Birth Story Project: JD’s Birth Story
7 – 9 pages
BIRTH STORY PROJECT
Guidelines and Requirements
To enable the student to use therapeutic communication and listening skills to elicit a woman’s history of her labor and birth. To enable the student to analyze a patient’s reported history using nursing process and medical perspective. To enable the student the opportunity for self-reflection.
The student will:
1. Identify a postpartum woman who agrees to tell her birth story.
2. Make undistracted time to sit with the woman and listen.
3. Use active listening, open ended questions, and therapeutic communication to elicit the woman’s labor and birth story.
4. Avoid writing during the interview.
5. Thank the woman for her time and contribution.
6. Directly following the interview, sit and write the story to the best of your ability while it is fresh in your mind.
7. That evening, revise and edit the birth story for fluency, flow, spelling, and grammar. Birth story should be written from the first person perspective. This is the mother’s voice of her experience.
8. From the nursing perspective, analyze and explain the labor and birth. Fill in the gaps. What was the woman feeling at each point in the story? What were her expectations? Did she have lack of understanding? Who were her supports? Did they meet her expectations? Did she experience trust, joy, fear or disappointment? What priority nursing interventions would you expect to implement during the unfolding of this story? When? Why? If you were her nurse, what would you have done differently?
9. Using your resources, complete a medical analysis of this woman’s birth story. Describe in medical language the progress of the story from start to finish and explain each medical intervention, indications, risks, benefits. This section should read like the medical notes in a patient chart
10. Write a reflective journal entry on this assignment. What did you expect going in? What did you find? What did you learn? Can you identify places in the story where the nurse and/or doctor had a n impact on the outcome? In what way? How do you feel about this labor and birth? What impact will this have on your nursing practice? This is your voice. What did you learn?
1. Each of the 4 sections of the project should be clearly labeled.
2. Include a cover sheet with your name, the pt’s initials, date collected, name of course.
3. Due Date: 11/05/2016 (Last Saturday prior to Week 9). Please submit your completed birth story via Blackboard on or before this date. Papers will not be accepted in any other format. Ten percent of grade per day will be subtracted for late papers. In the unlikely event that you have not had a postpartum day in clinical by that time, please email me with a proposal for an alternative due date. Please be sure to cc: your clinical instructor. Feel free to turn in your project earlier than the due date if possible.
1. Birth Story-First person mother’s voice 25% – completeness – fluency
2. Nursing Analysis- 25% – demonstration of understanding of nursing priorities and actions related to patient’s experience – use of nursing diagnosis and terminology – organization
3. Medical Analysis 25% – demonstration of understanding of medical procedures and interventions – completeness – correct use of medical terminology – organization
4. Journal Entry 25% – demonstrates understanding and self-reflection – answered questions
NOTE: Outside resources need to be cited using APA format.
Adapted with permission from:
Shealy, S. (2014). Birth story project [Class project]. School of Nursing, Mount Saint Mary’s University, Los Angeles, CA.
Birth Story Project: JD’s Birth Story
Section 1: Mother’s Perspective
It was my first time to have to be pregnant. I was not that much scared, but I was very apprehensive about how things will turn out to be. The pregnancy had not given me a lot of problems though sometimes I used to get exhausted. I had visited the clinic four times as required by you people and everything seems okay. According to my encouraging and supportive doctor, my baby was growing just fine. My husband, who has given me much support, accompanies me every time I went to the clinic.
During my first visit to the hospital, I went through a lot of tests. I remember the doctor taking my blood of samples for sexually transmitted infections (STI), blood grouping and HIV test. Although the doctor explained to me later, I couldn’t understand why the doctors were performing so many tests. He told me that such tests are necessary for the health of my unborn child. Anyway, it was okay for me as long as it was for the child best interest. All the other clinic visits were uneventful. In every visit, the doctor could check my belly to see how the baby was growing and he used to reassure me that everything was fine. It is interesting when on my second visit, a scan was made to visualize my baby. I could also see the child on the screen, and the doctor explained the parts he could see and assured me once again that everything was normal.
In my last visit to the antenatal clinic, my doctor measured the height you people keep saying and he told me that the baby was at term. He also correlated the dates of periods that I had given to him on my first visit. I wonder why they ask about it, but I later understood that it helps you people to count and estimate delivery time and dates. The scanning which they called ultrasound had also given them dates about when am like to delivery. And so on my last visit, the doctor advised me that I should now prepare to deliver at any time. He told me to look out for certain signs and symptoms, and in case I experience them, I should come straight to the maternity ward. I don’t remember all that he told me, but there was a headache, in case I fainted, vaginal bleeding or water coming out and stomach pains especially in the lower part.
It was at night the day before yesterday that I suddenly felt something hot coming out of my vagina. I was so scared and helpless that I woke my husband. I went to the bathroom to check with him, and I couldn’t understand. It was a clear fluid leaking from my vagina. The liquid had no smelly at all but was it was warm. I remembered my doctor mentioning it and there it was. I knew my time had come to deliver. It was strange to me before I had heard that labor pains must be present for when one is almost delivering. I did not have any pains myself. My husband was so concerned, and therefore we decided to come to the hospital straight away. We drove me to this place very first but was keen not to cause any discomfort to me. Since it is my first pregnancy, I did not know what to do about it but my prayers that I deliver without a C.S. I did not want to go through that. I never liked the stories I had from my neighbors about the procedure. I wanted to deliver normally no matter what. Because I had gained a lot of weight during the pregnancy period, I was very much convinced that I will be able to push the baby.
My doctor had evaluated my vagina and pelvis and had assured me that it was adequate for me to push the baby. When we reached the hospital, we went directly to the maternity ward as I had been advised by my doctor. I went to the triage area as you people call it. There I met a nurse who was very kind to me and welcomed me. She asked me about my condition and what I had experienced that prompted me to visit the hospital. I explained everything to her before the doctor came and-and also had to explain to him too. I was okay with no pains as I observed other mothers writhing in pains. The doctor explained to me what was happening. He told me that my membranes had ruptured prematurely before the onset of labor. He said that it was normal and that I was to be admitted for them to monitor my labor progression. He examined me generally and then a vaginal exam was done. He told me that I was 2cm dilated and had my membranes bulging. He also said that it was good to observe whether I would go to spontaneous labor. He said if that did not happen, they would induce me either by medication or artificial rupturing of the membranes. I got a bit scared, the doctor assured me that everything was going to be okay.
I was taken to my bed, and my husband advised to go home or wait at the waiting bay. That night was uneventful, and I felt no pains. Yesterday at around two in the afternoon I started experiencing lower abdominal pains. At first, it was just fine and not radiating anywhere. I called the nurse in charge of my room and informed her about it. She told me that it was a good that because it meant that labor was progressing well. With time the pain started radiating towards my back, and I could feel my stomach contracting. The contractions were increasing in number and intensity. The doctor came to examine me. After the examination, he told me that, my cervix was 4cm dilated, but the membranes had still bulging. He said that they would give me another few hours if the membranes would not have ruptured, they will do it artificially so that labor progresses. I could feel the pains so severely. I had never experienced such pains.
It was around a quater to 6 in the evening when the doctor came to examine me again. He said the labor was progressing on well and it was time to rupture my membranes. I go scared about it when I saw the needle that was to be used. It was okay, and he ruptured the membranes, and I felt a lot of water coming out through my vagina. I forgot to tell you that earlier on like one hour before this, they had given me some drugs that I put under my tongue.
It was a few hours later that the pains became so intense that I could not contain it anymore, so I started crying and cursing. I was taken to the delivery room. I could not comprehend what they were doing, but I could feel my baby coming. They put me in a position that for the first time is quite disgusting, but then you do not even care. Getting your baby is what was in my mind. They kept telling me to push. Although it was so painful, I had to go through it. I mean I wanted to hold my baby in my arms as soon as possible. My last push was dramatic; I just pushed, and the next thing I had was a baby crying. And wow I had done it. I think it was so fast that they midwife nurse and the doctor did not realize it. My baby was the put in my chest, and the pain was no more. I was now a proud mother. All that time my husband was waiting patiently on the good news of our baby. The doctor told me that I had sustained perineal tears because the baby’s head was a little big. He assured me not to worry because it was not serious. I was given some injection a few minutes before I expelled the placenta. The doctor then sutured my tears before being taken to my bed where I spent till now when am almost discharged. My husband has spent the entire night hear that taking care of our child and me. The baby boy is healthy, and the doctor told me that he is fine.
Section 2: Nursing Analysis
My patient, JD, 23 years old G3K1L5S0A0M4. I have spent a few minutes talking to her about her experience about her birth story. It was not that complicated and progressed well until she finally gave birth. It was her first pregnancy, and therefore she was very apprehensive about what was going to happen.
On her last ANC visit, JD was told that she was at term and the doctor gave her the signs and symptoms to look out for so that she could come back to the hospital to deliver. When she arrives, and the nurse at the triage takes her history, she gives an account that corresponds to a diagnosis of PROM at term in a primigravida. According to Ackley & Ladwig. (2014).Being a primigravida in itself should alert the nurse that the patient needs to be carefully monitored because it can turn either way. The nurse needs to explain to her that it is okay to have PROM at term and that next course of action is to wait for spontaneous labor to start. The patient is well explained by the doctor, and after examination, the patient is admitted for observation. At this point it is even to do a loepoles’ maneuver to determine the lie, presenting part, descent, engagement and fundal height (Lewis et al., 2014). Additionally, depending on the presenting part, the nurse can identify whether the patient should deliver vaginally, or by other methods
It is crucial and necessary to inform the patient that sometimes the labor do not start immediately but one has to be induced using medication or artificial rupture of the membranes. The mother should also be made aware that the PROM can take even more than 24hrs before labor sets in. Such information will help reduce anxiety about her labor initiation. According to Ricci (2013), fetal status should also be monitored and measured after every one hour so that in a case of fetal distress signs like the passage of meconium, the plan of management can change depending on the grade. The nurse should even tell JD that she should report perceived fetal movements. She can be given a paper to chart the fetal movement she perceives so that the nurse to monitor the wellbeing of the fetus adequately.
The nurse should also inform JD that she need to report when lower abdominal pains start as the early signs of labour commencing. Such information will enable the nurse to chart labour progression in the partograph for accurate monitoring with respect to time. There is the need to continuously do a vaginal examination to determine the progression of cervix and help in coming up with Bishop’s score. According to Skidmore-Roth (2015), the score will predict the adequacy of the cervix to give way for vaginal delivery to be conducted.
There is also a need to work closely with the doctor so that the nurse can communicate well and promptly with the physician for proper and timely interventions. JD is determined to give birth vaginally, but the nurse needs to make her aware of signs that can make her taken to the theatre for a C-section. Such information will cause the mother have and accept the operation in case her labour does not progress as anticipated. The nurse should also inform JD about complications like perineal tears and how to handle it. Such will make her ready to make follow instructions concerning her recovery after birth. Episiotomy needs to be explained to her just in case the need to make one arises (Skidmore-Roth, (2015). Being a primigravida, she is concerned about her vagina and how to take of it, so that average-size and muscular strength returns. According to Abdul‐Kadir (2014), Siegel’s exercise need to be explained to her so that bladder control is gained as it were before pregnancy.
Section 3: Medical Analysis
18/10/16 – Obstetrics Note
The patient is a 23yr old primigravida at 37wks+ 6days with an EDD= 21/10/2016. U/S report 39wks.
Patient presents with drainage of water for 3 hours before admission. There was only one episode which lasted for a few minutes. The liquor was warm, non-smelly and with no blood or meconium. There are no lower abdominal pains perceived.
Reports of perceiving good fetal movements.
On examination, the patient is gravid, in a fair general condition with no pain distress. She is not pale, not jaundiced, has pitting oedema on both lower limbs.
On vaginal exam, normal vagina perineum, no signs of infections, the cervix is posterior; 2cm dilated with bulging membranes, and there is show on the examining finger.
Patient desire for vaginal delivery. The labour pains are presents and on a vaginal exam(VE), the cervix is 4cm dilated with bulging membranes. Monitor the patient for the next two hours and if cervical dilatation progresses, augment with Cytotec 600micrograms sublingually and perform artificial rupture of membranes.
VE was done, and cervix is 6cm dilated. 600mincgrams of Cytotec administered sublingually and artificial rupture of membranes done. The nurse monitor the patient for the maximum of four hours for labour progression. Prepare to perform delivery at any point.
Patient in labour. Has been taken to the delivery room for vaginal delivery. The delivery pack is in place, and the doctor and midwife nurse are ready. The patient is normally pushing with difficulty but with adequate progression. The patient has delivered a baby boy who has scored well in APGAR score. Oxytocin has been administered to manage the third stage of labour, and placental tissue is expelled. There is first-degree perineal tears but has been repaired by suturing using absorbable suture by the doctor. Patient has been taken but to her room for recovery and monitoring every 30 minutes for the first one hour then every hour till the patient is discharged.
Section 4: Reflective Journal
I have had every opportunity to interact with JD about her experience being a first-time mother. She was very open about it, and she answered all the questions I had for her. She was very appreciative of me being concerned about her well-being. I could help her to the bathroom or just encourage her to take her drugs and how to take care of her little boy. I could go back to ask a question I had forgotten to ask or to seek clarifications.
Being a primigravida is challenging since most mother has no experience on how delivery occur. The mother has heard stories either true or not concerning labour experience. There is the need for the health care providers especially the nurse to explain to her about her condition and the possibilities. Experiencing PROM can make a gravid mother worry and develop anxiety. Such is because there are no labour pains that is being experienced by the patient. It is always good to give the mother a chance to decide what she wants as long as the mode of delivery is concerned. She was jubilant that the nurse and the doctor explained to her what may happen and duration she may need to wait before going into labour.
I thanked JD and her husband and wished them all the best in their journey of bringing up their son. I recalled a topic we had been taught about PROM in OBS/GYN and how a nurse can manage such a patient. In my view, I think the nurse who admitted and observed JD did a good job. Involving the doctor in every step of management so that they had a common ground for JD management was a good thing, and such health care provider relationships are encouraged.
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