Critically explore how wider determinants of health may impact on women, newborn infants, and their families.

Midwifery care in teenager pregnancy ( public health related)

Case study
Chelsea is a 17-year-old teenager whom you and your practice supervisor met at the antenatal clinic for her booking appointment at 16 weeks gestation. This is her third pregnancy and unplanned. She found out about her first pregnancy when she was 15 but had a termination of pregnancy because her mum and stepfather were unsupportive. Her boyfriend then was 16, who told her he was too young to be a dad and he did not want to have anything to do with her. She had Jerzy 11 months ago at 36 weeks, birth weight was 1900grams and his biological father is not around. Both Chelsea and Jerzy live in a 3 bedroomed rented flat in Medway, with her mum, stepfather, 12-year-old younger brother Fraser and her half – siblings, Alice and Sammie who are 5 years old twins. The flat is very cramped and damp, which has been reported to the local housing office. The family would like to be rehoused and are on the waiting list. Jerzy was formula fed and has had 2 episodes of emergency admissions for gastro-enteritis. The Health Visitor regularly monitors Jerzy’s health and development.
Chelsea was born in Medway when her own parents were 17 and 18 respectively. She is of mixed ethnicity, her mother is UK White, while her father is originally from North Africa. Her parents never married but lived together in Medway until Chelsea was 7 and Fraser was 2. Both experienced traumatic events during their childhood when their parents were together, they witnessed domestic abuse in the family and there were concerns about neglect before the parents separated. Their father moved to France shortly after the separation and hardly gets in touch neither with them nor their mother.
The relationship between Chelsea and her stepfather is difficult, she finds him controlling and has run away from home on a number of occasions. She was twice admitted for intentional self-harm at 16 and has since been on medication for anxiety and depression. Chelsea smokes 10 cigarettes a day and finds it difficult to quit because both her mum and her stepfather smoke. She mentioned that smoking helps her cope with stress levels and poor mental health. She also smoked throughout her last pregnancy, had poor antenatal care engagement due to socio- economic issues and had growth scans for suspected fetal growth restrictions. Her mother is unemployed, but her stepfather is a manual labour worker, which he finds stressful.
Chelsea’s boyfriend, Raz is 18 of Nepalese background. He has been in the UK since he was 5-year-old. He is unemployed, but happy about the pregnancy and trying to get a job to support himself, Chelsea, and the family. Chelsea is interested in working with children and due to start her childcare apprenticeship job before she fell pregnant again but has not attended recently as she felt so tired. At booking, her Body Mass Index was 17 kg/m2. You found on her online record that she was recently treated for Chlamydia, has had two suicide attempts requiring A&E admissions and previously used recreational drugs which were not disclosed at booking.
Scenario based assessment and plan of care with rationale, meeting the module’s four learning outcomes (3,000 words).

For a given scenario, students are required to:
1)  Evaluate the role of the midwife in managing and evaluating normal midwifery care and in developing care plans to meet individual needs.

2)  Critically explore how wider determinants of health may impact on women, newborn infants, and their families.

3)  Critically analyse the public health role of the midwife in leading and promoting normality when working with multi-disciplinary, multi-agency and specialist teams in different settings.

4)  Challenge assumptions around maternal vulnerabilities, mental health, social needs, or individual differences in the provision of effective care.
Underpin their assessment with relevant literature and contemporary policy.

 Critically explore how wider determinants of health may impact on women, newborn infants, and their families.

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