Introduction to the Care of the Childbearing Family

What is the period following childbirth?

Postpartum

What is an unborn child greater than 8 weeks of development called?

A fetus

What is the secretion of milk from the mammary glands?

Lactation

What is the time period before the birth?

Antepartum

What is the infant age of up to 28 days following birth?

A neonate

What is the time period spanning from the onset of labor to the delivery of the placenta?

Postpartum

What are the childbirth settings?

• Traditional vs. Family Centered Care

• Labor-Delivery-Recovery (LDR) Rooms

• LDRP Rooms (includes postpartum)

• Birth Centers

• Home Births

What is family centered care?

A model of care based on the philosophy that the physical, sociocultural, psychological, spiritual, and economic needs of the woman and her family, however the family may be defined should be integrated and considered collectively

What is included in family centered care?

• Childbirth is usually a normal, healthy event in the life of a family.

• Childbirth affects the entire family, and family relationships need to restructured.’

• Families are capable of making their own decisions if given adequate information and support

What are the factors impacting maternal and women’s health care?

• Increase in responsibility by individuals and families for own health

• Family desire for information and participation in decision-making process

• Respect for family’s views and concerns

• Addressing of issues and concerns

• Regard for client, partner, and parents as important participants

What to know about infant mortality

• Infant mortality rate: number of deaths of infants

  • <1 year of age per 1000 live births.

• 5.60  infant deaths per 1000 live births (2022)

What are the leading causes of infant death?

• Congenital Anomalies (Birth defects) (leading cause)

  • Alcohol, drug abuse, older births, diabetes

• Prematurity & low birth weight

  • Smoking, morbidity, lack of prenatal care,

• Sudden Infant death (SIDS)

• Injuries (e.g. suffocation)

• Maternal pregnancy complications

What to know about maternal mortality?

• The death of a woman during pregnancy or within 42 days of termination of pregnancy

• Approximately 300,000 women die from pregnancy and childbirth globally

• United States ranks 47th in the world (23.8 deaths per 100,000 live births in the U.S.) 2022

• Decreased to 18.6 deaths per 100,000 live births

What are the main causes of pregnancy related deaths in the US?

• Severe bleeding (sometimes called hemorrhage)

• Mental health disorders (suicide)

  • Otw to #1

• Infections and sepsis

• Cardiovascular conditions, such as:

  • Blockages (sometimes called embolisms) in arteries and veins

  • Stroke (also called cerebrovascular accidents)

  • Blood pressure disorders of pregnancy, including

  • Heart muscle problems (called cardiomyopathy)

  • Heart disease

• Problems with anesthesia

• Amniotic fluid embolism

• Non-cardiovascular conditions, such as diabetes and breathing problems

What are health care disparities?

The differences in the health status across various socioeconomic, ethnic, and racial groups attributed to social, political, economic, and environmental factors

Who is more likely to die from a pregnancy related condition?

African American women

What are the social determinants of health?

Social determinants of health are conditions in the places where people live, work, and play that affect a wide range of health and quality if life risks and outcomes(CDC).

What is culture?

• The characteristic features of everyday existence (such as diversions or a way of life) shared by people in a place or time. Merriam-Webster

  • Thoughts

  • Ways of doing things

  • Values

  • Ethnicity

  • Religious views and beliefs

What are the key determinants of culture?

• Ethnicity

  • Cultural expression and identification

• Race

  • Associated with biology and linked with physical characteristics

• Country of origin

• Language

• Gender

• Age

• Religious beliefs

• Socioeconomic class and status

What is cultural competence?

• “The knowledge and interpersonal skills that all providers need to understand, appreciate, and work with individuals from cultures other than their own” (Fleming & Towy (2001))

• Having Cultural Competence implies that you, as the nurse, have the ability to recognize, understand, and resolve conflicts that are created by different cultural values and beliefs or language while providing care.

• It involves an awareness and acceptance of cultural differences, self awareness, knowledge of a patient’s culture, and adaptation of skills.

What are the keys to being a culturally competent healthcare provider?

• The capability to shift cultural perspective and adapt - or bridge - behavior to cultural commonality and difference

• Self Awareness

  • Understanding one’s “cultural” self

• Other Awareness

  • Exploring other cultural norms, values, and beliefs

• Bridging Skills

  • Learning to be culturally adaptive

• Consider your own cultural biases and how these affect your nursing care.

• Understand the need to recognize cultural implications in planning and implementing nursing care.

• Learn how to use cultural assessment tools.

• Treat patients with dignity and respect.

• Use sensitivity in providing culturally competent care.

• Recognize opportunities to provide specific culturally based nursing care.

• Evaluate your own previous encounters with patients from other cultures and backgrounds.

What is cultural humility?

• “Cultural humility is a process of openness, self awareness, egolessness, and self reflection and critique after interacting with diverse culture individuals.”

• Knowledge, willingness, and ability to adapt health care practices to be consistent with clients from diverse cultures

• Nurses who have cultural humility have a respect  for other’s culture and are willing to suspend what they think they know about a person

• Cultural aspects: perspectives, traditions, values, practices, and populations

• Dynamic, lifelong learning process

• Barriers: those related to providers and those related to systems

What is important to consider when caring for a pregnant woman?

• Family dynamics

  • Who is in charge in the household

    • Is the cultural background more paternalistic or maternalistic

• Provider gender

  • Some women request a male or female provider based on cultural or personal preferences.

• Religious and cultural beliefs

  • Food preferences

  • Circumcision

  • Infant feeding

  • Baby naming

• Communication

What is the role of the nurse?

• Teacher

• Counselor

• Collaborator

• Researcher

• Manager

• Advocate

What are the critical issues in maternal-newborn care?

• Lack of Access to Care***

  • Lack of Early Prenatal Care

  • Poverty

  • Education

  • Homelessness

  • Smoking - Drugs – Alcohol

  • Domestic Violence

    • pregnant women are the most at risk for intimate partner violence

  • Teen Pregnancy

  • Premature Births

  • Birth Defects

  • Abortion

What is evidence-based practice?

• “A systematic approach to determine the most current and relevant evidence upon which to base decisions about patient care”(Melnyk & Fineout-Overholt, 2005)

• Clinical expertise

• Patient values

What are the standards of practice for perinatal and women’s health nursing?

• Nursing Practice – Scope of Practice

• Standards of Care

  • ANA

  • Assoc. of Women's Health, Obstetrical and Neonatal Nurses (AWHONN)

  • American College of Obstetrics & Gynecology (ACOG)