Psychological Challenges in Obstetrics and Gynecology: The Clinical Management

Cover Page......Page 1
Title Page......Page 3
ISBN 184628807X......Page 4
Foreword......Page 5
Preface......Page 7
Contents (with page links)......Page 10
List of Contributors......Page 13
Part One Background for the Study of Psychosomatic Obstetrics and Gyneocology......Page 17
1.1. The Essentials of Psychosomatic OB/GYN......Page 19
1.2.1. Contents......Page 20
1.3.1. Contents......Page 22
1.3.2. Educational Methods......Page 23
1.4.1. The Psychosomatic Diagnostic Process......Page 24
1.4.2. Psychosomatic Therapeutic Interventions......Page 26
1.5. Summary......Page 29
References......Page 30
2.2. Communication......Page 31
GMC Guidance, December 2001......Page 32
2.5. Competence to Give Consent......Page 33
Vaginal Examination......Page 34
2.6.1. How Do You Feel, Doctor?......Page 35
2.6.3. How Are You Behaving, Doctor?......Page 36
Things to Think About......Page 37
2.8. Potential for Abuse......Page 38
2.10. Avoided Examination......Page 39
2.12.1. Vaginismus......Page 40
Vaginismus: Definition......Page 41
2.13. How Do You Feel Now, Doctor?......Page 42
Suggested Reading......Page 43
3.1. Communication Skills......Page 45
3.2. Breaking Bad News......Page 47
Reference......Page 48
4.1. Transference......Page 49
BOX 1 Managing Negative Transference......Page 50
4.1.3. What to Do Instead......Page 51
4.2. Countertransference and How to Use It......Page 52
4.3.1. How to Address Somatized Distress BOX 2......Page 53
4.4. Defenses......Page 54
4.4.2. Primitive Defenses......Page 55
4.5. Trauma and Psychological Space......Page 56
4.5.1. How to Help Prevent Trauma......Page 57
References......Page 58
5 Sexuality......Page 59
5.2. Classification and Diagnosis......Page 62
5.4. Treatment Options......Page 63
References......Page 66
6.1. Normality and Difference......Page 67
6.2. Disability as a Human Rights Issue......Page 69
6.3. Disability and Sexuality......Page 71
6.4. Disabled Parents......Page 72
6.5. Disability and Screening......Page 73
References......Page 74
Web sites......Page 75
7 Cross-Cultural Issues in Gynecology and Obstetrics......Page 77
7.2. What the Stars Foretell......Page 79
7.3. The Dowry (Dahej) System......Page 80
7.5. Infant Mortality......Page 81
References......Page 85
8.1. Introduction......Page 87
8.2. What and Who Is a Family?......Page 88
8.3. The Impact of Developments in Medicine on Family and Kinship......Page 89
8.4. Some Implications for Professionals......Page 92
References......Page 94
9.1. Introduction: The best of Both Worlds......Page 97
9.2. One World Standard......Page 98
9.3. BenchMarking: The Methodological Approach......Page 99
9.4.2. Dualism......Page 100
9.4.3. Toward a Humanistic Monism......Page 101
9.5. Ten Postulates......Page 102
References......Page 103
Part Two Obstetrics......Page 105
10 Coping and Adjustment in Pregnancy: Giving Babies a Better Start......Page 107
10.1. Defining Coping......Page 108
10.2. What Can Go Wrong to Create Difficulties in Coping?......Page 112
10.4. Shifting People into More Helpful Ways of Coping......Page 116
10.5. Important Personal Considerations for Clinicians......Page 120
10.6. When to Refer to......Page 121
For an Alternative Perspective......Page 122
11.1. Introduction......Page 123
11.2.2. Stress and Anxiety......Page 124
11.2.3. CVS and Amniocentesis, the Choice......Page 125
11.2.4. Women Who Have a Fetal Abnormality Detected......Page 126
What to Say and How to Say It......Page 127
11.2.6. Aftercare......Page 130
11.2.7. Antenatal Care......Page 131
11.2.8. Preparing for Birth......Page 132
Key Points—Continuing a Pregnancy......Page 133
References......Page 135
12.2. Management......Page 137
12.4. Debriefing After Emergency Delivery......Page 138
Current Useful UK-Based Web Sites......Page 139
12.5.1. Extreme Prematurity......Page 140
12.6. Psychological Impact of Premature Parenthood......Page 141
12.8. Caring for Fathers......Page 142
12.9. Neonatal Death 12.9.1. Parental Fears and Reality......Page 143
12.11. Caring in the Next Pregnancy......Page 144
References......Page 145
13.1. What is PTSD?......Page 147
Sarah (13.1)......Page 148
Juliet (13.2)......Page 150
13.2. What Causes PTSD in O&G?......Page 151
13.3. What Are the Clinical Implications of PTSD?......Page 153
13.4. What Is the Best Way to Treat PTSD in O&G?......Page 154
13.5. Summary and Conclusion......Page 155
Review of PTSD after Medical Illnesses......Page 156
14 Antenatal and Postnatal Depression......Page 157
14.1.2. Impact On the Child(ren)......Page 158
14.1.3. Clinical Management......Page 160
14.2.1. Booking Already Being Treated for Depression......Page 162
14.3.1. Factors Placing a Woman at Risk of Postnatal Depression......Page 164
14.3.2. Postnatal Screening: Measurement of Risk......Page 165
14.3.3. The Effect of Antidepressants on Neonatal Outcome......Page 166
14.4.1. General Principles of Prescribing in the Breastfeeding Mother......Page 167
14.4.2. Advice for Postnatal Support and Health for the Family......Page 169
References......Page 170
15 Maternal Suicide......Page 173
15.3. Methods......Page 174
15.5. Problems in Identification and Risk Assessment......Page 175
15.6.2. Screening Questions......Page 176
15.6.3. Liaison......Page 177
15.6.5. Psychological Autopsy......Page 178
Sharing of Information......Page 179
Further Reading......Page 180
16.2.1. Tokophobia: An Anxiety Disorder......Page 181
16.3. Treatment Studies for Fear of Childbirth......Page 182
16.4.1. Tokophobia Secondary to Childbirth......Page 183
16.5. The Obstetric Consultation......Page 184
16.6.2. The Pregnant Woman with Tokophobia Requesting a Termination of Pregnancy......Page 185
16.6.5. The Woman with Secondary Tokophobia......Page 186
16.7. Managing the Consultation......Page 187
General Reading......Page 188
17.1. Introduction......Page 189
17.2.1. Stages of Grief......Page 190
17.3. Cultural Differences......Page 191
17.6. Stillbirth......Page 192
17.7. Breaking the Diagnosis of Death......Page 193
17.9. Delivery......Page 195
17.11. Postdelivery......Page 197
17.12. Postmortems......Page 198
17.13. Communication......Page 200
17.14.2. Emotional Support for the Next Stage......Page 201
17.16. Preparation for the Poststillbirth Appointment......Page 202
17.17. Conduct of the Appointment......Page 203
17.17.1. Giving the Results......Page 204
17.18. Implications for Future Pregnancy......Page 205
Bibliography......Page 206
18.1. What Are the Physical Problems of Pregnancy After Stillbirth?......Page 209
18.2. Complication for the Baby In Pregnancy After Stillbirth......Page 210
18.5. Risk Factors for Psychological Problems......Page 211
18.7. The Baby’s Psychological Development......Page 212
18.9. Women’s Coping Strategies in Pregnancies After Stillbirth......Page 213
18.10. General Principles of Care......Page 214
18.12.2. Establish a Clear Outline Plan for the Pregnancy......Page 215
18.14. Previous Mid-Trimester Loss and Cervical Cerclage......Page 216
18.18. Maternal Behavior Toward the Unborn Baby......Page 217
18.20.1. Feelings About Having a Baby After a Stillbirth......Page 218
18.20.3. Timing of Delivery......Page 219
18.22. Postnatal......Page 220
18.23. Postnatal Adjustment Problems/Differences in Women in Next Delivery After Loss......Page 221
References......Page 222
Part Three Gynecology......Page 225
19 Health Care and Young People: A Challenge......Page 227
19.1. Considerations of Adolescence......Page 229
19.2. Sexual Assault......Page 231
19.3. Pitfalls of Adolescent Medicine......Page 232
19.5. The Consultation......Page 236
19.5.1. Probity......Page 238
19.7. Child Protection......Page 239
19.8. Young Age and Pregnancy......Page 240
19.9. Examining Young People......Page 243
19.10. Body Image......Page 245
19.11. Vaginal Problems......Page 246
19.13. Eating Problems......Page 248
19.14. Conclusion......Page 250
Reference......Page 251
The Abortion Act 1967......Page 253
20.2.1. Public Opinion......Page 254
20.2.2. Medical Opinion......Page 255
20.3. Unplanned, Unscheduled, or Unwanted Pregnancy?......Page 256
20.3.2. Psychological Impact of Abortion......Page 257
20.4. Identifying Those at Risk of Psychological Sequelae......Page 258
20.5. Understanding Those Presenting for Repeat Abortion......Page 259
20.6. The Unplanned Pregnancy Consultation......Page 260
20.7. Summary......Page 261
References......Page 262
21.1. Reacting to Loss......Page 263
21.2. Language and Vocabulary......Page 264
21.4. Miscarriage and the Family......Page 266
21.6. The Formal/Legal Framework for Miscarriage......Page 267
21.7. Abnormal Grief......Page 268
21.10. Summary......Page 269
Bibliography......Page 270
22.1. Prevalence, Definitions, and Diagnosis of Premenstrual Problems......Page 271
22.2.2. Psychological Theories and Treatments......Page 273
22.3. A Biopsychosocial Approach to Assessment and Treatment of Premenstrual Symptoms......Page 275
Box 1 Goals of assessment......Page 276
22.4. Summary......Page 277
References......Page 278
Box 1 Effect of psyche on infertility......Page 279
Box 2 Motivation to conceive......Page 281
Box 3 Effect of infertility on psyche......Page 282
23.4. More General Effects......Page 283
Box 4 Treatment......Page 284
23.5.1. The Couple......Page 285
23.5.2. The Doctor......Page 286
23.7. Intractable Infertility in the Couple......Page 288
23.7.1. Acceptance......Page 289
Suggested Further Reading......Page 290
Useful Addresses......Page 291
24.2. Rates of Sexual Assault......Page 293
24.3.1. Response of the Clinician to Direct Disclosure......Page 294
24.3.2. Nondisclosure but Abuse Is a Possibility......Page 295
24.4. Therapeutic Needs of Rape Victim......Page 296
24.5.1. Injuries......Page 297
24.5.2. Forensic Sampling......Page 299
24.6.1. Rape Trauma Syndrome......Page 300
24.7. Contact Details, Useful Web sites, and so on......Page 302
Appendix: Diagnostic Criteria from Diagnostic and Statistical Manual for Mental Disorders DSM-IV Posttraumatic Stress Disorder......Page 303
25.1. How Has This Patient Ended Up in My Clinic?......Page 307
25.2. A Conceptual Framework......Page 308
25.3. Assessment in the Clinic......Page 310
25.5.1. Does This Patient Need a Laparoscopy?......Page 311
25.5.3. What Are the Principles of Chronic Pain Management, and Will My Patient Accept Them?......Page 312
References......Page 313
26 Communicating with Cancer Patients......Page 315
26.1. The “Four-Cusp” Approach 26.1.1. Cusp A: Potentially Curable/Cured......Page 317
Case 1......Page 318
Case 2......Page 319
26.1.2. Cusp B: Living with Cancer......Page 320
26.1.3. Cusp C: Preterminal Phase......Page 321
Bibliography......Page 322
27.1. What is the Menopause?......Page 323
27.1.1. Biochemical Changes......Page 324
27.1.3. Cultural Differences in Menopausal Experiences......Page 325
27.2. Depression and the Menopause......Page 328
27.2.1. Treatment of Depression......Page 329
27.2.2. Complementary and Alternative Therapies......Page 330
27.2.3. Sexual Problems......Page 331
27.2.5. Androgens and Effects on Sex......Page 332
27.2.7. Psychosexual Therapy......Page 333
References......Page 334
About the Editors......Page 339
Index (with page links)......Page 341