Midwifery and nursing issues in the intensive care setting

Introduction The admission of a critically ill pregnant or postpartum woman to an intensive care unit (ICU) provides unique challenges to nursing staff for a variety of reasons. The physiological adaptations of pregnancy underscore a different set of “what is normal.” Obstetric conditions that ICU staff may be unfamiliar with, nursing needs unique to this population, such as checking the fundus and supporting the establishment of lactation, and the presence of the fetus, all contribute to making the pregnant and postpartum woman a challenge. Similarly, midwives and obstetric nurses may find caring for critically ill pregnant and postpartum women testing given the potential instability of each woman’s condition and the additional monitoring and technological support she may require. It can present a challenge for two healthcare teams, critical care and maternal health, and requires clear communication, explicit patient goals, and sometimes negotiation to promote the health of the mother and fetus. Little research has been done to provide an evidence base to guide the management of critically ill pregnant and postpartum women. Consequently, much that has been written is experiential observational work or extrapolated from the non-obstetric critical care literature [1]. The purpose of this chapter is to provide meaningful information for nurses and midwives caring for critically ill pregnant and postpartum women. This chapter discusses the various clinical settings in which critically ill parturients may be cared for, along with the common nursing and midwifery staffing arrangements. Modifications to routine ICU care for pregnant women are outlined as well as the routine maternity care for pregnant women in ICU. Maternity care for critically ill postpartum women is described in detail.