Women's Health across the Lifespan: A Continuing Education Theme Issue

This continuing education theme issue of the Journal of Midwifery & Women's Health focuses on women's health across the lifespan. In the call for manuscripts, the editors invited submissions focused on sexual, reproductive, and gynecologic health as well as primary care. The goal for this issue was to solicit articles focusing on women's health care beyond childbearing considering this a substantial portion, and for some the majority, of the care provided by women's health clinicians. Authors submitted manuscripts on diverse topics related to women's health, as you will see in reading this editorial and issue. The issue begins with an article by Van Hoover and Holt on expanding the scope of midwifery practice to reclaim palliative care.1 Many clinicians see the similarities between guiding patients and their families through births and deaths, and a number of midwives work in hospice or palliative care. This article provides information for midwives who want to make that transition as well as for the palliative care community to see the value of midwives as providers in that specialty area. Leslie and Briggs address the risk of future vascular disease and mortality in women who have had preeclampsia.2 There is substantial evidence of this risk, and clinicians should implement strategies to prevent future vascular disease in women with a history of preeclampsia. This article is also an important reminder of the importance of obtaining thorough health histories from women and carefully considering how a woman's history to date might affect her future health and health care. Two articles focus on abortion care. Patil et al add to the growing body of evidence supporting advanced practice clinicians (APCs), including midwives, as safe abortion care providers.3 This study demonstrates that APCs’ outcomes when performing aspiration abortion with immediate intrauterine device insertion are comparable to those of physicians.3 Tschann et al review use of nonpharmaceutical pain management methods during first-trimester surgical abortion.4 Although these interventions did not reduce pain or anxiety scores, women strongly endorsed their use. This article is an excellent reminder that understanding patients’ needs requires more than quantitative assessment of outcomes. Hanson et al review probiotics for the treatment and prevention of urogenital infections in women.5 It appears these products are effective and do not cause adverse effects, but high-quality evidence is limited. With the ever increasing use of complementary and alternative therapy, it is important to rigorously assess the risks and benefits of these interventions. Two articles focus on preconception care. Nypaver et al use a case-based approach to discuss preconception screening, health promotion, and interventions to improve maternal, fetal, and neonatal outcomes.6 Nobles-Botkin et al present resources clinicians can use in providing preconception care.7 Due to the high rate of unintended pregnancy in the United States, some experts recommend approaching all clinical encounters with women of reproductive age who are not pregnant as preconception visits.6 There is good evidence supporting preconception care, and many of its components are good general health recommendations that are not just applicable to women who are planning to become pregnant. However, clinicians need to consider that treating every woman of reproductive age who isn't pregnant as an unintended pregnancy waiting to happen risks disrespecting women who have made the conscious decision not to have children, are unable to conceive, or are not at risk of pregnancy. Clinicians must also be careful not to convey a lack of confidence in women's ability to prevent pregnancy. Implementation of evidence-based, public health strategies to optimize perinatal outcomes must always be tailored to the individual woman's circumstances as well as her right to autonomy and self-determination. Paterno and Draughon provide an update on intimate partner violence (IPV) screening.8 Screening for IPV is imperative but can be daunting to implement. This article identifies best practices and provides practical information, which combined can benefit providers and women by identifying IPV and providing related assistance. It also causes one to consider what other topics in clinical practice might benefit from using a standardized approach with a systematic protocol, screening script, and validated screening tool. Deneris presents the International Federation of Gynecology and Obstetrics’ PALM-COEIN classification system for abnormal uterine bleeding (AUB), which is organized according to the causes of AUB.9 This system replaces terms that were not always clearly and consistently defined, such as menorrhagia and polymenorrhea. Using standardized nomenclature can clarify the etiology of AUB and improve communication among providers. The Clinical Rounds article in this issue focuses on a case report of human papillomavirus (HPV)-related oropharyngeal cancer.10 While oropharyngeal cancers related to HPV are still rare, they are increasing. It is important for clinicians to remain vigilant for HPV-related cancers beyond the cervix. Clinicians should also be aware that some experts now recommend anorectal cancer screening for women who have HPV and high-grade cervical lesions or genital intraepithelial neoplasia.11, 12 This issue ends with a new Share with Women patient education handout on combined hormonal contraception. The Share with Women handouts are one of the most popular features of the Journal based on downloads and our reader surveys. There are now more than 100 Share with Women handouts available, including several in Spanish. All of the handouts can be found at www.sharewithwomen.org and are freely available for clinicians to reproduce and share with women. You can obtain continuing education units (CEUs) for this issue by visiting the Journal's continuing education Web site, www.jmwhce.org, where you can receive a continuing education certificate immediately by taking the test, completing the evaluation, and paying processing fees online. Alternately, you can mail or fax the form at the end of the issue to receive CEUs. The Journal offers 2 continuing education theme issues annually, in our May/June and November/December issues. Our other issues contain single articles or collections of 2 to 3 articles for which you can obtain continuing education issues. One of the Journal's goals is to develop continuing education offerings that meet the needs of midwives and other women's health clinicians. I welcome your feedback on how we can continue to improve in that regard and hope you will find this continuing education issue relevant to your work in being with women, for a lifetime.