Question

Critical Thinking: Having a baby

Scenario: Having a Baby

The patient is a 17 year old female who is thought to be approximately 30 weeks pregnant, but is unsure of the date of her last menstrual period. She is a first time patient at the clinic and is accompanied by her mother. She has not had any prenatal care previous to this visit. In an effort to hide the pregnancy for as long as possible, the patient has been eating little, and is slightly underweight. There has been no effort to date to take prenatal vitamins or to alter nutritional intake or change habits. The patient states she continues to go to parties “occasionally”, where she has up to three alcoholic drinks and smokes marijuana. She doesn’t smoke tobacco. The patient is insured through her parent’s medical coverage.

The patient is single and comes from what she describes as a “strict” family. The patient informed her parents the previous week that she is pregnant and states her parents “called the family lawyer right away to ask how adoption works.” The patient says she would like to “keep her baby” but that her parents state she must be able to provide for the child if she that is her intention. She is currently not employed, and has never been employed in the past. The patient is very emotional, has not taken any steps to prepare for the baby as she has kept it a secret from her family. The father of the child is known to the mother, but she says he is refusing to accept responsibility at this point. He has cut off all communication.  

Treatment Plan:

• Ultrasound to evaluate the baby and establish a due date.
• Begin prenatal vitamins.
• High protein, increased calorie prenatal diet.
• Immediately stop alcohol consumption and drug usage.
• Fasting Lab work, including Complete Blood Count with Differential (CBC with diff), Complete Metabolic Panel (CMP), Hepatitis B and C, rubella, Rh factor, STI testing (Sexually Transmitting Illnesses), HIV, Group B streptococci.
• Weekly prenatal appointments.

This is a very complex scenario, but one that is also very common. You will note that the doctor wrote a treatment plan to address the physiological issues, with which the patient may need assistance. There are also many important sociological issues which may require the patient be directed to resources. So, what would you ask the patient? Remember, you are not solving the problems or providing the information, just asking to gather information so that the problems can be addressed by the appropriate person. Think common sense and about what kind of concerns the patient and family may have, not medical care. 2-3 questions to ask to the patient.

Answer 1

The concerns which the patient can have is how to continue this pregnancy, how to manage her academics at this time, future planning and for parents how to handle social stigma and criticism, and adoption center .The question which can be asked to the patient are

• How will you be able to care for the newborn as she herself is in parents insurance and not employed
• Is she will for giving the child for adoption .