The obstetric patient

2010 ◽  
Author(s):  
Marion I Andrew ◽  
Allan M Cyna
Keyword(s):  
Central Nervous System ◽  
Common Sense ◽  
Focus Of Attention ◽  
Third Party ◽  
Generalized Anxiety ◽  
Cultural Shift ◽  
Pregnancy And Childbirth ◽  
Social Concerns ◽  
Fear And Anxiety ◽  
Pregnancy And Birth

The obstetric anaesthetist’s clinical practice is concerned with the safety of not one, but two intricately interwoven individuals, and much of this takes place in the presence of a third party—partner, friend or relative. Pregnancy and birth are natural and normal processes in the lives of most people. In this context, communication might be expected to be a matter of common sense and somewhat intuitive. How we communicate with women is a pivotal factor in determining their experience and, although recognized as such by many within the midwifery community , this is perhaps less so by doctors. Advances in medicine and changes in society over the last 100 years have resulted in a safer but, socially and technologically, a more complex experience for both women and their babies. Communication in childbirth originally occurred between women caring for each other, but this subsequently became dominated by an authoritarian medical machine, which has left some women feeling vulnerable and ‘processed’. Recognition of the importance and value of patient rights and satisfaction has been responsible for a cultural shift in many maternity units. However, the medicalization of childbirth continues to take over even when labour is proceeding normally. Anaesthetists are perfectly positioned as providers of analgesia and anaesthesia, within a multidisciplinary team, to communicate with women in a way that empowers them and supports their autonomy. Women become highly focused on the pregnancy and labour as the evidence looms ever larger in front of them. Pregnancy and childbirth usually represent a challenging psychological and physiological experience. This focus of attention on the pregnancy makes women highly suggestible to subconscious communications. For this reason, messages received can function as powerful determinants of how women perceive their pregnancy, and respond during childbirth. Central nervous system (CNS) changes occur that reduce anaesthesia requirements during pregnancy and increase hypnotizability, dissociation, daydreaming and an ability to use imagery to experience labour in a fulfilling way. There is a range of emotional responses to pregnancy. For some, there is joy and excitement, while for others there is no excitement—just fear and anxiety. Overlaying this, there may be pre-existing generalized anxiety, social concerns, obstetric problems and other complications.

Tingkat Kecemasan Ibu Hamil Trimester III dalam Menghadapi Persalinan

2021 ◽  
Vol 3 (1) ◽  
pp. 18-24
Author(s):  
Nilda Yulita Siregar ◽  
Cici Fitrayanti Kias ◽  
Nurfatimah Nurfatimah ◽  
Fransisca Noya ◽  
Lisda Widianti Longgupa ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Preterm Labor ◽  
Community Health Center ◽  
Sampling Technique ◽  
Descriptive Study ◽  
Age Group ◽  
Third Trimester ◽  
Pregnancy And Childbirth ◽  
The Third ◽  
Fear And Anxiety

Introduction: Fear and anxiety during pregnancy and childbirth can cause problems such as preterm labor and low birth weight. Purpose: The purpose of this study was to determine the level of anxiety of third-trimester pregnant women in dealing with labor. Methods: This type of research is a descriptive study and analyzed with frequency distribution. The population was all pregnant women in the third trimester who were in the working area of ​​the Mapane Community Health Center with a total of 37 people. The sampling technique used total sampling. The results showed that only 8.1% of pregnant women experienced mild anxiety, while 91.9% did not experience anxiety. pregnant women who experience mild anxiety are 20% in the risk age group, 20% with diploma education, 11.5% in mothers who do not work, 60% in primigravidas, and 15.8% in mothers who do not get support from their husbands. Anxiety occurs mostly in primigravida because it is the first experience of pregnancy. It suggested for village midwives providing information about pregnancy and childbirth, especially for primigravida mothers, and involving their husbands in posyandu activities for pregnant women.

scholarly journals Cytomegalovirus infection and reproductive health of women

2016 ◽  
Vol 65 (4) ◽  
pp. 24-33 ◽  
Author(s):  
Natalia R. Belyaeva
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Reproductive Health ◽  
Cytomegalovirus Infection ◽  
Near Miss ◽  
Pregnancy And Childbirth ◽  
Quality Of Medical Care ◽  
Pregnancy And Birth ◽  
Main Factor

The article presents material about critical states in obstetric and gynecologic practice (“near miss”), obtained on the basis of their own research, as well as the data of domestic and foreign authors. It is shown that the main factor determining the outcome of the pregnancy and birth, is the quality of medical care provided to the woman. The characteristics of “near miss”, indicated the risk factors for its occurrence. A measure of the health care until serious complications of pregnancy and childbirth, as well as possible ways to reduce the frequency of their development.

Southern Water Authority v Pegrum and Pegrum [1989] Crim LR 442 (DC) Facts: The respondents were charged with an offence contrary to s 31(1) of the Control of Pollution Act 1974, causing polluting matter (pig effluent) to enter a stream. The respondents reared pigs; effluent produced by the pigs was held initially in tanks and then transferred by gravity into a lagoon constructed for the purpose. The lagoon itself was emptied of liquid content for use as manure several times a year and of sediment annually. In the winter of 1987, after heavy rain, a blocked drain resulted in rain water flowing into the lagoon. A fissure developed at the top of one side of the lagoon and polluting liquid escaped, finding its way into a stream and eventually into a river. The magistrates found that the overflow from the lagoon was caused by an act of God – the ingress of rainwater – and that it was unnecessary to consider whether the respondents were negligent either in not inspecting the drain or discovering the overflow promptly enough or in not providing an adequate drain. They further found that the blocked drain causing the ingress of rainwater was an intervening event ‘breaking the chain of causation’. They dismissed the information and the prosecutor appealed by way of case stated. Held, allowing the appeal and remitting the case with a direction to convict, the following principles applied: (1) where the defendant conducts some active operation involving the storage, use or creation of material capable of polluting a river should it escape, then if it does escape and pollute, the defendant is liable if he ‘caused’ that escape; (2) the question of causation is to be decided in a common sense way; (3) a defendant may be found to have caused that escape even though he did not intend that escape and even though the escape happened without his negligence; (4) it is a defence to show that the cause of the escape was the intervening act of a third party or act of God or vis major which are the novus actus interveniens defences to strict civil liability referred to in Rylands v Fletcher (1868) LR 3 HL 330; (5) in deciding whether the intervening cause affords a defence the test is whether it was of so powerful nature that the conduct of the defendant was not a cause at all, but was merely part of the surrounding circumstances. On the facts of the present case, the active operations or positive acts of the respondents were the storage and re-use of the effluent which resulted in the formation of the toxic sediment which polluted the stream. The magistrates erred in finding that the ingress of rainwater was an act of God; an act of God is an operation of natural forces so unpredictable as to excuse a defendant all liability for its consequences. The quantity of rain could not properly be regarded in itself as an act of God and in any event the ingress of rainwater into the lagoon was the result of the overflow from the blocked drain. Although unpredictable and unforeseeable operation of animate forces can amount to an act of God (see Carstairs v Taylor (1870) LR 6 Exch 217), there was no factual basis for such finding in the present case. The respondents submitted that the blocked drain was an effective intervening cause relegating the respondent’s effluent operation to a mere surrounding circumstance; it was sought to distinguish Alphacell Ltd v Woodward [1972] AC 824 on the basis that in

1996 ◽  
pp. 143-143
Keyword(s):  
Common Sense ◽  
Civil Liability ◽  
Heavy Rain ◽  
Rain Water ◽  
Third Party ◽  
Liquid Content

scholarly journals As soon as there was life, there was danger: the deep history of survival behaviours and the shallower history of consciousness

2021 ◽  
Vol 377 (1844) ◽  
Author(s):  
Joseph E. LeDoux
Keyword(s):  
Common Sense ◽  
Survival Function ◽  
Point Of View ◽  
Theme Issue ◽  
Nervous Systems ◽  
Systems Neuroscience ◽  
History Of ◽  
Physiological Adjustments ◽  
Fear And Anxiety ◽  
Practical Implications

It is often said that fear is a universal innate emotion that we humans have inherited from our mammalian ancestors by virtue of having inherited conserved features of their nervous systems. Contrary to this common sense-based scientific point of view, I have argued that what we have inherited from our mammalian ancestors, and they from their distal vertebrate ancestors, and they from their chordate ancestors, and so forth, is not a fear circuit. It is, instead, a defensive survival circuit that detects threats, and in response, initiates defensive survival behaviours and supporting physiological adjustments. Seen in this light, the defensive survival circuits of humans and other mammals can be conceptualized as manifestations of an ancient survival function—the ability to detect danger and respond to it—that may in fact predate animals and their nervous systems, and perhaps may go back to the beginning of life. Fear, on the other hand, from my perspective, is a product of cortical cognitive circuits. This conception is not just of academic interest. It also has practical implications, offering clues as to why efforts to treat problems related to fear and anxiety are not more effective, and what might make them better. This article is part of the theme issue ‘Systems neuroscience through the lens of evolutionary theory’.

Emotional labour: Exploring emotional policy discourses of pregnancy and childbirth in Ontario, Canada

2019 ◽  
pp. 095207671986978 ◽  
Author(s):  
Stephanie Paterson
Keyword(s):  
Insurance Plan ◽  
Canadian Province ◽  
Emotional Labour ◽  
Pregnancy And Childbirth ◽  
Healthcare Profession ◽  
The World ◽  
Healthcare Insurance ◽  
Natural Life ◽  
Pregnancy And Birth ◽  
Policy Discourses

In 1991, Ontario became the first Canadian province to pass legislation establishing midwifery as a self-regulated healthcare profession and integrating it into the provincial healthcare insurance plan. Since its implementation, there has been a partial convergence of obstetric practice in the province, where, despite seemingly distinct professional philosophies of care, both midwives and physicians cohere around representations of pregnancy and birth as “normal” or “natural” life events rather than medical conditions requiring treatment. In this paper, I suggest that understanding this convergence and the effects produced by it requires an interrogation of the emotional policy discourses that shape (and are shaped by) the ways we experience the world around us. In doing so, I develop a framework for tracing the emotional policy discourses surrounding pregnancy and birth from the turn of the 20th century until the early 1990s, demonstrating that these representations reflect the merging of two emotional registers, joy and fear, where pregnancy and birth are represented as joyous, life changing events, but where joy is tempered by the fear of complications and potential tragedy. I thus show that contemporary emotional landscapes bind various “birth experts” and bracket “expertise” around particular forms of knowledge, shaping expert and maternal subjectivities along gendered, racialized, ableist, and class-based lines.

Birth Matters

2021 ◽  
pp. 15-30
Author(s):  
Louise Marie Roth
Keyword(s):  
Public Health ◽  
Conceptual Framework ◽  
Maternity Care ◽  
Scientific Evidence ◽  
Medical Model ◽  
Normal Pregnancy ◽  
Authoritative Knowledge ◽  
Pregnancy And Childbirth ◽  
Developed Nations ◽  
Pregnancy And Birth

This chapter outlines the medical and midwifery models of childbirth. In most developed nations, the medical model of childbirth dominates maternity care and obstetricians have authoritative knowledge. This chapter defines the medicalization schema as a deep, largely unconscious conceptual framework that organizes beliefs about pregnancy and birth. The medicalization schema contains three key components: the pathologization of normal pregnancy and childbirth, scienciness, and technology fetishism. This chapter defines the concepts of scienciness and technology fetishism with respect to common obstetric practices and technologies that lack the support of scientific evidence. Lackluster public health results and critiques from women’s health movements challenge the validity of medicalization.

scholarly journals The influence of stress during pregnancy on the central nervous system of mother and her child

2021 ◽  
Vol 47 (3) ◽  
pp. 492-499
Author(s):  
Anna Kupryjaniuk ◽  
Michał Sobstyl
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Prefrontal Cortex ◽  
Pregnant Women ◽  
Brain Research ◽  
Behavioral Therapy ◽  
Well Being ◽  
Anxiety And Depression ◽  
Pregnancy And Childbirth ◽  
The Central Nervous System

Pregnant women may experience high levels of stress, including those associated with finding oneself in a new reality. In addition, the new reality is the COVID-19 pandemic, which has contributed to the deterioration of the mental state of many people. Chronic stress can lead to neuroanatomical changes in the mother, but also in her baby. It leads to atrophy of neurons in the hippocampus and prefrontal cortex, and to the growth and enlargement of the amygdala, i.e. those structures that are responsible for emotions. The mother's emotions also shape the synapses in the fetus, and the neurotransmitters secreted by the mother modify the development of the baby's brain. Research is ongoing in many countries on the consequences of anxiety and depression in pregnant women during the COVID-19 pandemic. For this reason, it is important to take care of psychological well-being, for example by using the techniques of cognitive behavioral therapy. Support from relatives during pregnancy and childbirth is also an extremely important element in the proper development of the central nervous system of the mother and her child.

scholarly journals Audit of quality of care in critical conditions in obstetrics (“near miss”)

2016 ◽  
Vol 65 (4) ◽  
pp. 15-23 ◽  
Author(s):  
Eduard K. Ailamazian ◽  
Vladimir O. Atlasov ◽  
Konstantin V. Yaroslavsky ◽  
Viktor K. Yaroslavsky
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Quality Of Care ◽  
Near Miss ◽  
Critical Conditions ◽  
Pregnancy And Childbirth ◽  
Quality Of Medical Care ◽  
Pregnancy And Birth ◽  
Main Factor

The article presents material about critical states in obstetric and gynecologic practice (“near miss”), obtained on the basis of their own research, as well as the data of domestic and foreign authors. It is shown that the main factor determining the outcome of the pregnancy and birth, is the quality of medical care provided to the woman. The characteristics of “near miss”, indicated the risk factors for its occurrence. A measure of the health care until serious complications of pregnancy and childbirth, as well as possible ways to reduce the frequency of their development.

scholarly journals Systematic Review on the Efficacy of Interventions for Fear of Childbirth, Anxiety and Fear in Pregnant Women

2021 ◽  
Author(s):  
Carmen Birner ◽  
Gerlind Grosse
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Quality Assessment ◽  
Pregnant Women ◽  
Controlled Trials ◽  
Fear Of Childbirth ◽  
Pregnancy And Childbirth ◽  
Randomized Controlled ◽  
Quantitative Studies ◽  
Fear And Anxiety

Abstract Background: Fears and anxieties during pregnancy and childbirth are a frequent phenomenon and can have negative consequences on wellbeing, psychological health and birth outcomes. Therefore, it is important to focus on the interventions to reduce those fears and anxieties during pregnancy and childbirth. A systematic review was conducted to examine the current literature on psychological interventions to reduce anxieties and fears during pregnancy and childbirth. Scopus and PubMed were searched from 2015 up until December 2020 for relevant studies. Included were pregnant women, with no restriction on age ranges or parity. Entered in the review were quantitative studies, including randomized controlled trials (RCTs), non-randomized controlled trials as well as treatment evaluations. After reviewing titles, abstracts and studies, 72 studies were included in this review as they met the inclusion criteria. Standard methodological procedures for systematic reviews were used. The quality assessment of included articles was done by using the Quality Assessment Tool for Quantitative Studies (EPHPP). Results: The main results of this review concern the fear and anxiety reducing effects of psychoeducation, relaxation techniques, guided imagery, supportive care through a midwife, group discussion, “lifestyle based education”, writing therapy, cognitive behavioral therapy groups and stress intervention, individual structured psychotherapy, communication skills training, counseling approaches (except distraction techniques), a motivational interviewing psychotherapy, emotional freedom techniques, breathing awareness and different hypnotherapeutic techniques on different fears and anxieties during pregnancy and childbirth. For mindfulness-based interventions mixed results are found. The effect of an acceptance and commitment therapy, biofeedback interventions, a mind body intervention, mental health training courses, the group intervention Nyytti® as well as cognitive analytic therapy is unclear, due to weak ratings. Antenatal class attendance reduced delivery fear significantly only in first time mothers. An internet-based problem-solving treatment did not reduce anxiety during pregnancy. Conclusion: A broad range of interventions show positive effects on fear of childbirth and fear and anxiety in pregnancy. Further research should address other acknowledged psychotherapeutic practices, like psycho-dynamic as well as systemic interventions, as they are underrepresented within this review. Furthermore , there is a need for manualized therapeutic interventions, with regards to a combination of effective intervention components.

scholarly journals Effect of Attentional Focus Instructions on Motor Learning and Performance of Patients with Central Nervous System and Musculoskeletal Disorders: a Systematic Review

2018 ◽  
Vol 3 (3) ◽  
pp. 40 ◽  
Author(s):  
Alessandro Piccoli ◽  
Giacomo Rossettini ◽  
Simone Cecchetto ◽  
Antonello Viceconti ◽  
Diego Ristori ◽  
...  
Keyword(s):  
Systematic Review ◽  
Central Nervous System ◽  
Randomized Controlled Trial ◽  
Nervous System ◽  
Motor Learning ◽  
Controlled Trial ◽  
Attentional Focus ◽  
Focus Of Attention ◽  
Improve Performance ◽  
Randomized Controlled

Exercise is one of the main rehabilitative interventions, commonly used to improve performance and motor learning. During the application of attentional focus strategies, External Focus of Attention (EFA) aiming at the movement effect has been reported to have more efficacy than Internal Focus of Attention (IFA) aiming at movement characteristics in healthy subjects. There are not many studies that compare the EFA and IFA instructions in people with Musculoskeletal (MSK) and Central Nervous System disorders (CNS). The purpose of this systematic review is to determine if IFA or EFA, in patients with CNS or MSK, may improve performance and have some effects on motor learning. Databases used for research: PubMed, CINAHL, Cochrane Library, PEDro, PsycINFO, SCOPUS. Inclusion criteria: Randomized Controlled Trial, quasi-Randomized Controlled Trial, enrolled subjects with CNS or with MSK and compared the efficacy of EFA and IFA. The studies suggest that the EFA is better than IFA in affecting the movement execution in patients with MSK, while conflicted findings emerge in presence of CNS disorders. Studies included in the qualitative analysis showed heterogeneous methodological features in study design and conductance, so results must be interpreted with caution.

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