Christine R. Isaacs

Strategies for Providing Low-Cost Water Immersion Therapy With Limited Resources

At our university-affiliated medical center, a major renovation of the womens health and birthing unit resulted in the temporary loss of the permanent tub used for water immersion therapy during labor. Because 40 percent of the women in the nurse-midwifery practice utilize hydrotherapy, we undertook a rigorous search for an interim solution. We developed a safe and cost-effective strategy that can be easily replicated and utilized by others to provide hydrotherapy for laboring women.

Implementation of a Hydrotherapy Protocol to Improve Postpartum Pain Management

Introduction: A growing number of women are seeking alternatives to traditional pharmacologic pain management during birth. While there has been an extensive array of nonpharmacologic options developed for labor, there are limited offerings in the postpartum period. The purpose of this quality improvement project was to implement a hydrotherapy protocol in the early postpartum period to improve pain management for women choosing a nonmedicated birth. Process: The postpartum hydrotherapy protocol was initiated in a certified nurse‐midwife (CNM) practice in an urban academic medical center. All women who met criteria were offered a 30‐minute warm water immersion bath at one hour postpartum. Pain scores were assessed prior to the bath, at 15 minutes after onset, and again at the conclusion (30 minutes). Women who completed the bath were also asked to complete a brief survey on their experience with postpartum hydrotherapy. Outcomes: In women who used the bath (N = 45), there was a significant reduction in pain scores (P < .001) between the onset of the bath and scores at both 15 minutes and 30 minutes. There was no significant difference between pain scores at 15 minutes and 30 minutes (P = .97). Of those women who completed a survey (n = 43), 97.7% reported both that the bath reduced their pain and improved their birth experience. One hundred percent reported they would use it again in another birth. Discussion: This project demonstrated successful implementation of a hydrotherapy protocol as an alternative or adjunct to medication for early postpartum pain management that significantly reduced pain and improved the birth experience for those who used it. It offers a nonpharmacologic alternative where there have traditionally been limited options.

Images in gynecologyHide and seek: Surgeons discovered multiple omental tumors during a hysterectomy

Stefansson. Hide and seek. Am J Obstet Gynecol 2014. Case notes A 46-year-old woman, gravida 4, para 4, was scheduled to undergo a hysterectomy for management of symptomatic fibroid tumors. Her past medical history was notable only for tobacco abuse. An uncomplicated total abdominal hysterectomy was performed using a vertical skin incision. Significant adhesive disease was noted in the pelvis. At the end of the procedure, multiple masses were palpated on the omentum. When exposed, the masses visually resembled fibroids and varied in size up to approximately 4 cm in diameter (Figure). One was resected and sent for frozen section. It was reported as a leiomyoma, which was consistent with the final pathology.

Hide and seek: surgeons discovered multiple omental tumors during a hysterectomy.

Stefansson. Hide and seek. Am J Obstet Gynecol 2014. Case notes A 46-year-old woman, gravida 4, para 4, was scheduled to undergo a hysterectomy for management of symptomatic fibroid tumors. Her past medical history was notable only for tobacco abuse. An uncomplicated total abdominal hysterectomy was performed using a vertical skin incision. Significant adhesive disease was noted in the pelvis. At the end of the procedure, multiple masses were palpated on the omentum. When exposed, the masses visually resembled fibroids and varied in size up to approximately 4 cm in diameter (Figure). One was resected and sent for frozen section. It was reported as a leiomyoma, which was consistent with the final pathology.