Maternal Newborn Nursing Today

What is maternal-newborn nursing?

Care of clients during pregnancy, childbirth, postpartum (up to 1 year for maternal outcomes), and newborns (first 4 weeks)

Primary goals of maternal-newborn nursing?

Health promotion, prevention of complications, education, advocacy, and family-centered care.

Definition of fertility

Ability to achieve pregnancy within 6-12 months without medical intervention

At what age does female fertility begin to decline?

Around age 32.

Why does fertility decline with age?

Decreased number and quality of oocytes

BMI ranges associated with infertility

BMI >27 (ovulatory dysfunction) and BMI <17 (hormonal dysfunction/anovulation)

Lifestyle factors that decrease fertility

Smoking, obesity, excessive/vigorous exercise (especially with BMI <25), poor diet

Definition of maternal morbidity

Health conditions caused by pregnancy or childbirth

Definition of maternal mortality

Death during pregnancy or within 1 year postpartum related to pregnancy

Leading cause of pregnancy-related death in the U.S.

Mental health conditions (suicide, substance use disorder)

Definition of postpartum hemorrhage

Blood loss >500 mL after vaginal birth or >1000 mL after cesarean birth

Most common cause of PPH

Uterine atony

The “4 Ts” of PPH

Tone (uterine atony), Trauma (lacerations), Tissue (retained placenta), Thrombin (clotting disorders)

Age associated with increased maternal risk

Older than 35 years

Chronic conditions that increase maternal risk

Hypertension, diabetes, cardiovascular disease, asthma, mental health disorders

Lifestyle factors that increase maternal morbidity

Smoking, alcohol use, substance use (including marijuana)

Definition of fetal mortality

Death after 20 weeks of gestation

Definition of infant mortality

Death before 1 year of age

Leading causes of infant mortality

Congenital anomalies, prematurity/low birth weight, SUID, unintentional injuries

Which group has the highest maternal mortality in the U.S.?

Black clients

Contributing factors to racial disparities in maternal health

Structural racism, implicit bias, chronic conditions, access to and quality of care, SDOH

Goal maternal mortality rate

15.7 deaths per 100,000 live births

Key maternal-related Healthy People 2030 goals

Reduce maternal death, reduce severe complications, increase postpartum depression screening, reduce preterm birth

Key components of therapeutic communication

Active listening, open-ended questions, respect, empathy, silence, clarification

Why therapeutic communication is important

Builds trust, improves outcomes, increases client satisfaction

Definition of family-centered care

Care that includes family as part of the care team and decision-making process

Example of community-based care

Home visits, breastfeeding support groups, immunization clinics

Certified Nurse-Midwife (CNM)

RN with a graduate degree who provides pregnancy, birth, and postpartum care

Certified Professional Midwife (CPM)

Non-RN midwife, often attends home births, cannot prescribe medications

Indicates for transfer during home birth

Fever, meconium-stained fluid, abnormal fetal heart rate, prolonged labor, hypertension

Four elements required to prove malpractice

Duty, breach of duty, harm, causation

Definition of beneficence

Acting to benefit the client and do more good than harm

Definition of autonomy

Respecting the client’s right to make their own decisions

What is a therapeutic abortion?

Abortion performed to protect the client’s health or life (e.g., ectopic pregnancy)

Medications used for medication abortion

Mifepristone & Misoprostol

Postpartum blues

Mild mood changes beginning 2-3 days postpartum and resolving within 2 weeks

Biggest risk factor for postpartum depression

History of depression

Postpartum psychosis manifestations

Hallucinations, delusions, confusion; medical emergency

What are mifepristone and misoprostol used for?

Together, they are used to end an early pregnancy safely.

Which medication is given FIRST?

Mifepristone is given first, then misoprostol.

Mifepristone - what does it do?

Blocks progesterone, which stops pregnancy from continuing.

Why is progesterone important in pregnancy?

Progesterone maintains the uterine lining to support pregnancy.

What happens after taking mifepristone?

The uterine lining breaks down and pregnancy support ends.

Common side effects of mifepristone

Cramping, bleeding, nausea, headache

Major contraindication to mifepristone (HIGH YIELD)

Ectopic pregnancy

Misoprostol - what does it do?

Causes uterine contractions to expel pregnancy tissue

Drug class of misoprostol

Prostaglandin

What should the client expect after misoprostol?

Strong cramping, heavy bleeding, and passage of tissue.

Most common side effect of misoprostol

Diarrhea

Normal vs abnormal bleeding after these medications

Bleeding is expected; soaking 2 pads per hour for 2 hours is NOT normal

When should the client call the provider?

Heavy bleeding, fever >100.4 F (38 C), severe abdominal pain, foul-smelling discharge

Why must ectopic pregnancy be ruled out first?

These meds will not treat ectopic pregnancy and can cause rupture

How can you remember the difference between the two meds?

MIFEpristone = Maintenance hormone blocked (progesterone) MISOprostol = Muscle contracts (uterus)

If a test question asks for priority nursing actions, what comes first?

Assess bleeding, pain, vital signs, and rule out ectopic pregnancy