Sierra was ready for Wendy to be born – it had been a long
pregnancy, and, in the heat of the summer, it was even more difficult to be
pregnant. Sierra was miserable and ready to get on with being a mom again. Her
older daughter was staying with a friend when Sierra went to the hospital to
deliver Wendy. All seemed relatively normal to Sierra – she did have a bit of a
headache – but it turned out that Sierra had preeclampsia and had to have a
Cesarean section.
Sierra had chosen to keep her health insurance policy, as
bad as it was, which meant that she was going to be responsible for a hefty
chunk of the hospital bill. She didn’t know how she would pay, and, while the
thought barely crossed her mind as she met Wendy for the first time, she knew
that the financial aspect of her life would be a huge obstacle. Add to that the
fact that a complication developed with the incision the doctor had made for
the Cesarean – it had developed a hematoma and was slightly infected. The
doctors chose not to discharge Sierra for an additional day and a half.
Once Sierra and Wendy finally came home, Wendy continued to
breastfeed. Sierra introduced her older daughter to Wendy, and the three
enjoyed the company of friends and co-workers throughout the first several
weeks. Sierra didn’t often have to feed herself as friends brought ready-made
meals, making the challenges of raising a 2 year old and a new born that much
easier.
Wendy was a delightful baby who seemed to be happy and
healthy. Sierra was thrilled, but there was this growing, nagging sense that
something was wrong. There was nothing wrong with Wendy, but Sierra had a
creeping sense of doom and foreboding. She recognized the familiar sense of
depression beginning to emerge.
* What are the risks associated with a Cesarean section
delivery? There is some debate in the birthing community regarding that surgery
and vaginal delivery. Which is safer? Under what circumstances would someone
choose to have a Cesarean section versus a vaginal deliver? Does a Cesarean
preclude later vaginal delivery? (Hint: Look at the term VBAC) What are the
costs associated with Cesarean versus vaginal delivery?
* Outline the typical developmental milestones for newborns
and infants in their first year.
* What are the recommended immunizations for newborns? What
immunizations are typically provided just after birth? Which ones in the first
year? How frequently should the newborn visit the pediatrician in terms of what
is recommended? What is the CHAT and when is it given to parents? Outline
Wendy’s first year in terms of doctor visits. Provide rough information as to
the fees associated with these visits.
* What is preeclampsia? What is postpartum depression? What
is the prevalence of the disorder? How is it typically treated? What resources
might be available to Sierra in terms of self-care? Describe the potential
impact of postpartum depression on parent-child attachment.
DECISION POINT :::
A Cesarean section delivery has many risks for the mother as this is considered a major surgery. Some risks include possible infection, hemorrhage, increased blood loss, injury to organs, adhesions, extended hospital stay and recovery time, reactions to medications, emotional reactions, additional surgeries, and even possible mortality (American, 2007). The baby also encounters some risks such as breathing problems, premature birth, low APGAR scores, and fetal injury during the delivery (American, 2007).
ReplyDeleteIn general, doctors say that neither delivery option is safer than the other (Curtis, 2011). A Cesarean delivery and a vaginal delivery each have different risks. On the one hand a Cesarean delivery is a major surgery and takes more time to recover from; however a vaginal delivery may cause internal damage and is painful (Curtis, 2011). So each option comes with its own risks.
Most women decide to have a Cesarean section over a vaginal delivery if the doctor recommends it or if it is an emergency to make sure the baby and mother both live. Some specific reasons why women choose to have a Cesarean section include when the baby’s head is too large to fit through the pelvis, if she is having twins or triplets, if the baby is coming out feet first, if the baby seems distressed during labor, if the mother has eclampsia, or if the mother is sick or extremely tired during labor (Welford, 2010).
A Cesarean does not mean one cannot have later vaginal deliveries. If you have had a Cesarean birth and want to have a vaginal delivery the next time, it is possible. About 80% of women who previously had a Cesarean section were able to have vaginal deliveries safely (Weiss). However, there are some risks for VBAC (vaginal birth after Cesarean) such as uterine rupture, C-section scar opening, heavy blood loss, hypoxic ischemic encephalopathy (lack of oxygen to baby’s brain), and infections of the uterine lining. At the same time there are also risks for having a Cesarean surgery again, so mothers must decide which option is the best for them (Cornforth, 2004).
The average cost of a Cesarean section ranges from $15,799 to $21,495 while a vaginal birth costs from $9,617 to $12, 532 in the United States (Childbirth, 2011). So some Cesarean sections can be almost twice as expensive as a vaginal birth.
Sources:
American Pregnancy Association. (2007). Risks of a cesarean procedure. Retrieved January 24, 2012, from http://www.americanpregnancy.org/labornbirth/cesareanrisks.html
Childbirth Connection. (2011). Average U.S. facility charges for giving birth. Retrieved January 24, 2012, from http://transform.childbirthconnection.org/resources/datacenter/chargeschart/
Cornforth, T. (2004). Is vaginal birth safe after c-section? Retrieved January 24, 2012, from http://womenshealth.about.com/od/labordelivery/a/vbacs.htm
Curtis, P. (2011). Caesarean or natural birth- which is safer? Retrieved January 24, 2012, from http://www.guardian.co.uk/politics/reality-check-with-polly-curtis/2011/nov/23/health
Weiss, R. (n.d.). 10 reasons to choose VBAC. Retrieved January 24, 2012, from http://pregnancy.about.com/od/vbac/a/reasons2vbac.htm
Welford, H. (2010). Elective and emergency caesareans. Retrieved January 24, 2012, from http://www.bbc.co.uk/health/physical_health/birth/birth_caesarean.shtml
2. For a newborn, there are many typical milestones. From age one to three months, the baby may start to smile, by either on his/her own or in response to the environment. The baby may raise their head and chest when on their stomach, track objects with their eyes and gradually decrease eye crossing, open and shut their hands and bring hands to mouth, grip objects with their hands, and swipe at or reach for dangling objects.
ReplyDeleteFrom four to six months, they are learning to reach out to their environment even more so than from age one to three months. Babies at this age roll over front to back or vice versa. Babies will also show their first sign of language by babbling which is making sounds that are not exactly language, but are beginnings of understanding language. Babies also share their first laughter, reach out and grab for objects, and sit up with support and have good hand control.
From age seven to nine months, the baby may be on the go quite often. The baby may start to crawl, which includes scooting, army crawling, but may also be skipped depending on the child. They will sit up without any support, clap and play games such as patty-cake, pull up to a standing position. They may also respond to words such as "no" and may start to babble "mamma" and "dadda." For many parents, this is also the prime time to baby-proof the home to prevent injury.
The last developmental stage of the first year is from nine months until the child turns one year old. The child may begin to feed on their own, such as holding o-shaped foods such as Cheerios with their fingers. They may cruise around the rooms by using their feet and holding onto furniture, point at objects they desire, and may even take their first steps. Babies at this age also may use "mamma" and "dadda" for parents, but the amount of first words can vary depending on the child. They may also start to "pretend play" by copying those around them and use objects such as talking on the phone
(Baby Development Stages, 2011).
Sources:
Baby Development Stages: The First Year. (18 October 2011) WebMD-Better information, better health. Retrieved January 23, 2012, from
http://www.webmd.com/parenting/baby/infant-development-9/stages-of-development
3. There are many immunizations suggested for newborns during the time they are first born to the age of eighteen months. The immunization provided at birth is HepB, which protects against hepatitis B. During this age range, babies are recommended to have multiple doses of various vaccines, requiring new born infants to attend doctors’ visits at least five times during this period from birth to eighteen months of age. The CHAT stands for the Checklist for Autism in Toddlers. Parents are given this checklist when their child is 18 months old to see if their child is at risk for autism.
ReplyDeleteAn outline could look something like this: at birth Wendy should receive the hepatitis B vaccine, and within one to two months she should receive the second dose of the HepB vaccine. At two months of age, she should receive the DtaP vaccine, the pneumococcal vaccine, the Hib vaccine, the polio vaccine, and the rotavirus vaccine. Around four months, Wendy should receive second doses of all of the vaccines administered at two months. At six months of age, she should receive third doses of DTaP, Hib, pneumococcal, and rotavirus. Between six and eighteen months Wendy should receive a third dose of the polio vaccine and hepatitis B vaccine, and additionally between twelve and fifteen months, she should receive the MMR vaccine and fourth doses of the Hib and pneumococcal vaccines and varicella or chickenpox vaccine. These immunizations during the first year cost at least $620.00 for families who do not have health insurance. For parents with adequate health insurance, however, the cost of immunizations during the first year of life may be around $242.00, which includes co pays for the four or five visits where the shots are administered. In Wendy’s case, since her insurance is not that good, some of these shots may not be covered. If that is the case, it may be possible to get a referral from Wendy’s doctor to a public clinic where the cost would be much more affordable.
Sources:
National Immunization Program. (2011). Centers for disease control and prevention. Retrieved January 26, 2012, from http://www2a.cdc.gov/nip/kidstuff/news
The National Autistic Society. (2011) Checklist for autism in toddlers (CHAT). Retrieved January 26, 2012, from http://www.autism.org.uk/chat
4. When a pregnant woman develops high blood pressure and protein in her urine, right around the 20th week of pregnancy, this is preeclampsia. There is no known specific cause; however your genes and your diet may play a factor. Sometimes after giving birth women experience moderate to severe depression. The medical terminology refers to it as “post partum” or “postnatal” depression. The length of onset can vary between weeks after the pregnancy to months, all the way up to a year. It is normal for women to feel some depressive symptoms in the week or two following birth, but if these feelings do not subside it indicates a more serious problem. Anywhere from 10-15% of women will be diagnosed with some form of post partum depression. The smallest amount of these women will be diagnosed with the most severe form, postpartum psychosis. Doctors confirm the diagnosis by ruling out all other possibilities by way of lab tests, physical examination and history. Cognitive-Behavioral therapy and Interpersonal therapy along with medicinal approaches are used to treat postpartum depression. Sierra can do one or several things with regard to self-care in hopes of coping with her depression. One very important recommendation is to maintain a strict, full 8-hour sleep cycle. Spending time relaxing can do wonders for your mental health. Sierra should try to spend as much time enjoying the sunshine as possible. Along with sleep and healthy eating, Sierra should exercise regularly. Exercise releases endorphins and has been known to aide in the treatment of depression. Sierra can take certain antidepressants with a very rare risk of harming Wendy through breast-feeding. Wendy is in her critical period during the first months/year of her life. If Sierra does not get better she may not adequately bond with Wendy. Not creating secure attachments and feelings of trust will carry through in life. Sierra is the primary caregiver and only parent in Wendy’s life; it is absolutely essential a proper mother-daughter bond be formed.
ReplyDeleteSources:
Postpartum depression. (2010). In U.S. National Library of Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004481/
Postpartum psychiatric disorders. MGH Center for Women’s Mental Health. Retrieved from http://www.womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-disorders/
Preeclampsia. (2011). U.S. National Library of Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001900/
Segal, J., Smith, M. (2012). Postpartum depression and the baby blues: Symptoms, treatment and support. HelpGuide.org. Retrieved from http://helpguide.org/mental/postpartum_depression.htm#self
Decision Point:
ReplyDeleteSierra’s depression is dangerous for not only herself, but Wendy as well. Wendy needs her mother’s love and support now and throughout the years to come. It is very important for Sierra to treat her depression right now, not later. Because her health-care coverage is so poor, it is unlikely that she will be able to afford counseling. Sierra needs to begin antidepressants as soon as possible, but she must be weary of her prescription as to not risk passing negative effects through her breast-milk. Sierra may be able to attend some type of support group for mothers experiencing postpartum depression. Sierra should also begin to regularly incorporate exercise into her daily routine and find ways to truly enjoy spending time with herself and Wendy.