Cases

Chapter 5 Parenthood

Case 1: A surrogacy arrangement

A midwife is called to attend the birth of a baby. The childbearing woman, Sally, aged 32 is Gravida 3, para 2. Her two children are aged five and three. She is pregnant as the result of a surrogacy arrangement. It is not stated whether she is a full surrogate, or a partial surrogate. Therefore, the genetic origins of the baby are not clear. The commissioning parents (social father and social mother) are in the birthing room in attendance. Sally is a married woman; this was the case at the time of making the surrogacy arrangement. Sally is no blood relation of the commissioning couple.

On transfer to the community, the commissioning parents have arranged for the baby to take up immediate residence with them.

Questions

• a) Who is considered to be the mother of this baby?

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  Correct answer:
  The gestational mother, Sally.

• b) When and how could parental status change in this situation?

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  Correct answer:
  Parental orders take effect after six weeks postpartum; prior to this a surrogate mother may decide not to relinquish her baby.

• c) To whom does the midwife have a duty of care?

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  Correct answer:
  The gestational mother Sally and the baby. Midwives are primarily concerned with supporting childbearing women and babies, whilst appreciating the diversity of parenting roles they may encounter.

• d) The commissioning parents live in a neighbouring city: what involvement should the midwife have in the continuing care of the gestational mother and the baby and why?

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  Correct answer:
  The gestational mother Sally and the baby will still require the provision of postnatal care by the midwife, health visitor and GP. Midwives duty of care is to the gestational mother and baby.

Case 2: New parents

A community midwife (Liz) is visiting a primiparous woman, Jasmine at home the 10^th postnatal day. When she arrives at the home, she notices that the baby is in the prone position (on his front) in the cot, wearing several layers of clothing and a hat, with a blanket covering him. Jasmine is a 20-year-old and lives with her husband and her husband's parents. When Liz asks Jasmine about the baby's sleeping arrangements, Jasmine tells her that this was recommended by her mother-in-law as the baby is prone to vomiting his formula feed; this position was to prevent him from choking.

Questions

• a) What kind of family structure does this represent?

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  Correct answer:
  Extended family structure.

• b) Who may be seen as the source of authoritative knowledge, by Jasmine and her husband in this situation and why?

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  Correct answer:
  The mother-in-law, because she has experienced being a mother. The midwife would need to educate the grandmother, sensitively and respectfully since she is so influential and important to this family.

• c) How should the midwife educate the family about safe sleeping practices and what information should be included?

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  Correct answer:
  The midwife has a responsibility to inform the parents that the current body of evidence overwhelmingly supports the following key messages, which should be conveyed to all parents when discussing reducing the risk of sudden infant death syndrome:

  • The baby should be placed on their back to sleep, never on their front or side.
  • The safest place for your baby to sleep is in a cot by your bed for the first 6 months.
  • The baby should not be over-dressed or covered with too much bedding.
  • The room should not be too hot (16-20°C) is ideal.
  • Sleeping with your baby on a sofa puts your baby at greatest risk.

Case 3: Teenage parents

Ingrid and Caleb are both 15 years old and live at home with their parents; Ingrid has recently found out that she is 10 weeks pregnant. This is not a planned pregnancy. Initially no-one was happy about the pregnancy, but all the families are now getting more used to the idea. Ingrid wants to keep the baby and Caleb is excited about becoming a father. Both Ingrid and Caleb smoke, but have decided that they would like to stop or cut down due to the pregnancy.

Questions

• a) How can Ingrid and Caleb be supported in their role as parents?

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  Correct answer:

  • Ingrid should be referred to a teenage specialist midwife if there is one available.
  • Appropriate communication strategies should be used to engage teenage parents.
  • Ingrid and Caleb should be informed about the maternity services for teenage parents, including antenatal classes aimed at teenagers.
  • Caleb can be referred to a Father's Worker.
  • The family nurse partnership support families in these circumstances.
  • Ingrid should be supported to remain in school.
  • Ingrid and Caleb should be referred to the smoking cessation services.