Page 6 P H Y S I O T H E R A P Y September, 1961 A B D O M IN A L DECOMPRESSION Its Development and Facilitation of Labour B y B R E N D A K A S T E L L , M .C .S .P . ( T e a c h e r s ’ C e rtif ic a te s ) , L e c tu r e r in P h y s io th e r a p y , U n iv e r s ity o f t h e W itw a te r s r a n d . ( W r itte n w ith k in d p e r m is s io n o f P ro f . O . S. H e y n s , M .A ., D .S c ., F . R . C . O . G . : P r o f e s s o r o f G y n a e c o lo g y , T h e U n iv e rs ity o f th e W i t w a te r s r a n d .) A system which has been developed after many years o f research at the Queen Victoria M aternity Hospital, Johannesburg, S .A ., under the direction o f Professor Heyns, D .Sc., F.R.C.O .G. T H E D E C O M P R E S S IO N U N IT Patient undergoing decompression T h e first tim e d e c o m p r e s s io n w a s u se d in l a b o u r w a s in N o v e m b e r , 1955. E a r l i e r , “ in M a y 1954, in c o l l a b o r a t i o n w ith H a llid a y , c e r t a i n o b s e r v a t i o n s w e re m a d e o n t h e c o n t o u r o f a n a b d o m e n , th e m u s c u la tu r e o f w h ic h h a d b e e n p a r a ly s e d w ith S c o lin e ” . A c o n t i n u o u s c i n e m a t o g r a p h r e c o r d w a s m a d e o f t h e c h a n g e s in t h e c o n t o u r o f th e a b d o m e n d u r in g u te r i n e c o n t r a c t i o n . T w o p o in ts a r o s e : 1. A s p a r a ly s is o f t h e d i a p h r a g m c a u s e s s o m u c h d is tr e s s , it w a s n e c e s s a ry t o u se a n a e s th e s ia in t h e f o r m o f P e n t o t h a l . A t th is s ta g e th e effe c t o f P e n t o t h a l o n th e c o n t r a c t i o n o f t h e u t e r u s w a s n o t k n o w n . 2 . T o b e a b l e t o r e c o r d e le c tr ic a l im p u ls e s in a s tr e tc h e d a b d o m i n a l w a ll, n o o t h e r m e a n s o f a c c o m p lis h in g th is o t h e r t h a n b y a c o n t r a c t i n g u t e r u s w e re a v a ila b le . S c o lin e w a s u se d o n t h e firs t c a s e a n d t h e effe c t w a s d r a m a t i c in t h a t t h e c e r v ic a l o s d ila te d w ith g r e a t r a p i d i ty — i.e. f r o m a s t a te o f b e in g in d o u b t f u l l a b o u r t o th r e e fin g e rs d ila te d in 68 m in u te s . T h e s e c o n d c a s e — o n t h e 3 rd A u g u s t, 1954— w a s e q u a lly d r a m a t i c , th e r e b y p r o v in g t h a t t h e s p e e d o f d i l a t i o n o f c e rv ix d e p e n d e d u p o n a re la x e d a b d o m i n a l w a ll, o r in o t h e r w o r d s , w ith a n o n - r e s i s t a n t a b d o m i n a l w a ll c e rv ic a l d i l a t i o n w a s m o r e r a p id t h a n u s u a l. C o n s i d e r a t io n w a s n o w g iv e n t o t h e m e c h a n ic s o f th e a b d o m i n a l c a v ity a n d its w a ll. S o m e m e t h o d o f r e la x a tio n o f t h e m u s c le s w a s s o u g h t o t h e r t h a n b y c u r a r iz in g a n d a n a e s t h e t i c te c h n iq u e s . A t th is p o i n t (1) D ic k R e a d ’s m e t h o d , (2) H y p n o t i s m a n d (3) L o c a l a n a lg e s ia — w e re a n a ly s e d . D i c k R e a d ’s tr a i n in g a p p e a r e d , c o n t r a r y t o his id e a (i.e. te n s e m in d , te n s e c e rv ix — w h ic h in c id e n ta lly h a s p ro v e d fa lse ), t o h a v e m o r e effe c t o n g e n e ra l r e la x a tio n , th u s p r o ­ d u c in g a re la x e d a b d o m i n a l w all a ls o . I t w a s fe lt, h o w ev er, t h a t th is ty p e o f t r a i n in g w a s n u llifie d in s o m e su b je c ts by a n x ie ty a n d la c k o f c o n f id e n c e a n d u n d e r s t a n d i n g . f H y p n o t i s m w a s a g a in lim ite d t o th o s e w h o m a y p r o v e to be g o o d su b je c ts . L o c a l a n a lg e s ia p r e s e n te d te c h n ic a l d iffic u ltie s a n d u su a lly lig h t a n a e s th e s ia w a s a ls o r e q u ire d . A m e th o d w a s th e n s o u g h t t o p r o d u c e a c o n tro lle d r e la x a tio n o f t h e a b d o m i n a l w a ll w ith a s t r e t c h o f the a b d o m i n a l m u s c le s to a g r e a te r e x te n t t h a n n o r m a lly fo u n d . R e d u c t io n o f a t m o s p h e r i c p r e s s u re o u t s i d e th e a b d o m e n was t h e n c o n s id e r e d . E x p e r im e n ts w e re c o n d u c t e d w ith th e K ifa ty p e o f a p p a r a t u s a p p lie d o v e r t h e a b d o m e n . I t w a s fo u n d t h a t w ith r e d u c t i o n o f a t m o s p h e r i c p r e s s u r e b y a 150 m m . o f H g ., r e t r a c ti o n o f th e a b d o m i n a l w a ll w a s im p o ssib le . E ff o r ts w e re th e n d ir e c te d t o c o n s t r u c t a s m a ll d e c o m ­ p r e s s io n c h a m b e r to fit o v e r th e a n t e r i o r a b d o m i n a l w all. D iffic u ltie s w e re e x p e r ie n c e d in a c q u i r i n g a n a d e q u a t e fit a n d se a l. H o w e v e r , th e firs t p a r t u r i e n t w a s tr e a t e d w ith d e c o m p r e s s io n in N o v e m b e r , 1955, a n d o n th e 1 5 th N o v e m ­ b e r th e r e w e re tw o c a s e s w ith s p e c ta c u la r r e s u lts — one d e liv e r in g in th r e e h o u r s a n d th e o t h e r in tw o h o u r s and tw e n ty m in u te s f ro m t h e s t a r t o f d e c o m p r e s s io n . F r o m 1955 t o p r e s e n t d a t e , 1 9 6 ), m o d ific a tio n s a n d p e r­ f e c tio n s o f th e d e c o m p r e s s io n a p p a r a t u s h a v e ta k e n a great d e a l o f t h o u g h t , o b s e r v a tio n a n d tim e . A t t h e p r e s e n t tim e th e a p p a r a t u s in u se is c o m f o r t a b l e , p r a c tic a l a n d relativ ely in e x p e n s iv e . C e r t a i n m o d ific a tio n s , h o w e v e r, m a y still be r e q u ir e d . B u t a lr e a d y m a n y p a r t u r i e n t s , p r im a g r a v id a e an d o t h e r s b e a r te s tim o n y o f th e b e n e fit e x p e r ie n c e d b y d e c o m J p r e s s io n in l a b o u r in a ll s ta g e s. " The Decompression Unit T h e u n i t c o n s is ts o f f o u r p a r t s : (1) T h e S u it; (2) T h e C h a i r ; (3) T h e F r o n t P ie c e a n d B a c k S u p p o r t ; (4) T h e P u m p . The Suit T h is is d e s ig n e d in s t r o n g p la s tic m a t e r ia l lik e a to p le ss d r e s s in t h e u p p e r h a l f a n d a s le e p in g -b a g in t h e lo w e r half, w ith a n a i r - t i g h t z ip f a s te n e r u p t h e m id d le . T h e im p o r ta n t f a c t o r is t h a t t h e s u it fits tig h tly r o u n d t h e c h e s t, so th a t d u r i n g o p e r a t i o n a n a ir - tig h t se a l is m a i n t a i n e d . T h e suits a r e , t h e r e f o r e , m a d e t o fit t h e u n d e r - a r m c h e s t m e a s u re m e n ts a n d e a c h p a t i e n t t o u n d e r g o ‘d e c o m p r e s s io n ’ is iss u e d w ith h e r o w n s u it. The Chair T h is is d e s ig n e d lik e a te le v is io n c h a i r a n d c o m f o rta b ly s u p p o r t s t h e h e a d , b a c k , k n e e s a n d fe e t. It c a n e ith e r be u p r ig h t o r a l m o s t h o r i z o n t a l d e p e n d in g o n t h e p a t i e n t ’s p r e fe re n c e . T h e p o s itio n o f t h e c h a ir is s u c h t h a t t h e p a tie n t is a b le t o r e la x m o r e e a s ily . O n e c a n n o t h e lp v isu a liz in g r o w s o f c h a ir s in a d m is s io n w a r d s in m a te r n ity h o s p ita ls in t h e f u t u r e , t o b e u s e d in t h e f irs t s ta g e o f l a b o u r in s te a d o f b e d s w h ic h a r e m o s t u n a n a t o m i c a l in d e s ig n . R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) The chair has a light tubular steel frame with canvas seat extending down to the feet. Front Piece and Back Support The front piece is a large sem i-circular device m ade o f fibre-glass and fits over the p atien t’s abdom en onto a con­ cave support placed on the chair behind the p atien t’s lum bar region and hips. This su p p o rt is a fram ew ork only w ith the middle cut out to allow a lordosis during suit operation which greatly relieves backache. Pump The present H oover C onstellation vacuum cleaner pum p has been found to be suitable and efficient. T he pressure in the suit can be lowered to 50 mm. o f mercury below atm o ­ spheric pressure within six seconds and thus relief o f pain is rapidly obtained. T he patient has com plete control of the device, and can decrease the pressure at will to a maxi­ mum slightly in excess o f 100 mm. o f m ercury as required. FU N C T IO N The unit is used during the first stage o f lab o u r for any patient wishing decompression. T he patients are given six to eight one-hour runs in the suit p rio r to the onset of labour at about 36 to 38 weeks. I t is th o u g h t th a t the rhythm ic periods of decompression find relaxation (i.e. 40 secs, decompression and 20 secs, rest every m inute) have the effect o f accelerating the physiological changes which occur just before the onset of labour. T he patient also becomes acclimatized to the decompression. What does decompresssion d o ? D uring each contraction, as the air is sucked out o f the suit and pressure reduced, the abdominal wall is pulled forw ard a b o u t four inches. This allows the uterus to rise up into a position directly over the pelvis and, when contracting, to do so m ore efficiently as a spherical organ. As th e longitudinal fibres o f the uterus contract the cervix is gradually taken up. If the uterus is functioning as a spherical organ instead o f being indented by the lum ber spine posteriorly and flattened by a tense abdominal wall anteriorly, th e function is m ore efficient and the cervix is opened symmetrically and m ore rapidly. It is thought that decompression before labour allows for better oxygenation o f the foetus, being specially valuable for vital tissues such as the brain, and therefore leads to delivery o f a foetus in excellent condition. U SES (1) T o reduce the apparent length and th e pain o f con­ tractions. The patient does n o t feel the early p a rt and the end o f the contraction, and therefore the length appears less and the peak o f the contraction is m ore bearable. (2) To relieve severe backache—by producing a lordosis and a very deep inspiratory movem ent with decompression, the sacro-spinalis muscle becomes greatly stretched a t its ^attachments. This results in the reduction o f spasm and relief ro f pain in the back during labour, dysm enorrhoea and, incidentally, backache o f other origins, e.g. ‘slipped discs’. (3) To reduce the time o f the first stage o f lab o u r—i.e. dilation of the cervix is m ore rapid. (4) Special apparatus has been constructed for the appli­ cation o f decompression in the second and third stages o f labour. Although a large num ber o f patients have been delivered in this way, this m odification is n o t yet in general use. Comments by Patients: “The suit grips the pain and takes it aw ay.” “The backache which was terrific when ou t o f the suit was greatly relieved when returning to it.” C O N C L U SIO N It is felt that not only can a contribution be m ade tow ards the foetal condition at birth as decompression is exerted both ante-natally and during labour, b u t also th a t the patient experiences great relief and is often in lab o u r for a much shorter time. Acknowledgement I would like to thank D r. J. M. Sam son, M .R .C .O .G ., F.C.O.G.(S.A.), Lecturer at W itw atersrand U niversity Medical School, for his assistance and for providing the photograph. September, 1961 P H Y S I O T H E R A P Y Page 7 Th is h y g ie n ic P h y s i o t h e r a p i s t U n i f o r m h a s so m a n y g o o d p o in t s ! Sanforised, Mercerised w h ite tw ill Adjustable neckline to the specification o f the U n ive rsity Physiotherapy Section Breast p o c k e t-- " ' * Long sleeves Detachable belt T w o hip pockets, one w ith concealed inside p o c k e t ... Button fro n t DELILAH GARMENT OF QUALITY AND STYLE T H E H O U S E OF E N S I G N M an u fa ctu red by The AFRICAN CLOTHING FACTORY td. P.O. B O X 1098 CAPE T O W N a n d obtainable fr o m good clothing stores everywhere R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )