Painful breasts and perineum are a very common phenomenon in the early postnatal period. Both types will cause acute pain and may cause considerable distress and discomfort for many mothers. Assessing pain before offering advice on how best to alleviate the pain is an important issue. Midwives will, therefore, need to routinely assess the intensity and quality of the pain by asking mothers to self-report. It is generally accepted that acute pain is managed inadequately by the use of systemic analgesics alone. Localized pain relief, however, can assist to alleviate acute pain and hot and cold therapy throughout the centuries has been used effectively to achieve this. This product focus describes the benefits of two cooling devices (Mom's Breast Soother and the feme Pad) manufactured by Florri-Feme Pharmaceuticals Ltd, that will assist newly delivered mothers to achieve breast and perineal pain relief.
Calvert, Jan; Steen, Mary (Mark Allen Publishing, 2007-03)
The first of two articles. This article discusses a study that assessed the usage and impact of providing a self-administered kit of homeopathic remedies at the end of pregnancy, childbirth, and post-childbirth. The study was undertaken at the hospital and at home. Nineteen women in south Leeds participated in this study between September 2005 and February 2006.
This article discusses the anatomy and physiology of the pelvic floor and the important role it plays during childbirth. It will also consider damage that can be caused to the pelvic floor and in the genital/rectal region. Urinary and faecal incontinence, perineal injury (naturally occurring or surgically induced) and haemorrhoids can cause a lot of distress and pain for many women following childbirth. Alleviating the distress and pain associated with these problems is vitally important and will be explored.
This article discusses the high prevalence of genital tract trauma and its many negative consequences for women, such as being unable to sit down comfortably. Its highlights how suture technique and suture material can significantly contribute to the severity of perineal pain and discomfort and the importance of asking women about their ‘pain experience’. Treatments to alleviate the pain and discomfort are then reviewed. In conclusion, it would appear that a combination of systemic and localised treatments is necessary to achieve adequate pain relief which will meet individual women’s needs.
Steen, Mary; Allen, Rose (Mark Allen Publishers, 1999-07)
Pregnancy may trigger or exacerbate domestic violence, but current involvement of health professionals in dealing with this is poor. A training initiative undertaken in Leeds has developed a programme to help the midwife to recognise and support women who experience violence.
Steen, Mary; Jones, Alun; Woodworth, Barabara (Mark Allen Publishing, 2013-12-01)
Although becoming and being a parent are considered happy life events, parents can suffer from varying degrees of anxiety and variable mood. Anxiety and mood changes can be missed and this can lead to mental health problems if not recognised at an early stage. An insecure attachment in a parent's early infanthood can contribute to increased levels of anxiety and emotional problems when becoming and being a parent themselves, which can influence mother and child bonding as well as wider difficulties within family relationships. In many instances, attachment styles can be passed on to the infant causing a range of emotional and intellectual difficulties. In certain circumstances, these parents may benefit from psychotherapy. Psychotherapy is a method of addressing troubling emotions along with life difficulties and relationship struggles. Using psychological methods, a psychotherapist can help a person change his or her life for the better by becoming more effective in work or personal relationships. Local community support and befriending approaches have been shown to be beneficial in alleviating anxiety and depression. This article briefly describes what psychotherapy is and demonstrates ways in which interpersonal attachment styles established early on in life can bring difficulties to adult relationships. Two disguised scenarios referring to actual psychotherapy consultations are included to illustrate how plans can be put in place to address interpersonal difficulties related to attachment styles.
Women perceive, describe and react to pain differently; it cannot be easily quantified. Pain is a private and personal experience to the individual. It is, therefore, impossible for another person to know exactly what someone else’s pain feels like. When measuring pain there is a need to assess both the intensity and the quality of the pain to gain an insight into a person’s experience of pain. Therefore during a PhD Study which involved the investigation of the effectiveness of localised cooling treatments to alleviate perineal pain, women were asked to describe the pain as well as the intensity (Steen & Marchant, 2007). The quality of pain was measured by asking the woman to describe the pain in her own words. These words were analysed as pain descriptors under the themes of sensory, affective, evaluative and miscellaneous as described by the McGill Pain Scale. In addition, intensity, discomfort, physical symptoms, metaphors used and links to the expectations of the woman were considered. (Melzack & Wall, 1996). This article will give an overview of the pain syndrome, discuss measurement of pain methods and the use of word descriptors to assess the quality of pain. The assessment of perineal pain and women’s descriptions will be further explored. This insight will give an understanding of the pain experience of women who have perineal trauma following childbirth and this may lead to further research and the development of a specific evaluating tool.
Navviba, Shahin; Abedian, Zahra; Steen, Mary (Mark Allen, 2009-11)
The purpose of this paper is to report the findings of a randomised controlled trial undertaken at the Hazrat Ommolbanin University Maternity Hospital in Mashhad, Iran which investigated the effectiveness of localised cooling treatments to alleviate perineal trauma. From October 2005 to February 2006, 121 primiparous women who were at term and had an episiotomy were randomly recruited to one of three treatment groups (Group 1 - no localised cooling, Group 2 - Ice pack, Group 3 - cooling gel pad). The intensity of pain, wound healing and women’s satisfaction levels were the main outcomes measured. The intensity of pain was measured by a (Numeric Rating Scale (NRS) (0-10) and wound healing was evaluated by the REEDA scale within 4 hours of episiotomy repair, at Day 1, Day 2, Day 5 and finally at Day 10. The usage of oral analgesia (acetaminophen) was measured at Day 10. Women’s satisfaction levels with oral analgesia and localised cooling treatments were also assessed at Day 10 by a NRS (0-10). There was evidence that localised cooling treatments are effective at alleviating perineal pain which was in favour of the cooling gel pad group. A statistical significant difference was reported at 4 hours (p=0.003) Day 2 (p=0.004) and at Day 10 (p=0.044). At Day 1 and Day 5 there was evidence of a reduction in the intensity of pain but this did not reach a statistical significant difference. A reduction in the usage of oral analgesia (acetaminophen) was reported in favour of the cooling gel pad group (p<0.001). Women’s satisfaction levels with oral analgesia were similar within the three treatment groups but a higher level of satisfaction when assessing localised treatment was reported by the cooling gel pad group (p<0.001). Wound healing rates were also reported to be better in the cooling gel pad group when compared to the other two groups(p<0.001). In conclusion, treatments to alleviate perineal pain without any adverse affects on wound healing and women’s views are important aspects of midwifery care. This trial has demonstrated evidence that localised cooling of the perineum reduces the intensity of pain, women were more satisfied when applying cooling gel pads and this treatment appeared to assist in wound healing.
The risk of perineal injury during childbirth continues to affect the majority of women. Morbidity associated with perineal injury and repair is a major health problem for women. Therefore, it is vitally important that midwives are educated and trained to recognise risk factors and the extent of perineal injury. Education and training has been shown to assist midwives to gain confidence and clinical skills to suture competently and keep themselves up-to-date with the best available evidence on which to base their care. This article provides an overview of the literature relating to risk, recognition and repair of the perineum during the childbirth continuum.
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