Shari Munch

Health-related quality of life in women with nausea and vomiting of pregnancy: the importance of psychosocial context

Objective:To test whether women with hyperemesis gravidarum (HG) demonstrated lower health-related quality of life (HRQoL) scores compared with those with nausea and vomiting of pregnancy (NVP).Study Design:Women with HG or NVP were examined during the first trimester. Multivariate models identified characteristics of women at risk for low HRQoL, as measured by an NVP-specific HRQoL test and a generic HRQoL test, the Short Form (SF)-36.Result:Although the SF-36 assessment did not discriminate between the two groups, the NVP-specific test showed that women with HG (N=29) were 3–6 times more likely than women with NVP (N=48) to have low HRQoL. Both tests demonstrated that perceived physical symptoms and multiple psychosocial factors, such as depression and marital status, seemed to be equally or more important than having HG.Conclusion:Although a low HRQoL was associated with an HG diagnosis, multiple physical symptoms and psychosocial factors placed both groups of women at risk.

Chicken or the egg? The biological-psychological controversy surrounding hyperemesis gravidarum.

Womens somatic complaints are more likely to be labeled by physicians and other health care professionals as psychologically based when the condition has an obscure etiology. Perhaps because of this, there are a number of medical conditions which have been under investigated and where erroneous assumptions about them exist. Hyperemesis gravidarum (HG)--severe nausea and vomiting during pregnancy--is an example of such an illness. HG remains a puzzling condition for both physicians and patients because there is no known cause or cure. By its very nature, HG has a clearly established biological cause--pregnancy. Yet, because the exact causal pathophysiological mechanism is unknown, the organicity of the pregnant state is either minimized or ignored. This paper examines how HG is characterized in the literature and the empirical basis for psychogenesis. Analysis of the literature reveals a tension in the discourse such that both biologic and psychologic approaches to HG have existed in parallel tracks throughout history. Still, results support that sociocultural factors rather than scientific evidence have shaped the overarching and predominant illness paradigm of psychogenesis. Implications for womens health care and HG, in particular, are presented.

Women's experiences with a pregnancy complication: causal explanations of hyperemesis gravidarum.

Abstract There is a multiplicity of proposed causes, yet a scarcity of research regarding the pregnancy complication, hyperemesis gravidarum (HG), severe nausea and vomiting. This is not unlike other female medical conditions that have been underinvestigated, and perhaps as a result, erroneous assumptions about them persist. This is a report of qualitative findings from a larger study that investigated, in part, illness perspectives of 96 women with HG. Results reveal women view HG as biologically determined and that it has substantial impact on their daily functioning. The study challenges commonly held notions that HG is a psychosomatic disorder.

Gender-Biased Diagnosing of Women's Medical Complaints: Contributions of Feminist Thought, 1970–1995

ABSTRACT With the advent of second-wave feminism during the 1970s, a significant body of literature emerged describing sexist practices in womens health care. Gender-biased diagnosing-the notion that somatic complaints by female medical patients are more likely to be labeled by physicians as psychosomatic-became a concern that garnered considerable attention in Europe and the United States because of the increased health risks it posed for women. This article examines the impact of feminist knowledge on this topic during the quarter century spanning 1970–1995. Analysis of the literature reveals feminist perspectives played a critical role in uncovering and problematizing gender bias in womens health care.

A qualitative analysis of physician humanism: women's experiences with hyperemesis gravidarum.

OBJECTIVE: To explore the humanistic qualities of physicians deemed important to women who have experienced hyperemesis gravidarum (HG), thereby, contributing to patient satisfaction.STUDY DESIGN: Semistructured telephone interviews were conducted with 96 women who had experienced HG. Content analysis was the qualitative method used to analyze and interpret the interview texts.RESULTS: Patient satisfaction was associated with womens perceptions that physicians believed their accounts of their symptoms (i.e., that the woman is neither fabricating symptoms nor overreacting). The perception of being believed by doctors (and other health care provides) was important in terms of feeling validated that their illness was “real,” and imperative to women seeking and receiving medical care. Perceived delays in diagnosing and/or instituting treatment were viewed as contributing to unnecessary exacerbations of the illness and hospitalizations, increased emotional strain, and psychologic stress.CONCLUSION: This study highlights the importance of physicians “believing a patients story” in contributing to patient satisfaction and possibly health outcomes.

Predictors of Maternal Depression in the First Year Postpartum: Marital Status and Mediating Role of Relationship Quality

Existing literature has documented the associations between marital status and maternal depression within the first year postpartum. Using data that is representative of urban non-marital births in the United States with a large over-sample of non-marital births, we investigate the association of maternal depression with not only marital status but also relationship quality with the father of the baby. Quality is independently associated with maternal depression after controlling for marital status and other variables that have been documented as risk factors for maternal depression. In addition, relationship quality explains away the associations between marital status and maternal depression. After controlling for relationship quality, single women were no more likely to be depressed compared to married or cohabiting women.

Support for Siblings of NICU Patients: An Interdisciplinary Approach

Siblings of hospitalized newborns in neonatal intensive care units (NICU) experience unique thoughts and feelings in response to this situational crisis. Providing an opportunity for siblings and their parents to address both of their concerns can improve sibling adjustment to the NICU, and is also consistent with a family-centered care philosophy. This article traces the development and evolution of sibling policy and program changes at Helen DeVos Childrens Hospital (HDVCH) NICU, and describes the current comprehensive model for inclusion of siblings. Particular emphasis will be given to the cornerstone program “Celebrating Siblings Pizza Party.” Infection control considerations and the importance of an interdisciplinary team approach to enhance an array of sibling services are also highlighted.

The Women's Health Movement: Making Policy, 1970-1995

Abstract With the advent of second-wave feminism during the 1970s, a significant body of literature emerged describing sexist practices in womens health care. Gender-bias and gender disparities found in womens health care became concerns that garnered considerable attention in the United States because of the increased health risks posed for women. This article describes key historical challenges and accomplishments made in U.S. womens health care policy during the quarter century spanning 1970-1995 that influence contemporary health care social work practice and social work education.

The Writing Series Project: A Model for Supporting Social Work Clinicians in Health Settings to Disseminate Practice Knowledge

Social work clinicians across health care settings are uniquely positioned to disseminate valuable practice experience, thereby contributing to knowledge development within their field of practice and across disciplines. Unfortunately, practitioners tend to shy away from writing and research, and are often reluctant to publicly disseminate their expertise through peer-reviewed journals and conference presentations. To better support health social workers in scholarly endeavors, we developed and implemented The Writing Series Project in southeast Queensland, Australia. This article reports on the development, programmatic challenges and practitioner feedback that offer insight into the benefits and pitfalls that we encountered.

Practicing maternal virtues prematurely: The phenomenology of maternal identity in medically high-risk pregnancy

ABSTRACT In this study, we examine the phenomenology of maternal identity development among U.S. women hospitalized with medically high-risk pregnancies (MHRP). We conducted 16 in-depth interviews with women and found that they drew on culturally normative notions of maternal nurture, worry, and sacrifice to construct maternal identity in the context of MHRP. Based on our findings, we suggest that MHRP shape womens sense of connection to and distinctive cognitive representations of their fetus. We conclude that hospitalization simultaneously promotes and challenges womens early maternal identifications.