Medical Family Therapy in Obstetrics and Gynecology

  • Angela Lamson
  • Kenneth Phelps
  • Ashley Jones
  • Rebecca Bagley
Part of the Focused Issues in Family Therapy book series (FIFT)


The combined disciplines of obstetrics and gynecology (Ob-Gyn) are committed to the reproductive physiology of women’s health throughout the lifespan and include an integration of medical and surgical care. Ob-Gyn providers attend to the social, physiological, environmental, and genetic factors that influence or exacerbate health conditions in women. As such, Ob-Gyns’ expertise in and attention to diverse factors that influence the physical health of women makes medical family therapists (MedFTs) a logical partner for integrated behavioral healthcare (IBHC). Both disciplines train providers to recognize and care for the unique biopsychosocial-spiritual (BPSS) health needs (Engel, 1977, 1980; Wright, Watson & Bell, 1996) of each patient over the lifespan and in the context of her family system. Furthermore, both disciplines include training in their respective areas across prevention, health education, assessment, diagnostics, and intervention.


Glossary of Important Terms for Care in Obstetrics and Gynecology

Breech presentation

When the fetus is positioned inside the uterus in a manner whereby its feet or buttocks would—without intervention—deliver first (instead of the head).

C-section (Cesarean birth)

A surgical delivery of a baby through incisions made in the abdomen and uterus.


The opening to the uterus, located at the top of the vagina.

D&C (dilation and curettage)

A surgical procedure for removal of tissue from inside the uterus by opening the cervix and inserting an instrument into the uterus.

Ectopic pregnancy

Also known as a mislocated pregnancy; symptoms include unexpected vaginal bleeding and cramping. The fetus may grow enough to rupture the fallopian tube (typically after about 6–8 weeks), whereby a woman usually feels severe pain in her lower abdomen. If the tube ruptures later (after about 12–16 weeks), the risk of death for the woman is increased because the fetus and placenta are larger and lead to an increased loss of blood. In most women, the fetus and placenta from an ectopic pregnancy must be surgically removed.


A surgery for removal of the uterus. It is termed a “total hysterectomy” if the cervix is removed with the uterus.

Placenta previa

A condition that occurs in about one in every 200 deliveries; it refers to when the placenta is mostly or completely covering the cervix, in the lower (rather than upper) part of the uterus. Placenta previa can cause painless bleeding from the vagina that suddenly begins late in pregnancy necessitating emergent delivery. It is a risk for maternal and fetal death due to blood loss.


An illness that occurs in pregnancy or after delivery where a woman has high blood pressure and symptoms of organ injury or dysfunction. Some of these symptoms include an abnormal amount of protein found in the urine, abnormal liver or kidney function, vision changes, decreased number of platelets, upper abdominal pain, fluid found in the lungs, and severe headache. (note: Eclampsia is an extension of preeclampsia, resulting in maternal seizures.)

Preterm delivery

When a baby is born before week 37 of the pregnancy.

Preterm labor

Also called premature labor; it refers to when uterine contractions occur before 37 weeks of pregnancy.

Previable delivery

A delivery prior to 23 weeks (22 weeks in some facilities).

Sexually transmitted infections/diseases (STI/D)

Some women may not know that they are carrying an STI /D; this becomes an even more of complicated issue during pregnancy or at the time of delivery. Some STI /Ds are more dangerous for the fetus than others, especially when considering vaginal deliveries. Some hospitals are using rapid human immunodeficiency virus (HIV) testing during labor and delivery for pregnant women who were not tested previously during pregnancy. If a woman is found to be HIV-infected, providers are then able to begin antiretroviral therapy immediately to prevent perinatal transmission.

Thromboembolic disease

In the United States, thromboembolic disease is the leading cause of death in pregnant women. It occurs when blood clots form in blood vessels that travel through the woman’s bloodstream and block an artery. This disease most commonly occurs 6–8 weeks after delivery. The risk is much greater after a cesarean section than after vaginal delivery.


  1. Ahangari, A. (2014). Prevalence of chronic pelvic pain among women: An updated review. Pain Physician, 17, 141–147.
  2. Ahuja, S. P., & Hertweck, S. P. (2010). Overview of bleeding disorders in adolescent females with menorrhagia. Journal of Pediatric Adolescent Gynecology, 23, S15–S21. CrossRefPubMedGoogle Scholar
  3. *Al-Abbadey, M., Liossi, C., Curran, N., Schoth, D. E., & Graham, C. A. (2016). Treatment of female sexual pain disorders: A systematic review. Journal of Sex & Marital Therapy, 42, 99–142.
  4. Alijotas-Reig, J., & Garrido-Gimenez, C. (2013). Current concepts and new trends in the diagnosis and management of recurrent miscarriage. Obstetrical & Gynecological Survey, 68, 445–466. CrossRefGoogle Scholar
  5. Alliman, J., Jolles, D., & Summers, L. (2015). The innovation imperative: Scaling freestanding birth centers, centering pregnancy, and midwifery-led maternity health homes. Journal of Midwifery & Women’s Health, 60, 244–249. CrossRefGoogle Scholar
  6. American Congress of Obstetricians and Gynecologists. (2005). The scope of practice of obstetrics and gynecology. Retrieved from
  7. American Congress of Obstetricians and Gynecologists. (2015). Frequently asked questions. Retrieved from
  8. *American Congress of Obstetrics and Gynecology (2015). Practice bulletin number 150: Early pregnancy loss. Obstetrics & Gynecology, 125, 1258–1267.
  9. American College of Obstetrics and Gynecologists. (2015). The menopause years
  10. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM 5. Washington, D.C: American Psychiatric Association.CrossRefGoogle Scholar
  11. Bakan, D. (1966). The duality of human existence: Isolation and communion in western man. Boston, MA: Beacon.Google Scholar
  12. Bergink, V., Burgerhout, K. M., Koorengevel, K. M., et al. (2015). Treatment of psychosis and mania in the postpartum period. American Journal of Psychiatry, 172, 115–123. CrossRefPubMedGoogle Scholar
  13. Berishaj, K. (2017). Sexual assault. In K. Schuiling and F. Likis (Eds.), Women’s gynecologic health (3rd ed., pp. 327–356). Burlington, MA: Jones & Bartlett Learning.Google Scholar
  14. Black, B. P., & Wright, P. (2012). Posttraumatic growth and transformation as outcomes of perinatal loss. Illness, Crisis, & Loss, 20, 225–237. CrossRefGoogle Scholar
  15. *Calhoun, L. G., & Tedeschi, R. G. (2014). Handbook of posttraumatic growth: Research and practice. New York, NY: Psychology Press.Google Scholar
  16. Cason, P. (2017). Sexuality and sexual health. In K. Schuiling and F. Likis (Eds.), Women’s gynecologic health (3rd ed., pp. 191–208). Burlington, MA: Jones & Bartlett Learning.Google Scholar
  17. Centers for Disease Control and Prevention (2016). Sexually transmitted disease surveillance 2015.
  18. *Coady, D., & Fish, N. (2011). Healing painful sex: A woman’s guide to confronting, diagnosis, and treating sexual pain. Berkley, CA: Seal Press.Google Scholar
  19. Corsini-Munt, S., Bergeron, S., Rosen, N. O., Steben, M., Mayrand, M. H., Delisle, I., … Santerre-Baillargeon, M. (2014). A comparison of cognitive-behavioral couple therapy and lidocaine in the treatment of provoked vestibulodynia: Study protocol for a randomized control trial. Trials, 15, 506–517. CrossRefPubMedPubMedCentralGoogle Scholar
  20. Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. British Journal of Psychiatry, 150, 782–786. CrossRefPubMedGoogle Scholar
  21. Cuijpers, P., van Straten, A., Andersson, G., & Van Oppen, P. (2008). Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies. Journal of Consulting Clinical Psychology, 76, 909–922. CrossRefPubMedGoogle Scholar
  22. Cunningham, G., Leveno, K., Bloom, S., Spong, C., Sashe, J., Hoffman, B., … Sheffield, J. (2014). Stillbirth. In F. Cunningham, K. Leveno, S. Bloom, C. Spong, J. Dashe, B. Hoffman, B. Casey, & J. Sheffield (Eds.),  Williams obstetrics (24th ed., pp. 661–667). New York, NY: McGraw Hill Education.Google Scholar
  23. Dehlendorf, C., Krajewski, C., & Borrero, S. (2014). Contraceptive counseling: Best practices to ensure quality communication and enable effective contraceptive use. Clinical Obstetrics and Gynecology, 57, 659–673.
  24. Desrochers, G., Bergeron, S., Landry, T., & Jodoin, M. (2008). Do psychosexual factors play a role in the etiology of provoked vestibulodynia? A critical review. Journal of Sex and Marital Therapy, 34, 198–226. CrossRefPubMedGoogle Scholar
  25. Ellis, S. A., Wojnar, D. M., & Pettinato, M. (2014). Conception, pregnancy, and birth experiences of male and gender variant gestational parents: It’s how we could have a family. Journal of Midwifery & Women’s Health, 60, 62–69. CrossRefGoogle Scholar
  26. El-Mohandes, A. A., Kiely, M., Gantz, M. G., & El-Khorazaty, M. N. (2011). Very preterm birth is reduced in women receiving an integrated behavioral intervention: A randomized controlled trial. Maternal and Child Health Journal, 15, 19–28. CrossRefPubMedPubMedCentralGoogle Scholar
  27. Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129–136. CrossRefPubMedGoogle Scholar
  28. Engel, G. L. (1980). The clinical application of the biopsychosocial model. American Journal of Family Medicine, 137, 535–544. Google Scholar
  29. Fairbrother, N., & Woody, S. R. (2008). New mothers’ thoughts of harm related to the newborn. Archives of Women’s Mental Health, 11, 221–229. CrossRefPubMedGoogle Scholar
  30. Finer, L. B., & Zolna, M. R. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception, 84, 478–485. CrossRefPubMedPubMedCentralGoogle Scholar
  31. *Hertlein, K. M., Weeks, G. R., & Gambescia, N. (2015). Systemic sex therapy (2 nd ed.). New York, NY: Routledge.Google Scholar
  32. Hodgson, J., Lamson, A., Mendenhall, T., & Tyndall, L. (2014). Introduction to medical family therapy: Advanced applications. In J. Hodgson, A. Lamson, T. Mendenhall, and D. Crane (Eds.), Medical family therapy: Advanced applications (pp. 1–9). New York, NY: Springer.Google Scholar
  33. Jordan, R. (2014). Perinatal loss and grief. In R. Jordan, J. Engstrom, J. Marfell, and C. Farley (Eds.), Prenatal and postnatal care: A woman-centered approach (pp. 409–415). Iowa: John Wiley & Sons.Google Scholar
  34. Joseph, J. G., El-Mohandes, A. A., Kiely, M., El-Khorazaty, M. N., Gantz, M. G., Johnson, A. A., … Subramanian, S. (2009). Reducing psychosocial and behavioral pregnancy risk factors: Results of a randomized clinical trial among high-risk pregnant African American women. American Journal of Public Health, 99, 1053–1062. CrossRefPubMedPubMedCentralGoogle Scholar
  35. *Frederiksen, Y., Farver-Vestergaard, I., Skovgard, N. G., Ingerslev, H. J., & Zachariae, R. (2015). Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: A systematic review and meta-analysis. BMJ Open, 5, 1–18.
  36. Lafarge, C., Mitchell, K., & Fox, P. (2017). Posttraumatic growth following pregnancy termination for fetal abnormality: The predictive role of coping strategies and perinatal grief. Anxiety, Stress, & Coping, 1–15.
  37. Lamson, A., & Phelps, K. (2011). Labor and delivery. In Clinical updates for family therapists: Research and treatment approaches for issues affection today’s families (Volume 4). Alexandria, VA: American Association for Marriage and Family Therapy.Google Scholar
  38. *Luk, B. H. K., & Loke, A. Y. (2015). The impact of infertility on the psychological well-being, marital relationships, sexual relationships, and quality of life of couples: A systematic review. Journal of Sex and Marital Therapy, 41, 610–625.
  39. Magant, A., & Dodgson, J. E. (2011). Centering pregnancy: An integrative literature review. Journal of Midwifery & Women’s Health, 56, 94–102. CrossRefGoogle Scholar
  40. Martin, J. A., Hamilton, B. E., Ventura, S. J., Osterman, M. J., Wilson, E. C., Mathews, T. J., et al. (2011). Births: Final data for 2010. National Vital Statistics Reports, 61, 1–72.
  41. Massachusetts General Hospital Center for Women’s Mental Health. (2017). Homepage.
  42. Meana, M. (2012). Sexual dysfunction in women. Cambridge, MA: Hogrefe Press.Google Scholar
  43. Meana, M., Maykut, C., & Fertel, E. (2015). Painful intercourse: Genito-pelvic pain/penetrative disorder. In K. M. Hertlein, G. R. Weeks, and N. Gambescia (Eds.), Systemic sex therapy (2nd ed., pp. 191–209). New York, NY: Routledge.Google Scholar
  44. Monga, M., Alexandrescu, B., Katz, S. E., Stein, M., & Ganiats, T. (2004). Impact of infertility on quality of life, marital adjustment and sexual function. Urology, 63, 126–130. CrossRefPubMedGoogle Scholar
  45. *Murkoff, H. & Mazel, S. (2016). What to expect when you are expecting (5th ed.). New York, NY: Workman Publishing Company.Google Scholar
  46. Murphy, P., Hewitt, C., & BeLew, C. (2017). Contraception. In K. Schuiling and F. Likis (Eds.), Women’s gynecologic health (3rd ed., pp. 209–260). Burlington, MA: Jones & Bartlett Learning.Google Scholar
  47. National Institute of Mental Health (NIMH). (2015). Major depression among adolescents.
  48. Newport, D. J., Fernandez, S. V., Juric S., & Stowe, Z. N. (2009). Psychopharmacology during pregnancy and lactation. In A. F. Schatzberg and C. Nemeroff (Eds.). The American psychiatric publishing textbook of psychopharmacology (4 th Ed.).
  49. Office of Women’s Health, US Department of Health and Human Services (2017). Homepage.
  50. O’Hara, M. W., Stuart, S., Gorman, L., & Wenzel, A. (2000). Efficacy of interpersonal psychotherapy for postpartum depression. Archives of General Psychiatry, 57, 1039–1045. CrossRefPubMedGoogle Scholar
  51. Osborne, K. (2017). Health promotion. In K. Schuiling and F. Likis (Eds.), Women’s gynecologic health (3rd ed., pp. 61–76). Burlington, MA: Jones & Bartlett Learning.Google Scholar
  52. *Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. Journal of the American Medical Association, 303, 1961–1969.
  53. Postpartum Support International. (2016). You are not alone! Retrieved from
  54. Rising, S. S. (1998). Centering pregnancy: An interdisciplinary model of empowerment. Journal of Nurse Midwifery, 43, 46–54. CrossRefPubMedGoogle Scholar
  55. Shin, J. H., & Howard, F. M. (2011). Management of chronic pelvic pain. Current Pain and Headache Reports, 15, 377–385. CrossRefPubMedGoogle Scholar
  56. Soleimani, A. A., Najafi, M., Ahmadi, K., Javidi, N., Kamka, E. H., & Mahboubi, M. (2015). The effectiveness of emotionally focused couples therapy on sexual satisfaction and marital adjustment of infertile couples with marital conflicts. International Journal of Fertility and Sterility, 9, 393–402.
  57. Soltani, M., Shairi, M. R., Roshan, R., & Rahimi, C. (2014). The impact of emotionally focused therapy on emotional distress in infertile couples. International Journal of Fertility and Sterility, 7, 337–344.
  58. Stein, S. L. (2013). Chronic pelvic pain. Gastroenterology clinics of North America, 42, 785–800.
  59. Stephenson, M., Awartani, K., & Robinson, W. (2002). Cytogenetic analysis of miscarriages from couples with recurrent miscarriage: A case-control study. Human Reproduction, 17, 446–451. CrossRefPubMedGoogle Scholar
  60. Stuart, S. (2012). Interpersonal psychotherapy. In M. J. Dewan, B. N. Steenbarger, and R. P. Greenberg (Eds.), The art and science of brief psychotherapies: An illustrated guide (pp. 157–193). Arlington, VA: American Psychiatric Publishing.Google Scholar
  61. Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing scale: Development and validation. Psychological Assessment, 7, 524–532.
  62. Suri, R., Lin, A. S., Cohen, L. S., & Altshuler, L. L. (2014). Acute and long-term behavioral outcome of infants and children exposed in utero to either maternal depression or antidepressants: A review of the literature. Journal of Clinical Psychiatry, 75, 1142–1152. CrossRefGoogle Scholar
  63. *Tripp, D. A., & Nickel, J. C. (2013). Pain clinical updates: Psychosocial aspects of chronic pelvic pain. International Association for the Study of Pain, 21, 1–7.
  64. Uguz, R., & Ayhan, M. G. (2011). Epidemiology and clinical features of obsessive-compulsive disorder during pregnancy and postpartum period: A review. Journal of Mood Disorders, (4), 178–186.
  65. Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive guide to interpersonal psychotherapy. New York, NY: Basic Books. Google Scholar
  66. *Wenzel, A. (2014). Coping with infertility, miscarriage, and neonatal loss: Finding perspective and creating meaning. Washington, DC: American Psychological Association.Google Scholar
  67. *Wenzel, A., & Kleiman, K. (2015). Cognitive behavioral therapy for perinatal distress. New York, NY: Routledge.Google Scholar
  68. Wheaton, M. G., Galfalvy, H., Steinman, S. A., Wall, M. M., Foa, E. B., & Simpson, H. B. (2016). Patient adherence and treatment outcome with exposure and response prevention for OCD: Which components of adherence matter and who becomes well? Behaviour Research and Therapy, 85, 6–12. CrossRefPubMedPubMedCentralGoogle Scholar
  69. Wright, L. M., Watson, W. L., & Bell, J. M. (1996). Beliefs: The heart of healing in families and illness. New York, NY: Basic Books.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Angela Lamson
    • 1
  • Kenneth Phelps
    • 2
  • Ashley Jones
    • 2
  • Rebecca Bagley
    • 3
  1. 1.Department of Human Development and Family ScienceEast Carolina UniversityGreenvilleUSA
  2. 2.Department of Neuropsychiatry and Behavioral ScienceUniversity of South CarolinaColumbiaUSA
  3. 3.Department of Advanced Nursing Practice and EducationEast Carolina UniversityGreenvilleUSA

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