Scenario go through

Background-

  • 28 years old

  • from Romania

  • 34+6 weeks

  • husband 30 lives in medway

  • moved to UK to be with her husband

  • unplanned pregnancy

  • husband also smokes

Prev hx

  • third pregnancy G3 P1+1, misc 2021 18 weeks,

  • 2022 EMCS 41+2- prolonged second stagte, suspected fet compromise, failed instrumental after mediolateral episiotomy

    • neonatal resus- neonatal unit admitted

    • moderate hypoxic ischaemic encephalopathy- recieved therapeutic hypothermia

    • disch at 7 days


Social factors

  • husband answers on her behalf whilst at day unit

    • discloses partner inc controlling over past year

    • manages household finances, checks her phone, discorages contact with her friends, insists on going to all antenatal appointments

    • denies physical violence- feeling frightened and changes behaviour to dec conflict

  • worried about rising food costs and reduced her job hours due to fatiuge

  • skips meals as financially struggling- feels guilty about not providing enough for family

  • She reports a history of adverse childhood experiences

    • witnessing DV in family

    • unable to education after 16 years- financial

  • socially isolated and unsupported

  • booked pregnancy at 16 weeks

    • missed 2 appointments

  • misses follow-up appt in diabetes clinic- childcare, work, transport cost

  • find hard follow healthy diet advice- cost

Physical factors

  • reports RFM more than 24 hours

  • skips meals- financial reason

  • booking BMI 32

  • smoker

    • 10 a day- due to stress

  • 28 weeks- GDM

    • attended initial diabetic clinic but not follow-up reviews- childcare, work, transport cost

    • find hard follow healthy diet advice- cost

    • not monitor glucose levels, recorded several high levels

    • LGA can be caused by gest diabetes

    • link to bmi

    • HIE- GDM

  • ultrasound 34+4- LGA 92nd centile

Psychological factors

  • once alone becomes anxious

  • after prev birth

    • PTSD- received trauma-focused Cognitive Behavioural Therapy

    • symptoms improved but recurred in current pregnancy

  • ongoing anxiety- poor sleep, intrusive memories, feeling on-edge

    • especially when conflict or raised voices

  • struggled develop emotional attachment to unborn baby

  • stressed- smokes 10 a day

  • RFM triggered fears baby complications same as prev happened

  • scared about labour and birth and how will cope after baby born

  • "Everyone thinks I'm coping, but most days I feel overwhelmed and sometimes wonder whether my family would be better off without me”- says as leaves appt


go over in class-

  • husband answers on her behalf whilst at day unit

    • discloses partner inc controlling over past year

    • manages household finances, checks her phone, discorages contact with her friends, insists on going to all antenatal appointments

    • denies physical violence- feeling frightened and changes behaviour to dec conflict