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
- As the nurse, what priority data would you collect from this couple to help define relevant interventions to meet their needs?
- 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?
- 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?
Full Answer Section
- Psychosocial history: This would include information about Mrs. Wong's and her husband's emotional state, their support system, and their religious and cultural beliefs.
- Knowledge of fetal anomalies: This would assess Mrs. Wong's and her husband's understanding of open spinal defects and Down syndrome, as well as their knowledge of the risks and benefits of prenatal testing and termination of pregnancy.
- Decision-making process: This would assess how Mrs. Wong and her husband make decisions, whether they are in agreement about the future of the pregnancy, and what kind of support they need in making a decision.
Helping the Couple Cope with a Negative Outcome
If Mrs. Wong and her husband experience a negative outcome in the birthing suite, the nurse can help them by:
- Providing support and comfort: This may involve sitting with them, holding their hands, and offering words of encouragement.
- Listening to their concerns: The nurse should allow Mrs. Wong and her husband to express their feelings and to ask questions.
- Providing information: The nurse can provide Mrs. Wong and her husband with information about open spinal defects, Down syndrome, and their options for care.
- Helping them to make decisions: The nurse can help Mrs. Wong and her husband to weigh the risks and benefits of different options and to make a decision that is right for them.
Personal Views on Terminating or Continuing a Pregnancy with a Risk of a Potential Anomaly
Personally, I believe that the decision of whether or not to terminate a pregnancy with a risk of a potential anomaly is a personal one that should be made by the woman and her partner in consultation with their healthcare provider. There is no right or wrong answer, and each situation is unique.
Factors that may influence my views include:
- The severity of the potential anomaly: Some anomalies are more severe than others and may result in a significant decrease in life expectancy or quality of life.
- The availability of treatment options: If there are no effective treatments available for the potential anomaly, this may make the decision to terminate the pregnancy more difficult.
- The woman's personal beliefs and values: Some women may feel that it is their moral obligation to continue the pregnancy, even if the fetus has a potential anomaly. Others may feel that it is in the best interests of the fetus to terminate the pregnancy.
How the Human Genome Project Will Change Maternity Care
The Human Genome Project has made it possible to predict open spinal defects earlier in pregnancy. This has led to changes in maternity care, such as offering prenatal testing to all pregnant women.
In the future, maternity care is likely to become even more personalized, with healthcare providers using genomic information to tailor care to the individual needs of each pregnant woman. This may include using genomic information to predict other potential fetal anomalies, such as Down syndrome and cystic fibrosis.
Conclusion
The decision of whether or not to terminate a pregnancy with a risk of a potential anomaly is a complex one. The nurse can play an important role in supporting the couple through this decision-making process.