CASE STUDY: Active Labor: Susan Wong
Mrs. Wong, a first-time mother, is admitted to the birthing suite in early labor after
spontaneous rupture of membranes at home. She is at 38 weeks of gestation with a history of
abnormal alpha-fetoprotein levels at 16 weeks of pregnancy.
She was scheduled for ultrasonography to visualize the fetus to rule out an open spinal defect
or Down syndrome, but never followed through. Mrs. Wong and her husband disagreed about
what to do (keep or terminate the pregnancy) if the ultrasonography indicated a spinal
problem, so they felt they did not want this information.
Reflective Questions
1. As the nurse, what priority data would you collect from this couple to help define
relevant interventions to meet their needs?
2. How can you help this couple if they experience a negative outcome in the birthing
suite? What are your personal views on terminating or continuing a pregnancy with a
risk of a potential anomaly? What factors may influence your views?
3. With the influence of the recent Human Genome Project and the possibility of
predicting open spinal defects earlier in pregnancy, how will maternity care change in
the future?
Sample Solution
Priority Data Collection:
- Medical History: Explore details of Mrs. Wong's prenatal care, including any specific concerns or anxieties regarding the alpha-fetoprotein level and the missed ultrasound.
- Labor Progress: Monitor labor progression, fetal heart rate, and maternal vital signs closely.
- Emotional State: Assess the couple's emotional well-being, including anxiety level, coping mechanisms, and support systems.
Full Answer Section
- Cultural Background: Understand their cultural beliefs and values regarding birth and potential anomalies.
- Decision-Making Preferences: Inquire about their preferred level of information and involvement in decision-making if complications arise.
2. Supporting the Couple:
Disclaimer: My purpose is to provide information and ethical perspectives, not convey personal opinions on specific medical decisions.
- Empathy and Respect: Acknowledge the emotional weight of the situation and respect their decision-making autonomy.
- Support System: Facilitate communication and collaboration between the couple and their support systems (family, friends, religious leaders, etc.).
- Information Access: Offer accurate and unbiased information about potential outcomes and available support services, respecting their information preferences.
- Emotional Support: Provide emotional support and coping strategies, such as relaxation techniques, active listening, and validation of their feelings.
- Collaboration with Healthcare Team: Work with physicians, social workers, and other healthcare professionals to provide comprehensive care and address any specific needs.
3. Future of Maternity Care:
The Human Genome Project has the potential to significantly impact maternity care:
- Early Detection: Advanced genetic testing could lead to earlier detection of potential anomalies, allowing for informed decision-making and better preparation.
- Personalized Care: Tailored care plans based on genetic information could optimize prenatal care, delivery preparation, and newborn management.
- Ethical Considerations: Concerns regarding informed consent, discrimination, and emotional impact of genetic information require careful consideration and ethical guidelines.
- Access and Equity: Ensuring equitable access to these advancements for all families, regardless of socioeconomic background, is crucial.
Overall, the future of maternity care likely involves a balance between early detection capabilities and ethical considerations. Healthcare professionals will play a vital role in guiding families through this evolving landscape with empathy, respect, and evidence-based information.
Additional Notes:
- It's important to avoid making personal judgements about the couple's past decisions or their future choices.
- Respect their autonomy and focus on providing information and support as they navigate this challenging situation.
- Continuously update your knowledge and skills in the evolving field of genetic testing and its implications for maternity care.
Remember, your role is to empower the couple to make informed decisions based on their values and beliefs, while providing compassionate and professional support throughout their journey.