THEORIES OF PSYCHOPROPHYLAXIS IN OBSTETRICS (PROPHYLAXIS OR THERAPY)

The most widely used drugless method of obstetrical analgesia is the psychoprophylactic method (PPM) described by Velvovski. It is an offshoot of the hypnosuggestive method (HSM). Hypnosis has been abandoned. The new method is based upon instruction in anatomy and physiology, and training in techniques of relaxation, breathing and active participation during labour, all in a good emotional climate.

The two methods have been contrasted thus. The HSM is said to be based on suggestion, the PPM on persuasion, with the appropriate physiological corollaries, namely cortical inhibition in the case of the former, hence therapy, and excitation in the case of the latter, hence prophylaxis. But this contrast is challenged in the absence of physiological proof. The two methods do differ, but in another way. In HSM, the pain-preventing effect consists principally in verbal, massive, direct action. In the PPM, too, part of the pain-preventing effect appears as verbal and direct but not massive. It is diluted in a network of relationships. But it also appears in a verbal and indirect form; the suppression of fear has beneficial effects on contractions of the uterus. There is finally the non-verbal form represented by breathing exercises, active relaxation and other pain-preventing "procedures." The psychotherapeutic element remains of importance in the PPM. The HSM requires a particular skill from those who apply it, and what is more, hypnosis, surrounded as it is by a mystical halo, meets with much conscious and unconscious resistance, both among the public and in the medical world. In eliminating hypnosis, Velvovski has shown his sense of realities; no doubt he has been unable to interpret in a wholly satisfactory way the physiological and psychological realities on which the method rests, but we should not find this surprising when we realize the difficulty in this field. The field offers a vast and exciting prospect of research to all concerned to understand the nature of pain and to find the means of relieving it. In taking the discussion into the realm of science, Velvovski has already himself achieved considerable progress. Moreover, his rationalization has reassured both public and doctors and thus permitted the application of the method on a large scale.