MIDW1005 WELL WOMEN PREGNANCY, LABOUR, AND BIRTH, POSTNATAL. ASSESSMENT 2 ANTENATEL CASE STUDY RENEE FOSTER STUDENT NUMBER 21829419 INTRODUCTION assessment 2 case study involves 34-year-old women (G1 PO) who is currently 12 weeks pregnant. Jacinta is a healthy and well woman who has presented to the antenatal clinic for her first visit. Jacinta lives out of town with her partner Gerard who works as a fly in fly out worker in the mines. Gerard has been known to enjoy a few beers on his days off and has been a smoker for many years. Jacinta has expressed that her partner has never been physically violent towards her or her child Jed from a previous relationship. Jacinta has shown her love for the garden and manages a 5-acre property located 2 hours outside of Brisbane. Jacinta does not have her mother close by but does have Gerards parents come visit on the weekends where they attend the local church as a family. Jacinta does not have a drivers licence and must rely on the bus service to get her son Jed to and from school. Jacinta is softly spoken and seems to hesitate before answering questions. Jacinta has expressed she would like to have a natural birth. JACINTAS BOOKING IN VISIT Jacinta has presented to her 1^st booking in visit as a healthy 34-year-old women (G1 PO). My role as her midwife during this exciting time in her life is to ensure she feels empowered and capable of fulfilling her desire to have her baby naturally. According to (Al-Ateeq & Al-Rusaiess, 2015) antenatal care is connected to women centred care which can lead to more positive outcomes for mother and baby. Information such as medical history, previous pregnancy, and a good understanding of Jacintas mental, emotional, and physical wellbeing will be established. Pregnancy is a very venerable time in a womens life, and it is a very important role for midwives to create an environment which is warm and friendly. Active listening skills, warm and gentle greeting, eye contact, respecting a womens privacy and insecurities as well as explaining in detail what will be happening step by step throughout her pregnancy journey which may alleviate some of her stress and anxiety when it comes to childbirth and breastfeeding. (OBrien et al., 2021) describes trust during the building of a relationship between expectant mother and midwife is crucial to developing a positive and healthy outcome. JACINTAS HEALTH HISTORY A health history is a critical part of Jacintas pregnancy to ensure all areas of mental and physical wellbeing are assessed.

1. Medical history including family history of both biological parents? Jacinta has noted her father was a smoker and died of lung cancer when she was 30 and her mother has had no serious health concerns but did have a stillborn baby with her 3^rd child. (Rowe et al., 2022) explains the importance of a medical history with each expectant women to help create an understanding of the womens health history, risks associated with pregnancy and birth.

1. Previous or current health concerns which include depression, anxiety, severe mental illness, phycological trauma or psychiatric treatment to identify possible mental health problem.? Jacinta is quietly spoken and appears to be very timid and lacks confidence. There have not been mental health problems in her life or trauma that she has expressed during this session. (Silverman & Loudon, 2010) claims that evaluating and assessing phycological risk factors during the 1^st pre-natal visit is a sufficient means to identifying women who may be at risk of developing postpartum depression.

1. Current and recent medicines including over the counter medications or supplements and herbal remedies. Jacinta has been taking a pregnancy multi vitamin for the last 3 months and has noted feeling more energised since taking the vitamins. (Czeizel & Bnhidy, 2015) describes the importance of folic acid during the 1^st trimester of pregnancy in developing a healthy baby.

1. Does the patient suffer allergies? No allergies noted.

1. Occupation risk factors associated with this. Jacinta manages a 5-acre property most the time on her own as her husband works away on an oil rig 9 days out of every fortnight. She has expressed this has been okay so far but as her pregnancy progresses, she may find day to day management of tasks more challenging. The property can be extremely hot during the summer months and brown and red belly black snakes have been noted as a possible danger to herself, unborn child and 5-year-old stepson. (Silverman & Loudon, 2015) states that Pregnant women working on farms are at increased risk of injury due to harsh conditions and lack of support.

1. Family and home situation, available support network and any health or other issues affecting her partner or family members that may be significant for her health and wellbeing? Jacinta has mentioned feeling isolated when her partner is working away. She does not hold a drivers licence nor is she close to her family and friends. Her husbands family visit on weekends but offers little support. Gerard (Jacintas partner) has smoked since her was a young boy which Jacinta is finding difficult as she has never been a smoker or drinker. Gerard can at times drink too much alcohol and becomes short tempered towards herself and Jed. Jacinta has felt upset at times with this behaviour but has not expressed concerns about physical violence. The Edinburgh depression scale (Cox et al., 2014) is a widely used depression tool to determine and assess mood, anxiety, and depressive symptoms. Jacinta has scored in the lower range at a score of 10 out of 30 putting her in the lower end of the depression scale. Jacinta has mentioned wanting her partner to stop smoking in which I have offered information on quitting smoking (Australian Government Department of Health, 2019) 13 QUIT.

1. Nutrition and diet Jacinta have a good understanding of diet and nutrition and has a normal BMI and blood pressure. Although Jacinta does not have accesses to a swimming pool or gym, she states that keeping the family acreage running is more than enough physical activity to keep her healthy. (Marshall et al., 2021) states that a healthy diet and lifestyle has many positive effects on mother and baby and can greatly contribute to a healthier outcome post pregnancy for mother and baby.

1. Domestic abuse/cohesive control. This is a sensitive area and needs to be treated as such. Jacinta has arrived at her 1^st appointment alone giving me the perfect opportunity to ask if anything like this has been occurring in which she has answered no and in previous conversations. (Australian Government Department of Health, 2019) states that antenatal screening has become a vital component to the approach in recognising family violence during antenatal care for women.

JACINTAS CONTINUING PREGNACY JOURNEY Blood screening for serious disease such as HIV, syphilis, Hepatitis B, blood type and NHS foetal abnormality program is recommended to eliminate potential dangers to baby and mother. This is not compulsory, and Jacinta will have the options to accept or decline. (Di Mattei et al., 2021) states that blood screening can eliminate many uncertainties that come with pregnancy, but this routine testing is always the womens choice. Ultrasound scan to take place between 11 + 2 weeks and 14 + 1 week to determine gestational age, detect multiple pregnancies and to screen for down syndrome. Another ultrasound will take place at 18 weeks and 20 + 6 weeks to detect any foetal abnormality and to determine the placenta location. (Roberts et al., 2015) describes that although ultrasound is a womens choice it does have the benefit of allowing mother and baby to bond as well as the ability to check babies growth and health. Jacinta has been informed that she will need to attend 10 antenatal visits for the remainder of her pregnancy which can be booked around time frames that suit her best. MODELES OF CARE

1. Midwifery group practise (MGP) consists of a unit of midwives with a primary midwife.
2. Public hospital care which will consist of antenatal, birthing, and postnatal care through the public healthcare setting.
3. Private obstetrician care which will be at a higher cost, but the women will receive more personalized individualized care.
4. Shared care which will be a combination of general practitioner and a hospital or midwifery team.

(Rayment-Jones et al., 2020) explains that models of care during pregnancy, birth any post-natal has been proven to generate healthier outcomes for mother and baby. Under the ACM consultation and referral guidelines (2021) and the information Jacinta has provided. I would like to refer Jacinta to antenatal classes at the local hospital and a mother group to help with social and emotional isolation. (Heaperman & Andrews, 2020) describes the importance of community and social connectedness for improving outcomes related to depression and social isolation.

Jacintas case study highlights the importance of addressing all areas of the well womens life to ensure I have a whole personalized picture of her health and emotional wellbeing. This case study has highlighted the significance of different models of care available to pregnant women and gives Jacinta an understanding of which model would suit her best. This case study highlights the value of mothers support group and antenatal classes for education and emotional support as well as connectedness to other expectant mothers. Overall, Jacintas case study emphasises the importance of holistic Care and an individualized approach to pre-natal care to ensure mother and baby have the best plan for a healthy outcome. REFRENCES Al-Ateeq, M., & Al-Rusaiess, A. (2015). Health education during antenatal care: the need for more. International Journal of Womens Health, 7(7), 239. https://doi.org/10.2147/ijwh.s75164 Australian Government Department of Health. (2019). Welcome to the Department of Health. Australian Government Department of Health and Aged Care. https://www.health.gov.au/ Branjerdporn, G., Clonan, T., Boddy, J., Gillespie, K., OMalley, R., & Baird, K. (2023). Australian womens perspectives of routine enquiry into domestic violence before and after birth. BMC Pregnancy and Childbirth, 23(1). https://doi.org/10.1186/s12884-023-05345-7 Cox, J., Holden, J., & Henshaw, C. (2014). Perinatal mental health : the Edinburgh postnatal depression scale (EPDS) manual. Royal College Of Psychiatrists. Czeizel, A. E., & Bnhidy, F. (2011). Folic acid supplementation and risk reduction in preterm birth. The American Journal of Clinical Nutrition, 94(6), 16511652. https://doi.org/10.3945/ajcn.111.026690 Di Mattei, V., Ferrari, F., Perego, G., Tobia, V., Mauro, F., & Candiani, M. (2021). Decision-making factors in prenatal testing: A systematic review. Health Psychology Open, 8(1), 205510292098745. https://doi.org/10.1177/2055102920987455 Heaperman, A., & Andrews, F. (2020). Promoting the health of mothers of young children in Australia: A review of face to face and online support. Health Promotion Journal of Australia. https://doi.org/10.1002/hpja.334 Kelley, M. A., Flocks, J. D., Economos, J., & McCauley, L. A. (2013). Female Farmworkers Health during Pregnancy. Workplace Health & Safety, 61(7), 308313. https://doi.org/10.1177/216507991306100706 Marshall, N. E., Abrams, B., Barbour, L. A., Catalano, P., Christian, P., Friedman, J. E., Hay, W. W., Hernandez, T. L., Krebs, N. F., Oken, E., Purnell, J. Q., Roberts, J. M., Soltani, H., Wallace, J., & Thornburg, K. L. (2021). The Importance of Nutrition in Pregnancy and Lactation: Lifelong Consequences. American Journal of Obstetrics and Gynecology, 226(5), S0002-9378(21)027289. https://doi.org/10.1016/j.ajog.2021.12.035 OBrien, D., Butler, M. M., & Casey, M. (2021). The importance of nurturing trusting relationships to embed shared decision-making during pregnancy and childbirth. Midwifery, 98(102987), 102987. https://doi.org/10.1016/j.midw.2021.102987 Rayment-Jones, H., Silverio, S. A., Harris, J., Harden, A., & Sandall, J. (2020). Project 20: Midwives Insight into Continuity of Care Models for Women with Social Risk factors: What works, for whom, in What circumstances, and How. Midwifery, 84(102654), 102654. https://doi.org/10.1016/j.midw.2020.102654 Roberts, J., Griffiths, F. E., Verran, A., & Ayre, C. (2015). Why do women seek ultrasound scans from commercial providers during pregnancy? Sociology of Health & Illness, 37(4), 594609. https://doi.org/10.1111/1467-9566.12218 Rowe, R. E., Garcia, J., Macfarlane, A. J., & Davidson, L. L. (2002). Improving communication between health professionals and women in maternity care: a structured review. Health Expectations, 5(1), 6383. https://doi.org/10.1046/j.1369-6513.2002.00159.x Silverman, M. E., & Loudon, H. (2010). Antenatal reports of pre-pregnancy abuse is associated with symptoms of depression in the postpartum period. Archives of Womens Mental Health, 13(5), 411415. https://doi.org/10.1007/s00737-010-0161-7

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