Promoting and Facilitating Informed Choice
Promoting and facilitating informed choice. Women who face care decision dilemmas.
This essay will explore the care received by a woman during her pregnancy, with particular reference to the application of Lesley Page’s (2000) five steps (Appendix I). In accordance with the Nursing and Midwifery Council (NMC), 2004 guidelines on confidentiality, the woman’s name has been changed.
[pic]
Finding out what is important to the woman and her family.
As Page (2000) states, in providing woman centred care, it is important to understand the woman together with her values, worries and hopes for her pregnancy. In Jill’s case, it was important for the midwife and student to approach her as a pregnant woman and not as woman with diabetes who happened to be pregnant, thereby medicalising her pregnancy. The midwife and student let Jill talk about her anxieties and wishes regarding the pregnancy. It was explained to Jill that regular appointments with the obstetrician and diabetic team would be recommended, but that continuity would still be maintained with the midwife and student. In practice, midwifery professionals actively pursue best outcomes for the women and babies in their care, with reduction in mortality/morbidity highly prioritised (Page, 2000). However, the inherent risk is that of adherence to guidelines standing in the way of the midwife viewing the woman holistically (Page, 2000). Although Jill had obvious medical needs due to her diabetes (Bewley, 2004), the midwife and student involved her in the decisions about her care, thus empowering Jill whilst still ensuring safety, a vital part of midwifery care (Page, 2000). Further discussion at booking revealed Jill’s wish for minimal intervention during labour and that she hoped to be able to avoid elective caesarean section. The midwife and student acknowledged Jill’s feelings and suggested that discussions continued as the pregnancy progressed, as decisions would need to be made depending on both
This essay will explore the care received by a woman during her pregnancy, with particular reference to the application of Lesley Page’s (2000) five steps (Appendix I). In accordance with the Nursing and Midwifery Council (NMC), 2004 guidelines on confidentiality, the woman’s name has been changed.
[pic]
Finding out what is important to the woman and her family.
As Page (2000) states, in providing woman centred care, it is important to understand the woman together with her values, worries and hopes for her pregnancy. In Jill’s case, it was important for the midwife and student to approach her as a pregnant woman and not as woman with diabetes who happened to be pregnant, thereby medicalising her pregnancy. The midwife and student let Jill talk about her anxieties and wishes regarding the pregnancy. It was explained to Jill that regular appointments with the obstetrician and diabetic team would be recommended, but that continuity would still be maintained with the midwife and student. In practice, midwifery professionals actively pursue best outcomes for the women and babies in their care, with reduction in mortality/morbidity highly prioritised (Page, 2000). However, the inherent risk is that of adherence to guidelines standing in the way of the midwife viewing the woman holistically (Page, 2000). Although Jill had obvious medical needs due to her diabetes (Bewley, 2004), the midwife and student involved her in the decisions about her care, thus empowering Jill whilst still ensuring safety, a vital part of midwifery care (Page, 2000). Further discussion at booking revealed Jill’s wish for minimal intervention during labour and that she hoped to be able to avoid elective caesarean section. The midwife and student acknowledged Jill’s feelings and suggested that discussions continued as the pregnancy progressed, as decisions would need to be made depending on both
References: BEATON, J. AND GUPTON, A., 1990. Childbirth expectations: a quantitative analysis. In: Midwifery 6 p133-139. BEWLEY, C., 2004 13th ed. Medical Disorders of Pregnancy. In: HENDERSON, C., and MACDONALD, S., eds. Mayes’ Midwifery: A Textbook for Midwives. Edinburgh: Balliere Tindall. CONFIDENTIAL ENQUIRY INTO MATERNAL AND CHILD HEALTH: Pregnancy in women with Type I and Type 2 Diabetes in 2002-2003 in England, Wales and Northern Ireland. London: CEMACH, 2005. CRESSWELL, J., 1997. Delivering Satisfaction. Nursing Times, 93(19), 23-25. DEPARTMENT OF HEALTH, 2001. National Service Framework for Diabetes: Standards. London: DOH. DIABETES ADVISORY CARE COMMITTEE, 2000. Recommendations for the management of pregnant women with diabetes (including gestational diabetes). Diabetes UK. DIMOND, B., 2002. Legal Aspects of Midwifery. Oxford: Butterworth Heinmann. JARDINE-BROWN, C., DAWSON, A., DODDS, R. 1996. Report of the Pregnancy and Neonatal Care Group. In: Diabetic Medicine. 13 S43-S53. LINDSAY, P,. 2006. Creating normality in a high-risk pregnancy. In: Practising Midwife. 9(1) p16-18. MITCHELL, M., 2000. Improving maternity care for pregnant diabetics. In: British Journal of Midwifery. 8(9) p560-564. NURSING and MIDWIFERY COUNCIL, 2004. The NMC Code of Professional Conduct: Standards for Conduct, Performance and Ethics: London, NMC. PAGE, L., 2000. Putting science and sensitivity into practice, In: L.A. PAGE and P. PERCIVAL, eds, The New Midwifery: Science and Sensitivity in Practice. Edinburgh: Churchill Livingstone, 45-70. SALISBURY HEALTH CARE NHS TRUST, 2004. Guidelines for the Management of Diabetes in Pregnancy. STABLES, D., 2004. Metabolic Disorders in Pregnancy. In: Physiology in Childbearing. Edinburgh: Balliere Tindall.