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?
In the event that Mrs. Wong and her husband experience a negative outcome in the birthing suite such as an open spinal defect being identified, it is important for the nurse to provide emotional support and resources to help them make a decision which they can be comfortable with. This could involve providing unbiased evidence-based information on available options, facilitating conversation between the couple where they are able to express their feelings without judgement or pressure from either side, offering access to counselling services if required, and providing contact information for any relevant organizations (such as Down Syndrome Foundation). In terms of personal views on terminating or continuing a pregnancy when there is risk of an anomaly present, my perspective is one which places importance on patient autonomy over clinical opinions - I believe that it is ultimately up to each individual patient or couple to decide what course of action feels right for them based upon available evidence combined with personal values/beliefs. Factors which influence this view are my own experiences with patients who have been faced with difficult choices around reproductive health matters - seeing these patients empowered by making decisions based upon what felt right for them has helped me appreciate how important it is not impose pre-existing beliefs onto others.
The Human Genome Project has already had a large impact on maternity care through increased access to genetic screening tests during early stages of pregnancy such as Non-invasive Prenatal Tests (NIPT). This technology has improved our ability to predict fetal anomalies earlier in gestation than ever before. Moving forward we will likely see further advances including more precise techniques enabling us to diagnose rarer conditions earlier on in pregnancy than currently possible. These advancements will bring both benefits (eg increase accuracy) but also risks including ethical dilemmas related to termination versus continuing a pregnancy after diagnosis amongst others - thus leading healthcare professionals into unchartered territory where new systems must be developed in order facilitate informed decision making processes and ensure continuity of compassionate care regardless of outcomes experienced by families/couples throughout maternity care pathways.