Сборник научных работ по материалам ii-й Международной конференции под редакцией И. В. Добрякова Санкт-Петербург, 3 5 октября 2003 года
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^Batuev A.S. (St-Petersburg, Russia) Scientific Centre "Psychophysiology of the mother and the child " St-Petersburg State University. Now days the fetus began to represent for the scientists not simply physiological structure, but being endowed with feelings. Nevertheless it does not have abilities of an adult man. During last months of pregnancy the foetus shows physiological reactions, can distinguish voices, recognizes syllables, two phrases, two different odours and two gustatory sensations. It gets used to regular actions and is capable to be trained. Fetus as well as premature baby will distinct between speech of the mother addressed to it/her and to somebody else. At the end of pregnancy unborn baby prefers noise to silence, voice – to noise, female voices – to male's ones, especially if it is voice of her mother. The newborn baby only few hours old would prefer smell of her own amniotic fluids and her mother’s milk to all the rest (Kushnarenko et al.) The foetus has already some representations about the outside world due to taste, smells, sounds and tactile sensations. It reacts to movements of the mother, her endearment, taste of food absorbed by her and physiological changes connected to emotions. Early prenatal education plays a major role in the sense of postnatal unfoldment of the genetic programme, as well as during the first stages of baby’s adaptation to the new environment. It is important to remember, that in a course of prenatal development the various touch and motor systems ripen generochronically, whilst sensitive periods for each of them do not coincide with each other. The importance of the genetic development programmes regularity, their anticipatory character (Anokhin, Sergiyenko) as well as prenatal sensitivity periods’ features, enables maximize a role of specific methods and means of "education of the mother by her future baby " in order to form the potentially adequate environment for realization of the individual inclinations incorporated in the baby and her/his successful postnatal social abilities. ^ Kovalenko N.P. (St-Petersburg, Russia) Perinatal psychology is a new field of knowledge-based research in the conditions and laws of initial phases in human development - perinatal (antenatal), prenatal (intranatal) and neonatal, and their influence on individual's subsequent life in general. It belongs to the interface between several fields of science, primarily psychology and medicine. In fact perinatal psychology underlies the initial chapter of general psychology, dealing with the impact of genetic and innate factors on individual human psychologies. It aims at discovering and science-based rationalizing of the subtle mechanisms governing human psychology in the perinatal phase, the course of obtaining information from the mother and general environment, and memorizing of such information by an unborn child. This offers scope for discovering and, where required, eliminating the psychological, social and biological impediments to the process, thus making it possible to prevent personality discords stemming from pre- or perinatal conditions. Reducing special perinatal features to physiology eventually resulted in total monopolization of the period by medicine regarding the psycho-emotional aspect of pregnancy, confinement and adult/infant relationships as peripheral and therefore negligible. Yet modern science has proved that prenatal growth should be considered both in terms of anatomic and morphological change, and the origins of further human growth, including psychology, spirit, character and mental health. Of particular importance are the subtle, hidden, mediated influences like mother's emotional troubles often not immediately manifested but having consequences extremely difficult or even impossible to combat. Among the essential points in this context are: the need to devise and refine the principal and conceptual bases, goals and methods of psychological maternity training to optimize mother/child mental and physical conditions, improve their adaptivity to the new environment; and the deplorable shortage of guidance and methodologies in preventive psychology and corrective therapy during pregnancy and confinement. Therefore the topical interest of this monograph is governed by the demand for refined theoretical and practical rationales for psychological preventive and corrective therapies for emotional conditions of pregnant and confining women, as well us the demand of maternity hospitals and welfare centers for qualified staff of professional practicing psychologists. Chapter One in the monograph on “Perinatal Psychology” deals with the conceptualization of perinatal psychology as a new line of research in the integral mental and emotional “mother/child” system in the perspectives of medicine (maternal and fetal physiology), psychology (individuals and personal abilities), psychotherapy and medical psychology (mind and psyche). Chapter Two “Overview of literature. Goals and purposes of research” contains a critical analysis of accouchement traditions since ancient times until the present. These involve cultural and ritual traditions protecting the emotional sphere of a pregnant or confining woman, marital morals and ethics related to pregnancy and delivery, and ethnographic parallels or differences among various world nations with regard to psychological support during this important period in life. Analysis of literature on personal growth psychologies emphasizes the concept of integrated approach to human psychology proposed by Prof. V.N.Panferov. The author holds that emotions as a personality core, especially for women, influence the course of basic biological processes in a significant manner, enhancing the capabilities for survival. This suggests the need for "emotion literacy" for better social and emotional competence, improved adaptivity, resistance and endurance particularly important to bear and deliver a child. The work seeks to substantiate the need to enhance the woman's creative potential to attain the emotional harmony and physical stability required in bearing and delivery, building up a positive delivery schedule. The author's research hypothesis starts from studies of emotional conditions of pregnant women and their changing perceptions of the environment. This emphasizes the following essential points: the woman’s active and voluntary participation in the act of delivery; - implanting in the woman’s mind of a positive emotional dominant ensuring successful and painless delivery. Chapter Three “Description of the subject and methods of research” concerns the experimental techniques involved. Examinations of the specific emotional condition of a pregnant woman involved the anxiety level test, and a specially designed questionnaire of psycho-traumatic events permitting to find the psychological causes of emotional injuries before and after delivery. Basing on the classification of existing techniques of examination and psychological correction for pregnant and confined women, the monograph substantiates and presents the psychological preventive and corrective plan “Gloria” for emotional conditions of pregnant and confining women, designed to attain the following: improved family emotional conditions; favorable pregnancy process; successful delivery; enhanced family creative potential; healthy descendants. Chapter Four “Investigation results” describes psychological conditions of women during the ante- and post-natal periods. Findings from relevant surveys indicate such primary emotional parameters as fear of miscarriage, fear of death, fear of confinement, fear of pain. With general positive motivations for delivery, subconscious female fears sometimes considerably influence the course of delivery, inhibiting the normal process. The emotional world of a pregnant woman is discussed in terms of social and psychological environment and the nature of interpersonal relations. Attention is drawn to the husband’s role during the period in promoting the positive motivation for delivery and confidence of success. The chapter discusses findings from anxiety tests in Spilberger-Hanine situational and personal and Nemchinov-Norakidze mental anxiety scales. The MK-test proposed in the monograph indicates the following areas of greatest emotional strain for pregnant women: fear of delivery, lack of confidence in personal maternal abilities, family emotional troubles. The questionnaire of psycho-traumatic events designed by the author demonstrates that in 95% of the cases family-related emotional injuries among confining women have provoked inhibited delivery, particularly so where the emotional injury was associated with the woman’s mother, Analysis of the effects of creative training under the “Gloria” plan indicates the average anxiety level shifting from initially high to moderate or low on completing the •course. Moreover, physical conditions were estimated 1.5 to 2 times and chances of successful delivery 56% higher than for untrained cases. The monograph of N.P.Kovalenko seeks to meet the current demand among psychologists, obstetricians, pediatrists, undergraduate and graduate students of medical and psychological departments. Hopefully, the broader public interested in modern perspectives of assisted delivery and preventive and corrective psychological therapies will likewise find the book both very informative and instructive. ^ OF AN ABANDONED CHILD PSYCHOLOGICAL PATHOLOGY Brutman V.I, Severnyi A.A. (Moscow, Russia) Association of the children's psychiatrists and psychologists 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:
^ AND ITS INFLUENCE ON THE CHILD’S DEVELOPMENT Grechanyi S.V., Bochkareva S.A., Stepanova A.V. (St-Petersburg, Russia) St.-Petersburg State Medical Pediatric Academy, Faculty of Psychiatry Background: Recently experts of various medical areas come across adverse consequences of drug use by pregnant women. There is a diverse influence on a developing fetus of narcotic substances used in pregnancy process. The consequences of perinatal drug addiction are manifistated by destruction of pregnancy process, intrauterine development of the foetus, neonate abstinent syndrome and remote consequences as abnormal mental development. Objectives: The aim of the research was to study parameters of mental development of 2 groups of children: First – born to drug addicted mothers (use of heroin during pregnancy) and Second – born to mothers –alcohol addicts. Setting: First group included 25 children (13 boys, 12 girls). The average age of children has made - 13,4 months. Second group – 25 children (12 boys, 13 girls), average age - 20,8 months. All children were from the children’s home № 12. St.-Petersburg. Methodology: Two methods for an evaluation of mental development were used:
Average rate of the executed tasks by children from both groups was calculated for quantitative comparison of results of an estimation of mental development on various subscales (motility, emotions, speech etc.). Results: Research on a technique DDST in both researched groups have revealed in the whole low enough parameters of mental development. Out of 25 children of both subgroups more than 20 had reduced parameters of all four mental fields that corresponds to a general delay of mental development. The last is present in all groups. Average rate of the performed tasks does not exceed a level 50 % in all areas and using GNOM method – even a 15% level. First group of children has authentically higher average parameters of development of fair motility, speech and social adaptation (p < 0,05). Children from second group have higher parameters of general motility development, however distinction is not authentic (p > 0,05). The parameters of mental development on DDST were compared to the data received on a technique GNOM. It was discovered that children of second group give higher parameters of behaviour development (p < 0,05), while the parameters of other areas are similar. Thus, the data of more profound technique GNOM does not allow to reveal the statistically authentic distinctions of a level of development of both groups on the basic areas, and in behaviour area even prevalence of second group parameters. Conclusion: On the basis of results of the research it is possible to make the following conclusions: 1) the remote consequences of perinatal drug addiction could be seen in definite mental development retardation in early childhood; 2) the delay of the development has rather uniform character, including both senso-motor, and emotional-willed and communicative areas; 3) the remote consequences of drugs use by pregnant women (heroin) for mental development of children in early age as a whole are comparable to a consequence of intrauterine influence on the future development of children of alcohol. ^ AT THE PARENTCRAFT CLASSES WITHIN MATERNITY UNIT Lantzburg M.E. (Moscow, Russia) Antenatal birth preparation as part of the “responsible parent development” programme Classes purpose:
Formula of the harmonious attitude towards labour Three components of labour – three integral conditions of proper life. JOY: Difference from PLEASURE. Birth as cognitive experience. «Torments of creativity ». Joy from meeting with the baby. The first birthday of the child. WORK: mothering qualities development in labour: patience as major. Maternal quality. Spiritual work in the first period. Physical work in the second period of labour. CHALLENGE: A situation of uncertainty in labour. Challenge as a turning point of development. Assistance to flexibility of behaviour development, as well as to readiness to work and to make decisions in labour « here and now ». 4. Development of maternal-child bonding drive during labour. 5. Development of readiness to accept ambivalent emotions in labour and feelings towards the child in their founding and development. 6. Finding out the partner’s capabilities in labour and way of his participation. Three terms of successful participation of the partner in labour:
7. Installation of pain acceptance in labour and interaction with labour pain skills creation. 8. Development of various behaviour patterns skills in labour: a) comfort maternal positions for different labour periods; b) breathing techniques in three periods of labour; c) relaxation and visualization techniques; d) massage and self-massage; e) interaction with the partner. 9. Informing on conditions and types of the help given in maternity units. Orientation to interaction with medical professionals. 10. Formation of a personal responsibility position for one’s own labour and ability to chose the suitable medical establishment and doctor. Reorientation towards internal support from external one. 11. Acquaintance with achievable amendments of deviations in child’s development, caused by complications of birth. ^ Malgina G.B. (Ekaterinburg, Russia) Background: Psycho-emotional stress during pregnancy can cause the formation of perinatal complications. Pregnancy clinical features, pregnancy outcome, fetal and neonate well being at 792 pregnant women who have suffered stress effects due to major technogenic accidents were investigated. Settings: The stage/phase tendency of General Adaptation Syndrome during pregnancy (GAS), described by G Selier, was confirmed. The control group was picked up by a method of “copy pairs” under the specially developed program, that has allowed to predict the obstetric and perinatal abnormality connected to experienced stress. Relative Risk (RR) and Chances Relations (CR) of perinatal problems development were also studied. ^ There is a dependence in term of pregnancy at the moment of stress influence on RR and CR of various types of obstetric and perinatal pathology formation. So, for example, acute Psycho-emotional stress that took place in early stages of pregnancy, considerably increases Relative Risk (RR) and Chances Relations (CR) of development of spontaneous abortion risk (in 3-11times), severe forms of pre-eclampsia (in 5 times). In 2 times is increased Relative Risk (RR) and Chances Relations (CR) of placenta praevia and morbid adherence of the placenta. RR and CR of IUGR (intrauterine growth retardation) is increased in 3 times, also there is a 3-4 times increase of - chronic intrauterine fetal hypoxia and 8-10 times increase of premature labour. When woman experienced stress at the end of her pregnancy, all attributes of there of formation of labour dominant formation defects were marked (RR and CR of prolonged pregnancy is increased in 2,5-2,7 times, secondary uterine inertia and dystocia - in 7,0-7,6 times). RR and CR of retained placenta is increased in 4-4,2 times, abnormal blood loss - in 2,7- 2,9 times, RR and CR of fetal hypoxia are increased in 3,8-4,4 times. Findings: The results of laboratory studies prove the stage/phase nature of GAS (General Adaptation Syndrome), and duration of a stage of anxiety was - 7-10 days, resistancy stage- 1,5 - two months from the moment of stress experience, and from the end of the second month the signs of a stage of an exhaustion, and signs of stress chronization in connection with formation « of a system structural trace » in elements of functional system “MOTHER – PLACENTA – FETUS" are already could be seen. Conclusion: Compensatory sources are periodically included, but as a whole, for women who have suffered acute psycho-emotional stress in first half of pregnancy the consequences for the mother and the baby are most adverse. There are clinical obstetric and perinatal specific features depending on a type of psychological indemnification correlating with age, educational level and social status of the pregnant woman an the presence of chronic psycho-emotional stress. RELATIVE RISK AND CLINICAL FEATURES OF PERINATAL COMPLICATIONS UNDER PSYCHO-EMOTIONAL STRESS DURING MEANING OF PSYCHOLOGICAL RIGIDITY AT PSYCHOEMOTIONAL STRESSES OF PREGNANT WOMEN ^ There are 47,3% pregnant women living in industrial centres who experience chronic psychoemotional stresses. It was noticed that stress stimuli of the same kind were causing heterogeneous psychological reactions of these women. ^ 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. ^ Kiselyov A.G. (St-Petersburg, Russia) Two types of pain are caused by birthing process (Cromford M.J., 1965):
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. ^ 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”. ^ 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. ^ 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. ^ 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. |
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