CASE STUDY #5 POST-DATES PREGNANCY

Pregnancy experience

You are the LMC for Nadia Lee who is a 32 year old G2 P1. Nadia booked with you 20+1 weeks. An EDD was calculated by the 19 week anatomy scan as no LMP was known.

Nadia’s previous pregnancy two years ago ended with an induction of labour (IOL)at 41/40, with a long hard labourand a ventouse birth two days after IOL commenced.

This pregnancy Nadia has been healthy and well, presented with a normal BMI at booking, experiences mild anxiety but has managed this well. Nadia declined a referral to Maternal Mental Health.

40 + 2/40 –  AN visit

You see Nadia at your AN clinic at the above gestation. Nadia feels ‘down’ about being ‘overdue’ again. Nadia has remained very healthy throughout the pregnancy and all antenatal assessments of Nadia and her baby have been normal. Nadiais worried because she keeps remembering her first birth which was very hard because of the IOL. Her partner, Gareth, is not able to take much time off and is very busy in a couple of weeks.

Because Nadia is healthy and her baby is well, you would not be recommending that her onset of labour be rushed via medical means at this point.

Note: You are only asked to explore what becoming ‘post-dates’ means for Nadia and how you would support and plan her care with her during this time. The options of alternative therapies and IOL are not expected to be discussed in this case study

Guide to writing the Case Study:

LO 1: Articulates the theory of midwifery partnership, Cultural Safety and Tūranga Kaupapa.

• Ways in which you have worked with Nadia and whānauto establish a partnership, uphold principles of Turanga Kaupapa and be culturally safe
• How your discussion with Nadia ensures you understand her concerns that have arisen from her becoming post-dates
• How a midwife might be challenged when discussing choices around a low-risk post-dates pregnancy with a woman who may have different views than yours.

LO 2: Demonstrates knowledge which underpins midwifery practice.

• Remember to refer to physiology and variations of physiology related to this topic
• Describe how post-dates pregnancy is defined and the most accurate measurement available to calculate gestational age of a baby and EDD
• Discuss current knowledge that underpinsmidwiferypractice in relation to low risk mothers and babies experiencing a post-datespregnancy.

LO 3: Demonstrates practice reasoning that underpins midwifery practice when common variations to physiological processes occur.

• Discuss assessments you will make on Nadia and her baby at this appointment
• Stateyour on-going plan of care for Nadia at 40+2 weeks gestation, including information you will provide.
• Provide rationale for all your discussions, assessments and plan of careformulated with Nadia

LO 4: Demonstrates an understanding of the professional frameworks which guide midwifery practice.

Throughout your discussion refer to and discuss the main frameworks that guide midwifery practice when discussing a post-dates pregnancy eg. NZCOM and MCNZ guidance, Ministry of Health guidance, Section 88, Referral Guidelines, National and DHB guidelines, etc

LO 5: Integrates research findings and evidence supporting midwifery practice.

• Discussion of Nadia’s care needs to be supported by research evidence. Some literature (ie 2 -3 research articles) is expected amongst the required minimum of 10 recent relevant references, Journalarticlesshould not be olderthan5-10 years unless you are using historical material. Using historical material can be important at times to show the development of evidence and practice.
• Guidelines need to be appropriate and referenced(eg. National, MOH, DHB etc)
• Briefly discuss any controversial aspects related to post-dates pregnancy and how this can impact on a women’s experience