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Family / Social Circumstances Protective Factors (please tick): Partner employed Family support Community support Child-care arrangements Able to access support Other (Please state). Social Circumstances and Family Functioning (Discuss using suggested questions in Section 2 of the Family Health Assessment guideline) What cultural or social isses are identified with the family that may impact on the child and / or parenting? Parental Physical and Mental Wellbeing (Discuss using suggested questions in Section 3 of the Family Health Assessment guideline) What parental health issues are identified with the family that may impact on the child and / or parenting? Domestic and Family Violence (Discuss using suggested questions in Section 4 of the Family Health Assessment guideline) What relationship issues are identified with the family that may impact on their child and / or parenting? Alcohol, Tobacco and Other Drug Use (Discuss using suggested questions in Section 5 of the Family Health Assessment guideline) What substance use issues are identified with the family that may impact on their child and / or parenting? Pregnancy Outcomes (Discuss using suggested questions in Section 6 of the Family Health Assessment guideline) What pregnancy / birth issues are identified with the family that may impact on their child and / or parenting? Infant Health (Discuss using suggested questions in Section 6 of the Family Health Assessment guideline) What infant health issues are identified with the family that may impact on their child and / or parenting? Family Strengths and Resources (protective factors) What strengths and resources does the parent/carer identify that support their child and / or parenting? Peer/interdisciplinary review required Care plan documented Thank the parent for their participation. Health professional to explain the following in own words: x In this health service, we are concerned about your health and safety, so we ask all women the same questions about violence at home; x this is because violence is very common and we want to improve our response to families experiencing violence. In the last year, has your partner hit, kicked, punched or otherwise Yes No hurt you? In the last year, has your partner put you down, humiliated you or Yes No tried to control what you can do? Yes No If domestic violence has been identified in any of the above questions, continue to questions 5 & 6 5. Here is an example already completed I have felt happy: Yes, all the time c this would mean ?I have felt happy most of the time Yes, most of the time z during the past week No, not very often c Please complete the other questions in the same way No, not at all c In the past 7 days: 1. Yes, most of the time I haven?t c As much as I always could c been able to cope at all Not quite so much now c Yes, sometimes I haven?t been c Definitely not so much now c coping as well as usual Not at all c No, most of the time I have coped c quite well No, I have been coping as well c as ever 2. I have been so unhappy that I have had things difficulty sleeping As much as I always did c Yes, most of the time c Rather less than I used to c Yes, sometimes c Definitely less than I used to c Not very often c Hardly at all c No, not at all c 3*. I have felt sad or miserable things went wrong Yes, most of the time c Yes, most of the time c Yes, quite often c Yes, some of the time c Not very often c Not very often c No, not at all c No, never c 4. I have been so unhappy that I have been reason crying No, not at all c Yes, most of the time c Hardly ever c Yes, quite often c Yes, sometimes c Only occasionally c Yes, very often c No, never c 5*. The thought of harming myself has occurred good reason to me Yes, quite a lot c Yes, quite often c Yes, sometimes c Sometimes c No, not much c Hardly ever c No, not at all c Never c Administered/Reviewed by: Date. Mothers who score above 13 are likely to be suffering from a depressive illness of varying severity. The scale will not detect mothers with anxiety neuroses, phobias or personality disorders. More information and support for women is available through Beyond Blue: the national depression initiative, 2007 Information Line: 1300 22 4636 W:

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Smoking is linked to heart disease and cancer, In a small percentage of strokes there is bleeding into as well as to stroke. This bleeding can be from a broken blood damages blood vessels and makes blood more likely vessel or from a bulging aneurysm that has broken open. If you smoke and would like to quit, many There is no way to tell the type of stroke until the person techniques and support systems are available to help, gets to an emergency room and undergoes a thorough including seeking help from your health care provider medical evaluation. Most mini-strokes get stop, and some of the damage from smoking actually better within a few minutes, although they can last several may be reversible. Although the signals of a mini-stroke disappear person has stopped smoking, his or her risk of stroke quickly, the person is not out of danger at that point. Even if you do not smoke, be aware risk of having a full stroke within the next 2 days. Avoid long-term exposure to cigarette smoke Risk Factors and protect children from this danger as well. The risk factors for stroke, meaning things that make a stroke more likely, are similar to those for heart disease. Other risk factors can be controlled through diet, build up on the walls of your blood vessels. With a history of high cholesterol include egg yolks and organ meats, such as liver blood pressure, previous stroke or mini-stroke, diabetes and kidneys. High Blood Pressure Uncontrolled high blood pressure is the number one Preventing Stroke risk factor for stroke. If you have high blood pressure, You can help prevent stroke if you: you are approximately seven times more likely to have a stroke compared with someone who does not have high Control your blood pressure. Regular exercise reduces your damages organs, including the brain, heart and kidneys. Ask the chance of developing high blood pressure, heart the person to raise both arms. As with other sudden illnesses, looking or feeling ill, or behaving in a strange way, are common, general signals Time: Try to determine when the signals began. By paying attention to the signals of stroke and reporting Sudden severe headache. The person will not know them to your health care provider, you can prevent what caused the headache and may describe it as damage before it occurs. Do not Dizziness, confusion, agitation, loss of consciousness ignore its stroke-like signals, even if they disappear or other severe altered mental status. Does one side of In the past, a stroke usually caused permanent the face droop (Fig.

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Others said they had to dig and dig for information about reimbursement for a home birth, often getting few answers from the 39 As this dissertation goes to print, in fact, the Florida Legislature is proposing a 20% cut to fees for birth centers and midwives paid by Medicaid, a move that could further reduce the number of midwives and birth centers that accept the state-based insurance (Felicia). One Blue Cross/Blue Shield subscriber wrote that the birth center she used ?had a hell of a time billing them but they eventually paid up (Julie, ?Re: Your Study). However, for the care she received after she had to transfer to the hospital: ?They paid thousands to [the doctor] and the hospital without a peep. According to her bill, her insurance company paid for $20,000 of the cost, and she was left with $6,000 to pay out-of pocket. With her third child, she had a similar experience?home birth turned cesarean?but this time was enrolled in Medicaid, and the government program footed the entire bill. What the bills she received do not show, however, is what fraction of the cost Medicaid actually paid, or what rate her insurance company negotiated to pay with her first birth. What she sees is that the government-funded program paid every cent without giving her any trouble; with her first birth, she was still getting calls from the midwife because insurance refused to pay a portion of the cost. By contrast, ?Medicaid definitely made this pregnancy the most stress free financially. Clearly, there are a host of factors at work in shaping the contours of maternity care in Florida. One of those is how such care is paid for, both because caregivers are constrained by economic forces and because women are constrained in their choices about which caregiver to see. However, the use of insurance to pay for maternity coverage is not simply a business transaction, it is also a series of discursive exchanges, of one discourse community communicating with others, of the health insurance industry communicating not only with 149 pregnant women and their families, but also with health care providers and the general public. What the following analysis will show is that beneath any explicit list of services available to women based on their insurance status, lies a powerful discourse that identifies what kind of patient they are, based largely on how their care will be paid for. My argument is that this discourse acts as another constraining force by delineating which women should be proactively making meaningful decisions about their care and which ones should be grateful for whatever care they receive. Only since the 1990s has health insurance been its main business, when it merged with U. For the past three years (2008, 2009, and 2010), Fortune magazine has named the company the most admired company in the Health Care: Insurance and Managed Care category (?Aetna History), and the company currently has 37 million enrolled members (?Aetna Facts). Dedicated to helping people achieve health and financial security, Aetna puts information and helpful resources to work for its members to help them make better informed decisions about their health care (?Aetna Facts). The image of the informed health care consumer looms large in industry discourse, as we will see, and also in the language of consumer advocacy groups?organizations like Childbirth Connection are based around the idea that informed pregnant women should be able to make meaningful decisions about their 150 health care (?Vision, Mission, and Beliefs). Henderson further defines ?consumers as people who are able to make their own decisions about the care they receive, express opinions about the care and evaluate the care (105). In one image, a baby with big blue eyes and a red and white striped hat looks upward, and the caption below reads, ?We?ll empower, not overwhelm. The overall message of this flashy part of the site instructs users to maximize their health care by utilizing all of the state-of-the-art technology Aetna has created to make the experience of health care provision a user-friendly 151 Figure 8: Screen capture of the SmartSource tool for Aetna members. By customizing the website and making available the use of mobile applications, the website gives users tools for becoming smart health care consumers. The implicit message for Aetna users is that utilizing technologies designed especially to help them maximize their benefits is one way they can take ownership of their health care and start to make ?better informed decisions.

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Communication Eating, drinking Explain all procedures, seek permission, and discuss findings with the woman. Cleanliness Encourage her to breathe out more slowly, making a sighing noise, and to relax with each breath. Use clean gloves for vaginal To prevent pushing at the end of first stage of labour, teach her to pant, to breathe with an open examination. Birth companion Encourage support from the chosen birth companion throughout labour. Unless indicated, do not do vaginal examination more frequently than every 4 hours. If not felt: Hold the baby gently with hands around each thigh and thumbs on sacrum. Include: >more warm cloths >two sets of cord ties and razor blades >resuscitation equipment for 2 babies. If transverse or oblique lie, gently turn the baby by abdominal manipulation to head or breech presentation. There may be one large placenta with 2 umbilical cords, or a separate placenta with an umbilical cord for each baby. If pallor: Severe palmar and conjunctival pallor or If late labour: >Is it severe pallor? Therefore it is important to start thinking early about what family daytime feedings more than 4 hours apart and no night feedings more than 6 hours apart; no planning method they will use. If she (and her partner) want more children, advise that >her menstrual cycle has not returned. Discuss how to prepare for an emergency in postpartum Advise to always have someone near for at least 24 hours after delivery to respond to any change in condition. Preparation for home delivery Immediate postpartum care of mother Check emergency arrangements. Delivery care Postpartum care of newborn Follow the labour and delivery procedures D2-D28 K11. If partner is present in the clinic,askthe woman if she feels comfortable ifproblem? If pallor,check for anaemia ?Assess if in a high risk group:Occupational exposureIs the woman a commercial sex ?No pallor. If heavy vaginal bleeding Record all treatment given, positive findings, and the scheduled next visit in the home-based and clinic recording form. If dribbling urine ?Have you been able to concentrateHave you had your usual level ofHow has your sleep been? Assess if in a high risk group: Occupational exposure Is the woman a commercial sex worker? If due:?Explain to the woman that the vaccine is safe to be given in pregnancy; it will not harm the baby. The injection site may become a little swollen,red and painful,but this will go away in a few days.

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