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A reflection on Maternity Care and the Role of Medical Staff

A reflection on Maternity Care and the Role of Medical Staff

This essay is structured using Gibbs (1988) Reflective Cycle and the following subheadings correspond to that cycle. In accordance to the principles of confidentiality, all the identifying information about the mother and child have been removed or changed so that such individual is not recognisable. All names have been replaced by initials. The following is an experience that a member of my family experienced. The story is told in a first person perspective where I reflect and analyse her experience giving my feelings for what she had to go through from the start of the pregnancy to the end describing each part.

Description: What Happened?

Myself and my partner got married in September 1994 and decided to buy a house to start a family within the preceding twelve months. In December of the same year, where I was only nineteen years old, I had come back from the GP overly excited that I had confirmation that I was six weeks pregnant and this was my first child. This was quite a rush to have had everything so close together but this was the best news I could have received at Christmas. Not just for us but the whole family. Over time I started to visit the library to get books about pregnancy and motherhood since this was the main source of information unlike these days where a quick search on the internet returned thousands of results. I even bought a PC and some CD-ROMS so I could receive some information about what I would and should be experiencing in the pregnancy. At eight weeks I was called by my GP to start the process of testing my blood as a pre-natal blood test. This also included giving family background and history due to my partners’ twin brother having Spina Bifida. At twelve weeks I was able to book another scan so that I could have my child measured for dating and hopefully find a heartbeat The crown rump length was measure which was in the range of forty-five to eighty-five. The anatomy was also checked which included the skull, brain, arms, legs, the heart, stomach, bowels, pelvis and bladder. Everything was going normal but due to Spina Bifida in the family, an in-depth scan was undertaken to determine if there were any abnormalities of the child’s spine. I remember the change of the sonographer’s expression in her face. I knew with the feeling and atmosphere in the room from that one little change of face expression that suddenly developed that there was something wrong. I knew something was not right, my stomach had sunk and my heart was ripped apart. A second opinion from another sonographer was needed to confirm what the first sonographer saw was correct. To my disappointment, it was as I feared. There was something definitely wrong. The conclusion of both sonographers were that my child had what they call Congenital Butterfly Spine. Even though I had not known what this was, I could already imagine my child not making it to full term or having some sort of severe disabilities when born. After the scan I was consulted with by a doctor who was kind enough to refer me to Kings College Hospital London to see Professor Kypros Nicolaides who is a world expert in fetal surgery and interventions. At this moment of my pregnant I needed all the support I could. It seemed the hospital were not aware that I was feeling suicidal at this point and no help was offered after finding out these problems with my child. I thought I would have had a healthy family and live perfectly like a fairy-tale ending. An appointment was arranged for me to see Professor Nicolaides all the way in London. And coming from a village in South Wales was no easy task back then, when all this stress was around and my partner had to work to pay the bills. However, I managed to get to Kings College Hospital to check in at the reception and sit down to wait for my name to be called. All I remember was counting the seconds in my head, dreading the sound of my name being shouted from a nurse that could appear out from the door way. My name got called and before I knew it I was laying down on the bed in the room with my top up having a scan with Professor Nicolaides. During the scan he was able to confirm the spinal abnormalities but he also managed to find something else. He managed to find that my baby had severe Hydronephrosis on the left kidney and moderate Hydronephrosis on the right kidney with dilated Ureters. Only a mother could imagine the pain I was going through and the only ones to support me were my partner and family. At the end of the appointment I was offered to terminate the pregnancy as I was below the twenty-fourth week. I had to refuse this. I knew there was still a way that I could get through with a baby which I can look after and love. I was warned that if I carried on with the pregnancy, due to the severity of the pregnancy, the kidneys will lead to kidney failure by the age of fourteen. I broke down and died inside. At this point we explained that we would take any chances to go ahead with the pregnancy so we can have our baby. After saying we will continue, he did suggest that he could operate inside the womb by placing a shunt in the Ureters to stop or at least prevent the reflux further damaging the kidneys. I agreed and an appointment was made to return in four weeks for this procedure. The only good outcome I had was finding out the gender of my child, which is a boy. This made me a little happier knowing I could start thinking of names and what types of clothes and room designs. Over the next four weeks I had become sick with what I believed to be morning sickness. At least I think it was. It could have been the fact that I was slowly dying inside. However, I decided that I wanted to find out about the conditions that my child was going to have. I started to develop a “baby bump” and started to feel all pregnancy symptoms such as nausea, fatigue, sickness and cravings. I could not help myself but I had to eat pineapple fritters which I obviously sent my partner out to get… the closest place (which was a Chinese) to sell them was seventeen miles away! Around a month later in the March where I was 20 weeks into my pregnancy, I was back at Kings College London where I had another scan. The professor said that he would not be able to do the shunt anymore as the procedure would be non-beneficial for the kidneys and could cause further complications and the procedure was invasive. He wished me well for the remainder of the pregnancy and I returned home feeling lonely with pain. I was depressed. Nothing else could be done. I had already been asking my GP for help with this matter but it seemed that everything was going too slow. My GP explained that I could have access to counselling which could help me in my situation. I took this opportunity, however it seemed the GP was not interested. I found out that after leaving my GP and pestering for days that no phone calls had been made to help me with counselling. I had to persist with the help I could get but it didn’t seem to get anywhere. In the end I told them to forget it and carried on myself getting the help I needed from family, specifically my sister. At this point I was considered as high risk by a consultant. This lead to me having frequent scans around every three to five weeks. I had to sit down with the consultant so that I could discuss my pregnancy plan. He was very explanatory with what problems could arise and certain procedures and their worst case outcomes. The consultant was someone I could talk to comfortably. He was speaking in a nicely manner, very warm and relaxed. He was opposite to Nicolaides who seemed stern and straight to the point. At twenty-five weeks pregnant I had another scan. This time I could see on the ultrasound screen that the babies heart beat was very active and it seemed that they were actually trying to find something wrong. The big day arrived. July 2nd when my waters broke all over my bed cover. Six weeks early. I rushed downstairs with my waters going all over my carpet. I was petrified and emotional. I was alone when this happened as my partner was in work. I reached for the phone to ring my mother and father to come help me as I was panicking. It was my mother who rung the ambulance for me and to my surprise my mother managed to get to my house way before the ambulance arrived. I waited just under an hour for any sort of paramedic to arrive. With the nature of the conditions and now a premature the ambulance took forever. When they finally arrived they confirmed that my waters had broken while checking my blood pressure. I was rushed straight to the ambulance and taken to the hospital where I had my own room. On arriving, I had to be placed on a drip as my contractions had not yet started. This was to cause contractions. My contractions started within the hour after having the drip where I proceeded to give birth. All I remember was seeing six nurses or doctors in the room with me which I found to be in excess and I was not comfortable about that amount. I finally gave birth to my baby boy even though I had to undergo an episiotomy. Once the baby was delivered he was taken away without me even getting a chance to hold him. At this point I was getting stiches for my episiotomy and after that was complete, the doctor left the room and the room was empty. No one was in there and I was all alone. A few occasions the midwife came in to check up on me and at those moments I kept asking where’s my baby. But every time there was no satisfactory answer. My partner even went out of the room to find someone who he could talk to about the situation but they didn’t seem too interested to help much, or it seemed they couldn’t be bothered to go and see what’s wrong and report back. I was not told what was going on. Eventually I got told that there would be a consultant coming to speak to me about my boy. Five and a half hours passed by after giving birth where I was taken into a consultation room where I got told the baby was in an incubator on oxygen and that he needed surgery. I went with the consultant to the neo-natal ward to finally see my son. It was here that I got told that it would be suggested that I were to breastfeed and they stated that its better for a premature baby. However, I didn’t feel up to it for breast feeding. But the nurses were so adamant that they made me feel bad, pressuring me as if I wasn’t going to be a good mother as I wouldn’t breast feed. Twenty minutes later I was in the back of an ambulance with my baby heading to a hospital in Cardiff. I was in a lot of pain mainly because of my stitches and that I had to sit in an upright position in the back of the ambulance. This was emotionally draining. Not only that, but my partner was not allowed to travel in the back of the ambulance so I was alone and afraid. At the hospital we were rushed to the intensive care neonatal unit were I was separated from my child again. I had to wait in a small room again while my baby was being prepared for an operation. At this point I was desperate for some sort of support, but I was never offered any. After the operation, I sat down with the doctor where I was told the outcomes were successful but he is in critical condition and that throughout his life he will need to visit the hospital regularly as he needed to be watched carefully up to adulthood in case his conditions worsened. My son is now twenty-one living a fulfilling life as a student. One day he plans to have his own family and I hope the same doesn’t happen.

Feelings: What was I thinking and feeling?

After listening to my relative telling me the story, I was afraid to think of what she even went through and that there could have been many things which could have been improved. This is certainly a rare occurrence for all these conditions to be present. I myself am trying for a baby and I feel that if there are complications and similar things happened to me then will I get the support I deserve? The help from the GP was relatively next to nothing. The pain and agony that my relative was going through would have been intense and she should be entitled to that help anytime throughout the pregnancy. It seemed that her particular GP did nothing or at least didn’t put the mother first. By not seeking help there could have been worse consequences such as possible suicide. Upon hearing that after having the episiotomy and then being left alone for hours makes me feel upset and empathetic as how can a mother be expected to wait hours on end when they do not have any idea on what is happening to her own child that she just delivered. Not even the chance to hold the child to get skin on skin contact with mother on child. She was depressed knowing that her baby had problems, all she knew was that the baby could have died. I was upset knowing that something so simple such as a notification on what’s happening was missed. Another point to make was when the baby was being rushed to Cardiff hospital, they were aware of the mother’s stitches so why wasn’t she provided with some sort of alternate position so that she didn’t feel uncomfortable. Having skin sliced then stitched is not an easy bearable pain especially in the region of what you got to use to sit on. Also my relative was being pressured into breastfeeding. This is disgraceful. Even though it might be healthier, there is no need to pressure someone into breastfeeding. It is her body and she may do what she pleases. She has her rights.

Evaluation: What was good and bad about the experience?

During this stressful time, my relative had many challenging emotions. For me to learn from this experience, I had to assess the information given to me and reflect upon it to teach me as a woman. Unfortunately, the maternity care team such as midwives did not get involved throughout this pregnancy until the very end when they are no longer needed. Most of the appointments, scans and antenatal care was done by consultants via referrals due to complications. This taught me that if I were to work within a maternity unit then I would need to be positive, supportive, caring, helpful and highly skilled at what I do. The care given at all times must be adequate and should take both maternal and the baby into consideration. Care for the mother was not provided in an adequate way. Not only speaking for my relative but for any other person who is pregnant with a baby that may have complications, that the mother is the key piece. Without the mother there is no baby and without the baby there is no pregnancy therefore you need to make sure the mother is calm and relaxed all the way through and stress reduced to a minimum and allow the mother to vent out their questions and thought with someone they can talk to and trust. This was inappropriate for the GP to basically do nothing and it could have made my relatives pregnancy that little bit more relaxing. At least some doctors aren’t as stern as others and can be comforting which is highly needed. There’s no use of doctors being stern and being straight to the point which can cause more worries that what’s needed. The worst is when your baby that you gave birth to has been taken without the chance to even hold the baby. After listening to the experience, it brought me and my relative closer in a way where we communicate a lot more as I am able to show empathy to what she went through.

Analysis: What sense can you make of the experience?

There are a number of issues from this experience. Some of the issues will be focused upon in this part. I will research to support my analysis from research articles and books. The GP was not quick enough to act for the mother when she is clearly going through a difficult time. The GP is meant to look after the wellbeing and promotion of the health within the community. Kendall-Tackett (2010) shows that the depression in pregnancy is a stronger risk factor post pregnancy. The help she didn’t get could have turned into severe depression. Depression can lead to neglect of the baby and mental issues with the mother or even higher risk of psychological effects that raised from a traumatic childbirth (Soet, Brack and Diloriao, 2003). Another issue to mention was the feeling of pressurisation of the need to breastfeed. Even though according to Simkin, Whalley, Keppler, Durham, Bolding (2010), breastfeeding is shown to boost the immune system and that breast fed premature babies are less prone to infections and serious bowel problems if they’re breast fed which would have been perfect considering the complications. However, it is her decision and the nurse needs to consider the health needs and to respect patient’s wishes. Yet another issue which the mother did not like was the fact that when she was giving birth, there were too many maternity staff in the room. She felt violated. However, Smith and Kroeger (2010) shows that between pregnancy and birth, the woman is in a difficult position so she doesn’t have control about what is going to happen so she might not be in a state of mind to actually care much on what’s going around her as everything can be going so fast. While it must have been a busy time for the maternity team, I can’t help to think if my relative could have had prompt notification on what was happening to her baby since it was taken away from her before she could even manage to hold the baby. Neifert (2009) shows that studies have been undertaken to determine premature babies and how skin-to-skin contact is advantageous. It allows the mother and baby to bond and usually has a positive effect on long-term breast feeding. Even though they asked for her to breastfeed, by allowing an initial skin-to-skin contact, it could have helped possible future breast feedings. During the ultrasound in London, hydronephrosis was diagnosed in both kidneys. Each with their own severity. This was one of the many factors which caused the baby to be taken away straight after birth. According to Williams & Wilkins (2006) hydronephrosis is where there is an obstruction in the ureter. This is a passage way that allows urine and other waste to leave the kidney and enter the bladder. Due to swelling and possible damage, it would have been wise to immediately take the baby for further testing and to check kidney function as soon as it was born. Schrier (2007) shows that bilateral hydronephrosis in infants particularly males need to be urgently investigated and treated. This might explain the reason why the baby was taken away so quickly.

Conclusion: What Else Can Be Done?

It is evident that there are a number of issues which got me thinking if the quality of care given to women is satisfactory. Some of the health professions could have acted in a way that is different so that the process would have been less stressful. The GP could have processed information to the relevant persons for prompt care for the mother. The maternity team which delivered the baby could have attempted to keep the mother updated on the process and what was going to happen in advanced. The best thing to see is that my relative is able to stand up and advise people who are in need of help during pregnancy and that her son has grown up relatively problem free where he is able to attend university and make something of his life. My relative said how she got support from her sister through the pregnancy as she already had her own children, considering that Deave, Johnson and Ingram (2008) show that in their research that may women are able to get the best support from female relatives where there’s a transition to parenthood. In the end there was a healthy baby and mother. But after hearing how shw struggled over the first few months, she would have been better off to have the relevant professional support. Gottman, Shapiro and Parthemer (2004) describes that by providing parental education support and interventions, they can help parents during a challenging time like this experience.

Action Plan: If it occurred again, what would you do?

If I were to experience what my relative experienced I would be mortified. I would have pursued the option of getting more help I possible could get and maybe look into viewing other doctors to get different opinions on what procedures would be available. That would include making myself heard so that I have a say throughout the complications

References

Deave, T., Johnson, D., & Ingram, J. (2008). Transition to parenthood: the needs of parents in pregnancy and early parenthood. BMC Pregnancy and Childbirth, 8, (30) doi:10.1186/1471-2393-8-30

Gibbs G (1988) Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford.

Gottman, J.M., Shapiro, A.F., & Parthemer, J. (2004). Bringing baby home: a workshop for new and expectant parents. International Journal of Childbirth Education, 19, (3) 28-30.

Kendall-Tackett, K.A.K (2010). Depression in New Mothers Oxon. Routledge.

Neifert, M.N. (2009) Great Expectations: The essential guide to breastfeeding New York. Sterling Publishing Co.

Schrier, R.W. (2007) Diseases of the Kidney and Urinary Tract Philadelphia. Lippincott Williams & Wilkins.

Simkin, P., Whalley, J., Keppler, A., Durham, J., Bolding, A (2010). Pregnancy Childbirth and the Newborn: The Complete Guide. New York. Simon & Schuster.

Smith, L.J., & Kroeger, M. (2010) Impact of birthing practices on breast feeding. (2nd Ed). Sadbury, MA: Jones and Bartlett Publishers.

Soet, J.E., Brack, G.A., & Dilorio, C. (2003) Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth, 30, (1) 26-46.

Williams, L., Wilkins, (2006) Handbook of Medical Surgical Nursing; Ambler, PA: Lippincott Williams & Wilkins.

Biology


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