CH 1 Maternity and Women’s Health Care Today

Antepartum

Before birth, admitted for a problem such as GD, water broke preterm, BP issues, hyperemesis.

Intrapartum

During birth, time of labor

Postpartum

4 hours after birth

Family-centered maternity care

- Physical and psychosocial needs of the family.

- Fosters the family unit.

- Care describes safe, high-quality care that recognizes and adapts to both the physical and psychosocial needs of the family, including the newborn.

- Goals are family unity while maintaining physical safety.

Principles of family-centered care

- Childbirth is usually a normal, healthy event.

- Childbirth affects the entire family.

- Families making decisions about care.

- Family and others.

Support people

➢ Father of baby

➢ Relative or friend

➢ Doula (trained labor support)

Siblings

➢ Presence of children at birth is controversial.

➢ Some children may attend all or part of labor and birth.

Education

➢ Importance of perinatal education

Healthy People 2030 Perinatal & Women's Health Care

- Attain higher quality, longer lives free of preventable disease.

- Achieve health equity, eliminate disparities, and improve the health of all groups.

- Create social and physical environments that promote good health for all.

- Promote quality of life, healthy development, and healthy behaviors across all life stages.

What are the perinatal Core Measures

- Decrease the rate of elective deliveries.

- Decrease the rate of cesarean births.

- Increase the rate of antenatal administration of steroids in preterm labor.

- Decrease the rate of newborns with septicemia or bacteremia.

- Increase the rate of exclusive breastfeeding.

Elective delivery

A scheduled labor induction or cesarean scection (c-section) performed for non-medical reasons. Major health organizations strongly advise against these procedures prior to 39 weeks of pregnancy, as early-term births carry significantly higher risks for breathing complications, NICU admissions, and neonatal mortality

What medication is needed to give if baby is less than 36 weeks?

- Get steroids to prevent the lungs from getting too sticky like betamethasone.

- Surfactants in the baby's lungs cause them to stick

Current trends in perinatal and women's health care management

- Cost containment

- Effects of cost containment on maternity care

- Length of stay

- Maternal and infant problems after discharge

- Legislative mandates

- Reduced teaching time

Cost containment

We need to save money. Government insurance companies hospitals, all try to control costs.

Mortality rates

The number of deaths that occur in a given year in different categories.

Maternal morbidity

Any short- or long-term health problems that result from being pregnant and giving birth.

Maternal mortality

All deaths during any pregnancy or within 42 days after pregnancy ends.

Pregnancy-related mortality

Deaths during pregnancy and up to one year after pregnancy that are related to the pregnancy.

What country has the highest maternal mortality rate? (among the world's developed nations)

The United States

Infant mortality

The death of an infant before his or her first birthday.

What are some factors of infant mortality?

- Birth defects

- Preterm birth and low birth weight

- Sudden infant death syndrome

- Injuries (e.g. suffocation)

- Maternal pregnancy complication

Multiple factors affect outcomes in

- Lack of access to care

- Preexisting cardiac disease

- Poverty

- Lack of social support

Atypical risk factors that may affect pregnancy

- Chronic stress.

- Experiences of racial. discrimination, which is a main factor for VLBW infants.

- Racism can be a part of the health disparities in the United States.

Adolescent pregnancy factors

- Teen birth rates have decreased

- Teen pregnancy rates are higher in the United States compared to other industrialized nations

Women's health factors

- Cardiovascular disease

- Obesity

Clinical nurse specialist (CNS)

- Master's- or doctoral-prepared nurses

- Specialize in the care of childbearing women with complex problems, but do not provide primary care.

Clinical nurse specialist Core competencies:

• Direct care consultation

• Systems leadership

• Collaboration

• Coaching

• Research

• Ethical decision-making

Certified nurse-midwife (CNM)

- Cares for women at low-risk, for complications, and refers them to a backup physician if problems develop.

- Registered nurses (RNs) who have completed a program of study and clinical experience

- Provide complete care during pregnancy, childbirth, and the postpartum period.

- Counsel & support the childbearing family

- Provide annual well-woman exams

- Approach to childbirth is non-interventionist & supportive.

Nurse Practitioner

- Prenatal and newborn care

- Does not perform deliveries

- RNs with advanced preparation

Women's health nurse practitioners (WHNPs)

Provide wellness-focused, primary, reproductive, and gynecologic care over the lifespan, starting at adolescence.

Family nurse practitioners (FNPs)

Provide preventive, holistic care for young and old family members.

Neonatal nurse practitioners (NNPs)

Assist in the care of high-risk newborns in the immediate post-birth care or in a neonatal intensive care unit (NICU).

Pediatric Nurse Practitioners (PNPs)

Provide health maintenance care for infants and children not requiring the services of physicians.

Physician

- OB/GYN- Trained surgeon

- Family Medicine with Obstetrics training

Doula

A trained professional who provides continuous physical, emotional, and informational support to their patient before, during, and shortly after childbirth to help them achieve the healthiest, most satisfying experience possible.

Birth preferences

Place of birth, and desired/or not desired aspects of care (aka birth plan).

Certified Nurse-Midwife (CNM) is qualified to

- Administer local anesthesia.

- First assist for cesarean deliveries.

- Attend vaginal deliveries.

- Repair tears associated with childbirth.

Prescribe medications, including narcotics such as Schedule 2 medications, depending on state laws.

Before 20th century

"Granny" midwives had childbirth in the home and were apprenticed.

Emergence of medical management

In the late 19th century, people moved to hospital births because of the developments available in hospitals. Doctors had resources in the hospital, so people wanted to give birth in a hospital. By 1960, 90% of births were happening in the hospital.

Lay midwifery

Became illegal

All families could have prenatal care, but

The poor could not

Consumer demands

1950's women began to be more involved in their pregnancy

Government involvement in federal funding

- Because of poor outcomes for low-income women.

- The Sheppard-Towner Act was developed for mothers and children.

- WIC, Head Start

- Still not an equitable distribution of healthcare

-partum

Labor or childbirth

Traditional hospital setting

- Labor, delivery, recovery rooms (LDRs)

- Labor, delivery, recovery, postpartum rooms (LDRPs)

Birth centers

Freestanding facilities (usually with close access to, but not affiliated with, a hospital) where childbirth is approached as a normal, healthy process

Homebirths

- The insurance provider may limit the choice of healthcare provider or setting.

- Not many Americans give birth at home, many midwives have moved their practive inot hospitals or birth centers

Birth settings

Most common location for vaginal birth is in a hospital in the LDR room

Birth centers are designed for what kind of patients? What do they offer?

- Low-risk patients outside the hospital.

- Provide maternity care, annual well-woman examinations, and contraceptive counseling.

- May offer classes to learn about childbirth, breastfeeding, infant care

- Follow care continues for first 6 weeks after birth

- Less expensive compared to hospitals but offer more support than at home.

What are the disadvantages for birth centers?

Not equipped for emergencies and will need to be transferred to the hospital

What are the advantages of a home birth?

Familiar environment, no limitations on family visitors, bonding with infant, breastfeeding, sense of control.

What are the disadvantages of a home birth?

Must be low risk for complications, setting for birth & adequate supplies required, must consider the nearest hospital if an emergency occurs.

What is a patient safety bundle?

A set of evidence-based practice done together to improve outcomes.

Women's health quality measures

Freedom of movement in labor

The Interprofessional Education Collaborative (IPEC) Core Competencies are a set of 33 consensus-based statements

Designed to prepare healthcare professionals for effective, team-based, patient-centered care. They are divided into four main domains: Values/Ethics, Roles/Responsibilities, Communication, and Teams/Teamwork

length of stay of a non-complicated vaginal birth

24-48 hours

Length of stay if c-section?

72-96 hours, or 4 days.

2019 maternal pregnancy-related mortality rate ?

20.1 every 100,00 live births

Non-hispanic black women most risk for?

Highest rate of preeclampsia and maternal death

Very Low Birth Weight (VLBW)

Birth weight below 1.5kg or 3.3 pounds (1,500 g).

Certified midwives CM

- Who provide the same services as CNMs but who lack the training and certification of a registered nurse

- Direct-entry midwives are trained only through the midwifery model of care and perform prenatal and delivery outside of the hospital; they are not nurses.