Psychological Aspects of Women’s Health Care: The Interface between Psychiatry and Obstetrics and Gynecology, 2nd Ed. Stotland, Nada L., and Stewart, Donna E., Eds. Washington, DC: American Psychiatric Press, 2001. xv + 654 pp.
This is the second edition of a 1993 classic Psychological Aspects of Women’s Health Care. These books followed the volume, which we first welcomed with great pleasure in 1978, The Woman Patient, Medical and Psychological Interfaces: Sexual and Reproductive Aspects of Women’s Health Care, edited by Carol Nadelson and Malkah Notman. Many of the chapter titles are similar to those of the 1993 book and remain relevant and many have been updated. There have also been new chapters and authors added to this 2001 volume. Its goal is to increase the awareness and current knowledge about women’s health care from a biopsychosocial point of view not only for obstetricians and gynecologists but also for all medical specialists who care for women. The book fulfills its mission.
This volume is divided into three sections after a brief foreword by Robert Pasnau, a great pioneer in this field. The first part is an extensive review of pregnancy and the puerperium, followed by a section on gynecology and then a section on general issues, which is quite diverse and not necessarily restricted to obstetric and gynecologic specialties. It is interesting to compare the current volume with its predecessors and to observe what information has been added or deleted. There is a good essay on Normal and Medically Complicated Pregnancies written by Diane Phillips and Melanie Carr. In the section on the Psychological Stages of Normal Pregnancy, there are statements requiring further research such as quoting a paper which supposedly shows that women have impaired memory during pregnancy. The quote is “Nevertheless, beginning in the first trimester and continuing into the early postpartum period, a woman’s memory may be somewhat compromised” (p. 16). Another comment quotes a study suggesting that “women with high risk pregnancies were less likely to engage in health protective and health promoting behaviors than those with low risk pregnancies” (p. 24). Overall, the discussion of high risk pregnancies is good, but there is little mention here of ultrasound’s visualization of the fetus and its effects on attachment behaviors of both mothers and fathers. A shortcoming of this chapter is a lack of description of psychological management strategies in normal and/or high risk pregnancies. The essay on fetal anomalies does well at updating information on genetic disorders and describes the psychological distress experienced by the parents who may be called on to abort a wanted pregnancy. However, there are only two paragraphs on psychotherapy. The bibliography is short on recent references.
Laura Miller writes a beautiful chapter on the psychiatric disorders during pregnancy. As usual, her work is well organized, well written, very inclusive, and helpful to medical staff working on obstetric units as well as to the psychiatric consultants. It includes some very practical ideas in her section on General Principles of Intervention during Pregnancy including use of screening tools to help with diagnosis. She modestly does not include her own excellent book on postpartum psychiatric disorders in the extensive bibliography. Stewart and Robinson write in their usual excellent scholarly manner about psychotropic drugs and ECT during pregnancy and lactation. The only problem here again is that many of the references are more than 10 years old. These authors also have a chapter on postpartum disorders.
A new chapter in this section is definitely a classic and should be read by every staff person whose professional or personal life touches those of pregnant or would be pregnant women and their families. It is Irving Leon’s essay on pregnancy loss, which is beautifully written, extensively researched, and gives readers an outstanding overview of this subject. He discusses some general definitions and raises some questions pointing out that fetal demise is higher in the United States than in other industrialized nations. Ectopic pregnancies are more prevalent due to increased occurrence of pelvic infections. The greatest impact on coping and depression two years after a perinatal loss may not be the intensity of the initial grief reaction but the prepregnancy mental health of the individual. He points out that the effects of culture have not been well studied and that a woman’s attachment to her baby is a “variable psychological process not a biological inevitability” (p. 144). The pearls within this chapter are abundant. There are 6½ pages of references.
The section on gynecology begins with an outstanding review of the Psychological Aspects of the Menstrual Cycle by Margaret Jensvold and Corinne Dan. The chapter on Infertility remains almost unchanged from seven years before despite the editors promises that there is a “rapidly developing field of new reproductive technologies” (p. 7) and the book would reflect that. There is very little about management, which would have been helpful. Barbara Sherwin, noted for her research and writing on menopause, has written well about this subject and summarizes management in a brief way. The section on Chronic Gynecologic Pain by Steege and Stout should be regular reading by all trainees in the health care of women. Well organized and clear, it discusses one of the most difficult problems faced in gynecologic practice.
Another new classic in this book is the chapter written by Linda Hammer Burns on Gynecologic Oncology. She brings in and weaves together personality, biology, culture, and sexuality, uses tables that don’t appear elsewhere, and spends 2½ pages on psychologic treatments. It would have helped to have the editors use this chapter for a model for a more coordinated approach to their project.
There are several excellent review chapters: Women and HIV Infection, Female Sexual Disorders, Psychopharmacology in Women, Eating Disorders and Reproduction, Breast Disorders, Breast Cancer, the Male Perspective, and Lesbian Health Care. All medical providers need to read the chapters on Alcohol and Substance Abuse and Women and Violence. The latter contains a 22-page bibliography. Carol Nadelson has written a classic chapter on Ethics and Women’s Health, which is highly recommended for bioethicists as well as health care personnel. Mindy Fullilove’s chapter, What is a Minority: Issues in Setting a Dialogue, belongs close to the beginning of the volume rather than at the end so that each subject might be seen and read with more awareness of that aspect of care.
Some overall comments about this excellent book concern the editing. Although the book carries a publication date of 2001, in the section on brief biographies of the authors, there are inaccuracies. Katherine Wisner is no longer at the University of Pittsburgh and left there several years ago. Kimberly Yonkers is at Yale, not at the University of Texas. Many of the references are old; some still relevant, many not so. Many chapters beautifully describe their subjects, including the medical and psychological characteristics, but there is not as much information on management and treatment as one might hope.
Finally, in an excellent and highly recommended chapter on Lesbian Health Care, Margery Sved writes in her introduction that this text seeks to ameliorate the troubled relationship between women and the providers of their obstetric and gynecologic care. This book, as it predecessors did, has a much wider mission, to inform and educate both women and their caregivers so that preventive measures may help increase their health and wellness. It reaches its goal. It should be read and evaluated not just by psychiatrists but by the wider medical community.
Miriam B. Rosenthal, M.D.
Associate Professor of Psychiatry and Reproductive Biology, Case Western Reserve University, Chief of Behavioral Medicine, Department of Obstetrics/Gynecology, University MacDonald Women’s Hospital