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Using Music to Overcome Elderly Parturient Stigmatization - A Case Report
Abstract Number: SU-31
Abstract Type: Case Report/Case Series
CASE: A 63-year-old G2P0 at 33 weeks of an IVF pregnancy presented for Cesarean delivery (CD) of a severely growth restricted fetus. Despite severe symptomatic pre-eclampsia, the patient refused CD. She had a high level of anxiety and mistrust of the hospital. She was also nervous and afraid of the pain of the needle and wanted to maintain her dignity by keeping her dentures in. The healthcare team was so concerned about her anxiety and refusal that psychiatry was consulted.
In order to build trust with the patient, we offered the patient a chance to listen to music during the perioperative period. A selection of Mozart sonatas previously studied for their anxiolytic effects were played.  The patient stated that her level of anxiety surrounding the anesthesia and obstetric care was significantly reduced with the music, and she felt much more comfortable during the neuraxial technique and surgical procedure. The obstetrician, resident, and nurse in the room also stated that they felt the level of anxiety in the room was significantly neutralized by the music.
DISCUSSION: Management of the very advanced maternal age population can be challenging. Primiparae aged ≥45 are more likely to have chronic health conditions, gestational diabetes, gestational hypertension and pre-eclampsia.  They have increased healthcare needs, including a higher risk of hospitalization during pregnancy, preterm delivery, and increased rates of CD.  Infants born to mothers in this population have increased rates of low birth weight and neonatal intensive care unit admission. This patient had unique concerns secondary to her advanced age including prolonged postpartum follow up for her uncontrollable hypertension.
Beyond potentially life-threatening medical conditions there is a social and psychological stigma associated with being older and pregnant. Despite reports that media attention is favorable towards older moms, our patient felt prejudiced and developed a mistrust of the healthcare system.  This is a very rare situation, which likely would not have happened if the patient was of a younger age. The use of music was a tool to build trust and rapport with the patient. We wanted to communicate to her and demonstrate that we would not treat her differently just because she was older and pregnant. As caregivers we must approach unique pregnant populations with sensitivity.
1. Conrad, C., et al., Overture for growth hormone: requiem for interleukin-6? Crit Care Med, 2007
2. Ben-David, A., et al., Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price? Matern Child Health J, 2015.
3. Heffner, L.J., Advanced Maternal Age — How Old Is Too Old? New England Journal of Medicine, 2004