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Monday,
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Sunday, September 26, 2010
Title: Fear Factor: Anxiety Disorders in the Intrapartum Environment
Discipline: Women’s Health (WH), Professional Issues (PI), Newborn (NB), Childbearing (CB)
Learning Objectives:
Submission Description:- Discuss anxiety disorders related to childbirth.
- Describe interdisciplinary communication strategies used when caring for laboring women with anxiety disorders.
- Examine implications for future nursing practice.
This case study describes a nulliparous woman with a history of generalized anxiety who presented to labor and delivery at 40 weeks gestation with spontaneous rupture of membranes without onset of contractions. While the anxiety was controlled with medication prior to becoming pregnant, the woman was unmedicated during her pregnancy and had high levels of anxiety at the time of admission to the hospital for labor and birth.
Anxiety in pregnancy is common and changes through the course of pregnancy. It has been shown to be a risk factor for pre-term birth (Orr, Reiter, Blazer, & James, 2007) and postpartum depression (Lee, Lam, Lau, Chong, Chui, & Fong, 2009; Söderquist, Wijma, Thorbert, & Wijma, 2009). Much attention has been paid to detection of anxiety and other psychiatric disorders during pregnancy yet little information exists in the literature on how to effectively care for such women in the intrapartum setting. Anxiety during childbirth presents a problem for health care providers because of the resulting physiologic response. When a person experiences stress and anxiety, the body reacts by releasing catecholamines that serve to increase heart rate, respirations, cardiac output, blood pressure, and peripheral resistance. Normally this serves to help a person respond to the stressor but in the case of a person with an anxiety disorder, unnecessary neuronal activity occurs causing amplified anxiety symptoms. In the case of a pregnant woman, this excessive response has the potential to decrease blood flow and oxygen to the uterus and fetus.
In order to decrease adverse effects for mother and child, it is important that health care providers utilize psychological interventions during labor to decrease unnecessary anxiety and provide coping mechanisms that promote relaxation. This may present a challenge for nurses, physicians, and midwives who have only basic training in psychiatric care. Furthermore, laboring women presenting with high anxiety may experience low levels of perceived coping self-efficacy and increased pain resulting in an even greater need for reassurance and support.
In such an environment, the labor nurse has the opportunity to initiate communication with the patient, family, and physician in order to provide care that will promote effective coping and reduction of external stessors, resulting in a satisfying birth experience that is safe for mother and baby. The objectives of this session are to use a case study to describe the influence of interdisciplinary communication on patient outcomes, examine how anxiety affects the labor process, and discuss specific strategies utilized to promote maternal and fetal well-being while meeting the goals identified in the patient’s birth plan. The presentation will consist of an outline of the case study, review of the literature, interdisciplinary communication strategies, and implications for future practice.
Anxiety in pregnancy is common and changes through the course of pregnancy. It has been shown to be a risk factor for pre-term birth (Orr, Reiter, Blazer, & James, 2007) and postpartum depression (Lee, Lam, Lau, Chong, Chui, & Fong, 2009; Söderquist, Wijma, Thorbert, & Wijma, 2009). Much attention has been paid to detection of anxiety and other psychiatric disorders during pregnancy yet little information exists in the literature on how to effectively care for such women in the intrapartum setting. Anxiety during childbirth presents a problem for health care providers because of the resulting physiologic response. When a person experiences stress and anxiety, the body reacts by releasing catecholamines that serve to increase heart rate, respirations, cardiac output, blood pressure, and peripheral resistance. Normally this serves to help a person respond to the stressor but in the case of a person with an anxiety disorder, unnecessary neuronal activity occurs causing amplified anxiety symptoms. In the case of a pregnant woman, this excessive response has the potential to decrease blood flow and oxygen to the uterus and fetus.
In order to decrease adverse effects for mother and child, it is important that health care providers utilize psychological interventions during labor to decrease unnecessary anxiety and provide coping mechanisms that promote relaxation. This may present a challenge for nurses, physicians, and midwives who have only basic training in psychiatric care. Furthermore, laboring women presenting with high anxiety may experience low levels of perceived coping self-efficacy and increased pain resulting in an even greater need for reassurance and support.
In such an environment, the labor nurse has the opportunity to initiate communication with the patient, family, and physician in order to provide care that will promote effective coping and reduction of external stessors, resulting in a satisfying birth experience that is safe for mother and baby. The objectives of this session are to use a case study to describe the influence of interdisciplinary communication on patient outcomes, examine how anxiety affects the labor process, and discuss specific strategies utilized to promote maternal and fetal well-being while meeting the goals identified in the patient’s birth plan. The presentation will consist of an outline of the case study, review of the literature, interdisciplinary communication strategies, and implications for future practice.
