Maternal Healthcare and Midwifery

This assignment delves into the multifaceted realm of maternal healthcare, emphasizing the vital contributions of midwives. It examines various aspects of pregnancy, childbirth, and postpartum care, highlighting the unique skills and knowledge required by midwives to provide comprehensive support to women throughout these life stages. The importance of interprofessional collaboration, effective communication, and evidence-based practices is also underscored.

Midwifery

INTRODUCTION
Midwifery is a branch of health science that deals with pregnancy, prenatal care, post-
partum time and intensive care of the new born child (Schneider and Whitehead, 2013). Midwifery
is an independent health profession which includes direct specialization in obstetrics. A person who
is specialised in midwifery is known as midwife. Midwives are highly trained to deliver a child
normally but more trained high professionals are required to handle pregnant ladies with severe
complications. A midwife helps in assisting the patient throughout the gestation period so that they
are aware of development and complication if it arises in any situation (Henshaw, Clarke and Long,
2013). They follow a basic assessment criteria which helps them in determining various
physiological and mental condition of an individual. A regular ultrasonography is done to examine
growth taking place in the foetus.
The overall report will be based on a case study which includes a pregnant women who is
under the influence of substance misuse from a very long period of time. The report will include
overall history of the women such as family background, history of previous medical condition and
different complexities which are addressed by her. It will also include gestation records and
development of foetus during the overall period. The report also aims to consider her psychological,
social and physical state of mind which is affected due to the influence of alcohol and several drugs.
Lastly the report will also address the role of midwife and multidisciplinary team which can help in
successfully taking care of the patient.
Summary of the Case study
The case study in this report is based on 29 year old married woman who has completed 10
weeks of gestation period. She is reported to be under the influence of alcohol and drug before and
during her pregnancy period (Gilkison and et.al, 2015). Over the time she has developed different
complexities which provoked her to continue substance misuse. After discussing her family history
it was familiar that her parents separated when she was a teenager due to mutual incompatibilities.
As she was attached to her parents she could not accept there separation and started developing
psychological issues which tempted her to consume alcohol and drugs to a greater extent.
She resides in Cardiff city UK, with her partner and a 3 year old boy (Butler and et.al, 2014).
She is reported to suffer miscarriages and pregnancy termination previously due to her poor
physical and mental health. Her husband is a full time employ in one of the private sectors of UK.
During the initial period of her gestation, a thorough check-up of body was done and she was found
to develop liver ailment due to excessive drinking and sniffing habits. She also suffers from various
mental problem due to the separation of her parents. She is strictly advised to quit drinking and
misuse of drugs as it is directly affecting the health of both mother and the developing foetus
(Withnall Bourgeois and Hill, 2015).

Role of midwife in the case study
In this case the patient is reported to be misusing alcohol and illicit drug during her
pregnancy period which increases the risk of complications during the delivery of child (Joseph,
2015). Further it has an adverse effect on well-being of both child and the mother. The woman is
found to be a poly drug user who is addicted to alcohol, cocaine and several other drugs including
benzodiazepines. According to a UK survey 6% of women are addicted to illicit drugs in there
pregnancy whereas 21% of women are reported to consume alcohol during their gestation period.
Some percentage of individuals are also reported to smoke cigarettes during pregnancy (Personal
characteristics and skills required by midwifery team, 2016). All these habits ultimately have a
drastic and life threatening impact on growing foetus and on mother's health.
The case describes that the woman is addicted to different substances due to her bad and
bitter past were her parents separated because of different reasons and issues (Clayton, Rolland and
Bosanquet, 2015). Parting away from her parents during her teenage years developed a sense of
insecurity and less attention which she wanted from her parents. Later on she also started
experiencing anxiety and depression due to loneliness in her life. All these reasons were somehow
responsible for developing drinking and substance misuse habits in her. In such cases it is the role
and responsibility of midwife to guide and take care of her so that she do not face any complication
during and after the post-partum process (Slater, 2015). There are numerous roles and
responsibilities of midwife which needs to be addressed so that she maintains her physical and
mental health properly. Different roles of midwife related to the case study have been discussed
below
 It is the duty of midwife to have a detailed report of the patient which includes, family
history, individual background, medical history and complexities which affects her mental
physical and emotional health (Dip, 2015).
 During the verbal conversation with the patient, the midwife should enquire about presence
of history of substance misuse so that they can plan a proper strategy to reduce the habit of
drug abuse.
 A team of midwifery should include at least one midwife who is specialized in substance
misuse during the gestation period (Bridgett and et.al, 2015).
 The patient who is exposed to drugs and alcohol should be encouraged to attend the prenatal
programs so that they are aware of there benefits and results. The assigned midwife should
also book a prior appointment with the consultant or the paediatric physician so that a proper
plan of child's well-being is prepared in advance.

 The prenatal care appointments should be individually discussed by midwife and the
professional so that they can easily plan a growth chart and can carry the necessary
diagnosis of this patient (Watson and et.al, 2016).
 As this woman is reported to consume high amount of drugs and alcohol it is very necessary
to perform a regular ultrasonography scan at the end of every four weeks so that she can be
checked of any deformity.
 The midwifery team should also perform various test on her to detect hepatitis C,Band other
sexually transmitted diseases caused due to the over consumption of alcohol and drugs
(Cornthwaite, Alvarez and Siassakos, 2015). If the results drawn from those diagnosis
proves to be positive then it is the responsibility of midwifery team discuss a proper
obstetric plan to prevent these diseases.
 As she is experiencing anxiety and depression a more special attention and care should be
given to her so that she is able to recover from her trauma and depression very easily.
 Midwife should encourage to develop a positive behaviour and attitude which can help
during the time of delivery of the child (Hunter and Segrott, 2014).
 If she do not maintain positivity in her mind then she is likely to face many complications
such as increase or decrease in in levels of blood pressure, heart palpitations and other
mental issues.
 A down syndrome test should also be performed on the patient because it is effective in
detecting different types of abnormality present in the child (Scott and et.al, 2015). It is
usually used to determine deformities caused due to gene mutation in the foetus due to drugs
and alcohol.
 It is very important to develop an effective birth plan after considering her cultural and
religious vies of the woman. As she is exposed to substance misuse and alcohol
consumption, a copy of birth plan should also be submitted to community drug and alcohol
team.
 A prior discussion of mother's breastfeeding should also taken into account after 33 weeks
of gestation period (Connelly and et.al, 2013). This will allow the implementation of any
specific plan for mother if the normal breastfeeding procedures fail.
 As he is a vulnerable patient and is at higher risk of getting traumatized it is the duty of
midwifery team to maintain an alert form which will provide special antenatal care to the
mother till the time of delivery.

 There are greater chances of premature birth of a child if mother is exposed to substance
misuse (Nelson, Bougatsos and Blazina, 2012). If she delivers premature child then the new
born baby should be kept in neonatal unit of incubation.
 The period of incubation should not be less than 11 days depending upon the health of
premature child. After the incubation period is completed the midwifery team should plan an
effective strategy to transfer the new born home safely so that she do not infected with any
disease (Ruger and Lazar, 2012).
Role of the multidisciplinary team and inter-professional working
Multidisciplinary team in healthcare consists of nurses, general physicians, rehabilitation
therapists, team of counsellors and social workers (Multidisciplinary Team, 2016). By training and
assessment they acquire basic skills and knowledge which is very important for addressing the
physical, mental and emotional state of a person in appropriate manner. This team also consist of
nutritionists, pathologists paramedical interns psychologists and healthcare coordinators which
emphasize on providing better healthcare services to all the service users. There is also a proper
interaction between other team members such as interdisciplinary and transdisciplinary team but
due to different objectives and goals they are not able to coordinate properly which creates conflicts
(Seeman, 2013). Multidisciplinary team mainly focus on four different stages which are forming,
storming, norming and performing. There are different roles of multi-disciplinary team and inter-
professional working in healthcare department. The are discussed below.
 Apart from midwives, general physicians and practitioners are also members of
multidisciplinary team hence it is the responsibility of all the members to guide the patient
in proper way so that she is aware of the necessary information (American Academy of
Pediatrics, 2015).
 It is very necessary for general physicians discuss topics related to contraception and safer
sex as she consume drugs and other substance to a higher extent. She should also have
knowledge about the pre-conceptual care
 She should be regularly investigated about the substance misuse so that they can inform the
family members about the risk associated with substance misuse during pregnancy (Perry
and et.al, 2014).
 Apart from midwifery team it is the responsibility of multi-disciplinary to arrange an
appointment for her so that she can interact with the team and discuss her personal issues
with them.
 Nurses and other team members should prepare a report which consist of ll the medicines

prescribed to her. It should also mention different types of drugs and alcohol which is
misused by her during and before the pregnancy.
 Regular blood test and urine samples of the woman should be examined to refer different
aspects such as the counts of red blood cells, white blood cells, platelets, creatinine and
different minerals and compositions present in urine and blood samples (Schneider and
Whitehead, 2013).
 The multidisciplinary team should also analyse the mental and emotional behaviour of the
individual so that they are able to prevent any negative impact of adverser mental or
physical health on the unborn baby.
 The general practitioner should inform the local drug and alcohol team about the drug
prescribed to her so that they can check if any adverse drug occurs during the pregnancy
(Henshaw, Clarke and Long, 2013).
 If the outcomes of excessive consumption of alcohol and drugs have affected the health and
growth of the unborn child then midwife or the multi-disciplinary team should submit a
report to the child protection committee so that they can adopt measures to safeguard the
unborn child.
 The meetings which are organised by multi-disciplinary team should always involve patients
who have been misusing drugs and other substances for a longer period of time (Gilkison
and et.al, 2015).
 They can also adopt various pre-planning strategies related to birth of the child so that they
can avoid any sort of complications at the time of delivery.
 It is the duty of midwife and other healthcare professional to inform community drug and
alcohol team that she is pregnant and has a history of drug misuse. She can also
communicate the same information directly to the team by telephone or by letter.
 It is very necessary for that particular team to carry out a detailed assessment of patients
during different time of gestation period (Butler and et.al, 2014). The assessment should
include various information such as current and past history of different drugs used,
frequency of medications taken everyday, social, physical, mental and emotional history,
medical history an other concerns related to patient.
 When she reveals that she is pregnant and has history of substance and alcohol abuse then
she should be confirmed of her pregnancy with the help of several tests conducted by her
midwife and GP (Withnall Bourgeois and Hill, 2015).

 She should be encouraged to adopt the prenatal care plan which will directly influence the
drug and alcohol plan. designed by the community team.
 She should be ensured full support and safety during and after the gestation period. They
should also inform her about the adverse effect of drugs and alcohol on both mother's and
her child's health so that she can develop an attitude of quitting these habits (Joseph, 2015).
 Various plans and strategies are devised by healthcare team so that she can easily stabilize
the consumption of drug and alcohol in a systematic way.
 There should be a proper communication and interaction between all the multi-disciplinary
and inter-professional working team so that they can provide a better idea to handle patients
who undergo various severities during the birth of a child (Henshaw, Clarke and Long,
2013).
 It is the duty of midwife to provide emotional and mental support so that she do not have to
face much higher level of trauma and pain during the time of labour. (Withnall Bourgeois
and Hill, 2015)
Recommendations for future care
It is very important to suggest various recommendations which will help her in maintaining
her health in a more better way (Clayton, Rolland and Bosanquet, 2015). According to diagnosis,
the midwife and general practitioners reported that she is physically very weak which can create
severe complications during the delivery of her child. During verbal communication with her she
expressed she suffered a miscarriage and two medical terminations were adopted to dissolve the
pregnancies earlier (Cornthwaite, Alvarez and Siassakos, 2015). This has affected her mental and
physical health to a great extent. She is also exposed to different types of drugs and alcohol due to
her bad family experience. The developing foetus is at a higher risk of developing severe
abnormality due the substance misuse by her mother, hence, it is very important to suggest her
effective recommendations so that she is able to she is able to stabilize or reduce the habit of
drinking and drug abuse in appropriate and planned manner
(Ruger and Lazar, 2012). Several recommendations have been discussed below.
 The main topic of concern women and ladies in their reproductive age is preconception
issues. It is very important for a woman to be aware of preconception health son that she do
not face any complication and problems during conceiving of a child (Steen, Jones and
Woodworth, 2013).

 Preconception should be considered as one most important topic because due to
unawareness many women are not able to conceive children in their reproductive age which
leads to develop various other problems.
 The risk of preconception increases with increase in adversities during pregnancy
(Schneider and Whitehead, 2013). If a female who is not prepared mentally and physically
for bearing a child then it directly affects the health which often leads to female mortality
during the time of delivering a child
 In many cases it has been noted that the woman who is bearing a child tends to suffer from
various acute and chronic disorders which further creates complications. It is the duty of
midwife and other general practitioners to guide all woman to get a regular medical check-
up done so that they are aware of their physical state (Gilkison and et.al, 2015).
 In foreign countries like UK the minimum child bearing age of woman is 19 years and
according to survey it has been reported that by the age of 25 years all the woman have
experienced single birth.
 Due to improper lifestyle and eating habits many individuals are reported to suffer from
different diseases such as obesity, cardiac disorders, pregnancy loss and hypertension
(Watson and et.al, 2016). In UK, statistics show that more than 7% of woman are diagnosed
as obese and 12% of them have suffered from myocardial infraction once or twice in their
lifetime.
 A major percentage of women are reported to be involved in substance misuse and excessive
alcohol consumption hence it is very important to create an awareness about the adverse
effects of such habits (Cornthwaite, Alvarez and Siassakos, 2015).
 Various training programs and health camp should be organised by multi-disciplinary teams
and to provide vast knowledge about health outcomes due to different issues. When a
woman who conceives a child is not healthy then are chances that she may suffer from a
miscarriage or still birth during the delivery
 The government of UK should implement various measures and strategies so that females
do not consume alcohol or harmful substances during the pregnancy period (Ruger and
Lazar, 2012).
 For future care and safety, it is the foremost duty of all the healthcare professionals, nurses
and midwife to convey adverse syndromes of alcohol and drugs so that the health of both
mother and child is not compromised (Recommendations to Improve Preconception Health
and Health Care, 2016).

 The issue of conception and safe sex should also be provided to woman so that sexual health
is promoted. Hospitals should also provide various physical and chemical contraception
barriers so that they maintain a proper gap between first and second pregnancies.
 Woman who bears a child should be completely diagnosed so that physician are aware of all
the medical conditions associated with them (Clayton, Rolland and Bosanquet, 2015). If a
patient is suffering from various health problems during her pregnancy then she should be
given special attention and care and care so that she is able to deliver the child without any
severe complications.
 The family of the patient should be well informed about the health complications which she
can suffer due to misuse of alcohol and other drugs. A person who consumes much alcohol
and other harmful substances is likely to develop many other diseases which can prove
lethal to the health to both parents and the child (Withnall Bourgeois and Hill, 2015).
 When a physician or midwife is prescribing various medications to the subject then it bis
very necessary for the medical professional to review the current and past history of the
patient. If they are not aware of the different symptoms associated with the patient they may
prescribe drugs which can cause adverse drug reactions and may lead to pregnancy loss in
individuals (Henshaw, Clarke and Long, 2013).
 Patients who have mental and physical health problems should be provided counselling
sessions on regular basis so that they develop a sense of positivity which will help in
improving their physiological and psychiatric health (Steen, Jones and Woodworth, 2013).
They should be given complete care and attention so that they are able to recover from acute
anxiety and depression problems.
 If a person has developed severe issues which do not allow the person to deliver a child
normally then the healthcare professional team should formulate an effective caesarean plan
for delivering a child so that she faces only a certain level of pain and trauma due to surgery
and other medical complications (Cornthwaite, Alvarez and Siassakos, 2015).
CONCLUSION
The overall report is based a case study which includes pregnant woman who has a current
and previous history of substance misuse from a very long period of time. It also includes her
family history, medical history and various physiological, psychiatric and emotional concerns that
has affected her life to a higher extent. The report discussed a detailed description of role of
midwife in the above case study during and after the period of gestation. It included the analysis of
different test result such as blood reports, pressure levels, urine examinations and other assessment

related to biological functioning of her body. During the stay, midwifery team also performed a
down syndrome test on her to analyse or detect if any type of deformity or abnormality is present or
not.
The report also explored the role of multi-disciplinary team and inter-professional working.
This team included members such as nurses, general practitioners, counsellors, psychologists,
pathologists and different therapist which understands the mental, physical and social state of all the
individuals who are experiencing anxiety and depression due to various reasons. Further, it also
included development of different plans and strategies before and after the birth of child so that the
health of mother and child is restored. Lastly it also concluded various recommendations which are
very important for future care of both mother and the child. It also included various
recommendation to avoid drug reactions and interactions so that mental health and physical health
of both the individual is not affected.

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