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Follow-up study of psychological consequences of caesarean childbirth
Citations from the Literature also significantly more likely than controls to have been a victim of childhood and adult sexual abuse. There were no significant differences in either the degree or type of pelvic disease between patients with pelvic pain and controls. Impact of sexual and physical abuse on women’s mental health Mullen PE; Romans-Clarkson SE; Walton VA; Herbison GP Department of Psychological Medicine, University of Otago, Dunedin. New Zealand LANCBT; l/8590(841-845)/1988/ The level of psychiatric symptomatology was assessed with the General Health Questionnaire and the Present State Examination in a random community sample of women. Subsequently it was ascertained which of the women had been the victims of sexual or physical abuse, in either childhood or adult life. Women with a history of being abused were significantly more likely to have raised scores on both measures of psychopathology and to be identified as psychiatric cases. 20% of women who had been exposed to sexual abuse as a child were identified as having psychiatric disorders, predominantly depressive in type, compared with 6.3% of the non-abused population. Similar increases in psychopathology were found in women who had been physically or sexually assaulted in adult life. These findings indicate that the deleterious effects of abuse can continue to contribute to psychiatric morbidity for many years. Follow-up study of psychological consequences of caesarean childbirth Garel M; Lelong N; Kaminski M INSERM, Unite 149, 94807 Villejuif Cedex, France EARLY HUM. DEV.: 16/2-3 (271-282)/1988/ This study was the follow-up part of a survey of psychosocial consequences of caesarean delivery (J. Psychosom. Obstet. Gynecol., 6 (1987) 197-209). Two groups of primiparous mothers were compared, one group of 103 mothers delivered by caesarean section and one control group of 103 mothers delivered by vaginal delivery. Semi-structured questionnaires were mailed at 2 months and 1 year after birth to explore the mothers’ physiological and psychological condition and mother-infant adaption. At 2 months, 92 mothers in the caesaren section group and 84 mothers in the control group returned a completed questionnaire. At one year there were, respectively, 79 and 71 in each group. The data indicated that the most obvious long-term psychological ill-effects of caesarean delivery appeared to be on mothers. They more often reported psychosomatic symptoms during first year than controls. At 2 months the concerns of caesarean mothers seemed more self-oriented than in the control group. They also felt less confident about their abilities to care for their babies. At 1 year these differences disappeared. Signs of disturbance in motherinfant interaction were not linked to the mode of delivery either at 2 months or at 1 year. The influence of the mode of anaesthesia for surgical delivery was also examined. The positive consequences of epidural analgesia which were observed are discussed taking into account the role of confounding variables.
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The pregnant brain dead and the fetus. Must we always try to wrest life from death? Loewy EH Depaknent of Medicine, University of Illinois College of Medicine, Peoria, IL 61656, USA AM. J. OBSTET. GYNECOL.; 157/5 (1097-1101)/1987/ This article deals with the ever more timely and often vexing topic of maintaining a brain-dead mother as an incubator for her developing offspring. It explores the issue by: (1) reviewing the history of the problem and the ‘state of the art’ today, (2) examining the moral problem of using brain-dead persons as incubators for potential or actual others, (3) searching for moral differences between maternal death early or late in pregnancy, and (4) presenting a possible resolution in such tragic cases. It concludes that (1) a moral necessity to deliver viable infants from brain-dead mothers exists; (2) the farther from viability brain death occurs, the more maintaining the mother as an incubator resembles experimental therapy with its imperative for careful, informed consent; (3) experimental therapy not being morally necessary, its proceeding under these tragic circumstances should invoke community support for the next of kin in dealing with the immediate and long-term costs; (4) all ethical problems proceed in a context to which the moral actors must be sensitive and one that alters the conclusions made.
Neonatologists judge the ‘Baby Doe’ regulations Kopelman LM; Irons TG; Kopelman AE Department of Medical Humanities, East Carolina University School of Medicine, Greenville, NC 27858-4354, USA NEW ENGL. J. MED.; 318/11(677-683)/1988/ The federal regulations now in effect governing the treatment of severely handicapped infants - the so-called Baby Doe regulations - are based on the 1984 amendments to the Child Abuse Prevention and Treatment Act; these regulations require that, except under certain specified conditions. all newborns receive maximal life-prolonging treatment. We sent quetionnaires to the 1007 members of the Perinatal Pediatrics Section of the American Academy of Pediatrics to determine their views on the Baby Doe regulations and on whether the regulations had affected their practices; 494 of the members (49 percent) responded. Of the respondents, 76 percent believed that the current regulations were not necessary to protect the right of handicapped infants; 66 percent believed that the regulations interfered with parents’ right to determine what course of action was in the best interests of their children; and 60 percent believed that the regulations did not allow adequate consideration of infants’ suffering. In responding to the three hypothetical cases of severely handicapped newborns, up to 32 percent of the respondents said that maximal life-prolonging treatment was not in the best interests of the infants described but that in the Baby Doe regulations required such treatment. The responding neonatalogists’ concerns about the current Baby Doe regulations were similar to those expressed by the United States Supreme Court in rejecting an earlier set of Baby Doe regulations. This similarity suggests that the current Baby Doe regulations should be reevaluated. Int J Gynecol Obstet 28
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The pregnant brain dead and the fetus. Must we always try to wrest life from death? Loewy EH Depaknent of Medicine, University of Illinois College of Medicine, Peoria, IL 61656, USA AM. J. OBSTET. GYNECOL.; 157/5 (1097-1101)/1987/ This article deals with the ever more timely and often vexing topic of maintaining a brain-dead mother as an incubator for her developing offspring. It explores the issue by: (1) reviewing the history of the problem and the ‘state of the art’ today, (2) examining the moral problem of using brain-dead persons as incubators for potential or actual others, (3) searching for moral differences between maternal death early or late in pregnancy, and (4) presenting a possible resolution in such tragic cases. It concludes that (1) a moral necessity to deliver viable infants from brain-dead mothers exists; (2) the farther from viability brain death occurs, the more maintaining the mother as an incubator resembles experimental therapy with its imperative for careful, informed consent; (3) experimental therapy not being morally necessary, its proceeding under these tragic circumstances should invoke community support for the next of kin in dealing with the immediate and long-term costs; (4) all ethical problems proceed in a context to which the moral actors must be sensitive and one that alters the conclusions made.
Neonatologists judge the ‘Baby Doe’ regulations Kopelman LM; Irons TG; Kopelman AE Department of Medical Humanities, East Carolina University School of Medicine, Greenville, NC 27858-4354, USA NEW ENGL. J. MED.; 318/11(677-683)/1988/ The federal regulations now in effect governing the treatment of severely handicapped infants - the so-called Baby Doe regulations - are based on the 1984 amendments to the Child Abuse Prevention and Treatment Act; these regulations require that, except under certain specified conditions. all newborns receive maximal life-prolonging treatment. We sent quetionnaires to the 1007 members of the Perinatal Pediatrics Section of the American Academy of Pediatrics to determine their views on the Baby Doe regulations and on whether the regulations had affected their practices; 494 of the members (49 percent) responded. Of the respondents, 76 percent believed that the current regulations were not necessary to protect the right of handicapped infants; 66 percent believed that the regulations interfered with parents’ right to determine what course of action was in the best interests of their children; and 60 percent believed that the regulations did not allow adequate consideration of infants’ suffering. In responding to the three hypothetical cases of severely handicapped newborns, up to 32 percent of the respondents said that maximal life-prolonging treatment was not in the best interests of the infants described but that in the Baby Doe regulations required such treatment. The responding neonatalogists’ concerns about the current Baby Doe regulations were similar to those expressed by the United States Supreme Court in rejecting an earlier set of Baby Doe regulations. This similarity suggests that the current Baby Doe regulations should be reevaluated. Int J Gynecol Obstet 28