Long-term antepartum care in the hospital
- 5 Care of the antepartum patient that's on your unit for an extended length of time can be a huge challenge, both for staff and for the patient. These are women who, for whatever reason have a pregnancy complication that cannot be managed on an outpatient basis. Diagnoses can range from preterm labor to premature rupture of membranes to placenta previa to high-order multiple pregnancy to hyperemesis gravidarum, and anything else you could imagine.
The challenges are numerous. To begin with, the woman is facing something that is (in most cases) completely unexpected. They are trying to cope emotionally with an unexpected pregnancy complication - it's a pretty fair assumption to make that most women don't get pregnant expecting to have to stay in the hospital for weeks or even months. Apart from that is the worry that things at home may fall apart - bills still need to be paid, house and cars still need to be maintained, and there may be child care issues if this is not a first pregnancy. Being that most high-risk antepartum units are housed in bigger teaching hospitals, the woman's family may live far away, and support in the form of visitors may be minimal.
The woman almost completely loses control of her schedule and her personal space. Meals are brought on the hospital's schedule, there are physician rounds, nurses coming in and out of the room, and the woman may be awakened in the night for assessment. I have had many many patients express a huge sense of frustration at this - they are already asleep at night when someone comes in to assess them and monitor the baby. They are hungry at times other than meals, or they're not hungry when the meal comes. They lose privacy, as we are always asking them when the last time was they peed, pooped, or ate, or if they're bleeding vaginally. Some women deal better with this than others, but nearly all have expressed to me that it's difficult no matter what.
I've not had a patient yet that is not concerned for the welfare of the baby that she's carrying. It's been my experience that most women on our inpatient unit will deliver their babies early and the baby will stay in intensive care (NICU) for at least some time. Since there is not really much to do but sit and think and worry, it is often a challenge to these women to not overdo the worrying. This is their baby, after all. We schedule a visit to the NICU if the woman is stable enough to ride in a wheelchair to visit, or at the very least a neonatologist comes to her room to talk with her about what to expect once baby is born.
Finally, these women are often bored completely out of their minds. They are often on bedrest with bathroom privileges, stuck in the same hospital room for weeks or months, and watching TV is not everyone's idea of fun. It is especially difficult for women who are used to being active on a daily basis.
So can we as nurses do to make these women's lives easier? In my nursing practice and at my facility, there are several things we do. First, we try to give these women as much control over her schedule as possible. Yes, we may have to perform NSTs a certain number of times in a day, but we try to work around the woman's preferences. I work 12-hour night shifts, and if a woman has to have q4 hour temperatures, I ask them to call me when they get up to go to the bathroom. I've not had a pregnant patient yet who does not get up in the middle of the night to go to the bathroom! This works pretty nicely.
If a patient has been stable for a while (exact length of time depends on the patient and her condition), the nurses may ask the doc if we can back off on certain things - like taking the woman's temp at 0400. We may also ask if she can have a 30-min wheelchair ride per day so she can perhaps go outside and get some fresh air.
We try to let patients make their room as much like their home as we reasonably can. If they want to keep snacks, or their laptop, or books, or a white noise machine in their room, we let them. We encourage visitors. We encourage a support person to stay the night with the woman, whether that is a husband, friend, or other loved one. There is a notable difference in the moods of women who have family support versus those who don't; really, that should come as no surprise.
As well, we do our best to encourage these women to talk - whether about their families, about their concerns or just about the weather. It is so vital for these women to have human contact that may or may not revolve around their pregnancy. They may just want to be themselves and NOT talk about it for a change. Or they may want to ask more questions about the pregnancy, the baby, what to expect after delivery, or what to expect once baby is in the NICU. Having a human connection is so vital to these women. I find it a joy most days to meet their needs at such a critical time in their lives.
What does your hospital do, or what do you do personally for the antepartum women in your care?
Elvish has 'a few' year(s) of experience and specializes in 'Community, OB, Nursery'. From 'Where the bluebirds sing...'; 35 Years Old; Joined Nov '06; Posts: 19,336; Likes: 19,269.2Dec 30, '08 by jillianraeMy hospital is pretty good about giving these women some of their own time. We have one now that takes a nightly walk (she's stable) and we go by her nightly schedule. No vitals from 2300 to 0500 and the docs try to get most of the women to Q4hr monitoring when possible. We have wi-fi and all the rooms just got DVD players installed. Still only basic TV 13 channels ha ha. You can hear the frustration in their voices sometimes and we think they are being difficult or nasty or particular, but really they are trying to hold onto some sort of independence in a world where we have taken it away.0Dec 30, '08 by Elvish GuideI love the way you phrased that last bit, jillianrae. It is so very true. We currently have one who constantly complains about how bored she is and how she hates the food. It kind of grated on my nerves until I realized that if I had to be hospitalized for as long as she has been, those would be my two biggest complaints too. Puts things in perspective!0Jan 1, '09 by southlady_1We do all of the above suggestions.......plus encourage video games, DVD players, etc. Our hospital has WiFI which helps. Having been on bedrest with my past pregnancy, I can appreciate that it is a difficult situation when we take all control away. I encourage pts to journal......it seems to help a lot. No one may ever read it but it is interesting how when I mention how journaling helped me to get rid of a lot of anger, guilt, grief, and fear, they are all doing it within a few hours. Also, I encourage them to put together photo albums,etc. Bear in mind that Magnesium as well as some other meds may make it harder to focus enough to read......audio books are another great source. I use these when I'm painting murals etc.0Jan 4, '09 by mollyaquaThis thread is exactly what I was looking for when I logged in tonight. Our long term antepartum population has grown steadily over the last year, largely due to the now oft diagnosed "shortened cervix" and the greatly increased number of multiples. We have some nurses who have really taken on the mission of coming up with new ideas for meeting the physical, emotional and practical needs of thisl group of women. We have initiated an "All About Me" sort of poster that includes notes about the patient's family, with photos of her children, extended family and pets. She can divulge as much as she wishes on this poster. The unit has also instituted a scrapbook that is shared with antepartum patients. Patients that wish to share their story with future patients are invited to create scrapbook pages to add to the book after they are discharged. Journaling excerpts are wonderful gifts to share with the next mom admitted with a high risk pregnancy.
I've taught a couple of our long term moms how to knit a simple baby blanket, and a few of the moms have also made up baby hats for the unit to use with stockinette and yarn ties. Some moms become very quiet and withdrawn, and some are just so lonely. Each one handles the confinement in her own way, and the nurses challenge is to ease the stress as best we can.
We have nurses that are trained in Healing Touch that visit our patients on a regular basis. One nurse even helps with manicures and pedicures, and helps patients arrange for hairdressers to come in for a quick cut and style.
I would love to hear what is happening on your unit. Are you providing PT or OT visits for your patients on long term bedrest? Does anyone have some sort of option for massage therapy? Do you have any lists or suggestions for online resources for antepartum mothers? Maybe we could start a list of online resources...some directly pregnancy related and some simply diversional. Freerice.com and Boxerjam.com are two that come to mind.
I look forward to hearing what you are doing at your facility!1Jan 4, '09 by Elvish GuideWe kind of have to be proactive in reminding the docs to order PT/OT consults for longterm bedresters but they do get it. They get deep breathing & other simple exercises they can do in the bed, sometimes they will get special mattresses, it just depends.4Jan 6, '09 by Daisy DoodleI want to first thank all of you Antepartum Nurses. I am a NICU nurse that required two months of inpatient care in our antepartum unit. I can't tell you how hard being on bedrest was. In the end we were blessed with healthy twin boys born at 32 weeks. From my experience my nursing practice will change. JillianeRae hit the nail on the head. I felt a complete loss of independence. I was air-evaced from our small town up to the University Hospital. I was without my family and my belongings. I was so scared, mind you I am a Nurse I understand how these things go. I knew what to expect.
The early morning visits from Doctors, Interns, Residents, and students became very difficult. The problem was that they all come in at different times. They dont read the charts, dont identify themselves and freely give diagnosis and orders without consulting eachother. My nurses stepped in and limited and coordinated the visits. In one day I had 27 different people come into my room in on 24 hour period.
The other important point is PLEASE make sure that Physical Therapy is consulted. I became so swollen ( Renal failure) that I had no range of motion in my lower extremities i.e. knees and ankles. Physical thereapy came in once. The after effect now 8 weeks I had extreme muscle atrophy and muscle contractures. This has caused terrible pain, limited mobility and require physical therapy. This doesn't make new born twins any easier.
I went from an indepent busy person to completely dependent. I looked forward to my nurses coming in. I looked forward to their company and their support. It is so appreciated. We (patients) might complain about the food or lack of entertainment, but can you imagine eating hospital food 24/7 for 2 months. A few nurses would bring in something different for me from time to time and this meant so much.
Because my husband could only come up on the weekends I needed my nurses to help get my through. They provided more that just "nursing" care. I really felt that they cared about me and my boys. Thank you!0Jun 3 by tsclarkHi Elvish,
Thank you for your post! I am a mother of two, and the final baby was coming early (or so we thought). I ended up in the hospital's L&D unit for 50 days! Then I went home for 33 days and gave birth to my baby girl when she was 36 weeks, 6 days. It was rough. I have a healthy baby and I feel fortunate for that. However, I also have residual stress, what to me feels like a post traumatic stress disorder from feeling like I was hanging over a cliff for 50 days (and then another 33 days at home, which was a little easier than being in the hospital). Now that it is all said and done, when I tell professionals who are involved with women like me about what I went through, they are somewhat shocked. They ask if I ever saw a social worker (answer: nope). Did I get physical therapy (answer: nope).
So I now feel compelled to contact that hospital and try to affect some change in their antepartum unit. I know they have nurses there who previously worked for other hospitals that have lots of activities and things like physical therapy and counseling available to women on bedrest. Do you have any tips for me before I submit a letter to the manager of the L&D unit? I really want them to take me seriously and not just toss out my letter thinking they have another irritated new mother on their hands. Thank you so very much!