Complexities in Midwifery Care

This article discusses the complexities in midwifery care during pregnancy, labor, and the postpartum period. It explores the factors that make a pregnancy complex and evaluates the woman's experience. It also describes the impact on the woman's physical, social, and emotional wellbeing, as well as the care received by the woman and the neonate. The pharmacological management of the woman's complexities is discussed, along with the appropriate consultations and referrals.

Running head: MIDWIFERY 1
Midwifery
Student’s Name
Institutional Affiliation

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1. Explain why the woman's pregnancy, labor/birth, the postpartum period was
considered complex, Evaluates complexity about the woman's experience. A high
level of analysis and connection are demonstrated. All significant areas are
comprehensively covered, with information synthesized
There are many factors which can make a pregnancy either complex or healthy. Some of
the factors comprise of the health conditions, the age of the mother, the health issues, together
with the lifestyle of the mother. In this case, Sam’s pregnancy was considered complex because
of the highlighted factors below. As per Sam’s pathology results at 25 weeks of pregnancy, it
was confirmed that she had low Iron in the body. This might be because she had a heavy
menstrual cycle. In that case, she could experience low birth weight, preterm birth or perinatal
mortality (Al-Momen, Al-Meshari, Al-Nuaim, Saddique, Abotalib, Khashogji & Abbas, 2016).
The pregnancy is also considered complex since even though Sam maintained exercise
regime and followed GDM diet, but still there were so many complications. She was referred to a
dietician for proper guidance on how to take meals. Accordingly, Sam’s blood glucose level was
erratic just after she started taking insulin. As an illustration, if the body cannot produce
sufficient insulin, then it means the pregnant woman may develop gestational diabetes and might
also become more resistant to insulin. Under those circumstances, she commenced insulin to
help control the glucose level since a woman’s body usually requires a lot of insulin during
pregnancy. At this period of time, the placenta typically produces a lot of glucose (Biro,
Waldenström & Pannifex, 2015).
Despite all the recommendations, Sam experienced intrauterine growth restrictions,
which means that the baby in the womb was smaller than it was supposed to be. This could result

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in a baby with the following feature; low birth weight, low resistance to infection, low blood
sugar, or issues with body temperature. The pregnancy was also complicated in the sense that she
started swelling, had frontal headache together with floating spots in her eyes. Some of the
causes of frontal headache in pregnant women are usually due to dehydration, low blood sugar,
or stress (Brown, von Chamier, Allam & Reyes, 2014).
Sam started using antihypertensive during pregnancy in order to correct blood glucose
level. This situation also reveals how complex was her pregnancy. This shows that she was
having a hypertensive disorder, which could cause long term disability and even morbidity. She
was also taking Labetalol 100mg to control blood pressure. The high blood pressure in Sam
might have been due to the first time pregnancy being obese. Accordingly, at around eight
months, Sam was having abnormal placental functioning, which required the artificial
stimulation of the uterus to start labour (Dhar & Sokol, 2016).
The labour and birth of Sam was complex in the manner explained below. To start with,
there was an artificial rupture of the membranes. This was to speed up the dilation, to try
stopping bleeding during labor. Some of the risks involved here are that there are high chances of
infection due to the opening of the amniotic cavity to pathogens. The physicians were to make
sure that the cord does not end up below the head during this process. She also had only three
hours of labor before she progressed to normal vaginal birth (Goldman & Glei, 2016).
The complications during the postpartum period were that there was a gush of blood as
the placenta is born. As an illustration, the postpartum haemorrhage is reported to be the most
contributing factor of maternal mortality. In this case, a lot of precautions has to be taken
because it also reported that Sam was bleeding heavily which reduced her weight (Le Bouteiller,

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Solier, Pröll, Aguerre-Girr, Fournel & Lenfant, 2014). There was also poor uterine tone which
occurs when the uterus fails to contract after delivery of the baby. However, this condition can
also lead to a life-threatening condition (Wladimiroff & Campbell, 2016). There was also a
heavy PPH despite the uterine compression; therefore, the bimanual compression was done.
Accordingly, there was a risk of losing a lot of blood after the return of the uterus.
Pregnancy is a powerful and sophisticated time in a woman's life, and she faces multiple
physical changes and processes which are different, unique, and could be life-altering. Therefore,
the role of the practitioner or provider involves promoting health promotion through emotional
support and client education. Unhealthy habits can affect both foetus and mother even before the
mother know that she is pregnant (Pringle, Kind, Sferruzzi-Perri, Thompson & Roberts, 2015).
2. Describes how the woman's physical, social, and emotional wellbeing was impacted
upon by the complex care situation and complex needs of her baby.
Common social-emotional adjustments in pregnancies include mood swings, hormonal
changes, cravings, and adapting to the ability of bonding with the child while still in the womb.
In that case, Sam might develop cravings for salty items when pregnant. Furthermore, she
become overly emotional and began being frustrated things she wouldn't usually (Mitchell,
Peiris, Kobayashi, Koh, Duncombe, Illanes & Salomon, 2015).
Jay had a very complex care situation. As an illustration, he was taken to the neonatal
intensive care unit because of prematurity. In that case, the baby has to feed with tubes where
these tubes enter through the mouth or nose. Physically Sam loosed weight since she had to
pump the milk regularly to provide the expressed breast milk for her son. This usually happens
when the baby is ill or premature (Burnyeat, 2015). Sam was also stressed since Jay being in

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NICU, kept her away from the family members and friends. Therefore, she had to way until the
day the baby will be ready to go home. In that case, Sam ha to pay close attention to her baby,
her own special needs since she had gone through a complex pregnancy and complex birth too.
Sam also had to think of Ben, who is her husband (Davis‐Floyd & Davis, 2016).
Sam also feels disappointed since, at the begging, she was able to provide sufficient milk
for her son. Jay was placed in IUGR because he was not getting enough oxygen along with
nutrients which slowed his growth. In this case, emotional Sam might be stressed since her son
might develop health problems while IUGR (de Laat, van Aldermen, Franx, Visser, Bots &
Nikkels, 2017).
3. Analyze and discuss the midwifery care of the woman, and the neonate received
about the complex situation, including a discussion of the pharmacological
management of the woman's complexities.-Demonstrates a significant level of
analysis of the midwifery care received by the woman and the neonate during the
complex situation.
The midwifery is always an important solution to challenges of providing newborn care
and maternal services of high quality for both women and the newborn. As far as midwifery care
is concerned, there was a friendly and good communication between Sam and the clinic midwife.
The clinic midwife was giving Sam support and advice regarding her health status. The midwife
was also helping Sam with hospital bookings along with the routine tests and checks. As per the
case study, the midwife made a phone call to Sam, advising her regarding her pathology results.
Sam was also given help on how she could breastfeed her baby (Rorie, Paine & Barger, 2015).
Sam was also given information, encouragement together with emotional support at the
time she was frustrated with her complex pregnancy. Sam was being monitored by the midwife

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on her progress and was given appropriate strategies to help during labour. There was also
continuous glucose monitoring.
Neonatal care is usually offered in an intensive medical attention such as NICU. NICU
usually has advanced technologies along with trained healthcare professionals that can perfectly
provide specialized care. The birth of a baby is usually complex and a lot of emotional and
physical changes are usually involved.
Concerning the neonate care, when the baby is born, there are always chances that
his/her organs are not developed fully which can result in many health problems. Under these
circumstances, the neonatal care received by Jay was for gestational age and therefore was taken
into IUGR for respiratory support. The baby was also commenced on IV dextrose to boost blood
glucose level. While in NICU, Jay was attended to by the Neonatologist who supervises the
pediatric fellows. There was also a dietitians together with respiratory therapists so as help Sam’s
baby accordingly.
Conversely, at week he was discharged and handed over to the paediatrician who is the
medical practitioner that specializes in children together with the disorder so that incase of any
complication, it is addressed on time.
Discuss the pharmacological management of the woman, discuss the medications
used, and the implications of these medications on the woman and the pregnancy.
The pharmacology management of blood pressure in pregnancy is usually affected by
pharmacodynamics effects of different agents together with changes in drug disposition. In that
case, some of the medications that were used are as highlighted below. To start with, there was
the treatment of low iron with diet together with Ferrogradumet C twice daily. This was mainly

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to prevent and treat iron deficiency anaemia. Women are likely to be diagnosed with anemia
(low iron) and should refrain from fish with high mercury content. I would recommend Sam to
drink a lot of water per day and eat lots of green vegetables. Additionally, I would recommend
eating fully cooked meats to keep your iron count high. Only consume 300 more calories extra
per day and just have a wholesome diet (MacDorman & Singh, 2014).
The cardiac disorder typically puts the pregnant woman at the risk of not being able to
compensate for the a lot of workload placed on her heart at the period of pregnancy.
Accordingly, the Ferrograd C has sulphate that is in the form of iron along with ascorbic
acid that has vitamin C. This helps in the production of the haemoglobin which is oxygen
transporting substance that is usually in red blood cells. At 30 weeks period, Sam was taking
insulin. The primary purpose of this was to control the blood glucose level. This is because she
was reported to have a low Blood Glucose Level. Sam was also admitted for antihypertensive,
Labetalol 100mg BD after assessment and review. The function of the antihypertensive was
mainly to treat severe hypertension (Kirkham, 2014). The baby was commenced on IV dextrose
infusion so as to help boost his blood glucose level.
4. Discusses the consultation/referral that took place during this time, including why
the consultation / referral was appropriate.
The first consultation was when Sam together with her husband book in the antenatal
clinic at 17 weeks. The primary purpose of this consultation was to diagnose the aspects of the
bodily specimens. However, there were no abnormalities. Accordingly, Sam was refereed by the
clinic midwife to the diabetic clinic. This referral was appropriate since she could be advised on

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the best diet to take (Renfrew, McFadden, Bastos, Campbell, Channon, Cheung & McCormick,
2014). During this period, she could also be advised on the treatment of diabetes. Sam was also
invited in the birth suite where there was an assessment of the urinary tract infections. During
this assessment, she was also found with photophobia, which is a condition where the bright light
hurts the eyes.
Sam was also referred to like the social worker for emotional support. At this time she
was disappointed with producing only 5mls each side every 3 hours. Sam and Jay were also
linked to the local community mums to follow up with the pediatrician. This was important since
in case of any disease to the child then it could easily be detected since they are experts in that
field.

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References
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