Models Of Maternity Care And Rh Blood Typing Education

1.Drawing on the literature, analyse two of the models of care available to the woman, with an emphasis on the differences between the two models of care.

2.The woman has a negative blood group. Describe how, within a midwifery group practice model of care, the midwife would provide her with information relating to this, and plan care in partnership with the woman.

Difference between Caseload Midwifery and GP Shared Care Models

A woman came to a booking visit at an organization where two model of care was available to her. The first included the midwifery group practice (the caseload model) and the second included standard hospital maternity care. Midwifery group practice can be defined as midwife-led model of antenatal care where physical assessment, antenatal education peer support is coordinated by a midwife. It can be given in various ways and one of those approach is the caseload midwifery. The term caseload midwifery is given when each midwife takes responsibility for the provision of care for agreed number of women per year. Caseload midwifery is more popular than team midwifery in UK and Australia (Beckmann, Kildea & Gibbons, 2012). In addition, GP shared care model is one in which GPs, midwives and obstetricians collaborate with each other to provide high standards of care. A GP lead the care provision. However, this model of care is applicable for low-risk pregnancy.

Different types of care provision will be available to the women if she chose either GP-shared care or the caseload midwifery care model. In terms of responsibility, GP shared is useful for low risk pregnancy. However, caseload midwifery is a much better option as this model has been developed to handle caesarean cases (Harris et al., 2018). In terms of safety provision, another advantage of caseload midwifery is that it is associated with high level of satisfaction among women. Beckmann, Kildea and Gibbons (2012) proved the efficacy of midwifery group practice by comparing outcome of midwifery group practice and other models of care. The study findings revealed that caseload midwifery is not associated with more number of vaginal births however women in midwifery group had more antenatal visits than others. Hence, the model has advantage in terms of continuity of care, satisfaction with service. In contrast, review on patient’s satisfaction with GP shared care has revealed high satisfaction with GP led service however women visiting such services also expressed regarding little continuity of care and poor collaboration with their GP. Discrepancies have also been found in relation to guidance on breastfeeding and nutrition information (Lucas et al., 2015).

The main reason for seeking any model of care in antenatal service is to receive high quality care and positive birth outcomes. This is also the most vital standards of midwifery practice as midwife has the responsibility to provide safe and quality care using the best available evidence (Nursing and Midwifery Board of Australia, 2018). Sandall et al. (2016) proved caseload midwifery as a safe and cost effective option for women by showing that proportion of elective caesarean section is low for caseload midwifery compared to other models of care. However, one issue found in midwife led deliveries is high rate of adverse events because of autonomous practice of midwives in New Zealand. Although the result may not be applicable for other countries, however evaluating the skills of midwife is necessary. Hence, this shows that the success of caseload midwifery is dependent on type of training given to maternity care professional, type of collaboration between midwives and doctors and the triage process. In contrast, GP led births has been found to improve outcome. Very few cases of birth related asphyxia or complicated case has been found from the GP led antenatal care (Wernham et al., 2016). Another advantage of GP led care is that it is associated with reduction in clinical waiting time. Both models have the potential to maintain continuity of care if certain barriers are addressed (Wong et al., 2016).

Advantages and Disadvantages of Caseload Midwifery and GP Shared Care Models

In the context of collaboration, another standard of practice for midwife is to practice ethically by respect for dignity, privacy and rights of patient (Nursing and Midwifery Board of Australia, 2018). A study revealed the effectiveness of caseload midwifery in motivating women and empowering them towards safe pregnancy. This is possible in this care model because caseload model provide antenatal care from an primary midwife and a backup midwife as well as obstetric or physicians. However, in GP led, support from only GP and obstetric is available (Allen et al., 2017).

While providing education to a woman with negative blood group, it is necessary for midwife to provide appropriate education to promote safe pregnancy and positive outcome for the women. Education in this area is necessary to explain the need for Rh blood typing for women and the risk associated with Rh negative blood group during pregnancy. The first strategy that is needed is to enter into therapeutic communication with the women by first developing good rapport with the women and then making her aware about the importance of maintaining a safe pregnancy. This would mean entering into women-centred communication with the client so that the client develops feeling of control and she gets the perception that her safety and babies health is most important priority for a midwife (Chang et al., 2018). This is also importance according to Nursing and Midwifery Board of Australia (2018) standard of practice of midwife as it states that engaging in ethical and respectful partnership is essential to enter into compassionate partnership with patient. Instead of directly disclosing the risk associated with Rh negative blood during pregnancy, the plan is to make women feel empowered instead of being dejected by the information on Rh incompatibility.

The women centred communication strategies that can be taken by midwives during the communication process includes treating the women with kindness, respect and dignity. The first approach should be to evaluate the beliefs and values of the woman in relation to the care of herself and the baby (Lohmann, Mattern & Ayerle, 2018). Language wise preference in communication will also be judged during this time and education will be provided in the preferred language of the client (National Collaborating Centre for Women's and Children's Health, 2008). Hunter et al. (2017) supports the fact that women centred care can be provided through midwife led models of care. Hence, the midwife providing care to women can use the philosophy of women centred communication to provide women the opportunity of having normal birth. At the first point of contact, the pregnant women should be provided general information related to pregnancy care, lifestyle consideration, importance of screening test and pregnancy care related services (Lohmann, Mattern & Ayerle, 2018). In the next session, the women can be provided information regarding why Rh blood typing is important for her. Instead of making the women panic, all evidence based information should be provided by midwife regarding the consequences of Rh negative blood group during the pregnancy and the treatment options available to treat the condition.

Standards of Practice for Midwives

While providing information related to adverse effect of Rh negative blood group during pregnancy or Rh incompatibility, the approach should be to provide evidence based information as well as provide women genuine choice through education. This would help to establish therapeutic partnership with the women to promote evidence based decision making and fulfilling the requirement of informed consent as well. The advantage of effective information sharing process is that it will empower women with all information related to risk and facilitators of safe pregnancy (Krubiner et al., 2016). If the woman is well-informed, then she can take decision on her own regarding her health. The midwifery group practice model also provides midwife the opportunity to maintain continuity of care provided information regarding ways to avoid Rh incompatibility at the right time.

Using the women centred communication approach, the women can be made aware regarding how having Rh negative blood can affect the health of her baby. The midwife can explain that Rh incompatibility occurs when the pregnant women have rhesus negative blood and the fetus has Rh positive blood group. When rhesus negative blood comes in contact with the rhesus positive blood, it results in development of rhesus antibodies which cross the placenta and destroy red blood cells of the fetus. This form of Rh sensitization can cause fetal anaemia, still birth and miscarriage for the newborn (Kumari et al., 2017). After this, the women can be empowered to take effective decisions for her by providing her treatment options to prevent rhesus incompatibility. The midwife can do this by providing information related to Rhogam, a medicine that prevents pregnant woman’s blood from making antibodies that destroy Rh positive blood cells.

Education related to safety in terms of medication administration is also a vital part of care planning and education process for the woman. In relation to patient administration safety, the patient can be informed regarding the time during which the RhoGAM injection is needed for the mother. This information includes providing the RhoGAM medication at 28 weeks of pregnancy. Another dose of the medication will also be provided within 72 hours after birth. The midwife can also give information related to safety of the medication and any side effects associated with the use of RhoGAM. Certain precautions related the medicine use such as avoiding vaccines after taking the injection is also necessary and the midwife can also ask the woman regarding any cultural or religious barrier to taking a blood product (midwife.org, 2018). In case any cultural barriers exist, the midwife can give the option to the woman regarding undergoing blood test regularly in the last semester to detect possibility of Rh sensitization.

Women-Centered Communication Strategies for Rh Blood Typing Education

References:

Allen, J., Kildea, S., Hartz, D. L., Tracy, M., & Tracy, S. (2017). The motivation and capacity to go ‘above and beyond’: Qualitative analysis of free-text survey responses in the M@ NGO randomised controlled trial of caseload midwifery. Midwifery, 50, 148-156.

Beckmann, M., Kildea, S., & Gibbons, K. (2012). Midwifery group practice and mode of birth. Women and Birth, 25(4), 187-193.

Chang, Y. S., Coxon, K., Portela, A. G., Furuta, M., & Bick, D. (2018). Interventions to support effective communication between maternity care staff and women in labour: A mixed-methods systematic review. Midwifery, 59, 4-16.

Harris, M. J., Gabriel, R. A., Dutton, R. P., & Urman, R. D. (2018). A retrospective analysis of factors associated with anesthetic case duration for cesarean deliveries. International journal of obstetric anesthesia, 34, 42-49.

Hunter, A., Devane, D., Houghton, C., Grealish, A., Tully, A., & Smith, V. (2017). Woman-centred care during pregnancy and birth in Ireland: thematic analysis of women’s and clinicians’ experiences. BMC pregnancy and childbirth, 17(1), 322.

Krubiner, C. B., Salmon, M., Synowiec, C., & Lagomarsino, G. (2016). Investing in nursing and midwifery enterprise: Empowering women and strengthening health systems—A landscaping study of innovations in low-and middle-income countries. Nursing outlook, 64(1), 17-23.

Kumari, A., Kumar, R., Verma, N., & Pankaj, S. (2017). Study on Perinatal Outcome in Rhesus Negative Pregnancy. IJOPARB, 119.

Lohmann, S., Mattern, E., & Ayerle, G. M. (2018). Midwives' perceptions of women's preferences related to midwifery care in Germany: A focus group study. Midwifery, 61, 53-62.

Lucas, C., Charlton, K., Brown, L., Brock, E., & Cummins, L. (2015). Review of patient satisfaction with services provided by general practitioners in an antenatal shared care program. Australian family physician, 44(5), 317.

midwife.org (2018). Rh-Negative Blood Type and Pregnancy. Retrieved from: https://www.midwife.org/acnm/files/ccLibraryFiles/Filename/000000003906/Rh_negative_blood_pregnancy.pdf

National Collaborating Centre for Women's and Children's Health (UK. (2008). Woman-centred care and informed decision making. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK51901/

Nursing and Midwifery Board of Australia (2018). Midwife standards for practice. Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/midwife-standards-for-practice.aspx

Sandall J, Soltani H, Gates S, Shennan A, & Devane D. (2016). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5

Wernham, E., Gurney, J., Stanley, J., Ellison-Loschmann, L., & Sarfati, D. (2016). A comparison of midwife-led and medical-led models of care and their relationship to adverse fetal and neonatal outcomes: A retrospective cohort study in New Zealand. PLoS medicine, 13(9), e1002134.

Wong, C., Gordon, J., Pan, Y., Henderson, J., & Britt, H. (2016). Antenatal care in Australian general practice. Australian family physician, 45(8), 538