Implications For Midwifery Care For A Woman With Multiple Pregnancies: A Case Study

Identifying Risk Factors for the Mother and Fetus

Ivy being a woman who has had more than two pregnancies and one birth, some of the midwifery care and services that I would provide to support Ivy along with Tony are as highlighted below. The first care is to spread health along with well-being to Ivy and the family members at large. Accordingly, I will support, facilitate and implement the choice of Ivy depending on her state. I will also diagnose the factors which may adversely affect maternal or the fetal well-being. In that case, because Ivy has a BIM of 29 which is overweight, it means she has to lose some weight so as she gets in the range of 18.5 to 24.9 which is considered healthy (Renfrew, McFadden, Bastos, Campbell, Channon, Cheung & McCormick, 2014).

 I have to identify and in case of any complications arises then am responsible for referring Ivy to a doctor who is trained to deal with special situations considering her past medical history. She has ever experienced a miscarriage which is usually prone in week 23, and some of the aspects which cause miscarriage are overweight (Baas, Erwich, Wiegers, de Cock & Hutton, 2015). Accordingly, as per her medical history, she has ever had a premature birth, stillbirth along with cesarean delivery which is all caused by being overweight. In that case, I will advise her on the proper ways of losing weight such as eating small portions of calorie exercising daily for at least 30 minutes. This will help her to reduce the congenital disabilities and also easy her some of the pains that she might be experiencing during pregnancy.

The exercises that I will recommend Ivy to take are gardening since comes from an area that is agriculture predominantly with wheat and canola, walking along with swimming. At the same time, I have to let her know some of the harmful activities which she should not do such as the ones that cause pain, those performed in heat or those which are done at her back. Moreover, since Ivy would like to know other therapies that she can be administered to then I will suggest anti-CXCR3 treatment which redirects the mother’s harmful immune cells away from the placenta which is coupled with antimicrobial treatment to avoid stillbirth (Shapiro, Kaar, Crume, Starling, Siega-Riz, Ringham & Dabelea, 2016).

Because Tony is an agricultural supplier and Ivy helps him in the business, there are high chances that she always experiences back pains due to lifting commodities from one location to the other which might also result to her complications that she experiences (Renfrew et al. 2014). Furthermore, it is stated in the case study that Tony do smokes, and therefore there are high chances that Ivy is a passive smoker. In that case, I would advise Ivy to avoid activities which cause pain in her back along with being a passive smoker which causes abnormalities in the fetus thus resulting in complications.

Providing Support and Facilitation for the Mother

I will also ensure a perfect relationship with Ivy since this will make her feel safe and enable her to relax aiding delivery (Lange, Probst, Quere, Rehm & Popova, 2015). In that case, I should be responsive and respectful. Since I have to offer different options and hence seek to reduce any technological interventions and also eliminate the unnecessary interventions which might affect Ivy’s good health, I will have to take an eye on the physical, psychological along with the social well-being of Ivy throughout her childbearing cycle (Baas et al. 2015). Furthermore, I will also have to provide her with individualized education, counseling together with prenatal care, continuous hands-on assistance during labor and delivery.

My services to Ivy will depend on my qualifications along with licensing credentials that I have and in my case, I can offer her the most comprehensive array of healthcare services (Lange et al. 2015). Some of the facilities that I can provide to Ivy comprises of labor and delivery support, prenatal care, preconception care, newborn care along with family planning. In general, I will offer her education infertility, nutrition, exercise, contraception, pregnancy health, quality infant care along with breastfeeding.

Some of the occupational risk factors which are affecting Tony and Ivy are a heavy workload which includes lifting of commodities, psychological stress, and chemical exposures since they own an agricultural shop and also they come from a town with is predominantly agricultural and there are higher chances of such factors. In that case, since Ivy’s parent lives on a large property outside town which seems environmentally comfortable, I will advise Ivy to go and stay with her parents until delivery before she can come back to her husband. That will keep her away from heavy loads in the shop, chemical exposure, pestcides and being a passive smoker which are the complete factors that causes premature birth, stillbirth and miscarriage (Lawn, Blencowe, Waiswa, Amouzou, Mathers, Hogan, & Shiekh, 2016).

Evaluate maternal nutrition, diet, and BMI during pregnancy, identify risk factors and identify relevant local and national referral support services and programs (LO1, LO2);

The way in which a pregnant woman usually nourishes her body during pregnancy typically affects the health of her body along with that of her baby. This is so because pregnancy usually creates extra demand for particular vitamins, minerals along with nutrients like the folic acid, iron, protein, along with vitamin D. As an illustration, folic acid is usually a B group vitamin which plays a crucial role in healthy fetal development. Accordingly, it helps to prevent congenital disabilities of the baby’s brain along with spinal cord (Renfrew et al. 2014).

Offering Complementary Therapies and Treatments

 Iron is the second nutrient which recommended for pregnant women since it is used to make blood cells that carries oxygen around the body. Furthermore, during pregnancy, the blood volume usually increases as the baby’s blood is developing too, and therefore Iron can help prevent Anemia. Iodine is another nutrient required which allows for the development of thyroid hormones to promote growth and development throughout the body (Postma, Bush & van den Berge, 2015).

Tony and Ivy lives in a rural town where medical services are limited which is a risk factor. Accordingly, being far from town Ivy might experience back pan travelling from place to place looking for checkups and proper medication as far as her condition is concerned.

Vitamin D is usually essential for pregnant mothers since it is needed to keep the bones healthy and also regulates the amount of calcium and phosphate within the body. Last but not least, the protein usually helps for proper growth of fetal tissue which comprises the brain. In that case, the Mama Care pregnancy formula is essential to make sure that the pregnant mother together with the baby is meeting the increased nutritional demand (Shapiro et al. 2016).

The excellent quality diet during pregnancy usually comprises of a variety of nutrients which are rich in foods such as fruits, vegetables, high fiber cereals, fish, and good quality meats along with vegetable oils like olive oil (Crume et al. 2016). Moreover, the best maternal diet during pregnancy includes fine-tuning the eating habits to ensure she receives enough nutrition for the health of the mother and her baby. The pregnant mother is not limited to protein sources, grains, bread along with dairy products (Baas et al. 2015).

  The fruits usually have vitamin C along with folic acid which is needed by the pregnant women daily. Some of the fruits are tomatoes, broccoli, honeydew, oranges along with grapefruits. Accordingly, the whole grains together with enriched products usually provides crucial nutrients like iron and vitamins B. Meat, poultry, fish beans along with eggs (Menendez, Castillo, Martínez, Jordao, Lovane, Ismail & Hurtado, 2017).

The Body Mass Index is usually found by multiplying the weight in pounds by 703 then dividing the answer by height in inches and hence split the response by the height in inches again. The body mass index of pregnant women that is 25 or more can affect her fertility along with the baby’s health (Postma, Bush & van den Berge, 2015). Accordingly, being underweight during pregnancy can cause premature birth or have a small-for-dates baby. On the other hand, being overweight exposes pregnant women to higher chances of developing risks such as high blood pressure. The BMI of 18.5 and below usually indicate underweight. Accordingly, the BMI of 25-29.9 is generally deemed as overweight (Baas, Erwich, Wiegers, de Cock & Hutton, 2015).

Understanding Maternal Nutrition and Diet During Pregnancy

Some of the risk factors as per the case study are highlighted below. The first one is alcohol use. It is stated that Ivy does take some glasses of wine while socializing. Alcohol consumed during pregnancy usually passes directly to the fetus via the umbilical cord. This often increases chances of miscarriage together with stillbirth (Bagnardi, Rota, Botteri, Tramacere, Islami, Fedirko & Pelucchi, 2015).

Furthermore, the other risks are high chances of having congenital disabilities (Crume, Brinton, Shapiro, Kaar, Glueck, Siega-Riz, A. M., & Dabelea, 2016). The second risk factor is cigarette smoking. It is clearly stated in the case study that Tony who is Ivy’s husband do smoke. This automatically makes Ivy a passive smoker since they live together. Smoking usually puts the fetus at risk for preterm birth together with her mother at risk for health problems (Horan, McGowan, Gibney, Byrne, Donnelly & McAuliffe, 2016).

Identify and interpret risk factors of smoking and alcohol consumption during pregnancy including outlining how you would support abstinence/decreasing tobacco and alcohol intake with Ivy and identification of support services and programs available (LO1);

The risk factors of smoking while pregnant are as mentioned below. The first one is sudden infant death syndrome, congenital disabilities, increases the baby’s risk of developing respiratory problems, and increases premature birth along with low birth weight (Hrolfsdottir, Schalkwijk, Birgisdottir, Gunnarsdottir, Maslova, Granström & Halldorsson, 2016). The other risks are increases chances of miscarriage together with stillbirth and the baby’s heart rate. On the other hand, some of the dangers of drinking alcohol while pregnant are as highlighted below. The first one is that heavy drinking dramatically increases the chances that your baby will suffer from FAS (Menendez et al. 2017).

I can help Ivy abstain or decrease alcohol and smoking by doing the following. The first thing that I will do is to let her know some of the effects that alcohol together with tobacco has on her and her baby (Crume et al. 2016). Furthermore, I will motivate her about the positive impacts that might be there in case she stops smoking and drinking alcohol. I will also advice Tony to stop smoking because he is making Ivy a passive smoker which is more dangerous.

Summarise how to assess, plan, provide and evaluate safe and effective midwifery care for the newborn with complex needs related to the possible effects of smoking, an overweight mother and include discussion on infant feeding options (LO1, LO6, and LO8).

Evaluating the Effects of BMI on Mother and Baby’s Health

The newborn whose mother was smoking is likely to have heart defects like missing and deformed limbs, cleft lips together with the anomalies of the valve and vessels which carry blood to the lungs. On the other hand, the babies born of women who are overweight during their pregnancy usually have less mature lungs.  In that case, the newborn has to be assessed at birth for signs of the above complications. The midwife will have to perform a complete physical exam which comprises every body system (Horan et al. 2016).

Apgar scoring has to be checked which helps to find any breathing problems together with the other issues. In this case, the baby is monitored from one to five minutes of his birth for the heart along with the respiratory rates, the muscle tone, reflex along with the color (Bode & Lynch, 2017). The Apgar score is usually given after the immediate issues have been taken. Every area should have a score of 0, 1, or 2 with 10 points as the maximum. Accordingly, the majority of the babies usually score 8 to 9 with one or two points being taken off for blue hands due to immature circulation.

The newborn has to be weighed too to check the growth together with the baby’s need for fluid and nutrition, and in case of any complications due to the smoking mother then necessary measures have to be taken. The full term babies are usually born between 37 to 41 weeks of pregnancy, but due to smoking and consumption of alcohol, the baby might be born when the correct duration is not yet (Hrolfsdottir et al. 2016).

 The other midwifery assessment of the newborn is measurements of the head circumference that is distance around the baby’s head, abdominal circumference together with the measure from the top of head to the heel. Temperature, pulse, and breathing rate are also checked.

Some of the infant feeding options are as highlighted below. The first one is breastfeeding. Breast milk is usually the natural food for human babies since it supplies all the nutrients that the baby needs in the first six months of life. Moreover, it usually satisfies hunger and thirst, so no extra water is required. Accordingly, it often protects the baby against infections and diseases (Bode & Lynch, 2017). The second option of infant feeding is infant formula. This is generally used if the mother cannot breastfeed. It’s bought in the supermarket and chemists and often comes with a tin of powder.

The third option of infant feeding is heat-treated breast milk. This option in most cases is usually used when the mother is not in the best conditions of breastfeeding the child such as the HIV positive mothers. This is because it is recorded that heating the breast milk removes HIV. The fourth and last option of infant feeding is the fresh cow’s Milk (Postma, Bush, & van den Berge, 2015).

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