OB Unit 1: Maternity & Family Culture

postpartum

the first 6 weeks after birth

perinatal

the period of preconception, prenatal/antepartum, intrapartum, and postpartum periods

birth rate

number of live births per year per 1000 population

fertility rate

number of births per 1000 women between ages 15 and 44 per year

maternal mortality rate

number of maternal deaths from births, pregnancy complications, and puerperium (the first 42 days after termination of the pregnancy) per 100,000 live births

maternal morbidity

unexpected complications of labor and delivery that can lead to severe consequences for the woman’s health

pregnancy-associated deaths

all deaths during pregnancy within the 1 year following the end of pregnancy

pregnancy related deaths

deaths that are a complication of pregnancy, an aggravation related to pregnancy, or a chain of events that were initiated by pregnancy

perinatal mortality rate

number of stillbirths and number of neonatal deaths per 1000 live births per year

neonatal mortality rate

number of deaths of infants younger than 28 days per 1000 live births

infant mortality rate

number of deaths of infants younger than 1 year of age per 1000 live births

low birth weight

birth weight less than 5lbs 8oz

preterm birth

birth before 38 weeks gestation

stillbirth

an infant at birth who demonstrates no signs of life such as breathing, heartbeat, or voluntary muscle movement

What is the primary goal of family-centered care?

viewing the family as the primary unit of socialization and healthcare decision-making. The goal is to foster active collaboration between the patient, family, and healthcare team; deliver education to patient/family, and adapt to families needs

How does family centered care address caregiver strain?

Families often experience emotional and financial strain. Involving the family and caregivers in the care that is needed provides essential education and psychological support overall reducing caregiver burden and improving maternal-infant outcomes

what are the causes of infant mortality?

• low birth weight

• preterm birth

• sudden unexpected infant death (SUID)

• congenital/structural abnormalities

• infections

what are the causes of intrauterine fetal demise?

• fetal complications

• placental complications (abruption, cord accidents)

• maternal diseases (hypertension, diabetes, obesity)

Leading causes of maternal mortality rate?

• pre-existing cardiovascular conditions (such as cardiomyopathy, stroke, embolism, hypertension/preeclampsia)

• mental health conditions (postpartum depression, etc)

• violence

What is the single most significant barrier to accessing prenatal care?

the inability to pay

What nursing and system strategies increase attendance at prenatal appointments?

• Overcoming financial barriers (assisting with insurance or helping with community referrals)

• Group prenatal care (peer-group visit models)

• Home care prenatal services (for blood pressure monitoring, comorbidity management, helping with transportation/childcare barriers)

• Therapeutic communication

What are the two most frequently reported maternal risk factors for pregnant patients who are obese (BMI < 30)?

Gestational Diabetes and Pregnancy-associated hypertension/Preeclampsia

How does an elevated BMI effect fertility and pregnancy outcomes?

Ovulation dysfunction increases at a BMI greater than 27

(For every 11 lbs of weight gained increases the time to conceive by 5%)

What does obesity during pregnancy increase the risk for?

• fetal demise

• large for gestational age infants

• cesarean delivery

• severe maternal morbidity

Acculturation

adapting to and adopting traits of a new dominent culture while retaining elements of one’s original culture

Ethnocentrism

the belief that one’s own cultural group, values, and practices are superior to those of other cultures

Assimilation

The complete absorption of an individual or group into a dominant culture, shedding their original cultural identity

cultural relativism

evaluating and understanding a patient’s beliefs and behaviors within the context of their own culture rather than judging them by external standards

cultural awareness

self-examination and exploration of one’s own biases, values, and assumptions

cultural competence

synthesizing cultural awareness and knowledge to deliver practical, patient-centered care tailored to the specific cultural needs, communication, styles and preferences

How should the nurse address modesty and privacy during perinatal assessments?

Ask about the patient’s preferences and restrictions they may have during the physical examination. Provide privacy, explain what you are going to do, ask permission before examining, and respect cultural boundaries

What are the nursing guidelines when using a medical interpreter?

• always use a trained, official medical interpreter, NEVER use family members as interpreters

• maintain eye contact with the patient and address the patient directly, not the interpreter

• Speak in short simple sentences

primary prevention example

preventing disease before it occurs

• prenatal immunizations (Tdap/COVID-19)

secondary prevention example

early screenings and prompt diagnosis

• STI screening at initial prenatal visit

• Edinburgh postpartum depression screening

tertiary prevention example

managing existing disease to prevent further disability

• blood glucose management in gestational diabetes

quaternary prevention example

protecting patient’s from over medicalization or medial treatments that cause more harm than benefit

What four essential elements are required to establish medical malpractice/negligence?

• duty: the standard of care owed to the patient

• breach of duty: failure to provide minimally competent care

• harm/injury: actual physical or psychological injury sustained by the patient

• causation: the provider’s breach directly caused an injury

How does the nurse navigate conflicts between patient autonomy and beneficence (such as refusing a emergency C-section)?

Advocate for autonomy through informed consent/refusal. When an autonomous choice poses a severe risk, balance autonomy against beneficence using therapeutic communication, involving the healthcare team, and consulting the hospitals ethics and legal services

What is the HITS Screening tool?

To assess for interpersonal violence (IPV) and scored on a scale of 1-5 in each category

• H: Hurt physically

• I: Insult or talk down

• T: Threaten with harm

• S: Scream or curse

A score > 10 indicates partner violence

Postpartum blues

Onset 2-3 days postpartum, resolves spontaneously within 2 weeks. Causes tearfulness, mood, lability, and mild anxiety.

Postpartum depression

Onset within first few weeks up to 1 year postpartum and lasts > 2 weeks. Causes severe despondency, negative thoughts towards infant, and inability to care for self or newborn

Postpartum psychosis

medical emergency featuring hallucinations, delusions, severe confusion, and has a high risk of harm.

how soon after birth should a follow-up appointment be schedules

within the first 3 weeks

what time poses the highest risk of neonatal maternal death risk?

first 6 weeks after birth