In essential exams to check if everything was as

In this assignment, I
need to reflect on the situation that taken place during my clinical placement.
As a student of midwifery it is important for me to be with experienced
gynecologists and learn from their experience so that my future practice will
be as enrich as possible. 

Midwifery means
”With Woman” which includes the necessary care and needs of woman and not the
needs of obstetricians. As I could say, a midwife is a fundamentally person
centered in the woman with compassion, encourage and advisory role.

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first week that I went to the hospital and I was at the external obstetrics, a
37 years old woman, I will name her ‘Mrs. A’, came to find out if she was
pregnant because she has missed 3 periods. The doctor told me to weigh her and
take her pressure. After that we analyzed the woman’s health history. Her BMI
was 28, so she was an obesity woman and the child was going to be her first
one. The exams shown that she was at 10-11 weeks’ gestation. The doctor told
her to do the essential exams to check if everything was as expected for her
and the baby that she could manage to continue the pregnancy. Doctor also
recommended her to notice her nutrition because of her weight. Before she leaves,
she mentioned to the doctor that her job is full-time and a very anxious one
and she used to smoke 1-2 cigarettes per day. The doctor seemed to be annoyed from
the fact she forgot to mention such important issue but he advised her to relax
and quit smoking because it affects the baby’s health. It seemed quite clear to
me that the woman did not understand the seriousness of the case and the fact
that her health at the time of pregnancy reflect the progress of the fetus, but
I hoped she would follow doctor’s instructions. It was very special for me to participate
to an announcement of a pregnancy because it is the most joyful news especially
for a couple who has not a child yet . Next appointment with MRs A was planned
for the following week so I continued my clinical placement.

 When Mrs.A arrived, she had all the exams but
she seemed to be little nervous. I asked her if she was okay but during our conversation,
I could not stand the intense smell of a cigarette meaning that she did not
follow the doctor’s instructions . Doctor was the first one to remind her about
the smoking but she told him that she controls it and there was no worry about
it. I felt very strange because this was going to be the first child and she had
 to protect it by all means. She left and
the next appointment was planned in a month to see the progress of the
pregnancy. By the end of the month my practice was ended and I thought that I would
not meet MRs. A again but one day she showed up.. She was very upset and
confused and she was desperately looking for the doctor and when she finally
found him she started talking to him incessantly. She told him that the last 2
days, she experienced a vaginal bleeding where the blood was red, in big
quantity, but she thought it was nothing until the time an unbearable pain
started. Immediately the doctor sent her for an ultrasound exam and he
confirmed her nightmare, that there was no heartbeat, in other words, MRs A has
a miscarriage. At that moment the emotions was so intense. She started crying;
continuously repeating herself that she was the one to blame and that
everything was her fault. I tried to calm her down without showing my feelings
as I had to be strong and supportive for a woman who had just lost her child.

After one hour the
doctor informed her about the loss. Miscarriage is defined as a loss of
pregnancy before 13 weeks’ gestation. The type of miscarriage that Mrs. A had
was ‘threatened abortion’, more specifically a pregnancy which shows bleeding
from genitals without threatening the woman’s life. The etiologies are
different in any case but one cause is the age of the mother. Usually at the
age of 35-40 the risk is higher and Mrs. A already knew that, chromosomic and
anatomic anomalies are also factors that affect gestation. Furthermore, risky
habits such as smoking can cause a miscarriage. The doctor gave her 2 different
options from which she had to choose and follow as a treatment. 

The first one was
medical treatment and the second surgical. Then he explained to her the
advantages and disadvantages of each option. Mrs. A, considered the surgical
option as safer, so they planned the surgery for the next day. She stayed in
the hospital all day, until the surgery was completed. For the rest of the day
I was by her side trying to give her the appropriate care she needed. The next
day was full of pressure and anxiety as Mrs. A was scared and horrified of the
next step, but I tried to calm her down. After the surgery she was exhausted
and she was in pain. I did not know how to help her, so I tried to call the
doctor. I had been trying to contact him for 3 hours but he wouldn’t answer, so
a nurse helped Mrs. A until doctor came. She stayed in the hospital for 3 days
and the time she was about to leave, she told me that I had been really useful
and supportive and that she appreciated all the help I had given to her.



In this paragraph I
will discuss my feelings and thoughts. I empathized with Mrs. A, because I was
in front of the pregnancy announcement and I knew that her pregnancy would be
an important change in her life.I could say that she was worried about that
baby but there were many risk factors that she had to take into consideration.
After the confirmation of pregnancy loss I tried to build up a trustworthy
relationship with Mrs. A because she had to trust me so I could encourage her.

I still remember how
difficult it was because at my first attempt when I asked her to calm down and
listen to me she was crying over 10 minutes without listening to anyone so I
had to be helpful. I brought her a glass of water and I asked her to drink it
and few minutes later she was relaxed and felt comfortable with me. I tried to
make a start by keeping an eye contact with her because according to Wilma,
direct eye contact could express a sense of interest in the other person. Then,
Mrs. A held my hand and she tried to express her pain. I stood next to her so
she could understand she could count on me. In that way I was able to support
her not only psychically but as well as emotionally. My emotions before I found
out about the pregnancy loss were different about Mrs. A. When I smelled the
cigarette I was annoyed because I thought that she did not care about that
pregnancy and I judged her for that behavior. But, when I tried to come closer
in order to calm her down I realized that she really wanted the baby and was a
hurt woman and very sensitive.


It is important for
me to provide at least the basic care. If I ever come across a client like Mrs.
A, I would know how to deal with it. I would prepare myself better, firstly,
not to judge anyone and also to know how to help a woman in pain after surgery.
In regard to the doctor, I believe he tried to provide the best professional
care in the way he could, but I consider that he should have asked Mrs. A if
she used to smoke. Smoking in general is an unhealthy habit and in cases like a
pregnancy it affects baby’s health, as well. Also, after a surgery he has to
nurse the patient. The 3 hours waiting was very painful for Mrs. A. The doctor
has to be close to his patient and keep control of their progress. In addition,
I believe that  Mrs. A should have been
more careful, too. She should have listened to her doctor’s advice and quit


After writing this
reflection, I have realized how important it is to communicate and compassion
with the patients. Mrs. A needed encourage and professional care and I this is
the reason why I have to always be available. A pregnancy loss causes pain,
guiltiness and anger. There are normal feelings that the woman experiences and
she needs a person next to her to support and listen to her concerns. The woman
has to recover and to move on. Every midwife ought to have the knowledge to
confront this situation and provide professional and sensitive care without
involving and her own feelings.




Action Plan

My plan for my future
role as midwife is to develop my skills in communication and caring in order to
ensure the trust of clients. Communication is the key to an honorable
relationship. I have to be able to support the woman not only emotionally but
practically and with the right information. I have to be a professional and not
to bond with the patients because I will not be able to offer the highest
quality care if I involve my own feelings in each situation. I will educate my
spirit in order to give advices and answer all the patients’ questions. The
caring needs of a woman are individual and depend on how each woman perceives
her loss so I have to be able to give the appropriate attention.