Promoting and Facilitating Informed Choice

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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 Jill’s and the baby’s wellbeing (Salisbury Health Care NHS Trust, Guidelines for the Management of Diabetes in Pregnancy, 2004.(Trust Guidelines) Appendix II).

Using information from the clinical examination.
In accordance with NMC (2004) Code of Professional Conduct, the midwife and student cared for Jill within their sphere of practice. A woman with IDDM requires care not just from the midwife but from the multi-professional team (Bewley, 2004). Jill received regular care at the hospital for observation of fetal progress and monitoring of her diabetes, as well as normal midwifery care. The benefits of continuity are well recognised (Cresswell, 1997) however, these benefits are magnified in cases of medical complications as the midwife is able to act as both advocate and supporter in times of anxiety (Lindsay, 2006). The development of a trusting relationship allows the midwife not only to determine health of mother and baby but also to establish normality in the high risk situation (Lindsay, 2006).

Jill’s medical condition required a number of tests to be carried out regularly throughout her pregnancy, designed to monitor physical wellbeing and fetal development (Trust Guidelines). Bewley (2004) documents how the physiological changes of pregnancy influence glucose metabolism and hence diabetes. The results of these ongoing tests could be used by the obstetric team to determine care pathways. It is vital for the midwife to recognise that, although such medicalisation may appear routine to staff, for the woman it may induce angst and concern (Lindsay, 2006). The role of the midwife is central in providing the woman with the freedom to enjoy her pregnancy (Lindsay, 2006).

Through discussion and evaluation of clinical examinations, care was planned with Jill’s full involvement. As Page (2000) states, such information is important in determining care pathways and assessing the likelihood of unfavourable outcome. Jill’s health and that of the baby...
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