Case Study and Literature Review
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The assignment will be based on a case study of a woman to whom you have provided continuity of care. The assignment will include a literature search on an aspect of care relevant to the case study. Introduction. This assessment is based on a case study of Katie during her pregnancy, birth and postnatal period. It will include a literature review on breastfeeding as an aspect of care. It will also reflect upon the experience the student gained in providing continuity of care. With the application of Driscoll's reflective cycle (Driscoll 2000). Pseudonyms will be used to ensure confidentially as stated by the Nursing and Midwifery Council (NMC) (2004) The midwife will be referred to as Jane and the client Katie. Case Study Whilst on a community visit. my mentor and I were called to see a client, Katie. Katie was 21 weeks gestation and had slipped onto the kitchen floor she was very shaken and worried about her baby. After a thorough examination she was found to have suffered no ill effects. Over the next few months I saw Katie at antenatal clinic and found her very easy going and always willing to let me "practice" my newly learned skills on her. Katie was a 33 year old primip, (first pregnancy) who was working in a professional capacity for the local Government. Educated to a high standard and with a good social support network Katie devoured all the information that she could find on pregnancy and childbirth. The dating scan at 12 weeks corresponded with her dates and the anomaly scan at 18 weeks confirmed that there were no abnormalities detected.
New mothers should initiate breastfeeding as soon as possible after birth. When mothers initiate breastfeeding within one hour of birth, the baby's sucking reflex is strongest and the baby is more alert. Early breastfeeding is associated with fewer night-time feeding problems, longer continuation, and better mother/infant communication (Coombs & Moreland 2000). While in hospital, every woman who breastfeeds should be given instructions about breastfeeding. Gagliardi & Sinusas (2001) stated that the mother needs to be counseled on aspects such as positioning, techniques to ensure satisfactory latching on, and sounds from the infant indicating swallowing during feeding. Especially in the case of first time mothers, it is important that a designated health professional talk with the mother after the infant is discharged from the hospital. The Baby Friendly Policy produced by the United Nations Children's fund (UNICEF) and the World Health Organisation (WHO) suggests ten key recommendations (UNICEF UK Baby Friendly Initiative 1998). The standards for the maternity services, "Ten Steps to Successful Breastfeeding" suggests that all care staff have the skills necessary to help women to breastfeed successfully and to implement the policy. Women should be provided with positive information about the benefits of breastfeeding, with support and encouragement to help mother's breastfeed exclusively. Encouraging mothers to hold their baby against their skin as soon as possible after delivery tend to breastfeed longer. Mothers are encouraged to "room in" for the first twenty four hours and not to introduce any food or drink other than breastmilk, breastfeeding on demand is encouraged as this promotes the flow of breastmilk. Step ten of these standards advises supporting breastfeeding mother's through local support groups to help the continuation of breastfeeding and peer support (UNICEF 1998).
At each visit in the ante-natal clinic her questions regarding her pregnancy, birth and chosen feeding method were answered by Jane with the professionalism always shown to her clients. Katie was given all the information that she required to assist her with breastfeeding and was given one-to-one support on her arrival at the birth centre. This support in the early days of breastfeeding is vital to ensure good attachment and feeding techniques. A midwife needs to observe and assess the mother's ability to respond to her infants feeding demands, as this is much easier when there is already a relationship between the midwife and mother. The best care is often when a midwife suggests to the mother what to do and then watch and guide her in getting the attachment right. Jane was always patient and reassuring to give Katie the confidence that she required to breastfeed successfully. Katie attends the local breastfeeding group every week and has expressed how welcoming she has found the peer support that she receives there. Katie is for myself a good example of how with the right information and support breastfeeding can be a wonderful, fulfilling experience. Plan of Care On her arrival home from the local district hospital Katie's care was handed over to Jane who is the community midwife that attended her antenatal visits. After twenty eight days it will be handed over to the local Health visitor. Community midwives and health visitors play an invaluable role in the support they provide to new mothers and babies. Over time Katie will grow in confidence with the support she receives from her midwife at the breastfeeding support group and in the comfort of her own home.
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