WEBVTT

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(calm music)

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<v ->Since this is your first visit with us,</v>

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we're going to be doing

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what we call a prenatal profile today

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then after our checkup, we'll be drawing blood

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and getting a urine specimen from you

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then if you agree, I'd like you to go over to the hospital

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for an ultrasound.

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That'll give us a better idea of the baby's gestational age.

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<v ->Whatever.</v>

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<v ->You said that you thought</v>

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you were around six months pregnant?

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<v ->Right.</v>

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<v ->You mentioned that you got prenatal care</v>

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with your other three pregnancies.

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<v ->Yeah.</v>

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<v ->Well, I'm wondering,</v>

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what was different this time with this pregnancy?

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<v ->What was different this time?</v>

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Well, at first, I didn't think I was pregnant.

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When I kept missing my period,

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I thought maybe I was going through the change already.

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Wishful thinking.

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<v ->So this pregnancy wasn't planned?</v>

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<v ->No.</v>

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<v ->What did you think</v>

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when you realized that you were pregnant?

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<v ->I thought, oh, joy, here we go, another kid, fourth one.</v>

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<v ->So you weren't happy about it?</v>

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<v ->What do you want me to say?</v>

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<v ->Well, how are you feeling now?</v>

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Has anything to changed?

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<v ->If you're talking to someone and they're looking away</v>

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or they're evasive in their answers

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then just ask, what's wrong, what are you going through,

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what can I do to help you

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and to let them know I'm here and I'm listening

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and sometimes they may not respond right away

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but a lot of times,

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if you make that available to patients right away

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that even if their answers very curt and dry,

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"nothing, I don't wanna talk to you,"

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okay but I am here if you do wanna talk and I'm listening

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and a lot of times, when you come back

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then they might say a little bit more and a little bit more

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but just to constantly reinforce that I'm here to help.

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<v ->I use a lot of open-ended questions.</v>

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I just let her talk basically,

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have the Kleenex box on the side

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and just closeness, eye contact, touch

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and just really listen to her 'cause everyone's different,

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everyone's story is different

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and I just try to use the most non-judgmental

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and very calm body language

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but really just listening to their story,

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taking cues from them and building that trust and rapport.

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<v ->Has anything changed?</v>

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I notice that you left marital status blank

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on your intake form.

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<v ->Oh, well, I'm married.</v>

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<v ->Is your husband the father of all your children?</v>

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<v ->Yes, all my children like the soap opera.</v>

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<v ->Well, how did you both feel about having another baby?</v>

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<v ->Considering my husband wanted me to get an abortion,</v>

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what do you want me to say?

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<v ->This must be very difficult.</v>

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<v ->Yeah.</v>

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<v ->What made you decide against having an abortion?</v>

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<v ->I couldn't do it.</v>

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I basically chickened out.

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I made the appointment and I couldn't go through with it.

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Sometimes I wonder if I should have gone through with it.

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<v ->Have you and your husband ever discussed other options</v>

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for the baby?

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<v ->I don't know what I'm going to do.</v>

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<v ->So it's important for the nurse</v>

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and to realize that not only do we have to plan

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for the health of this pregnant person

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and to be concerned about the health of this unborn child

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but we also have to be concerned about the emotional

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and social health of both the mother and the unborn child.

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<v ->Of course, looking at them, watching their body language,</v>

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watching their nonverbal communication also tells a story.

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<v ->So if there's anything in that interviewing process</v>

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that gives an, that is an indicator or a red flag even

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that something else is going on here

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then it's time to make a referral

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because what you get is a closer look.

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<v Joni>Come in.</v>

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<v ->Joni, have you got a minute?</v>

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<v ->Sure.</v>

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I really need to talk to you about one of my patients.

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I'm having a hard time figuring out how to help her.

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<v ->Okay, well, let's talk over coffee.</v>

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<v ->Okay.</v>

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<v ->Okay, so what's going on?</v>

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<v ->40 year old woman, fourth pregnancy, 24 weeks along.</v>

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<v ->Mhm.</v>

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Yeah, this looks private.

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<v ->She came in for her first prenatal visit</v>

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just the other day.

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When I was examining her, I found bruises on her wrists

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and on her chest.

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What happened here?

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I had already asked her

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all the usual domestic violence questions and she denied it.

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So I asked her again.

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<v ->Go on.</v>

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<v ->Her husband wanted her to get an abortion</v>

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but she couldn't go through with it.

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He's battering her now, I know it.

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I caught myself thinking,

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don't you dare take that baby home.

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I can't believe I got so upset.

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I mean, it is not my decision

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but I am so worried about that baby's welfare.

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<v ->Well, I'm glad you talked to me about it.</v>

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Elaine, you are such a wonderful nurse

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and it's great that you care so much about your patients

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but I'm a little concerned right now

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that you're so involved with this woman

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and that you're so upset.

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<v ->Wait, it gets worse.</v>

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I just got her blood work and her ultrasound.

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Spina bifida.

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<v ->Wow.</v>

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<v ->I'd really like you to go in with us next time we meet</v>

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so that we can talk to her together

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and you can talk to her about pregnancy options.

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<v ->Okay, good, I'll be glad to.</v>

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<v ->Good, thank you, Joni.</v>

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Celia, I know the doctor talked to you yesterday

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so you know that your baby has a form of spinal bifida

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which is a defect of the spinal column

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and can cause disabilities.

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The good news is that there are many children

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that get along really quite well.

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<v ->I know, I knew it, I knew there was something wrong.</v>

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I could feel it.

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The baby will be brain damaged, won't it?

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Just tell me.

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<v ->Not necessarily.</v>

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Spina bifida can cause brain damage

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but there is a surgical procedure called shunting

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which can be done shortly after the baby's birth

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if necessary.

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That will relieve the pressure on the baby's brain and-

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<v ->I can't handle this right now.</v>

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<v ->Look, I know you're upset.</v>

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I know the information that you got is overwhelming

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and I know you must probably have a lot of questions.

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Part of my job is to make sure

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that you have all the education and information you need.

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I brought you these pamphlets to read.

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I wanna make sure you know about all your options

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including the option of adoption.

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You certainly don't have to make any decisions right now.

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I do want you to know all the information though

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so you can make the best choice for yourself

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and for your family.

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<v ->I think adoption should be presented as an option</v>

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right from the beginning.

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People often say, "I don't know what I'm gonna do"

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and I think right then is where options can be presented

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that you know what, it's not a hopeless situation.

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There are options available to you

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and women are thinking about options

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right from the beginning

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then it may change their ultimate decision.

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<v ->When there is ambivalence about the child</v>

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or ambivalence about the role of parenting

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that that child may not thrive in that environment

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and when that child is not able to thrive

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in that environment

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that an option for that child may be adoption

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and parents often need help

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to be able to choose that option.

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<v ->Now, there are different types of adoptions</v>

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including attorney assisted adoption

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and placement with relatives.

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<v ->No one in my family</v>

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would be able to handle a baby with problems.

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<v ->Okay, well, there are adoption agencies</v>

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that specialize in finding families

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for babies with special needs.

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A lot of them encourage the birth parent

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to help select an adoptive family

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and even to have contact after the adoption is finalized.

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There are families that would consider adopting a baby

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with spina bifida.

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<v ->Really?</v>

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<v ->Absolutely.</v>

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Now, is it okay for me to meet with you

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after your next OB appointment?

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That way, you don't have to make two trips?

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<v ->Yes, that would be fine.</v>

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<v ->Good.</v>

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When we have a little more time together,

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we can talk about options

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or whatever else might be going on.

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I can get you more information

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or help you get plugged into whatever services

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you might need and help you make decisions

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about what your next step will be.

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And Celia, I will need to explain to you

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that your husband will have to agree

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to whatever plan you make for the baby.

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<v ->You're not telling anyone this is what you should do,</v>

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this is what you have to do but what you're saying

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is that this is an option that's available to you

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and I just wanna provide information about it

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because it may not have been something

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that they ever thought about in a lot of cases, it isn't.

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<v ->The person might just plainly come out and ask me,</v>

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"what shall I do, what shall I do?"

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I say, well, I cannot tell you what to do

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but I can help you.

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The decision is yours.

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However, I am willing to work with you

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to help you make that decision.

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<v ->I do believe that a lot of the problems</v>

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that our clients have come from a lack of self-esteem

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and it's amazing when you start to work with somebody

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what kind of impact you can have on them

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by showing them that respect

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and by saying that, I believe you can do it

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because I believe that people can help themselves

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if you give them a little bit of help

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and you give them a little bit of hope

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and a little bit of self-confidence.

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<v ->If we work with women and and use this opportunity</v>

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to really support them,

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they will look back on this experience

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and feel good about the decisions that they made

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that they actually made the decision,

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that they didn't become more dependent

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on someone else to make it for them

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and no one will ever be able to take that away from them.