脱サラゲイの海外生活 -ワーキングホリデーから海外移住を目指して-トロント、ハワイ編

カナダ・トロントでのワーキングホリデーを経て東京へ。NY・LAを目指して転職中のはずが縁あってハワイへ。ダンスで時々息抜き。ゲイなのでセクシャルな記事も書きますが、一緒に楽しめる方はそのまま覗いて行ってください!

マッサージ

妊娠中、後のマッサージ02/ハワイ・マッサージ学校-ゲイの海外生活-

投稿日:

*授業で習ったものの個人的なメモです。内容の整合・不整合は個人でお確かめください。10/16/2019

Kapiolani Community College のMassage Therapy Programより。

Stage of Labor 出産に至るまでとマッサージ

First Stage Of Labor

  • Intensity/duration - dilation(拡張) of cervix(子宮頸) 5 - 8 min
  • Effacement(子宮膣部展退) & and dilation of cervix 3 cm
  • 12-14 hours - may increase for 1st mom

子宮膣部展退

子宮頚部は子宮頚管とも表現され、分娩前は中の空洞がほとんどないちくわのような「管」です。 「子宮頚管の開大」がこの「ちくわ」の横の広がりを表現するのに対して、「子宮頚部の展退」は「ちくわ」の長さが短くなって行くことを表現しています。

分娩の進行に伴って、子宮頚管はその長さがどんどん短くなって行きます。 分娩前にはその長さが4センチくらいありますが、全開大直前には1ミリ以下(薄くなって)になってしまいます。 元々の長さからどのくらいの長さになったのかを割合(%)
で表現します。
「展退50%」とは子宮頚管が半分くらいの長さになったことを表しています。

http://www.san-kiso.com/sannka/bishop.html

Mother Status

  • Low nagging backache - menstrual(月経)-like cramp which becomes more painful
  • Lobor hormones - nor epinephrine & epinephrine stimulate uterine muscle contractions.

エピネフリン

アドレナリンともいう. 副腎髄質,アドレナリン作動性ニューロンで合成され,ホルモンとしても,また神経伝達物質としても作用する. 高峰譲吉,上中啓三により1900年に結晶化され発見された最初のホルモン. 発見の経緯からいうと,「アドレナリン」が正しい名称だが米国や日本薬局方では「エピネフリン」を使う.

https://kotobank.jp/word/エピネフリン-37207

ノル エピネフリン

ノルアドレナリン 交感神経の情報伝達に関与する神経伝達物質。 副腎髄質から分泌されるホルモンの1つでもある。 ノルアドレナリンとは、激しい感情や強い肉体作業などで人体がストレスを感じたときに、交感神経の情報伝達物質として放出されたり、副腎髄質からホルモンとして放出される物質です。

https://www.weblio.jp/content/ノルエピネフリン

Massage

  • Relaxing Swedish Movements/strokes
  • During contractions, use slow, Swedish strokes
  • Rhythmic movement

In-between Contractions

  • Flush lactic acid - kneading, Swedish Strokes
  • Stretching
  • Positional changes
  • Walking, breathing

ACTIVE 1st Stage Of Labor

  • Contractions more intense, longer and more frequent. 3 - 45 min long every 2 - 3 min (人によってその間隔や長さは大きく異なる)
  • Cervix continues to thin and open to 7cm
  • 1st time would be 2-6 cm
  • Pain and fear
  • She may choose an epidural(硬膜外麻酔)

硬膜外麻酔とは、お背中を局所麻酔した後に比較的太い針を硬膜外腔まで進め、この針伝いに直径僅か1mm弱の細い管を硬膜外腔に留置し、この管を通じて局所麻酔薬などの鎮痛薬を注入することによって、末梢神経からの刺激伝達を遮断し、痛みを緩和するというものです。

https://www.kanto-ctr-hsp.com/ill_story/201712_byouki.html

Massage and Transition Phase of First Stage

  • Smaller increments(増加) of hands, feet other tender areas
  • 7 - 10 cm effaced & dilated

Second Stage Of Labor

  • Bear down(体重をかけつつ押す)
  • Abd effeurage
  • Continue Swedish
  • Baby Comes Out

Third Stage Of Labor

  • Expel(押し出す)of placenta
  • Breath
  • C-section(帝王切開)- Breathe, support for her and family

Labor Massage Techniques to Teach Partners

会陰部などへのマッサージになるのでパートナーとなる人に手伝ってもらい負担を軽減する。

  • Pain from incision(切開), abdominal & intestinal gas
  • Extreme fatigue, low energy
  • Need for movement, gentle exercise
  • Emotional wreck/loss of control
  • Increase risk of thrombophlebitis(血栓性静脈炎),and pneumonia(肺炎)

Common Feelings

fear, worry, anxiety, powerlessness, loss of control, disappointment, shock, trauma, depression, defeat, anger, resentment, blaming, sadness, abandonment

Post-Partum(産後)Positioning

  • Supine - kee bolsers
  • Side Lying - firm pillow or contoured body cushion to maintain horizontal angle
  • Prone - reduce pressure on breasts. After cesarean brith(帝王切開) release
  • Comfort Factors : Breast of incision tenderness. Milk leakage, epidural site(硬膜外麻酔), Baby

Summary Of Contraindication to Post-Partum Massage Therapy

  • Modify leg and abd massage to prevent dislodging clots
  • No leg massage if birthing complications(出産時の合併症) require bed rest
  • With cesarean births, no abd techniques until incision heals and with a medical release
  • No massage without physician's release when maternal complications(合併症) have occurred

Summary of Post-Partum Massage Therapy Goals

  • Nature and provide emotional support
  • Restore and normalize abd structures
  • Facilitate restoration of pre-pregunancy physiology
  • Alleviate muscle strain/fatigue or labor and birth

Pre-Labor Signs

  • Hormone/physical changes
  • 1 mo before labor starts experiencing. Warmup contractions aka Braxton Hicks(前駆陣痛) contractions

前駆陣痛とは?

偽陣痛や練習の陣痛とも呼ばれる前駆陣痛 (この子宮緊縮について説明したイギリス人のお医者さんブラクストン・ヒックスから命名) は本陣痛ではないですが、本陣痛と同じように子宮の筋肉が収縮することで起こります。

https://www.jp.pampers.com/pregnancy/giving-birth/article/braxton-hicks-contractions-what-are-they

Post-Partum Period(産後)

The postpartum Period is a wonderful but difficult time for families. Families need to be tough during their childbirth education class realistic expectations of this time so that they can plan and be prepared for it. Parents also need to be given resources to obtain help if they need it.

  • Mom is getting acclimated(順応した)to "mothering"
  • Healing from episiotomy(会陰切開)
  • Uterus still contracting and returning to original position
  • Hormonal changes still occurring
  • Relaxin wearing off all joints/ligaments returning to pre-pregnancy state
  • Brest feeding

Post-Partum Brest Rngorgement(鬱血)

2nd - 5th day after baby's birth, the mom will notice changes in her breasts. They become larger, somewhat firm, and slightly tender as they begin to produce large amount of milk. This is called breast engorgement.

Enlargement is hormonal process. Unrelieved pressure during breast engorgement can cause soreness, however, and breast swelling & engorgement may take it difficult for the baby to latch on. This may cause baby to latch on incorrectly and the mother to produce less milk and even stop producing milk. Knowing how to manage engorgement will help to avoid these problems.

Cause: Results form hormone changes after delivery. The changes in hormones cause a sudden increase in the amount of milk produces. Swelling of the breast tissue & increased blood flow to the breasts also contribute to engorgement.

  • Usually last just a few days until mom's body adjustments to the process of making/releasing milk
  • The swelling of beast tissues that accompanies engorgement makes it seem like mom is producing more milk than baby needs. Engorgement is not the production of too much milk, however, but the result of milk NOT flowing out as much as it needs to. Getting the milk is flowing is the key to relieving engorgement.
  • Once baby is nursing well and the milk is flowing easily, there will be less swelling & firmness.
  • Within a few days the mothers breasts will have adjusted to her baby's appetite if she has exclusively been breast feeding.
  • Mom's body will then ease into a supply and demand systems as much as her babu takes from her breasts.
  • By the end of the first week after delivery, the mother's breasts have usually adjusted and they will be much less engorged.

Home Care

  • Prevention by request nursing
  • Managing fullness & discomfort
  • Mom and warm her breasts just before nursing. Heat improves flow & helps her milk let down (i.e.: warm shower or warm washcloth)
  • Mom can gently massage & press on firm area of her breasts while baby nurses to help empty & soften engorged areas.
  • Cool washcloths on the breasts between feeding may help relieve discomfort & reduce swelling

Breast Infection : Mastitis(乳房炎)

Mastitis is the name. Condition usually occurs in women who are breast feeding.

The symptom include

  • why flu-like symptoms
  • Breast pain
  • Breast redness
  • Firmness
  • Nipple or Areola(乳輪) pain
  • Difficulty getting milk flow
  • Fever
  • Chills
  • Headaches

C-Section

Cesarean Section (C-Section) is the surgical delivery of a baby through an incision in the abdomen and the uterus. It can be a lifesaving operation when the mother or the baby experiences certain problems before or during labor. Most mothers would prefer a vaginal birth but all would agree that having a healthy baby is more important than the method of delivery.

Being prepared for a cesarean birth includes knowing when it is indicated, what can be done to reduce the chances of having one, what is involved in this surgical procedure, and being able to deliver vaginally.

C-Sections are done for the following reasons

  • Cord prolapse (when the umbilical cord falls into the vagina)
  • Bleeding from the placenta
  • Abnormal pelvic structure
  • Shoulder presentation of the baby
  • Serious maternal health problems (i.e., infection, diabetes, heart disease, HBP, etc.) when labor would not be safe for the mother or baby.
  • Dystocia(難産)which includes labor that fails to progress, prolonged labor, and CPD (cephalopelvic disproportion) when the baby is deem to large to pass safely through the mother's pelvis.
  • Breech
  • Fatal Distress: the baby may show signs of distress such as heart rate or acid in the flood before delivery can be completed quickly.

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