Cases

Chapter 2 Team working

Case 1: Waterbirth

Jayne is 28 weeks pregnant; at booking her BMI was recorded at 35. At the 28-week antenatal appointment Jayne states she would like to have a waterbirth, but has been told she cannot have one in the local maternity unit due to her raised BMI. Jayne informs the midwife that she has therefore decided to have a home birth and will be ordering a pool so that she can have her waterbirth at home. She is not particularly keen to have a home birth, but is adamant that she wants a waterbirth. It is Jayne's first baby and she is fit and healthy.

Questions

• a) What can you do to support Jayne's wish to have a waterbirth whilst making the birth as safe as possible for both Jayne and her baby?

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  Correct answer:

  • Ensure that Jayne has all the up to date evidence with which to make an informed decision.
  • Arrange for a supervisor of midwives to meet with the Jayne to discuss her plan.
  • Arrange for Jayne to meet with her obstetrician to discuss her plan.
  • Identify whether there is any way to negotiate Jayne having a waterbirth in the unit despite her BMI.
  • Support Jayne in her choice and ensure that the community midwives are aware of this request and that appropriate plans are in place for the birth.

Case 2: Gaining a woman's trust

Jackie is on a methadone programme; she has not attended for her last two antenatal appointments, and she is visited at home by the midwife. Jackie tells you that she has not attended her appointments as at her booking appointment she felt that the midwife and doctor that she saw were judging her in relation to her drug use. Due to this she has not attended any other appointments except her ultrasound scan and a meeting with a drug counsellor. Jackie tells you that she is feeling guilty about taking drugs whilst pregnant and is doing her best for her baby by remaining on the methadone programme; she has also reduced the amount of cigarettes she is smoking.

Questions

• a) How can you help to build a trusting relationship with Jackie and so encourage her to attend for her antenatal appointments?

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  Correct answer:

  • Apologise for how Jackie felt about her booking appointment.
  • Discuss with Jackie the importance of attending for antenatal appointments.
  • If there is a specialist midwife for substance misuse, refer Jackie to this midwife and refer to a consultant obstetrician.
  • Consider arranging for Jackie to see you for other antenatal appointments so that you can build up a relationship with her.
  • Give positive reinforcement to Jackie for her progress on the methadone programme and reduction in smoking, emphasising how this will have improved her health and that of her baby.
  • Discuss with a supervisor of midwives Jackie's experiences at the booking appointment.

Case 3: Bullying and harassment

Catherine who has been qualified as a midwife for 5 years, is working on the labour ward and is having difficulties with one of the other more experienced midwives (Betty) on the ward. Betty is constantly questioning Catherine's practice in front of other members of staff, which Catherine has been trying to 'laugh off'. When she has tried to discuss this with another midwife they have just told her that this is how Betty is and she needs to just get on with it. Catherine knows that her practice is safe and evidence-based, and that the women and their partners are happy with the care she is giving. Catherine is now finding it increasingly difficult to go to work and is constantly questioning her practice. She dreads being on the same shift as Betty as this tends to make Catherine feel worse.

Questions

• a) As a fellow health professional what would you advise that Catherine should do?

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  Correct answer:

  • Catherine should contact her supervisor of midwives to discuss this situation with her.
  • Catherine needs a mediator so that Betty can be made aware of how she is making Catherine feel.
  • Discuss the situation with the ward manager.
  • Contact Trade Union for support and advice.