Preterm Labour and Birth - Case Study Example

Running Head: PRETERM LABOUR AND BIRTH Name Course Instructor Date PRETERM LABOUR AND BIRTH Shelly case form part of statistic of preterm labour as a leading worldwide cause of perinatal mortality and disability, there is increase concern on impact of preterm both to the child and its family (Anderson, 2000). Preterm labour can be defined as labor which happen earlier or before 37 weeks of pregnancy has not been completed. Preterm labor can lead to preterm birth commonly known as premature birth. Research indicates that 14% of Australian perinatal deaths in the year 2005 were due to preterm delivery (Anderson, 2000). Nevertheless, most women that have symptoms of preterm labor normally deliver with a minimal minority delivering within seven days of onset of the symptom (Anderson, 2000). This paper focuses at describing effects of preterm labour, its connection to a previous case of a preterm birth on a pregnant woman, its management and role of midwife using Shelly as the case study. Shelly’s past history of having a baby born spontaneous vaginal birth at 22 weeks had an impact on her mental state and is largely connected to the current pregnancy. Research indicates that mothers of preterm infants have a greater risk of psychological distress as compared to mothers’ full term infants which is a similar case Shelly is experiencing (Giles et al, 2000). Past study has indicated a high connection between preterm birth and increased risk of having schizophrenia (Anderson, 2000). It is quite evident that Shelly’s visibly upset, having the feeling that her current pregnancy will end just like the previous one is one of the key symptom of mental problem. The feeling that Shelly’s have shows a link between preterm birth and a range of psychiatric disorder that may have resulted to her current state (Australian College of Midwives, 2013). During preterm labour or when patient experiences rupture membranes during a pregnancy midwives play critical role. In Shelly’s case, midwives can offer her emotional support to her assuring her that what happened in the last pregnancy will not happen in her current pregnancy. Emotional support assists the patient in changing her mental perspective in regard to her present condition. The stress displayed by Shelly’s can be the key factor that contributed to preterm birth from her recent pregnancy (Anderson, 2000). Additionally, due to the ruptured membrane, Shelly midwife can engage in the provision of midwifery care in accordance to National midwifery guidelines for consultation and referral. This will enable Shelly to obtain maximum care during her pregnancy, labour and birth (Australian College of Midwives, 2013). Through referral and consultation Shelly midwife will be in a position to recognise the various variations of normal progress to Shelly pregnancy such as ruptured membrane and deal with these variations to ensure they do not pose danger to both her and the infant (Giles et al, 2000). For instance, in Shelly’s case it is the midwives duty to find out she is a febrile and that her vital signs are within normal limits. Arriving at the birth suite, midwife is expected to create an excellent opportunity to establish a rapport with Shelly through observing, questioning, reviewing her history so as to create an atmosphere of acceptance. Further, Shelly midwife is expected to advice on the various examinations necessary for the earliest possible diagnosis of pregnancies at risks. This is done through recognising the different warning signs of abnormality in Shelly such as the discharge which may require a specialist’s attention. In case Shelly delivers, Shelly midwife is expected to examine as well as take care of the newborn taking all necessary initiatives which are important to ensure the mother and child health are stable (Australian College of Midwives, 2013). Midwife need to create a rapport with Shelly by acknowledging her feeling. Nurses can plan for counseling session with Shelly explaining to her refer is necessary for her case (Bhattacharya, 2010). Shelly has presented to birth suites with query rupture membranes and because of her gestation there is need for midwives to refer her to other health care providers. The midwives have several level of consultation towards enhancing their roles and responsibilities (Bhattacharya, 2010). Based on Shelly case, the midwife is expected to initiate discussion with other health care providers so as to plan as well as provide optimal medical care to her. Such discussions do not necessarily mean transfer of responsibility but rather foster sharing of information (Australian College of Midwives, 2013). Additionally, Shelly midwife is expected to initiate effective consultation through communication with other health care providers. Consultation may involve a face to face assessment of Shelly’s. After consulting with other health practitioners, the midwife can refer to health practitioners in consultation with her. It is important that even after referral, Shelly midwife continue to provide midwifery care within her prescribed midwife scope of practice (Bhattacharya, 2010). It is quite evident that preterm birth occurs for various reasons. (Bhattacharya, 2010) maintain that most efforts in identification of risk factors for preterm birth either ignore the primary cause or consider preterm birth as a single entity. From Shelly’s case study it is quite evident that there are various factors that attributed to her recent preterm birth. Her previous preterm birth can be considered to be a key risk factor of her recent preterm birth. It is quite important that prevention of preterm birth is not only important for the current pregnancy but also for future pregnancies. Normally, during birth women tend to have babies whose birth weight and gestational age are similar to those that were experienced in a previous pregnancy. Shelly has been admitted to birth suite with ruptured membranes at 24 weeks gestation compared to a 22 week gestation experienced in the earlier pregnancy. The 24 week gestation has higher survival than 22 week (Bhattacharya, 2010). This is a clear indicate that the risk of a current preterm is greatly increased due to a previously experienced pregnancy. Shelly midwife need to assist her so as to reduce the risks linked to future pregnancy (Dobbie, 2003). Through this period, Shelly will need regular clarifications of events as there are several impacts of her condition and on the well being of the baby, the mother and the larger family. Birth before 28 weeks has various significant problems which affects the child survival rate. It is evident that morbidity is inversely related to the gestation age and therefore difference in the 22 and 24 gestation periods. Preterm births have been known to cause blindness, cerebral palsy and blindness (Giles et al, 2000). Evidence indicate that preterm babies born between 24 and 28 week are at a higher risk of suffering from cerebral palsy compared to those born above 28 gestation week and if maximum care is not issued to Shelly it can happen to her baby. Preterm does not only affect the new born babies but also its family and mother. The mother has a likelihood of suffering from mental health problems similar to what Shelly is experiencing. Parental-infant and infant-family bonding is important for an infant development and survival. Infection can be another risk factor towards Shelly preterm birth. From the case, Shelly has reported that she has some clear fluid on a pad that she put on at home stable (Australian College of Midwives, 2013). Research indicates that vaginal infection that goes untreated can result to preterm birth. Despite, Shelly report she does not have urinary tract infections, the white fluid may be a sign of vaginal infection. This infection in Shelly case may have attributed the ruptured membrane at 24 weeks gestation (Kelly, 2008). Symptoms of virginal infection may include unusual discharge similar to Shelly case. Studies show that urinary tract infections can causes several activities resulting to the rupture of the membrane and thus leading to preterm birth (Steer, 2005). As midwife advice to Shelly, it is important that she empty her bladder often, wear 100% cotton panties and use proper perineal hygiene (Kelly, 2008). The percentage in outcome between 22 and 24 week gestation is that the 24 week gestation has a higher survival rate compared to the 22 weeks (Steer, 2005). For Shelly case, there are several examinations that can be conducted to give a clear picture on whether she is likely to deliver. An effective clinical test should be able to predict high risk for preterm birth in the first and early part of the middle trimester when their impact is highly considered to be of significance (Kelly, 2008). In Shelly’s case, cervical changes can be used as compared to fetal fibronectin due to the observed contraindication displayed in her ruptured membrane. Although, fetal fibronectin is one of the popular tests cervical changes which can be done though virginal examination is an important test that can be used in Shelly’s case (Nicolaides, 2006). When the fetal fibronectin is positive there is an indication that there is a risk of preterm labour within the next seven days and when negative no preterm labour is likely to occur in the next seven days. Women such as Shelly who are at a risk of having preterm labour can be subject to steroids injection which improves baby chance of doing well (Dobbie, 2003). The injection is one of the recent discovering in carrying for pregnant women like Shelly who are at risk of preterm delivery. The steroids used during preterm labour are cortiscosteroid. Steroid treatment has been reported to minimise the risk of lung problem especially those born between 24 and 34 weeks (Dobbie, 2003). Shelly should receive steroids once in a week until she delivers. Additionally, corticosteroid has been shown to low life threatening diseases on the premature baby. For Shelly case, the steroids appear safe for her in long term the benefits outweighs any possible problems (Dobbie, R. (2003).  If Shelly was to give birth, it is quite evidence that it will impact her and her family mentally, socially and financially. Based on mentally, the family and mother need to prepare adequately mentally so as to assist the infant in development. Newborn requires a lot of attention and therefore the family will suffer from stress and anxiety towards meeting the new demands for the infant. Socially, the family will have to be present at all time to provide the baby with adequate care This therefore implies the family need to minimise their social activities so as to accommodate the new born. Finally, the baby come with higher financial needs ranging from hospital fee, clothing and hygiene required thus straining the family budget (Olsen, 2007). It is therefore necessary that Shelly family plan in advance on the arrival of a new born to avoid stress linked to giving birth. Parent and family of a premature infant keep their infant at a distance and thus affecting the infant development outcome (Steer, 2005). It is very important that the family and parents bond with the infant to assist in its development. The family should avoid being stressful and emotional and focus on the child development. Shelly need to be offered with a follow up care whether she or does not deliver (Steer, 2005). If Shelly delivers she midwives are expect to offer her with postnatal care so that she can be in a position to love and accept the new born. If she does not deliver, midwives should offer emotional support to assist Shelly carry on with her pregnancy. This information will ensure the Shelly is informed, confident and in control of her condition (Olsen, 2007). In cases of impact of perinatal death, Shelly family will have severe negative impact which will require adverse care by the midwives. According to Dobbie (2003), perinatal death is defined as death of a baby during the gestation period. The impacts of perinatal deaths are largely associated with adverse mental health which is associated with traumatic grief, anxiety and post traumatic post disorder especially between the father and mother. During perinatal death, the midwife needs to determine emotional feelings (Dobbie, 2003). Here an emphatic approach needs to be deployed and the approach seeks to understand and identify the woman thoughts. It is normally difficult to predict how perinatal death can affect a woman and therefore the midwife is expected not to make assumption about the duration and intensity of the woman grief. Additionally, parents displayed symptoms of traumatic grief that are largely associated with risk of other physical and mental health problems which includes myocardial infarction and suicide. Here, it is important that the midwife support the family and parents to reduce the outcome of impact of perinatal death. Here, the midwife is expected to make meaning of their loss. It is important that care and support within a hospital to be multidisciplinary whereby social workers, midwives, nurses and doctors are used during perinatal death care and follow up (Hendler, Goldenberg, Mercer et al, 2005). Midwives are expected to initiate the patient in parental distress intervention programs, in various models of counseling and in family therapy session (Nicolaides, 2006). It is important that even after perinatal death, midwives continue to provide midwifery care within their prescribed midwife scope of practice References Anderson, H. (2000). Use of fetal fibronectin in women at risk for preterm delivery. Clinical Obstetric Gynecology. 43(4):746-58. Australian College of Midwives (2013). National midwifery guidelines for consultation and referral. Australia: Australian College of Midwives Bhattacharya, S. (2010). "Inherited Predisposition to Spontaneous Preterm Delivery". Obstetrics & Gynecology 115 (6): 1125 Dobbie, R. (2003). "Interpregnancy interval and risk of preterm birth and neonatal death: retrospective cohort study". British Medical Journal 327 (7410): 313. Giles W, Bisits A, Knox M, Madsen G, Smith, R (2000). The effect of fetal fibronectin testing on admissions to a tertiary maternal-fetal unit and cost savings. Am Journal Obstetric Gynecology.182 (2):439-42. Hendler I, Goldenberg RL, Mercer BM, et al. (2005). "The preterm prediction study: association between maternal body mass index (BMI) and spontaneous preterm birth”. American 192 (3): 882–886. Kelly, E. (2008) Multiple courses of antenatal corticosteroids for preterm birth. Lancet. 372:2143-51. Nicolaides, K. (2006). Sonographic measurement of cervical length and fetal fibronectin testing in threatened preterm labour. Ultrasound Obstetric Gynecology. 27:368-72. Olsen, J. (2007). "Medical Abortion and the Risk of Subsequent Adverse Pregnancy Outcomes". New England Journal of Medicine 357 (7): 648–653 Steer P (2005). "The epidemiology of preterm labour". British Journal of Obstetrics & Gynecology 112: 1–3 Read More