Cases

Chapter 6 Antenatal midwifery care

Case 1: Booking appointment

A 25-year-old woman in her first pregnancy at 10 weeks gestation attends the booking clinic. The woman's medical and surgical history is assessed and her physiological observations including: temperature, pulse, respirations, blood pressure, urinalysis, height and weight measurement are measured and recorded. Blood screening tests are offered including: group and antibodies, rubella, full blood count, syphilis, hepatitis B, human immunodeficiency virus and haemoglobinopathies.

Questions

• a) What other information needs to be ascertained?

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  Correct answer:

  • Personal details and partner.
  • Family history.
  • Known allergies.
  • Calculate Body Mass Index.
  • Lifestyle - including, exercise, smoking, alcohol, social drug use.
  • Information about social circumstances.
  • Emotional issues, any previous pregnancy losses, relationship difficulties.

• b) What other risks assessment need to be performed?

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  Correct answer:

  • Assess mental health status - using Whooley questions.
  • Routine enquiry about domestic violence.
  • Determine 'risk factors' for appropriate pathway of care, e.g. midwifery-led care or consultant-led care.

• c) What other information is given at the booking appointment?

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  Correct answer:

  • Screening options for fetal abnormality.
  • Further scheduled appointments and birth preparation classes.
  • Dietary and nutrition advice including recommended vitamin supplements.
  • Maternity benefits.
  • Safety and seat belts.

Case 2: Fear of labour and birth

At 16-year-old woman in her first pregnancy attends for the 28-week antenatal appointment and expresses that she is very anxious about coping with labour and giving birth.

Questions

• a) What could you advise to support her?

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  Correct answer:

  • Enquire about the type of support networks available to her and whether she has a birth partner.
  • Find out about how her supporters feel about childbirth.
  • Determine the depth of the problem and if she requires referral for counselling through perinatal mental health services.
  • Offer birth preparation classes.
  • Consider complementary therapies such as hypnotherapy.
  • Suggest some relevant reading.
  • Arrange a visit to the local maternity unit.

Case 3: Planning a homebirth

A 28-year-old woman, single parent, with one previous child aged 5, has attended her routine antenatal appointment at 36 weeks and states that she wants to have a homebirth.

Questions

• a) What would your assessment and considerations be?

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  Correct answer:

  • Assess if there are any physiological, social or emotional risk factors impacting on the safety of having a home birth.
  • Assess her obstetric history and wellbeing.
  • Discuss the organisation of care and accessing community midwives.
  • Organise for relevant equipment to be available.
  • Ascertain support mechanisms the woman has available, consider referral to local support agencies.
  • Ascertain childcare arrangements
  • Arrange to visit the home and make an assessment in terms of safety. Consider: access to the house, parking, amount of room, suitability, landline availability, time it takes to transfer to the maternity hospital.
  • Discuss progress of labour and transfer to hospital arrangements in the event of developing risk.
  • Consider if Midwifery Supervision involvement would be pertinent.