Pregnancy Case Study: Laura

Pregnancy Case Study: Laura

This case study was design to develop your critical thinking skills in how to assess risk factors, nutrition, toxic substances, and symptoms a woman may encounter during a pregnancy.  Please read the case study carefully and thoroughly answer the questions provided at the end.

Background

You work as a health coach with a group of midwives. Today you are meeting with Laura, a 34 year old woman who is 30 weeks pregnant. Laura has had one previous pregnancy that resulted in the birth of a 4400 g healthy baby, Sarah, who is now 16 months old. Laura is married, and her husband, David, is with her at this visit. David works full time as a Physician Assistant, but the practice that he works for has recently been purchased by a health plan and he is unsure about his job’s future right now. Laura works half time as a legal secretary.

Laura and David carefully planned for their first pregnancy. They were married several years ago, but waited to have their first child until they were financially secure enough that Laura could work part time after the baby came. They both made a point of making healthy food choices and avoiding alcohol when they were trying to conceive their first child. They attended both a preconception health education class and a prepared childbirth class.

Sarah proved to be a challenging baby. She is only now beginning to sleep through the night. She had “colic” symptoms until she was almost 6 months old. Laura and David felt strongly about breastfeeding, and had been to classes and read books about breastfeeding. However, they encountered some difficulties with breastfeeding for the first few weeks. These included sore nipples, a breast infection, and a perceived lack of an adequate milk supply. When Laura went back to work 3 months post-partum Sarah eagerly took bottles of formula while her mother was at work. Despite Laura’s plan to maintain exclusive breastfeeding and pumping of breastmilk for several months, Sarah was soon just nursing a couple of times a day, and stopped nursing altogether 2 to 3 weeks after Laura discovered that she was pregnant again.

Laura and David had wanted another child at some point, but this current pregnancy was not intended. Although they have accepted the pregnancy, they state that they have concerns about the effect that a new baby will have on Sarah, their marriage, and their finances. Laura admits to you while David is in the bathroom that this has caused her to be stressed and anxious about the baby for the last two months.

Laura and David have good health insurance coverage, but Laura has only been seen 4 times for prenatal care for this pregnancy.

Anthropometric Data

Laura’s prepregnancy weight with this pregnancy was 175lb. She is 6’1 ” tall. She gained 55 pounds in her first pregnancy, and lost 20 of those pounds before she became pregnant again. Today her weight is 200lb.

Health History

Laura’s health history is unremarkable. Her blood pressure today is within normal limits. She denies use of drugs, tobacco, but her husband David smells like smoke and you can see a pack of cigarettes in his shirt pocket.

Laura states that she does not like to exercise. She joined a health club a few years ago, but stopped going after about 6 weeks because she felt out of place and she thought that it was boring. She started a walking program after her first pregnancy with another new mother from her mom’s group, but her friend moved away and Laura doesn’t like to walk alone.

At the beginning of both of her pregnancies Laura experienced considerable nausea and occasional vomiting as well as overwhelming fatigue. Today Laura complains of the onset of several pregnancy discomforts that also bothered her toward the end of her first pregnancy. These include heartburn, intermittent diarrhea and constipation, fatigue, and edema in her ankles.

Dietary Intake

Before the visit you asked Laura to keep three day food records. She brings them with her today. She states that this pattern is typical for a weekday when she works mornings. Saturdays are variable depending on what errands need to be done, but usually one or two meals are at a fast food place. On Sundays Laura goes out with David and Sarah after church for a large breakfast at Denny’s (fried eggs, bacon, toast, hash browns) and then has a pizza meal in the evening.

Day OneDay TwoDay Three
Breakfast2 c. Coffee with creamBreakfast2 c. Coffee with creamBreakfast2 c. Coffee with cream
Break at WorkDonutDecaf Coffee with creamBreak at WorkDonutDecaf Coffee with creamBreak at WorkDonutDecaf Coffee with cream
LunchTuna sandwich (water packed albacore tuna, mayo, pickle relish, white bread)12 oz unpasturized Whole milkPotato chips½ sandwich leftover from Sarah’s lunchLunchSwordfish and sautéed green beansunpasturized Whole Milk½ c pretzels¼ Tuna sandwich leftover from SarahLunchTuna sandwich (water packed albacore tuna, mayo, pickle relish, white bread) 1 c Apple slices12 oz unpasturized Whole Milk½ leftover Tuna sandwich from Sarah
Snack with Sarah10 Triscuit  Crackers2 oz Cheddar Cheese slicesUnpasturized Apple Juice – 12 ozSnack with Sarah10 Triscuit Crackers2 oz Cheddar Cheese slicesUnpasturized Apple Juice – 12 ozSnack Sarah10 Triscuit Crackers2 oz Cheddar Cheese slicesUnpasturized Apple Juice – 12 oz
Dinner1/3 a large  chicken and spinach Pagliachi Pizza12 oz beerDinner1 ½ c. Spaghetti¾ c tomato sauce with ground beef1 ½ c Salad with iceberg lettuce, carrots, and tomatoes2 Tbsp. Ranch Dressing2 thick slices buttered garlic bread12 oz whole unpasturized milkDinner1 Ham and Cheese “Hot Pocket”½ c Green Peas20 French Fries12 oz whole milk1c. Hagen Das Ice Cream with Dove Chocolate Sauce
Peppermint tea 12 ozPeppermint tea 12 ozPeppermint tea 12 oz

Questions:

These questions must be answered in paragraph form (At least 2 paragraphs each, each paragraph 4-6 sentences). 

  1. What are the nutritional concerns you have about Laura?
  1. What impacts might her weight status have on this pregnancy?
  1. What recommendations might you make regarding weight gain, diet, exercise dietary supplements, and discomforts of pregnancy?
  1. What factors could affect Laura’s health during pregnancy? What factors could affect her health and her baby’s health after pregnancy? (Read carefully through all of the information given to you. This could mean toxic substances, behavior, culture, etc.)
  1. What recommendations might you have regarding these factors and improving Laura and her baby’s health?
  1. What are some lifestyle behaviors and medical interventions that Laura may want to consider during this time?
  1. If you have the opportunity to see Laura at her next prenatal visits at 32 and 34 weeks, how would you prioritize and plan your counseling?
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