Integrated Care Pathway - Contemporary Women - Essay Example

Integrated Care Pathway Contemporary Women It is beyond reasonable doubt that in the contemporary socio-economic scenario, women in particular are becoming more exposed to a growing number of new trends. "Most women needed men for their economic survival before the equal-opportunity movement in the 1960s, which opened access to most all careers. Moreover, the expansion of white-collar jobs and jobs for secondary earners since the 1960s has presented women with a viable range of employment alternatives to traditional domestic life". (Neil, 2005) Problems may arise when the diverse needs of women directly or indirectly create anomalies in women who are mothers of newborn children or, more importantly, are carrying a child and are going to become a mother. This essay, therefore, is going to focus on developing an integrated care pathway with the prime objective of promoting normality for the kind of women discussed. This integrated care pathway will attempt to: Link problems during pregnancies and childbirth that women may face and the role of midwives in this situation Lay down relevant strategies midwives may adopt to harmonise the process Explore the diverse needs these contemporary women may have Explain the circumstances women have to face during child birth Explain what caesarean section is, defining it while exploring the risks involved Focus on the success rate of VBAC and attempting to clarify any misunderstandings Midwifery To promote normality, midwives can perform a number of functions that can bring harmony in different phases a woman may go through before, during and after her pregnancy period. However, midwives need to put in stringent efforts so as to develop strategies, which can enable them to work in partnership with women viewed as high-risk. Strategies for Midwives First and foremost priority should be given to establishing a truthful bond with the mother. The maxim of midwifery can be directly linked to the notion of social support as applied to pregnancy, which can be defined as "social relationships, information, nurturance, empathy, encouragement, validating behaviour, constructive genuineness, sharedness and reciprocity, instrumental help, or recognition of competence". (Melinda, 1994) Since faith of the people has shifted more towards institutional health care, midwives should focus on affiliations with renowned institutions that offer authenticated certifications. "In the United States, for instance, institutes like The American College of Nurse-Midwives (ACNM) provides certifications under non-nurse midwife programs, as well as to colleges which graduate nurse midwives". (Midwifery) Role of Midwives A professional midwife is capable of providing women with thorough prenatal care, while assisting her during labour and postpartum depression. Working women in particular can share their responsibilities with midwives during prenatal care. Experts have also laid down tips to help women face postpartum depression. Some of them include "getting as much as rest as a mother can, talking to other mothers or joining support groups, communicating with the spouse, health care practitioner and friends regularly, eating well, keeping a diary to write down emotions". Midwives can truly help ease the pressure. (Postpardum Depression) Moreover, midwives can extend support to mothers in a variety of different ways: Rothman explains: "Most midwives are happy to provide whatever documentation is needed for a woman to be excused from work when complications indicate it would be best. If together we feel she needs to cut back on her hours or stop working altogether, I just ask what her workplace requires in order to excuse her, and I do whatever is needed." (Working While Pregnant) Even if the care providers generally follow certain practices during labour and delivery, they may be willing to accommodate specific preferences of the mother. A midwife can help the mother write out a birth plan which can help both of them focus on what is important during labour and delivery. (Moms: Prenatal Care) Women in labour need lots of encouragement and need helpers who are calm, positive and caring. No matter what is happening in the rest of the world, it is important to keep the room peaceful and to focus on the mother's needs. She needs support and reassurance to do the hard work of labour. Midwives can be there for her and her baby. (Giving Birth In Place) Stacy Gaskin of Baton Rouge, Louisiana, had never heard of postpartum depression. It took her close to a year, but she eventually got help. She says she was embarrassed to confide in someone because she thought she was a bad mother. "But once I talked to my doctor, I was so excited there was a diagnosis and a treatment." A midwife could have helped her much earlier had she been in touch. (Postpardum Depression) Antenatal Care To extend antenatal care to mothers, choices of care should be discussed and a care plan developed. Care can be shared by the obstetrician, midwife and general attending practitioner. Details of medical history should be recorded on a one to one basis with the midwife. A number of blood tests should then be carried and an ultrasound scan can be offered. Ultrasound scanning produces a picture of the child inside the mother's womb. "A detailed anomaly scan at 18 - 20 weeks gestation may be offered to some women. While most structural anomalies may be identified on this scan 10 - 15% of problems cannot be identified." (Antenatal Care) Every woman attending for an antenatal care program should be offered blood tests which may indicate an increased risk of abnormality in the child. Around one out of ten women are called for further counselling after conducting such tests. The care plan should be updated with each visit to the attendants. Midwives should visit the mother at home before birth to extend support and advice. Postnatal tests should be undertaken after every 6 weeks to keep the care plan updated. A parenthood program should be planned which should be aimed at informing and preparing for labour, breathing and relaxation techniques, options available for pain relief, breastfeeding and adapting to parenthood. A physiotherapist should attend the ward after birth to offer physical exercise and advice help to avoid problems like back pains. Women Having Diverse Needs Childbirth and reaching motherhood is a uniquely intense, intimate and imperative moment in any woman's life. Today, based on statistical evidences, growing number of women are interested in paid work, yet they are not so strongly dedicated to a career that they would give up their motherhood. Accordingly, women of today can be categorized under two broad classes known as the "neo-traditional" and "modern" groups. "The neo-traditional group contains families with two children whose working mothers are physically and emotionally involved more in their home life than their jobs, which are often part-time. The modern family usually involves a working mother with one child. These women are more career-oriented and devote greater time and energy to their paid employment than neo-traditional women". (Neil, 2005) What is most needed is to give equal consideration to the diverse values that influence how women respond to the conflicting demands of work and family life. Public child-care establishments and growth of institutionalised midwifery have, to some extend, catered with this matter and even though they do not offer a perfect substitution to motherhood, yet manage to extend a supportive role to assist women having such diverse needs. Caesarean Section The most common way of childbirth is through a vaginal delivery but a Caesarean Section is used under certain situations. Caesarean Section, commonly known as C-section, "is a form of childbirth in which a surgical incision is made through a mother's abdomen and uterus to deliver one or more babies. It is usually performed when a vaginal delivery would lead to medical complications". (Caesarean section - Wikipedia) In many instances, even if vaginal birth is possible, C-section is considered a safer route to childbirth. However, C-section is not performed if there is no sufficient ground to justify its operation. Such a major surgery involve risks and may involve heavy bleeding at the time of surgery and after delivery, infection in the wound or clotting of blood in the leg veins. Risks of such complications can be substantially reduced if appropriate measures are taken by the attending obstetrician and midwife. VBAC (Vaginal Birth After Caesarean) Divergent from popular belief and what most doctors might suggest to women, numerous studies have found VBAC to have very good success rates. Interestingly, these success rates are also highly dependent on the study that is carried out. For instance some studies have indicated a VBAC success rate of 45% while others have shown rates as high as 90%. But then the question would arise as to why such a wide range persists VBAC success rates vary widely depending on the purpose of study, the type of providers in the study and their philosophy or approach towards the study, responses of individual caesarean cases, etc. According to another study, "roughly 75 percent of all VBACs go routinely, and those that don't usually end up as non-emergency Caesareans. This means that if a woman accepts a 1-in-200 chance of a rupture and emergency Caesarean, she has a 75 percent chance of avoiding another C-section altogether." (VBAC Backlash) Although some caesareans are purely due to physiological reasons, many women still emphasize the emotional aspects involved in the process. Similar argument is presented in favour of VBAC where mothers feel that emotional processing is important for preparation of VBAC and may help increase its success rate. "A Planned vaginal birth after a previous caesarean section should be recommended for women whose first caesarean section was by lower segment transverse incision, and who have no other indication for caesarean section in the present pregnancy. The likelihood of vaginal birth is not significantly altered by the indication for the first caesarean, nor by a history of more than one previous caesarean section ". (VBAC.com) Conclusively, it would be inappropriate to state that VBAC is a risky endeavour. Neither can an argument be established to state that it is the safer route. The decision of going for a VBAC should not only be based on the physical medical conditions of a woman but also on her emotional approval and should also involve appropriate counselling from obstetricians and midwives. References Caesarean section. Retrieved 22 January, 2006, from http://www.netdoctor.co.uk/health_advice/facts/caesarian.htm Caesarean section - Wikipedia, the free encyclopedia. Retrieved 22 January 2006, from http://en.wikipedia.org/wiki/Caesarean_section Emotional Recovery From a Cesarean. Retrieved 4 February 2006, from http://www.plus-size-pregnancy.org/CSANDVBAC/csemotionalrecov.htm Giving Birth In Place. Retrieved 05 February, 2006 from http://www.mymidwife.org/index.cfmid=107 Melinda Cook, B.H.S (Nursing). "The role of social support in midwifery practice and research". Hunter Valley Midwives Association (HVMA) Journal, Nov/Dec 1994. Midwifery Today - Pregnancy, Birth, Homebirth and Midwife Information. Retrieved 4 February 2006, from http://www.midwiferytoday.com Midwifery - Wikipedia, the free encyclopedia. Retrieved 22 January 2006, from http://en.wikipedia.org/wiki/Midwifery Moms: Prenatal Care Retrieved 05 February, 2006, from http://www.mymidwife.org/index.cfmid=25 Neil Gilbert. What Do Women Really Want Public Interest. Issue:158. Winter 2005. Antenatal Care Retrieved 08 February, 2006 from http://www.nhsis.co.uk/yorkhill//////maternity/antenatal_care.asp Postpardum Depression. Retrieved 22 January 2006, from http://www.mymidwife.org/momstobe/postpardumdepression.cfm Pregnancy. Retrieved 22 January 2006, from http://www.mymidwife.org/momstobe/pregnancy.cfm VBAC Backlash - Why are hospitals forbidding women who have had C-sections the right to have Retrieved 22 January 2006, from http://www.slate.com/id/2111499/ VBAC.com - a woman-centered, evidence based, resource. Retrieved 4 February 2006, from http://www.vbac.com/chapter38.html#4 Working While Pregnant. 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