Book Review

Abstract

J. Cockburn and M.E. Pawson, editors. Psychological Challenges in Obstetrics and Gynecology. The Clinical Management, Paper back, 332 pages, 15 illustrations. London: Springer-Verlag London Limited, 2007. ISBN-13: 978-1-84628-807-4. Price EUR 62.95, sFR 110.00, USD 79.95. This is a truly interesting volume, in which the editors and authors detach themselves from the common pathway where every ailment is labeled with an unequivocal diagnosis for which there is an evidence-based prescription. Thirty of the contributors to Psychological Challenges in Obstetrics and Gynecology are from UK, one from New Zealand, two from The Netherlands and one from Switzerland. They are a good mixture of psychologists, psychiatrists, social scientists, philosophers, general practitioners, obstetricians and gynecologists, and some whose specialty I have not been able to decipher. Their basic theme that mind and body are connected is not new, but often forgotten or neglected in our pursuit of an organic cause and the perfect treatment for each patient's complaints. Throughout the book we are reminded that human reactions to stimuli expected and unexpected are not uniform but differ widely. To become pregnant evokes joy in some women and depression in others. A few develop tokophobia, which is a profound dread and avoidance of childbirth. It may be rational, based on previous experience, or just a fear that defies common sense. Coming to grips with a diagnosis of infertility is a difficult process for the two individuals concerned, in which the physician will also be involved in unpredictable ways. We have all met the woman complaining of chronic pelvic pain, where all our diagnostic paraphernalia (including repeated laparoscopy) do not come up with a single cue. Communicating with cancer patients is an art demanding obeyance to certain rules. These are just a few of the many psychosomatic challenges in obstetrics and gynecology which are discussed in the book, with good advice and simple rules on how to help, counsel and treat. Some of the chapters are supplied with instructive case histories. The first part of the book gives the background for the study of psychosomatic obstetrics and gynecology, with teaching, the vaginal examination, communication skills, sexuality, and disability, normality and difference as some of the chapter headings. I was particularly intrigued by ‘Cross-cultural issues in gynecology and obstetrics’, in which Pittu Laungani (now deceased) describes traditions and customs relating to marriage, parental attitudes toward male and female children, infant mortality, examination of the patient, attitudes to contraception and sterilization, and more, from the Oriental (mainly Indian) point of view. The second part is devoted to psychosomatic problems in obstetrics: coping and adjustment in pregnancy, prenatal diagnosis, preterm labor and the premature baby, posttraumatic stress disorder, antenatal and postnatal depression, maternal suicide (did you know that suicide is now the major cause of maternal death in the UK?), tokophobia and stillbirth. The third part concerns gynecology, with unwanted pregnancy and early pregnancy loss as two of the themes, and premenstrual problems and sexual violence in addition to some I mentioned in the first paragraph as others. In appropriate chronological order, psychosocial aspects of the menopause conclude the thematic index. Psychological Challenges in Obstetrics and Gynecology deserves to be studied and consulted by obstetricians and gynecologists, from trainees to consultants, who should all heed its philosophy and good advice. It will also be of interest to general practitioners, midwives, psychologists and psychiatrists, in short all professionals consulted by women in need of help.