Case study 3:Doula care for c-section and gestational diabetes


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This case study describes the care plan that a doula may use to take care of a client who is planning a c-section and has gestational diabetes. It describes what kind of labor support a doula can give in this situation.

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Case study 3:Doula care for c-section and gestational diabetes

  1. 1. Case Study 3Gestational DiabetesOccasionally I will be presenting case studies separate from the lesson to help you integratethe information you have learned as well as reinforce concepts taught. This particular casehas come from a client I had with the names changed. Her main need did not have to do withgestational diabetes, but this definitely played a role in her choices and her goals. I beginwith my notes and assessment during the interview process, then move on to finding out herneeds and planning accordingly. At the end of this, a birth plan was made that followed hergoals and ideas.Goals To understand how to apply knowledge of a specific medical diagnosis to your role as a doula. To provide an example of how to incorporate the assessment and interview into the birth plan and your practice as a doula. To provide an example of the all steps in the nursing process.Reading assignments:Pages 244-247 in The Birth Partner by Penny Simkin.Read the medical terminology in the lesson.Listen to the link below: Beginnings Beginnings Doula Training
  2. 2. The Interview,Assessment, andBirth PlanInitial Interview DataFirst baby During this interview I took notes, thenShe had gestational diabetes and took medication for this. She possibly later wrote them up.also had pre-eclampsia. At 37 weeks, she went in for a NST and foundsome problems, she was then induced. She labored for a while and got I also wrote downan epidural. Due to fetal distress, she had an emergency c-section. her own goals,During this birth she was separated from her first husband, but he was questions, andthere along with her mother. She had a hard time with him there and didnt desires. Iwant much to do with him. formulated a birth plan from theseSecond baby notes. If a woman already has a birthShe had a normal pregnancy and had a planned c-section at 39 weeks. plan written out, IIm unsure if VBAC was even offered to her. She had pre-term labor that will just add my ownwas controlled with medications. She had difficulty breastfeeding because thoughts and ideasshe felt like she was not giving her baby enough milk. Baby lost weight inthe hospital and was supplemented with formula. This continued at home. to her and get her approval.This pregnancy She possibly may be type 2 diabetes but it is controlled with diet. She has seen a nutritionist for this and wants to avoid taking medications for it. She would like a repeat c-section because she feels more comfortableNew Beginnings Beginnings Doula Training
  3. 3. with this. She already has other complications going on and her husband also feels more comfortable with this. She is also having numerous urinary tract infections. OtherThis interview took She has anxiety/panic attacks but is not taking medication for this. During her births she had a few panic attacks and would like help with this.about 2 hours. This is Deep breathing and visualizations help with this, as well as having aa normal amount of support person close by. She does not like the oxygen mask. It makestime for me. her anxiety worse. Shes okay with it if it is held close by, but not on. She was frustrated with how long her baby was taken away after her last two births and wants to make sure they are with her as soon as possible. Care provider and place of birth She will be delivering with Dr. X. Right now she is trying to decide which hospital she wants to go to and would like help choosing. Client goals or desires She would like to have the baby with her unless there is a serious medical reason. Would like help with breastfeeding Help with anxiety. Would like to find a hospital that will support her desires. Wants help with shoulder/gas pain after c-section.Needs listed at this Needs Identification, Prioritizationtime are more like and Doula Actionsanticipated needs.These are needs Physiologic Needsthat you areexpecting to Risk for imbalanced nutrition status related toencounter during NPO status during c-section and gestational diabetes.labor and birth. -Actions implemented: Provide clear liquids or other food according to what is ordered or desired. Plan to have foods that she likes available. Risk for dehydration related to NPO status during c-section. -Actions implemented: Remind your client to drink. Plan to have drinks available that she likes. Risk for fatigue related to anxiety about birth. -Actions implemented: Address anxiety the day before as well as the day of her c-section.(See below for actions taken for anxiety).New Beginnings Beginnings Doula Training
  4. 4. Body temperature fluctuations related to c-section.-Actions implemented: Provide warm blankets or heating padsimmediately afterwards. Provide warm fluids if desired. Request warm ivfluids be hung right after the c-section is finished. Impaired mobility related to epidural and c-section.Actions implemented: Help control pain to allow movement sooner(seeactions addressing pain below). Nausea related to c-section.Actions implemented: Offer peppermint tea or peppermint oil for nausea.Offer liquids and foods slowly. A fan may also be used. Risk for shaking related to epidural use.-Actions implemented: Make sure that warm iv fluids are usedintraoperatively and immediately afterwards. Request warmed blanketsduring the operation and afterwards Request warm blankets while beingbefore, during, and after the surgery. Diffuse peppermint in the airafterwards or rub some on the feet. Risk for itching related to epidural use.-Actions implemented: Find something to distract your client from theitching while it wears off.Safety Needs Desires control related to birthing place.Actions implemented: Research the hospitals in the area to see what theirprotocols are regarding infant care afterward, particularly as it relates tobabies born by c-sections and from mothers who have gestationaldiabetes. Desires control related to infant bonding.Actions implemented: Make sure staff knows that your client wants thebaby with her as much as possible. Encourage skin-to-skin. Pain related to should/gas pain after c-section.Actions implemented: Hot packs to shoulders. Distraction techniques.Get your client up and moving quickly. Pain related to incision after c-section.Actions implemented: Ice packs for the first 24 hours, then heat packs. Pain related to ivActions implemented: Use heat or ice(whichever feels better). Before theiv is put in, warm the hand where is is going to be placed. Information seeking behavior related to breastfeeding asmanifested by desire for more knowledge and difficult past experiences.Actions implementd: Find the closest LLL group. Make sure your client isable to see a lation consultant. Encouragement. Reassurance. Place asing on babies crib that says not to give this baby anything else by mouth. Anxiety related to c-section.Actions implemented: Reflexology. Lavender oil. Music therapy.Encouragment. Make sure spouse is close by. Teach spouse light toughto use during c-section.New Beginnings Beginnings Doula Training
  5. 5. Anxiety related to gestational diabetes. Actions implemented: Point out what your client is able to control(i.e. Food choices). Focus on signs of good health. Connect them to a nutritionist if possible. Make sure your clients have any medical questions answered by their chosen care providers and provide information they are unablet to obtain. Social Needs Opportunity for enhanced parent/infant bonding. Actions implemented: Provide resources on breastfeeding. Provide resources and information on bonding. Risk for impaired parent/infant bonding related to c-section and complications from gestational diabetes. Actions implemented: Research hospitals to find one that is committed to mom and baby staying together. Make sure the staff understands that your client wants her baby with her as much as possible. Opportunity for enhanced relationships. Actions implemented: Discuss plan of care with spouse or significant other. Make sure spouse is doing all that he wants to do. Discuss what your clients spouse can do to be involved. Isolation related to c-section policies. Actions implemented: Make sure that someone is always with your client afterward. Get the majority of the prep work done before your client goes into the operating room. Opportunity to enhanced connection to the birthing process. Action implemented: Allow your client to see as much as she desires of the c-section birth. Ask to do skin to skin as soon as possible afterward. Esteem Needs Risk for body image disturbance related to physical changes and c-section. Actions implemented: Mirror therapy. Opportunities for enhanced feelings of empowerment. Actions implemented: Make sure your client understands her choices and is given choices. Opportunities for keeping environment focused. Actions implemented: Request music that your client would like. Make sure choices made are in accordance with your clients wishes. Speak in soft tones. Dim lights as much as possible. Be aware of your clients privacy needs and ask that those be respected as much as possible.New Beginnings Beginnings Doula Training
  6. 6. Written Birth PlanBirth Plan for C-section/gestational diabetic clientTo my care providers and hospital staff:I would like to express my appreciated of your care for me and let you know of mydesires for this birth. Written birth plans are done to allow yourI have chosen to have a repeat c-section, but have some specific desires related to client to communicatethis. I would like to have all preliminary preparation done before I go into the OR. her wishes to herThis would include the epidural and catheter placement, as well as medications. medical provider and hospital staff. It isAfter the birth, I would like to have my baby with me unless there is a medical reason based off of the plannot to. Please discuss with me any reason for this not being possible. you come up with together and expressDuring the surgery, I would like to have my own music playing and I would like to the exact desires ofuse some essential oils that I have found useful for anxiety. your client.I am also concerned about breastfeeding and would like to make sure that nothingelse is given to my baby besides my own breast milk unless it is deemed medicallynecessary. I would like to be able to discuss any questions about this with apediatrician should a question arise.Thank-you again for your care and making sure that me and my baby are safe.StaceyBecause of the birthing environment we have in our culture, birth plans areviewed as unuseful and sometimes hostile by some medical personnel.Therefore, I do not always recommend giving one to the medicalpersonnel at the hospital, but leave it up to you and your clients discretion.In the absence of hostility, a birth plan can be a good way to let your careproviders know what your desires and wishes are, so that they can beprepared to offer you the care that you desire.New Beginnings Beginnings Doula Training