Obstetrics: follow pregnancy care, choices and continuity
The primary focus of obstetrics is the process of pregnancy, labor and delivery and the postpartum time frame surrounding these events. Therefore, care encompasses both routine assessments and the responses to the unique needs of the individual. Understanding why an appointment was scheduled or what an examination/test is intended to accomplish is far more beneficial than merely memorizing a schedule of all stages of care without any knowledge of what each stage is intended to accomplish.
Pregnancy care begins with an individual assessment
Routine antenatal care combines multiple sources of information concerning the mother's present state of health, prior pregnancies, medications she takes, her mental well-being, and practical considerations. In addition to midwifery staff and physicians, other health care providers may also become involved based upon the specific needs of the mother. As additional information develops, the individualized plan may also develop. While there is a defined pathway for providing routine obstetric services, this pathway represents a structured format of services provided and does not represent the actual number of visits or examinations required for each patient.
Identify what is currently known and what question remains unanswered for each subsequent visit. Include concerns/questions of the expectant mother regarding her pregnancy and/or delivery as well as include her desires/needs/concerns. Scheduling each visit is much easier when each visit has a specific purpose (i.e., to discuss laboratory results or explore various options related to prenatal care). The scheduling and visitation frequency should be established by the respective maternal care provider.
A screening result may lead to a further question
Screening during pregnancy allows for the identification of risks associated with certain medical conditions and provides information regarding potential issues related to either the mother's or child's health. Some screening results report a lower or higher chance of a condition rather than a definite diagnosis. Additional discussions/testing may occur depending on the level of risk identified. Understanding this difference will help minimize over-interpretation of screening test results as definitive predictions of future outcomes.
Compare screening to diagnostic investigations by evaluating whether each test provides a definitive diagnosis. The decision to participate in screening should be preceded by an explanation of the purpose and limitations of screening, including an explanation of possible actions taken after receiving screening results. There may be specific times when certain screenings/tests must be performed. A general educational webpage cannot replace personalized guidance regarding which screening tests are available and appropriate at a given point in time.
Preferences and clinical circumstances both inform the plan
Discussions regarding childbirth can encompass birth location, available support systems, methods for relieving pain during childbirth and situations that could potentially alter the birthing approach. Preferences, informed choices and clinical circumstances all contribute to decisions. The plan represents a method to communicate preferences, concerns; however, it does not eliminate uncertainty or provide an assurance that labour and birth will proceed along a single path.
Separate a preference from a clinical finding and a decision based on the findings. Explain how information would be communicated if the original plan were modified. Avoid treating one birth experience as the model by which everyone else should be judged. Each individual circumstance should be explained in relation to the assessment conducted and allow for inquiries at each stage.
Care needs continue after the baby is born
Follow up after birth addresses physical recovery, emotional wellness, feeding and medication administration, and practical assistance to mother and infant alike. Several types of healthcare professionals may contribute to the mother's care during the postpartum time frame; therefore, effective communication is critical. A discharge document should assist the subsequent service(s) to understand what occurred during the preceding care episode and what aspects require continued evaluation. Discharge from a hospital does not signify completion of all maternity-related care needs.
Raise concerns occurring during pregnancy or after birth with your maternity team or appropriate healthcare service rather than waiting until your next scheduled appointment. Contact instructions for emergencies will be provided by that service. To aid in your preparation for exams/revisions, follow a single concern from the initial discussion through assessment, decision-making, and follow-up. This demonstrates how continuity exists throughout the entire maternity pathway.
Check your understanding
A short quiz, with an explanation after each answer.
What does antenatal care refer to?
Begin with the most difficult area of the section you have difficulty with and explain the example using no reference material other than your own memory. Then check your explanation; once again take the quiz at a later date. It is better to know how to articulate your reasoning than simply remember where a correct answer existed on a timed quiz.