Reference no: EM133703015

Case Study

Min, a 37-year-old multigravida woman. She and her husband, Li, of 6 years and they already have a son, age 3. She and Li met as undergraduate students at York University. The couple moved into their new home in Markham, Ontario five years ago. Her mother, Mei also lives with them as they had originally immigrated from Hong Kong 25 years ago. Min has a younger brother who lives in Vancouver with his family. Li's family also lives in Markham, and he has a younger brother. Min is a working as an elementary school teacher. Li is a computer engineer. Li and Mei were fully vaccinated for Covid-19 but did not receive their booster vaccines in the fall of 2023. However, Min and Li declined the influenzae vaccine. An obstetrician with a planned hospital delivery will manage Min's care. Min experienced nausea and vomiting during her 1st trimester and heartburn. She likes her physical workouts but has found it hard to schedule with a toddler and being pregnant. After 32 weeks gestation, she began to experience low backache. Min had Enhanced First Trimester Screening with a Nuchal translucency ultrasound at 12 weeks and was concerned about the results given her age. Min also decided to have Non-Invasive Prenatal Testing. Her pre-pregnancy BMI = 19 kg/m2. Min gained 8 kg by 20 weeks gestation, and she eats a large variety of fruits and vegetables. She also eats fish and chicken, but not much beef. During her prenatal visits, Min was found to be slightly anemic and wondered if she was eating properly. Min is hesitant about receiving the Covid-19 and the new RSV vaccine while pregnant, although the rest of her routine vaccinations are up to date. Min was noted to have a Rh-positive blood type. During the last month, Min and Li attended a refresher childbirth class and developed a birth plan. Min decided that Li and Mei would be the support persons for her during labour and delivery. Min, at 40 weeks and she has been in labour for five hours. Her membranes have ruptured at home shortly before leaving for the hospital. Li and Mei accompany her to the hospital. She arrived at Labour and Delivery Unit as her contractions are now 5 minutes apart. She was very worried about labour pain as she was in a great deal of pain with her 1st delivery and had tried "natural" childbirth. She is now 6 cm dilated, 80% effaced and receives an epidural block for pain relief. Li and Mei help her with positioning and breathing techniques especially during the 2nd stage. Fetal heart rate monitoring showed 2 periods of early decelerations. Min's baby girl is born after four more hours of labour with the assistance of vacuum extraction. Min also has a second-degree perineal laceration. Min is discharged 24 hours after delivery. The baby girl was full-term, weighing 3200 g with Apgars of 7 and 10. Her daughter had some small lacerations on her head in the temporal area, which Min is concerned about. Min plans to breastfeed her baby. The baby girl passed her first stool 8 hours after birth. Her stool was dark green and sticky. There was a follow-up phone contact from the Healthy Babies, Healthy Children program 2 days after discharge, Min noted her lochia flow increased when she was ambulating. She has not had a bowel movement. Min does feel rather fatigued in caring for 2 children now- a very active older toddler and a newborn but is grateful for her mother's help. Li is able to take a week off from work to also help her. Mei is also helping Min by encouraging her to rest for a month and not to eat or drink anything cold as per Chinese custom. Min feels her infant is having trouble breastfeeding and she is concerned about the latching onto the breast. She has noticed that her infant only feeds for about 5 minutes and her breasts do not feel emptied and has also only a few wet diapers and one diaper with a stool per day. Min finds she sometimes needs to wake her infant up to feed. Min is also struggling with some engorgement. Min contacts the hospital's breastfeeding clinic for advice.

1. Identify and describe two social determinants of health (other than culture) impacting Thuy's perinatal experience. Provide a rationale for your response.

2. Discuss two ways that you will incorporate family-centred care when looking after Min. Provide a rationale for your response.