Beverley Chalmers

Postpartum depression and companionship in the clinical birth environment: a randomized, controlled study.

OBJECTIVEnPostpartum depression is a common feature of childbearing and is the cause of considerable morbidity. We have explored the possibility that clinically oriented care during labor may contribute to its occurrence.nnnSTUDY DESIGNnOf 189 nulliparous women laboring in a familiar community hospital, 92 were allocated by randomized, sealed envelopes to receive additional companionship from one of three volunteer labor companions recruited from the community.nnnRESULTSnThe group receiving support attained higher self-esteem scores and lower postpartum depression and anxiety ratings 6 weeks after delivery.nnnCONCLUSIONnIn the clinical labor environment companionship modifies factors that contribute to the development of postnatal depression. We emphasize the importance of paying attention to the psychosocial environment in which labor takes place, to facilitate adaptation to parenthood.

Social support in labor―a selective review

Support during labor has been offered by a variety of different people, including fathers, professional medical staff, trained labor coaches and monitrices, untrained lay supporters and family and friends. A comparison of the various findings shows that support given by trained or lay untrained female supporters, who are not necessarily known to the laboring woman, yields the most extensive, methodologically sound, and consistently positive effects on obstetric and psychosocial outcomes. Although trained labor coaches have been shown to exert a positive effect on outcome, the results of doula support are the most impressive when both methodology and outcome effects are considered. Studies of father support have yielded contradictory findings, although women do appear to value their presence in most studies. Family and friends have not been shown to influence outcomes. Support from professional medical staff is rare, but when given, has, in some cases, had a positive effect. These findings are important for the field, since the use of lay supporters constitutes a low-cost preventive intervention. The inclusion of lay supportive women is also consistent with traditional practices in most countries in the world.

Labor Experience, Maternal Mood and Cortisol and Catecholamine Levels in Low-Risk Primiparous Women

This exploratory, prospective study was set up to determine the relationship between cortisol and catecholamine levels and labor experience and postpartum maternal mood. It was performed at the Coronation Hospital, which serves a low-income urban population in Johannesburg. Blood samples were taken from 189 low-risk primiparous women in active first stage of labor and analyzed for cortisol, norepinephrine, epinephrine and dopamine. The stress hormone levels were then correlated with maternal anxiety, depression and self-esteem scores, and changes associated with mothers labor experience and pain. Patients who were distressed and required analgesia had higher cortisol levels. Those who described a more positive labor experience at 24 hours also had higher cortisol levels. There were no significant correlations between psychological test scores and stress hormone levels. Both labor pain at the time and a more positive recollected labor experience were associated with high cortisol levels. Cortisol and catecholamine levels in labor did not correlate with postpartum psychological test scores.

Post-Partum Depression: a Revised Perspective

Post-partum depression is discussed from both a theoretical and a clinical standpoint. Theoretically, some aetiological issues surrounding the ‘third day blues, and ‘post-partum depression as opposed to ‘post-partum psychosis are summarized. Based on literature reports as well as on clinical experience with White South African women, some major concerns of women presenting with post-partum depression are outlined.The idea that ‘post-partum depression is an inappropriate name for this condition is presented. Treatment is discussed within this context.Finally, the aetiology of post-partum depression within a broad societal change framework is speculated upon

Critique of a critique

In her article II Anagrams: Ars Magna?lI in the May 1974 Word Ways, Judith Tarr Isquit described the results of an experiment in which 20 anagrams and antigrams, ten composed by Jezebel Q. Xixx and ten compo sed by variou s membe r s of the National Pu zzIe r s I Le ague, were rated by a pane] of 25 people regarding their appositeness and grammatical correctnes s. In a critique following this article, Ms. Xixx argued that the panel was demonstrably incompetent, on the grounds that they rated an excellent antigram (of hers) much lower than a relatively inferior anagram (of the NPL) .

Terminology used in early pregnancy loss

The use of the term ‘abortion’ to describe an unwanted early pregnancy loss is frequently reported as hurtful to women (Chalmers & Hofmeyr 1989; Oakley et al. 1984). Overtones of ‘induced’ or ‘illegal’ abortion often contrast with women’s disappointment at the time of the unwanted loss. Some years ago Beard et al. (1985) appealed for attention to be directed to the psychological meaning of the term ‘abortion’ for women who experience a pregnancy loss unwantedly. It appears that publications in the British Journal of Ohstetrics and Gynaecology have taken heed of this appeal. A count of the titles of papers published in this Journal referring to unwanted early pregnancy loss in 1981-2 and 1989-90 revealed a change in terminology used before and after the editorial by Beard et al. (1985) (Table 1). Whereas almost all the papers at the start of the decade used the term ‘abortion’ in their titles, none of those published later did so. Little research has, however, systematically examined the meaning of terminology regarding pregnancy loss for women. Some exploratory research in this area suggests that the preferred terminology, at least from the woman’s perspective, may be culturally determined. Cross cultural research into womens’ preferences for the use of ‘abortion’ or ‘miscarriage’ indicates that women from different cultural backgrounds may not be equally concerned about medical terminology with its possible negative emotional overtones. In a study of 106 women experiencing a first pregnancy loss before 28 weeks, 32 expressed a dislike for the word ‘abortion’, 37 were indifferent to its use whereas 25 preferred it. In this small pilot sample, women of mixed cultural origin disliked the term more than others; White and Indian women were predominantly indifferent to its use and African women expressed a liking for it (Chalmers & Meyer 1991). It is apparent that cultural variations in the meaning of medical terminology may occur and must be recognized by doctors. Further research is needed to explore this issue. Research and comment has concentrated on the use or misuse of the term ‘abortion’ for describing spontaneous early pregnancy loss. There are, however, other phrases used when caring for women who lose babies which may also have emotionally negative connotations and which should be examined. Terms such as ‘failed pregnancy’, ‘incompetent cervix’, ‘inadequate germ plasma’, and ‘abnormal chromosomal

Cross-cultural Obstetrics Black women's birth experiences: Changing traditions

Black traditions regarding pregnancy and birth are explored amongst women experiencing hospital or clinic births in both rural and urban environments. A total of 171 Pedi women were interviewed with regard to their knowledge of and adherence to traditional Black approaches to childbirth. Traditions regarding signs of pregnancy, events during pregnancy and delivery, practices regarding early infant care and sources of knowledge about these experiences are explored.In general a lack of adherence to traditional approaches to pregnancy and birth is revealed in the sample studied. Exceptions to this occur with regard to the husbands role in labour and the early post-partum period, as well as to the womens need to keep news of their pregnancies to themselves. Results suggest that women are turning to medical professionals, particularly nurses, as sources of knowledge about pregnancy, birth and infant care, rather than to traditional sources of such information.

Behavioural Associations of Pregnancy Complications

Research into the aetiology of pregnancy complications has concentrated on physiological and psycho-social variables. With the exception of research into preparation for childbirth and social support during pregnancy, little attention has been given to the influence of maternal behaviour or attitudes on pregnancy outcome. The present study has examined, in an exploratory manner, the association of some maternal behaviour and attitudes with obstetric difficulties.Data were obtained from 551 women. Exploratory statistical analysis of the 152 variables measured suggests that behaviour and attitudes that reflect a denial of the difficulties occurring frequently during pregnancy may be associated with obstetric complications. On the other hand, an acknowledgement of negative aspects of pregnancy appears to be less strongly related to obstetric difficulties.

A Conceptualization of Psycho-Social Obstetric Research

A framework within which to view psycho-physiological pregnancy research is presented. Based on a model of stress, the framework follows a sequence of demand-perception-response-consequence. Each stage of the sequence is analysed in terms of its psychological (incorporating emotional, cognitive, and psycho-social components), behavioural and physiological aspects. It is suggested that the model is most useful for the conceptualization and design of multivariate research on psycho-social obstetric issues.

Obstetricians' and mothers' perceptions of obstetric events

The present study was designed to explore mothers experiences of obstetric events and obstetricians perceptions of these experiences. A positive—negative rating continuum was used to assess the reactions of 147 women and 46 obstetricians to 46 events occurring during pregnancy and labor.In general, mothers view obstetric interventions positively. Psychosocial factors in particular arc viewed very positively. Obstetricians, on the other hand, overestimate the negative reactions of mothers to most obstetric events and underestimate the positive value of psychosocial factors for women in labor.