Prenatal care

Nurses serve a beneficial and most significant role in providing health care, their efforts in maternity care being immense and noteworthy. Pregnancy is a natural process and interventions and guidelines should be developed with the aim to provide health care benefits and prevent associated health care problems to the women throughout their course of pregnancy. Maternal care is highly essential to ensure proper neonatal development and promote quality living to the women during the pregnancy period (Clark, Beatty & Reibel, 2015). Maternity nurses are highly specialized health care experts having enormous experiences in providing care, advice, beneficial suggestion and support, thereby ensuring the good health of both foetus and the mother (Miller et al., 2016). Maternity care involves taking care of the regular checkups of the pregnant women, screening to check that both the mother and foetus are taken care during gestational period. Maternity nurses have essential responsibilities in providing prenatal care and preventing pre and post pregnancy complications; giving expert advice and quality care to the newborns are core to maternity nursing. These nursing experts take efforts to meet to the needs of the mother and the newborns, ensuring quality care (Koblinsky et al., 2016). Many of the deaths have resulted due to improper maternity care during gestational and post pregnancy periods; birth of low-weight babies, neonatal death, still births are few cases of lack of maternity care. Nursing professionals are updating their knowledge and experiences with time and evidences to improve the maternal care, thereby minimizing the complications arising from improper maternity care.

Women can progress through their gestational periods without complications and manage efficiently with minimum support from health care professionals during pregnancy; still, health care promotion during prenatal stages are essential for the well-being of both the mother and the foetus to ensure a normal delivery without any complications. Maternity care initiates from the early gestational periods to promote health support and beneficial advice for the prenatal care.

Maternity nurses perform efficiently during antenatal stages in close association with the expectant parents. Their proficiency in communication skills provide education to the expectant parents regarding the importance of prenatal care in well-being of both mother and the foetus. Prenatal care involves assisting the primary care givers and provide a physical examination of the expectant mother; knowledge of any prior medical condition that may relate to the neonatal birth is also taken care of (Azarmehr et al., 2018). Maternity nurses focus on the living style of the would-be mothers, particularly on their nutritional requirements and diet to promote healthy buildup of the foetus. They render early interventions so as to avoid any chances of complications; they have a central role in educating the expectant parents about the parenting skills and care of the newborn. Nursing professionals perform careful monitoring of the developmental stages of the foetus in the mother’s womb for medical complications that may arise and affect neonatal birth. They promote healthy habits among the expectant parents like prohibiting alcohol and contraceptive intake, encouraging folate consumption and healthy dietary practices (Downe et al., 2017). There are many expectant mothers who suffer from medical diseases that may cause pregnancy complications. Maternity care, particularly prenatal care has a central role to play in this area. Maternity nurses involve in physical examination of the would-be mothers, screening to check if the foetus is at a risk of inheriting any such complications (Almonia et al., 2017). Prenatal care givers provide a helpful education to these mothers on management of chronic diseases during gestational period.

Case study description

A 25-year old woman paid her first visit in the 6^th week of her gestational period, reporting with frequent urination and a feeling of excess tiredness. She consulted with the primary care professionals, Midwife who suggested a thorough physical examination. Oral examination revealed that she had a familial history of diabetes and she had been consuming high carb-high fat diet during the initial few weeks. She was advised to undergo a blood test and a urine test to confirm gestational diabetes. Positive test reports suggested that she needed to consult diabetologist to undergo prenatal care, taking care of the regular diet required to control gestational diabetes. She was prescribed a diet chart by her dietician, advising her to consume fiber rich complex carbohydrate foods. Lean foods like chicken, fish are encouraged; foods with low-glycemic index like whole grain cereals, carrots, beans, chickpeas are recommended. The patient was strictly warned not to skip meals. Eating vegetable and fruit salads were recommended every 2 hours. In the 10^th week, she came in for her second prenatal care visit when she underwent blood tests to check for HIV infections, presence of Rh factor and anemia. She was suggested a pelvic exam and also to ensure for bladder infections and gonorrhea. She was prescribed adequate medications to take care of her mild bladder infections upon confirmation. A genetic counseling was performed to check for chromosomal aberrations and related genetic abnormalities; the test reports being negative. A health care visitor was appointed on a home-basis to ensure that her living and dietary requirements were met. On her 14^th week visit, she was recommended an intake of 600mg of folic acid during her gestational months to prevent any neural tube defects or cleft palate formation in the neonates. During her 18-20th week period, the patient was carefully monitored for blood pressure, gestational diabetes and regular body weight. A neonatologist educated her on parental skills, newborn care and post pregnancy side-effects. She underwent an ultrasonography in the 24^th week to carefully monitor the position of the foetus with the assistance of ultra-sonographer and radiologist. She was again monitored for blood sugar levels which showed an uncontrollable rise in blood sugar levels. She had a premature delivery with a lower weight of a baby son, weighing 1800grams.

The case study reported had complications and therefore resulted in premature delivery. Gestational diabetes normally give a normal delivery; in the above case study blood sugar test reports in the last week before delivery showed a fluctuating higher level of blood glucose. Expectant women who had been diagnosed with gestational diabetes before 24 weeks of pregnancy are at a higher risk of premature labor and premature child delivery. The above case study also reported a high blood glucose level at the end of pregnancy period which thereby, increased the likelihood of a caesarian delivery. The ultrasonography showed the image of the foetus, confirming a larger size of head, which made normal delivery very difficult. Gestational diabetes is associated with premature labor, a condition observed in the above case study. The patient had premature labor; she conceived at the end of seventh month. The expect ant mother had a severe abdominal bleeding which resulted in her unconsciousness. A delayed response and attention was provided by the health care team and the doctors. The premature baby had a low weight of 1800 grams with a larger head size. Post-delivery, the baby suffered from jaundice and anemia with pale yellow skin. The baby had been reported with breathing troubles after few days of premature delivery. Mineral deficiency occurred in the baby later.

Case study analysis

The complications reported in the above case study could have been managed with a proper planning of prenatal care, being specific according to the needs of the expectant mother. A more generalized approach had been taken by the practitioners; as a result this led to a negligence on meeting the requirements on a family basis. The health care visitor did not make considerable effort to look into the dietary requirements, which resulted in a surge of blood glucose level (McCarthy et al., 2016). The ultra-sonographer was not efficient in performing and analyzing the development and position of the foetus. This however, presented complications during delivery. A more collaborative approach towards understanding and screening of the patient was needed to improve the management of gestational diabetes during the pregnancy period. A more thorough and routine monitoring could have minimized the complications of premature delivery. Nursing process was less efficient in providing quality care to this patient (Debessai et al., 2016). A lack of proper communication among the health care practitioners and maternity care givers was a significant cause of not meeting the dietary requirements. There was inefficiency in providing educational skills by the health care visitor, who did not involve a routine follow up for the patient.  Since the patient belonged to a minority community, she received less attention in the labor room which made her unconscious for a while. Clinical guidelines on prenatal care are clearly mentioned; however, nursing approaches did not properly maintain that. Proper management methods need to be employed for controlling gestational diabetes during pregnancy (Russo et al., 2015). There had been knowledge gaps among the nursing officials, which need to be urgently considered in order to improve complicacies. Prior cases of complications in pregnancies should be taken as evidences to rectify the functional roles of the health practitioners. Biasness as observed for minor communities should be eliminated (Harrison et al., 2017). All health care professionals should have only one approach towards patients; promoting unbiased quality care with the goal of improving and minimizing the cases of complications during pregnancies.

As a nurse attending to the above case in prenatal care, I would have involved into a systematic planning method. I would have approached a multidisciplinary team of diabetologists and taken regular follow up with the team to enhance my knowledge of the reasons of complications that may arise due to gestational diabetes. I would have taken a regular follow-up at the patient’s house on a weekly basis to ensure that the patient abides by exact requirements of her diet and regular exercises as mentioned. I would have developed a rationale so that the patient understands the complete schedule specific for her pregnancy treatment requirements. I would provide non-judgmental support to the patient throughout the treatment and care. Non-biasness is prime in providing quality health care and assistance. I would have made sure that the patient felt comfortable during the course of prenatal care. Telephonic interaction would have been a part of my care giving program so that the patient could reach out to me whenever in need. I would have indulged in gaining a complete knowledge of the patient’s medical history with an effort to understand the signs and symptoms of complications that might arise; based on this I would have assisted with primary care setting to develop a personal pregnancy care plan to meet the individual requirements related to the pregnancy. Besides, I would have acquainted the patient family with insurance policies and claims procedure so that for any unknown complications, the insurance would cover the health adversities post pregnancy complications. Collaborative efforts between the health care professionals involving primary care settings, diabetologist, prenatal care provider and neonatologist and health staffs related to the patient’s pregnancy details would have been followed and maintained from the beginning of pregnancy care till initial months after the birth of the newborn. A routine follow-up to ensure the well being of the newborn and the mother would be attended with equal care and support.

Case study complications

Conclusion

Pregnancy is a natural physiological process which requires extreme care throughout the stages and even after the birth of the newborn.  Quality care provided to the expectant mothers is essential as it determines the health of the foetus inside the womb and after its birth. Prenatal care is provided during the beginning of pregnancy to the expectant mothers. The basis of prenatal care is to provide an understanding and educate the would-be parents about the experiences of initial stages of parenthood. They are provided with a learning training on how to give quality care to the newborns and how to develop beneficial habits of living to ensure a healthy life for both the mother and the foetus. Quality care and assistance given during prenatal care by the nurses is essential in maintaining a sound pregnancy and healthy delivery of the child. Prenatal care is essential in order to avoid complications that may arise during pregnancy in cases where prenatal care has not been provided. Prime concern should be given by the medical team, both primary and maternity care settings to provide health living habits and quality care. Clinical guidelines should be maintained while providing maternity care, with an effort to promote equality and cultural diversity at the patient as well as the doctor level. Therefore, it is highly commendable that maternity care is central in providing highly essential and beneficial medical assistance during pregnancy. 

References

Almonia, S., Damian, K., Enea, G., Karlsen, S., & Markham, J. (2017). Factors & Risks Associated with Adolescents Late Entry into Prenatal Care. doi.org/10.1016/j.jpag.2016.10.001

Azarmehr, H., Lowry, K., Sherman, A., Smith, C., & Zuniga, J. (2018). Nursing Practice Strategies for Prenatal Care of Homeless Pregnant Women. Nursing for women’s health. doi.org/10.1016/j.nwh.2018.09.005

Clark, K., Beatty, S., & Reibel, T. (2015). Maternity care: a narrative overview of what women expect across their care continuum. Midwifery, 31(4), 432-437. doi.org/10.1016/j.midw.2014.12.009

Debessai, Y., Costanian, C., Roy, M., El-Sayed, M., & Tamim, H. (2016). Inadequate prenatal care use among Canadian mothers: findings from the Maternity Experiences Survey. Journal of Perinatology, 36(6), 420. doi.org/10.1111/jmwh.12379

Downe, S., Finlayson, K. W., Tunçalp, Ö., & Gülmezoglu, A. M. (2017). Factors that influence the provision of good-quality routine antenatal services: a qualitative evidence synthesis of the views and experiences of maternity care providers [Protocol]. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD012752.

Harrison, M. E., Clarkin, C., Rohde, K., Worth, K., & Fleming, N. (2017). Treat me but don’t judge me: a qualitative examination of health care experiences of pregnant and parenting youth. Journal of pediatric and adolescent gynecology, 30(2), 209-214. doi.org/10.1016/j.jpag.2016.10.001

Koblinsky, M., Moyer, C. A., Calvert, C., Campbell, J., Campbell, O. M., Feigl, A. B., & McDougall, L. (2016). Quality maternity care for every woman, everywhere: a call to action. The Lancet, 388(10057), 2307-2320. doi.org/10.1016/S0140-6736(16)31333-2

McCarthy, E. A., Walker, S. P., Ugoni, A., Lappas, M., Leong, O., & Shub, A. (2016). Self?weighing and simple dietary advice for overweight and obese pregnant women to reduce obstetric complications without impact on quality of life: a randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, 123(6), 965-973. doi.org/10.1111/1471-0528.13919

Miller, S., Abalos, E., Chamillard, M., Ciapponi, A., Colaci, D., Comandé, D. & Manuelli, V. (2016). Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. The Lancet, 388(10056), 2176-2192. doi.org/10.1016/S0140-6736(16)31472-6

Russo, Lindsey M., et al. “Physical activity interventions in pregnancy and risk of gestational diabetes mellitus: a systematic review and meta-analysis.” Obstetrics & Gynecology 125.3 (2015): 576-582. doi: 10.1097/AOG.0000000000000691