Long-term antepartum care in the hospital

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?