VARGAS, Kathleen F.

RR22

2. Read, understand, analyze and answer the following situations:

A. Moja Hamma is a 29-year-old woman pregnant with her first baby. Her

labor began with ruptured membranes and dark green meconium-stained

amniotic fluid. Moja called her nurse-midwife, who instructed her to come to the

hospital immediately. Moja drove herself and arrived in 20 minutes. Fetal heart

rate (FHR) was 100 beats/min. An obstetrician was consulted, and she scheduled

Moja for an immediate cesarean birth. Moja reacted calmly to the news that she

needed surgery until she realized her boyfriend would not be able to get to the

hospital in time to be with her in surgery. At that point, she refused to sign

permission for surgery, saying, “I can’t. I just can’t go through this alone.”

1. Is Moja’s response typical of a woman who is told she needs a surgical

procedure for the birth of her baby? What would be your best action to help her

accept this procedure?

As a nurse, I will conduct a health teaching to the patient and explain to her

the possible risk factors if she will wait for her boyfriend to get a cesarean birth

procedure. Although, it is her legal right to have a companion of their choice

during labor, birth and the immediate postpartum period. But then I will just tell
her to undergo the procedure without her boyfriend because there are many

possible risk factors if she will prolong her pregnancy.

2. After learning that Moja wanted to wait for her cesarean birth to begin until her

boyfriend arrives, the nurse learns the boyfriend has texted to say he cannot

possibly stay with Moja in the operating room; he’ll feel so nauseated he’ll

probably faint. Would it be best to plan on supporting Moja yourself or to try to

involve the boyfriend?

As a nurse, I will tell Moja that her boyfriend cannot accompany her so what

I can do is to provide a continuous support to Moja. Continuous support from the

nurse and the midwife are stronger in providing the supportive care to the patient

who is in the labor.

3. Moja, who will have epidural anesthesia for her cesarean birth, refuses to

remove her contact lenses for surgery even though it is hospital policy for anyone

receiving anesthesia to do so. She tells the nurse, “I won’t be able to see my baby

afterward without them.” Would the nurse insist she take them out or ask the

anesthesia team member if she could be an exception to a rule?

I will ask the team if she will allow her but in general, you are not permitted

to wear contact lenses or glasses during surgery of any kind. If you wear clear

ones, they would not know that you were wearing one but it would be best to

leave them out it is because even during a cesarean section there is always a

possibility that the pregnant woman will be put under general anesthesia and
there is a risk of something going wrong and you needing to be sedated quickly

and once you are sedated they generally put an ointment directly on your eye,

and then close your eyes. It keeps your eye from drying out. Leaving your

contacts in during this potential action could damage your corneas.

4. Moja Hamma refuses to allow the nurse to assess her fundal height after her

cesarean birth because she has so much pain. How would the nurse approach this

situation?

Provide the woman adequate pain management to allow her a sense of

control and comfort.

5. The nurse is interested in exploring one of the 2020 National Health Goals

related to cesarean birth. Most government-sponsored money for nursing

research is allotted based on these goals. What would be a possible research topic

to explore, pertinent to these goals, that would be applicable to Moja and her

family and that would also advance evidence-based practice?

If the myth “once a cesarean, always a cesarean” is true?

b. Amy Whithaven is a 38-year-old gravida 4, para 3, who wants to have her

fourth child as naturally as possible, the same as she did for her other three

children. Her husband, Paul, the chief executive of a public relations firm, is with

her in a birthing room as her support person. He assures you Amy is a “veteran”

at labor, will use controlled breathing as pain management, and will have no

problems. He adds they are especially looking forward to this baby because she

will be their first girl. Four hours into labor, Amy experiences sharp abdominal

pain and begins to have fresh vaginal bleeding. Amy’s blood pressure falls to

100/55 mmHg; the FHR decreases to 80 beats/min. Amy’s obstetrician diagnoses

placental abruption and asks you to prepare her for an emergent cesarean birth.

1. Because having a cesarean birth is so opposite from what the couple planned

for labor, Paul says he wants to investigate Amy’s symptoms on the Internet using

his laptop or else secure a second opinion from another doctor before surgery can

proceed. Would you support him in asking for this?

I will educate the husband of the mother that placental abruption is one of

the major life-threatening obstetric conditions and cesarean delivery could

prevent further disease progression and possible maternal death in cases of

severe preterm placental abruption where vaginal delivery is not imminent.

2. Amy realizes immediately that something is wrong. She asks you if this has

something to do with the fact she is having her first girl. Are more girl infants born

by cesarean than male infants?

 Increased cesarean deliveries for failure to progress among women with

male fetuses is related to the larger size of the male fetus, whereas the increase

for fetal distress is not, and may relate to other developmental differences

between male and female fetuses. But it does not necessarily mean that they are

their first baby girl that us why there is something wrong with her labor.

3. Amy is transported to surgery and, within 20 minutes, a 7-lb 3-oz girl is born.

Named Honor, she needs resuscitation to breathe and is transferred immediately

afterward to the neonatal intensive care nursery for care. Paul declines to visit

Honor in the nursery. He says he’ll wait until Amy can be “disappointed” along

with him. What actions could you take to help this couple begin bonding with their

new daughter?

Bonding is the intense attachment that develops between parents and their

baby after giving them birth and bonding is very essential for babies. Most infants

are ready to bond immediately. Parents, on the other hand, may have a mixture

of feelings about it. Some parents feel an intense attachment within the first

minutes or days after their baby's birth. For others, it may take a bit longer.

Advise the parents to immediately bond with their child.