Morganna is 42 years old and has been married to Gavin (48) for the last 15 years. They have undergone a number of infertility investigations and on the second IVF attempt Morganna became pregnant.
At a private Ultrasound scan appointment at 6 weeks a multiple pregnancy was confirmed and they are both delighted.
• List some of the causes of male infertility?
• List some of the causes of female infertility?
• What investigations may Morganna and Gavin have accessed to achieve this pregnancy?
• What are the average costs for IVF treatment and investigations in the UK?
• What are the current NHS guidelines re accessibility to free fertility treatments including IVF?
• What are the current NHS guidelines re accessibility to free fertility treatments including IVF to women on Morganna’s age?
• What other restrictions than age may have affected whether Morganna and Gavin were able to access free treatments and investigations?
• Review current guidelines of the government regulator responsible for making sure fertility clinics and research centres comply with legislation.
Resources: https://www.hfea.gov.uk/
Using a PISCES model think of one thing that may affect each of the following in relation to Morganna’s wellbeing in the antenatal period when you meet her today at 8 weeks in a community antenatal clinic?
PHYSICAL
INTELLECTUAL
SOCIAL
CULTURAL
EMOTIONAL
SPIRITUAL
• Using the latest NICE Guidelines identify what are the key things the midwife needs to ask when Morganna “books” with her community midwife today?
Morganna is currently not working as she is worried re ongoing pregnancy as had a history of early miscarriages.
• How can you allay some of her anxieties re increased risks of 1st trimester miscarriages?
• What agencies and support groups are available that you could refer Morganna to for additional support with these anxieties.
Morganna is very worried re the screening tests on offer at the hospital because of her age and now that it is confirmed that she is pregnant with twins? How can we help allay these anxieties?
Resources:
Review NHS choices website
https://www.nhs.uk/conditions/pregnancy-and-baby/screening-tests-in-pregnancy/
Review “Screening test for you and your baby” (Public Health England)
https://www.gov.uk/government/publications/screening-tests-for-you-and-your-baby
Critically discuss the quality of materials available to those parents experiencing a multiple pregnancy?
• What support services are in place to support Morganna and Gavin in the antenatal period to prepare them for a twin birth?
• What other multi-disciplinary agencies could the community midwife encourage Morganna to contact to support her once the baby is born?
With a multiple pregnancy many women report that minor disturbances of pregnancy are exaggerated and more prolonged.
• List some of the minor disturbances that may affect Morganna?
Morganna rings you in between antenatal appointments at 12 weeks.
She states that she is still experiencing a lot of morning sickness, which is “why she has stopped working at present.” She has requested a “sick note” from her GP as she feels so sick all the time especially in the mornings. She says she “thought this goes away by now doesn’t it? Is is something for her to worry about?”
• What questions would you ask her today?
• What advice can you offer Morganna to cope with her symptoms
By the end of the pregnancy Morganna has a record of 8 ultrasound scan appointments.
• List the reasons and rationale for this number of Ultrasound scans being undertaken.
• Why is it important to have accurate determination of chorionicity?
Morganna is admitted for an elective caesarean section under general anaesthetic at 37 weeks. Two girls, Faith and Hope are born in good condition and are transferred to the NNU for observations and review.
After discussion with both parents a plan is agreed that both babies are to stay in NNU until day 10 as both are being fed expressed breast milk via a nasogastric tube.
Faith weighed 2.2kgs at birth and Hope 2.4kgs and both have physiological jaundice due to prematurity.
Morganna is an inpatient on the postnatal ward until day 5 when she is transferred home to community midwife care.
Describe the support the midwife can offer Morganna and Gavin when Morganna is transferred home on day 5.
• What financial support can Morganna and Gavin access to help them with visiting their daughters in NNU?