UNIT 2 ASSIGNMENT 3: Medical History
Reading from course material:
· Read and .
Case Study 4: Anemia
· To understand how to apply knowledge of anemia to your role as a doula.
· To understand how your plan of care/birth plan may change depending on a medical diagnosis.
· Listen to the OBGYN Morning Rounds case study on anemia
If your client were to tell you that she had anemia, there are certain things that you could immediately begin to prepare for during labor, depending on how severe it may be. Chances are, a woman with anemia is going to be even more tired. During labor this may be something that you would have to contend with. You may want to plan to work on some energy saving techniques. Since most anemias can be treated during pregnancy, you can also encourage your client to do so, to help alleviate some of the problems that may come during labor.discuss way to treat it with her care provider.
You may want to be prepared for a diagnosis of oligohydraminos. Help your client become more educated on what that is and what the usual course of labor is for someone who has this. This should include discussing it with her care provider as well as other reliable resources. You can also anticipate the need to help calm fears and anxieties if other complications arise due to anemia. While this is something that is necessary for every labor, knowing what the cause may be will help you prepare.
There is more that we could think of that you could prepare for just by knowing that your client has anemia. Of course, this may change. Thus you can then take the time to change you plan of care.
Case Study 5
Case Study 5: Gestational Diabetes
This client’s main need does not have to do with gestational diabetes, but this definitely plays a role in her choices and her goals. I begin with my notes and assessment during the interview process, then move on to finding out needs and plan accordingly. At the end of this, a birth care plan is made that follows her goals and ideas. I have highlighted the needs that directly relate to gestational diabetes.
· To understand how to apply knowledge of a specific medical diagnosis to your role as a doula.
· To provide an example of how to incorporate the assessment and interview into the birth plan and your practice as a doula.
· To provide an example of the all steps in the nursing process.
Reading from purchased books:
· Read sub-section on Gestational Diabetes Mellites in “Chapter 7: Complications in Late Pregnancy, Labor, or Afterward,” The Birth Partner, pp.243-46
Initial Interview Data
During this interview I took notes, then later wrote them up. I also wrote down her own goals, questions, and desires. I formulated a birth care plan from these notes. If a woman already has a birth plan written out, I will just add my own thoughts and ideas to hers’ and get her approval.
She had gestational diabetes and took medication for this. She possibly also had pre-eclampsia. At 37 weeks, she went in for a NST and found some problems, she was then induced. She labored for a while and got an epidural. Due to fetal distress, she had an emergency c-section. During this birth she was separated from her first husband, but he was there along with her mother. She had a hard time with him there and didn’t want much to do with him.
She had a normal pregnancy and had a planned c-section at 39 weeks. I’m unsure if VBAC was even offered to her. She had preterm labor that was controlled with medications. She had difficulty breastfeeding because she felt like she was not giving her baby enough milk. Baby lost weight in the hospital and was supplemented with formula. This continued at home.
She possibly may be type 2 diabetes, but it is controlled with diet. She has seen a nutritionist for this and wants to avoid taking medications for it. She would like a repeat c-section because she feels more comfortable with this. She already has other complications going on and her husband also feels more comfortable with this. She is also having numerous urinary tract infections.
She has anxiety/panic attacks but is not taking medication for this. During her births she had a few panic attacks and would like help with this. Deep breathing and visualizations help with this, as well as having a support person close by. She does not like the oxygen mask. It makes her anxiety worse. She’s okay with it if it is held close by, but not on. She was frustrated with how long her baby was taken away after her last two births and wants to make sure they are with her as soon as possible.
Care provider and place of birth
She will be delivering with Dr. X. Right now, she is trying to decide which hospital she wants to go to and would like help choosing.
Client goals or desires
· She would like to have the baby with her unless there is a serious medical reason.
· Would like help with breastfeeding
· Help with anxiety.
· Would like to find a hospital that will support her desires.
· Wants help with shoulder/gas pain after c-section.
Needs Identification, Prioritization and Doula Actions
Needs listed at this time are more like anticipated needs. These are needs that you are expecting to encounter during labor and birth.
Risk for imbalanced nutrition status related to not being able to eat during c-section and gestational diabetes.Actions implemented: Provide clear liquids or other food according to what is ordered or desired. Plan to have foods that she likes available. Make sure client has discussed nutritional needs related to gestational diabetes with her care provider or nutritionist. Provide encouragement for healthy eating choices.Risk for dehydration related to not being able to drink during c-section.Actions implemented: Remind your client to drink once it is okay. Plan to have drinks available that she likes.Risk for fatigue related to anxiety about birth.Actions implemented: Address anxiety the day before as well as the day of her c-section. (See below for actions taken for anxiety).Body temperature fluctuations related to c-section.Actions implemented: Provide warm blankets or heating pads immediately afterwards. Provide warm fluids if desired. Request warm iv fluids be hung right after the c-section is finished.Impaired mobility related to epidural and c-section.Actions implemented: Help control pain to allow movement sooner(see actions addressing pain below).Nausea related to c-section.Actions implemented: Offer peppermint tea or peppermint oil for nausea. Offer liquids and foods slowly. A fan may also be used.Risk for shaking related to epidural use.Actions implemented: Make sure that warm iv fluids are used during the operation and immediately afterwards. Request warmed blankets during the operation and afterwards. Help her relax to decrease shaking.Risk for itching related to epidural use.Actions implemented: Find something to distract your client from the itching while it wears off.
Desires control related to birthing place.Actions implemented: Research the hospitals in the area to see what their protocols are regarding infant care afterward, particularly as it relates to babies born by c-sections and from mothers who have gestational diabetes.Desires control related to infant bonding.Actions implemented: Make sure staff knows that your client wants the baby with her as much as possible. Encourage skin-to-skin.Pain related to should/gas pain after c-section.Actions implemented: Hot packs to shoulders. Distraction techniques. Get your client up and moving quickly.Pain related to incision after c-section.Actions implemented: Ice packs for the first 24 hours, then heat packs.Pain related to ivActions implemented: Use heat or ice (whichever feels better). Before the iv is put in, warm the hand where it is going to be placed.Information seeking behavior related to breastfeeding as manifested by desire for more knowledge and difficult past experiences.Actions implemented: Find the closest LLL group. Make sure your client can see a lactation consultant. Encouragement. Reassurance. Place a sign on babies’ crib that says not to give this baby anything else by mouth.Anxiety related to c-section.Actions implemented: Reflexology. Lavender oil. Music therapy. Encouragement. Make sure spouse is close by. Teach spouse light tough to use during c-section.Anxiety related to gestational diabetes.Actions implemented: Point out what your client is able to control (i.e. food choices). Focus on signs of good health. Connect them to a nutritionist if possible. Make sure your client has any medical questions answered by their chosen care providers and provide information they are unable to obtain.
Opportunity for enhanced parent/infant bonding.Actions implemented: Provide resources on breastfeeding. Provide resources and information on bonding.Risk for impaired parent/infant bonding related to c-section and complications from gestational diabetes.Actions implemented: Research hospitals to find one that is committed to mom and baby staying together. Make sure the staff understands that your client wants her baby with her as much as possible.Opportunity for enhanced relationships.Actions implemented: Discuss plan of care with spouse or significant other. Make sure spouse is doing all that he wants to do. Discuss what your clients spouse can do to be involved.Isolation related to c-section policies.Actions implemented: Make sure that someone is always with your client afterward. Get the majority of the prep work done before your client goes into the operating room.Opportunity for enhanced connection to the birthing process.Action implemented: Allow your client to see as much as she desires of the c-section birth. Ask to do skin to skin as soon as possible afterward.
Risk for body image disturbance related to physical changes and c-section.Actions implemented: Mirror therapy.Opportunities for enhanced feelings of empowerment.Actions implemented: Make sure your client understands her choices and is given choices.Opportunities for keeping environment focused.Actions implemented: Request music that your client would like. Make sure choices made are in accordance with your clients wishes. Speak in soft tones. Dim lights as much as possible. Be aware of your client’s privacy needs and ask that those be respected as much as possible.
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