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Laboring Client and Postpartum Hemorrhage: Case Study

Gestational age is a significant measurement during pregnancy with the help of which it is possible to track and control the changes of a mother and a fetus. The normal gestational age for giving birth is between 37 and 42 weeks. When a patient is at her 42 weeks, the pregnancy is called post-term, and certain risk factors have to be discussed. Extra attention should be paid to a baby and a mother to be sure that everything is going well. Still, some fetal, neonatal, and maternal complications and risk factors, including primiparity, previous post-term pregnancy, obesity, male fetus, obesity, or hormonal factors, are usually underestimated (Galal, Symonds, Murray, Petraglia, & Smith, 2012). Besides, genetic predisposition has to be considered.

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A fetus may be at risk because of reduced placental perfusion, and a mother may have psychological stress. In any case, such safety concern as stress avoidance has to be mentioned. As a rule, there are no clear causes of post-term pregnancy, and, in many cases, the due date is wrongly calculated (Wang & Fontaine, 2014). Besides, a future mother may try to eat spicy food or have sex in order to promote an induction. All such decisions have to be properly weighed and discussed with a doctor so that no harm can be done to a baby, and less harm is done to a woman.

During the 42 weeks of pregnancy, water can break anytime, and a nurse has to be ready for any outcome. First, the nurse has to calm the woman down and make sure there are no traumas or other unexpected issues like bleeding or vomiting. The clarification of whether labor is false or true is required. Second, it is important to check the time and contractions. The review of lab and diagnostic tests is required to identify the health status of a patient. Then, it is necessary to inform a primary health care provider. The provision of the correct lab and diagnostic data is the priority of the nurse to promote appropriate labor.

During labor, the role of the client’s husband is crucial. The nurse could involve the partner in several ways. First, the partner could be included in the assessment, as well as the admission process, to support the wife and make sure the patient has a familiar face nearby. Second, the nurse could ask if the partner wants to participate in labor, and, after getting approval from the client, prepare a person for a big moment. Finally, the partner can be a direct assistant and helper during labor by supporting the client, helping to do specific physical exercises, talking to her, and providing appropriate communication between the woman and other medical staff.

The nurse is one of the main sources of support and information for the woman during labor (Stivastava, Avan, Rajbangshi, & Bhattacharyya, 2015). If no pain medications are given to the patient, the nurse has to focus on additional interventions to be implemented, including the maintenance of a calm and confident environment, the assessment of the woman’s level of pain and the number of contractions, and the provision of care to prevent dry mouth, damp clothes, and other nuisance that may cause discomfort. Medications and other supportive means can be given by a nurse only after the primary healthcare provider approves their importance and appropriateness in a particular situation.

Taking into consideration the fact that the client is at her 42 weeks gestation, certain complications have to be identified in addition to the postpartum complications any mother is at risk for. Such problems as postpartum infections, after-delivery bleeding, and vaginal discharge can bother any woman. Postpartum hemorrhage can be caused by a large size of an infant that is an ordinary thing during post-term pregnancy. Vaginal discharge may be the complication caused by a prolonged gestational age. Finally, gestational diabetes can be the complication, even if a woman did not have this disease before labor. Gestational diabetes is the disorder that can be observed and diagnosed after giving birth to a baby (Lahti et al., 2015).

Polyhydramnios is usually defined as “an excessive accumulation of amniotic fluid without an amniotic fluid index” observed at 95% for gestational age (Gondra et al., 2016). This medical condition promotes changes in the fluid that surrounds the fetus and causes such complications as shortness of breath, swelling, infections, and hemorrhage. In some cases, polyhydramnios may go away on its own due to its mild nature. However, the same condition may be a sign of diabetogenic fetopathy, and the prevalence of diabetes in such cases is possible. Safety concerns should include the possibility of draining excess fluid or using medications that reduce urine production. Any kind of intervention has to be approved by a doctor.

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If the patient is a Jehovah’s Witness, the management of pregnancy, labor, and delivery should be careful and respectful. The main aspect of caring such patients is a blood transfusion. Jehovah’s Witnesses refuse blood transfusion in any case, even if its avoidance may lead to a death of an absolutely healthy person. Therefore, in the case of postpartum hemorrhage, the patient cannot be treated by means of using other’s blood. The result of such rule is evident: many mothers might die but for blood transfusion. In some cases, healthy patients may store their blood before pregnancy in order to use it in the case of hemorrhage. In such situation, patients use their own blood being transfused, no rules are broken, and the improvement of the patient’s health is possible.

The nurse could use several interventions to minimize the patient’s risk of complications. These interventions include the electronic fetal monitoring with the help of which it is possible to control a mom and a baby at the same time, the promotion of bed rest and the choice of an appropriate recumbent position that can help to reduce pain during labor, and vaginal exams to determine cervical changes and prevent the development of complications (Jansen, Gibson, Bowles & Leach, 2013).

Skin-to-skin contact is characterized by a number of the evident benefits for both, a mother and a child. After a sudden change a baby experiences during childbirth, it is necessary to provide them with warmth and security that was felt when the baby was in the womb. If the health conditions of the mother and the child are normal, the first contact could happen in 1-2 hours after birth. A naked baby is placed on the mother’s naked area between her breasts. Such benefits of skin-to-skin contact between a mother and a child as reduced anxiety, a better attachment behavior of a mother, and a better cognitive development of a child are usually observed.

References

Galal, M., Symonds, I., Murray, H., Petraglia, F., & Smith, R. (2012). Postterm pregnancy. Facts, Views, & Vision, 4(3), 175-187.

Gondra, L., Decramer, S., Chalouhi, G.E., Muller, F., Salomon, R., & Heidet, L. (2016). Hyperechogenic kidneys and polyhydramnios associated with HNF1B gene mutation. Pediatric Nephrology, 31(10), 1705-1708.

Jansen, L., Gibson, M., Bowles, B.C., & Leach, J. (2013). First do no harm: Interventions during childbirth. The Journal of Perinatal Education, 22(2), 83-92.

Lahti, M., Eriksson, J.G., Heinonen, K., Kajantie, E., Lahti, J., Wahlbeck, K., … Barker, D.J.P. (2015). Late preterm birth, post-term birth, and abnormal fetal growth as risk factors for severe mental disorders from early to late adulthood. Psychological Medicine, 45(5), 985-999.

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Stivastava, A., Avan, B.I., Rajbangshi, P., & Bhattacharyya, S. (2015). Determinants of women’s satisfaction with maternal health care: A review of literature from developing countries. BMC Pregnancy and Childbirth, 15(97).

Wang, M., & Fontaine, P. (2014). Common questions about late-term and postterm pregnancy. American Family Physician, 90(3), 160-165.

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