REFLECTION ON OWN PRACTICE AS A TRAINEE NURSING ASSOCIATE CARING FOR A WOMAN WHO MISCARRIAGE HER PREGNANCY

A pregnant patient was referred to me as the nurse associate after admission in my area with a PV bleeding during the sixteenth week of pregnancy. After introducing myself, I offered water and a cup of tea to the patient after observing she was in excruciating pains. My task was to ensure she was well, tend to her needs and console her during her emotional grief.  The doctor suggested an internal vaginal scan to assess the situation. The patient was diagnosed with a miscarriage, and the conception products were still in the uterus. The lady was given medical choices (either through manual vacuum aspiration or medical management) to confiscate the residual parts of conception. The client and family opted for medical management of miscarriage and willingly decided how to burry the fetus according to the Muslim religion. The essay aims to study the process of medical management of miscarriage and the procedure of fetus burial.

Late miscarriages that occur after three months of pregnancy are rare compared to early miscarriages. Almost 20% per cent of miscarriages happen within three months in the UK, while only 2% of loss of a baby occurs beyond the first trimester (RCOG, 2012). In some circumstances, doctors cannot explain the reason for a miscarriage while in some cases, several factors can encourage a late miscarriage. The factors that may lead to a late miscarriage include infections, genetic factors that lead to chromosomal defects, developmental problems of the fetus, abnormalities in the uterus shape, weak cervix, diabetes and thyroid complications, antiphospholipid syndrome (APS) and thrombophilia (RCOG, 2012). The loss of a baby can be a devastating moment for a mother and family, and therefore personal and compassionate care may be necessary. For instance, holding the hands of the patients, offering water, talking to the patient and reassuring the client of a safe procedure may be significant. It is also essential to eliminate blaming attitudes from the victim since late miscarriages are unavoidable. However, the risks of a recurrent miscarriage can be avoided through body fitness, taking healthy diet and avoiding drugs and drinking (NCT, 2019).

The main indications of a miscarriage are vaginal bleeding which may be accompanied by severe pains in the abdomen and cramping. However, a patient may experience light vaginal bleeding during the first trimester without necessarily meaning a client has a miscarriage (NHS, 2018). Therefore, it is essential to verify if the symptoms are due to pregnancy loss or pregnancy complications by having an ultrasound scan. The next step should be informing the patient about the procedures, the side effects, risks or possibility of complications of the abortion management methods available. The medical staff should respect the decision of the client after offering him/her with the relevant information. The contents of natural abortion can be eradicated through surgical methods, by medical management or naturally by expectant management (Tommy’s, 2020). Surgical abortion can be carried out by dilatation and curettage(less preferred) or by use of an electric pump or manual aspiration.

Medical management of abortion involves the use of drugs such mifepristone accompanied by misoprostol or gemeprost. A patient can use misoprostol solely in case of an early pregnancy loss. Emergency treatment plans such as aspiration, treatment of resuscitation and shock should be available for patients who take up medical abortion. The medical staff should medically access the client to know whether she has allergic reactions to the abortion pills or if she has a case of haemorrhagic disorder. The abortion pills activate the uterus contraction, causing labour and soften the cervix that forces the fetus and remain of conception out of the vagina. The side effects of abortion pills may include vomiting, diarrhoea, nausea, abdominal pain, fever and headaches (Vekemans, 2008). Mifepristone and misoprostol are sometimes administered together since they work better to complete a miscarriage. Patients can take misoprostol pills orally by placing under the tongue to by introducing into the vagina. For late miscarriages like the patient in question, she may need to remain in the hospital for regular checkups to ascertain all the products are expelled. When misoprostol tablets are taken orally, three are used by placing under the tongue for not less than 30 minutes and four if placed in the vagina. The intake of abortion pills may be accompanied by antibiotics (BPAS, n.d.).

The usual symptoms experienced after medical management of abortion include bleeding and severe cramping within a few hours of pills intake. The pain due to cramping can be relieved by ibuprofen. Bleeding may extend up to fourteen days while cramping may be experienced for two weeks. The patient is also likely to experience emotional fluctuations due to hormone interference (HealthLink BC, 2020). Adverse conditions such as continuous bleeding for more than 12 hours, infections, vaginal discharge; swelling in the genital areas and hot flushes may require thorough medical attention. The patient should be adequately prepared for the expected results of the procedure since the remains may subject the mother to emotional turmoil. The discharge may also be ugly to witness, and therefore a lot of care is required (MiscarriageAssociation, 2020). The complications that may arise include blood clots jamming the cervix, uterine muscle rupture, infections or atony.

Physical and emotional discovery from a miscarriage may take some time depending on the client’s nature. The patient may feel exhausted and uncomfortable or relieved due to the termination of the process. However, the patient may need time off work to regain physical and emotional stability due to the loss of blood (MisccariageAssociation, 2020).  The hospital has the responsibility of informing the patient on the available disposal options and respecting the client’s decision. The medical staff should handle the remains with revere and consider the cultural and religious beliefs of the patient. The disposal options available include burial, cremation, incineration or handing over to the family involved (HTA, 2015). According to the Muslim religion, a fetus of sixteen weeks is developed and can be identified as a baby and human being. If the abortion was unintended like the lady in question, the fetus deserves a proper cremation ceremony (Kilshaw, 2017). 

           I had an incredible experience working with the lady and delivered my best as a nurse associate trainee. I learnt that tending to the needs, preferences and desires of a patient is paramount in the delivery of medical care. Even though I might be a professional, considering the patients need is significant and creates a positive working environment. However, medical staff should inform a client about medical procedures and provide compassionate care due to patient vulnerability. I also learnt the causes of late miscarriages could be determined after abortion by tests and body scans to avoid recurrent miscarriages in patients (Babycentre, 2007). For future practices, I will boost my efforts in caring for the patient to console them during the grievous moment and informing him/her on the medical procedures available.

References

Babycentre. 2007. Understanding late miscarriage. BabyCentre UK. Viewed 28 November <https://www.babycentre.co.uk/a1014773/understanding-late-miscarriage>

BPAS. n.d.. Medical management | Miscarriage care | BPAS. Abortion clinics, Information, Advice and Treatment | BPAS. Viewed 29 November <https://www.bpas.org/more-services-information/miscarriage-care/medical-management/>

HealthLink BC. 2020. Medical abortion care. Viewed 28 November https://www.healthlinkbc.ca/health-topics/tw5273

HTA. 2015. Guidance on the disposal of pregnancy remains following pregnancy loss or termination. Viewed 28 November <https://www.hta.gov.uk/sites/default/files/Guidance_on_the_disposal_of_pregnancy_remains.pdf>

Kilshaw, S. 2017. Birds, meat, and babies: The multiple realities of fetuses in Qatar. Anthropology & Medicine24(2), 189-204. Viewed 28 November< https://doi.org/10.1080/13648470.2017.1324617>

MiscarriageAssociation. 2020. Missed or incomplete miscarriage – information for you. The Miscarriage Association. Viewed 28 November< https://www.miscarriageassociation.org.uk/information/information-on-coronavirus-covid-19/missed-or-incomplete-miscarriage-information-for-you/>

MisccariageAssociation. 2020. After a miscarriage. The Miscarriage Association. Viewed 28 November <https://www.miscarriageassociation.org.uk/information/miscarriage/after-a-miscarriage/>

NCT. 2019. Miscarriage: Your questions answered. NCT (National Childbirth Trust). Viewed 28 November <https://www.nct.org.uk/pregnancy/miscarriage/miscarriage-your-questions-answered>

NHS. 2018. Miscarriage. nhs.uk. Viewed 28 November< https://www.nhs.uk/conditions/miscarriage/>

RCOG. 2012. Recurrent and late miscarriage. Royal College of Obstetricians & Gynaecologists. Viewed 28 November <https://www.rcog.org.uk/en/patients/patient-leaflets/recurrent-and-late-miscarriage/>

Tommy’s. 2020. Incomplete miscarriage. Viewed 28 November< https://www.tommys.org/pregnancy-information/pregnancy-complications/baby-loss/miscarriage/types-miscarriage/incomplete-miscarriage>

Vekemans, M. 2008. First trimester abortion guidelines and protocols Surgical and medical procedures. International Planned Parenthood Federation (IPPF), 37. Viewed 28 November <https://www.ippf.org/sites/default/files/abortion_guidelines_and_protocol_english.pdf>

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