Exercise is often recommended as a treatment for PMS, but there is no published study demonstrates its efficacy as the sole intervention. Timonen and Procope surveyed than 700 female college students and reported that premenstrual complaints were less frequent among those who participated in sports. Prior and Vigna compared the effects of exercise on premenstrual symptoms in sedentary women and runners. Increased exercise was associated with improvements in fluid and breast related symptoms, based on daily symptoms reports, as well as premenstrual dysphoria up to 6 months after initiation of an exercise program. No changes in control subjects were observed. In the strongest study design, Lemon evaluated the effect of aerobic training in 32 women with prospectively confirmed PMS. Women were randomly assigned to either a high-intensity aerobic training group or a low-intensity control group. Although the high-intensity aerobic group reported greater reductions, both groups exhibited significantly fewer symptoms as compared with baseline. Further controlled studies are needed to clarify whether exercise can alleviate or mitigate physiologic or psychological symptoms of PMS.
Source:
Debra A. Krummel, Penny M. Kris-Etherthon. Nutrition in Women's Health. Aspen Publishers, 1996.
Ectopic pregnancy occurs whenever the blastocyst implants anywhere except in the endometrium lining the uterine cavity. Possible sites for ectopic pregnancy include the cervix, fallopian tubes, ovaries, and abdomen. Predisposing factors to ectopic pregnancy are given in this section. For a woman with a suspected ectopic pregnancy, the midwife should draw blood for a quantitative human chorionic gonadotropin, obtain an ultrasound, and notify the consulting physician. Early diagnosis and referral to the physician are critical. If a tubal pregnancy can be diagnosed before rupture, microsurgery or medical management with methotrexate is more likely to save the fallopian tube.
Source:
Helen Varney. Varney’s Midwifery. Jones & Bartlett Publishers, 1997.
Postpartum depression starts later, is more intense and devastating, and lasts longer than postpartum after-baby blues. It may start anytime during the first year postpartum. The mother gradually slips deeper and deeper into depression, becomes increasingly incapable functioning, and thinks angry and hurtful thoughts about her baby, which she suppresses because she’s “not supposed to think this way.” She becomes lonely and isolated and feels she has lost control. She is truly suffering.
Beck has identified 11 themes and developed a checklist of 11 symptoms of postpartum depression a mother can experience, to be used by a health care professional in discussion with a mother:
Lack of ability to concentrate; feeling “in a fog”
Loss of previous interest and goals; feeling empty.
Unbearable loneliness; feeling that no one understands.
Insecurity and need to be mothered herself.
Obsessive thinking about being a bad mother.
Lack of positive emotions-perceives herself as going through motions like a robot.
Loss of self from fear that normalcy in her life is irretrievable.
Loss of control of her emotions.
Anxiety attacks; feeling that she is on the edge of insanity.
Guilt and fear at thoughts of harming infant.
Thoughts of death to end this living nightmare.
Postpartum depression should be differentiated from postpartum psychosis, which is a very confused state of extreme highs and lows, agitation, seeing and hearing things that others don’t (including voices that may “order” the persons to do things she normally would not do), and frightening thoughts of harming herself of her baby. A mother with these symptoms needs immediate psychiatric help. Postpartum depression also must be differentiated from postpartum thyroiditis with its symptoms of extreme fatigue and weight loss, or later, weight gain. Differentiation is difficult because both postpartum depression and postpartum thyroiditis present with overwhelming fatigue, which affects the mother’s activities of daily living and her capacity for taking care of her baby. A thyroid work-up is indicated when a mother’s depression is prolonged, her weight does not stabilize, the onset of her fatigue was rapid, and fatigue is present without physical exertion.
It is most helpful in the midwife’s approach to a mother with postpartum depression to acknowledge what she is experiencing and to tell her it’s ok to express what she may think are socially unacceptable negative feelings. Connecting her with support groups may be useful. Mild forms of depression may be helped with plans for coping such as getting out of the house, doing something for herself each day, having contact with and communicating with adults, talking with a friend about what she feels, doing some form of exercise, and paying attention to nutrition.
Source:
Helen Varney. Varney’s Midwifery. Jones & Bartlett Publishers, 1997.
Research in the 1930s led to the development of the earliest of the natural family planning methods,the “rhythm” method, also known as the calendar method. The method was based on this finding, a woman’s fertile period can be identified.
This method has many limitations because of the wide variation in the length of menstrual cycles. Because a fairly regular menstrual cycles. Because a fairly regular menstrual cycle is essential to any reliable estimation of the time ovulation, the following women cannot depend on the calendar method: women with menstrual cycles shorter than 25 days, women with irregular menstrual cycles, women with menstrual cycles that vary in length by 8 days or more, postpartum women, women who are lactating and women in the perimenopause.
The calendar method can only predict the days in a menstrual cycle during which a woman is more likely to get pregnant. This prediction is based on the projected time of ovulation as determined by calendar calculations made from the history of the length of the last 8 to 12 cycles. A woman must keep a record of menstrual cycles to identify the longest and shortest cycles so that all possible fertile days may be projected. The calculations used today allow for a variation factor of +2 days around the approximately 14 days prior to the onset of the next menstrual period, 2 or 3 days for sperm survival, and 1 day for ovum survival, for a minimum total of 9 fertile days.
The woman subtracts 20 days from the length of her shortest cycle to determine her first predicted fertile day and 10 days from the length of her longer cycle to determine her last predicted fertile day. The couple then abstain from sexual intercourse during the projected fertile days to prevent conception.
Although this method may be selected by some couples in United States and is still used in many countries, it has been supplanted by modern natural family planning methods that have proved to be more effective and require fewer days of abstinence. The latter methods differ from the calendar (rhythm) method in that they are based on clinical indicators of hormonal changes and identify the times of fertility and infertility as they occur in each and every cycle. These biological signs can be observed and interpreted by women and their partners.
Source:
Helen Varney. Varney’s Midwifery. Jones & Bartlett Publishers, 1997.
