Page 8 P H Y S I O T H E R A P Y September, 1969 tingencies o f re in fo rc em e n t w hich p revail in th e e n v iro n m e n t. C o m m u n ic a tio n a n d d iscussion a re b e h a v io u rs e n c o u ra g ed by th e clim ate o f a social g ro u p . W h ere th e p u rp o se is to in s tru c t, p a rtic ip a tio n by m em bers o f th e g ro u p s h o u ld be e n c o u ra g e d ; th e ir u n d e rsta n d in g o r k n ow ledge being shaped in a p p ro x im a te step s to c o m p le te b e h av io u r. T h e re aliz a tio n th a t facts a re being m aste red a n d th a t m ean in g fu l p a rtic i­ p a tio n in d iscussion is possible, will in itself be re in fo rc em e n t for in d iv id u a l in te ra c tio n . T h e a cq u ired p o sitiv e a ttitu d e s a n d c o n stru c tiv e b e h a v io u r will e n g en d e r a n o p tim istic b u t in fo rm e d a p p ro a c h to la b o u r. T h e g ro u p s itu a tio n c a n also be used as a p la tfo rm to disse m in a te facts o n c h ild -rea rin g p ra ctic e s w hich c o n fo rm to th e c u ltu ra l n o rm s. A g a in , th e con tin g e n cies in g ro u p in te ra c tio n s c o uld initiate , m odify o r e x tinguish in d ividual a ttitu d e s. Since th e a cq u isitio n o f com plex social b e h av io u r is lon g te rm , c o m p le te re g u la riz a tio n o r c o n fo rm ity o f c h ild -rea rin g b e h a v io u r c o u ld n o t be achieved in th e s h o rt tim e dev o ted to a n te n a ta l train in g . T h e guide-lines, how ever, c o uld be e stab lish e d . W h a t develops la te r w o uld be d e te r­ m ined by th e m o th e r’s social m ilieu. R E F E R E N C E S 1. B exton, W . H ., H e ro n , W ., a n d S c o tt, T . H . 1954. E ffects o f decreased v a ria tio n in th e sensory e n v iro n ­ m ent. Canadian Journal o f psychology, 8, 70-76. 2. D ic k -R e a d , G ra n tly , 1958. Childbirth w ithout fe a r . 3rd ed. L o n d o n , H e in em an n M edical Books. 3. E w ert, P. H ., 1930. A stu d y o f th e effect o f inverted re tin a l s tim u la tio n u p o n sp a tia lly c o -o rd in a te d b e h a ­ v io u r. G enetic P sychol. M onogr., 8. 4. F ra n k s , C. M ., 1965. Conditioning techniques in clinical practice a nd research. L o n d o n , T a v isto c k P u b lica tio n s L im ited. 5. K itzin g e r, S. A n approach to antenatal teaching. T h e N a tio n a l C h ild b irth T ru s t. N .C .T . T .A .2. 6. K itzin g e r, S., 1967. The experience o f childbirth. Rev. ed. G re a t B rita in , P e lic a n B ooks. 7. Ja c o b so n , E ., 1938. P rogressive relaxation. C hicago, U n iv e rsity o f C h ica g o Press. 8. L am az e , F ., 1958. P ainless childbirth. L o n d o n , B urke P u b lish in g C o m p an y . 9. L az aru s, A . A ., 1961. G ro u p th e ra p y o f p h o b ic d iso rd e rs by system atic de se n sitiz atio n . J. A bnorm . Soc. P sychol., 63, 504-510. 10. S perry, R . W ., 1952. N e u ro lo g y a n d th e m in d -b ra in p ro b le m . A m erican Scientist, 40, 291-312. 11. S tra tto n , G . M ., 1897. V isio n w ith o u t in v ersio n o f th e re tin a l im age. Psychol. R ev., 4, 341-60, 463-81. 12. W olpe, J., 1961. T h e system atic d e se n sitiz atio n tr e a t­ m e n t o f neuroses. Jnl. o f N ervous a n d M e n ta l Disease, 132, 189-203. Treatment Notes Physiotherapy in Ante and Postnatal Field B y M rs. P . U N IA C K E P h y s io th e ra p y in o b ste tric s has c o m e very m u ch to the fore in th e p a st 20 years, especially in th e a n te n a ta l field. “ N a tu ra l C h ild b irth ” . T h is is a tta in e d “ w hen on the physical p la n e la b o u r is p h y siological a n d u n o b stru c te d a n d o n th e m e n ta l p la n e th e m o th e r-to -b e is u n a fra id ” . T h is w as th e p rin c ip a l to be p u t in to pra ctic e a n d , w ith th e in v alu a b le h elp o f th e late H e le n H e a rd m a n ’s tw o b ooks, The W a y to N a tu ra l Childbirth a n d P hysiotherapy in O bstet­ rics a nd G ynaecology, th is h a s b ecom e q u ite sim ple. T h e p a tie n ts m u st n a tu ra lly have th eir d o c to r’s perm ission to a tte n d classes a n d sh o u ld s ta rt a n y tim e fro m 4J- to 5 m o n th s . T h e first tim e th e y a tte n d th e y co m e 15 m inutes e arly a n d we sit a n d h ave a q u iet d iscussion a b o u t re la x atio n . I t is im p o rta n t fo r th e m to realise w hy they a re d o in g all th e exercises. A sm all d ia g ra m o f th e c o n te n ts o f th e pelvis is show n to th em a n d th e n a n e x p la n a tio n o f the m u sc u la r m ov em e n ts o f th e u te ru s d u rin g th e first stage o f la b o u r. D u rin g a n u terin e c o n tra c tio n the p a ra sy m p a th e tic in n erv a te s th e lo n g itu d in a l fibres o f the u teru s, w hich sh o rte n , c ausing the u te ru s to c o n tra c t a n d re tr a c t; the c irc u la r fibres, m eanw hile, relaxing. I f the w o m a n s ta rts to tense th ro u g h fear, th e sy m p a th e tic is called in to pro tec tiv e a c tio n cau sin g sp a sm o f the low er segm ent a n d th e longi­ tu d in a l fibres now have to ov e rco m e the re sistan c e o f the c irc u la r ones. T h e re is no w w a rfare betw een th e tw o o p p o sin g forces a n d tru e p a in results. All th is is exp la in ed to th e p a tie n t in sim plified te rm s to b rin g h e r to th e re a lis a tio n th a t fear cau ses ten sio n , tension c au ses th e n eck o f th e cervix to tig h te n , w h ich cau ses p ain w hich leads to m o re fear th u s estab lish in g a vicious circle. T h e p a tie n t is n ow re a d y to jo in th e class. T h e follow ing e q u ip m e n t is used: (a) F o a m m a ts ; th ree p a tie n ts to a m at. T hese c a n be ro lle d u p a fte r use a n d easily sto re d . (b) Sm all pillow s fo r th e h e ad c o v ere d by sm all tow els w hich a re easily la u n d e re d . (c) A g ra m o p h o n e . P a tie n ts p e rfo rm the a b d o m in a l a n d leg exercises fa r b e tte r w ith m usic th a n w ith o u t a n d it also a d d s in te rest fo r th em . E xercises a re given in th e follow ing o rd e r: (a) A b d o m in a l a n d c hest b re ath in g . (b) Pelvic rocking. (c) Pelvic floor c o n tra c tio n s. T h e im p o rta n c e o f these exercises being stressed fo r c o n tro l o f th e b lad d e r b e fo re a n d a fte r b irth . (d ) F iv e a b d o m in a l exercises c a rrie d o u t to m usic. (e) Pelvic flo o r stre tc h in g exercises. ( / ) B re ast exercises, im p o rta n c e being stressed th a t these exercises m u st be d o n e by th e p a tie n t a fte r th e b irth o f the child, fro m th e first day. A p a rt fro m p ro m o tin g th e flow o f m ilk it helps to c o n tro l th e sw elling, lu m p s a n d d isc o m fo rt as th e b re a sts enlarge. (g ) R e la x a tio n w ith c o n tro lle d slow bre ath in g . P a tie n ts a re ta u g h t to re la x o n e ac h side. D u rin g th e first stage o f la b o u r o n e side is usually m o re c o m fo rta b le b u t b o th sides s h o u ld b e p ra c tis e d a t classes as it is to o early to tell w hich side will be used. T h re e types o f b re a th in g a re ta u g h t: (a) Slow b re a th in g . T h is is sta rte d low d o w n in the d ia p h ra g m g ra d u a lly c om ing up to in te rc o sta l w ith a c o u n t o f 15 in a n d 15 o u t. F o u r to five c o u n ts o f 15 last fo r 60 seconds w hich is ro u g h ly th e len g th o f one c o n tra c tio n . S om e p a tie n ts c a n p ro b a b ly b re a th e far slow er b u t in a class it is b e tte r to ta k e a n a verage th a t c a n be m an a g ed by all. T h is m u s t be pra ctised a t h o m e every day. (b) W h en th e c o n tra c tio n s a re to o s tro n g fo r th e p a tie n t to m an a g e 15 c o u n t they can c o u n t 10. (c) A t th e e n d o f th e first stage, d eep b re a th in g th ro u g h th e m o u th to a c o u n t o f 3. T h is c o m pletes th e first stage o f lab o u r. I f th e p a tie n t w ishes h e r h u s b a n d to be p re sen t a t the b irth sh e is a sk e d e a rlie r o n to te a c h h e r h u s b a n d h o w to c o u n t. T h is h a s been fo u n d to be a g re a t help. S E C O N D S T A G E O F L A B O U R P a tie n ts d u e in 6 to 7 weeks tim e c om e 20 m in u te s e arlie r th a n th e re st o f the class a n d sta rt exercises fo r th e second stage. T h e b e a rin g d o w n se n sa tio n , i.e. th e desire to e m p ty the bow els, h e ra ld s th e be g in n in g o f th e second stage. T he p a tie n t, o n feeling this, is to ld to rin g th e bell a n d in fo rm th e m idw ife th a t sh e desires to p u sh . (a) C ro o k lying. W ith e ach c o n tra c tio n ra ise th e legs, h o ld in g th em u n d e r th e k n e e w ith the k n ees a p a rt. T a k e a deep b re a th in, low er th e sh o u ld e rs in a g ain st th e b e d a n d p u sh w ith th e re c tu m fro m the w aist d ow n, low ering th e legs a t th e e n d o f e ac h c o n tra c tio n . (b) A s th e h e ad s ta rts to descend th e v a gina th e p a tie n t m ay experience a terrific sp littin g se n sa tio n . S he m u st 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. ) S e p t e m b e r , 1969 P H Y S I O T H E R A P Y Page 9 be w arn ed o f this a n d to ld n o t to p a n ic a n d she will realise th a t it is n o t p a in fu l, m erely frightening. (c) A s th e h ead is b o rn th e d o c to r will ask th e p a tie n t to s to p p u sh in g so th a t he c a n c o n tro l th e b irth a n d a v o id tea rin g . T h e re is o n ly o n e w ay to s to p a n d th a t is to p a n t quickly. T h e p a tie n t m u st be to ld this rep ea te d ly so th a t she a u to m a tic a lly s ta rts to p a n t w hen to ld to sto p pushing. (d) A fte r a s h o rt p e rio d o f w a iting o n e fu rth e r expulsive e ffort will p ro d u c e th e plac en ta . P O S T N A T A L E X E R C IS E S H a v in g a busy p riv a te p ra c tic e I e n d e a v o u r to c u t to a m in im u m p o s tn a ta l visits a n d I have fo u n d th a t if I give e ach p a tie n t a p rin te d list o f exercises to p e rfo rm d u rin g h e r 7 d ays in th e n u rsin g hom e, th ree visits a re sufficient. I d o n o t spend m o re th a n 10 m in u te s w ith e ach p a tie n t. T h is c u ts the c ost to the p a tie n t a n d saves tim e fo r me. (a) A b d o m in a l m assage fo r a b o u t 4 m in u te s w hile e n q u irin g h o w th e p a tie n t is. T h is h elp s th e re tra c tio n o f th e u teru s, p ro m o te s p eristalsis a n d gives a general feeling o f w ell-being. In fact I th in k m assage does far m o re th a n it is g e nerally given c re d it for. (b) B reast exercises. (c) A bd o m in al-p elv ic flo o r exercises. Tw elve exercises in all, 4 new o nes e ach visit. C A E S A R E A N S E C T IO N (a) Exercises. A s fo r a n o rm a l c h ild b irth , th o u g h m odified, sta rtin g w ith deep b re a th in g exercises. (b) A b d o m in a l m assage fo r flatulence is a g re a t help. L ig h t effleurage a n d finger k n e a d in g o ver th e colon. In co n clu sio n I d o feel very stro n g ly th a t all this teaching o f re la x a tio n is o nly successful if o n e h a s th e c o -o p e ra tio n o f th e n u rsin g sta ff involved. 1 a m fo rtu n a te , in th a t m o st o f m y p a tie n ts a tte n d the sam e n u rsin g h o m e a n d th e m a te rn ity sta ff th ere a re only to o delighted to le a rn th a t a p a tie n t has a tte n d e d classes. T hey e n c o u ra g e th em to relax a n d b re a th e a n d find the p a tie n ts fa r m o re c o -o p e ra tiv e a n d c o n tro lle d th a n those w ho have th e ir b a b ie s w ith o u t a n y p rio r in stru ctio n . G E N E R A L M E D IC A L N E W S R E P O R T IN G — C O N F E R E N C E 4th-5th Ju ly , 1969 T h e m ain re aso n this C o n fe ren c e w as held, is th e d is­ sa tisfac tio n w ith M e dical N ew s R e p o rtin g in S o u th A frica. T h is w as an a tte m p t to find a m odus vivendi b etw een the M edical P ro fe ssio n a n d th e M ass M edia. T h e ten sio n betw een th em w as well illu stra te d by th e exchange o f w ords betw een P ro f. C . B a rn a rd a n d M r. P iet C illie o f D ie Burger. T h re e foreign sp e a k ers w ere in vited to lo o k a t the p ro b lem s as th ey have o c cu rre d a b r o a d a n d to discuss the m easures ta k e n to solve these p r o b le m s : D r. C. G . R o la n d , a p a st E d ito r o f th e Journal o f the A m erican M e d ic a l A ssociation a n d a t p re se n t H e a d o f the Section on P u b lic a tio n s o f th e M a y o C linic a t R o c h este r, M in n e so ta , d e scribed th e p re se n t-d a y scene in th e U .S .A . D r. S. S. B. G ild er, pre v io u sly a ssociated w ith British M e d ic a l Journal a n d Canadian M e d ic a l Journal a n d a t p re sen t E d ito r for D ocum enta Geigy a n d th e W orld M e d ic a l Journal, de sc rib e d p ro b lem s a n d th e ir respective so lu tio n s in C a n a d a , S c a n d in a v ia, F ra n c e , G e rm a n y , A u s tria a n d S w itzerland. M r. P . R . B ruce, a sso c iated w ith m edical d o c u m e n ta ry w o rk fo r the B B C television n e tw o rk , discussed p ro b lem s th a t a ro se w ith som e o f th e series he d id a n d ho w these were solved. M r. P . Cillie, e d ito r o f D ie Burger a n d M r. R . M . de V illiers, e d ito r o f The S ta r p o in te d o u t som e o f th e difficulties th e new s re p o rtin g sta ff m ee t w ith, w hilst P ro f. G . N . B a rn a rd sta te d th e feelings o f som e m em b e rs o f th e m edical p ro fessio n o n th is m a tte r. It w as a greed th a t th e m ain o b stacle w as th e lac k o f tra in e d science w riters in S o u th A frica a n d th a t p e rh ap s org a n ised m edicine sh o u ld stim u la te the tra in in g o f these people. It w as also agreed th a t this m eeting sh o u ld be follow ed up by a series o f m eetings o f a sm all c o m m itte e c o nsisting o f re p re se n tativ es o f m edicine a n d th e m ass m ed ia in eq u al p ro p o rtio n s w ith D r. v an Biljon, E d ito r o f th e S o uth A frican M e d ic a l Journal, as co n v en o r. It was a lso suggested th at som e liaison o n a re g io n a l basis w as e stablished. N .P. S O U T H A F R IC A N M E D IC A L C O N G R E S S 6th-12th J u ly , 1969 A g re at n u m b e r o f sp eak ers, b o th from S o u th A frica a nd overseas, sp o k e o n a variety o f subjects. O f p a rtic u la r in te rest to P h y sio th e ra p ists were th e d iscussion sessions on intensive care, rh e u m a to id a rth ritis a n d o rth o p a e d ic s a n d th e local p h y sio th e ra p ists used every o p p o rtu n ity to benefit from these. M o s t lec tu re s a n d d iscussions w ere e ith e r in the form o f p le n a ry o r su b -p le n ary m eetings, o r confined to specific specialties. T h e exhibits w ere divided in to th ree categ o rie s: Scientific, w here th e S .A .S .P . w as a lso invited to p a rtic i­ p a te . T his w as u n d e rta k e n by th e N o rth e rn T ra n sv a a l B ranch. T rad e s, w here all firm s dealing w ith m edical in stru m e n ts, d rugs, e q u ip m e n t, etc., show ed w h a t they h a d to offer. H o b b ie s, a fa scin a tin g e x h ib it o f th e w ide ra n g e o f activities a n d skills th a t d o c to rs p u rsu e in th e ir free tim e. A very full social p ro g ra m m e w as also a rra n g e d , b o th for delegates a n d th e ir wives, d u rin g th e week o f the congress. N .P . S .A .S .P . P o s t G ra d u a te C ourse: M iss M . R o o d . M iss M a rg a re t R o o d is pre sen tly visiting th is c o u n try and d u rin g A u g u st c o n d u c te d a th ree w eek c o u rse in J o h a n n e s ­ b u rg o n N e u ro -M u s c u la r T ec h n iq u e s to a n u m b e r o f m em ­ bers o f the Society fro m all o v e r th e R e p u b lic . T ra in in g Schools, P ro v in c ia l H o s p ita ls a n d S chools u n d e r the D e p a rtm e n t o f H ig h e r E d u c a tio n all sent re p re se n tativ es to ta k e a d v a n ta g e o f this u n iq u e o p p o rtu n ity o f lea rn in g from a n in te rn a tio n a lly recognised e x p ert in th e p e rso n o f M iss R o o d . A P P O IN T M E N T S B U R E A U T h e fu n c tio n o f this b u re a u is p rim a rily to assist p h ysio­ th e ra p is ts from overseas in finding su itab le p o sts in this c o u n try . A t p re sen t, th e b u re a u is seldom a d vised o f v a ca n ­ cies o r locum s needed a n d so c a n n o t p u t in terested p ersons in d irec t c o n ta c t w ith em ployers. T h e b u re a u th u s falls s h o rt o f its aim s by n o t hav in g th e necessary in fo rm a tio n — in th e form o f v a ca n t p o sts— re q u ire d in o rd e r to direct a n o th e r p h y sio th e ra p ist in a n y needed direc tio n . Y o u r a ssistan ce in fo rw a rd in g details o f v a ca n t p o sts to the a p p o in tm e n ts se c re tary o r g eneral se c re tary will be m uch a p p rec ia ted . P lease su b m it in fo rm a tio n , a n d w ho know s, th e p h y sio th e ra p ist y ou have lo n g b een needing, m ight m aterialise. I f e n o u g h vacancies a re availab le, th e service c o uld certain ly a lso be used by S o u th A fric a n m em bers. W O R L D C O N F E D E R A T IO N O F P H Y S IC A L T H E R A P Y F orthcom ing C ongresses 1970 (P hysical Therapy) 6 th In te rn a tio n a l C o n g ress o f W o rld C o n fe d e ra tio n for Physical T h e ra p y , T h e R a i C o n ­ gress C e n tre , A m ste rd a m , N e th e rla n d s , A p ril 2 6 th -M a y 2nd, 1970. 7th I n te rn a tio n a l C o n g ress o f W o rld C o n fe d e ra tio n of Physical T h e ra p y , C a n a d a , 1974. 0Occupational Therapy) 5 th In te rn a tio n a l C ongress o f W o rld F e d e ra tio n o f O c c u p a tio n a l T h e ra p is ts , Z u ric h , S w itzerland, J u n e ls t-6 th , 1970. 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. )