Intrapartum Care for Women With Multiple Pregnancy

Intrapartum management of multiple pregnancy presents many challenges for obstetric nurses. Optimal care often is complicated by prematurity, low and very low birth weights, and the unique circumstances of the delivery of multiple neonates. Higher perinatal mortality for multiple pregnancies continues to complicate delivery outcome. Nurses need special knowledge and skills to provide care for women with a variety of high-risk conditions in rapidly changing situations.     

Case Report of Nursing Care for a Pregnant Woman With Cystic Fibrosis

Life expectancy for individuals with cystic fibrosis (CF) has significantly increased during the last few decades, and subsequently, more women with CF are considering pregnancy. A detailed understanding of the management of pregnancy, specific pulmonary treatments, and necessary medications is essential to provide specialized care for women with CF. In this article, we present the physical and psychosocial aspects of care for pregnant women with CF and describe a case involving the planned pregnancy of a nulliparous woman with CF. We suggest vigilant monitoring for adequate nutrition, weight gain, and pulmonary function throughout pregnancy as implications for nursing care.     

Assessing Women's Preferences for Intrapartum Care

Background: Recent government reports have recommended involving consumers in the planning of health services. Although satisfaction surveys have traditionally been used, they have several limitations. This paper describes a relatively new method of eliciting consumer preferences that allows respondents (women) to indicate the importance that they attribute to specific aspects of a service. The aim was to explore the feasibility of using a discrete choice experiment to assess the importance to women of different aspects of intrapartum care. Methods: In this pilot study of 301 women at low obstetric risk, data were collected using an anonymous self‐complete questionnaire given to each participant by the midwife at the booking visit. Results: The results of the regression model suggest that respondents prefer maternity units that offer greater continuity of caregiver, more methods of pain relief, continuous fetal heart rate monitoring, a homely appearance, routine involvement of medical staff, and greater involvement for the woman in the decision‐making process. Although all attributes were important to women, they were not all of equal importance. For example, if continuity of caregiver were achieved at the expense of decreasing the availability of pain relief then women would be worse off. Conclusions: The discrete choice experiment appears to be a useful tool in assessing the strength of women's preferences for different aspects of maternity care. Future research should include a qualitative approach to explore in greater depth the processes involved in shaping women's preferences.     

Part 2. Antepartum and Intrapartum Care

The spread of human immunodeficiency virus (HIV) disease among childbearing women presents a unique nursing challenge in the delivery of specialized antepartum and intrapartum care. The nurse must be competent in the delivery of psychosocial and physical care to these women, as well as assume a pivotal role as a member of the multidisciplinary health-care team. Aspects of care, from the diagnosis of pregnancy through delivery of the neonate, that are unique to women with HIV disease are described.     

Using Evidence-Based Practice to Improve Intrapartum Care

The Cochrane Data Base (www.cochranelibrary. com/clibhome/clib.htm, retrieved February 23, 2001), a comprehensive international review of current medical and obstetric practices, demonstrates that birth outcomes improve with one-to-one labor support but not necessarily with continuous fetal monitoring. Because of a cultural bias toward technology, however, few extrinsic rewards exist for nurses who provide individualized labor support. Clinical scholarship in the obstetric setting is one way to begin changing ritualized practices, incorporating evidence-based practice, and improving nursing care.     

Intrapartum Fetal Intensive Care: 2-Year Experience

Summary: Reappraisal of 2,279 electronically-monitored labours in the fetal intensive care unit enabled the formation of a policy for the management of high risk pregnancies in labour. In the presence of meconium, major cardiotocographic heart rate abnormalities were as predictive of perinatal outcome as fetal acidosis (pH < 7.25). However, fetal scalp pH estimation did significantly reduce the incidence of Caesarean section for fetal distress. The perinatal mortality in the study was 1.32 per 1,000 births.     

Family Centered Intrapartum Care: Revisiting an Old Concept

The historic development of family centered care to the present time is traced, and future development is proposed. A family systems approach can help nurses focus on the family as a unit and on individual members. This requires nurses to develop skills in working with multiple family members, provide care and advocacy for varying and sometimes conflicting family needs, and promote family clarification of their own values and priorities. Such an approach can help intrapartum families add to their experience of coping with stress in a way that builds family cohesion and mutual support.     

Nursing Care of the Pregnant Woman with Diabetes Mellitus

A review of pregnancy and diabetes and a discussion of nursing in relation to pregnancy, mental health, and diabetes are presented. The various complications of a chronic disease complicated by pregnancy are discussed, including emotional tensions, family life, sexual changes, and financial responsibilities. The authors propose collaboration of team members with a clinical nurse specialist as central to care continuity, education to help the diabetic woman fulfill the medical plan of therapy, counseling to assist her in adjusting to pregnancy, and nonseparation of pregnancy and diabetes for purposes of nursing and medical care.