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Caroline Flint explains how the nursing process can be successfully applied to midwifery and outlines how it enables antenatal care to be more satisfactory for the pregnant woman as well as giving continuity of care One of the last questions we ask women who are booking with us is `What about labour? Is there anything special you are hoping for?' Some women come to the booking clinic having thought about this a great deal and can give us a very comprehensive picture of their ideal labour, but most women have not thought about labour much yet. And some women are so anxious about whether they will be able to hold on to this pregnancy because of their past history that they really cannot think so far ahead. For those mothers-to-be who have definite ideas we can fill in their care plan for labour. For example: `Jenny would like to avoid an episiotomy at all costs, she would prefer to avoid analgesia but if she needs something she would prefer to have a small dose of pethidine in preference to an epidural. She does not want either an enema or a perineal shave. Jenny would like the baby delivered on to her abdomen.' `Shermaine would like to be as ambulant as possible during labour and she would like to be delivered in the birth chair.' `Fiona would like to have an epidural as early in labour as possible. She would prefer to have an enema because she cannot bear the thought of soiling the bed. Fiona's husband Tom would very much like to cut the cord when the baby is born. Fiona would prefer not to be told the sex of the baby, she would like to look for herself.' For most women their care plan for labour has to wait until nearer the time when they have thought about it more.We have just introduced a 'programme for pregnancy' for each woman attending the clinic after the booking visit. This is really a diary of what the woman can expect week by week as she comes to the clinic or goes to see her GP. There is a space for her to tick off each procedure as it happens to her. There is also a space for her to put in the questions she wants to ask that day. All women see a midwife at 28 weeks and this gives them a chance to make further additions to their care plan, to discuss breast preparation and to find out about classes. Again at 37 weeks all women see a midwife, in the `programme for pregnancy' it is listed in Table 11. Women keep their `programme for pregnancy' with their co-operation card and all this can be kept safely in the Health Education Council's `pregnancy care card'. This card is an attractive wallet for the co-operation card and it also contains questions for the women to ask herself such as `Do I know all the benefits I can get when I'm pregnant?' and `Have I felt my baby kick or move for the first time?' Prospective mothers who know what to expect at each visit are strengthened by that knowledge, and by the use of these programmes. We hope to encourage women to feel that they have control over what is happening to them.
Energy and time are wasted looking for notes that have disappeared. When a woman is responsible for her own notes these problems almost disappear. We have looked at our assessment and care plan for labour, but we are still looking at ways of using a standard care plan for the postnatal ward. To this end we are discussing with the health visitors what help they will give us with evaluating our care. Notes are never static - they have either gone to the cardiac department or `skins', or the researcher has spirited them away.Energy and time are wasted looking for notes that have disappeared. When a woman is responsible for her own notes these problems almost disappear. We have looked at our assessment and care plan for labour, but we are still looking at ways of using a standard care plan for the postnatal ward. To this end we are discussing with the health visitors what help they will give us with evaluating our care. January 5 1983 |
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