Optimal Maternity Care Essay For Advanced Age Pregnancy In CALD Woman, Australia.

Significance of Midwifery Care in Advanced Age Pregnancy

Discuss about the Promote Optimal Maternity Care Plan For Alima.

According to Kenny et al. (2013), pregnancy at an advanced stage in life of a woman (> 35 years) is associated with several adverse outcomes. The aim of this essay is to promote optimal maternity care plan for Alima who is a 46 years old culturally and linguistically diverse (CALD) women residing in Australia for the past 3 years and is expecting her 7th children. The essay will initiate with stating significance of midwifery care in advanced stage pregnancy followed by the impact of pregnancy in the health and well-being of advanced age mother. The essay also aims to throw light over the optimal care plan that will be suitable for Alima at her 26^th week of gestation and how this care plan aligns with the principle of primacy care  and other significant concerns in relation to Alima’s case study.

According to Sauer (2015) advanced age pregnancy is associated with different level of complications. The main adverse outcomes associated with the advance age pregnancy include low birth weight, pre-term birth, unexplained foetal death, still birth and increased risk of Caesarean section (Kenny et al., 2013). Moreover, a woman, as in case of Alima who belongs from the CALD community, the challenges are even high in case of handling the advanced age pregnancy because of communication barrier. Moreover people who are have immigrated to Australia as refuge have higher chances of the pregnancy related complications in comparison to the Australian originals. This may be due to the lack of proper access to healthcare and lack of proper education about pregnancy related complication and importance of maintenance of healthy lifestyle during pregnancy. Here comes of the importance of the midwives in the advanced age pregnancy care. According to the Australian Government Department of Health (2018), it is the duty of the midwives to provide quality care to advanced age mother in order to reduce the associated complications. According to the NMBA standards, it is the role of the midwives to procure woman-centred care. This women-centred care will focus on the unique needs to women like her aspirations, expectations while recognizing her right to self-determination in the domain of choice, control and continuity of care while addressing her emotional, social, physical, spiritual, psychological and cultural needs.

According to Fitzpatrick et al. (2017) women like Alima (46 years) who are giving birth at an advanced maternal age have greater risk of developing a wide range of pregnancy complications. In case of multiple pregnancy, the impact of the advanced age women further increases. Gestational diabetes is one of the significant complications among the older age group women and this is followed difficulty in the mode of delivery. This is because, the myometral function decreases with age leading to postpartum haemorrhage and difficulty in delivery. There is also an increase in the likelihood of advanced maternal age women delivering underweight baby due to transplacental flux of nutrients or placental perfusion (Kenny et al., 2013).

Impact of Advanced Age on the Health of Mothers

Midwives play an important role for the women from culturally and linguistically diverse (CLAD) communities via providing same level of support and communication as offered to others (Carlon, 2016). The care for Alima will mostly encompass proper education with the help of an interpreter about several complications associated with pregnancy at an advanced age and this education will be done with a positive regard and proper information with emphasis given over the health information. For example, Alima should be educated like how she must maintain a healthy diet so that she can dodge risk factors associated with diabetes and deficiency of Vitamin D (Kenny et al., 2013). However, this lifestyle advice should take cultural issues of Afghanistan into consideration. Health information about complications that may rise from any further chances of pregnancy must also be given to Alima. Education must be given about the importance of taking protection in order to avoid unwanted pregnancy development (Australian Government Department of Health, 2018).

In this case study, Alima denies any problems with her pregnancy and was found saying that she can feel fetal movements. However, this personal assessment of Alima can be apparent and thus a thorough check up of Alima is mandate in order to evaluate is there are any complications associated with her upcoming delivery. Since Alima is an advanced age mother and is on her 26^th of gestation, extra caution must be undertaken  in order to avoid any further complications.

Pregnancy: Significant pregnancy concern for Alima will encompass adverse maternal preinatal outcomes like postpartum haemorrhage, cephalopelvic disproportion and eclampsia. The adverse infant outcome may include poor foetal growth, preterm birth. poor birth weight and neonatal mortality (Cavazos-Rehg et al., 2015).

Labour: According to Kenny et al. (2013), women who belong to older primiparous group are most likely to give birth by Caesarean section. However, women who are over 40 years of age, as in case of Alima, will have three times more risk from the planned caesarean delivery. Favilli et al. (2012) is of the opinion that while providing antenatal care, it is frequently observe that the women who are above 40-year of age, there occurs problem in labour induction. Moreover, if Alima had already had two caesarean surgeries during her two previous deliveries, conducting another caesarean delivery will be extremely difficulty. Moreover, myometrial dysfunction are at times observed among the advanced age pregnant women which further causes labour complications.

Optimal Care Plan for Alima on Her 26th Week of Gestation

Puerperium: The main puerperium complications in case of Alima may include excessive bleeding during the delivery leading to the pain in the perineal area (between the rectum and vagina), infection of breast along with clogged ducts. Other puerperium complications include superimposed preeclampsia and severe preeclampsia (Cavazos-Rehg et al., 2015).

Primary healthcare encompasses a large range of healthcare service providers across public, private and non-government sectors. The primary healthcare in birth and the postpartum period will be procured by midwives, community nurse and general practitioners (Australian Government Department of Health, 2013). In order to minimise the risks of complications, the midwifery care plan for Alima is illustrated below in the table

(Source: Australian Government Department of Health, 2013)

Thus, in antenatal care in case of Alima mainly aligns with the principle of the collaborative approach of primary care. According to this principle, it is duty of the midwife to procure care to the pregnant women under a collaborative approach especially under the active supervision of the general physicians and gynecologist. Since Alima is an advanced stage expecting matter, period consultation with the doctors is mandatory in order to negate the chances of the complication during and after the birth. The antenatal care of Alima also coincides with the multidisciplinary approach of the principles of primary care. Under this multidisciplinary approach it will be the duty of the midwives to work effectively with the multidisciplinary team (Australian Government Department of Health, 2018a). For example, in case of Alima multidisciplinary team will mainly include a dietician who will frame a proper diet plan for Alima via taking into consideration of her age, labour status and the tendency of developing gestational diabetes mellitus. Other members of the multidisciplinary team will be a physical trainer who will train Alima in mild to moderate physical exercise in order to ensure fewer complications during child delivery (Bain et al., 2015). The role of the community health nurse in the multidisciplinary team will be encourage Alima and her husband to participate in the community level activity this will in turn educate them about the importance of taking protection while having se in order to reduce the chances of unwanted pregnancy and other complication associated with pregnancy during the advanced stage of life. This education will help Alima and her husband to avoidance conceive children in future. The community nurse must be culturally diverse ad must be equipped with an intrepretter so that it becomes easier for Alima and her husband to easily participate in the interactive educational sessions (Bender et al., 2013). This community level engagement again coincides with the primary health care principle of delivery core health care program to the mother and her family for proper management of pregnancy (Australian Government Department of Health, 2018a).

Conclusion

Thus from the above discussion it can be concluded that midwives play an important role in antenatal care. In case of Alima there can be several complications starting from problem during labour, gestational diabetes, still birth and other adverse neonatal outcomes. It will be the role of the midwives to devise a care plan for Alima who is again a CALD woman, such that it will improve the health and wellbeing of the Alima and her family. The midwives must function in accordance to the principles of primary care and thereby promoting multidisciplinary care approach and increase in the community level participation.

References

Australian Government – Department of Health. (2018). Clinical Practice Guidelines: Pregnancy Care. 2018 Edition. Access date: 28^th July. Retrieved from: https://www.health.gov.au/internet/main/publishing.nsf/Content/4BC0E3DE489BE54DCA258231007CDD05/$File/Pregnancy-care-guidelines-updated-24-July-2018.pdf

Australian Government Department of Health (2018a). Principles for success for primary health care services. Access date: 28^th July. Retrieved from:  https://www.health.gov.au/internet/publications/publishing.nsf/Content/health-oatsih-pubs-linkphc~health-oatsih-pubs-linkphc-local~principles

Australian Government Department of Health. (2013). Primary Health Care in Australia. Access date: 28^th July. Retrieved from:  https://www.health.gov.au/internet/publications/publishing.nsf/Content/NPHC-Strategic-Framework~phc-australia

Bain, E., Crane, M., Tieu, J., Han, S., Crowther, C., & Middleton, P. (2015). Diet and exercise interventions for preventing gestational diabetes mellitus.

Bender, M. S., Nader, P. R., Kennedy, C., & Gahagan, S. (2013). A culturally appropriate intervention to improve health behaviors in Hispanic mother–child dyads. Childhood Obesity, 9(2), 157-163.

Carlon, M. (2016). Equitable midwifery care-supporting women from culturally and linguistically diverse (CALD) communities. Australian Midwifery News, 16(1), 29.

Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Bommarito, K., Madden, T., Olsen, M. A., ... & Bierut, L. J. (2015). Maternal age and risk of labor and delivery complications. Maternal and child health journal, 19(6), 1202-1211.

Favilli, A., Pericoli, S., Acanfora, M. M., Bini, V., Di Renzo, G. C., & Gerli, S. (2012). Pregnancy outcome in women aged 40 years or more. The Journal of Maternal-Fetal & Neonatal Medicine, 25(8), 1260-1263.

Fitzpatrick, K. E., Tuffnell, D., Kurinczuk, J. J., & Knight, M. (2017). Pregnancy at very advanced maternal age: a UK population?based cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 124(7), 1097-1106.

Kenny, L. C., Lavender, T., McNamee, R., O’Neill, S. M., Mills, T., & Khashan, A. S. (2013). Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PloS one, 8(2), e56583.

Sauer, M. V. (2015). Reproduction at an advanced maternal age and maternal health and management. Fertility and sterility, 103(5), 1136-1143.