For more information
Call 1-800-351-0222
Call 1-800-351-0222
ROLE OF RISK ASSESSMENT IN MIDWIFERY.
Term Paper ID:28471
Get This Paper Free! or
Essay Subject:
Importance of process during pregnancy through delivery. Discusses issues, medical risk factors & use in birth center settings.... More...
8 Pages / 1800 Words
9 sources, 18 Citations,
APA Format
$32.00
More Papers on This Topic
Paper Abstract:
Importance of process during pregnancy through delivery. Discusses issues, medical risk factors & use in birth center settings.
Paper Introduction:
RISK ASSESSMENT & MIDWIFERY
Introduction
This paper will discuss risk status assessment and its role in midwifery. Included in the discussion will be how risk assessment fits into a birth center setting, and how explaining the concept of risk assessment to a client would take place.
Risk Status Assessment & Midwifery
Risk status assessment is an important part of the primary prevention of disease or negative outcome. Negative outcomes are avoided by reducing or altering susceptibility of risks. Secondary prevention of outcomes includes early detection and treatment, also through risk assessment. Tertiary prevention includes the alleviation of problems with the promotion of health, as much as possible within the disease state. Thus risk
Text of the Paper:
The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper.
(1993, September). n.j.,67-69. Kawzi, H. (1989). Uterine activity that is suddenly reduced, scar pain, andprolonged fetal bradycardia are the most common signs of rupture, however,predictors vary, further indicating the need for ongoing comprehensive riskassessment (pp. Riskassessment provides information needed to ensure the most reliable results(Murphy, pp. American Journal of public Health, 87(3), 344-351.----------------------- 1 Many of the staff wereunaware of risks noted and in some cases factors failed to be noticed inthe first place. Antenatal screeningwith comprehensive history taking was found to be an important part of riskassessment (p. For example, lack of a high school education is a risk factor thathas been associated with an adverse outcome. Withoutcautionary measures, risk assessment can result in labeling, loss ofconfidence levels, and unnecessary interventions. % werepredicted to result in more complications than did occur. Caring for our future: Thecontent of prenatal care. Assessment begins immediately, with informal methods, beforeexplaining the values of formal assessment. Since birth center settings handle only uncomplicated births, and areill-equipped to handle high-risk patients, ongoing risk assessment isimperative. Risk Status Assessment & Midwifery Risk status assessment is an important part of the primary preventionof disease or negative outcome. A., Hart, L. The following issues were included in the assessment:medical and emotional history, behavioral patterns, biobehavioral patterns,coping styles, family medical history and genetic factors, nutrition,stresses, energy levels, and conflicting beliefs. AmericanDemographics, 44-49. M. World Health, 51(1), 2 -21. They arerequired to be located within 3 minutes of a hospital, most are within 1 minutes. Initial screening begins with identification of patients withhigh risk pregnancies, who's birth process cannot be dealt with at thisfacility. Low maternalprepregnant weight is a risk of low birth weight. Risk assessment is an ongoing process that optimally continues, fromprior to pregnancy, through the delivery process. De Witt, P. 67). Formal assessment tools are developed, based on risk factors that areknown. Psychosocial risk factors include social and economic disadvantages,a lack of formal education, poverty, age, parity, and interpregnancyinterval. (1998). Chap.2,Risk Assessment. 12). Danel, I., Berg, C., & Atrash, H. studied of 315 pregnant women, and assessed all partsof the woman's life, with the belief that birth complications are a resultof the total person. Some view certain possibilities as disastrous andothers are willing to accept high risks, still others are unaware ofprocedures available or have limited ability to understand consequences (p.14). Risk factors may not always be easily classified, and they may notalways lead to adverse outcomes, however, examples of high risk variablesare known (PHSEP, p. For example, formalassessment can lead to risk labels being assigned, which can result in aloss of self-confidence. For this study, a retrospective case-notes-review bythe authors was conducted. Explaining Risk Assessment to a Client Care and consideration are needed when explaining risk assessment toa client. It was found that information collectedincluded past obstetric, medical, and family history and details of thecurrent pregnancy. 13). The goals of promotion of health and prevention of diseaseare not news to the midwifery profession, who's primary job has always beento educate their client and provide preventative prenatal care. Approaches tohandling patients, by midwives and doctors varied. Murphy, P. Kawzi and Kamil (1998) studied rupture of the uterus in labor in 14cases to determine possible risk factors. Psychological risks include a lack of support network, highstress levels, emotional disorders, and negative beliefs about thepregnancy. Otherdifferences found between nurse-midwives and physicians, was the midwife'stendency to deliver without operative interventions, epidural anesthesia,or episiotomies. Not all risk factors do lead to adverse outcomes,and labeling can also result in medical interventions that are unnecessaryand problematic. Medical risk factors include genetic, nutritional and anthropometric,medical disorders, reproductive history, and specific pregnancy hazards.Chromosomal abnormalities are a cause of reproductive loss. Secondary prevention of outcomesincludes early detection and treatment, also through risk assessment.Tertiary prevention includes the alleviation of problems with the promotionof health, as much as possible within the disease state. Successful assessmentand resulting intervention can change risk status. E., McRae, J., & Peterson, g. Hamilton, S. G., Schneeweiss, R.(1997). Findings revealed that women were managed poorly. Grimes et al. Screening tools must be accurate and they must avoidthese concerns, however, the benefits of prenatal risk assessment areobvious, and this process is necessary for the midwife. 68-69). 27). The authors state thattraditional approaches focus on past gynecological problems as riskfactors, and ignore additional factors such as nutrition, life stress,relationship problems, other medical problems, and beliefs about pregnancy,that also contribute to risk. Thus the ratingsystem was more likely to take precautions than not. M. 429-43 ). Tests were also performed during the pregnancy. With this system, womenwere rated according to predicted high risk for labor (39.7%). (1998). It was concluded that formal training is needed for thoseinvolved in risk status assessment, and clear protocols are necessary toidentify women at risk and structure their adequate management (Hamilton &Maresh, p. These low-risk pregnanciesare defined as having an uncomplicated prenatal course, with adequateprenatal care, and are determined to be prospects for a normaluncomplicated birth (De Witt, 1993, pp. Special Delivery, 21, 1 . Possible pregnancyand birth complications must be known and avoided if possible. Rosenblatt, R. 18-2 ). The success rate of midwifery and birth centers, lendscredence to their methods, however, another important factor is the factthat they only deal with low-risk pregnancies, which is dependent onadequate and continual assessment throughout pregnancy (pp. The importance of risk assessment for pregnancy, prior to labor, hasbeen established, however, procedures for this assessment vary. Pregnancy in the USA:Risks are higher for some women. W., & Kamil, K. (1999). 15-18). Along with a review of the advantages and disadvantages, the birthattendant or midwife will need to point out the different methods ofassessment. Results of risk assessment help determine what is needed regardingprenatal care, including increased numbers of prenatal visits or homevisits. The birth business. Over two-thirds of the rupturesoccurred in women with unscarred uterus; for this group, grand multiparity,cephalopelvic disproportion and malpresentation were contributing factors.Labor induction with prostaglandin preparations has been found to lead touterine rupture. 29-3 ). Interspecialty differences in the obstetric care of low-riskwomen. 344-349). Diabetes mellitus, blood group incompatibilities,multiple gestations, maternal phenylketonuria and sickle cell anemia,abnormalities of the placenta, infections such as HIV, syphilis,chickenpox, hepatitis, and toxic or teratogenic agents are all pregnancyrisk factors (PHSEP, pp. Hamilton and Maresh pointed out that women perceive risk factorsin different ways. Allinformation was available to the midwifery and medical staff that wereinvolved in the care of the patient. The overall approach fordiscussion of the process must be ascertained prior to its initiation. Of the 14 casesexamined, four patients had a previous lower segment transverse cesareansection scar and 1 did not. Rupture of the uterus inlabour: a review of 14 cases in a general hospital. Ages of patients ranged from 23 to 47 years;43% of patients had five or more pregnancies beyond 28 weeks gestation(grand-multiparity). The phenomenological approach allows for theindividual to present her entire case history (p. Negative outcomes are avoided by reducingor altering susceptibility of risks. A. Ruptured uterus is acomplication of childbirth with potentially devastating results; it is oneof the major causes of maternal and perinatal mortality. Antenatal screening by history taking - amissed opportunity. This assessment must include a comprehensive historyand physical examination and laboratory tests. The prenatal careprovider, such as in the case of the midwife, must determine if the woman,fetus or family are at a risk of failing to achieve benefits of prenatalcare and are in need of intervention, and if the risks predict acomplicated delivery. (1998). Grimes, L., Mehl, L. Although risk assessment is important, there are also negativeconsequences if it takes place without care. Thus, although the phenomenal approach to risk assessment focuses onthe whole person, it must not overlook medical assessment techniques.Hamilton and Maresh (1999) report on the importance of both obstetriciansand midwives being able to identify and manage women who are at increasedrisk of fetal abnormality and birth complications. 14). For their study, Hamilton and Maresh investigated seven hospitals.In all units, the midwife took the initial history which was then reviewedby the obstetrician. Disorders such ashypertension, anemia, diabetes, or psychiatric disorders may complicatepregnancy. Rosenblatt, Dobie, Hart, and Schneeweiss (1997) point out thatnurse-midwives are less likely than physicians to use continuous electronicfetal monitoring and other formal tests during childbirth. 67). (1983).Phenomenological risk-screening for childbirth: Successful prospectivedifferentiation of risk for medically low-risk mothers. Although nurse-midwives maintain affiliations with physicians toserve as backups if complications do occur, birth centers handle birthsfollowing normal, uncomplicated pregnancies. The screening technique used with pregnant women is designedto assess for these and other risk factors (Danel, Berg, & Atrash, 1998, p.2 ; Murphy, p. Washington, DC: General Printing Office. Thus riskassessment is an important part of educating and caring for the patient(Murphy, p. A., Dobie, S. Facts about certifiednurse-midwives. Journal of Obstetrics and Gynecology, 19(1), 1 -14. On the other hand,phenomenological methods that inquire about the total woman, provide a morecomprehensive profile, with information that can help determine whichfactors present risks and which can be alleviated during prenatal care.For example, nutrition and support factors may be risks that can beovercome, once they are identified. Journal of Nurse-Midwifery, 28(5), 27-3 . Nurse-midwives are registered nurses and they have undergone training in labor,delivery, and maternity care. Black women that are 4 yearsof older are six times more likely to die from pregnancy than the same agewhite woman. Risk factors includemedical, psychosocial or both factors (Public health Service Expert Panelon the Content of Prenatal Care, Department of health & human Services[PHSEP], 1989, p. 1 -11). Public Health Service Expert Panel on the Content of Prenatal Care,Department of health & human Services. (n.d.) Risk, risk assessment, and risk labels. Health behaviors such as illicit drug use, smoking, andalcoholism are also known pregnancy risk factors (PHSEP, pp. Thegoal of risk assessment is for women to benefit from its continencethroughout pregnancy, to identify problems, and prevent adverse outcomes. 67). Grimes,Mehl, McRae, and Peterson (1983) report results of their study of aphenomenological risk-screening technique. Journal of Obstetricsand Gynecology, 18(5), 429-43 . This system can helpidentify and possibly reduce complications (pp. Other aspects of risk assessment to consider are the possiblenegative consequences of this assessment as noted by Murphy. K. Grand-multiparity was only a factor present in onepatient with spontaneous uterus rupture. 1 ; Murphy, p. 47, 281). History (patient or family) ofabnormalities or inheritable diseases, maternal age of 37 or over atdelivery, consanguineous relationship, and teratogenic drug exposure, wereconsidered risk factors (pp. Prior preterm delivery is the best predictor of preterm birthand reproductive difficulties are found to cluster in the same women.Preeclampsia in the third trimester is a risk that is currently avoided byadequate prenatal care. Risk factors associated withnegative outcomes for pregnant women, include lack of education, race, age,marital status, and levels of prenatal care. Included in the discussion will be how risk assessment fitsinto a birth center setting, and how explaining the concept of riskassessment to a client would take place. 1 ). Traditional methods that determine medical problems, includinglaboratory tests are valuable measures of conditions that will requirehigher levels of maintenance or prenatal care. Resultsshowed that 215 women (68.3%) were accurately predicted and 21. These and other factorsmust be mentioned along with the advantages and necessity of understandingpossible risk factors, to allow for interventions and adequate preparationsin pregnancy and childbirth. Risk assessment is an important part ofmidwifery, ranging from assessment of how to best educate the patient andproviding adequate information to the patient, to screening forcomplications and avoiding adverse birth outcomes (American College ofNurse Midwives, 1998, p. RISK ASSESSMENT & MIDWIFERY Introduction This paper will discuss risk status assessment and its role inmidwifery. Risk Assessment & Birth Center Settings Birth centers are defined as a health facility, place, or institutionthat is not a hospital, where births are planned to occur. References American College of Nurse Midwives.
If this paper is not what you are looking for, you can search again:
or
We can write a Custom Essay just for you.
Browse Essays by Subject