Outcome in the Birthing Suite

Mrs. Wong, a first-time mother, is admitted to the birthing suite in early labor after
spontaneous rupture of membranes at home. She is at 38 weeks of gestation with a history of
abnormal alpha-fetoprotein levels at 16 weeks of pregnancy.
She was scheduled for ultrasonography to visualize the fetus to rule out an open spinal defect
or Down syndrome, but never followed through. Mrs. Wong and her husband disagreed about
what to do (keep or terminate the pregnancy) if the ultrasonography indicated a spinal
problem, so they felt they did not want this information.
Reflective Questions
1. As the nurse, what priority data would you collect from this couple to help define
relevant interventions to meet their needs?
2. How can you help this couple if they experience a negative outcome in the birthing
suite? What are your personal views on terminating or continuing a pregnancy with a
risk of a potential anomaly? What factors may influence your views?
3. With the influence of the recent Human Genome Project and the possibility of
predicting open spinal defects earlier in pregnancy, how will maternity care change in
the future?

1. As the nurse, the priority data I would collect from this couple to help define relevant interventions to meet their needs include:

• Gather information about Mrs. Wong’s medical history, including any previous pregnancies, complications, and current health status.
• Explore the couple’s concerns, values, and beliefs regarding pregnancy, childbirth, and potential anomalies.
• Assess their understanding of the risks and implications of open spinal defects or Down syndrome.
• Inquire about their support system, including family, friends, or religious or cultural community.
• Determine their knowledge and understanding of available resources, such as genetic counseling or support groups.
• Assess their emotional well-being and coping mechanisms, especially regarding the stress and uncertainty they may be experiencing.
• Discuss their preferences for involvement in decision-making and their desired level of information disclosure.

By gathering this data, I can better understand the couple’s needs, preferences, and emotional state, allowing me to provide appropriate support and interventions throughout their birthing experience.

2. If the couple experiences a negative outcome in the birthing suite, such as the discovery of a potential anomaly, my primary role as a nurse is to provide emotional support and facilitate open and non-judgmental communication. I would:

• Offer empathy, understanding, and a safe space for the couple to express their emotions, fears, and concerns.
• Provide accurate and unbiased information about the potential anomaly, its implications, and available options for further testing or management.
• Respect and honor their autonomy, ensuring they have the opportunity to make informed decisions based on their values and beliefs.
• Offer resources for genetic counseling or specialized medical consultations to help the couple explore their options further.
• Collaborate with the healthcare team, including physicians, counselors, and social workers, to ensure comprehensive care and support for the couple.

Regarding my personal views on terminating or continuing a pregnancy with a risk of a potential anomaly, as a nurse, it is crucial to set aside personal beliefs and values in order to provide unbiased care and support to the couple. My role is to advocate for the couple’s autonomy, respect their decisions, and provide the necessary information and resources to help them make informed choices based on their unique circumstances.

Factors that may influence my views include personal experiences, cultural or religious background, and exposure to ethical dilemmas and diverse perspectives in healthcare. However, it is essential to prioritize the couple’s autonomy and respect their decisions, regardless of my personal views.

3. The influence of the recent Human Genome Project and advancements in prenatal genetic testing may significantly impact maternity care in the future. With the possibility of predicting open spinal defects and other anomalies earlier in pregnancy, several changes may occur:

• Increased availability and utilization of prenatal genetic testing: As testing becomes more accurate, accessible, and non-invasive, it is likely to become a routine part of prenatal care for high-risk pregnancies, allowing earlier detection and intervention.
• Enhanced preconception counseling: Healthcare providers may emphasize the importance of preconception counseling to educate couples about genetic risks, discuss available testing options, and help them make informed decisions.
• Ethical considerations and decision-making: With earlier detection of anomalies, couples may face more complex and emotionally challenging decisions regarding pregnancy continuation or termination. Healthcare providers will need to provide adequate support, counseling, and information to facilitate these decisions.
• Advancements in medical interventions and treatments: Early detection of anomalies may lead to the development of novel medical interventions or treatments, aiming to improve outcomes for both the fetus and the mother.
• Continued research and advancements: The field of genetics and prenatal testing is likely to evolve rapidly, with ongoing research and technological advancements. Maternity care will need to adapt to these changes, ensuring that healthcare providers stay informed and competent in providing the best possible care for their patients.

Overall, the integration of genetic information into maternity care has the potential to improve early detection, intervention, and decision-making, but it also presents ethical and emotional challenges that need to be addressed compassionately and ethically.