Stop. Look. Listen! Page 17

incidence among women who had Cesareans without a trial of delivery.

Overall, he concluded, the surge in Cesarean deliveries has not
significantly increased serious maternal complications with morbid
consequences, because independent of surgical vs. vaginal delivery
route, serious complications are declining for deliveries overall.

At the same time, he noted if Cesarean deliveries had not increased
beyond 19 percent of low-risk deliveries, there might have been

greater improvement among several types of maternal complications:

Systemic complications would have declined 52 percent, not
35 percent

Major infections would have declined 49 percent, not 44 percent

Vascular complications would have increased 5 percent, not
26 percent

Transfusions would have increased 69 percent, not 94 percent

Maternal Safety and the

Delivery of Safe Patient Care

Anthony Tobia, MD

Research Scientist
Clinical Associate Professor of Psychiatry
Rutgers Robert Wood Johnson

Medical School

ncreasing attention has been placed over the past few decades
on identifying and treating women with postpartum depression, a

condition that affects an estimated 13 percent of women--about one
in every eight--usually within one to three months after delivery.
Symptoms of postpartum depression range from mild to severe and
usually last a minimum of two weeks. There are many protocols in
place that aim to assist new mothers who experience postpartum
depression.

Although most health care teams and patients know about postpartum
depression, scant attention has been directed to the prevalence of
anxiety and specific anxiety disorders (e.g., panic attacks, anxiety due to
medical illness, specific phobias, etc.) in postpartum women and
providing them with treatment for these conditions. Yet, anxiety appears
to be far more common in the days after childbirth than depression,
according to findings published in the April 2013 issue of Pediatrics.

Anxiety, or "psychic pain," is a signal to an individual of an impending
internal threat. There is conflict between the part of the individual's psy-
che that is concerned about the way she is feeling and the part that
discounts those feelings (Patients may think, "It's not right to think that
the doctors don't know how to handle my pain; they're wearing white
coats, not me."). This conflict creates a friction that is expressed in a
variety of verbal and non-verbal signs and symptoms. However, in some
individuals, their ego defense mechanisms may result in their not saying
anything about their concerns, or suppressing what they are feeling,
Dr. Tobia said. As a result, a patient's anxiety may get in the way of
proper clinical diagnosis and treatment--particularly if the practitioner
is unaware of the non-verbal cues, or the possibility anxiety may be
present in the postpartum patient who is not verbalizing it.

Two strategies can help practitioners avoid missing this diagnosis:

(1)

recognize that postpartum anxiety may be an issue with the

patient, and

(2)

overcome the tendency toward minimalizing this

condition if anxiety is present.

One means of facilitating improved
maternal health and safety is to

EMPOWER

patients:

liminate

aternity

atients'

bstacles

ith

mpathetic

egard. Central to this idea

is the provision of patient-centered care
that focuses on listening, understanding
body language, and effective clinician/
nurse/patient communication. Active
listening skills, coupled with adaptation
of a formal assessment tool for post-
partum depression, not only can improve
the overall outcome of the patient,
but in particular, help determine whether
a patient may be experiencing anxiety.
Data clearly show that anxiety can often
be a barrier to care.