Healthy Childbearing For Reproductive Phase: Midwifery Care For Women With Pregnancy-related Anemia

Description of the Condition

Discuss about the Healthy Childbearing for Reproductive Phase.

Pregnancy is the reproductive phase, when a woman nourishes a fetus in her womb. A healthy pregnancy is crucial for having a healthy baby, as pregnancy can affect a child’s health after birth and even during the adulthood. There are several risk factors, which may hamper a healthy pregnancy. Therefore, the midwifery care needs to ensure that all the risk factors are properly monitored and eliminated. There are several risk facts that has been seen to develop during the period of pregnancy. These include diabetes, liver function problems and anemia. These issues need to monitor properly along with appropriate care practices, to reduce complications during pregnancies and reduce health issues in the newborn (Goddard et al., 2011). These health issues may also raise complications during labor, thus, needed to be monitored and cared properly. Here, in this essay, the key focus is Jenny, who is having her first pregnancy and she is 28 weeks pregnant. She is representing the symptoms of anemia with low blood hemoglobin level. Now, the essay will focus upon the midwifery care of Jenny to ensure a healthy child bearing and intrapartum management, along with the initial care of the new born.

In the case scenario, the key concentration is upon the pregnant woman Jenny, who has arrived for her antenatal clinic visit. Currently Jenny is 28 weeks pregnant. It is her first pregnancy. Thus, Jenny is quite nervous about her condition. However, on recent check up, Jenny reported something unhealthy, that is, she is feeling tired and it is becoming hard for her to go to work every day. On her visit, she looked pale and tired. Although these symptoms are common in pregnancy, however, her health issue became more significant, when her last blood tests showed a significant low level of hemoglobin, i.e. 90 g/L. In this context, she seeks assistance to deal with her condition from the Community Midwifery Team. Based on her condition, it is understood that she is experiencing with significant episode of anemia, which needs immediate care.

It has been revealed from Jenny’s current symptoms, that Jenny is experiencing with pregnancy related anemia. During pregnancy, body produces more blood for supporting the growth of the fetus. When body does not get enough iron or other nutrients, like vitamin D or folate, body might not be able to produce enough amounts of red blood cells needed for making the additional blood required for the fetal growth and development. Thus, it is common to have mild anemia during pregnancy. All the pregnant women are at the risk of developing anemia. However, Jenny’s blood report is showing significant concern regarding her low level of hemoglobin. For instance, the normal blood hemoglobin level is 120 g/L to 160 g/L, whereas, Jenny is having 90 g/L. In case of Jenny the reason may be iron deficiency in her diet. It has been argued by Pavord et al., (2012) that severe or untreated iron deficiency anemia can enhance the risk of having a preterm or low birth weight baby. Untreated folate deficiency increases the risk of low birth weight of baby and serious birth defect of brain or spine, whereas untreated vitamin B12 deficiency rises the risk of delivering a baby with neural tube defects. In addition to these conditions, a severe anemia during pregnancy also enhances the risk of postpartum depression, newborn with developmental issues or need for a blood transfusion, while losing a significant amount of blood during delivery.

Risk for healthy Child Bearing

Initially, a thorough diagnosis is required for identifying the cause of anemia and the severity of anemia. Jenny is 28 weeks pregnant and it is common to experience mild anemia during this period. However, significant care and treatment is needed to mitigate the issues. Within the initial diagnosis, the hemoglobin test and hematocrit test needed to be done (Yakoob & Bhutta, (2011).

After the initial diagnosis, Jenny’s key cause of anemia or hemoglobin deficiency would be identified. There are three key causes of anemia, i.e. iron deficiency, folate deficiency or vitamin B12 deficiency. In case of iron deficiency, the midwifery care would encourage Jenny to take iron supplements, which is replaced by folic acid supplement, if the cause of the anemia is folate deficiency (Milman, 2012). On the other hand, in case of vitamin B12 deficiency, vit B12 supplements would be administered to Jenny. In addition, doctor would suggest her to take an appointment with the dietician, who would recommend her to include high iron or folic acid in diet. In addition, Jenny would be advised to include more animal food in diet including meat, eggs and dairy products. Additionally, Jenny’s midwifery care team would encourage her to consume more beans, nuts and seeds, dark leafy greens, fortified cereals, eggs along with lots of fruits like melons or bananas. In addition, according to the doctor’s instruction, prenatal vitamins containing iron and folic acid would be administered, for improving Jenny’s red blood cell production. In case of iron deficiency, Jenny would require more than 6mg iron per day, to combat with anemia and proper growth of her baby (Milman, 2011).

In addition, another option for restoring her iron or folate deficiency is by injecting the iron supplement or folic acid supplement solution through intravenous route. However, it is important to investigate, which option is the most appropriate one based n Jenny’s and her baby’s health status. Although there is less evidence regarding any significant difference between the oral and intravenous iron supplement administration, it has been revealed from recent reports that intravenous supplements are better for mitigating gastrointestinal harms, whereas blood transfusion is better in dealing with fatigue (Jackson et al., 2012). According to evidence based care, Jenny would be advised for routine checkups, where the midwife would regularly attempt to measure her blood hemoglobin and hematocrit level. Jenny would be advised to take sufficient amount of rest to combat with her tiredness. After establishing a significant positive relationship with Jenny, the midwife would attempt to encourage Jenny to be more socialize, which would help to burst her stress out, thereby helping her to reduce her tiredness or nervousness regarding her first pregnancy. All of these midwifery interventions would lead to Jenny’s healthy child bearing.

Care Options

The key concern of Intrapartum management of Jenny is managing the risk of blood loss during delivery. In case of Jenny, as her blood hemoglobin concentration is significantly low, if significant amount of blood is lost during delivery, blood transfusion may be required. Thus, the midwifery care team needs to ensure minimum amount of blood loss during her delivery. Evidences suggest that higher blood loss attributed to impaired uterine muscle strength for labor, if prolonged (Alden et al., 2012). Moreover, it has also been suggested that reduced uterine blood flow or low uterine muscle strength could influence the uterine contractions, which is mediated by iron stores and iron deficiency anemia.

A health promotion plan would be developed for improving jenny’s awareness regarding her condition, the risk factors associated to these and the severity prevention strategies for having healthy child.  In these sessions, she would be informed that a C-section would include greater risk of blood loss, compared to a vaginal birth. Thus, jenny would be provided awareness and guidelines for preparing herself for a vaginal birth (Goonewardene, Shehata & Hamad, 2012). Mental and physical preparation is needed for a vaginal birth, as it is a lengthy and more painful process compared to C-section. Pain management needed to be done by both the OB physician and midwifery team with the administration of pain relief medication, which is not harmful to the fetus. In addition, the midwife needs to motivate Jenny continuously to eliminate her stress and anxiety related to risks of her first pregnancy due to health condition.

As a part of the planning for Jenny’s care, the midwife would assist Jenny to make a birth plan with her. This plan would describe the place of birth, the suitable way of birth, people Jenny would like to be in the labor room or Operation Theater, suitable pain relief Jenny would require to deal with her pain and Jenny’s wish regarding the whenua.

In addition, to combat with a significant amount of blood loss during delivery, the OB and midwifery team need to arrange for additional blood of her blood group, from the blood bank or donor. It would help to mitigate her immediate blood loss and the risk of hemorrhagic shock due to blood loss. Her BP, oxygen saturation, RR, HR and hemoglobin level needs to be monitored continuously by the midwife to check any signs of emergency care (Khalafallah & Dennis, 2012).

Intrapartum management

From the article provided by Koura et al., (2012) it has been revealed that the midwifery team needs to guide the mother regarding the initial care of the newborn, as the mother is experiencing the newborn care for the first time. In the operation theater or labor room, the midwives have the responsibility to take care of the baby. In this context, initially, the baby should be checked and after approximately 1 hour or so, the baby would be put on Jenny’s chest straight away for helping her to breast feed her baby for the first time. Some babies need specialized care in a newborn baby unit, which is possible in case of Jenny, as she is experiencing anemia. Therefore, midwives are responsible for assisting neonatal team to deal with the newborn’s case by providing all the details of the infant, the mother and her complications during or prior delivery. After birth, the newborn baby would be screened for any kinds of birth defects, rare medical disorder or infection, which would be assisted by the midwifery team. The midwife would assist Jenny for making decision regarding what she wants to do with the placenta, as per the birth plan made for her.

A high risk of iron deficiency and bleeding is present postpartum, which is applied in jenny’s case also. In a Danish study showed that 26 % woman not taking iron supplements, which had undergone a normal delivery, became iron deficient one week after delivery, which may lead to serious consequences to both mother and child (Jackson et al., 2012).

Once home, the midwife or a midwife working on behalf of Jenny’s specialist doctor would visit her regularly, i.e. at least five visit at home. These health visits ware for supporting Jenny’s health as well as her baby’s condition. As Jenny is anemic, if intranpartum management significantly managed or eliminated the chance of excessive blood loss and blood transfusion during delivery, there is a chance of postpartum bleeding, which may significantly affect Jenny’s health and may be fatal, if not taken care properly. The Midwife would visit Jenny regularly until the baby is 6 weeks old, while supporting Jenny regarding care for her baby. Moreover, the midwife would check Jenny’s surgical site for any kinds of infection, ooze, swelling, pain or discomfort (Ramakrishnan et al., 2012). At 6^th week visit, the midwife would check both Jenny and her child’s health, ensuring that both mother and baby is healthy and well and there is limited or no risk for postpartum bleeding for Jenny. The Midwife would also assist Jenny to reduce her postpartum stress, onset of fatigue or exhaustion and would encourage her to continue with her iron tablets, until her specialist doctor prescribe to stop them. Midwife would also assist her by advising some exercise. In the mean time, Jenny would be regularly monitored for her blood hemoglobin and hematocrit level (Litton, Xiao & Ho, 2013). Delivery of the baby is related to increased oxidative stress and inflammatory response, in addition, Jenny needs to breast feed her baby, for which she needs iron supplements to be continued.

For her future pregnancies, Jenny would be advised to undergo regular checkups, for managing her iron deficiency and anemic symptoms, as it can affect her pregnancy and the new born.

Conclusion

A healthy pregnancy is wanted by every woman for having a healthy baby without any birth defect. For ensuring a healthy child bearing, the midwifery care has a significant contribution. There are several risk factors arising during pregnancy and the midwifery care has the responsibility to provide proper care and mitigate the issues. In this essay, a significant pregnancy issue has been demonstrated through the analysis of a case study. In the case study a 28 weeks pregnant women’s case has been focused, who has been diagnosed with pregnancy related anemia. The essay presented the appropriate midwifery care, which has been planned on the basis of evidences revealed from the previous literatures. The plan included defining the care options, intrapartum management of Jenny’s condition, initial care of the newborn, follow up care guidelines and the considerations for the future pregnancies. Therefore, it can be interpreted that this essay provided a significant knowledge regarding the antenatal care of anemic woman.

Reference List

Alden, K. R., Lowdermilk, D. L., Cashion, M. C., & Perry, S. E. (2013). Maternity and women’s health care. Elsevier Health Sciences.

Goddard, A. F., James, M. W., McIntyre, A. S., & Scott, B. B. (2011). Guidelines for the management of iron deficiency anaemia. Gut, gut-2010.

Goonewardene, M., Shehata, M., & Hamad, A. (2012). Anaemia in pregnancy. Best practice & research Clinical obstetrics & gynaecology, 26(1), 3-24.

Jackson, S., Fleege, L., Fridman, M., Gregory, K., Zelop, C., & Olsen, J. (2012). Morbidity following primary cesarean delivery in the Danish National Birth Cohort. American journal of obstetrics and gynecology, 206(2), 139-e1.

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Koura, G. K., Ouedraogo, S., Le Port, A., Watier, L., Cottrell, G., Guerra, J., … & Garcia, A. (2012). Anaemia during pregnancy: impact on birth outcome and infant haemoglobin level during the first 18 months of life. Tropical Medicine & International Health, 17(3), 283-291.

Litton, E., Xiao, J., & Ho, K. M. (2013). Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. Bmj, 347, f4822.

Milman, N. (2011). Iron in pregnancy–how do we secure an appropriate iron status in the mother and child?. Annals of Nutrition and Metabolism, 59(1), 50-54.

Milman, N. (2012). Oral iron prophylaxis in pregnancy: not too little and not too much!. Journal of pregnancy, 2012.

Pavord, S., Myers, B., Robinson, S., Allard, S., Strong, J., & Oppenheimer, C. (2012). UK guidelines on the management of iron deficiency in pregnancy. British journal of haematology, 156(5), 588-600.

Ramakrishnan, U., Grant, F., Goldenberg, T., Zongrone, A., & Martorell, R. (2012). Effect of women’s nutrition before and during early pregnancy on maternal and infant outcomes: a systematic review. Paediatric and perinatal epidemiology, 26(s1), 285-301.

Yakoob, M. Y., & Bhutta, Z. A. (2011). Effect of routine iron supplementation with or without folic acid on anemia during pregnancy. BMC public health, 11(3), S21.