Search

In the last 10 years about 130 women with a drug addiction and more than 100 HIV-positive pregnant women were treated at the 1. University Hospital of Obstetrics and Gynaecology in Munich. Besides a specialized medical treatment both groups required intensive psychosocial care. HIV-infected people are still isolated and suffer from the social stigmata. Their essential needs for sexuality and children of their own are often ignored or even condemned because of irrational fears about HIV, which continue despite rapid medical improvements. The life-expectancy for example has increased since the inauguration of protease inhibitors. Vertical transmission of HIV is below 2% through medical treatment in pregnancy, elective cesarean section and renunciation of breastfeeding. Drug addicted pregnant women are given the opportunity to change their life in order to care for their children appropriately. The basis for this is a substitution with levomethadone and elimination of the use of other drugs. The addicted women often can reduce the dosage of levomethadone during the course of their pregnancy and sometimes can cease totally. Normally they are highly motivated and thus can ease the withdrawal symptoms of their newborns following delivery. By establishing a reliable social net during pregnancy mothers learn to recognize the demands of their children after birth and thus emotional and cognitive deficits can be prevented.

Several more recent research results in psychosomatic obstetrics and gynecology will be presented, and directions for the practice will be given. In conclusion, it will be discussed how, for the realization of psychosomatic concepts, 'old-fashioned thinking' with biased, monocausal, scientific approaches is unproductive. This concerns, in particular, university gynecological hospitals where psychosomatic thinking is only very hesitantly accepted. The goal is, therefore, to promote a new thinking process, which incorporates an increased consideration of reference points like sensibility, flexibility and creativity.

The mounting problems of drug addiction now also confront the obstetrician and pediatrician. 1/3 of the 60,000 addicts to opiates in the Federal Republic of Germany are women. Of these 80% are in the reproductive age group. Despite endocrine problems pregnancies do occur and are high risk pregnancies because of hepatitis, venereal disease, malnutrition, phlebitis, abscesses, premature deliveries, premature rupture of the membranes, malpresentations, dysmaturity, pre-eclampsia, and numerous other social and psychological problems. Because of the varying content of heroin on the black market the fetus runs the risk of acute overdose or withdrawal. Withdrawal results in extremely marked fetal movements, with increased oxygen consumption and a danger of intra-uterine asphyxia sometimes resulting in intra-uterine fetal death. Most newborns develop a withdrawal syndrome with irritability, high pitched cries, shivering, tachycardia, perspirations, fever and generalized seizures. The experience of the Department for Women for the Free University in Berlin-Charlottenburg are presented and compared to a review of the literature. The medical, social, and psychological aspects of the problem are discussed.

In 43 imprisoned women in Berlin, the authors investigated the situation in which imprisoned women find themselves when they are pregnant, with particular reference to pregnancy, delivery and puerperium. A control group of 172 women was examined parallel to this study. It was evident that the imprisoned women had significantly more complications with regard to the course of their pregnancy and delivery, including the condition of the newborn. An analysis of the individual data yielded, for the majority of the women, a worsening of their primarily poor social and mental condition, i.e. an aggravation caused by the imprisonment. It was the aim of this study to formulate, first of all, appropriate suggestions for lowering infantile and maternal morbidity in this risk group. One of the factors examined in this connection was a possible overall change in law enforcement (imprisonment) practice (for example, suspension of imprisonment according to paragraph 455/455a, 3 of the Federal German Code of Criminal Procedure, 1981, or rescission of imprisonment). Secondly, the authors recommend more intensive care during pregnancy and delivery, taking into account the experiences collected and presented in this article.