- Email: [email protected]
Expecting the unexpected: Critical reflection on a case study of a rare occurrence of chorioamnionitis
Abstracts / Women and Birth 30(S1) (2017) 1–47
S6
S7
The state of maternity care for women with disabilities
Expecting the unexpected: Critical reflection on a case study of a rare occurrence of chorioamnionitis
Helena Wood Flinders University, South Australia, Australia Introduction: The common social belief that women with physical disabilities are asexual and do not desire to become pregnant and have children is a misconception. There have been studies showing the poor perinatal care of women with disabilities with barriers to good care being both physical and social. This is both a human rights issue as well as a feminist issue and needs to be addressed so that women receive the best care from their health care providers. A literature review on the current research shows that role of the midwife in these instances of care has not been widely researched as well as the effect of these women’s mental health. Aim: Gain knowledge on the role of the midwife in caring for women with disabilities through their pregnancy, birth and postpartum period. Methods: A review of the literature was undertaken using Flinders University Library page, Google Scholar and Medline on Ovid. The keywords used were women with disabilities, pregnancy, maternity care, feminism and disabilities, and physical disabilities. From the articles found in these searches the snowball method was then utilised to find other related articles. The journal articles were all in English (or translated into English), with no restriction on the location of the study. All articles that were reviewed were published from 2009 until 2016. They came from both peer reviewed journals and from books. Results: Very few journal articles found discussed a midwifery model of care for women with disabilities. Most articles were looking at medical models of care. These studies had common themes including the viewing of women with disabilities as asexual and not desiring a family, the lack of sexual health education, poor attitudes of health care providers, physical obstructions that make it difficult for women with disabilities to attend health care provider offices including transportation to and from appointments lack of accessibility to buildings and clinic rooms, as well as lack of accessibility to equipment in the rooms. Per the United Nations Convention on the Rights of Persons with Disabilities health care providers need to ‘provide equal access to health care and related services for people with disabilities’. There have been studies that show some HCP not upholding thee principles. Mainstream feminism has often been criticised for not being inclusive of women with disabilities as well as not putting maternity care issues in a place of high priority. The inclusion of these issues in mainstream feminist priorities could go a long way into helping women with disabilities get better maternity care Conclusion and implications: More research needs to be done on the impact of societal and physical barriers to maturity health care for women with disabilities. Improving education of both the women and the healthcare providers on sexual matters as well as the healthcare needs would help to give these women better care. If more women with disabilities were able to access midwifery models of care and have woman centred care with ownership over their journey through the maternity care system and her being an active participant in her healthcare then better physical and psychological outcomes may be achieved. http://dx.doi.org/10.1016/j.wombi.2017.08.009
3
Rebekah (Becky) Trevor University of Queensland, Queensland, Australia Introduction: Chorioamnionitis occurs in 1–5% of term pregnancies. Women with chorioamnionitis may be febrile and experience symptoms of uterine tenderness, malodourous vaginal discharge, and maternal and fetal tachycardia. Aim: This presentation will critically reflect on the case study of a mother who experienced chorioamnionitis during the intrapartum period. Content: Timeline analysis and a framework for the analysis of risk and safety (1) will be applied to the case study of Jane (not her real name). This will set the frame for reflection and evaluation of the care provided and the appropriate and best practice referral, consultation and action within a multidisciplinary team. Further discussion will outline the implications and learned experiences from the clinical incident. Original perspective: Timeline analysis and application of risk management frameworks are useful tools to support critical reflection and evaluation of care provided. Implications: Critical reflection and sharing clinical experiences can assist midwives to ensure early identification of rare clinical events and support rapid instigation of best practice. http://dx.doi.org/10.1016/j.wombi.2017.08.010 S8 Pre-empting shoulder dystocia: A case of midwifery-led, multidisciplinary best practice Chloe Sonter University of Queensland, School of Nursing, Midwifery and Social Work, Queensland, Australia Introduction: For 50% of cases of shoulder dystocia, the event is unpredictable and requires prompt recognition in order to initiate appropriate management and minimise the morbidity to the mother and infant. However, the other half of these incidents occur in the presence of risk factors, which, when identified, can enable the pre-empting of shoulder dystocia and hence a more rapid diagnosis and management, and potentially better outcomes. Aim: This presentation will analyse a case study, evaluate evidence and clinical practice policies and highlight the role of the midwife in the multidisciplinary team in the management of prolonged second stage of labour in the presence of risk factors for shoulder dystocia. Issue: This case study examines a multiparous woman who experienced a prolonged second stage of labour. The midwife demonstrated critical thinking and expertise in the application of relevant evidence in identifying risk factors for shoulder dystocia from clinical assessment, handover and maternal history. Consequently, the midwife instigated the involvement of the multidisciplinary team, the application of hospital policies and preparations to manage a shoulder dystocia; should it occur. Implications: This case provides an example of multidisciplinary best practice in pre-empting shoulder dystocia. On a broader scale, however, it highlights the importance of midwifery
S6
S7
The state of maternity care for women with disabilities
Expecting the unexpected: Critical reflection on a case study of a rare occurrence of chorioamnionitis
Helena Wood Flinders University, South Australia, Australia Introduction: The common social belief that women with physical disabilities are asexual and do not desire to become pregnant and have children is a misconception. There have been studies showing the poor perinatal care of women with disabilities with barriers to good care being both physical and social. This is both a human rights issue as well as a feminist issue and needs to be addressed so that women receive the best care from their health care providers. A literature review on the current research shows that role of the midwife in these instances of care has not been widely researched as well as the effect of these women’s mental health. Aim: Gain knowledge on the role of the midwife in caring for women with disabilities through their pregnancy, birth and postpartum period. Methods: A review of the literature was undertaken using Flinders University Library page, Google Scholar and Medline on Ovid. The keywords used were women with disabilities, pregnancy, maternity care, feminism and disabilities, and physical disabilities. From the articles found in these searches the snowball method was then utilised to find other related articles. The journal articles were all in English (or translated into English), with no restriction on the location of the study. All articles that were reviewed were published from 2009 until 2016. They came from both peer reviewed journals and from books. Results: Very few journal articles found discussed a midwifery model of care for women with disabilities. Most articles were looking at medical models of care. These studies had common themes including the viewing of women with disabilities as asexual and not desiring a family, the lack of sexual health education, poor attitudes of health care providers, physical obstructions that make it difficult for women with disabilities to attend health care provider offices including transportation to and from appointments lack of accessibility to buildings and clinic rooms, as well as lack of accessibility to equipment in the rooms. Per the United Nations Convention on the Rights of Persons with Disabilities health care providers need to ‘provide equal access to health care and related services for people with disabilities’. There have been studies that show some HCP not upholding thee principles. Mainstream feminism has often been criticised for not being inclusive of women with disabilities as well as not putting maternity care issues in a place of high priority. The inclusion of these issues in mainstream feminist priorities could go a long way into helping women with disabilities get better maternity care Conclusion and implications: More research needs to be done on the impact of societal and physical barriers to maturity health care for women with disabilities. Improving education of both the women and the healthcare providers on sexual matters as well as the healthcare needs would help to give these women better care. If more women with disabilities were able to access midwifery models of care and have woman centred care with ownership over their journey through the maternity care system and her being an active participant in her healthcare then better physical and psychological outcomes may be achieved. http://dx.doi.org/10.1016/j.wombi.2017.08.009
3
Rebekah (Becky) Trevor University of Queensland, Queensland, Australia Introduction: Chorioamnionitis occurs in 1–5% of term pregnancies. Women with chorioamnionitis may be febrile and experience symptoms of uterine tenderness, malodourous vaginal discharge, and maternal and fetal tachycardia. Aim: This presentation will critically reflect on the case study of a mother who experienced chorioamnionitis during the intrapartum period. Content: Timeline analysis and a framework for the analysis of risk and safety (1) will be applied to the case study of Jane (not her real name). This will set the frame for reflection and evaluation of the care provided and the appropriate and best practice referral, consultation and action within a multidisciplinary team. Further discussion will outline the implications and learned experiences from the clinical incident. Original perspective: Timeline analysis and application of risk management frameworks are useful tools to support critical reflection and evaluation of care provided. Implications: Critical reflection and sharing clinical experiences can assist midwives to ensure early identification of rare clinical events and support rapid instigation of best practice. http://dx.doi.org/10.1016/j.wombi.2017.08.010 S8 Pre-empting shoulder dystocia: A case of midwifery-led, multidisciplinary best practice Chloe Sonter University of Queensland, School of Nursing, Midwifery and Social Work, Queensland, Australia Introduction: For 50% of cases of shoulder dystocia, the event is unpredictable and requires prompt recognition in order to initiate appropriate management and minimise the morbidity to the mother and infant. However, the other half of these incidents occur in the presence of risk factors, which, when identified, can enable the pre-empting of shoulder dystocia and hence a more rapid diagnosis and management, and potentially better outcomes. Aim: This presentation will analyse a case study, evaluate evidence and clinical practice policies and highlight the role of the midwife in the multidisciplinary team in the management of prolonged second stage of labour in the presence of risk factors for shoulder dystocia. Issue: This case study examines a multiparous woman who experienced a prolonged second stage of labour. The midwife demonstrated critical thinking and expertise in the application of relevant evidence in identifying risk factors for shoulder dystocia from clinical assessment, handover and maternal history. Consequently, the midwife instigated the involvement of the multidisciplinary team, the application of hospital policies and preparations to manage a shoulder dystocia; should it occur. Implications: This case provides an example of multidisciplinary best practice in pre-empting shoulder dystocia. On a broader scale, however, it highlights the importance of midwifery