Medicine in Society Guide Malta 2021/22

Preparatory work

In preparation students should have:

• Found out about the range of local maternity services available to women; and some local and national data relating to childbirth.
• Prepared some questions in order to talk to a pregnant woman about her choices for antenatal care and the birth of her child.
• Looked at the NHS website, it’s heath A-Z  has a wealth of information for patients covering everything from fertility and conception to childbirth, and specifically reviewed the section covering antenatal care.
• Reviewed some of the information about pregnancy on the healthtalk.org website.
• Thought about the choices women face when they are pregnant, where they might seek information and what role healthcare professionals have in empowering women to make informed choices; the birthrights and national childbirth trust (NCT) websites are a good staring points for some of these questions.
• Read this newspaper article regarding the drop in teenage pregnancy rates in the UK and this summary of teenage pregnancy statistics.
• Looked at the MMRACE-UK website, focussing on the inequalities in maternal mortality (this infographic highlights the key messages from the 2019 report).
  
  

Aims 

To understand the course of an uncomplicated pregnancy; to be aware of the choices women have about their pregnancy and childbirth and to gain an understanding of the importance in facilitating and respecting these choices.

 

Learning Outcomes

By the end of the day, students should be able to:

• describe an uncomplicated pregnancy and childbirth;
• list some the possible choices that women can make in relation to ante-natal care and place of birth;
• discuss the different factors that influence women’s choices about their pregnancy and childbirth;
• describe a health promotion intervention for pregnant women provided by the practice;
• critically consider the health promotion information available within the practice and local area;
• practise blood pressure measurement and urinalysis.

  

Example timetable

9.30 – 10.30	Tutorial on pregnancy and childbirth
10.30 – 10.45	Tea break
10.45 – 11.45	Prepare for patient encounters Plan questions and observations   Patient encounters Interview a pregnant, or recently pregnant, woman Sit in with a midwife or GP for an antenatal appointment Meet with a professional involved in providing care to pregnant women e.g. midwife, doula, person working for local voluntary organisation
11.45 – 12.45	Students feedback to group on their patient, or other, encounters
12.45 – 13.45	Lunch
13.45– 14.45	Health promotion during pregnancy
14.45 – 15.00	Tea break
15.00 – 16.00	Pregnancy timeline activity Set homework for final session

 

 

Suggested Activities

• Tutorial on pregnancy and childbirth – could include discussion or debate of the question/s ‘is pregnancy a medical condition?’ and/or ‘what is the role of the medical profession?’; consider that the GP is often the first point of contact for a pregnant woman and what is covered in this initial appointment e.g. early discussion of choice about whether to proceed with the pregnancy, calculating gestation, discussing local antenatal care options; antenatal care schedule and check-ups including why do we check BP, urine, fundal height and fetal movements?
• Pregnancy timeline activity – students work in pairs/small groups to put key pregnancy milestones at the correct gestation.
• Health promotion during pregnancy– could include group discussion of areas/activities this covers e.g.  advice around smoking, diet, exercise, alcohol and immunisations; consider what information is available within the practice and what services the practice offers? Could include any current 'hot topics' e.g. occupational health for pregnant women during COVID-19 (see RCOG advice).
• Interview a pregnant, or recently pregnant, woman with a view to discussing her choices, and how she (and her partner/family) arrived at them; if possible, look at handheld antenatal notes.
• Interview with a healthcare professional, or other person, involved in providing services for pregnant women.
• Discuss informed consent and choices in the context of pregnancy and childbirth, the importance of communication skills, and the role of the GP, and other healthcare professionals, in in facilitating and respecting women’s choices; could use include role-play scenarios, case discussions, patient stories e.g. these graphic stories.
• Practise blood pressure measurement and urinalysis.

  

Questions for students to consider

• How did you view pregnancy and childbirth before today?  Have your views changed at all as a result of today’s meetings and discussions?
• How important do you think it is that women should have choices, and adequate information and support to make these choices, in pregnancy and childbirth?  Do you think this could pose difficulties for the healthcare professionals caring for pregnant women?  How might you deal with patients making choices that you did not agree with?