Antenatal Period:
Della was admitted to the antenatal ward from triage at 35 weeks and 2 days into her fourth pregnancy as it was thought by the triage midwife that she was in premature labour. My mentor and I took care of Della and were the primary care givers. Della had a lot of self-referral admissions to the antenatal ward (this was her 8th admission). She had admissions for many reasons such as pain in the abdomen and reduced fetal movements, all of which involved short stays on the ward and Della being discharged reassured that the pregnancy was progressing well. As well as these visits to the ward Della had also had regular consultations with the urology team concerning her hydronephrosis and the nephrostomy tube which she had in situ to allow urine drainage. In this pregnancy the nephrostomy tube was inserted when Della was 20 weeks pregnant. After being introduced to Della, I went on to perform an abdominal examination with Della’s consent. I then listened to the baby’s heartbeat using a pinnard stethoscope. The doctor that had seen Della in triage requested an admission cardiotocograph trace to monitor the baby’s heartbeat which had not been done in triage because it was busy over there and Della had appeared to be in a lot of pain. This information was all comprehensively documented in Della’s notes and highlights the importance of reading women’s notes thoroughly and promoting the importance of effective record keeping (NMC, 2004).
My mentor and I noticed that during the 20 minutes that we were with Della she didn’t appear to have any contractions or be in any pain. Just as we were about to leave the room Della’s husband arrived and her mood seemed to change very quickly. She became very tense and said that she was in pain and appeared to be having a contraction. Della is admitted to the Antenatal Unit for labour and then moved to the delivery suite, where the Delivery Summary will be completed.
Labour Period:
It can be said that the process of giving birth is a dramatic event in the life of placental organisms, because it demarcates the change from an aquatic to a terrestrial existence. The process of Della’s labour is not quite easy for the care team as there needs to learn about and adapt to the uterine environment in order to prepare Della for the postnatal life. Henceforth, the inability to directly observe and quantify fetal behavior during gestation led to much speculation by clinicians concerning the development of fetal state, movement and sensory capacity. Thus, the form of midwifery care focused on serving both the physical and emotional needs of the woman, providing her with information and following her lead in how she wanted to give birth.
Postnatal Period:
The care during the postnatal period is often provided by multiple caregivers and midwives of whom there is work in the antenatal clinic and or in the postnatal unit along with the continuity of care which is provided to Della by the health care team or a small group from pregnancy through the postnatal period. The postnatal care is very helpful in coping with the emotional and physical demands of motherhood which is packed with lots of practical help and advice to help them get the support they need as the midwife will visit the next day and will visit often as necessary. During the first few weeks after birth, both the midwife and health visitor will have to offer advice and support that Della need as much as possible.
Evaluation of Evidence
The consistent division between primary and secondary obstetric care for Della can be based on the principle that pregnancy and childbirth are basically natural events on a large scale by independent midwives. Thus, midwives are trained in recognizing early signs and symptoms of pathology and they are competent to do minor obstetric interventions per se. In their philosophy, the guidance of physiological pregnancy and birth requires a non-interventionist attitude that stimulates the confidence of the women in their own potential to give birth (Benoit, et al, 2001). Indeed, in most general hospitals it is possible for midwives and general practitioners to assume responsibility for deliveries. The midwife will guide Della during her pregnancy, delivery and postnatal period. Thus, adequate obstetric risk selection is an essential condition for the effective operation and the division of labour between obstetricians and midwives.
The importance of interpersonal skills and multidisciplinary work
Interpersonal skills and multidisciplinary work is important for the case situation dealing with Della as there has been the government’s policy to promote primary health care in the case of primary obstetric care as well as home births (Benoit, et al, 2001). This will be aimed at maintaining and in strengthening the delivery during pregnancy stage and the regularization along with the aim of the guidelines in promoting a well desired pregnancy and the giving of birth. This will also guide in establishing a sound relationship among Della and the care team within the assurance of better health service for pregnant women with certain case situations and in integrating better channels of communication during the total process as it is an important factor in determining a good rapport and camaraderie within the people involved and to resolve whatever underlying issues there is in the main areas of concern in terms of proper process of decision-making among the two parties. The mother and fetus made a recovery and the pregnancy has been successful due to the contribution of the skills and the discipline needed during and after Della’s pregnancy.
Awareness of professional accountability in aspects of the care delivery
Maternity application allows doctors, midwives and nurses to monitor antenatal, delivery and postnatal activities for their patients which captures data relating to child delivery and care in order to ensure quality care for the mother and her newborn. As the date of delivery approaches, the hospital monitors the expectant mother and the hospital staff are prepared for any unexpected occurrences such as complications. The purpose of the midwife care management is to identify any problems and manage them in the best possible way. The decisions that Della will make about her care and her involvement in the care are important. Being involved will help make sure that she feels comfortable with everything that is done in the process.
Midwifery care models:
Birth centers are separate from regular hospital care, but located close by the labour wards within the hospital. In a birth centre, midwives usually care for Della during her pregnancy, birth and after birth. Often the same midwife team supports a woman through pregnancy and birth. Birth centers feel more home-like and less clinical than hospital labour wards. Antenatal management takes place in the hospital setting generally in a dedicated outpatient clinic area. The woman may not see the same midwife through her pregnancy and those caring for her during the antenatal period may not be involved with the postnatal period.
Pregnant women should be offered evidence-based information and support to enable them to make informed decisions regarding their care. Information should include details of where they will be seen and who will undertake their care. Addressing women’s choices should be recognized as being integral to the decision-making process. There needs to be a schedule of antenatal appointments. For a woman having complicated pregnancy, a schedule of ten appointments should be adequate.
Pregnant women should also be offered an early ultrasound scan to determine gestational age and to detect multiple pregnancies. This will ensure consistency of gestational age assessments, improve the performance of mid-trimester serum screening for Down’s syndrome and reduce the need for induction of labour after. Lastly, there needs to have ample support for pregnant woman with hydronephrosis and therefore is accountable for the appropriate care and attention she needs respectively.
Credit:ivythesis.typepad.com
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