CASE STUDY: Active Labor: Susan Wong
Mrs. Wong, a first-time mother, is admitted to the birthing suite in early labor after
spontaneous rupture of membranes at home. She is at 38 weeks of gestation with a history of
abnormal alpha-fetoprotein levels at 16 weeks of pregnancy.
She was scheduled for ultrasonography to visualize the fetus to rule out an open spinal defect
or Down syndrome, but never followed through. Mrs. Wong and her husband disagreed about
what to do (keep or terminate the pregnancy) if the ultrasonography indicated a spinal
problem, so they felt they did not want this information.
Reflective Questions
1. As the nurse, what priority data would you collect from this couple to help define
relevant interventions to meet their needs?
2. How can you help this couple if they experience a negative outcome in the birthing
suite? What are your personal views on terminating or continuing a pregnancy with a
risk of a potential anomaly? What factors may influence your views?
3. With the influence of the recent Human Genome Project and the possibility of
predicting open spinal defects earlier in pregnancy, how will maternity care change in
the future?
Sample Solution
- As the nurse, what priority data would you collect from this couple to help define relevant interventions to meet their needs?
- Medical history: This includes Mrs. Wong's prenatal care history, her abnormal alpha-fetoprotein levels at 16 weeks of pregnancy, and her husband's medical history.
- Psychosocial history: This includes the couple's relationship with each other, their support system, and their cultural and religious beliefs.
- Emotional status: This includes the couple's feelings about the pregnancy, their concerns about the potential anomaly, and their coping mechanisms.
- How can you help this couple if they experience a negative outcome in the birthing suite? What are your personal views on terminating or continuing a pregnancy with a risk of a potential anomaly? What factors may influence your views?
- Providing emotional support and comfort.
- Helping them to understand their options and to make informed decisions.
- Connecting them with other resources, such as social workers and chaplains.
- The severity of the potential anomaly.
- The woman's age and health.
- The woman's wishes and values.
- The woman's support system.
- With the influence of the recent Human Genome Project and the possibility of predicting open spinal defects earlier in pregnancy, how will maternity care change in the future?
- More women will be offered genetic testing early in pregnancy.
- Women who test positive for a genetic disorder will have more information about their options and will be able to make more informed decisions about their pregnancies.
- Maternity care providers will need to be trained to provide genetic counseling and to support women who make difficult decisions about their pregnancies.