Case Study Summary
The case study involves a 28-year-old woman who is 22 weeks pregnant. The woman, named Jane, lives with her husband Harry who is a plumber and with whom they have a stable relationship. They reside in a rural area and are four hours away from a referral hospital. Jane’s current pregnancy is the second one. The first pregnancy was aborted after she suspected that the foetus had a genetic defect. Although the pathology on the body at that time was inconclusive, the incident will be taken into consideration in the care of Jane’s current pregnancy.
Genetic Physiological Changes of Jane during the Pregnancy
Many physiological changes take place when a woman is pregnant. Each system and organ of the mother’s body undergoes several transformations during pregnancy in order to prepare the mother’s body for the growth and development of the foetus as well as in preparation for labour. It is however important for the mother to be aware of the normal factors of transformation for early diagnosis and management of common health problems related to pregnancy such as hypertension and anaemia. Closely linked to the physiological changes of a pregnant woman is the development of genetic disorders in the foetus. The majority of pregnancies are normal and many babies are delivered without any problems. However, few exceptions worry each pregnant couple (Herman & Perry, 1997).
Approximately 3-4 per cent of pregnancies give rise to babies with either major birth defects that negatively affect the makeup or function of crucial body organs or slight birth defects that do not lead to functional or structural problems. Abnormalities of structure include cleft lip or heart defects while abnormalities of structure include haemophilia. While some birth defects are apparent immediately after delivery, others may take days, weeks or years to be discovered. One of the most pressing questions for a pregnant woman who had a previous experience with birth defects is: How can I prevent this from happening again? In some situations, the anxiety is reasonable because some birth defects have a high probability of recurring in subsequent pregnancies. Such fear can only be done away with a thorough examination of the baby after birth. In the case of Jane and Harry, it is reasonable for them to worry about the second pregnancy because the first one was aborted following suspicions of a genetic defect (Herman & Perry, 1997).
The first step that Jane and Harry should take to evaluate the risk of the development of a genetic defect in the current pregnancy is to get as much information as possible about the possible cause of the genetic defect in the first pregnancy. The couple needs to get information about any family history of birth defects or mental retardation. If there is a history of genetic disorders in either Jane’s or Harry’s family, the care provider should suggest that Jane takes tests to show whether or not the disorder has affected the baby. Genetic defects are caused by abnormal genes or abnormal chromosomes, which can arise either from inheritance or through mutation. Some genetic defects are transmitted by parent carriers and may affect only babies of a particular sex, for instance, genetic defects that are transmitted by mothers to their baby boys. A good example is a Fragile-X disorder, a condition that brings about the mental retardation and affects mostly male babies. If one parent carries a dominant gene for a certain disorder, or if both parents carry the recessive gene for the disorder, chances are that the baby will inherit the gene. If tests show the possibility of the baby having a genetic defect, then Jane and Harry should seek support and genetic counselling who will further advise them on the possible risks to the baby (Jones & Jones, 2004).
Thanks to advanced medical technologies, many genetic disorders can easily be identified and diagnosed before the delivery of the baby. This can be achieved through prenatal tests such as “the Quad Screen blood tests, ultrasound, amniocentesis, and chorionic villus sampling (CVS)” (Jones & Jones, 2004, p.180). Other blood screening tests can establish if either or both of the parents are carriers of the gene for a certain disorder. Such tests include screening tests for cystic fibrosis and sickle-cell anaemia among others. It is however important to note that genetic conditions can be complicated and that the available information can change quickly. To measure the risk of recurrence, the pregnant mother needs to obtain the most sophisticated assistance possible.
Although doctors may be of assistance, a pregnant couple should seek help from a genetic counsellor. In the case of Jane and Harry, the ability to undergo the genetic tests may be complicated by the fact that they live in a rural area that is four hours away from the nearest referral hospital. However, this should not discourage them. Harry should make transport arrangements to ensure that they get to the referral hospital as soon as possible for the genetic tests. This is because although the rural area may have prenatal clinics, such sophisticated tests can only be found in the referral hospital. Moreover, if the tests show a possibility of a genetic defect in the foetus, the couple will have the opportunity to seek expert advice from the physicians, obstetricians, gynaecologists and genetic counsellors in the hospital. Such expert advice may be hard to find in their rural area (Jones & Jones, 2004).
Psychological Changes of Jane and Harry during the Pregnancy
Pregnancy is one of the biggest changes in a woman’s life and causes more psychological changes than probably all other life events except puberty. However, different women react differently to their pregnancies depending on many factors that include: the environment in which they grew up, the socialization she received from her family concerning pregnancy, the societal and cultural influences of her adulthood, the timing of her pregnancy, her reasons for wanting (or not wanting) a baby, her present family situation and her marital status, among other factors (Pillitteri, 2009). The emotions, thoughts and actions of a pregnant woman change throughout the pregnancy period and even after the delivery of the baby. The majority of the changes have a significant repercussion for the woman’s entire life and may also spill over to other members of the family such as the husband. As a result, pregnancy should be perceived as a long-term process that affects not only the woman but also her entire family.
Some pregnancies are planned, while others come unexpectedly. However, this does not mean that every planned pregnancy will cause positive psychological changes and that every unplanned pregnancy will cause negative emotions. Ambiguous feelings are common during the early months of the pregnancy in which the woman may be joyful and excited on some days but anxious and nervous on other days. These emotions are normal and portray a healthy psychological perception of any imminent change to the woman’s life. Some anxiety during pregnancy is normal. However, too much anxiety that lasts too long a time is not desirable. Anxiety levels may be high in the early months of the pregnancy, partly because of the initial adjustment to the pregnancy that is needed, and partly as a response to physical uneasiness experienced such as nausea and tiredness. Nevertheless, anxiety is generally low during the middle trimester and increases again as labour approaches (Pillitteri, 2009).
One of the most common causes of anxiety in pregnancy is fear. Fears are common and include “fear of miscarriage or abnormality, of dying in labour, or of the baby dying, of hospitals and doctors, of the mother’s illnesses affecting the baby and or pain,” (Sellers, 1993, p.133). Many of these fears are however not made explicit. Some women even fear expressing their fears just in case it causes fulfilment. In reality, however, the expression of the fears can go a long way in reducing their concern and enabling the woman and her partner to know the fears. As a result, Jane and Harry should be encouraged by their care provider to be open about their fears concerning the pregnancy. This should take place in a setting that is conducive to an honest and open discussion, for instance, when the woman is fully dressed and seated next to the caregiver in comfortable surroundings. Settings in which the woman is psychologically vulnerable (for instance, when lying down, undressed, or during examination) are not conducive to any open discussion and should thus be avoided. Other psychological changes that affect pregnant women include emotionality. Mood swings are common while hostility and/or irritability occur frequently. Some women become dependent and insecure, although they are normally assertive and independent (Sellers, 1993).
Although much attention concerning psychological changes is directed towards the pregnant woman, current research shows that male partners also undergo similar changes (Pillitteri, 2009). The man’s participation in the pregnancy may result in changes in his eating habits, weight, aches and pains such as backache, toothache and tiredness. These alterations portray an almost compassionate understanding of the pregnancy with the woman. Additional reactions may entail elevated worries concerning his financial obligations and fears about his role in the new mother-father-baby triad. Fears of being replaced by the baby during the pregnancy and after the delivery are also common among men such that they compete with the baby for the woman’s attention. Each pregnant couple goes through unique psychological changes. With this in mind, Jane and her husband Harry should be encouraged by their care provider to be open about their worries and fears from early on. They should also be advised on the maintenance and enhancement of their marital relationship throughout the pregnancy and afterwards because marital status has a significant effect on pregnancy and parenthood (Sellers, 1993).
Social Changes of Jane and Harry during the Pregnancy
Pregnancy not only leads to physiological and psychological changes but also social changes. Changes in a pregnant woman’s social interactions are indeed often quite dramatic. In society, mothers are expected to make great sacrifices for the sake of their children. This is undoubtedly expected of pregnant women, who may regularly be informed that there is nothing in their lives that is more important than their job of giving birth to a child. Zeanah (2009) argues that “Pregnant women often report being treated like public property. The bodily boundaries of pregnant women are frequently no longer respected, such as when strangers think it appropriate to pat their bellies,” (p.28). Pregnant women are also subject to social scrutiny, even by strangers, and are regularly advised of proper behaviour such as non-smoking and non-drinking as well as the appropriate dress code.
One of the most common social changes of a pregnant woman is her lifestyle. A pregnant woman is required to follow a healthy diet regime by eating healthy foods and taking supplements such as folic acid for the foetus’ growth and development as well as to maintain her health during the entire period of the pregnancy. Good nutrition protects the foetus from developing undesirable health conditions and birth defects. Besides nutrition, a pregnant woman is required to keep fit by increasing her physical activities, for instance, through exercises such as walking and household chores. Physical activity helps to keep both the mother and the foetus strong and goes a long way in easing the labour process. Most importantly, physical activity helps reduce the negative psychological changes the mother may be going through such as anxiety.
Pregnancy also has a significant impact on the marital relationship between the woman and her husband. Zeanah (2009) argues that “the dyad becomes a triad, and it will be at least two decades before any decision can be made without considering the needs of their child,” (p. 29).
Pregnancy symbolizes a significant dedication to the marriage in that the couple, through the child, remains inextricably linked to each other for their lifetime. Even if they later decide to separate, the child will always be a connector between them. Therefore pregnancy has the power to intensify the intimate marital bond. On the other hand, pregnancy may also cause many stresses to the marriage. Pregnancy is therefore directly correlated with marital stability. “The higher the degree of marital satisfaction, the more the husband feels a part of pregnancy and childbearing,” (Zeanah, 2009, p. 29). Therefore, even though participation in childrearing is a life-promoting and life-changing encounter for many men, the relationship between the father and his child is highly dependent on the marital relationship. In the case of Jane and Harry, their marital relationship is stable. This, coupled with their caregiver’s advice on further enhancement of their marriage would go a long way in ensuring the success of the pregnancy. This is thanks to the active involvement of Harry in the pregnancy.
Because of the significant impact of social changes not only on the pregnancy but also on the woman’s relationship with her significant others, the woman needs to receive social support during the pregnancy. Littleton and Engebretson (2002) argue that “social support represents a woman’s sense of belonging and safety concerning a caring partner, family or community,” (p. 63). Research shows that women who lacked social support during their pregnancies are more likely than those who received social support to abuse the child and to suffer from prolonged postpartum depression (Zeanah, 2009). Many pregnant women obtain their primary social support from their partners and mothers. In the case of Jane and Harry, they are fortunate because they live in a rural area that has a communal living system. As a result, Jane is likely to receive social support not only from her husband but also from extended family members and members of the wider community.
Nursing Care of Jane at a Remote Area
Living in an urban area has many advantages for a pregnant woman mainly in the form of accessible and easily available high-quality medical and health care (Littleton & Engebretson, 2002). Nevertheless, the pregnancy outcome depends not only on the availability of medical care but also on demographic and environmental factors as well as health behaviours of the population. It is thus normal to record poor pregnancy and child health outcomes in urban areas because of air pollution and high crime rates among others. Nevertheless, living in a remote area can be disadvantageous to a pregnant couple because of the lack of easy and available health/medical services. If Jane and Harry lived in a remote area, the distance from their home to the nearest hospital would be large thus discouraging them from accessing prenatal and antenatal care. This would be made worse by the rough terrain that is the norm in remote areas, thus making it even harder for Jane to travel to the nearest hospital. This however does not mean that Jane would not receive adequate care if she and her family lived in a remote area (Littleton & Engebretson, 2002).
Remote areas make use of non-physician health care workers such as community health care workers and community nurse-midwives. These health care workers have adequate training in pregnancy, maternal and child health and other aspects surrounding childbearing and childrearing. The care provided by non-physician healthcare workers has been proven to be cost-effective yet of high quality because of their involvement with their patients and enhanced communication skills. Such skills are indeed crucial in remote areas where the majority of the people have little education. As a result, Jane can receive her prenatal care from the nurse-midwives and community health care workers. One of the greatest benefits of using non-physician healthcare workers is that they focus more on prevention and education rather than on treatment. As a result, Jane can benefit greatly from the healthcare workers by learning more about taking care of herself, her foetus and her baby when it is born. However, such healthcare workers cannot handle complex cases and if such a situation arises, Jane would be referred to an obstetrician or gynaecologist located at the nearest referral hospital. Alternatively, the non-physician health care workers can work hand-in-hand with the physicians to ensure that Jane’s pregnancy is successful (Littleton & Engebretson, 2002).
In conclusion, Jane and Harry have a high chance of a successful pregnancy. This however depends on their willingness to undergo tests to determine if the foetus has developed any genetic defect. If a genetic defect is confirmed, the couple will be advised by their care provider and genetic experts on the best measure to take to reduce the risk of the foetus and the baby once it is born. The couple’s marital relationship is stable, and this would help the pregnancy greatly by ensuring peace of mind for Jane, reducing the couple’s worries and fears and providing social support to Jane. Moreover, the couple lives in a rural area where social support from other communities and family members is assured. As a result, there is no reason why the couple should not have a healthy baby.
Herman, B. & Perry, S., 1997. The 12-month pregnancy: what you need to know before you conceive to conceive a health beginning for you and your baby. Los Angeles, CA: Lowell House.
Jones, S. & Jones, M., 2004. Great expectations: your all-in-one response for pregnancy and childbirth. London: Sterling Publisher Company.
Littleton, L. & Engebretson, J., 2002. Maternal, neonatal, and women’s health nursing. Thousand Oaks, CA: Cengage Learning.
Pillitteri, A., 2009. Maternal and child health nursing: Care of the childbearing and childrearing family. 6th ed. New York: Lippincott Williams & Wilkins.
Sellers, M., 1993. Midwifery, Volume 2. Lansdowne: Juta and Co, Ltd.
Zeanah, C., 2009. Handbook of infant mental health. Spring Street, NY: Guilford Press.