分娩阵痛对产妇心理因素及分娩的影响

目的：探讨分娩阵痛对产妇心理因素及分娩的影响。方法：收集在我院分娩的225例产妇,用自行设计的基于患者对产科优质护理指征问卷进行调查,对自然分娩与剖宫产产妇满意度比较。结果：提供支持减轻疼痛方面,剖宫产产妇的满意程度显著低于自然分娩产妇（Z=2．110,P=0．0035）,对于助产服务的其他方面的满意度评价无显著差异（P〉0．05）。结论：给产妇提供更多的支持、减轻分娩疼痛,促进自然分娩。     

The psychological consequences of childbirth

It is becoming increasingly recognised that some women develop post traumatic stress disorder (PTSD) after childbirth. This study aimed to determine whether women experienced symptoms of PTSD and depression at 6–12 months post‐partum; and what factors predict the development of psychopathology. This was a retrospective postal study of women who have given birth in the previous 6–12 months. A total of 102 women who delivered in hospital completed measures of PTSD, depression, perceptions of labour and delivery and provided clinical and demographic information at 6–12 months post‐partum (mean = 9.5 months). A total of 3.9% showed questionnaire responses suggesting clinically significant levels of PTSD. A further 19.6% women reported sub‐clinical symptoms. Regression analysis showed that higher depression scores, fear for the baby and unexpectedness of procedures during labour predicted higher scores on the PTSD measure. A total of 21.5% of women were depressed. A history of mental health problems and the presence of PTSD symptomatology predicted higher depression scores. This study demonstrates that a significant number of women continue to experience some level of PTSD and depression at 9.5 months post‐partum. It is important to be aware that births involving unexpected obstetric procedures may precipitate PTSD symptoms in some women.     

The association between depressive symptoms during pregnancy and post-delivery fear of childbirth; a prospective study

ABSTRACT

Background

Fear of childbirth is an important reason for a caesarean section on request.     

Women's lived experience of fear of childbirth

Objective

to describe women's lived experience of fear of childbirth.

Design

a qualitative study using a phenomenological approach and a lifeworld perspective. Data were collected via tape-recorded interviews.

Setting

Sahlgrenska University Hospital, Göteborg, Sweden in 2003.

Participants

eight pregnant women (24–37 gestational weeks) seeking help within an outpatient clinic for women with severe fear of childbirth. Two of the women were primiparous.

Findings

four constituents were identified: feeling of danger that threatens and appeals; feeling trapped; feeling like an inferior mother-to-be and on your own. The essential structure was described as ‘to lose oneself as a woman into loneliness’.

Key conclusions

fear of childbirth affects women in such a way that they start to doubt themselves and feel uncertain of their ability to bear and give birth to a child. Previous birth experience was central to the multiparous women. They described their experiences of suffering in relation to the care they received during childbirth. This mainly concerned pain and negative experiences with staff.

Implications for practice

pregnant women who fear childbirth are an exposed group in need of much support during pregnancy and childbirth. The encounter between the woman and the midwife can be a way of breaking down the feeling of loneliness and restoring the woman's trust in herself as a childbearing woman.     

Antenatal fear of childbirth and its association with subsequent caesarean section and experience of childbirth

OBJECTIVE: To investigate the prevalence of fear of childbirth in a nationwide sample and its association with subsequent rates of caesarean section and overall experience of childbirth. DESIGN: A prospective study using between-group comparisons. SETTING: About 600 antenatal clinics in Sweden. SAMPLE: A total of 2,662 women recruited at their first visit to an antenatal clinic during three predetermined weeks spread over 1 year. METHODS: Postal questionnaires at 16 weeks of gestation (mean) and 2 months postpartum. Women with fear of childbirth, defined as 'very negative' feelings when thinking about the delivery in second trimester and/or having undergone counselling because of fear of childbirth later in pregnancy, were compared with those in the reference group without these characteristics. MAIN OUTCOME MEASURES: Elective and emergency caesarean section and overall childbirth experience. RESULTS: In total 97 women (3.6%) had very negative feelings and about half of them subsequently underwent counselling. In addition, 193 women (7.2%) who initially had more positive feelings underwent counselling later in pregnancy. In women who underwent counselling, fear of childbirth was associated with a three to six times higher rate of elective caesarean sections but not with higher rates of emergency caesarean section or negative childbirth experience. Very negative feelings without counselling were not associated with an increased caesarean section rate but were associated with a negative birth experience. CONCLUSIONS: At least 10% of pregnant women in Sweden suffer from fear of childbirth. Fear of childbirth in combination with counselling may increase the rate of elective caesarean sections, whereas fear without treatment may have a negative impact on the subsequent experience of childbirth.     

Predictors of women's perceptions of the childbirth experience

OBJECTIVE: To determine the factors that predict women's perceptions of the childbirth experience and to examine whether these vary with the type of birth a woman experiences. DESIGN: Prospective cohort study. SETTING: The postpartum units of two eastern Canadian hospitals. PARTICIPANTS: Six hundred fifty two women and their newborns. DATA COLLECTION: Data were collected in hospital at 12 to 48 hours postpartum using self-report questionnaires and chart review. MAIN OUTCOME MEASURE: Perception of the childbirth experience was measured for women having a vaginal and emergency cesarean birth using the Questionnaire Measuring Attitudes About Labor and Delivery and planned cesarean birth using the Modified Questionnaire Measuring Attitudes About Labor and Delivery. RESULTS: Of the 20 predictors of women's childbirth perceptions, the strongest were type of birth; degree of awareness, relaxation, and control; helpfulness of partner support; and being together with the infant following birth. CONCLUSIONS: Of the predictors of a quality birth experience, most were amenable to nursing interventions: enhancement of patient awareness, relaxation, and control; promotion of partner support; and provision of immediate opportunities for women to be with their babies.     

The Edinburgh Postnatal Depression Scale as a measure for antenatal dysphoria

Background: Data arising from the Edinburgh Postnatal Depression Scale (EPDS), used as screening tool for perinatal depression, have been analysed as unidimensional in some studies and multidimensional in others. This study evaluates the dimensionality and item properties of the EPDS. Methods: 920 women recruited in antenatal clinics from two government tertiary hospitals completed the English EPDS between 26 and 28 weeks of pregnancy. Classical test theory and factor analyses were used to evaluate dimensionality. Item response theory was used to investigate item functioning. Results: The EPDS was essentially unidimensional. It has a common factor, ‘antenatal dysphoria’ and 3 subdomains ‘depressive’ (items 7–10), ‘anxiety’ (items 3–5) and ‘anhedonic symptoms’ (items 1, 2). Item 8 (I have felt sad or miserable) (discrimination = 3.13. SE = 0.24), item 9 (I have been so unhappy that I have been crying) (discrimination = 2.39. SE = 0.17) and item 10 (The thought of harming myself has occurred to me) (discrimination = 2.27. SE = 0.21) best discriminated participants that had dysphoria. Item 1 (I have been able to laugh and see the funny side of things) (threshold 1 = 1.49, SE = 0.14), item 2 (I have looked forward with enjoyment to things) (threshold 1 = 1.21, SE = 0.11) and item 10 (The thought of harming myself has occurred to me) (threshold 1 = 1.19, SE = 0.21) indicated dysphoria severity. Conclusions: The EPDS measures antenatal dysphoria rather than just depression. It could be used to screen for antenatal depressive, anxiety and anhedonic symptoms. The items discriminate and grade dysphoria unequally. The findings may impact on scale use and interpretation.     

Are non-pregnant women afraid of childbirth? Prevalence and predictors of fear of childbirth in students

Introduction: Fear of childbirth (FOC) has been mostly studied in peripartum women; however, it can be present in non-pregnant young women, and the question is whether it occurs even before pregnancy planning.

Objective: (1) to determine the prevalence of clinically significant FOC in non-pregnant female students, and (2) to investigate the role of anxiety sensitivity (AS), trait anxiety, childbirth pain expectancy, and sources of birth knowledge for FOC.

Methods: Non-pregnant female students (N?=?374) from different study programmes (health studies, social sciences and humanities, and biotechnical studies) participated in the study. They completed

Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ, version A), The State–Trait Anxiety

Inventory (STAI-T), Anxiety Sensitivity Index (ASI), the average expected labor pain, and sources

of information about childbirth.

Results: The results showed that 25.9% of students reported clinically significant FOC. FOC could be predicted by postponing pregnancy planning, the high expectancy of labor pain, high trait anxiety, and high physical dimension of AS. Students from health sciences reported a lower level of FOC, as opposed to social science and humanities’ students. Students reported receiving the most information about childbirth from family and the least from the professional books.

Conclusions: Fear of childbirth is highly prevalent in the sample of young nulliparous women with one in four women reporting clinically significant fear. The higher levels of the FOC could be predicted, by AS, trait anxiety, expected labor pain, and sources of knowledge about the childbirth. Implications of the findings are discussed.     

Co-located perinatal psychiatry clinic: impact of adding a psychologist on clinical quality improvement metrics

Purpose: To describe the impact of adding a psychologist (the intervention) to a co-located perinatal psychiatry clinic (PPC) in terms of effects on clinical quality improvement (QI) metrics.

Methods: Six-month pre- and postintervention study design with measurement of QI metrics: number of unique patients treated; number of new and established visits; percent no-shows for new and established visits; and mean wait time to new visit.

Results: Number of unique patients treated by the psychiatrist increased by 30%, from 90 preintervention to 118 postintervention (p?=?.06). Total number of visits completed by the psychiatrist increased by 20% from 174 preintervention to 208 postintervention. Mean wait time for new visits for a physician decreased from 20?days preintervention to 14?days postintervention, with a mean difference of 6.4?days (p?=?.0015). Percentage of no-shows for new visits increased slightly from 23% preintervention to 26% postintervention (p?=?.72). The percentage of no-shows for established visits decreased significantly from 22% preintervention to 10% postintervention (p?<?.005).

Conclusions: By adding a psychologist to the co-located PPC, we improved quality of perinatal mental health care by improving efficiency, timeliness and patient-centered care. The psychiatrist saw a greater number of unique patients, decreased wait time to new visits and decreased no-show rates for established visits, likely by better matching patient needs with provider services. A psychologist could be a valuable addition to a PPC, given the shortage of psychiatrists in the United States.     

Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research

ABSTRACT

Objective: To discuss and develop a statement on the current state of the evidence and opinion in Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide recommendations.

Background: A group met in 2019 to discuss the state of clinical and academic knowledge relating to FoC/Tokophobia. Five key areas were agreed as the focus of the meeting.

Methods: 12 internationally acknowledged experts, in this or a closely related area (e.g. PTSD) met to discuss their understanding of the evidence for FoC/ Tokophobia and current practice. The consensus described in this paper constitutes the expression of the general opinion of the participants and does not necessarily imply unanimity.

Keys points: Work focussed on tokophobia is recent and there remains a wide range of issues, which were addressed in the workshop including complexity in defining prevalence, a theoretical lack of understanding, which creates challenge for robust assessment and the identification of risk factors. An improved aetiological and developmental understanding of the tokophobia is required to underpin appropriate, effective and evidence-based interventions. Evaluation of pathways of care and relevant interventions, should be a focus of future research.

Conclusion: Significant gaps remain within the FoC/tokophobia knowledge base. Further research is necessary.     

分娩期女性性器官损伤及保护

分娩是女性的正常生理过程,但分娩期的一些病理变化不仅直接威胁妇女的身体健康,还可能成为影响产后女性生活质量的重要隐患。文章就分娩过程中如何最大限度地保护女性性器官功能,降低性器官损伤及丢失,并如何根据我国现有的医疗条件和患者的具体情况,采取针对性预防和治疗措施保护和重建女性性器官功能进行探讨。     

Beyond Romanow: The Future of Women’s Health Care in Canada

In November 2002, the Royal Commission on the Future of Health Care in Canada headed by Mr. Roy Romanow, will deliver its final report to the Governor-in-Council of Canada. In October 2001 the Society of Obstetricians and Gynaecologists SOGC submitted to Mr. Romanow concrete ideas and proposed actions to improve the health of Canadian women and their families and to sustain and strengthen Canada’s publicly funded health care system, in its report Ensuring Women’s Health: Options or the Future of Canada’s Health Care System. This Commentary brings to you the thoughts that the SOGC will continue to forward after the Romanow Commission’s report is delivered next month.     

SOGC 1996 Annual Clinical Meeting: Aboriginal Women’s Health: Cultural Values,Beliefs, and Practices

This article is a synopsis of presentations delivered at the SOGC Annual Clinical Meeting by Aboriginal health workers. Issues discussed included Aboriginal women’s health issues, Pap. smear screening, community midwifery, and HIV/AIDS.     

The effect of the magical hour on post-traumatic stress disorder (PTSD) in traumatic childbirth: a clinical trial

Objective: This study aimed to investigate the influence of the magical first hour after birth on post-traumatic stress in traumatic childbirths. Background: Traumatic childbirth with disturbing memories can have negative impacts on the mental health of postpartum mothers. Due to the growing trend of post-traumatic stress, the emphasis of recent research is on the identification and prevention of this kind of stress and the enhancement of maternal mental health. Methods: In this randomised clinical trial, which was carried out with 84 newly delivered mothers who were diagnosed with traumatic childbirth, participants were first randomly assigned into intervention (magical first hour) and control groups. Then, the nine instinctive stages were implemented to the intervention group while the control group received routine after-birth procedures. Then, using the Impact of Event Scale-Revised (IES-R), stress was measured at three intervals of 2 weeks, 4–6 weeks and 3 months after childbirth. The collected data were analysed using a mixed analysis of variance. Results: The mean total score of post-traumatic stress in the intervention group was 16.83 ± 1.1 and in the control group 21.04 ± 1.1, which showed a statistically significant difference between the two groups (P < 0.01). With the passage of time, the average scores of post-traumatic stress in both groups decreased and no interaction was observed between time and intervention. Conclusion: Implementation of the magical hour stages is recommended as a preventive and therapeutic guideline for relieving post-traumatic stress in women with traumatic childbirth experiences.     

Negative emotions,childbirth pain,perinatal dissociation and self-efficacy as predictors of postpartum posttraumatic stress symptoms

Objective: The aim of the study was to assess the contribution of negative emotions, childbirth pain, perinatal dissociation, and feelings of self-efficacy to the development of posttraumatic stress disorder (PTSD) symptoms following childbirth. Patients and methods: A prospective longitudinal study was carried out on 98 women from the south of France area. Four questionnaires were completed at 2–3 days postpartum: the Peritraumatic Emotions List (PEL), the French version of the McGill Pain Questionnaire, the Peritraumatic Dissociative Experience Questionnaire (PDEQ) and the Childbirth Self-efficacy Inventory (CBSEI). The Impact of Event Scale-Revised (IES-R) assessing posttraumatic stress symptoms was also completed 6 weeks after delivery. Results: Pain and negative emotions were significant predictors of the intensity of posttraumatic stress symptoms at 6 weeks postpartum. Although higher levels of pain contribute to increased PSTD symptoms, and higher negative emotion also contributes to PTSD symptoms, the effect of pain on PSTD is stronger when there are high levels of negative emotion. Discussion and conclusion: Our findings highlight that pain, negative emotions and their interaction were significant predictors of posttraumatic stress symptoms and confirm the importance of developing more specific treatments focusing on support and prevention.     

1607例妇女精神伤害状况分析

目的：了解深圳市妇女精神伤害的一般情况,探讨妇女精神伤害的影响因素及防控措施。方法：采取整群抽样的方法,调查深圳市16岁以上妇女1607人,分析妇女精神伤害的发生情况。结果：深圳市妇女精神伤害发生率为15．25％,各种类型的精神伤害发生率的差异具有统计学意义（P〈0．05）,非语言伤害的发生率最高为10.39％,强势压迫的发生率最低为2．61％。婚姻状况、月均收入、个人认知态度不同的妇女精神伤害发生率的差异有统计学意义（P〈0．05）,以已婚者、月均收入3000元者、认为精神伤害不违法、性质说不清的妇女精神伤害发生率较高,分别为10．21％、7．22％、14．87％、10．52％。结论 精神伤害严重影响着深圳市妇女的身心健康,应及早开展相应的干预措施,减少妇女精神伤害的发生。     

Obsessive-compulsive symptoms,intrusive thoughts and depressive symptoms: a longitudinal study examining relation to maternal responsiveness

ABSTRACT

Background

The postpartum period is a vulnerable time for the development of depression. While perinatal depression has been well studied, intrusive thoughts related to the infant and classic obsessive-compulsive (OC) symptoms (e.g. chequering, ordering and cleaning) are also common in the postpartum and less well understood.