In order to ensure that the outcome of the pregnancy is the best for mother and baby, a routine is undertaken which is embraced by the term Ante Natal care. Ante natal care is simply caring for the mothers before labour and delivery and also preparing the mothers fully for delivery because of safe motherhood. This can only be achieved by if mother is seen early preferably before the 10th week and at regular intervals thereafter. In this essay, I will be discussing one of the factors which are (GDM) gestational diabetes mellitus which affects the normal physiological pregnancy state. Gestational diabetes mellitus (GDM) is defined as carbohydrate in tolerance resulting in hyperglycaemia of variable severity with its onset and first recognition during pregnancy. Insulin is an essential hormone required for glucose transfer into the muscle and adipose tissue cells. For women with diabetes mellitus, pregnancy can present some particular changes for both mother and the child. If the woman who is pregnant has diabetes, it can cause early and very large babies (Macrosomia). Management of pregnant mothers with diabetes needs very firm and accurate control even in advance of having pregnancy. There are question whether the condition is natural during pregnancy or not. Gestational diabetes is caused when the insulin receptors do not function properly, due to pregnancy related factors such as the presence of human placental lactogen that interfere with susceptive insulin receptors. Gestational diabetes affects 3-10% of pregnancies, depending on the population studied, so may be a natural occurrence (Littleton, 2005,). During a normal pregnancy, many physiological changes occur such as increased hormonal secretions that influence blood glucose levels, such as glucose – drain to the fetus, slowed emptying of the stomach, increased excretion of glucose by the kidneys and resistance of cells to insulin.
Moving further, I as the ante-natal clinic nurse will first try to collect as much information as I can from the patient. During her 12th week of gestation, Mrs. B came for her ante natal case booking. She was already 3 months and this was her initial visit to the ante natal clinic. I booked Mrs. B by obtaining subjective data from her. I as the nurse, firstly I offered her seat so that she can sit in level with me. After that I took her personal history after greeting the client. She was feeling ease and welcomed. I communicated with her in English because she was able to understand and I also kept in mind that level of education might be low so I used simple interpretations of facts. Her first impression was very good because she was a Primip-gravida and she looked happy and relaxed. Her physical characteristics were good, because (posture) she was sitting comfortably and even she was working normally without any problem (gait). She looked health during her first visit to the clinic. After this observation during interview, I had taken her full personal history. Her full name is Mrs. B. She was born on 15th of April, 1989 at Labasa Hospital. Her age now is 24 years. Just because she is Fijian, I did not ask for her father’s name, nevertheless, she is married to a Fijian, 25 year old businessman. She is a primary school teacher. Her husband’s name is Mr. C and they reside in Namara, Labasa and both of them are Methodist. Both have attended tertiary institutions and are well educated. She gave her husband’s name and phone number for emergency purpose. Secondly, I obtained Mrs. B family history. Not much information was given by Mrs. B because her parent and grandparents were of Fijian origin and they lived in village. Her mother had diabetes only. Thirdly, I took the medical history of Mrs. B, according to her she is not having any medical problems and she was never admitted before for any illness. Mrs. B is only allergic to penicillin antibiotic. In her social history, it is interesting to know that this would be their first child in the family, so no case of negligence or overcrowding in the home. They both, husband and wife earn enough for their upcoming family. She is not a teenager and has a good age for first child bearing. She is physically, psychologically and financially strong to mother a child. They live in a concrete and iron roofing house and they reside in an industrial area. They both neither smoke nor consume alcohol or drugs. She did not have a surgical history. She did not have any abdominal, pelvic, cardiac surgeries or either injuries. I did not ask anything about her previous obstetric history because this was her first pregnancy. As a nurse, I asked her about any abortionsmiscarriage but Mrs. B said no because they used family planning devices before so she did not had any abortions and miscarriage. There was no gynaecological history for Mrs. B. Her menstrual history, she has menses which last for 3 days- 4 days. She was fourteen years when she had had her first menses (menarche). Just because Mrs. B was 12 weeks pregnant, I did not ask her about on set of movement but calculated her expected date of delivery (EDD). Her last menses occurred on 17th of February until 20th of February. It is a four days regular flow according to Mrs. B. So her expected date of delivery would be seventeen plus seven and add 9 months from indicated date, so that will be on 24th day of November. After this assessment, I did the physical examination of Mrs. B.