soviet science sought to change this forever . in 
 the late 1940s , soviet scientists invented a new non - pharmacological method called the 
  psychoprophylactic method of painless childbirth ( ppm ) , which later became well known as 
 the lamaze method in the west .
this gift 
 of soviet science to the women of the world was based on the assumption that it was possible 
 to eliminate the sensation of bodily pain during labour by training the mind of a pregnant 
 woman before she gives birth . in brief
, the argument is that the birthing process is controlled by the cerebral cortex , 
 which plays a role in the perception of pain .
pain , it was therefore claimed , is not an 
 essential part of labour as , in reality , it is the product of conditioned reflexes , and 
 these , in accordance with pavlov s theory of conditioned reflexes , are acquired and 
 temporary .
ppm acts to  reprogramme these conditioned reflexes and create new and positive 
 ones that prevent the perception of pain during labour and delivery .
ppm training draws on a 
 range of methods , including antenatal education , breathing techniques , suggestion and 
 massage . while ppm originated in the ussr , it became famous worldwide .
there are a number of studies 
 describing the development of the psychoprophylactic method in the former soviet union and france or depicting the history of what in the anglo - american west was 
 known as the  lamaze method. in contrast , 
 studies of ppm in other countries of the former eastern bloc are rare and are not generally 
 available internationally . by unearthing the story of czechoslovakia s experience with psychoprophylaxis , this article 
 contributes to the vibrant discussion among historians about the diverse national 
 experiences with this method and what this says about east and west during the cold war . in 
 czechoslovakia
, ppm followed a very different path from that taken in the west . in the 
 united states and western europe ,
it was further refined over time and was promoted 
 alongside biomedical approaches . in the united states , it gained popularity thanks to a 
 grassroots initiative , while , in france , women s communist organisations promoted the 
 method . but the czechoslovak experience was also very different from the path that ppm took 
 in the ussr . in the soviet union , all soviet childbirth facilities were issued an official 
 order to use the method by the ministry of public health on 13 february 1951 .
soviet medical experts , however , abandoned 
 interest in the method after stalin s death when it was no longer promoted by the political 
 authorities .
rediscovery of ppm in the last decade of the 
 communist regime in the 1980s when it was reintroduced by a few enthusiastic individuals , 
 most of whom , unlike the pioneers of ppm , were women .
the history of ppm in czechoslovakia 
 offers a vivid case study in how political and cultural factors have an impact on medical 
 science and medical practices .
it illustrates the various historical paths that the method 
 took within an eastern bloc dominated by the ussr and provides insight into the wider social 
 and political context that shaped the state - socialist birth - care system in different 
 periods .
this paper aims to reconstruct the story of ppm in state - socialist czechoslovakia and to 
 identify the key factors that affected its use and development .
i trace the history of ppm 
 from the early 1950s , when it was introduced into czechoslovakia , up to 1990 , when massive 
 social and political changes began to occur in the wake of the velvet revolution .
given my 
 wider objective of understanding current changes in the czech birth - care system , 
 particularly ones that relate to the competing discourses surrounding childbirth , i focus 
 here solely on professional medical and political debates and do not address the equally 
 important question of women s birth experiences .
this study is part of a wider project on the natural childbirth movement in the czech 
 republic which studies the concept of natural childbirth as a complex set of different ideas 
 of various origin and tries to identify and track the different paths and permutations these 
 ideas have taken .
i approach the history 
 of the psychoprophylactic method as one of the ideas associated with 
natural childbirth in 
 the czech republic today ; and , for these reasons , my analysis primarily focuses on the 
 development of ppm in the czech and moravian regions of the czechoslovak state . developed within the medical setting , but 
 elaborated further by natural childbirth activists , ppm is one of many systems of thought 
 and practices that are linked to both medicalised and 
alternative discourses on childbirth 
 management . untangling its history may help us to understand what sets these discourses 
 apart and in what ways they are linked and intertwined .
i shall begin by providing essential background information on the czechoslovak health - care 
 system into which ppm was introduced from moscow .
i then chronologically tell the story of 
 czechoslovak ppm in three parts , focusing , in particular , on the 1950s and the 1980s .
i 
 analyse the formative 1950s in detail in order to show the political background to the 
 introduction of ppm . in the 1960s ,
the method became widespread in practice but research on 
 ppm declined , while , in the 1970s , psychoprophylaxis was a little used practice .
at the 
 beginning of the 1980s , the method received a new impetus and i explain what events and 
 factors lay behind its rebirth .
the czechoslovak health - care system underwent a profound reorganisation in the post - war 
 period , especially after the communist coup in february 1948 .
the communist state 
 nationalised all the hospitals , sanatoriums , health spas and part of the pharmaceutical 
 industry .
it set up a comprehensive 
 social - insurance system that , among other things , expanded the existing maternity insurance 
 schemes .
nedvd plan , designed by a group of communist health experts headed up by dr  milo 
 nedvd during the second world war .
it proposed to build a unified and integrated 
 health - care system , financed and controlled by the state , in which health care would be free 
 of charge for citizens at the point of consumption . in these years
, new health - related laws were introduced and a new 
 network of district and regional health facilities was built .
these national health 
 institutions became the pillars of the nationalised health - care system .
in tune with these reforms , the government also started to build a national network of 
 antenatal clinics under new legislation introduced in 1947 .
this posed a problem because the antenatal clinics were designed not just to prevent disease 
 and educate pregnant women , but also to monitor their numbers and probe women s social and 
 family background ; thus they were to 
 serve as a tool of the state s biopolitics .
as there was a shortage of skilled obstetricians and gynaecologists 
 to staff the new czech maternity - care system , most of these clinics had to be run by general 
 practitioners , whose  insufficient knowledge of the subject was found to be the main reason 
 why the antenatal clinics did not appeal to women .
there was a general shortage of physicians in the late 1940s because czech universities had 
 been shut down by the nazi regime at the beginning of the war .
in the first years after the war , most women still gave birth at home 
 with the assistance of independent midwives .
248  on regional midwives , 
 introduced in october 1948 , attached midwives to the district institutes of national health 
 ( onz ) and assigned them health - related 
advisory work , including attending the home births 
 of women who were not entitled to national health insurance . from 1945 to 1948
, there was a sharp increase in the number of hospital births as new 
 maternity wards were built and , with the move from home to hospital , there was a concomitant 
 rise in the use of obstetric anaesthesia .
hospital births doubled and , by 1948 , they 
 accounted for 44.4 per cent of all births . amid the continuing expansion and administrative transformation of 
 maternity care after 1948
, hospital births reached 70 per cent of all births in 1951 , and , by 1955 , the figure was more than 92 
 per cent . during this time various 
 pharmaceutical methods for relieving the pain of labour were available in most maternity 
 hospitals .
trichloroethylene , an inhaled analgesic , was one of the most common ones and it 
 was available for use at almost every maternity ward . unlike in the ussr , where drug shortages led to the exploration of 
 psychological methods for relieving labour pain ,
czechoslovak obstetricians were not encouraged to seek 
 non - pharmacological methods of pain relief ; instead , they conducted studies to determine 
 which were the best and safest analgesics and experimented with using them in various 
 combinations .
in the autumn of 1950 , three clinical researchers and members of the communist party  
 obstetricians josef luk and miroslav vojta and paediatrician kamil kubt  joined a 
 three - month expedition by twenty - four leading experts from the communist bloc to the soviet 
 union , where they spent time in soviet hospitals to learn about a new method of labour - pain 
 relief : the psychoprophylactic method of painless childbirth .
shishkova gave the visiting experts a tour of several maternity hospitals in moscow , 
 where they studied the new method in detail .
luk wrote the first 
 article introducing it to czechoslovak gynaecologists , but it was vojta who became the method s main proponent when he 
 returned home .
vojta s first impressions of soviet maternity hospitals were probably not as positive as 
 his later publications and active involvement in promoting the method suggest .
zdenk 
 tembera , a perinatologist who once worked with vojta , wrote that , in the first letters vojta sent to his home 
 institution in prague , he expressed horror at the appalling conditions in soviet hospitals : 
  people [ ie . 
doctors ] go into the operating theatres and delivery rooms in their boots , 
 while blood flows in streams. this 
 shock was soon replaced by a compulsory enthusiasm .
tembera suggests that vojta s change in 
 attitude might have been inspired by a week of alleged 
offered 
 to everyone who had participated in the trip after they returned . according to tembera , the 
 participants had to hand over all their personal or other notes to the authorities and were 
 instructed on how to properly interpret what they had seen in the ussr and how to utilise 
 their findings  in a broader historical context. after their debriefing , vojta and luk not only promoted 
 psychoprophylaxis as a progressive method of pain relief in labour , but they took the 
 further , political step of denouncing the prague school of obstetrics as being in the grip 
 of bourgeois ideology and in need of intellectual and ideological overhaul .
the professional activities of vojta and luk were supported at the highest political 
 levels . shortly after becoming a supporter of ppm , vojta became editor - in - chief of the 
 leading journal eskoslovensk gynaekologie [ czechoslovak gynaecology ] . in 
 this prominent position , he could ensure that adequate space was given to the work of soviet 
 authors .
both doctors were , moreover , able to use their influential positions at research 
 institutions to promote wider social and political changes in the health - care system as a 
 whole and implement the political programme of building a healthy socialist society .
nikolaev , vojta 
 presented ppm as the perfect physiological method for eliminating pain during labour and 
 delivery .
he adopted the soviet line on how ppm worked , explaining that labour pain was a 
 consequence of ill - minded folk beliefs about the painfulness of the birthing process ; 
 childbirth itself could not be painful , as it is just a matter of contractions of the uterus 
 muscle , and contractions of other muscles do not hurt .
vojta also highlighted the other alleged benefits of ppm , claiming 
 that it sped up labour , minimised the potential for pathology and nurtured  health - care 
 providers in maintaining a moral [ ie . 
humane ] approach to women giving birth. vojta conducted his research on ppm at the institute for the care of mother and child in 
 prague ( icmc ) , which was founded in 1951 as the first of twenty - six new research institutes 
 in the country .
two clinics  the 3rd gynaecological  obstetrical clinic and the clinic for 
 newborn care in prague - podol  were merged to create a unique environment in which 
 obstetricians and paediatricians were able to collaborate with each other .
the icmc became a centre of national 
 research , where key studies on maternity and neonatal care , including research on ppm , have 
 been conducted since its foundation to the present day .
vojta was the main researcher 
 responsible for the implementation of ppm and for studying its efficacy .
his team , whose 
 members included dr  havrnek and dr  horsk , started to run ppm courses at the icmc in june 
 1951 . over the last six months of 1951 , they organised 360 lessons in ppm in which 
 seventy - two pregnant women took part , each woman attending five to eight lessons .
the women 
 who participated in these first courses were volunteers , mostly white - collar workers , and 
 were described as 
neurotic in type. 
 pavlovian neuropsychology , which psychoprophylactic theory invoked to explain how it worked , 
 distinguished several types of central nervous systems , four of which were of particular interest to ppm : 
 ( 1 )  strong / balanced and reserved ; ( 2 )  strong / balanced and active ; ( 3 )  strong / unbalanced ; and 
 ( 4 )  weak ( ie . ,  neurotic ) . in theory , identifying a woman s nervous 
temperament was 
 believed to be crucial to preparing her effectively for labour , but , in practice , the 
 czechoslovak researchers did not try to identify which of these categories the women 
 belonged to when they recruited them . 

they nonetheless drew conclusions similar to their soviet colleagues : women of different 
 temperaments needed to practise ppm - related exercises , which they had to perform in their 
 sleep , for differing lengths of time .
if the women did not practise a sleep duration suited 
 to their particular temperament , the lesson had no positive effects .
the researchers 
 concluded that this was why eleven out of seventy - two women in their first research sample 
 had to have a caesarean section .
two - thirds of the women allegedly experienced painless 
 childbirth , with only slight feelings of pain . these were women who had usually managed to 
 fall asleep during the lessons .
ppm failed in the case of women who had difficulty attaining 
 a state of relaxation sufficient to fall asleep during the lessons .
the researchers believed 
 that this failure spoke to their own inability to design courses tailored to women s 
 temperament types . assuming that the 
 soviet researchers were right , that women with a stronger and more balanced nervous system 
 experienced greater relief with ppm , then the poor results of czech researchers could only 
 be attributed to a prevalence of 
subsequent research tried to take greater 
 account of different nervous types . despite the fact that the efficacy of the ppm courses was low , especially in comparison to 
 contemporary soviet studies , which reported a 7096 per cent rate of success , researchers at the icmc deemed the method 
 suitable for use in the czechoslovak health system and recommended its implementation at 
 czechoslovak hospitals .
vojta argued 
 that local doctors had to contend with the  different psychology of czech women , as he put 
 it , and    the different way in which maternal care is organised in our country compared 
 with the ussr , which explained the poor 
 results of his team by implying the superiority of the soviets .
the six standard soviet 
 lessons consisted of three parts each : a physiological explanation , physical exercise and 
 the sleep needed to 
soviet caregivers trained the expectant 
 mothers in sessions lasting on average 1.5 to 2  hours each .
their czech counterparts found that they needed twice or even 
 three times as long to accomplish this task .
vojta s interpretation was that czech women 
 simply knew less about health issues than their russian sisters and therefore needed more 
 time to absorb what they had learned . 

these courses also revealed that the women needed additional study materials on ppm to 
 
vojta thus decided to write what became a 
 popular booklet on ppm for women titled childbirth without pain , which was 
 first published in 1953 .
the implementation and study of ppm were rolled out in four phases in 1952 , each of which 
 had several objectives and firm deadlines .
the objectives included revising the soviet version of ppm , 
 preparing preliminary instructions for conducting ppm in a czechoslovak context , introducing 
 ppm to every kind of clinical setting , training health - care providers at all institutions in 
 the country and , once provisional instructions had been drawn up , debating them with experts 
 from the czechoslovak gynaecological and obstetrical society and the ministry of health .
the 
 icmc also launched organised training in ppm for physicians and midwives at county maternity 
 hospitals and held lectures and special workshops across the country .
researchers also experimented with the method , modified 
 it and changed key variables such as the number of participants and classes . in the end , 
 they agreed that ppm should ideally be taught to groups of 1015 participants per 
 course .
czech doctors had doubts about a number of aspects of the version of ppm put forward by 
 their soviet colleagues .
they questioned the need for the last part of the lesson , when 
 women were to drift into a sleep that allegedly helped to cement the training and considered 
 it superfluous .
this was the phase in 
 which participants were supposed to enter what many physicians called a semi - hypnotic state , 
 and it was probably the difficulty of inducing this state , and perhaps even the lack of 
 clarity about the exact mechanism by which ppm was supposed to work , that led them to doubt 
 the need for this step .
moreover , not 
 all doctors in the institute shared vojta s enthusiasm for and belief in the benefits of the 
 method . in may 1952 , there was a meeting of all the icmc s employees and ppm was at the top 
 of the agenda .
the final report on the research conducted up to that time , which was written 
 by vojta and presented at the meeting , revealed that some obstetricians at the icmc had 
  ceased to be interested in getting positive results from the method and had become sloppy 
 in their application of it .
vojta blamed 
 those doctors for not adequately strengthening the conditioned reflexes that the women had 
 learned during the ppm classes .
he was quick to conclude that the doctors scepticism was 
 the main reason why the method was not as effective as it was supposed to be . in order to 
 overcome their resistance ,
the management of the institute decided to make ppm standard 
 protocol and ordered all the institute s physicians to use it .
as the next step in their research , vojta and his colleagues tried to determine appropriate 
 and objectively measurable criteria for assessing labour pain .
the criteria they had been 
 using up to that time had been imprecise , based mainly on physicians observations of how 
 women behaved during labour and delivery .
they arrived at three sets of criteria : ( 1 )  the birthing women s 
 subjective evaluations of pain ; ( 2 )  objective assessments of the painfulness of labour based 
 on a woman s behaviour ; and ( 3 )  what methods were administered that proved to be sufficient 
 to alleviate or eliminate labour pain . 

vojta s team was aware that the second criterion was problematic from a scientific point of 
 view , and they tried to find other , more empirically sound , objective criteria to assess 
 labour pain .
they experimented with a plethysmograph , which measured pain on the basis of 
 vascular responses ; however , this experiment was not successful enough to be taken any 
 further in clinical research .
in accordance with the plan to implement ppm , vojta arranged special training for selected 
 physicians .
training was directly 
 funded by the department of education at the ministry of health , which is indicative of the 
 strong political support that vojta was able to draw on to promote ppm .
the list of fifteen participating physicians included 
 representatives of the main clinics , maternity hospitals and  regional institutes of 
 national health ( knz ) in various parts of czechoslovakia .
soviet professor p.  chesnakov 
 gave a lecture on the organisation of scientific work in the ussr .
professor bla friedlnderov , a former top 
 athlete who represented czechoslovakia in swimming and diving before the second world war , 
 gave a paper on physical exercises for pregnant and postpartum women .
czechoslovak obstetricians clearly found the physical exercises the 
 most appealing part of ppm , even though the original soviet concept did not include this 
 aspect of preparing for labour to such an extent ; it just covered special breathing practices and training in 
 techniques that could be used to ease labour pain during the  pushing phase . together with professor ji trapl , 
 director of the icmc , friedlnderov proposed a series of  physical exercises for pregnant 
 women which were incorporated into ppm courses and became a key pillar of the czechoslovak 
 version of ppm .
all the papers presented 
 at this workshop were also published in a special issue of the medical journal 
 praktick lka [ the general practitioner ] in 1953 , which promoted the 
 use of ppm among the medical community on the widest possible level .
a substantial number of articles on ppm also appeared in the leading medical journal 
 czechoslovak gynaecology , of which vojta became the editor - in - chief . at 
 the beginning of the decade ,
books by the founding figures nikolaev and velvovskii were 
 translated into czech ; the publication of writings by local authors followed shortly 
 afterwards .
most of them 
 were papers describing ppm s basic principles on a theoretical level or focusing on its 
 practical aspects . however , there were few actual empirical studies on the efficacy of ppm . 

i found only two articles that explicitly built on the original research , but they suffered from many methodological imperfections 
 and were later severely criticised on that basis . in the early 1950s scientific journals
pavlov s work , 
 including papers that tried to link ppm to pavlov s theory of conditional reflexes .
second , there are studies written by the czech promoters of the psychoprophylactic 
 method of painless childbirth who , for the most part , just rephrased the ideas of the soviet 
 authors .
third , there are writings that provided information on the practical side of ppm 
 and what women trained in ppm needed in the delivery room .
finally , tembera refers to the 
 studies that evaluated the success rate of ppm .
most of the 
 articles published in scientific journals in the second half of the 1950s belong to a genre 
 that i name  how ppm is practised in our institution. these articles describe the authors 
 experiences with ppm in their health - care facilities and usually explain why and how the 
 practitioners modified recommendations that were part of the original ppm concept .
most of 
 these papers were of very poor scientific quality and would not meet today s scientific 
 standards .
however , they also reveal that almost every institution adopted the ppm 
 instructions in their own original way .
an article by slovak obstetrician ladislav hrako in 1954 is no exception to this tendency 
 towards an imperfect style of scientific writing , but it is interesting for two reasons .
first , it provides an 
 unusually rich theoretical explanation of ppm while comparing it with competing methods , 
 such as hypnosis and grantly dick - read s method of natural childbirth , which was very 
 similar to ppm but was developed in the 1930s .
dick - read , a british physician , built on 
 anthropological studies in  primitive societies from the late nineteenth century describing 
 painless childbirths among women in  primitive nations and concluded that , by nature , childbirth is a painless process . 
 in his view , it was the modern culture of 
civilised societies that made women scared of 
 childbirth and damaged their innate ability to give birth painlessly .
scientific than the pavlovian interpretation that ppm was 
 based on , as he attributed birth pain simply to tensions in the cervix that were caused by 
 fear . despite appearing in a number of 
 european languages
a number of 
 obstetricians in czechoslovakia criticised his work but rarely referred to his books , giving 
 the impression that they were chiefly parroting the views of their soviet and french 
 colleagues .
second , hrako s article is the only scientific paper that asks how mothers themselves see 
 ppm . in hrako
s view there are three types of women , each of which has a distinct approach 
 to ppm : first , there are  women who have heard about ppm as a ground - breaking achievement of 
 soviet science and are convinced of its good benefits and therefore ask for it. moreover , there are  uninformed women who 
 have not heard of the method and that is why they take an indifferent and distrustful view 
 of it. third , there are  women who take 
 a negative view of it and search for news about its failure. this categorisation of women into those who either love or hate 
 ppm as a soviet scientific invention is obviously informed by the dominant ideological 
 interpretation of ppm ; it does not actually say anything relevant about real women s 
 perceptions and experiences .
i did not find any study that explicitly investigated women s 
 experiences with ppm even though obstetricians at the icmc recorded women s impressions of 
 their birth experiences and included them as a factor in their general assessment of the 
 method s efficacy and vojta highly appreciated french obstetrician fernand lamaze s
left - leaning , but never a communist party member , lamaze visited the soviet union in 1951 to 
 learn more about ppm .
he modified it and made it widely popular in france with the support 
 of women s leftist grassroots organisations . among his main innovations
, his inclusion of testimony by women 
 about the virtues of ppm during training sessions stands out .
vojta was greatly impressed by how powerful the birth stories of 
 women who had used ppm were and even recommended following lamaze s idea of publishing them . 
 but
czechoslovakian obstetricians ignored appeals to investigate women s perspectives on 
 ppm . as their agenda  to make ppm part of socialist health care  did not have to respond 
 to consumers demands in the same way as in western countries , there was no urgency or 
 particular incentive to be responsive to any pressures from below . to coincide with the end of the state s first five - year plan ,
vojta summarised his team s 
 achievements in a final report . from 
 1951 to 1955
he and his team provided training to 1013 per cent of the women who came to 
 the icmc to give birth ( approximately 1000 women ) , using both velvovskii s original ppm 
 concept and their own modified version of it . by 1955 , lectures on ppm had been given at 
 forty - two institutes across the country , ten of them following velvovskii s original 
 instructions .
a total of 13  463 women had participated in ppm courses by that time .
this 
 number may be misleading , as it includes women who attended just one lesson , but it is 
 still remarkable , as it reflects how enthusiastically ppm was promoted in the 1950s among 
 health - care professionals and the general public .
politically , the pursuit of research on ppm proved advantageous because of the method s 
 collectivist ethos and emphasis on the importance of building a new socialist society by 
 transforming society s view of the inevitability of pain in childbirth .
vojta highlighted 
 ppm as  a method accessible to all women and all health - care providers. this statement supports velvovskii s 
 argument in favour of ppm , although 
 vojta does not directly refer to his words .
in compliance with the new ethos of 
 celebrating work and the role of the proletariat , vojta refined the metaphor of labour in 
 the birthing process , stating that :  the main advantage of psychoprophylactic preparation 
 for childbirth is that a woman cooperates actively during her labour , she comes to the 
 maternity hospital as she would come to work   . his emphasis on the importance of physical work in childbirth 
 resembles the emphasis that was being put on the importance of physical labour of any kind 
 during these years .
the soviet origin of ppm also allowed him to praise the ussr as a 
 model for czechoslovak society and science ; for example , he wrote : 
 medical science never before dared to set such a gigantic task to eliminate labour 
 pains completely .
such a goal could be achieved only by a health - care system that is 
 built on a deep and true human understanding of the individual s responsibilities ; 
 that is , by the soviet health - care system . achieving the complete elimination of 
 labour pain for all women is the kind of task that only the socialist establishment is 
 able to resolve . 
 
medical science never before dared to set such a gigantic task to eliminate labour 
 pains completely .
such a goal could be achieved only by a health - care system that is 
 built on a deep and true human understanding of the individual s responsibilities ; 
 that is , by the soviet health - care system . achieving the complete elimination of 
 labour pain for all women is the kind of task that only the socialist establishment is 
 able to resolve .
vojta argued further that the reason why so many soviet women gave birth painlessly was 
 the general atmosphere of warmth , friendly help and care in the soviet hospitals .
this , of 
 course , was an implicit critique of czechoslovak health - care workers , but not only of 
 them .
other scholars claimed that  normal women give birth without any pain , suggesting that women who felt pain were 
  not normal. in several articles vojta and others blamed czech women for listening to 
  old - wives tales and the backward opinions of other women who had prejudices about 
 childbirth as a painful process .
reflecting back later on the 1950s , pazek , tembera and other obstetricians pointed out 
 that the dominant ideology of that era uncritically and excessively favoured ppm and 
 exaggerated its analgesic effectiveness , which ultimately led to it eventually being 
 discredited .
pazek implies that 
 ppm was favoured at the expense of pharmaceutical methods of pain relief .
however , 
 labour - pain medications were considered important and the first czechoslovak concept of 
 ppm included a whole section on pharmaceutical pain relief methods to be applied if ppm 
 failed .
research on pharmaceutical 
 methods of pain relief in labour has a long and significant tradition in the czech lands 
 dating back to the second half of the nineteenth century and pain relief medications were thus seen as compatible with 
 the principles of ppm . according to 
 pavel epick , the contingent use of pharmaceuticals was typical for the whole soviet 
 school of ppm .
however , michaels shows that production shortages in the pharmaceutical 
 industry severely limited the use of anaesthetics and analgesics in obstetric practice in 
 the ussr .
epick compares soviet ppm 
 with the vellay school of ppm in france , which , in his view , applied a 
 neo - psychoanalytical interpretation of the emotional development of the mother 
child 
 relationship and saw any medication as having potentially detrimental effects on this 
 fundamental relationship .
similarly , 
 michaels argues that psychoanalytical interpretations of labouring women s psychology , as 
 formulated by freud s disciple helene deutsch , significantly influenced french ppm .
she demonstrates that a largely 
 psychological approach to labour - pain management had a special ring of credibility in 
 france , as it allowed women to stay 
 active and aware during labour while avoiding the harmful side effects of many of the 
 painkilling drugs available at that time , even though women s attitudes later changed .
psychoanalysis , as well as its moravian - born founder sigmund freud , was well known and 
 accepted in the czech lands , unlike in 
 the ussr , where freud s ideas were rejected as incompatible with pavlovian 
 neuropsychology . spreading from 
 vienna to leipzig ,
the region of central europe constituted a unique cultural milieu and 
 was where all the important schools of modern psychological science originated . 
 nevertheless , under communist rule , the fate and status of the discipline of psychology as 
 a whole worsened , especially in the early 1950s , when it was labelled a  bourgeois 
 pseudoscience and classified as a subfield of pedagogy
. surviving at universities with a 
 minimal number of students , the field of psychology became limited to studies of the 
 central nervous system and was thus transformed into the science defined by the ideas of 
 i.p . 
many psychologists , especially those with a background in non - marxian 
 research and theoretical traditions , left academia and went to work in clinical research 
 on health care , which provided them with a freer environment .
a number of them also worked 
 at the icmc , where they mostly studied the cognitive development of early newborns .
to coincide with the end of the state s first five - year plan , vojta summarised his team s 
 achievements in a final report . from 
 1951 to 1955
he and his team provided training to 1013 per cent of the women who came to 
 the icmc to give birth ( approximately 1000 women ) , using both velvovskii s original ppm 
 concept and their own modified version of it . by 1955 , lectures on ppm had been given at 
 forty - two institutes across the country , ten of them following velvovskii s original 
 instructions .
a total of 13  463 women had participated in ppm courses by that time .
this 
 number may be misleading , as it includes women who attended just one lesson , but it is 
 still remarkable , as it reflects how enthusiastically ppm was promoted in the 1950s among 
 health - care professionals and the general public .
politically , the pursuit of research on ppm proved advantageous because of the method s 
 collectivist ethos and emphasis on the importance of building a new socialist society by 
 transforming society s view of the inevitability of pain in childbirth .
vojta highlighted 
 ppm as  a method accessible to all women and all health - care providers. this statement supports velvovskii s 
 argument in favour of ppm , although 
 vojta does not directly refer to his words .
in compliance with the new ethos of 
 celebrating work and the role of the proletariat , vojta refined the metaphor of labour in 
 the birthing process , stating that :  the main advantage of psychoprophylactic preparation 
 for childbirth is that a woman cooperates actively during her labour , she comes to the 
 maternity hospital as she would come to work   . his emphasis on the importance of physical work in childbirth 
 resembles the emphasis that was being put on the importance of physical labour of any kind 
 during these years .
the soviet origin of ppm also allowed him to praise the ussr as a 
 model for czechoslovak society and science ; for example , he wrote : 
 medical science never before dared to set such a gigantic task to eliminate labour 
 pains completely .
such a goal could be achieved only by a health - care system that is 
 built on a deep and true human understanding of the individual s responsibilities ; 
 that is , by the soviet health - care system . achieving the complete elimination of 
 labour pain for all women is the kind of task that only the socialist establishment is 
 able to resolve . 
 
medical science never before dared to set such a gigantic task to eliminate labour 
 pains completely .
such a goal could be achieved only by a health - care system that is 
 built on a deep and true human understanding of the individual s responsibilities ; 
 that is , by the soviet health - care system . achieving the complete elimination of 
 labour pain for all women is the kind of task that only the socialist establishment is 
 able to resolve .
vojta argued further that the reason why so many soviet women gave birth painlessly was 
 the general atmosphere of warmth , friendly help and care in the soviet hospitals .
this , of 
 course , was an implicit critique of czechoslovak health - care workers , but not only of 
 them .
other scholars claimed that  normal women give birth without any pain , suggesting that women who felt pain were 
  not normal. in several articles vojta and others blamed czech women for listening to 
  old - wives tales and the backward opinions of other women who had prejudices about 
 childbirth as a painful process .
reflecting back later on the 1950s , pazek , tembera and other obstetricians pointed out 
 that the dominant ideology of that era uncritically and excessively favoured ppm and 
 exaggerated its analgesic effectiveness , which ultimately led to it eventually being 
 discredited .
pazek implies that 
 ppm was favoured at the expense of pharmaceutical methods of pain relief .
however , 
 labour - pain medications were considered important and the first czechoslovak concept of 
 ppm included a whole section on pharmaceutical pain relief methods to be applied if ppm 
 failed .
research on pharmaceutical 
 methods of pain relief in labour has a long and significant tradition in the czech lands 
 dating back to the second half of the nineteenth century and pain relief medications were thus seen as compatible with 
 the principles of ppm .
according to 
 pavel epick , the contingent use of pharmaceuticals was typical for the whole soviet 
 school of ppm .
however , michaels shows that production shortages in the pharmaceutical 
 industry severely limited the use of anaesthetics and analgesics in obstetric practice in 
 the ussr .
epick compares soviet ppm 
 with the vellay school of ppm in france , which , in his view , applied a 
 neo - psychoanalytical interpretation of the emotional development of the mother 
child 
 relationship and saw any medication as having potentially detrimental effects on this 
 fundamental relationship .
similarly , 
 michaels argues that psychoanalytical interpretations of labouring women s psychology , as 
 formulated by freud s disciple helene deutsch , significantly influenced french ppm .
she demonstrates that a largely 
 psychological approach to labour - pain management had a special ring of credibility in 
 france , as it allowed women to stay 
 active and aware during labour while avoiding the harmful side effects of many of the 
 painkilling drugs available at that time , even though women s attitudes later changed .
psychoanalysis , as well as its moravian - born founder sigmund freud , was well known and 
 accepted in the czech lands , unlike in 
 the ussr , where freud s ideas were rejected as incompatible with pavlovian 
 neuropsychology . spreading from 
 vienna to leipzig ,
the region of central europe constituted a unique cultural milieu and 
 was where all the important schools of modern psychological science originated . 
 nevertheless , under communist rule , the fate and status of the discipline of psychology as 
 a whole worsened , especially in the early 1950s , when it was labelled a 
surviving at universities with a 
 minimal number of students , the field of psychology became limited to studies of the 
 central nervous system and was thus transformed into the science defined by the ideas of 
 i.p . 
many psychologists , especially those with a background in non - marxian 
 research and theoretical traditions , left academia and went to work in clinical research 
 on health care , which provided them with a freer environment .
a number of them also worked 
 at the icmc , where they mostly studied the cognitive development of early newborns .
in the 1960s , czechoslovak ppm followed a course similar to that in the ussr , but with a 
 delay of approximately ten years . in the soviet union ,
criticism of the method reached a 
 peak in february 1956 at a conference in kiev , where its outcomes were evaluated five years 
 after its launch .
conference 
 participants pointed to its many shortcomings , including how time consuming the method was . 
 in that same year , the soviet ministry of health changed the name of the method from the 
  psychoprophylaxis of pain in childbirth to  psychoprophylactic preparation for 
 childbirth , despite the disapproval of velvovskii and nikolaev . according to bell ,
he also observes that the method was never officially 
 condemned or discarded and maintained its place in official statistics and ministry 
 directives ; in practice , however , it lost its appeal .
by contrast , in czechoslovakia , ppm flourished in practice in the late 1950s and early 
 1960s .
the number of ppm lecturers substantially increased , as the method spread across the 
 country . from 1955 to 1958 , only 6 to 7 per cent of pregnant women took part in ppm courses 
 in czechoslovakia , but , during 1959 , 
 that number increased to 13.5 per cent ( 1793  women ) ; 260 courses were organised that year , 
 each of them consisting of six lessons . 

there were 105 midwives trained in ppm in the country by 1961 and , in every district , there 
 was at least one obstetrician who was trained in ppm . with that level of trained staff , in 
 the early 1960s , it was possible to run ppm courses in almost every maternity hospital . while ppm expanded in practice , it declined as an object of medical research .
the last national 
 conference on psychoprophylaxis in czechoslovakia took place in 1962 . in the journal
czechoslovak 
 gynaecology , only two contributions directly dealing with ppm were published in 
 that entire decade .
only one of them built on empirical research conducted by stanislav 
 tra , an assistant professor based at the gynaecological  obstetrical clinic in prague and at 
 the institute of health education .
his study examined the effects of the modified version of 
 ppm on the occurrence of prolonged pregnancies . among the few publications on ppm published in this decade
, 
 slovak obstetrician duan bruch s book stands out for its theoretically rich and 
 sophisticated discussion and rigorous description of the applied methodology , which earlier 
 studies on ppm had lacked . besides 
 describing a whole ppm course structured into nine lessons , his study presented the results 
 of long - term research on the effects of ppm observed on 784 women trained in 
 psychoprophylaxis and on a control group of 500 women not trained in the method .
the 
 findings showed no significant differences in the length and intensity of labour between 
 these two groups except for significantly lower incidence of pre - term births among the women 
 trained in psychoprophylaxis . in the 1960s
, there were more articles published on the subject of antenatal exercises than 
 on ppm per se .
i found just a single empirical study on antenatal 
 exercises , written by ji pokorn and vlasta vclavkov , who investigated the potential 
 effects of their modified version of psychoprophylactic exercises .
there were 
 sixty - five district organisations that regularly organised classes in antenatal 
 exercises .
highlighting physical 
 over psychological preparation and the practical aspects of physical training , this shift 
 enabled obstetric nurses to take control of these courses , as they had expertise in the 
 physiology of childbirth and health organisations did not then have to hire 
 university - educated psychologists .
this reorientation is also reflected in a number of 
 educational booklets on ppm that were published in the first half of the decade and that 
 were aimed at the obstetric nurses who were running ppm s courses and at pregnant 
 women .
the central state institute 
 for health education also assisted ppm instructors by publishing brochures on physical 
 education for pregnant women and preparing and distributing visual and audio educational 
 aids and short films with mothers testimonies about the positive effects of ppm , which were 
 meant to be screened during the classes . during the 1960s , instructors , nevertheless , became increasingly disillusioned with the 
 promoters exaggerated claims of completely painless childbirths , as ppm often failed to 
 deliver on these promises .
even vojta 
 recognised that the ppm s main goal of total anaesthetisation was largely unmet .
but he 
 located the method s shortcomings not in unrealistic expectations but in the method of pain 
 assessment ; in his view , the main problem was that obstetricians , as well as birthing women , 
 assessed painlessness 
universally in a crude and general way , failing to differentiate 
 among different types or phases of pain .
they ignored various factors at play , such as the causes of pain , 
 the stages of labour and the duration of pain .
he argued that the standard of painlessness 
 in childbirth had increased and become more exacting over time , resulting in an impression 
 that the method does not work . 
 reflecting on these problems
, he proposed to redefine its official goals : instead of 
 ensuring complete painlessness in birth , ppm should aim to prepare women physically and 
 psychologically for childbirth .
accordingly , the official name of the method was changed in 
 1966 from the 
psychoprophylactic method of painless childbirth to  mental and physical 
 preparation for childbirth. this 
 choice of words also indicates that physical preparation was considered a significant part 
 of the method , which is especially evident in comparison with the changed soviet name , which 
 continued to emphasise ppm s anaesthetising effect .
but , in the early 1960s , vojta s word did not carry the same weight as it had in the 
 previous decade .
perhaps out of ideological motivations , vojta , as head of the icmc in the 
 late 1950s , decided to curb research in some promising areas of endocrinology , bringing him 
 into conflict with its scientific advisory board .
he prohibited the publication of original 
 research by icmc researchers in leading western journals despite the fact that such articles 
 could have earned the institution international recognition .
the scientific board and the advisory committee opposed his 
 decisions and submitted a request to the minister of health to dismiss vojta from his 
 position as director of the icmc . according to tembera , who led the icmc s trade union 
 committee that was seeking vojta s dismissal , severe conflicts at the icmc led the minister 
 of health to ask for advice from the soviet minister of health .
gynaecologist at the 
 ministry of health , to prague to 
 analyse the situation .
beloshapko recommended dismissing vojta from his position and the 
 czechoslovakian minister of health did so in 1963 .
tembera glosses over this with a remark that  as a consequence of these 
 changes dialectical materialism and marxist ideology stopped influencing scientific 
 activities at the institute. this was , indeed , the beginning of what many perceived as a new era . after twenty years
, 
 czechoslovakia finally seemed to be gaining freedom from the overbearing influence that the 
 soviet union had wielded over it since the end of the second world war .
czechoslovakia , like 
 other countries in central , southern and eastern europe , experienced similar tendencies in 
 their post - war development , often described as 
sovietisation. this term refers to the 
 process by which political alternatives were gradually restricted until the political regime 
 was turned into a restricted pluralist system or  more frequently  a stalinist 
 dictatorship .
sovietisation differed widely across the region in its form and timing , often 
 involving soviet military presence , which exerted powerful political pressure on local 
 governments .
it generally had severe 
 consequences on culture , science and social lives in the countries it affected . in the second half of the 1960s ,
obstetricians and gynaecologists became preoccupied with 
 new topics that they found more interesting than ppm .
more importantly , the prague spring 
 and the political liberation it ushered in loomed on the horizon and opening up new 
 opportunities .
czechoslovak researchers began to be allowed to publish their work in western 
 journals , to cooperate with prominent institutions in the west and to participate in 
 international symposiums abroad . 

tembera notes that scientific associations also began to have more say in who participated 
 in international conferences than before .
the ministry of internal affairs also gave the 
 czechoslovak gynaecological and obstetrical society permission to organise an international 
 symposium on intrauterine foetal development in prague in october 1966 .
the programme 
 featured 106 papers presented by local and foreign experts from both socialist and western 
 countries .
many participants had 
 international reputations , making the symposium a highlight of the decade .
following the suppression of the prague spring in august 1968 , the subsequent era of what 
 came to be called normalisation disrupted the process of fully integrating czechoslovakians 
 into the international community of scholars , as cooperation with western institutions was 
 curtailed .
vojta again rose to the forefront of the gynaecological  obstetrical community and 
 the articles he published in gynaecological journals on political occasions exhibit the 
 requisite political ethos .
but , in 
 part due to vojta s death in 1974 , the issue of ppm did not return to the pages of medical 
 journals .
the only notable work published on the subject in this decade was a short booklet 
 by tra providing advice on how to run ppm courses .
in the 1970s , psychoprophylaxis existed as  a mere column in statistical reports with 
 little relationship to real practice . 
 in research , as well as in clinical practice
this was mainly the work of the icmc s 
 dr  epick and his colleagues and students who published a series of articles on ppm during 
 this decade that initiated a heated debate on the issue .
they conducted research on ppm s 
 effects among ninety - four women who gave birth in the second gynaecological  obstetrical 
 clinic in prague .
they also examined the state of practice of ppm in the prague region based 
 on interviews with ppm course instructors in nine of the city s ten districts .
they came to 
 the dismal conclusion that , in most districts , the practice of ppm violated the method s 
 basic principles .
the courses had been 
 shortened and simplified ; moreover , the majority of pregnant women did not even undergo a 
 shortened version of the ppm course , although official statistics stated the opposite .
a sharp reaction from medical and public health authorities to this publication quickly 
 followed .
jitka kobilkov , the head of the second gynaecological  obstetrical clinic , 
 together with vclav trnka , a leading expert in obstetrics , communicated the position of the 
 regional advisory board on this view which reflected that of the majority of prague 
 obstetricians .
unscientific for its methodological weaknesses , arguing that epick s research 
 sample was not representative and the findings were thus misleading .
kobilkov and trnka 
 write in an enraged tone , as if epick s critical review were a personal affront meant to 
 discredit these senior experts .
furthermore , they accused epick and his co - authors of 
 arrogance for daring to evaluate the current state of ppm without first consulting with the 
 regional gynaecological board .
the journal s editorial board was not spared their fury 
 either , as kobilkov and trnka accused the editors of publishing the article without the 
 authorities approval .
epick and his co - authors responded in an apologetic tone that emphasised their deepest 
 respect for kobilkov s and trnka s expertise and sought to explain 
the 
 misunderstanding. they had not 
 designed their study as a representative survey , but rather as an initial empirical probe 
 into the everyday practices of ppm .
they believed that the bleak situation in the prague 
 districts was symptomatic of the whole country and that ppm had faded into obscurity and 
 needed to be revived .
epick took a particularly critical stand against the  classic 
 czechoslovak studies of the 1950s , pointing to their numerous methodological shortcomings , 
 such as failing to use control groups or the placebo technique . like earlier authors
, he argued that the standards of 
 quality had declined after an initial enthusiasm , leading to the poor results and the 
 method s discredit .
the articles on ppm published in czechoslovak gynaecology were based on 
 research by kvta ludvkov , a midwife who worked in the early 1980s with dr  epick in the 
 prague gynaecological  obstetrical clinic , informally known as  apolin. aspiring to complete a university degree , she started 
 studying in a new programme in 
patient care at prague s charles university and decided to 
 investigate birthing women s experiences and behaviour because she  did not like the kind of 
 childbirth management [ she ] saw in maternity hospitals. she asked dr  epick to supervise her master s thesis , as his 
 main research interest 
he agreed to work with 
 her on the project while using it as an opportunity to fulfil the publication obligations 
 placed on him by the icmc , his new employer . in the process of contacting ppm course instructors in prague city districts , ludvkov met 
 dr  marie peen , a psychologist with a background in midwifery . according to epick
she was one of the few graduates of a 
 special high school programme in midwifery that was opened in the mid-1970s .
during her 
 programme of internship in a maternity hospital , she witnessed an authoritarian , 
 paternalistic and moralising approach to women as  objects of medical care , which she did 
 not like . while her classmates and other obstetric nurses enjoyed coffee in the break room , 
 she ran around the ward with a pen and a piece of paper sketching uteruses and ovaries and 
 explaining what was happening in their bodies to women who were interested . in an interview 

i found that these women were seeking me out so they could stop me and ask me a whole 
 lot of questions , and i found it really sad that they had to wait for an enthusiastic 
 high school student to get these answers , and that this was not a common practice that 
 they were entitled to . 
   
i found that these women were seeking me out so they could stop me and ask me a whole 
 lot of questions , and i found it really sad that they had to wait for an enthusiastic 
 high school student to get these answers , and that this was not a common practice that 
 they were entitled to . at the age of sixteen
, she was concerned about how to help and calm down women who were 
 scared of childbirth .
she wondered what she could do about the way in which women were 
 treated and was worried that doctors and nurses did not pay any attention to 
the 
 psychological aspect of the care provided. she realised that it was important for her to 
 nurture  a nice relationship  one of respect for a woman. from the beginning , she thus 
 knew that she needed to  do something good for these women. at the same time she believed that : 
 there must be some kind of prevention that could somehow turn this 
 into something else and bring these people together in a different way , so that their 
 encounter is a harmonious one and this exactly is what can lead to a good outcome . 
 
there must be some kind of prevention that could somehow turn this 
 into something else and bring these people together in a different way , so that their 
 encounter is a harmonious one and this exactly is what can lead to a good outcome .
her vague idea of  prevention started to take firmer shape as the social and political 
 climate began to change slightly and  people did nt feel like being dragged along by what 
 someone else wanted anymore , even though he was the expert , right? as michal pullman has shown , from the end of the 1970s , 
 there began to be more and more room for diverse values , demands , attitudes and interests , 
 which thus created the potential for societal change .
fascinated by the psychological aspects of care , peen started to study psychology at 
 charles university and , coincidentally , she became pregnant in her first year of study , 
 giving her the opportunity to experience the system from the other side . despite being a 
 midwife by education
, she was surprised by the lack of information offered to patients about 
 the practical aspects of pregnancy , childbirth and birth care .
this led her to the decision 
 to write her master s thesis on the psychoprophylactic method .
she conducted empirical 
 research with seventy - nine women contacted through antenatal care units ; only twenty - three 
 of the subjects participated in her ppm course , in which she tried to apply as 
 individualised an approach as possible and to promote an active attitude to the birthing 
 process .
she built on her own observations of the labour and delivery of all the 
 participants and drew up questionnaires in which midwives and women could evaluate their 
 birth experiences .
she also developed a questionnaire to assess the pain thresholds of 
 individual women in the research sample . in this way
, she was able to find out how much the 
 women believed in their ability to overcome pain or any obstacles in the delivery process . 

her main finding was that there was indeed a difference in the experience of labour between 
 women in the control group and women who had been trained in ppm .
peen infers that ppm reinforced women s belief in 
 themselves and their own strength ; thanks to physical exercises they were able to assess 
 their own capabilities more accurately and spend their energy more effectively .
peen continued to run ppm courses and prenatal exercises at five different places in 
 prague as an employee of the onz of prague district 4 after her graduation in 1979 .
these 
 became a huge success and were attended by women from all around the city , including many 
 female physicians and nurses . during the next eight years ( 198088 )
, she managed to 
 substantially extend her ppm courses , integrating new methods of relaxation and 
 desensitisation of pain , massages , acupressure and various psychological techniques , so 
 transforming the course into a kind of group psychotherapy . in her hands , ppm was turned 
 into an approach that reflected the importance of respect and dignity for  the other in 
 health care .
like epick , peen also firmly believed that ppm could be an effective method for 
 overcoming fear and anxiety , which negatively affected the course of labour . with degrees in 
 both gynaecology and psychology ,
epick particularly stressed the psychological aspects of 
 providing care and promoted psychologists or psychotherapists as the main ppm instructors . 
 at the same time , he emphasised the emotional needs of birthing women over the material and 
 technical ones ( such as the design of delivery rooms ) , which seemed difficult to change at 
 that time because of financial constraints .
yet he observed that highly individualised care 
 could not be provided to all women on a daily basis because doing so was very demanding ; 
 only those who needed it most could get it , he argued .
unlike vojta , who emphasised the 
 democratising potential of ppm in the 1950s , epick now advocated a differentiated approach 
 to providing the appropriate form of the ppm , arguing that it was a common practice in 
  other countries. his appeal came 
 several years before the argument for more individualised and commercialised ( ie . 
private ) 
 health - care services emerged in the post - socialist era as part of the political discourse in 
 the  1990s .
epick , however , argued that ppm must be based on sound empirical research and , for this 
 purpose , he set about researching ppm s efficacy .
his research team conducted a large empirical study , the aim of 
 which was to distinguish and measure the  specific and  non - specific ( placebo ) effects of 
 ppm .
the findings indicated that all the research groups that went through some kind of 
 preparation for childbirth had better childbirth outcomes ( eg .  in terms of the length of 
 labour and of the particular stages of labour , the need for medication and the weight of the 
 newborn ) than the group that had none , while the differences between the groups according to 
 the different kinds of preparation for childbirth were not so significant .
in the revolutionary year 1989 , dr  epick approached dr  peen with a special offer to 
 co - found a psychosomatic laboratory that would be attached to the gynaecology ward at the 
 icmc .
both of them believed that this laboratory would be unique worldwide for its focus . 

dr  peen recalls her time in this laboratory as a creative period full of exciting projects 
 and ideas .
this feeling was amplified 
 by the post - revolutionary mood of enthusiasm and anticipation .
a  dream team. while peen loved  to create things with people in situ 
 and was practical , epick was a rigorous academic who was under an obligation to publish 
 the results of his work .
it seems that 
 it was the unique cooperation with dr  epick that made it possible for peen s ideas  

implemented in practice in the city s districts  to find their way into writing and 
 publication as a new ppm concept .
according to epick it was eva ettrichov who initiated the process of converting the new 
 ppm concept into a written course outline , including lesson content and instructor 
 guidelines , so that the concept could be issued as an official recommendation by the 
 ministry of health .
eva ettrichov was 
 an employee at one of the state institutes of preventive medicine and health education but , 
 more importantly , she had close personal ties to a high - level official at the ministry of 
 health .
as a result of her efforts , a committee was set up to draw up a formal version of 
 the new ppm concept for instructors ; the committee s members included marie peen , marcela 
 bendov , ilona kotkov and others who were also involved in the psychosomatic committee of 
 the czechoslovak gynaecological and obstetrical society . according to dr  epick : 
 the vision was that it was going to be written down , and professor bek , the head of 
 the clinic on the londnsk street [ in prague ] , would then recommend it as an official 
 guideline to a minister .
(  ) but before they were able to put this into practice at the 
 ministry , november 1989 arrived , and everything changed after that ! 
 
the vision was that it was going to be written down , and professor bek , the head of 
 the clinic on the londnsk street [ in prague ] , would then recommend it as an official 
 guideline to a minister .
(  ) but before they were able to put this into practice at the 
 ministry , november 1989 arrived , and everything changed after that
! the concept never achieved the status of an official guideline sanctioned by the ministry 
 of health , but it was published in czechoslovak gynaecology in may 
 1990 .
it broadened and redefined 
 goals of the psychoprophylactic method  now simply called  the preparation of pregnant 
 women for childbirth. it proposed that , unlike the  classic versions of ppm , 
modern 
 preparation for childbirth should not aim to eradicate pain but should instead seek to help 
 women to cope with new feelings of pain and accept them as part of the process .
women needed to learn how to adopt a 
  realistic attitude to childbirth and , therefore , they needed to be prepared for the 
 possibility of obstetrical complications and the medical management of childbirth , too .
the 
 substantial modification of the goals of ppm , however , did not mean that the  preparation of 
 pregnant women for childbirth turned to favouring medical interventions .
alternative methods of pain relief , such 
 as acupressure , massages or yoga , and alternative forms of childbirth management .
ppm has never regained its previous 
 heights , even though the new concept seemed to motivate some practitioners to promote 
 changes in the way ppm was being practised .
the events that took place after november 1989 opened up many new 
 opportunities , which obstetricians and midwives explored .
dr  peen extended the scope of 
 prenatal education : she offered and started to organise courses for midwives to teach them 
 her version of ppm .
a number of the participants in these courses went on to become key 
 figures in promoting changes in midwifery and the birth - care system as a whole .
the fall of 
 the iron curtain and the opening of the borders also allowed new ideas from the west , 
 including ideas relating to childbirth education , to flow more freely into the czech 
 environment .
the czechoslovak psychoprophylactic method of painless childbirth was imported from the 
 soviet union in the early 1950s as a form of political propaganda and demonstration of 
 ideological fealty . while in the ussr it offered a much welcome solution to the shortages in 
 the pharmaceutical industry ,
czechoslovakians were not faced with such shortages and were 
 able to experiment with various kinds of pharmaceutical pain relief . in czechoslovakia ,
ppm 
 was promoted for political reasons and was part of the  sovietisation of local science . 

czechoslovakians made important modifications to the method , a sign that within the soviet 
 bloc psychoprophylactic practice was implemented thoughtfully and critically and with an eye 
 towards national specificities .
for the most 
 part , the czechoslovakians conformed to the soviet model : the intense promotion of ppm in 
 the 1950s was followed by criticism in the 1960s and the method s de facto 
 abandonment in the 1970s . in the 1980s
ppm began a new stage in its history in 
 czechoslovakia thanks to the activism of a few enthusiasts , mostly midwives and 
 psychologists , who were unhappy with the depersonalisation and indifference of socialist 
 birth care .
this handful of enthusiasts managed to transform ppm from a method of labour - pain prevention 
 into a holistic philosophy .
surprisingly , this turn happened at the same time as a shift in 
 psychoprophylactic practice was also occurring in the united states , where advocates of this 
 kind of approach turned their attention to the lamaze method as a philosophy promoting more 
 natural , less interventionist birth practices .
there were other ways in which the czechoslovak version of ppm oscillated between the east 
 and west .
epick was envisaging the existence of a differentiated and individualised form 
 of birth care in czechoslovakia  associated in the post - socialist era with the capitalist 
 west  several years before any such system was even a feasible idea , let alone potential 
 reality .
the activism of these enthusiasts was not , however , defined in political terms ; 
 these individuals did not view their activities as being  against the regime. their efforts 
 grew out of an attitude that was widely shared in the late socialist era .
as pullman 
 suggests , first and foremost people were concerned with living normal lives , and it was 
  according to their normal lives and the values they nurtured in them , that they judged the 
 condition of the socialist regime  
 in so far at least as they could do so and remain  non - political and not question basic 
 ideological principles .
however indicative the history of psychoprophylaxis in czechoslovakia is of the wider 
 social and political forces that shape maternity care , it is important to acknowledge that 
 ppm has never been a priority on the research agenda in czechoslovak gynaecology and 
 obstetrics , even in the years when it was being vigorously promoted nationwide . 

gynaecologists and obstetricians in state - socialist czechoslovakia were primarily interested 
 in and researched problems such as perinatal and maternal mortality , the treatment of birth 
 trauma and obstetrical pathologies , and it was the study of these issues that shaped 
 czechoslovakian perinatology and earned it international fame .
that fame then faded after 1968 when most of the 
 renowned experts in this field were forced out of the icmc for political reasons . in this article ,
i have reconstructed the history of the ppm as a special method of 
 antenatal and birth care that underwent significant transformations over time .
contingent on 
 political context and on the position , proclivities and fate of its champions , not only did 
 the name of this method change repeatedly but also its content .
there is , nevertheless , a 
 certain continuity at its core by which it remains the same even as it shifts .
ppm appears 
 to be a fluid object of scientific inquiry . according to law and singleton , 

a fluid object differs from more conventional objects of scientific inquiry because it does 
 not have an immutable shape or name . 
oxymoronically , it is something that both changes and 
 stays the same. the practice of 
 psychoprophylaxis exhibits cohesion across national boundaries , yet yields to adaptation in 
 each national setting .
it retains enough of its essential form to allow for comparisons of 
 how it is practised in different places , but any such analyses must equally take into 
 account local actors and conditions .
it is an object that allows historians and social 
 scientists of medicine to shed light on key cultural and political aspects of obstetrical 
 practices and analyse their continuity and discontinuity across different historical and 
 societal contexts . by providing insight into the rich configuration of meanings that are 
 attached to childbirth and birth care ,
 this paper explores the history of the  psychoprophylactic method of painless childbirth 
 in socialist czechoslovakia , 
 in particular , in the czech and moravian regions of the 
 country , showing that it substantially differs from the course that the method took in 
 other countries . 
 this non - pharmacological method of pain relief originated in the ussr and 
 became well known as the lamaze method in western english - speaking countries . 
 use of the 
 method in czechoslovakia , however , followed a very different path from both the west , 
 where its use was refined mainly outside the biomedical frame , and the ussr , where it 
 ceased to be pursued as a scientific method in the 1950s after stalin s death . 
 the method 
 was imported to czechoslovakia in the early 1950s and it was politically promoted as 
 soviet science s gift to women . in the 1960s 
 the method became widespread in practice but 
 research on it diminished and , in the 1970s , its use declined too . 
 however , in the 1980s , 
 in the last decade of the communist regime , the method resurfaced in the pages of 
 czechoslovak medical journals and underwent an exciting renaissance , having been 
 reintroduced by a few enthusiastic individuals , most of them women . 
 this article explores 
 the background to the renewed interest in the method while providing insight into the 
 wider social and political context that shaped socialist maternity and birth care in 
 different periods . 
Introduction
Changes in the Health-Care System after the Second World War
The 1950s: PPM Arrives
PPM in a Wider Political Context
The 1960s: the Goals Reformulated
The 1970s and 1980s: Normalisation and PPMs Rebirth
Conclusion