Continuity of midwifery care for a pregnant woman with moderate hyperemesis gravidarum: A case study

Abstract

Background: Hyperemesis gravidarum (HG) can cause persistent nausea and vomiting, dehydration, reduced nutritional intake, and impaired maternal well-being. Although continuity of midwifery care is increasingly recommended for comprehensive maternal care, published case reports describing its implementation for moderate HG in Indonesian primary healthcare settings, particularly from pregnancy through childbirth, postpartum, neonatal, and family planning care, remain limited. Objective: This study aimed to describe the implementation and clinical outcomes of continuity of midwifery care for a pregnant woman with moderate hyperemesis gravidarum from pregnancy through family planning services. Methods: A descriptive case study was conducted at Elvi Diana Primary Clinic, Medan, Indonesia, involving a 19-year-old primigravida diagnosed with moderate hyperemesis gravidarum. Midwifery care was provided continuously using Helen Varney’s Seven-Step Midwifery Management Model and documented using the Subjective, Objective, Assessment, and Plan (SOAP) format. The intervention included 10T antenatal care, nutritional counseling, hydration management, dietary modification, iron supplementation, psychological support, ginger-therapy education, intrapartum monitoring, postpartum and neonatal care, breastfeeding support, and postpartum family planning counseling. Clinical outcomes were assessed through interviews, observation, physical examinations, supporting examinations, and documentation review. Results: At the initial antenatal assessment, the client experienced nausea and vomiting 6–8 times/day, decreased appetite, dry lips, coated tongue, and generalized weakness. During follow-up, nausea and vomiting decreased to mild and occasional, appetite and general condition improved, hydration status became adequate, and fetal growth remained appropriate for gestational age. Pregnancy progressed without maternal or fetal complications, followed by spontaneous vaginal birth at term. The newborn had an Apgar score of 10, birth weight of 2,800 g, length of 49 cm, temperature of 36.6°C, heart rate of 92 beats/minute, and respiratory rate of 30 breaths/minute. Postpartum recovery was physiological without signs of infection or abnormal bleeding, and exclusive breastfeeding was established. The mother subsequently initiated a three-month injectable contraceptive method. Conclusion: Continuity of midwifery care, including nutritional, hydration, psychological, antenatal, intrapartum, postpartum, neonatal, and family planning interventions, was associated with progressive improvement in HG symptoms and favorable maternal and neonatal clinical outcomes. This case highlights the potential value of continuous, comprehensive midwifery care for women with moderate hyperemesis gravidarum in primary healthcare settings.