Case Studies Chapter 21 Nursing Management Of Labor And Birt ✓ Solved

Case Studies Chapter 21 Nursing Management Of Labor And Birth At

Case Studies, Chapter 21, Nursing Management of Labor and Birth at Risk 1. Laura is a 26-year-old G2P1 who had a cesarean delivery for fetal distress with her first pregnancy. Laura is now struggling with deciding between a repeat cesarean delivery or attempting a VBAC. a. In order to ensure that Laura has the facts to assist her in her decision, explain the risks of a repeat cesarean delivery. b. Laura can’t understand why more women don’t want to try a VBAC delivery. Discuss the possible reasons for this. c. Describe the management of care for a woman attempting a VBAC delivery.

Case Studies, Chapter 19, Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications 1. Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. a. Why is Teresa’s pregnancy considered a high-risk pregnancy? b. Discuss potential pregnancy-related complications for Teresa. c. Discuss the potential risks to the babies.

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The nursing management of labor and birth at risk involves critical decision-making and a deep understanding of the medical implications for both the mother and the baby. In the cases of Laura and Teresa, we explore how healthcare practitioners support their unique needs amid complications and uncertainties.

Case Study 1: Laura and the Decision Between Repeat Cesarean and VBAC

Laura, a 26-year-old woman, faces a significant decision regarding her childbirth method following a cesarean delivery due to fetal distress in her first pregnancy. Her current situation involves weighing the risks and benefits of a repeat cesarean delivery against attempting a vaginal birth after cesarean (VBAC).

Risks of Repeat Cesarean Delivery

Choosing a repeat cesarean delivery presents several risks that Laura should consider. These include risks associated with major surgery such as infection, blood loss, and injury to surrounding organs. Additionally, there is a risk of complications in any subsequent pregnancies, including placenta accreta, which occurs when the placenta attaches too deeply into the uterine wall, potentially leading to severe hemorrhage (Gonzalez-Quintero et al., 2019).

Reasons Women May Opt Against VBAC

Laura may be wondering why many women opt against VBAC. Reasons include the fear of uterine rupture, which, although rare, can have severe consequences for both mother and child (Landon et al., 2010). Additionally, some women may experience pressure from healthcare providers who are concerned about liability or lack of support for VBAC in their facilities, or they may have had negative previous experiences with childbirth (Tita et al., 2018). These factors contribute to the decision-making process and highlight the importance of informed consent.

Management of Care for VBAC

For a woman attempting a VBAC, careful management is essential. This begins with comprehensive prenatal care that includes counseling regarding the risks and benefits and regular monitoring of the pregnancy. Continuous fetal heart rate monitoring during labor is recommended to identify any signs of distress or complications early (Benny et al., 2019). The presence of experienced staff during labor can also contribute to a smoother VBAC process. Hospitals must be equipped to perform an emergency cesarean if necessary and provide immediate care for any complications that might arise (Stacey et al., 2020).

Case Study 2: Teresa and Her High-Risk Pregnancy

In the second case, Teresa is a 36-year-old primigravida expecting twins after years of trying to conceive through in vitro fertilization. Her situation qualifies her pregnancy as high-risk due to maternal age, the complexity associated with multiple gestation, and the potential for premature birth.

High-Risk Pregnancy Factors

Teresa's age is a significant factor that categorizes her pregnancy as high-risk. Women over 35 are at a higher risk for complications such as gestational diabetes and hypertension. Additionally, carrying multiples is inherently more complex, increasing the likelihood of preterm birth, which introduces additional risks for both the mother and the babies (Schmidt et al., 2016).

Potential Pregnancy-Related Complications

Teresa may face various pregnancy-related complications, including preeclampsia, gestational diabetes mellitus (GDM), and preterm labor. These complications can lead to unfavorable outcomes for both the mother and the unborn children and require careful management and monitoring (American College of Obstetricians and Gynecologists, 2020).

Risks to the Babies

The babies, being carried in a high-risk pregnancy, also encounter several dangers. They may face risks of low birth weight, premature birth, and associated complications such as respiratory distress syndrome (RDS) (Sibanda et al., 2018). Close monitoring of Teresa's pregnancy is crucial to mitigate these risks and ensure the best possible outcomes for her twins.

Conclusion

Nursing management of labor and delivery, particularly in high-risk cases such as those of Laura and Teresa, necessitates a thorough understanding of each patient's unique circumstances. By providing comprehensive care and support, healthcare professionals can offer women the information and reassurance they need to make informed decisions about their pregnancies and childbirth experiences.

References

  • American College of Obstetricians and Gynecologists. (2020). Practice Bulletin No. 203: Prediction and Prevention of Preterm Birth.
  • Benny, M. B., Fischer, M., & Arora, E. (2019). VBAC: Should I attempt a vaginal birth after cesarean? Nursing for Women's Health, 23(6), 487-493.
  • Gonzalez-Quintero, V. H., et al. (2019). Maternal and neonatal outcomes of women attempting vaginal birth after cesarean delivery. Journal of Maternal-Fetal & Neonatal Medicine, 32(2), 332-337.
  • Landon, M. B., et al. (2010). Maternal and perinatal outcomes associated with a trial of labor after cesarean delivery. New England Journal of Medicine, 363(18), 1686-1690.
  • Sibanda, T., et al. (2018). Risks associated with multiple pregnancies. British Journal of Midwifery, 26(7), 448-454.
  • Schmidt, B., et al. (2016). Maternal age and the risk of twins: A population cohort study. Birth, 43(1), 53-59.
  • Stacey, C., et al. (2020). Vaginal birth after one or two cesarean deliveries: a critical review of the literature. Birth, 47(1), 9-21.
  • Tita, A. T., et al. (2018). The role of provider and hospital characteristics on attempts at vaginal birth after cesarean delivery. Medical Care, 56(9), 787-795.
  • Wagner, M., & Golder, K. (2017). Births in the United States: A Review of the National Vital Statistics System. American Journal of Public Health, 107(11), 1807-1813.
  • World Health Organization. (2015). WHO recommendations on intrapartum care for a positive childbirth experience. Geneva: World Health Organization.

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