Chapter 15: Care of the Childbearing Woman

Sabrina is a first-time mother, who had an emergency caesarean section as her labour had stopped progressing and the fetal membranes had been ruptured for over 24 hours. Sabrina and her baby Malachi were discharged home 36 hours after the birth as both of them were well, and Sabrina had good support at home from her partner and mother. Malachi is breastfeeding and initially appeared to position himself well at the breast and seemed to feed effectively.

Unfortunately, when Kay the community midwife visited Sabrina and Malachi at home on day 6 after the birth, it was clear that Sabrina was unwell, with a temperature and severe pain at the wound site. Kay completed a full assessment and realised that Sabrina had a severe wound infection with some dehiscence. Kay contacted Sabrina’s GP for an urgent review. Sabrina was subsequently admitted to hospital as her wound had failed to heal and she required intravenous antibiotics.

Sabrina and Malachi were admitted to a side room of the surgical assessment unit and you have been allocated to care for them. On admission, Sabrina is clearly upset and Malachi is unsettled.

Questions

  • What are your priorities?
  • How would you ensure that your care was individualised and person-centred?
  • Which other members of the multidisciplinary team would you ensure are involved in Sabrina and Malachi’s care?

Answers

You will need to prioritise care for both Sabrina and Malachi and also consider their needs as a mother–baby unit. Sabrina’s physical health needs are important and the wound infection needs to be treated and her vital signs monitored. It is important that the team are aware that Sabrina is breastfeeding and that her medication is prescribed appropriately. Sabrina’s pain also needs to be managed and her nutrition and hydration considered so that she is able to feed and care for Malachi. Sabrina may need additional snacks between meals to ensure wound healing and the nutrition required for breastfeeding. Sabrina’s emotional needs are important as the adjustment to motherhood can be challenging, particularly in the first 14 days after birth.

Sabrina’s birth experience may have been traumatic, and the early days at home may have been difficult due to the pain from the surgical wound and the effects of the infection. Sabrina will need support and reassurance to continue to care for Malachi during her admission, and may feel that she is not able to provide for Malachi’s needs as much as she would like. Sabrina is likely to need additional support from her family and consideration of having someone to stay with her during the day and overnight would be appropriate. It is important that Sabrina and Malachi be not separated to ensure that breastfeeding and bonding can continue to be established, and that her confidence in caring for her baby is built. Positioning and attachment for breastfeeding may be difficult and Sabrina may need to feed Malachi in alternative positions to avoid pressure on her abdomen. Referral to the infant feeding specialist and midwifery staff would be appropriate. Sabrina may also be seen by the tissue viability/wound care specialist nurse. In preparation for discharge, information should be shared with Sabrina’s GP and health visitor to ensure that she continues to receive appropriate support at home.