Telephone triage. A challenge for practicing midwives.

Telephone triage is the process by which a health care provider communicates with a client via the telephone and, thereby, assesses the presenting concerns, develops a working diagnosis, and determines a suitable plan of management. Determination of the seriousness of the situation will dictate whether a client can be cared for at a distance or whether a more comprehensive in-person evaluation is in order. The process of telephone triage is fraught with potential problems, including difficulty in establishing a reliable database, environmental distractions, cost concerns, liability issues, and, frequently, inadequate documentation. This article will describe an approach to these concerns by discussing the use of appropriate communication techniques, the development of a working diagnosis, the establishment of a plan of intervention, and the appropriate documentation of care. Such steps will go far toward diminishing the growing legal threats that arise to midwives who utilize this technology to render care to their patients.

The relationship between previous elective abortions and postpartum depressive reactions.

To test the hypothesis that primiparas who have had a previous elective abortion will have a higher incidence of depressive reactions postpartum than will primiparas who have not, 48 women pregnant for the first time and 25 who had had one abortion were interviewed six to eight weeks postpartum. No significant difference in the incidence of depression between the two groups could be found. In addition, when associations between their mean depression scores and other variables such as planned pregnancy, preferred infant sex, identified obstetrical problems, help at home, experiencing the baby blues, and an identified recent sad life event were calculated, no significant differences were noted. Spontaneous comments from the previously aborted women suggested that anxiety during pregnancy concerning the infant's health was a greater source of discomfort than was postpartum depression.

PIP: This study investigated an hypothesis which states that primiparas who have had a previous elective abortion would experience a higher incidence of depressive reactions postpartum that primiparas who had not. The experimental group consisted of 48 gravida 2, para 1, and the control group of gravida 1, para 1 included 25 women. All were interviewed 6-8 weeks postpartum, and data were tabulated in a 2 x 2 table. A chi-squared test of the hypothesis was equivalent to a significance level of P=.39, with a 1-tailed test and with 1 degree of freedom. Therefore, the data showed no significant differences between the 2 groups studied. This was further supported by the low coefficient of contingency (C=.03) which indicated little correlation between depression and prior abortion. In addition, there were no differences among the 2 groups in mean depressive scores with respect to other variables such as planned pregnancy, preferred infant sex, identified obstetrical problems, help at home, the baby blues, or an identified sad event. Spontaneous comments from the previously aborted women suggested that anxiety during pregnancy concerning the infants' health was a greater source of discomfort than was postpartum depression.