Perinatal period

Perinatal period - This is the period immediately preceding childbirth, as well as the childbirth itself and the period immediately following them. In the normal course of pregnancy, labor occurs around 38 weeks after conception. Usually the process of childbirth is divided into three stages : prenatal contractions, labor itself and expulsion of the placenta (placenta with umbilical cord). The first stage of labor is characterized by uterine contractions that gradually become more frequent and powerful. The cervix opens, forming a free passage into the birth canal, the process lasts from 12 to 24 hours during the first birth and from 3 to 8 hours during subsequent births. The second stage of labor, lasting from 10 to 50 minutes, consists in the expulsion of the fetus: strong uterine contractions continue, but the mother feels the urge to contract the muscles of the abdominal cavity, as this, simultaneously with each contraction, the baby is pushed down and out. The third stage is characterized by the expulsion of the placenta (the placenta separates from the uterine wall and comes out) and usually lasts 10-15 minutes.

It should be noted that there are huge cultural differences in both pregnancy management and obstetric practices.

On average, a full-term baby weighs 2.5–4.3 kg and is between 48 and 56 cm tall. Boys tend to be slightly taller and heavier than girls.

V. Apgar developed a standard rating scale for quickly determining the health status of newborns (Table 3.6).

Table 3.6

Apgar scale for assessing the condition of newborns

* In black newborns, the color of the mucous membranes, palms and soles is determined.

A source: [Craig, 2000, p. 186].

The assessment is carried out 1 min after birth and is repeated after 5 min. A score of seven or more indicates that the baby is in good physical condition. The result, which is in the range between four and six points, suggests that certain systems of the child's body are not yet fully functioning and he needs special help in establishing breathing and other vital processes. If the score is below four points, the infant needs urgent medical attention, immediate connection to life support systems.

The problems are significant prematurity and low weight child... Premature children are considered to be born more than 3 weeks before the completion of a full 38-week pregnancy. Small babies weigh significantly less than they should, based on the timing of gestation. Sometimes prematurity and low birth weight are combined, but this is not necessary. A baby can be born for all nine months, but does not have the prescribed 2.5-2.8 kg of birth weight, he is full-term, but low in weight. A baby born after 7 months and weighing 1.2 kg (average weight for this period) is only premature. Of these two complications, prematurity is the least dangerous for the mental development of the child. In the first year of life, premature babies often lag behind their full-term peers in development, but by the age of 2 or 3 years these differences are smoothed out, and most premature babies develop normally in the future [Kyle, 2002].

For low birth weight children, the prognosis is not so optimistic, especially if at birth they weigh less than 1.5 kg, such children, if they survive, usually lag behind in cognitive and motor development [Ibid]. If small children weigh more than 1.5 kg, then they have the best prospects, although they also face serious problems. During the first year of life, they are more likely to die, contract infectious diseases and show signs of brain damage. In the future, they may lag behind their peers in their development: they perform worse on intelligence tests, are more inattentive, perform worse in school, and demonstrate social immaturity [Burke, 2006].

For the normal development of children at risk (premature and low birth weight), it is very important supportive environment : quality medical care, attentive and caring parents, stimulating the development of the environment. TO special methods of stimulating such children include hanging hammocks and water mattresses for babies, replacing light movements that would be felt by a child if he was still in the womb; demonstration of an attractive toy; an audio recording of a heartbeat, soft music, or a mother's voice; massage; "Kangaroo technique" (a premature baby hides between the mother's breasts and looks out of her clothes). The results of many studies show that these forms of exposure contribute to a more rapid weight gain, streamlining the sleep-wakefulness cycle, and an increase in the infant's exploratory activity and motor development [Kyle, 2002].

Important problem - adaptation of the child to childbirth and birth ... Currently, there is a growing interest in the problem of influence on the mental and personal development of the prenatal and perinatal periods. The first to draw attention to this problem were psychoanalysts. Otto Rank places a central role in personality development birth trauma, considering birth as the deepest shock at the physiological and psychological levels [Rank, 2009]. Birth trauma, according to O. Rank, is associated with the separation of the child from the mother, when the child loses "bliss", the heavenly situation of intrauterine existence. It is this primary trauma that is the cause of all fear, traumatic experiences of all subsequent separations, as well as any neurotic conditions. O. Rank sees the entire period of childhood as a series of attempts to cope with the trauma of birth. The central human conflict, according to O. Rank, is the desire to return to the womb, to a serene, paradise state and at the same time, birth anxiety, the fear of returning to the mother's womb because of the fear of "expulsion from paradise." All pleasure, from his point of view, ultimately tends to restore the primary intrauterine pleasure. Likewise, sexuality is a symbolic reunion with the mother, the re-creation of intrauterine bliss. The trauma of birth, according to O. Rank, is a psychological force underlying human creativity, religious formations, art, philosophical constructions, which ultimately are attempts to overcome the trauma of birth, means of adaptation to it [Rank, 2009]. In his opinion, psychoanalysis should be recognized as the most successful attempt to overcome the trauma of birth [Ibid].

N. Foudor [Blum, 1996] believes that the experience of one's own birth is so traumatic that nature has taken care of ousting it from childhood memory. Fear of death actually occurs at birth, and birth trauma, childbirth, fear is symbolically represented in dreams (for example, in visions such as crawling through narrow holes; growing into the ground; sinking into mud or sand; crushing or squeezing; drowning; being sucked into a whirlpool , being dragged away by sharks, crocodiles, fear of being swallowed by wild animals or monsters; nightmares of strangulation or burial alive; phobias of injury or death). Complicated prenatal development or the process of birth leads, according to N. Foudor, to the fact that some children are already born neurotics as a result of intrauterine tests.

N. Foudor proposes four principles of prenatal psychology[Ibid]:

Childbirth is traumatic in almost every case;

Prolonged labor is accompanied by a large birth trauma and more serious mental complications;

The intensity of the birth trauma is proportional to the damage that the child receives during childbirth and immediately after birth, and subsequently leads to more serious consequences;

Loving and caring for the baby immediately after childbirth plays a decisive role in reducing the duration and intensity of the traumatic consequences.

Some modern researchers argue that the psyche of an infant during, and even more so before birth, is too undeveloped for the process of birth to have any serious impact on the subsequent development of the child. But other scientists (for example, psychoanalysts) argue that the process of birth is undoubtedly imprinted in the unconscious and, moreover, is available to mature consciousness [Grof, 1993; Marcher et al., 2003].

S. Grof, the founder of transpersonal psychology, suggests that mental life begins long before a person is born. The experience of the prenatal period and his own birth is preserved in a person at an unconscious level. It is carried by four so-called basic perinatal matrices reflecting the four clinical stages of biological birth: intrauterine existence (the first perinatal matrix - "serene intrauterine life"); prenatal contractions when the cervix is ​​still closed (the second perinatal matrix is ​​“the experience of cosmic absorption”); fetal advancement through the birth canal (the third perinatal matrix - "the fight between death and rebirth"); the actual birth of a child (the fourth perinatal matrix - "the experience of death - rebirth"). Many mental disorders (hypochondria, schizophrenic psychoses, depression, alcoholism, drug addiction, obsessive-compulsive disorder, tics, stuttering, autonomic neuroses, etc.) Grof explains by traumatic experiences experienced in the prenatal and perinatal periods by an unborn child. S. Grof created a variant of rebirth therapy (the technique of hyperventilation, or holotropic therapy), which accentuates the metaphorical and transpersonal aspects in order to overcome the problems associated with birth trauma.

A. V. Zakharov, based on his psychotherapeutic practice, believes that children who have undergone a traumatic birth experience have an earlier and more intense manifestation of fears. The fear of darkness, loneliness and confined space he calls perinatal triad of fears. You can get rid of or weaken them in psychotherapy, which consists in the possibility of anew, in a playful way, to safely go through the stages of "own birth".

L. Marcher, L. Ollars, P. Bernard also focus on the fact that birth trauma acts as one of the sources of psychological problems. Signs of the possible presence of problems associated with the birth process, from their point of view, are:

Strong feeling of confusion and inability to act in life: “inability to get out” of a difficult situation or inability to “get through it”; the feeling that you cannot use all your capabilities in this situation, the feeling that you are “stuck in the circumstances”;

Spontaneous physical sensations in areas of the body associated with the birth process (pressure in the head, sacrum, heels, navel);

In a stressful situation, a person's spontaneous adoption of an embryo posture;

The predominance in dreams and fantasies of images of canals, tunnels, etc.

In these cases, as well as in a situation where a person wants to fully work out the structures of his character, it is possible to carry out rebirth using the bodynamic method in order to create a new experience (imprint) of birth, so that the patient re-experienced this most important life milestone as it should have been. ... Rebirth solves two problems: 1) to come to an understanding of which factor turned out to be really traumatic or psychologically significant at the birth of an individual; 2) to create a new imprint ("fingerprint") of birth, allowing the client to really feel what was lacking in his real birth experience [Marcher, 2003].

Is the birth experience really that traumatic for the baby? There is no definite answer to this question among researchers. Childbirth is, of course, stressful, as evidenced, in particular, by a sharp rush of adrenaline, which is necessary to mobilize all the infant's forces needed to push himself through the birth canal. Stress can also be exacerbated by additional trauma, which can be caused by all sorts of complications or medical intervention. Violent contractions lead to strong pressure on the baby's head, regularly compressing the placenta and umbilical cord, as a result of which there is a temporary decrease in his oxygen reserves. However, healthy babies are well armed to withstand these injuries. The force of contractions is known to cause a child to produce large amounts of stress hormones, a large number of natural pain relievers (beta-endorphins) circulate in his circulatory system, which allow him to successfully cope with a stressful situation. This adaptive response helps the baby to withstand oxygen deprivation, prepares him for breathing by encouraging the lungs to absorb any remaining gases and expanding the bronchi, and stress hormones excite babies, as a result of which children are born in a state of full wakefulness, ready to interact with the world [Burke, 2006] ...

For a baby, birth is a stressful, shock event, but most newborns have everything they need to cope with this process. The question of whether the experience of one's own birth can be imprinted in the mental structures of a newborn remains controversial.

Prenatal and perinatal developmental periods

Prenatal period

Starting with the works of L. S. Vygotsky, in Russian developmental psychology, the period of embryonic development of a child is usually excluded from the schemes of age periodization, since it is "a completely special type of development, subject to other laws than the development of the child's personality that begins from the moment of birth" [Vygotsky, 1984, p. 256]. However, the origins of mental development are laid precisely in the prenatal period, the peculiarities of the course of which affect the subsequent postnatal development of the child, therefore, modern developmental psychology turns to the characteristics of prenatal development and the process of childbirth.

Prenatal or intrauterine development is a classic example of the maturational process, during which the transformation of a fertilized egg into a newborn baby takes place in a strictly defined and genetically fixed sequence. The period of prenatal development, which lasts an average of 38 weeks, is traditionally divided into three stages : zygote stage (about two weeks), embryo stage (from 2nd to 8th week) and fetal stage (from 9th week to birth). Let's take a quick look at each of them.

Zygote stage (germinal period). The first period of intrauterine development begins with the fertilization of the egg and ends when the fertilized egg, called zygote , or the embryo, is implanted into the wall of the uterus. A few hours after fertilization (usually within 36 hours), the first cleavage of the zygote occurs: first it divides into two cells, then every 12 hours a new cell division occurs, which gradually accelerates, and by the end of the first week the zygote consists of about 100 cells and represents is a hollow ball ( blastocyst) filled with liquid. Sometimes the zygote splits into two groups of cells, and this leads to the development of monozygous (identical) twins. Dizygotic (fraternal) twins develop when two eggs mature at the same time and are fertilized by different sperm.

Reaching the uterus, the zygote on the 7th-9th day begins to plunge into the wall of the uterus and join the maternal blood vessels. This process is called implantation. Simultaneously with it there is a process differentiation cells: from the inner cells of the zygote is formed germ disc from which the fetus subsequently develops. From cells directly adjacent to the wall of the uterus (outer protective layer - trophoblast), the structures that provide protection and nutrition of the developing organism develop. The trophoblast begins to grow rapidly. It forms amnion, a shell filled with amniotic fluid surrounding the developing organism. Amnion helps to keep the temperature of the prenatal world at a constant level, acts as a defense against any tremors caused by the movements of the mother. In addition, appears amniotic sac that produces blood cells until the developing liver, spleen, and bone marrow mature enough to take over this function [Burke, 2006]. By the end of the second week after conception, the trophoblast cells form another protective membrane, chorion that surrounds the amnion. From the chorion, thin villi grow, which perform the function of blood vessels. After these villi are implanted into the wall of the uterus, a special organ begins to develop that ensures the exchange of substances between the mother's body and the embryo, called placenta ... The placenta connects to the developing body through umbilical cord(umbilical cord), containing two arteries and one vein, delivering nutrients and removing waste products.

Stage of the embryo (embryonic period). A zygote that has completely invaded the wall of the uterus is called embryo... In the embryonic period, the fastest prenatal changes occur: the foundations of all structures of the body and internal organs are laid. Immediately after implantation, embryonic cells begin to differentiate into three separate layers: from the outer layer, ectoderm, the skin and nervous system subsequently develop; from the middle layer, mesoderm, muscle and bone tissue, circulatory and excretory systems are formed; from the inner layer, endoderm, the digestive system, lungs, urinary canal and tonsils are subsequently formed. These three layers are the foundation for the formation of all parts of the body.

First, the nervous system is characterized by the most rapid development: neural tube or a primitive spinal cord, and by 3.5 weeks the brain begins to form. In the fourth week, the heart begins to function, muscles, spine, ribs appear, the digestive and excretory systems, lungs are formed, but so far they do not work. During the second month, the eyes, nose, jaw and neck, limbs, fingers and toes are formed; internal organs become more distinguishable: different chambers are formed in the heart, the liver and spleen take over the production of blood cells.

If the embryo at the age of 3 weeks reaches no more than 2 mm in length, then by the end of the 8th week its size is already 2.5 cm, and its weight is approximately 4-6 g. The embryo can already move, although due to its small the size of the mother does not yet feel the faint movements of the embryo.

Fetal stage (fetal period). From the 9th week until the birth of the child continues fetal period sometimes referred to as the “growth and completion phase” [Burke, 2006]. At this stage, the size of the fetus's body increases significantly and the systems of its body begin to function.

Prenatal development is often divided into trimesters , or for three equal periods of time. The first trimester ends by the end of the 3rd month. By this age, the size of the fetus is about 8 cm, and the weight is about 28 g. The fetus develops the thyroid and pancreas, kidneys, the liver begins to function, the final differentiation of the reproductive organs occurs, that is, the external genital organs are formed so that they it is easy to determine the sex of the fetus using ultrasound. Other "finishing touches" appear, such as fingernails and toenails, the rudiments of teeth and eyelids that open and close, the rhythm of the heart intensifies, and can already be heard with a stethoscope.

In the second trimester, the fetus becomes covered with a white substance called original grease, which protects the baby's skin from cracking due to a long stay in the amniotic fluid. In addition, the entire body of the fetus is covered with white fluffy hair ( lanugo), which help the primordial lubricant to adhere to the skin. By the end of the second trimester (24th week), many organs are well developed. The development of the brain reaches the main stage: by the 24th week, all the neurons of the brain are formed. The development of the brain brings with it new possibilities. From 20 weeks of age, the fetus can respond to sound and light. For example, if the doctor examines the contents of the uterus using fetoscopy, the fetus tries to close its eyes with its hands.

At the stage of the fetus, behavior- fetal activity, expressed in well-coordinated movement patterns, the main of which are presented in table. 3.1.

Table 3.1

Development of fetal movement patterns

A source: [Butterworth, Harris, 2000, p. 72].

The active behavior of the fetus contributes to the normal development of joints, sensory organs, prevents "sticking" to the wall of the uterus, allows you to take a more comfortable position in the womb [Butterworth, Harris, 2000]. As you can see from the table. 3.1, from the 17th to the 24th week, the activity of the fetus decreases, which, apparently, is due to the formation during this period of those higher centers of the brain that coordinate the behavior previously controlled by the midbrain structures. After the 24th week, more subtle movements are observed, including expressive facial expressions.

By the last, third trimester, most of the systems of the fetus are functioning reliably enough, which gives a chance for survival outside the mother's body for a prematurely born child. The age from which the child is able to survive is called age of vitality , it occurs between the 22nd and 26th weeks of pregnancy [Burke, 2006]. However, a child born so early can survive only with intensive support and special care, and in the future he is likely to face serious problems in physical and mental development.

Over the past three months, the brain continues to develop rapidly: the cerebral cortex increases in size, the neurological organization improves, and the fetus spends more time awake. By the 20th week, heart rate variations indicate that the fetus is sleeping all the time, but by the 28th week the fetus is awake for about 11% of the time, and shortly before birth - 16% [Ibid]. With the transition to the 9th month of prenatal development, the fetus sets up sleep and wakefulness cycles. At 30 weeks, the fetus registers rapid eye movements, this is the phase of sleep that is accompanied by dreams in adults.

In the third trimester, fetal susceptibility to external stimulation also increases. Around the 24th week, the fetus experiences pain for the first time. Therefore, after this time, anesthetics should be used for any prenatal surgery. By the 25th week, the fetus reacts to nearby sounds through body movements. In the last weeks of pregnancy, the fetus begins to distinguish between the tone and rhythm of the mother's voice. In one study [Kyle, 2002], pregnant women were asked to read aloud Dr. Seuss' story, "The Cat in the Cap," twice a day during the last month and a half of pregnancy. By the time of birth, each child in the fetal stage had listened to the story for a total of at least 3 hours. The newborns were then allowed to suck on a dummy connected to a tape recorder so that the sucking infant could turn on or off the recording. The researchers found that the newborns sucked on a pacifier to enable the mother's recording of the "Cat in the Cap" story, but did not want to listen to the recordings of other stories read by the mother. Apparently, the newborns recognized the rhythmic structure of the story, which they remembered before birth.

Studies that have examined fetal responses have shown that fetal activity patterns predict an infant's temperament between 3 and 6 months of age after birth. Those fruits that alternated calm and active behavior usually became calm babies with predictable rhythms of sleep - wakefulness. Conversely, those fruits that were prone to long periods of activity in infancy were more likely to become children with a difficult temperament, demonstrating fussiness, rejection of new experiences, irregular feeding and falling asleep cycles, and high activity [Burke, 2006].

During the last month of pregnancy, the fetus develops a subcutaneous fat layer, which helps to regulate temperature; antibodies are transmitted from the mother's body to protect the fetus from disease and to support its own developing immune system. By the end of the 9th month, the fetus reaches a weight that usually exceeds 3 kg and grows to just over 50 cm.As it fills the uterus, its movements gradually become less frequent, which is also facilitated by the development of the brain, which allows the body to slow down its impulses ... The rate of weight gain in the fetus decreases; in recent weeks, most fetuses take a head-down position, the cells of the placenta begin to degenerate - the baby is ready for birth.

Table 3.2 presents the main milestones of prenatal development.

In the process of prenatal development, the following are found general trends [Craig, 2000, p. 165-166]:

cephalocaudal developmental trend - the course of development, in which the growth process takes place in the direction "from head to feet";

proximodistal developmental trend - the course of development, in which the growth process occurs in the direction from the center of the body to the periphery;

from general to specific - a developmental trend, consisting in the transition from generalized, body-wide reactions to more local and specific reactions;

differentiation - in prenatal biological development, this is a process during which undifferentiated cells become more and more specialized;

integration - organization of differentiated cells into organs and systems.

3. Ultrasound examination (ultrasound) during pregnancy. Color Doppler mapping (CDC). Fetal biophysical profile (FBF).
4. Genetic methods. Genealogical method. Fetal karyotype. Karyotyping. At-risk groups.
5. Immunological relationship between mother and fetus. Intensive care of newborns. Perinatalogue. Development of perinatology.

Perinatology -branch of medicine, aimed specifically at studying the period of a person's life, starting from 28 weeks of pregnancy (fetal weight 1000 g) and including the first 7 days after birth. The name of perinatology comes from three words: peri (Greek) - around, about; natus (lat.) - birth; logos (lat.) - teaching.

Perinatal period includes time before delivery - antenatal, during childbirth - intrapartum and after childbirth - neonatal periods. Perinatal period is extremely important for the development of a person in the future, since by the end of pregnancy the intrauterine formation of the fetus ends, during the process of childbirth, the plol is exposed to many factors, and during the first 7 days it adapts to extrauterine life. The number of fetuses and newborns that died in the ante-, intra- or postnatal periods determines the perinatal mortality rate, and the diseases appearing during this period - perinatal morbidity. The proposal to single out the ante-, intra- and postnatal periods of a person's life is associated with the name of the famous German obstetrician E. Saling. He pointed out the need for a thorough study of the perinatal period of a person's life with the involvement of various specialists to reduce perinatal morbidity and mortality. This was dictated by the decline in fertility observed in the 1950s and 1970s in many European countries and, at the same time, high rates of perinatal and infant (after 7 days of life) mortality. Zaling's idea was supported by many scientists, and in 1976 the European Scientific Society of Perinatology was created. Perinatology began to develop rapidly throughout the world.

In our country founders of perinatology were N.L. Garmashova (St. Petersburg), L.S.Persianinov (Moscow) and their students and followers: N.N. Konstantinova, G.M.Savelieva, I.V. Ilyin, V.M. Delnikova, A.N. Strizhakov, A.P. Klryushchenkov, M.V. Fedorova and others.

As the perinatology the temporal parameters of the perinatal period expanded - they began to distinguish prenatal (prenatal) development of the embryo and fetus, starting with fertilization processes up to 28 weeks of gestation. Thus, perinatology began to include all periods of intrauterine human development.

Currently the beginning of the antenatal (prenatal) period refers to the 22-23rd week of gestation (fetal weight 500 g), since starting from this gestational age, the survival of the born fetus is possible under conditions of adequate therapy.

natalis- related to birth) - perinatal period; divided by:

• antenatal(lat. ante- before) - prenatal
• intranatal(lat. intra- inside) - directly childbirth
• postnatal(lat. post- after) - 7 days (week) after childbirth

Intra- and postnatal periods are stable. In the antenatal period, the duration of pregnancy before delivery was first included, starting at 28 weeks. At the same time, not only the gestational age remains a criterion, but also the weight of the fetus (1000 grams). Subsequently, it was shown [ by whom?] that the fetus can survive even with a shorter gestation period, and then the antenatal period in most developed countries began to be calculated from 22-23 weeks (fetal weight is 500 grams). The period of pregnancy was previously named prenatal, that is, prior to the birth of a viable fetus.

Studies carried out in the prenatal period with the involvement of genetic, biochemical and ultrasound methods made it possible to identify congenital and hereditary fetal pathology in the early stages of pregnancy and, if indicated, to interrupt it. The intrapartum period is no less important. Objective diagnostic monitoring of the mother's condition, labor and fetal status made it possible to better understand the physiology and pathophysiology of the birth act with a more accurate assessment of the obstetric situation and optimization of delivery methods.

The introduction of new diagnostic and therapeutic technologies has contributed to significant progress in the health of the fetus and newborn. Methods of intensive care of newborns born in asphyxia, with intracranial trauma, premature or extremely low weight have been developed and are widely used in practice. Thanks to scientific and practical advances, 70% of children born between 22 and 28 weeks of gestation are now surviving in many clinics around the world.

As part of the development of perinatology, a new direction begins to emerge - fetal surgery.

Perinatal mortality

Perinatal mortality in Russia is determined by the number of dead fetuses, starting from 22 weeks of gestation (fetal weight 1000 grams or more, length 35 centimeters or more), during childbirth and newborns in the first 7 days (168 hours) after birth and is calculated per 1000 live births.

The dead in the ante- and intrapartum periods are classified as stillborns (stillbirth rate), the number of deaths in the first 7 days after childbirth is early neonatal mortality.

Perinatal mortality is recorded in all countries of the world. This indicator reflects the health of the nation, the social position of the people, the level of medical care in general and obstetric care in particular.

In the developed countries of the world, perinatal mortality is below 1 ppm. In this case, all births are taken into account, starting from 22 weeks of gestation (weight more than 500 grams). In Russia, termination of pregnancy before 28 weeks is referred to as abortion. Children who survived during these gestational periods (body weight less than 1000 grams, body length less than 35 centimeters) and survived 168 hours (7 days) are registered in the registry office as live births, and mothers are given a certificate of incapacity for work for pregnancy and childbirth. At the same time, termination of pregnancy up to 28 weeks is not included in the report of the medical institution on the number of births.

Perinatal mortality includes all those born after 28 weeks and having a body weight of more than 1000 grams and a length of more than 35 centimeters. At the same time, they distinguish between antenatal, that is, prenatal, child mortality; intrapartum (those who died during childbirth) mortality and postnatal (those who died within 7 days after birth) mortality. Perinatal mortality in Russia is constantly decreasing, but it is higher than in developed countries: in 2000 - 13.18 ppm, in 2001 - 12.8 ppm, in 2002 - 12.1 ppm; in 2003 - 11.27 ppm; in 2004 - 10.6 ppm, in 2005 - 10.2 ppm, 2006 - 9.7 ppm.

It is of national importance not only to reduce perinatal mortality, but also perinatal morbidity, since health in the perinatal period largely determines that throughout a person's life.

Perinatal centers

Of great importance in reducing perinatal morbidity is the creation of perinatal centers in Russia, where high-risk pregnant women are concentrated. At perinatal centers, it is planned to create departments to help children after discharge from the maternity hospital - the 2nd stage of nursing newborns. Children born with a small (less than 1500 grams) and extremely small (less than 1000 grams) weight are transferred to the 2nd stage; those born with symptoms of oxygen deficiency; birth trauma and other diseases. The creation of perinatal centers involves the use of the latest technology, modern diagnostic and therapeutic equipment. These centers have all the conditions for the provision of highly qualified care for mothers and children.

see also

Literature

This section of the article has not been written.

A baby in the womb is called a fetus, and after the baby is born, it is called a newborn for 4 weeks. Perinatal psychology (peri-around; natalis - related to birth) is the science of mental life in the perinatal period, its influence on the formation of a person's personality, as well as the relationship of the fetus and newborn with the mother and the influence of the mental life of the mother on the child. Perinatal psychology is a new direction in psychology. As a science, it has existed for about 30 years and is rapidly developing in civilized countries. The World Association of Perinatal Psychology was created, with its branches in various cities and countries.

Perinatal psychology proceeds from two main statements: the presence of mental life in the fetus, and the presence of long-term memory in the fetus and newborn.

Fetal long-term memory is assumed to extend to events during pregnancy, childbirth and the postpartum period. These events affect the formation of the subconscious and the formation of mental and behavioral reactions of an adult. Perinatal events especially strongly affect human behavior in critical situations (stress, divorce, work difficulties, accidents, etc.). In addition, the perinatal period affects a person's attitude to military service, war, sex, gambling, and is also responsible for a person's cravings for extreme sports, and in general for everything "acute".

The founder of the theoretical base is S. Grof, who proposed the theory of "perinatal matrices". Briefly, its main provisions are as follows: in a person, perinatal events are recorded in the form of clichés (stamps) - persistent functional structures that are basic for his mental and physical reactions and corresponding to the process of pregnancy, childbirth and the postpartum period. These are called basic perinatal matrices. S. Grof identifies four main matrices.

Naivety Matrix (Amniotic Universe).

The biological basis of this matrix is ​​the symbiotic union of the fetus with the maternal organism during its intrauterine existence. If there is no interference, such a life is close to ideal. However, various factors of a physical, chemical, biological and physiological nature can negatively affect this condition. In later stages, the situation may become less favorable also due to the size of the fetus, mechanical compression or unsatisfactory work of the placenta. For the formation of the naivety matrix, it is necessary to have a formed cerebral cortex in the fetus. Thus, its formation is attributed to the 22-24 week of pregnancy. Some authors assume the presence of cellular and wave memory, and, therefore, the naivety matrix may begin to form immediately after conception and even before it.

This matrix forms the life potential of a person, his potential, the ability to adapt. Desired children, children of the desired sex, with a healthy pregnancy, the basic mental potential is higher, and this observation was made by mankind a long time ago.

Sacrifice matrix.

It is formed from the moment of the onset of labor until the moment of complete or almost complete dilatation of the cervix, which roughly corresponds to the first period of labor. The child experiences the forces of the pressure of contractions, some hypoxia, and the "exit" from the uterus is closed. In this case, the child partially regulates his own birth by the release of his own hormones into the mother's bloodstream through the placenta. If the load on the child is too high and there is a danger of hypoxia, then he can slow down his childbirth somewhat in order to have time to adapt. From this point of view, the stimulation of labor disturbs the natural process of interaction between the mother and the fetus, forming the pathological matrix of the victim. On the other hand, the mother's fear of childbirth provokes the mother's release of stress hormones, placental vasospasm occurs, fetal hypoxia, which also forms the victim's pathological matrix. Activation of this matrix under the influence of unfavorable factors throughout the subsequent life of a person can lead to the identification in memory of situations that threaten the survival or integrity of the human body. Possible experiences of being in a confined space, a feeling of being trapped in a trap, a hopeless situation that does not see an end, a feeling of guilt and inferiority, the senselessness and absurdity of human existence, unpleasant bodily manifestations (a feeling of oppression and pressure, heart failure, fever and chills, sweating, difficulty breath).

With a planned cesarean section, this matrix cannot be formed, while with an emergency cesarean section, it is formed.

Struggle matrix.

Onaf is formed from the end of the disclosure period until the moment the child is born, which P approximately corresponds to the 2nd stage of labor. It characterizes the activity of a person in moments of life, when something depends on his active or wait-and-see attitude. If the mother behaved correctly during the strenuous period, helped the child, if he felt that during the period of struggle he was not alone, then in later life his behavior would be adequate to the situation. With a cesarean section, both planned and emergency, the matrix apparently does not form, although this is considered controversial. Most likely, it corresponds to the moment the baby is removed from the uterus during the operation.

Freedom matrix.

This matrix begins to form from the moment of birth. Its formation ends either in the first seven days after birth, or in the first month after birth. It is believed that this matrix can be revised throughout a person's life, i.e. a person all his life reconsiders his attitude to freedom and his own capabilities, taking into account the circumstances of his birth. Researchers are not unanimous about the duration of the formation of the 4th matrix. If a child is separated from his mother after birth for some reason, then in adulthood he may regard freedom and independence as a burden and dream of returning to the matrix of innocence.

It is believed that full breastfeeding for up to a year, good care and love can compensate for negative perinatal matrices (for example, if there was a cesarean section, if the child was admitted to a children's hospital immediately after birth and was separated from his mother, etc.).

If the child can be influenced by the mother, then an important practical question arises about the possibility of his prenatal education. Perinatal psychology claims that this is not only possible, but also necessary. To do this, there are prenatal (prenatal) parenting programs that emphasize the importance of a sufficient amount of positive emotions experienced by the mother. At all times, pregnant women were recommended to look at the beautiful around (nature, sea), not to get upset over trifles. It is very good if the expectant mother draws (even not knowing how to do it) and conveys her expectations, worries and dreams in the drawing. In addition, handicraft has a great positive effect. Positive emotions include the so-called "muscle joy" that a child experiences when his mother is engaged in physical education and sports, during long walks.

Of course, all the provisions on matrices are largely a hypothesis, but this hypothesis received some confirmation in the study of patients who underwent a cesarean section. The latter leads to the fact that the child born by cesarean section does not pass the 3rd and 4th matrices. This means that these matrices cannot manifest themselves in subsequent life.

At the same time, it is known that experienced obstetricians have long been striving (in the absence of fetal suffering) during a caesarean section to restrain the rapid extraction of the newborn, because this, through the reticular formation, contributes to the inclusion of the respiratory system, more precisely, the first breath of the newborn.

Recently, new observations have appeared that expand the position on the role of perinatal matrices. There is an opinion confirmed by psychotherapy about the possibility of activating matrices as a mechanism for the effort of natural evolutionarily developed ways of physiological protection and recovery of the body.

If we recognize that the fetus and the newborn have the ability to record information about the perinatal period for life, then the question immediately arises about the ways of transferring this information from the pregnant woman to the fetus and vice versa. According to modern concepts, there are several main ways of such transmission. It is believed that the transfer of information can be carried out through the uteroplacental blood flow (hormones are transmitted through the placenta, the level of which is partially controlled by emotions). There is a hypothesis (wave path) that an egg, which is in favorable conditions, can accept not any sperm, but only one that matches it in terms of the characteristics of electromagnetic radiation, and the fertilized egg also notifies the mother's body of its appearance at the wave level. Water can also be an energy-informational conductor and the mother can transmit certain information to the fetus simply through the body's fluids (waterway).

First of all, the fetus develops a sense of touch. At about 7-12 weeks, the fetus may feel tactile stimuli. The auditory and vestibular apparatus of the fetus are formed by 22 weeks of gestation. In the womb, babies hear too. However, they are hampered by the noise of the mother's intestines, the vessels of the uterus, and the beating of the heart. Therefore, external sounds do not reach them well. But they hear their mother well, because acoustic vibrations reach them through the mother's body. It has been proven that babies whose mothers sang during pregnancy have better character, are easier to learn, more capable of foreign languages, more diligent, and premature babies, who have good music in their cuvese, gain weight better. In addition, singing mothers have an easier time giving birth. their breathing is normalized, they learn to regulate exhalation. In utero, the child feels the taste, because from 18 weeks, he drinks amniotic fluid, and their taste changes somewhat, depending on the mother's food. With an abundance of sweet food, the waters are sweet. The sense of smell appears quite late, and some full-term newborns do not hear the smell of mother's milk for several days after birth, and babies at the age of 10 days already distinguish their mother by smell.

Birth crisis

The development of a child begins with the critical act of birth and the next critical age, which is called the newborn. The baby is physically separated from the mother during childbirth. Foreign scientists have proposed a theory of birth trauma. The birth of a child is a traumatic moment that affects the entire subsequent life. From this point of view, birth is a shock, and the first cry is a cry of horror. The representatives of this theory attach great importance to the experiences that accompany the process of birth. A newborn child, passing through the birth canal, may experience a number of experiences: fear, hopelessness, despair. These experiences can also manifest in an adult, which can cause neurosis.

There are recommendations for mitigating the birth trauma: maintain soft lighting, not make noise, do not swear, do not rattle instruments, use soft music, put the newborn on the mother's stomach for a while.

Domestic reflexologists expressed an opposite view of the mental life of a newborn: there can be no serious experiences in the life of a newborn, there is still no mental life, the psyche of a newborn is made up of some reflexes.

The modern approach to the consideration of the mental life of the newborn casts doubt on both of the above concepts. The newborn already has mental life, but due to the immaturity of the nervous system, all the senses have a fairly high threshold (low sensitivity).

A child is born with a certain set of reflexes, some of which provide physiological adaptation to the external world and persist in the future, others are atavistic in nature. However, the reflexes of a newborn are not the basis for his mental development.

The neonatal period is considered a crisis. This period of the child's mental development as critical was described as one of the last. The social situation of the newborn is specific and unique. It is determined by two important circumstances. On the one hand, this is the child's complete biological helplessness. Without an adult, he is not able to satisfy any vital need, in connection with which the infant is the most social being. On the other hand, with the maximum dependence on adults, the child is still deprived of the basic means of communication in the form of human speech. In this contradiction between maximum sociality and minimum means of communication, the foundation of all child development in infancy is laid. The need for communication with an adult develops during the neonatal period under the influence of active appeals and influences of an adult. From the very beginning, the mother treats the child as a full-fledged personality, endowing his actions and movements with a certain human meaning.

The main neoplasm this period - the emergence of the child's individual mental life. New in this period is that, firstly, life becomes an individual existence, separate from the mother's organism. The second point is that it becomes mental life, since, according to L.S. Vygotsky, only mental life can be a part of the social life of the adults around the child. The child develops a neoplasm in the form revitalization complex , which includes the following reactions:

• general motor excitement when an adult approaches;
• the use of shouting, crying to attract to oneself, that is, the emergence of communication initiatives;
• profuse vocalizations during communication with the mother;
• smile reaction.

The emergence of the revitalization complex serves as the boundary of the critical period of the newborn, and the timing of its appearance serves as the main criterion for assessing the adequacy of the child's mental development. The revitalization complex appears earlier in those children whose mothers not only satisfy the vital needs of the child (they feed on time, change diapers, etc.), but also communicate and play with him.