Birth Story Project
Pregnancy can be both a happy moment or an agonizing one for mothers depending on the type of prenatal care they receive. Healthcare providers should provide maximum care for expectant mother to make their journey safe up until and after delivery
Birth Story (Lyn’s Story).
Dennis and I found out that we were pregnant with our first baby Zoe towards the end of October 2017. My first trimester was perfectly normal, in that I had no stubborn symptoms including morning sickness. During my second trimester which started in February my doctor discovered that my blood pressure was a little high when I went for my prenatal appointment. At 17 weeks since by pressure was still high I was put under BP medication and the doctor diagnosed the probability of chronic hypertension. I started to experience heartburns during this period. During the end of the second trimester, I experienced stiffness and swelling in my fingers in the morning when I woke up but would disappear with time after I kept myself busy. I went to see my doctor who considered it normal since my body was producing more fluids to support the baby. On my third trimester which was in April my bp was at normal but my body temperatures were fluctuating. My feet started swelling during daytime.
My appointments shifted to twice weekly where my doctor monitored our baby’s heartbeat and the results were always positive, Zoe was doing okay in there. All this time however, I had not added weight as most pregnancy cases go, but I was eating healthy so the doctor said it was normal. At around 32 weeks I started experiencing morning sickness but everything was okay. Zoe weighed just over 4 pounds and at this point my bp was at 112/75 which was lower than I ever tested. At week 33, I felt a sharp pain on my right side under my rib, the pain subsided and when I visited the doctor, my bp was at 121/78 which was normal. However, my urine results showed that I had more proteins than normal which only meant that my kidneys were having troubles with getting rid of waste. The proteins were 3x normal rate and I had low platelets count as well as elevated liver enzymes a condition called HELLP syndrome which had me on Magnesium sulphate to prevent me from seizures.
To cut the story short, the OB GYN said that I would only be delivered through C section because of the condition and at 33 weeks Zoe was born and put under NICU for 6 weeks so she could grow. It took a while for the magnesium sulfate to wear off from Zoe. I was discharged after a week and we made arrangements on how to visit Zoe for lactation and at 36 seeks and 6 days we were discharged and ready to go home with Zoe. She is now a health and strong 3-months old baby.
Nursing Analysis
Being her first pregnancy, Lyn was excited and nervous at the same time. She feared that things might go wrong after she started experiencing pain and given that she is a working lady, the balance between work and her pregnancy may have contribute to the pressure fluctuations. Her husband Dennis was supportive all through and accompanied her during her appointments.
Lyn had had blood pressure which, low platelets count, and her liver enzymes were elevated which made her a candidate for HELLP syndrome which is occurs among pregnant women. The anxiety and fear she experienced through the pregnancy contributed to the condition (Wallace et.al., 2018).
My intervention measures would be to keep a regular weight and pressure check on the patient to check for any changes. I would also regularly check on her protein intake. I would monitor her urine color to check for changes. I would recommend bedrest for Lyn as juggling between work and her pregnancy complication could worsen situations. I would educate her husband on the need to monitor her diet, urine color, blood pressure, temperature, and any of her day to day activities and changes. I would recommend platelets transfusion to increase the count before delivery to promote her safety during birth since it was her first pregnancy.
Medical Analysis
PeriodHealthIndicationRisk FactorsConditionInterventionBenefit1-16 weeksNormalNo severe symptoms17 weeks BP 181/111HighPregnancy, fear, anxietyChronic HypertensionMethyldopaLower the BP to normal.
Safe During Pregnancy unlike ACE inhibitors (Vest, & Cho,2014).32 weeksMorning SicknessNausea vomiting
PregnancyNormal pregnancy symptomsNone-33 weeksBP 183/111 High BP
Dark Urine
Pain on right side of ribs
3x normal protein levelsLow platelets Count
Elevated Liver Enzymes
Emergency C-sectionThrombocytopenia
Hellp SyndromeMagnesium Sulfate Medication
Platelets TransfusionSubside the condition
Boost normal deliveryJournal Entry
I have heard of pregnancy and birth complication stories from women but I have never had a chance to discuss it on a one-on-one basis with a patient. I thought that having a C-section is an easy way out for most women but after talking with Lyn, I got to understand that she preferred normal delivery and she hoped that her doctor would have done something to help her achieve that. Lyn is very knowledgeable of the fact that she should not have been given pressure medication during her early pregnancy stages. However, the medication momentarily helped with her pressure, it did not work for the rest of the period. Her doctor even after noticing that she had a very high level of proteins, he or she did not advice on diet and nether did the doctor recommend on measures she should have taken. According to my opinion, the doctor is responsible for her advanced health condition. The doctor also failed to recommend a platelet transfusion which would have helped subside the Hellp syndrome by boosting the platelets counts and she would not have had to go through the preterm birth. The low platelets count could also have been a case of Thrombocytopenia in pregnancy (Cines, & Levine, 2017). The doctor should have also recommended bedrest for the patient which would have minimized the stress, fear, and anxiety Lyn was experiencing through her pregnancy. Anxiety, stress, and fear contribute greatly to hypertension which is very risky during pregnancy. She had to go through an immediate C-section at 33 weeks which was a preterm delivery and her baby was place under NICU which could be very traumatizing for first time mothers.
From Lyn’s case, I have learnt that as a healthcare provider dealing with expectant mothers, I should equip myself with sufficient knowledge on treatable and preventable conditions experienced by these mothers to boost their delivery outcomes. Hellp syndrome if identified early enough and appropriate interventions are made can be treated and a mother will not have to bear the agony of a C-section and preterm birth.
References
Cines, D. B., & Levine, L. D. (2017). Thrombocytopenia in pregnancy. Blood, blood-2017.
Vest, A. R., & Cho, L. S. (2014). Hypertension in pregnancy. Current atherosclerosis reports, 16(3), 395.
Wallace, K., Szczepanski, J., Spencer, S. K., Williams, J. M., Jayaram, A., & Novotny, S. (2018). Acute Kidney Injury in Pregnancy and HELLP Syndrome. The FASEB Journal, 32(1_supplement), lb347-lb347.
