The medical model in psychiatry assumes medical intervention is the treatment of choice for the constellations of diagnosed symptoms that comprise various mental disorders. These treatments may include pharmacotherapy, electroconvulsive treatment, brain stimulation, and psychosurgery. Therefore, psychopharmacology for older adults can be considered palliative rather than a cure for a brain disease causing psychopathology. Older adults experience many psychopathological problems, including anorexia tardive, anxiety disorders, delusional disorders, mood disorders, personality disorders, schizophrenia, and co-occurring disorders with substance abuse/dependence disorders. Therefore, it is critical for the social worker to understand the various manifestations of psychological problems in older adults from the perspective of an older adult, rather than extrapolating information commonly taught in social work programs that neglect to focus on older adults and restrict teaching to psycho-pathological problems in younger and middle-aged adults.

The baby boom cohort brings with it multiple types of substance abuse. Bisexual older adults have more co-occurring psychological problems than heterosexual older adults, older gay males, and older lesbians. An interesting finding is that immigration is contributory to older adult substance abuse. Older adults with alcohol-abuse problems do not seek help for their problems. Rather, they are often identified as having an alcohol-use problem when seeking care for other medical or psychological problems. Social workers assessing an older adult for alcohol abuse often confuse symptoms of possible alcohol abuse with dementia. Prescribing opioids and synthetic opioids to an older adult is complicated. An older adult can suffer from many forms of inner tension. Combining motivational interviewing with cognitive behavioral therapy is shown to be more effective for treating substance abuse that either therapeutic modality alone.

For older adults, the phenomenon of death is accepted and does not induce the fear experienced by younger adults. Older adults who do not engage in end-of-life planning may receive unwanted, unnecessary, costly, and painful medical interventions or withdrawal of desired treatment. Many older people feel that the goal of palliative care is to make the best possible dying experience for the older adult and his/her family. In addition to palliative care, an older adult will most likely find himself or herself in an intensive care unit as part of his or her terminal care. Euthanasia, or hastened death, is seen by some as an alternative to palliative care. A psychological aspect of death that an older adult is concerned with, in addition to place of death, is whether he or she will die in his or her sleep or die suddenly, making the death experience an individual phenomenon.

In the postpartum period, secondary postpartum hemorrhage (SPPH) and endometritis are two conditions that frequently present to an obstetric triage unit. These complications may coexist and can occur from 24 hours postpartum to 6 weeks postdelivery. SPPH is typically not as severe as a primary bleeding episode. Postpartum women ultimately diagnosed with endometritis are generally stable, but less commonly can present in septic shock. This chapter discusses presenting symptomatology, history and data collection, physical examination, laboratory and imaging studies, differential diagnosis, and clinical management and follow-up of secondary postpartum hemorrhage and postpartum endometritis. Prompt treatment of both SPPH and postpartum endometritis can reduce maternal morbidity and mortality. SPPH is managed with the same guiding principles as primary postpartum hemorrhage. Initial treatment for postpartum endometritis is intravenous clindamycin and gentamicin.

Pregnant women presenting with abdominal pain to an emergency department or obstetric triage setting frequently have a diagnostic ultrasound (US) to assess fetus, placenta, and adnexae. In the first trimester, symptomatic adnexal masses typically present with unilateral or bilateral pelvic cramping or pressure. Obtaining a history in a pregnant woman with abdominal pain is similar to doing so for the nonpregnant patient. In addition to routine cardiopulmonary examination, abdominal examination, and assessment for costovertebral angle tenderness, a sterile speculum and vaginal examination are performed to evaluate for adnexal or uterine tenderness, cervical dilation, and potential rupture of membranes. If a mass is suspected, US is the preferred imaging modality. Magnetic resonance imaging can be employed if additional imaging is needed. Differential diagnosis of abdominal pain in pregnant women must include other obstetric and nonobstetric causes of pain. This chapter describes clinical management and follow-up of pregnant women with adnexal masses.

Maternal sepsis is a common pregnancy-related condition; in the United States, it is a leading cause of maternal mortality, accounting for up to 28” of maternal deaths and up to 15” of maternal admissions to the intensive care unit. One contributing and modifiable factor to these deaths is failure to recognize sepsis, leading to delays in treatment. Therefore, rapid and accurate diagnosis and initial management of sepsis in pregnancy in the emergency department (ED) is paramount. Pregnancy poses a unique challenge given the baseline physiologic changes and the need to care for the mother while simultaneously caring for the fetus. Therefore, without clear pregnancy-specific data, recommendations are to follow the current guidelines for nonpregnant adults, yet be cognizant of the ways in which pregnancy may change maternal physiology and affect fetal well-being. Prompt identification and treatment of maternal sepsis will undoubtedly lead to the best possible maternal and neonatal outcomes.

Intimate partner violence (IPV) and sexual assault are common violent crimes perpetrated on women. Obstetric (OB) complications associated with trauma include miscarriage, preterm labor, and placental abruption. Ongoing mental health issues, including depression and anxiety, are more prevalent in pregnant women subjected to any form of IPV, whether or not direct physical violence is involved. One study showed that pregnant women subjected to verbal threats were twice as likely to deliver low-birth-weight infants. All women who present to an OB triage unit or an emergency department (not just those who present with an injury or complication) must be screened for IPV. An organized plan for providing the victim with resources must be readily available when a screen is positive. This chapter discusses presenting symptomatology, history and data collection, physical examination, laboratory and imaging studies, differential diagnosis, clinical management and follow-up care of IPV and sexual assault.

Intimate partner violence (IPV) is a global public health problem, linked to long-term health, social, and economic consequences. IPV is a preventable public health problem that includes physical and sexual violence, stalking, and psychological aggression directed at a woman by a person with whom she has, or has had, an intimate relationship. Violence against women interferes with the health of the woman and also affects the relationship with the primary care provider. This chapter explains in detail the assessment and health consequences of IPV. Most states have laws to protect women from their abusers. The courts in most states try to prosecute perpetrators. IPV continues to be a threat to the health of women and their families in the United States, at a cost $10 billion annually. The chapter’s goal is to provide sensitive, kind, well-informed, universal screening with appropriate referrals for all women who suffer from IPV.

The Intrauterine contraception (IUC) is a plastic contraceptive device that is inserted into the uterine cavity through the cervical canal. The IUC is for contraceptive use only. No IUC is intended to offer any protection against sexually transmitted infection transmission. There are five IUCs available in the United States, which includes copper IUC with white strings, levonorgestrel (LNG)-containing IUC with brown strings, LNG-containing IUC with blue strings. All types have a two-strand, polyethylene monofilament string that protrudes from the cervical os. Intrauterine contraception has been expanded to include not only the levonorgestrel containing Mirena, but also the new, smaller Kyleena device. Kyleena is an LNG-IUC system and provides continuous contraceptive protection for 5 years. A silver ring visible on ultrasound distinguishes Kyleena from other IUCs. The chapter also presents contraindications and management of side effects of IUC.

During the 1970s, there were several individual efforts to have a forum for lay midwives to share birth stories as well as their own stories of struggles, successes, and barriers to working as a midwife in the community. The 1977 El Paso meeting, the First International Conference of Practicing Midwives, was viewed by many as the beginning of the Midwives Alliance of North America (MANA) organization, though much work was to follow until MANA became an official midwifery organization in 1982. Shari Daniels, a self-taught practicing midwife, established the National Midwives Association (N.M.A) in June 1977 following the First International Conference of Practicing Midwives. Certified Nurse-Midwives (CNM) support was a need expressed throughout the development of MANA as a midwifery association. One of the key decisions made at the first interim MANA Board meeting with interim officers in 1982 was the adoption of a draft statement of philosophy.