Women’s Health Problems and Solutions

In this chapter, we will review four important milestones in women’s preventive health.

We will see the current recommendations for pregnancy management and childbirth care with the rights of women and recommended medical practices.

We will analyze the reproductive rights of women and the shift towards hormonal contraception. Cervical cancer continues to be a prevalent pathology and we will see how successful prevention programs are and we will analyze the new papillomavirus vaccines. Finally, we will review 2 topics of climacteric women: cardiovascular health and bone health.

In this chapter we review four major milestones in women’s preventive health.

We will see the current recommendations for the management of pregnancy and delivery care to the rights of women and the medical practices recommended. Analyze the reproductive rights of women and the shift to hormonal contraception. Cervical cancer remains a prevalent disease and we will see how prevention programs are successful and we should analyze the new papillomavirus vaccines. Finally, we will review two topics of climacteric women: cardiovascular health and bone health.

Introduction

Women’s Health offers an extremely interesting framework for the realization of preventive medicine. Given that during his life, from adolescence to the years after the climacteric, he will maintain close contact with his obstetrician or gynecologist, usually establishing a close and lasting relationship of trust.

This interaction in the different stages of the woman’s life cycle will give us the extraordinary opportunity to be able to interact proactively in her health in different processes during different ages of female life.

This is how adequate, professional, and modern delivery care has resulted not only in a reduction in maternal and perinatal morbidity and mortality but has also positively influenced the mother-child relationship, the father-child relationship, and the proper development of intellectual and psychosocial of the born individual. In this chapter, we will review some of the modern recommendations for adequate control of pregnancy and delivery care.

The incorporation of women into the world of work and the demand for equal opportunities with respect to men has meant giving greater importance to the right of women to regulate their fertility. The development of fertility regulation systems or mechanisms should not only offer contraception without negatively affecting health but in some cases should be a contribution to women’s health care. We will review the main methods of unnatural female contraception and why there has been a significant shift towards hormonal contraception.

Cervical cancer in the world today, according to reports issued by the World Health Organization, shows a growing trend. Around 10 million new cases occur annually, with around 15 million expected by 2020 (WHO 2005). In developing countries, cervical cancer is the second leading cause of cancer death in women (PAHO 2002). In the development of this article, we will review the importance of developing preventive programs that use cervical cytology and how these programs influence morbidity and mortality from cervical cancer. We will also review the incorporation of the recently incorporated papillomavirus vaccine and its future perspective.

The increase in the life expectancy of women has caused a growing interest in the health of aging. Currently, it has become a requirement of our women that health strategies be designed that allow them to age with an adequate quality of life. We will review how gynecological medical action in climacteric women from around 45 years of age allows preventive measures for mental, cardiovascular, and bone health.

Reproductive Recommendations

A very interesting story regarding birth and its implications is the prologue of the Manual of Personalized Care in the Reproductive Process of the Ministry of Health, Government of Chile, in which I quote verbatim: “Birth is a determining moment for the life of a child. every human being and both the period before and immediately after are decisive for the emotional, intellectual, and social development of the child, with a central influence of the mother, the father, and the family.

Every person has the right to enter the world in an atmosphere of affection and respect. In countries like ours, almost all pregnancies and births are attended to and accompanied by professionals and technicians, achieving significant results in maternal and infant morbidity and mortality due to the committed work of the health team.

Today, however, there are greater challenges, such as an emphasis on a new view of quality in health care, which goes beyond the correct delivery of technically adequate benefits, we must respond to the expectations of a population that demands dignity, respect, and welcome to public and private health networks, with an understanding of diversity, appreciation of vulnerability and sensitivity to uncertainties or lack of knowledge with which people give themselves to our care.

In this context, comprehensive care with a family approach to the reproductive process proposes to recover the psychological and social aspects of pregnancy and birth, offering care based on scientific evidence, personalized and respectful of the rights, values, beliefs, and attitudes of the woman.

Not all women experience the reproductive process in the same conditions. Not all families are the same. The health teams are called to work with flexible criteria that, without losing the north, welcome and accompany each particular situation.

Pre and postnatal support favor the development of affective ties between the child, the mother, the father, and the family. Thus, it also lays the emotional and psychological foundations that will accompany the new being throughout his life, giving him tools that will allow him to develop and insert himself into society.

Assistance during pregnancy, prepartum, childbirth, and postpartum

Much has changed in the last decade regarding vision and orientation during pregnancy.

Restricting the use of unnecessary technology during the pregnancy and delivery process and promoting breastfeeding are some of the changes. More specifically, measures such as skin-to-skin contact, breastfeeding within the first hour after delivery, rooming-in, breastfeeding on demand, and the presence of the father or significant other at delivery have resulted in decreased rates of child abuse, increased father involvement in child care, more successful breastfeeding throughout the first year, and lower newborn abandonment. The high rate of caesarean sections observed in Chile with an evident predominance in private practice requires an active process of change by obstetric care professionals and by the population that uses their services. The concern for the safety of the mother-child binomial must be balanced with the right of women to choose, with the best available information, the care modality that is most appropriate for them, including cultural relevance.

At the country level, in the public system, the percentage of caesarean sections reaches 33.7% and in relation to epidural anesthesia, it would have been administered to 25.7% of normal deliveries. The father’s participation in childbirth reaches an average percentage at the country level of 56% (Source: DEIS year 2006) and professional delivery care close to 100%.

Importance of Prenatal Care

Preventive prenatal interventions promote the physical and mental health of the mother, the child, and the family. In addition to its importance to promote healthy behaviors during pregnancy and to detect risk and alterations in the biological process, there are studies that have shown that some proactive preventive measures carried out during pregnancy have positive effects. The frequency of prenatal control is determined by the risk factors detected in that pregnancy and as many controls will be necessary as the detected pathology requires. In pregnancies without risk factors, the frequency of controls must be rationalized in relation to the magnitude of the obstetric population and the human resources allocated for its control.

The World Health Organization, based on a multicenter clinical study, recommends four prenatal controls for the care of pregnant women who do not present pregnancy-related complications or medical pathologies and/or risk factors for their health. This study showed that there were no significant differences in terms of severe postpartum anemia, pre-eclampsia, urinary tract infections, and low birth weight compared to care with a greater number of controls. There were also no significant differences in secondary maternal and/or perinatal outcomes, including eclampsia, maternal and neonatal death.

However, there are other modalities of prenatal control with a greater number of controls, such as that carried out by the Department of Obstetrics of the Catholic University of Chile and suggested in its Manual of High Obstetric Risk. Characteristically, prenatal controls are carried out every four weeks in the first and second trimesters of pregnancy. In the third trimester (from 28 weeks), controls are progressively more frequent until they are every seven days from 36 weeks to the end of pregnancy. The reason for this sequence is that from week 28 onwards it is possible to detect pathologies of high obstetric and medical risk with a viable fetus (fetal growth retardation, gestational diabetes, hypertensive syndrome of pregnancy, fetal macrosomia, threatened labor). prematurity, congenital malformations, intrahepatic cholestasis of pregnancy, etc.). If a patient enters at 8 weeks and resolves her delivery at 40 weeks, she will count twelve to thirteen prenatal controls that can be considered excess,

Care in Labor and Delivery

In recent decades, a critical appraisal of routine obstetric care reveals that various practices can be physically inconvenient. Performing painful procedures such as routine perineal and pubic shaving, enemas during labor, the efficacy of which have not been scientifically supported; permanent dorsal decubitus position during labor, routine episiotomy and excess cesarean sections are some of the topics to be analyzed.

The excessive “medicalization” of childbirth promotes the use of unnecessary interventions with a high overall cost of medical services and that has led to ignoring or underestimating the importance of the psychological aspects of pregnancy and childbirth.

In developed countries, and in the higher-income social sectors of developing countries such as Chile, the presence of a woman’s companion in the delivery room has been accepted; the important thing is to stimulate this company of a person emotionally significant for the woman.

The current trend in obstetric care is based on two ethical principles: respect for the woman’s autonomy in an experience of such emotional significance for her and not subjecting the mother to unnecessary harm (respecting the classic Hippocratic principle.

Specific practices for which evidence-based recommendations exist are listed below.

Ongoing emotional support in labor and delivery

Labor is a period of increased biological and psychological vulnerability for women; the support and presence of your partner, family member, or another person close to you effectively help to reduce stress and anxiety.

Continuous support is considered a way to relieve pain, even as an alternative to epidural analgesia.

Continuity of care

A study conducted with the objective of evaluating the continuity of care of professionals during pregnancy, childbirth, and the puerperium showed that women who received continuity of care were more likely to address concerns before and after delivery, less likely to receive drugs for pain relief during labor and their babies were less likely to require resuscitation. The authors conclude that continuity of care shows benefits and recommend that all women should have continuous support during labor and delivery.

Continuous fetal monitoring

Routine fetal monitoring in low-risk pregnancies has not been shown to significantly improve neonatal outcomes and therefore the indications should be considered relative. In general, they should be prioritized, if the resource exists in a limited way, only in pregnancies where there is a greater fetal risk. During labor and delivery of low-risk fetal pregnancies, continuous electrical fetal monitoring is not recommended.

Pain management in labor and delivery

Pain management is a fundamental aspect of the activity of the health team in charge of the support and professional assistance of a woman in labor and delivery. This management includes pharmacological and non-pharmacological alternatives.

It is the responsibility of the professional team to inform the mother at the time of formulating the initial management plan about the support she will receive when requesting help for pain relief. This will depend on local human and physical resources, concurrent medical or obstetrical problems, and the patient’s psychological resources and preferences.

Position of the woman during labor and delivery

Studies have shown that the upright or lateral position during the second stage of labor has advantages over the supine position. The upright position results in less discomfort and difficulty in pushing, less pain, less vaginoperineal trauma, and infection, and a shorter duration of the second stage of labor. Likewise, newborns have a lower frequency of Apgar indices less than seven, a lower frequency of alteration of the fetal heartbeat.

The protocols for childbirth care emphasize the freedom of position in the expulsive period, especially the vertical position. This position has advantages over the dorsal decubitus position: lower rates of caesarean section, episiotomy, analgesia, oxytocin, and duration of the second stage. The WHO recommendation is that women who deliver vaginally should not use the supine position.

Feeding During Labor

Traditionally, fasting has been indicated for women during labor. Currently, it is recommended to consider the possibility of some intake on the basis that the birth process requires significant energy consumption; the length of labor and delivery is unpredictable and fluid restriction can lead to dehydration and ketosis. Feeding during labor should be understood as a natural process of great importance and variability in women, recommending oral intake of liquids and a light diet, respecting the wishes of the woman. In the final period or transition stage of labor, a woman may request only fluids.

Enema Use

There is insufficient available evidence to recommend the use of routine enemas during labor. The enema causes discomfort increases the cost of care, and there is no evidence of benefit.

Perineal shaving

It has been shown that pre-operative shaving with a razor can cause micro lacerations of the skin that can favor the colonization of micro-organisms. Studies on routine perineal shaving show no evidence that it reduces postpartum febrile morbidity in the mother or the newborn, therefore it is not recommended in any case.

Episiotomy

The routine performance of an episiotomy is considered harmful because it creates a surgical incision of a magnitude greater than what many women might have experienced had it not been performed. There is strong evidence to recommend restrictive use or limit the size of the episiotomy. Recommendation at Level 1.

Early mother-infant skin-to-skin contact

Numerous studies have documented statistically significant effects and positive early skin-to-skin contact in infancy, more likely to continue breastfeeding one to three months after birth. Skin-to-skin contact, through sensory stimuli such as touch, heat, and smell, is a powerful vagal stimulant that, among other effects, releases maternal oxytocin. Hospital routines of delivery and postpartum wards can significantly disrupt the development of early interactions between mother and newborn.

Reproductive Health

The World Health Organization has defined reproductive health as the condition in which the reproductive process is achieved in a state of complete physical, mental and social well-being for the mother, father, and children. This implies that people have the ability to reproduce, that they can do so with minimal risk, especially for women during pregnancy and childbirth, that fertility can be regulated and they can enjoy healthy and happy sexual relationships.

The concept of sexual and reproductive health is new and is still widely debated. It is centered on people and their rights, rather than on population, programmatic or political goals. Service users participate together with health professionals in the search for a better quality of life for themselves, their partners, and their families.

Sexual and reproductive health incorporates the perspective of sexual and reproductive rights and the gender perspective.

However, in developing countries, we are far from reaching this goal. Environmental, socioeconomic, and cultural conditions differ between countries and regions, affecting health and the consequences of sexual and reproductive behavior in various ways. There are dramatic examples of this reality:

• Maternal mortality rates can be as high as 600 per 100,000 women in some developing countries, while they are 30 times lower in developed countries.

• Coverage of maternity care varies from almost 100% in developed countries to less than 25% in some developing countries.

• The first pregnancy occurs at a younger age and the total number of pregnancies is greater in women in developing countries, with consequent detrimental effects on the health of women and their children.

• Adolescent pregnancy is one of the biggest sexual and reproductive health problems everywhere, but poverty and lack of support systems make it a tragedy for most girls in developing and developing countries. the poor socioeconomic sectors of developed countries.

• The proportion of children with low birth weight, child malnutrition and high mortality rates in the first years of life are other examples of poor sexual and reproductive health in underdeveloped countries.

When talking about sexual and reproductive health and the necessary services, it is important to highlight the concept of singularity, that is, that each one of us is a unique and unrepeatable person. Each person has the right to be seen and treated as the unique human being that they are and has the right to fully express their genetic heritage. Everyone must be able to express their sexuality and decide their reproductive behavior according to their perception of themselves and their life situation.

In recent years there has been a very broad debate on the aspects that should be included in sexual and reproductive health services, both internationally and in some interesting countries. There is consensus regarding the priority that should be given to education and preparation for a responsible sexual and reproductive life, care during pregnancy, delivery and postpartum, family planning, child care, and the prevention of sexually transmitted diseases.

One of the pillars of any reproductive health program is the provision of information, education, and means to decide whether to have children, when and how many, which includes the provision of contraceptive methods, with the education and guidance necessary for people to choose the that are more appropriate for them.

Many countries have developed contraceptive programs based on economic and demographic considerations, without taking into account the concerns and needs of women and men regarding their health and status in society. These programs have met with resistance from women’s rights advocates, as issues related to health, sexual and reproductive rights, and women’s status in society should take precedence over demographic considerations.