X lce of husl,!3nd coe.chin;" and invol V€'f; ent was s L· ressed COl1- sistently by the respond ents. i�he maj ority of the comments also contained de'bailed accounts of the course of labor and what techniques the wo- man u�sGd and \v hy . also m ntioned how �hey could have better in labor. (lthers stat they sho�ld have practic rrlore . stressed the wonderful feel of closeness and fulfillment they felt ':lhem tr e lebor process \Vas stJared by the husband Bnd wife . They re�reted that the husbands were not alw "s a e to be allowed in the del ivery room , and express the hope tha � soon this woule! be chsnged . Some to become fe riliar w' th the merhod. �hey hoped tnat the metl10d would one felt tl1at it should be required for all expectant par nts. In terms of pain relief, they stated that they exper- ienced pain , but; I.,amazi3 8()abled. them to cope I'v ith their pain and turn it into useful act ivi (Got hers fGlt they vI ere vJel1 prepared b:' the classes ; to expect , and how to handle it . also fe],t the rne'�riod W28 JJore benefi c ial 1;0 the baby ana exnress e.G the lwr±l cries 01)S8rVed at birth . 6 c .L"'�ill,�.", e methO(l is c;a inin; 8cceptanc e rapidly wili cont inue to do so in bhis area . {.E he respondent s are very enthusiastic about the evidenced bv the large Dercerr� of questi onnaires and their 100 p(3rcent Ilrecommend;::d:;ion to a f'riend1J . appern's to have an import iOYll3h to inter- sing the classes . by 'l'h e i 1�{ 8 e to be 1, E� ibly inciicaLin[,: ,ilOL" for mothe:e to att (?nd classes . Int erest; out the :--;88- or the sessions , the cJ.asses t weJ'O not etr slital to in 1 It Via::; to not;,.:� th fiO �l C8d dB reCO:-DmE> (i Ctn\.l ice w: s ment ioned as 0 very art nt f�c-tOI' in ne i On(;t3 OlJt 0 resul-bs also indicate individual 88 feren �8S of P8 '.ient s a the divE�l's ity of the method . tee ue need no� be used for a p1- rt icular phase of 1 bor , l)ut can t; or omi Lt ired . not' Lc:L t3i 1 of resu1 -s were hellvily Vie ted to ODe sir;e or the other ieh owed the influence of the class pre�a1'at ion. �he 1'e8111 t: ¢ rei'lect; class con t e_nt the VJOill8n s to perforllr in lebor in accordance with the c s materiel . is also notable that relief was obtained by such a majori It \Vas interest that such actions by the personnel as preping , checkinf� dil at ion, etc ., dis- tracted the women and interrup ed their concentration. is sr ows the important role of meJtal concentration. To allay tt�_ 8ir pain, they em-cloyed a varie<�y of methods with tree, in?; patternE , rr3le.xation and husband: S sUPllort heErcli the e list . j\ very promicirw r sult from thiE study ic (De lar'"::e r� ion \vho 0 :1 ined from pain and who felt pro po r't relief B 1 ef:1:3ure of 8::1t i ction with thoir efforts. D£::termining the progress of ir lahors wllich� is in- in cnildhirth tion and so imoortant to the ;nother I S ility to initia't e acti VI8.S acbieved the or :(. coulct fal-i_ow instructions of those around theln . However , the response of some to the nurs nersonnel nt both of activity , brG, th , ana re laxation . notable are the answers to 'the last four ionc� , success of' e FlO !J hers . .FAH'J' III or 7: 51 7 ret",ults show that the respondents h:, ve ut ilized the IDethod and techniques as taught in the six we course , :md they have made adaprat ions to fit their OWL part iculiJ.r needs and labors . They considered their experience to be one of act ive part icipation and one with wb ich they can truly be sat isfied. lI'his sample showed thB.t Lamaze does off'oI' significant preparat ion for tilose willing to utilize it. Labor contrac tions were interpreted accurat ely and as sig"nals to be;�in a nattern \"h icl1 brou ht a vuri of re- suIts. �hese act ions were reinforc to the mother . Ttli� ud:y also cl feeli. of success were m\�a- surad in term:::: othE-Jr th::lfl relief of pain, such as husband ana wife �eam work , be awake and fully part icipet be able to remain i control. I, it did 01.) that the GlaZe techni "ue did pro vide ?n8ra�ion, -the r02 Jorl b8- in� effec r ive for l; i3 of' v] omen. ex ,1 as t() �he woman 's us of it 8nd reSi OIlse to i·�s ef ctiveness . The nreparat ion for this group did provide 52 for active part icipation on the part of the lai)orinK pa- tient . 'l'he results sh o\'J that the techniques employed brou[�ht the desired results in a ma,jority of these pat ients. Further areas which could be explored in the field oJ Lamaze are the husband-wife relat ionship in labor , staff r' eactions to Lamaze pat ients, and ho\'l they perceive their role viith them , and class content and teoching methods . Other areaS for research : Biochemical and physiological aspects and or alter ations in the mother durinr:; resulting labor from child birth preparat ion. i'l otiva [, ion of mothers I'lho take classes . Socio-economic and culcural characteristics of those who utilize prepared childbirth as compared to those who do not . Is there any significance in the ,)erfor mance in labore, Specific recommendations which can be made are : Class content should bf" maintained at a high ouality with use of visual aids , class discussion Of mutual interest topics , practice sessions , etc . Lama�e should be includ�d more ex tensively in nursinf' curriculums and a thorough knovlled'ce of I:;he goal and objectives of childbirth preparation should be taught to insure the needed support to patients in labor. APFl�NDIX )L\_ 'he follo1;I iIF fine the �crmG used in tbe ionne'ire . The exercises nre of two types : 1. Limbering : wh ich improve the mother 's phys ical well being and are not strenuous . 2. r� uscle control ano relaxation : 'rhe mother is taught that relaxat ion in le,bor is a,n active pI'ocess . 'l'hey are trained to release �otally those muscles that do no � t part in the progress of labor . Oonc Gntrating intensely on relaxing; not only helps a mot er maintain h,',' r SGlf control , but con�ributes to tl e inhibit ion of pain receotion . The nurpose of the exercises is to cond it ion the pat ient to react instantly to the comwand "Rc" lax !" by isolat ing J:mscle CTOUpS fore tng them t;o respond . BreathinR techniques are slow chest bre8th in� , accel erated-decelerated , transitional andpant ing. Slow chas·t is a deep respirat ion which uses primari intercosiJ muscles . There is lateral expandion of the ribs and a rise, B,nd fall of the ternum Vih ile th!? d uuuHl irwl muscles r8m::�'; in a.t re�"3t . '.I.'ll. i8 brge:t;hin:" is used ;:: 8 800 :).S 't he �ient fe� ls the noed for con :rol . �ccelerat ed-decelerated actively follows the of con'traction. It is shallow hut i�cI'ea8es in re te 83 of the contraction increases slows as the intensi 55 inp: rapid and shallow reg ir in"bense concentrated 8c-b ivi 'J1 he 1:lho1e body includinp: the ·'JbdomerJ is relaxed. -'::'.nt is used when the mother is no-I; pu sh since she can not Dont a; the same tirne . 'Cransitional breathin,['; i;3 used at the time when the is sl ly deeper E1.nct h:; s a more emphatic rhythm . It recui::ces four , six , or eight fast panting bre�ths followed by a forc- ible exhalation . Ti ie is c(,ntinued until the end of the contructioh . �ffleurage is n massa�_i techniou,,, used t,·, relax t; ense ( II 7',Ulin , paper on the 11:1ma5:&tt) method of thl'l method Be 10()uld you " '<_<"'_"9 57 No 58 Gould you to in the 59 " Ab:eamson , .T .E ., 8�nd Eeron , J.A. Obj ive ,:,valuation of Hypnos:Ls in Obstetrics ., 11 American IJOtlrnEll of etrics 1 T T' (1'�5'" 1060 ana� uyne � co Ogy. "1va . �_A j L) , p. /. J; S quo�ea � � " b�t l:Cichnrdson and c er , 27. I:·�ut;t! iCJ h p., lIeu , ::3h elly., . n Nurse t:.tt Labor.n AnH:;rican ,T ollI'nal of Nurs ing, Vo l. IJ�IV, 1'70 . 7 (�July 1961+) '��- '70-'7LI� . -.� � HendaI' , Barbara . II illest of the of Nurs ;.jupport l on ri otl1 ers in ",o. :u·� .,!! liJ� A HeF\ion_Bl C inic al Conference , 196? New York : Appl(3ton Century-Crofts, 1968 . , i/�abeth , 81 . ,FracticE?l r(lI'ainit.if!� Course for 21; JJ, ' the Ps:ychonroph:ylac l:ic r':ethoci of Ohil(lbirth (I,amaze 'i'ech niaue 2.. Bin&� Hui Karmel , lCkl . , ," .,l i � Six Pr�:lctical Le ssons for an E;:;Js ier (;Ld ld bU,bh . Jor}:: : (�rossEdJ and Dunl ap, 1969. � h nt h." \'l orJ d He;31th '''',eries. .. �/ . , (lQ:5T) , � p. ��6. t,; tiL,C).en er ') 1..1 .. .g in ra-�ion for Iv'iatc-jrnal Health [\:ursinp; by , Ious : \�rn .. G.. BroiNTi , Go .. , hxxt on, C. ]; o f' o f syc h pro phY18c_t_i_c___ �_=::C:--3 '::..,.=1 '--:o:.:r:..' _�'ie l;.;J.;;..' s:: .' ::.....:;:;: Ch il(\birtb fr-lin .. F-h ila/1e19h ia: �<,aUI1( rs , ,,:.;:;,; --�-.=-:-"'-'::';:;= ly62 . '�;rH' 1 in .- ,; i_-�) of J11 � f -, I\1 ursin:�: Outlook , V OJ... II, 14·-1 C;. " eLf; of ;v1 at; 1. n,,::;;;,c:::.::.;;::"-;;--�irrc,,:,::,:::-::.:::.....,�;;,;:;.;;:-:::-..::.:.:=:..t=h • • 6C Caplan , G. lli/ en't 1 or ,litl1 a hot " pproa c h iI ',�::�""':::.r:-c::-'::-3-':,-,:,-,=:::. ' ) , p. ', E', quoted Guttmacher , p.. �26. Cher-cok, L. !lHelaxat ion and }sychosom,�jtic i",ettods of .LT'e- par' tion for Childbirth." '.merican Journal of Obstet- rigs and Gynecolop;y. Vol . lXXX1I, No . 2 Umgust, 1961 ), pp . 262-267 . Clay , J)".8. tt Guidsl1ce in Infant Care (�0VIO r::onths Before and er Birth of the J1' irst-Bornil Pediatrics, Vol. II (1948) , 200 . quo'i; ed by chardson and Guttmac ner , p. • II , .J oy H.. 1/ /1.nd \,vhat Abo'�:t; ';�xerc i8GS . Bu lletin of the Americ::1n Col1eL:�e of Nurse-i'iJidw ifery , Vo l. XI, No . 1 (Sprinp; 1966) , 'pp . '5 15 . II Gravlf'ord. , !',;} ary . iol o :�:�: i c al 8I\G. 1"a1 es r) ts- turb(3nC eS in Ch i ld,b irth ." in of the j'merican Colle9�e of Nurse-l'iid\,Jifery , -V"'o'i'1':::.-;;";;XIV;-'Nci�:- r-CFe bruary 1969) , pp . 1?-24: � ze11 , Irene . H('�valui3.t ion of a Nll.Y'sinf'[ "',eaearch, Vol. ' 163 . tJavi ;::� F. ";6ward . t! Fron�r83s in the 01' Lebor DtDC! 1 ,Journal of the ;;JTIericcm icel Association , Vol. I, No . ') (January 30 , 1Cfbo), P . LI,09-413 . P -- D:::ivis, erence , f':�(J,rrone , :tAn ec l�ive ";vn1ua- n tion 01' a Frepared Ch ildbirth American Jour-- nal of' Obstetrics (}.11d (Tynecolop:y , Vol . IJ XXY�IV , No .9 (�( T' r. '-' U()' -I? ( J" , 0 �\"�'''''' 'f lO �'-'- 1 (..j{,2/'-' - ) , n",I i�' . 1 1 06: ' " '- • ile \J a:tt Gvil 8? hubert . J!tUhe Use of ObstetI'lical sia ' at the ;D rni ospital at; n{::Dc-; Vr3 J! Amoric[3,n Journal .• of Obstetrics and Gynecolo�y , Vol . LXXI I I , No . 3 (March 195(7 ) , pp . 473 LJ.',U. Ghil ti b--\-:ord jmeric� n Journal of _�UrS lng , -- -:- lLI53-1Lr')LI . 61 !:;:01.'-,SL j. , " ton rics and Gynecologv 1. Freric[!E3 , 1"'[£11' ioD Frerichs , llen ' if TJon 't; Overl ook Discussion.l! Journ,:11 of I';;u1's. inf';' :�:cJ:}c n.t: ion , Vo l II, No . if (T;!ovembc-;r 1 Ij6b) , T-b " �--.- II iv ;:1'y , 11 i um , N°o . 2 � ) , pp . 1! ies , I-'s:y'cbosomat ic iansh i p BetHGe ther Gila InflJilt" . Fsycr:.osomEl t:; ic l'le dic ine , Vo l. 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YOI� : Arple�on :r:---=-"", '" fts ,' 1967 -. -- ' pp . 117-124, . __ Lamaze, ]Iernand , �! . Pa inless Chi ldbirth . London : Burke , 1958 , 11 Laird, iVlarion D. andHogan , ect i ve Program O-Q 'Pr eDarat ion for ChileJb the Sloane I!o spi"Eal for i:JOmen , jv: ay 1951 to June 1953. H ,Am e r i c an Journal of ObST etrics and Gyne colo(ry , Vol. LUll, :'(0 . 3 (iiiep tember 1956) , pp . 641 -64 '7 . 11 l, itz, Annie . 11 Natural Childbirth . T'ulle1; in of the Amer ican College of Nurse-r�idwifery . Preparetion I'01' Childbirth. Ne,,! York : f' ateruity f) ent er Association, 1969 . f.'.cPrid,e , I\;, sry . HI in ' :3, nd �';ffective NUI'sin;:::; Practice .. 1! ANi\. Clinical ,;es:::io.LlS 'l 1 966 . 8YJ or1<::' /\pplcton Cen- tury-Crofts, 1%7 . pp . 75-82 . I'ie,nay , A .. J .. , et al . l1 Is NaturD l Childbirtr I\; atur -; l ';' 11 Psv- -' -" chOBomat ic Fi edicine . Vo l. XIV . (1952) , L>31. hs auoted by Richardson and �lttmacher, p. • I Stella, Sister . t!Farnily Cent Vat er ity Care .. t '1" ,,-, ' 1 'T 1 . ' J ,� _,� u Z-J ,l1Cl 11 amI y, " 0,<. .. I , "f1\ 0.. 2 (J�prl , 10'7b-2) , pp . 5'7 -U) . _ �iller , Lloyd R. nF:ducation for i l d birt h . n Obstetrics ,mel Qyne colop:;y . Vol . XVII , No . 1 (January 1961) , RP . 57-65 . 63 berts , 2teven v. " " Good f:ousekeeDin� , hubin , 1C i ;J,vior .1I OOY , Vol , No . 1 J ( ), pp . l11l !1 :C: L lye , 1 he ;'3 'C rElSS . mE:rj.cD.n. J'oUrl1FJ] of I\fursinr ::: Vol . V, No . 3 (Jviarch 065) , ·· pp .-9'1 -':39 . • t S , Judi l) I. . ";!hy e ehoose NaturGl �edboo � Januarv-' -'J 1060 " ... . ' .' .- <'" .� � t r;::: , Schultz , J.F. 8.nCi I!l ',] . i\ut� o '·'(3-(18 I" 'x'einl 11;-?:: . Grun6 3trE:.tton, 1959 . 1,' 83" nrch Vet hods in Soc ia I � i n r , '\l! int:d:; t) l] Do'f·t- H eh a t and , II endue , Virginia . /c cede" ic IS:Y CilOloi':Ls 100.11:8 at tur 11 al Gh ildbtrtt: . \io J IV , • No . 6 (December inner , B.F. !1 ilieaching I\->'.chir es .!i Sc ',entifi c Amer ic':1D vembi'r ( pri nt ) 1961 . er , B, of in Pro: 'r8mmed I�ar{' ln� : Theo r� tth , Pract ice . !"Jedell I. an" ' Iv-.0 ore) , J. ;\/11-' �o . rfains . Princeton JHrSey : , c., 1 " (31' ') !)e bornh l' ai or �- ;;;.k: pt� i(:)nce. n , () c t 0 b e r, 1 ;;...:.;'"' ...:..;;; ==�--'-;..:;..-"- ...... , Ii ;�) t; 't i;:; nal of Obs te br'ics and Gy necology, u '"[J< Iy 19�)1�.) ') up . 2?9-2SLJ- . '} er Y or.!::_ : !" ndi ion for Chj.J, 1. 1 • II ., tlo . VCln :i s:)J of T of 100 . c..');7 [ • • Van Vell , f/I .C. .F.. Dutton H l:J' Yankauer , fred , et hat l"joth ers c;:--- -: 1 db er;l r- ;ses .. II Vol. s CIa, Nursin'- Outlook , I, (, (Octobe!' lc)60 ) 1 J , ))p . 563-565 . • �. ions Zimmurman , I. ic tb ana the 01' \To Public r:'-' , 1 (1 q!.j_r:! )' , , :-� -,- , , - � 8rlri �uttmA cher , Pi