Critical Appraisal of Care and Treatment for Altered Health Conditions During Pregnancy and Birth

Pathology

This needs to clearly set out what you are about to discuss. Give a brief outline of the altered health condition and introduce the woman, making it clear that you will be maintaining confidentiality for all involved, including staff and organisation. You will need to set the parameters of your case study for example ‘throughout pregnancy and birth’, ‘antenatally’, ‘intrapartum’ or ‘postnatally’. You need to give an idea of the topic areas that will be included, the pathology, the pharmacology, the care and treatment given and how the multi-professional team worked to ensure safe and effective care. You should explain that this is a critical appraisal of the care and that you will be using current evidence; local and national guidelines to inform this discussion.

The introduction is often best reviewed after you have finished writing the assignment to check that you have discussed what you have set out in this section. It is important that this section sets a clear focus which is based upon the learning outcomes!

Here you need to demonstrate that you understand the pathology of the altered health condition; you may not be able to ‘critically appraise’ much within this section as generally the pathology cannot be disputed or argued however, this must be appropriately referenced using sound and up to date, academic pathology books. You should demonstrate the “normal” physiology and then identify how the pathology differs from this and how it might be diagnosed.

This is likely to be the largest part of your work. Here you need to appraise the care that was given or is recommended. Are the local guidance in line with the current national guidance? Here you should consider what recent national audits and reports have to say about care and how this can be improved. You may also want to consider the user service voice – there are national surveys that give a lot of extra but important information about how women feel about the care and treatments offered. You do need to consider the latest evidence and research and when doing so you should appraise the research for example, is it relevant; contemporary; what type of research is it? Was the methodology appropriate etc.? When looking at the evidence you may want to consider any new and innovative care/ treatment on the horizon and does the evidence suggest that will improve care and treatment? For this section you will need to do a good literature search. You should include the role of the midwife here and how collaborative practice is important in treating altered health conditions. What about the role of the woman in her own treatment and “expert” in her condition (especially important in chronic illness outside of pregnancy). Other areas of discussion for this section should include:

Care and Treatment

This section will also need to contain information about pharmacology; some of the conditions will be treated with a variety of drugs; others will have very few. You do not want this to take over the care and treatment sections; likewise for those cases that do not have a lot of drug treatment you do need to demonstrate that you understand how and when drugs are used. What is important about drug use, in particular the contraindications and side effects and most importantly how this affects the mother and the fetus. Consider the balance of risks; what are the alternatives?

The multi professional team and collaborative practice

Within this section you need to consider the role of the multi- professional team. What is the evidence to support this kind of working to improve outcomes? How can the midwife ensure that the women is referred to the correct health care professionals and at the right time? Here you need to consider the importance of ‘informed choice’ and the importance of this when it comes to supporting women to make informed decisions. This section is ideal for considering how we work collaboratively to ensure safe and effective care. You may want to discuss some of the recent reports that have shaped how we work today; for example Francis (2013) and Kirkup (2015). These reports have been key in current health service reviews and policy in relation to collaboration of multiple agencies and professional groups.

You should consider the impact this AHC has/ will have on the woman & Fetus. Some conditions that develop in pregnancy may cause problems late in life and in particular in future pregnancies. Women with underlying AHC’s may find that pregnancy has escalated this condition and this may impact her adversely in the future. Some AHC may cause serious trauma physically and emotionally (for example women may require intensive care). Outside to these very traumatic events many women are affected emotionally when they find that they have an AHC and this may also have an effect on her family. You may want to consider this using current evidence to support your discussion.

Conclusion

The conclusion is not a summary of the discussions made within the essay; it is a conclusion of your findings. This should include some reflection on how writing this assignment will influence your practice in the future.

Reference list 

This must be in alphabetical order and it must contain all of the citations within your essay. This is not a bibliography and should not contain references or sources that you have not used. If you have several pieces of work from an author within this they must be in chronological order. If they are the same author and the same year you must identify with a letter after the year.Make sure you refer to Cite Them Right to set this list out correctly.