Lecture 1: Introduction to Perinatal Nursing in Canada

Perinatal Period

Period during the childbearing year, from preconcepition all the way to first year post partum.

BScN degree, plus extra knowledge, extra education. It is a specialized area of nursing.

Requirements to eb a perinatal nurse in canada:

CAPWHN: Canadian association of perinatal and women’s health

This assosiation has standards for this specialty area that guide nursing care:

Obstetrician

Specialized physicians that are educated in caring for wome who are at high risk for perinatal (poor) outcomes. High risk issues during pregnancy

Family practive physicians

Doctors who look after low-risk pregnancies

1. obstetrician

2. family practice physician

3. Midwives

4. Nurses

5. Social workers

Members of the perinatal health care team:

Society of Gynecologists and Obstetricians of Canada (SOGC)

This society develops practice guidelines for perinatal care. Phycisians develop these guidelines, follows a biomedical model.

The body is broken into different parts, not looking at the hollistic person. Very medicalized. Pregnancy is seen as an illness that needs to be fixed.

How is pregnancy viewed from a biomedical perspective:

Canadian Nurses Association (CNA)

Who offers specialty certification for perinatal nursing in Canada?

1. Rural

2. Remote

3. indigenous communities

4. inner city

Where is it especially hard to access good quality maternity care? [4}

Great facilities, nobody to work them (staffing issues)

What is often an issue in rural Newfoundland towns in terms of perinatal care?

• People leave their communities, family support, to have their babies.

• Oftentimes they are scheduled to be induced and have to wait (often in hotel rooms out of their own pocket).

What happens when there is no access to perinatal care in an area?

1. less educated

2. living in poverty

two groups of women who often have poor perinatal outcomes:

Government imposed poverty,

No running water on reserves or access by roads

limited access to health care

Why might indigenous women have poorer than the national perinatal outcomes?

1. poor nourishment

2. smoking

3. alcohol and drug use

4. chronic conditions

Why might women living in poverty have poorer perinatal outcomes? [4]

Family-Centered Maternity and Newborn care

•Participation of clients and their families in the decision-making process concerning their perinatal experiences to promote optimal health and well-being

Family-Centered care.

Care model believes that childbirth and pregnancy is a normal, physiological process, and medical interventions are given only when absolutely necessary.

1. Epidurals

2. Pain medication

3. Ultrasound

Examples of medical interventions for perinatal care: [3]

c-section

As soon as a fetal heart rate goes on, the risk for what immediately increases?

30%

C-section rate in NL

1. Infection

2. Bleeding

3. puts baby at risk

C-section puts mom at risk for what?

1. Listen to what patient’s want

2. Listen to the language we use (not controlling or negative

How to provide culturally safe perinatal care: [2]

98%

How many people deliver in a hospital?

1% (there are none in NL)

How many people give birth at a birth centre?

1%

How many people give birth at home?

More in natural, normal, low risk. Very hands off, no medical interventions

Midwifery approach to delivery

Canadian Association of Midwives (CAM)

How are midwives regulated?

50

There are more than how many perinatal health indicators?

number of live births per year per 1000

Birth rate =

number of deaths of infant under the age of 1 per 1000 live births

Infant mortality rate =

MOrbidity

Disease and illness

830

According to WHO, how many women die each day related to complications in pregnancy and childbirth?

Bleeding to death

Leading cause of death for women during pregnancy and childbirth

1. bleeding out

2. Infection

3. Hypertensive disorders

4. Eclampsia

5. Preeclampsia

6. Unsafe/backstreet abortions

7. Obstructed labours

8. Mental health disorders

9. Anaphylactoid syndrome of pregnancy

reasons women die during childbirth/pregnancy [9]

Anaphylactoid syndrome of pregnancy, or amniotic fluid embolus

Membrane ruptures releasing amniotic fluid into the bloodstream, causing an embolus. It is a rare condition

problems because of chronic illlnesses, placental issues, and risk for abnormalities because of age (ex: downs syndrome)

Issues when pregnant in 40s and 50s

up

teen pregnancy rates in indigenous communities are going…

down

Teen pregnancy rates are going…

1. hypertension

2. diabetes

3. tend not to get pregnant easily

4. miscarriages

5. fetal death

6. Often need c-section

Risks for obese people and pregnancy [6]

Many obese people are malnourished. They have poor healing, need longer hospital stays. They are in the hospital for much longer.

Why are obese people more at risk of infection after c-section