The Role of Midwives in Providing Health Care for Women with Pre-Eclampsia - Case Study Example

A Case study based on a Woman with Pre-Eclampsia A lot of women’s health concerns are different from those of males. This stems from the various physical differences males and females have between them. As opposed to males, females have uteri to support child bearing, and they normally have monthly physiological changes to prepare for potential fertilization. In addition, they have mammary glands to support the child post-parturition. Because of these various concerns only females experience, health care practitioners (HCPs) that cater specific to women’s needs are needed and in demand. This paper looks into the role of midwives in providing health care for women, specifically for expectant mothers. A midwife’s primary role in properly assessing the situation and giving diagnosis is discussed. Focus is also given to the cooperation between midwives and other HCPs when dealing with conditions that are not usually seen among patients. To aid in the discussion, a case of a pregnant patient, Julie, is used as an example. Julie’s pregnancy is made complicated by the increased blood pressure and protein in blood observed late in pregnancy. The flow of this paper is as follows. First, a summary of the patient’s case is given. More details, should the summary be found lacking, are provided in the appendix. Next, the various roles of midwives are elaborated, especially in cases of pregnancy. Third, pregnancy-associated high blood pressure disorders, its causes and risk factors, symptoms, complications, and treatment are looked upon. Finally, the appropriateness of the attending midwife’s actions in dealing with Julie’s case is assessed. III. Case Summary IV. Role of midwives A. Various responsibilities given to midwives There is a concerted effort among international HCP associations to care for not only the physical, but the psychological, spiritual and social well-being of a woman and her family. A midwife must do her part on this venture by monitoring such aspects of a woman’s life, especially during the child-bearing cycle. As defined by the International Confederation of Midwives (ICM), midwives are licensed, autonomous HCPs who are specialized to provide well-being related to women’s reproductive health including gynaecological tests, family planning, sexual health, antenatal tests, delivery, postpartum care and menopausal care. Aside from facilitating birth giving and taking care of the newborn infant, they are responsible and accountable for giving proper advice to expectant mothers so that each of them will have a normal pregnancy and natural parturition. This includes preventive measures such as giving advice on diet and prenatal screening during regular check-ups. In addition, they are also trained to detect abnormal pregnancy conditions. If it does not pose threat to both the baby and the mother, they are also allowed to deal with normal variations, such as preparing for twin births or giving birth to a baby in a posterior position. However, if it is already outside the scope of their expertise, it is also their duty to seek proper assistance in terms of referral to an appropriate doctor (ICM, 2005). One of the more important functions of midwives lies on their availability. Midwives are known to work at various settings. Some work in hospitals or clinics, while others deal with patients at the comfort of their communities or their own homes. A group of midwives may practice in their own birthing homes where women can visit for their health concerns (ICM, 2005). B. The process of decision-making The profession of midwifery entails a lot of decision-making from the HCP. According to ICM (2002), five steps are necessary for a proper decision-making process that needs to be practiced by midwives. STEP 1: Collect information from the woman, from the womans and the infants records, and from any laboratory tests in a systematic way for a complete assessment. STEP 2: Identify actual or potential problems based on the correct interpretation of the information gathered in Step 1. STEP 3: Develop a comprehensive plan of care with the woman and her family based on the womans or infants needs and supported by the data collected. STEP 4: Carry out and continually update the plan of care within an appropriate time frame. STEP 5: Evaluate the effectiveness of care given with the woman and her family, consider alternatives if unsuccessful, returning to STEP 1 to collect more data and/or develop a new plan To go through these steps, a midwife must have at least these knowledge and skills: knowledge of the community including beneficial and harmful common health practices that a patient might have performed, causes of maternal and neonatal mortality and morbidity in the local community, access to collaborating HCP during emergency, advocacy for women empowerment and rights, benefits and risks of available delivery setting, ability to encourage women to avail of various safe birth settings, basic life support, and assembly, use, and maintenance of essential equipment needed for practice (ICM, 2002). V. High blood pressures during pregnancy During the 3rd trimester of pregnancy, the BP should be at normal levels (Brown, 2007). However, there are four conditions in which afflicted pregnant females become hypertensive. Hypertension is defined by the World Health Organization (WHO; 2008) as having diastolic blood pressures of greater than or equal to 90 mm Hg. Gestational hypertension (GH) is the rise in BP that is not accompanied by an increase in protein in the urine. In contrast, chronic hypertension (CH) can be a more prolonged condition than GH, because it can start as early as 20 weeks gestation and can last as long as 12 weeks postpartum. However, there is a similar condition called pre-eclampsia that causes more serious complications than CH and GH (Mayo Clinic, 2009). Pre-eclampsia is an idiopathic condition among pregnant women in which there is a significant increase in blood pressure and protein levels in urine. This condition is usually observed after 20 weeks gestation. However, it must be noted that pre-eclampsia cannot be associated with hypersensitivity or proteinuria alone because each of these symptoms are associated with a different set of conditions. For example, other causes of detecting high protein levels in urine are urinary tract infection, kidney disease, contamination of urine specimen with vaginal discharge, blood, or amniotic fluid, severe anemia, and heart failure (WHO 2008). Aside from high blood pressure and proteinuria, severe headaches, changes in vision, upper abdominal pain, nausea, dizziness, sudden increase in weight, and decreased urine output can be observed from a patient with pre-eclampsia, especially when it has become severe pre-eclampsia. (WHO 2008). Although the cause for this condition is not yet known, several risk factors are associated with it: personal history of pre-eclampsia, hypertension, migraine, diabetes, kidney diseases, rheumatoid arthritis lupus, urinary tract infections, or periodontal diseases, primigravida, vitamin D insufficiency, pregnancy at age below 20 or above 40, obesity, multiple pregnancy, prolonged interval between pregnancies, gestational diabetes (Mayo Clinic 2009). As mentioned, pre-eclampsia is known to cause serious complications for both mother and child, especially if it occurs early in pregnancy. Pre-eclampsia causes a decreased blood flow to the placenta. For the mother, secondary to this may be placental abruption, which can cause severe bleeding. It is also associated with the HELLP syndrome: Hemolysis of red blood cells, Elevated Liver enzymes, and low Platelet count. These effects causes the nauseous feeling, vomiting, headache, and upper abdominal pain a pre-eclampsia patient may be experiencing. If not controlled, pre-eclampsia might soon lead to seizures, which affects brain function if left untreated. Once seizures are observed from a patient, it is now called eclampsia. Aside from these complications, pre-eclampsia predisposes a woman to cardiovascular diseases and respiratory problems later after pregnancy (WHO 2008; Mayo Clinic 2009). As for the effects on the baby, the effects stems from the hypoxic conditions that may arise from placental abruption. The lack of oxygen decelerates the baby’s growth and development, causing intrauterine growth retardation (IUGR), leading to either physical or mental disability. If pre-eclampsia is experienced early in pregnancy (. International Confederation of Midwives 2005, Definition of the Midwife, Sept. 26, 2010, . Mayo Clinic 2009, Preeclampsia, Sept. 26, 2010, . World Health Organization 2008, Education Materials for teachers of midwifery, Sept. 27, 2010, . APPENDIX 1- CASE STUDY The patient, “Julie”, was a 30 year old female pregnant with her second child. She started 4-week antenatal check-ups at 10 weeks gestation, and at 12 weeks gestation her weight is 58 kg, and at this time her booking blood was taken. The results shown that she was blood type A, Rhesus positive, Rubella immune, and without Syphilis, hepatitis B, Sickle cell, Thalassaemia, and HIV. At that point, she also had normal body mass index (24 kg/m2) and haemoglobin levels (12.6 gm/dl). Blood pressure (BP) readings were within normal (60) until 30 weeks gestation. Julie’s placenta was also normally placed. She had no drug allergies, did not smoke nor drink alcohol, and had no experience of domestic violence or depression. As for her relevant medical history, she was pregnant with her first child last year, but it was miscarried at 12 weeks. Her family medical history revealed that her father had diabetes 2 and her mother had hypertension. In preparation for her pregnancy, folic acid was taken during the first semester, and Julie underwent regular urinalysis and ultrasound scan. Until 34 weeks, the results of these tests were normal. As for the condition of the baby, several tests were also conducted. The expected delivery date (EDD) was June 05, 2010. At 32 weeks of gestation, her BP started to rise, and 250 mg Methyldopa BD was given to supposedly given to treat high blood pressure by decreasing sympathetic neurotransmitter, epinephrine. Results of urinalysis and fetal assessment tests were normal. Two weeks before the scheduled delivery, BP was still high, and proteinuria was detected. Normal fetal condition and stable BP were assessed after conducting additional tests. Julie was advised to return on her EDD, and her medications were changed to Labetalol BD, and Betamethasone was given. On her term, the patient complained of severe headaches, abdominal pain and spontaneous rupture of membranes. Through caesarean, Julie delivered a live male infant, weighing 2.65 kg and in good condition. The Apgar score was 8 at 1 min. and 9 at 5 min. after delivery. Read More