Older women were more often classified as having “high-risk” pregnancy at initial appointment, and were more likely to have serum screening and amniocentesis (Windridge & Berryman, 1999). In an Australian qualitative study of first mothering over 35 years, the majority of participated women were well-educated (tertiary degree/diploma) career women. Most of these women had decided to delay childbearing to pursue their career goals or other plans (Carolan & Nelson, 2005). In another study which explored health concerns and health-promotion behaviors of pregnant women aged ≥ 35 years, 78% of participants were college educated (Viau, Padula, & Eddy, 2002). So these women were more likely than younger mothers to independently reach for health information, and gained perceptions that they were at risk for adverse pregnancy outcomes.

Women age 35 and over were more likely to have infants with lower birth weights, give birth before 37 week gestation, have multiple birth, and stillborn, compared to women age under 35 (Tough, Newburn-Cook, Johnston, Svenson, Rose, & Belik, 2002). Tough et al. (2002) found that maternal age did not influence the small-for-gestational-age (SMA) rates and suggested that maternal complications played a role in preterm delivery among women aged ≥ 35. In a later study, Newburn-Cook and Onyskiw (2005) did a systematic review to determine whether or not older maternal age is a risk factor for preterm birth and fetal growth restriction. They found that maternal age affected both gestational age and birth weight. However, earlier study of Windridge and Berryman (1999) found no association between maternal age and gestational age at delivery. Another study reported similar SGA and large-for-gestational-age birth rates among women of very advanced maternal age and of general population (Callaway, Lust, & McIntyre, 2005).

Interestingly, Windridge and Berryman discovered that infants who were born to women age 35 and older were more likely to have 1-minute Apgar score of 8 or over. Few maternal age effects were noted in the medical records of these women, so they should have “no objective reasons to have had more serious concerns for their babies’ safety, because of their own age alone, than women in younger age group” (1999).

So there are conflicting conclusions among studies about whether maternal age is linked to gestational age, and pregnancy outcomes. The disparate findings are probably a result of differences in the inclusion criteria. Those studies that reported positive pregnancy outcomes tended to recruit older women who had good general health, uncomplicated pregnancy, and a chromosomally normal fetus.  Newburn-Cook and Onyskiw suggested more studies with adequate control for age-dependent confounders needed to be conducted to determine whether maternal age caused an independent and direct effect on birth outcomes (2005).

There was a significant difference in Caesarean delivery rates between the group of women aged 45 or greater (49%) and the 20-29 year age group (23%) (Callaway, Lust, & McIntyre, 2005). However, in an earlier study, Windridge and Berryman found no age or parity associations with Caesarean deliveries (1999). The likelihood of women at age 45 or over undergoing Caesarean section might depend on whether they could conceive naturally, as this ability possibly was associated with good physical health. The Caesarean section rate was 44.6% in the group of women who conceived naturally, as opposed to 82% of women who required assisted reproductive technology (Callaway, Lust, & McIntyre, 2005).

Carolan (2005) interviewed and analyzed the pregnancy experiences of 22 first-time mothers aged 35 and over. The findings were grouped into five sequential themes: “the project” during pregnancy and prior to conception, “the nightmare of early mothering” 1-4 weeks postpartum, progress with difficulty and uncertainty 1-4 months postpartum, “giving in”/realizing/”finding my own way” 4-6 months postpartum, and “feeling like a mother” 6-8 months postpartum. Most women had tremendously prepared for their conception and pregnancy experiences by gathering information and trying to be as knowledgeable about their health and the available supportive resources as possible to ensure the best pregnancy outcomes. Despite their extensive planning to get pregnant, several women did not prepare supplies for the infant, such as a room, a pram or a cot, as they were unconfident about their infant survival. Younger women also expressed concerns about something might go wrong with the baby (Robb, Alder, & Prescott, 2005).

Robb et al. reported no relationship between maternal age and emotional experience in primigravidas, but significant differences might exist between individual women (2005). In another report, women aged over 35 years were more likely than younger women to have concerns for their babies’ safety during labor, more likely to express definite satisfaction with the way staff dealt with arising problems, and less likely to blame the staff to make their pain worse ( Windridge & Berryman, 1999). In contrast with common understandings of advanced mothers as having high anxiety and depression levels postpartum, of 22 women in Carolan & Nelson’s study, only one woman experienced mild postnatal depression (2007).

Although the studies of advanced maternal age pregnancy continue to generate controversy, researchers have shown that the differences in pregnancy outcomes and experiences among older and younger women are less significant than common understandings. The general health of a woman when getting pregnant seems to play an important role as one of the predictors for pregnancy outcomes (such as preterm birth and fetal growth restriction) rather than her age alone. More research needs to be conducted to confirm this implication. As the majority of older pregnant women are well-educated career women and proactive health seekers, nurses need to be knowledgeable about health resources and their accuracy to provide adequate answers to health concerns, establish trust and better support advanced maternal age women.

References

Callaway, L.K., Lust, K., & McIntyre, H.D. (2005). Pregnancy outcomes in women of very advanced maternal age. Australian and New Zealand Journal of Obstetrics and Gynaecology 45, 12-16. Retrieved October 1, 2008, from CINAHL database.

Carolan, M. (2005, October). Doing it properly: The experience of first mothering over 35 years. Health Care for Women International, 26(9), 764-787. Retrieved October 1, 2008, from CINAHL database.

Carolan, M., & Nelson, S. (2007). First mothering over 35 years: Questioning the association of maternal age and pregnancy risk. Health Care for Women International, 28 (6), 534-555. Retrieved October 1, 2008, from CINAHL database.

National Center for Health Statistics (1989). Trends and variations in first births to older women, 1970-86 (DHHS Publication No. (PHS) 89-1925). Hyattsville, Md. US Department of Health and Human Services.

National Center for Health Statistics (2001). Birth: Final Data for 1999. DHHS Publication No. (PHS) 2001-1120). Hyattsville, Md. US Department of Health and Human Services.

National Center for Health Statistics (2005). Birth: Final Data for 2003. Hyattsville, Md. US Department of Health and Human Services, 54 (2).

National Center for Health Statistics (2007). Births: Preliminary Data for 2006. Hyattsville, Md. US Department of Health and Human Services, 56 (7).

Newburn-Cook, C., & Onyskiw, J. (2005, October). Is older maternal age a risk factor for preterm birth and fetal growth restriction? A systematic review. Health Care for Women International, 26(9), 852-875. Retrieved October 02, 2008, from CINAHL database.

Robb, F.V., Alder, E.M., & Prescott, R.J. (2005). Do older primigravidas differ from younger primigravidas in their emotional experience of pregnancy? Journal of Reproductive and Infant Psychology, 23 (2), 135-141. Retrieved October 1, 2008, from Cumulative Index to Nursing and Allied Health (CINAHL) database.

Tough, S.C., Newburn-Cook, C., Johnston, D.V., Svenson, L.W., Rose, S., & Belik, J. (2002). Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics, 109 (3), 399-403. Retrieved October 1, 2008, from Cumulative Index to Nursing and Allied Health (CINAHL) database.

Viau, P.A., Padula, C.A., & Eddy, B. (2002). An exploration of health concerns and health-promotion behaviors in pregnant women over age 35. MCN The American Journal of Maternal/Child Nursing, 27 (6), 328-334.

Windridge, K., & Berryman, J. (1999, March). Women’s experiences of giving birth after 35. Birth: Issues in Perinatal Care, 26(1), 16-23. Retrieved October 30, 2008, from CINAHL database.

To get good grades:

• When I study, study to get 100%…of course I never finish my studying to be confident that I could get 100%, this is just to motivate myself, KEEP STUDYING)
• When I’m about to take the exam, imagine that I’m gonna get only 85% and still feel ok with that —> relax –> less anxiety, better grade.

So, the idea is to convince yourself that it’s ok to get a lower grade than you expected, RELAX ^^…

(Don’t be too relax that you on the exam like me once , I got bad grade for that one for being too anxious at first, and too relaxed at last. I find out I got 100% any time I did not want it badly, wish I could be calm and got luck more often.)

Don’t change my answer if I:

• have no idea about the topic
• don’t have a really good reason for the change

Change my answer if I:

• recognize I misunderstood the question and find the other choice correct
• find a part of my first choice is wrong

If I think all options given are wrong and can’t choose one:

• choose the one that even if it’s wrong, it’ll do the least harm.

If I think all problems given can be right to be serious:

• Choose the one that is most acute and require immediate attention (usually mental status involved)

If I have no idea about the topic:

• Eliminate those answers that can be in the same group (lab tests for the same purpose, same group of disease…), look for common points

Will add more if I can think of something else . Do you have any tip that can help me? Please share them .

What was my impression? Oh, my feeling was not good, it’s gonna be worse than mom-baby clinical. The instructor looked serious. She rarely smiled. The facility did not look that great: small, and well…not a warm and welcomed place. There are tons of paperwork that need to be filled out while on the floor: care plan, patient profile, med, psycho- social assessment…. can’t believe it. The assignment are not clear, and as my med-surg clinical last semester, there will be a lot to prepare before the day.

(Dân trí) – John thuộc tuýp dễ khiến người ta ghét. Bởi lúc nào anh cũng “phởn phơ” và luôn nói những điều tích cực. Giả dụ bạn có hỏi “dạo này anh khỏe không?”, thế nào anh ta cũng nói: “Nếu còn khỏe hơn được nữa thì hẳn tôi có anh em sinh đôi rồi”.

John là nguồn động viên tự nhiên nhất với mọi người. Nếu đồng nghiệp nào có một ngày làm việc tồi tệ, anh thường bảo họ cách nhìn ra khía cạnh lạc quan của hoàn cảnh. Chứng kiến điều này, tôi thực sự tò mò. Vậy là một ngày, tôi quyết định tới hỏi John: “Tôi không hiểu nổi! Không thể lúc nào anh cũng là người lạc quan. Vậy làm thế nào anh làm được điều đó?”.

Anh trả lời, “Mỗi sáng, khi thức dậy, tôi thường tự nhủ, hôm nay mình có hai lựa chọn. Mình có thể vui vẻ hoặc có thể cáu bẳn. Và tôi đã chọn tâm trạng vui vẻ. Mỗi khi có chuyện gì không hay xảy ra, tôi có thể chọn hoặc là nạn nhân hoặc có thể học hỏi điều gì từ chuyện đó. Và tôi đã chọn cách thứ hai. Mỗi lúc ai đó tới phàn nàn với tôi, tôi có thể chọn cách hoặc chấp nhận nghe lời phàn nàn của họ, hoặc có thể chỉ ra những phương diện tích cực của cuộc sống. Và tôi đã chọn cách nhìn ra niềm vui ở đời”.

“Vâng, đành là như vậy. Nhưng như thế cũng đâu có dễ dàng gì”, tôi phản bác.

“Đúng thế”, John tiếp tục. “Cuộc sống là những lựa chọn. Nếu anh vứt bỏ đi tất cả những điều vụn vặt thì mọi tình huống trong cuộc sống đều là sự lựa chọn. Anh chọn cách phản ứng với những tình huống đó như thế nào. Anh chọn cách để mọi người tác động tới tâm trạng của anh ra sao. Anh chọn vui vẻ hay buồn chán. Điều quan trọng nhất chính là lựa chọn bạn nên sống cuộc sống của bạn như thế nào”.

Tôi ngẫm nghĩ về những điều John nói. Chẳng bao lâu sau, tôi bỏ công việc đang làm để mở công ty riêng. Tôi và John mất liên lạc với nhau nhưng tôi vẫn luôn nghĩ tới anh mỗi khi cần phải lựa chọn trong cuộc sống thay vì phản ứng lại nó.

Nhiều năm sau, tôi nghe tin anh bị tai nạn rất nghiêm trọng. Nghe đâu anh bị ngã từ một tòa tháp viễn thông cao gần hai mươi mét. Sau mười tám giờ phẫu thuật và hàng tuần nằm điều trị đặc biệt, John ra viện trong tình trạng bị nẹp xương lưng.

Khoảng sáu tháng sau vụ tai nạn, tôi gặp lại anh. Khi tôi hỏi anh thấy thế nào thì anh đáp, “Nếu mà khoẻ hơn được nữa thì hẳn tôi có anh em sinh đôi. Này, có muốn ngó qua đám sẹo của tôi không?”.

Tôi từ chối nhưng hỏi anh đã nghĩ gì khi vụ tai nạn xảy ra. “Điều điều tiên lướt qua tâm trí tôi lúc đó là cuộc sống hạnh phúc của đứa con gái sắp ra đời của tôi”, John đáp. “Khi đó, tôi nằm trên mặt đất, tôi nhớ rằng mình có hai lựa chọn. Tôi có thể chọn để sống và cũng có thể chọn để chết. Và thế là tôi chọn sống”.

“Anh không sợ chút nào ư? Chẳng phải anh đã bất tỉnh đó sao?”, tôi hỏi.

John tiếp tục, “Các nhân viên y tế thật tốt bụng. Họ liên tục bảo rằng nhất định tôi sẽ ổn. Nhưng khi họ đưa tôi vào phòng cấp cứu, nhìn vẻ mặt của các y bác sỹ, tôi đã thực sự hoảng sợ. Trong mắt họ, tôi đọc thấy dòng chữ “anh ấy chết rồi”. Tôi hiểu rằng tôi cần phải hành động”.

“Và anh đã làm gì?”, tôi hỏi.

“À, lúc đó một cô y tá to lớn hét to câu hỏi vào tai tôi. Cô ấy bảo tôi có dị ứng với cái gì không. “Có”, tôi đáp vậy. Các y bác sỹ tạm ngừng công việc để chờ tôi trả lời. Tôi hít sâu một hơi rồi nói to: “Trọng lực!”.

Át đi tiếng cười của họ, tôi bảo: “Tôi đã chọn để sống. Hãy mổ cho tôi như là tôi đang sống chứ không phải đã chết”.

John đã sống, nhờ vào tài năng của các bác sỹ, nhưng cũng là nhờ thái độ sống kỳ diệu của anh. Tôi đã học được anh điều đó. Mỗi ngày, chúng ta đều có các lựa chọn để sống thật trọn vẹn. Sau tất cả mọi điều, thái độ sống là tất cả.

Đỗ Dương

Lược dịch theo Francie Baltazar-Schwartz

http://dantri.com.vn/tinhyeu-gioitinh/Dieu-ky-dieu-cua-su-lac-quan/2008/9/252273.vip

]]> http://wittyruby.wordpress.com/2008/09/27/di%e1%bb%81u-k%e1%bb%b3-di%e1%bb%87u-c%e1%bb%a7a-s%e1%bb%b1-l%e1%ba%a1c-quan/feed/ 0 wittyruby http://wittyruby.wordpress.com/2008/09/27/5th-clinical-day-labor-delivery-unit/ http://wittyruby.wordpress.com/2008/09/27/5th-clinical-day-labor-delivery-unit/#comments Sat, 27 Sep 2008 22:38:02 +0000 WittyRuby http://wittyruby.wordpress.com/?p=504 ]]>

I was on Labor and Delivery Unit. I expected to observe a vaginal birth, but there was none going on. The unit was slower than usual. There was only about 4 clients in the morning, and one of them did not want to have students. I was hanging around for a while, and then helped Kim prepare for a C-section of twin.

I observed tubal ligation with spinal anesthesia. The doctor gave me a quiz. Unfortunately, I forgot what 5% solution mean, so I got it wrong. Now I would remember for life, hopefully, that 5% solution means there is 5 g of drug in every 100 mL solution. He also taught me a way to calculate the dosage quickly. The surgeon made a short cut at the client’s umbilical area. I imagined after the incision healed, no one would notice any scar on the client, as it would be hidden with the umbilical skinfold. “That’s nice,” I thought. After pulling the tube out on one side, the surgeon tied it 3 times, cut it off, and did the same to the other side. I guessed the woman would have a lot of pain after all this pulling.

I also went into a ultrasound session. The parents came to have their fetus checked because they suspected their son was arrhythmic. The doctor said he was fine. He just turned around a lot. It was interesting for me to look at the ultrasound monitor. I could not tell one thing from the other, as everything was just black and white. Then while the doctor was explaining what was on the screen to the parents, I could see the fetal heart beating. That was eciting.

After lunch, I went to my third C-section. The client had twin. The same anesthestist gave the client an epidural anesthesia. Spinal and epidural anesthesia procedures looked the same for me. I could not tell which one is which by observing only. I took care of baby B and gave her medications. I did not have a chance to do her first bath, as her temperature was still low when I left.

Although there was not much going on in the early morning, it was another good day for me toward the end. So far, I haven’t done any Foley Catheter insertion, and haven’t seen hearing test, and vaginal birth. I hope I’ll have a chance next week.

…need to manage time better soon, ko thì bị tẩu hỏa nhập ma mất, …Stress is when you know exactly what to do, but don’t do it. I can, and will do it, yeah!

This week’s clinical day was more as an observation day for me. I followed S.J. to assess a baby, and this time it was not as easy for me to listen to the baby’s breath sounds. This baby’s heart beats were not as strong and clear as other babies I had, so it’s harder to listen to his breath sounds.

Then the mom tried to breastfeed her baby as much as she could before the baby had circumcision. It was difficult at first. A staff lactation nurse was called to assist her. I was there and learned some good information.

Then I collected the data for my project for almost the rest of my time. I learned to understand the information presented in the mom and baby’s charts. There are rich details from the charts.

After lunch, the nurse let me see how she removed the surgical staples from a C-section mom. It looks a little scary and seems to be painful for the mom. Anyway, she was fine after the procedure.

It was not a hands-on day for me, but still a good educational day. I learned a lot about finding information from the charts, and it was great to be able to understand what I read.