Event 2: Biopsychosocial Evaluation

Does your pain make any activities more difficult?

Ava, a 28-year-old Puerto Rican pregnant woman

The midwife asks Ava whether her pain makes activities more difficult.

“Well, I’m a pretty active person and I actually teach this exercise class,” Ava says.

“Great!” says the midwife.

“But I haven’t been able to teach it for the past two weeks because of the pain,” continues Ava. “So that’s been modified. I’m barely being able to keep up with my 2-year-old.”

“Yeah,” the midwife says, sympathetically

 “And he’s been especially clingy, so he only lets me bathe him, change him, and it’s getting a little bit harder and harder," Ava says.

Can Anyone Else Help Take Care of Your 2-Year-Old?

The midwife asks Ava if there is anyone who can help with her 2-year-old.

“The only person is my husband,” Ava says.

“Okay,” the midwife nods.

“We do have my in-laws, but they’re a little bit older and a little bit frail, so they’re not able to help as much. But my husband also works very hard. He owns his own company and he’s really busy.”

“Okay,” the midwife acknowledges.

“So, maybe it’s time to ask him to make some time,” Ava tells the midwife.

"I mean, it might be,” the midwife says. “You know, other things we can talk about with your toddler is, instead of bending over and picking your toddler up, if you are doing that, but inviting to maybe climb up and sit next to you and see if that doesn’t help a little bit with the pain.”

The midwife pats the seat next to her to emphasize her point of directing a toddler’s actions.

Ava's Safety

The midwife asks if Ava has ever felt concerned about her safety.

“No, I don’t think so” Ava says.

“Okay,” responds the midwife. “Ever any experiences of being hit or slapped?"

Ava draws a deep breath, incredulous. “No,” she says, as though she finds this suggestion to be laughable. “God, no.”

“Right,” confirms the midwife. “Okay, excellent. Well, we’re glad to hear about that.”

“Or my kid,” adds Ava, shaking her head at the thought of her husband hitting her or their toddler.

“All right,” the midwife smiles. “Wonderful! These are just questions we like to ask everyone to make sure they’re physically safe.”

Ava nods agreement.

The midwife continues, “If there’s ever a situation like that that does come up, please get in touch with us. We can help. Okay? There are things that we can do.”

Ava nods again.

Do You Have Access to Other Healthcare?

The midwife asks Ava if she has access to other healthcare.

Ava says, “Yeah. I have pretty good insurance that allows me to make appointments with whomever I want. So it’s been working out well.”

“Great,” says the midwife.

How Do You Get Around the City?

The midwife asks Ava how she gets around the city.

“I drive,” says Ava.

“Okay. Do you spend a lot of time in the car?” the midwife asks.

“Not really. I commute from the county to the city every day.”

“And when you’re sitting in the car, does that aggravate your pain at all?”

“No,” Ava says, “but transferring into and out of the car. It’s one of those things that really brings on the sharp pain.”

“Okay,” the midwife says.

Does Getting Out of Bed in the Morning Aggravate Your Pain?

The midwife wants to know if getting out of bed in the morning aggravates Ava's pain.

“Yeah,” Ava laughs.

“Okay,” nods the midwife.

“That’s another one.” Ava shifts around in her seat to show how she moves from side to side to situate herself to get out of bed in the morning.

“I kind of come up with this rolling over technique. I try to get up in an easier way, but it takes a little bit of time.”

“Extra time in the morning,” notes the midwife, smiling. “Yes,” Ava confirms.


  • Hasn’t been able to teach exercise class for 2 weeks
  • Having difficulty taking care of her 2-year-old on her own
  • Husband works long hours, in-laws older and unable to help much
  • No experiences with her or her child being hit or in danger
  • Access to good obstetric care and general healthcare via insurance
  • Drives to get around the city, usually for short periods of time
  • Pain aggravated by getting in and out of car
  • Pain also aggravated by getting out of bed in the morning
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