One of the American College of Nurse-Midwives' blue and white “Listen to Women” buttons sits on my desk. I've given several more away over the years because it is such an important message for clinicians and patients. There are only three words, but together they are very powerful. In reading the articles in this issue, that slogan and the significance of listening keep coming to mind.
This issue begins with the second article in a two-part continuing education series on mental health care.1–2 Hackley's earlier article reviews screening and treatment for depression,1 and her article in this issue focuses on antidepressant use in pregnancy.2 Listening to a patient is a key component of any health care assessment, but it is particularly crucial with mental health conditions. There are no laboratory tests to diagnose depression or assess the adequacy of treatment. Listening is required to make the diagnosis, determine the appropriate management plan, and monitor the effectiveness of treatment. Listening is also part of psychotherapy treatment.
The Coping with Labor Algorithm described by Roberts et al.3 was developed in response to listening to women and provides a new framework for listening. The authors' institution began using the Numeric Rating Scale, on which patients rate pain from 0–10, for pain assessment. This scale created confusion, and sometimes annoyance, for laboring women. In response to these concerns, a task force was formed to develop and evaluate a tool to assess and document labor pain that would meet The Joint Commission standards for pain management. The resulting algorithm focuses on coping, rather than pain level, and includes ‘coping' and ‘not coping' paths. When a woman is not coping well with labor, the algorithm provides management options to assist her in returning to the coping path.
Skinner4 gives readers an incredible opportunity to listen to and learn from her experiences of pregnancy, labor, and birth as a sexual abuse survivor. In reading about her journey, I was struck by her description of herself as a “difficult” patient. We have all cared for “difficult” patients. Hopefully we recognize that there is usually some issue underlying the patient behavior we find challenging, but do we take time to listen and try to understand why the patient is “difficult” or do we just become frustrated and hope the encounter ends quickly? Can we step back from what is difficult for us to learn about and empathize with what is difficult for the patient?
Listening well takes intention, time, and effort. Listening is one of the most important things we do in our professional and personal lives. I hope you will also find valuable the information in this issue about why we need to listen, what to listen for, and how to do that better.