PPN 301 Wk 1: Promoting the Health of Childbearing Individuals and Populations

Maternal (global trends in maternal, infant, and child health)

• Every day approximately 810 women died from preventable causes related to pregnancy and childbirth.

• 94% of all maternal deaths occur in low and lower middle-income countries

• Young adolescents (ages 10-14) face a higher risk of complications and death as a result of pregnancy than other women

Infant (global trends in maternal, infant, and child health)

• Globally 2.4 million children died in the first month of life

• Approximately 6700 newborn deaths occur every day, amounting to 47% of all child deaths under the age of 5-years

• An estimated 15 million babies are born preterm (before 37 completed weeks of gestation)

• Preterm birth complications are the leading cause of death among children under 5 years of age

Maternal and infant mortality in Canada

• 31 maternal death per 100,000 live births

• 1,750 infants or 4.7 infant deaths per 1,000 live births.

• 85.2% within first week of life with most occurring within 24 hours of birth.

• Infant mortality rates are twice as high for each Indigenous group, compared with the non-Indigenous population

• Risk of preterm birth is 8.9% higher compared to their White counterparts (McKinnon, 2016)

Black maternal mortality in US

• Black women/ African American are 3- 4 times more likely dies from Pregnancy and Childbirth-related complication

Maternal and infant health inequities

• Health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age. Health inequities are unfair and could be reduced by the right mix of government policies (WHO,2018)

Social justice defined (CNA, 2010, p.13)

• focuses on the advantage that some groups or individuals have relative to others; the need to understand root causes of inequities; and the need to take responsiblen action to eliminate inequities.

UN sustainable development (SDG) goal

3rd goal- good health and well-being

• ensuring healthy lives and promoting the well-being for all at the ages is essential to sustainable development

Target 3.1 (UN sustainable development (SDG) goal)

• Reduce maternal mortality

Target 3.2 (UN sustainable development (SDG) goal)

• Even all preventable death under 5 years of age

Target 3.7 (UN sustainable development (SDG) goal)

• universal access to sexual and reproductive care, family planning and education

Reproductive rights (promotion maternal health)

“basic rights of all couples and individuals to decide freely and responsibly the number,spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes the right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents.” (ICPD, Para 7.3\

• ability to decide

Reproductive justice (promotion maternal health)

“ is the complete physical, mental, spiritual, political, economic, and social well-being of women and girls, and will be achieved when women and girls have the economic, social and political power and resources to make healthy decisions about our bodies, sexuality and reproduction for ourselves, our families and our communities in all areas of our lives. (Asian Communities of Reproductive Justice

• access/availability to resources

Critical social theory perspctive

• Understand the root causes of inequities are historical and socio-politically situated

• Examines relationships of power and the underlying structures in society that produce population inequities

• Understand health inequities from Micro, Meso, and Macro by asking “WHY

• Challenges social inequities and injustices, and its impact on populations health

• Engages with the problem to bring about transformation

• Work with individuals, family, and multi sector collaboration to influence policy and address structural and systemic determinants of health

• Explicit commitment to social justice

Critical race theory (defined by champine et al, 2022)

• Rooted in the understanding that race is a social construct, and that racism is a central feature of society embedded within systems and institutions.

• Challenges race as a biological construct in the understanding of health disparities

• Analyzes the historical and sociopolitical structures contributing to differential health outcomes between races and for certain groups

• Reframe health disparities away from pathologizing marginalized communities.- look at health disparities without blaming community

Weathering hypothesis

• Repeated exposure to poverty, racism, discrimination, and marginalisation harms health

Social determinants of health

• income & social status

• employment & working conditions

• education & literacy

• childhood experiences

• social inclusion

• physical environment

• healthy behaviours

• access to health services

• gender

• culture

• aboriginal status

• race/racism

Intersectionality

• considers how systems such as racism, classism, sexism, homophobia and other forms of discrimination overlap and interact with one another to advantage some and disadvantage others at an individual and social-structural level.”

Anti-indigenous racism in perinatal populations

• Colonization and dominance of the biomedical model – lack of culturally appropriate perinatal care

• Isolated communities – need to travel to deliver baby (‘forced evacuation’ imposed by federal
  government)

• Before 2017, women delivered alone, without family or community support, because escorts were not deemed medically necessary

• In 2017, policy change: federal government now provides funds for travel companion for Indigenous women leaving communities to give birth

• Feelings of loneliness when forced to leave home communities and families

• Lack of traditional practices or ceremonies incorporated into birth experiences / newborn
  care

Structural racism and weathering hypothesis (racial disparities in birth outcomes in canada)

• Repeated exposure to socioeconomic adversity, political marginalization, racism, and perpetual discrimination can harm health

• Allostatic load: refers to the physiological effect of chronic or repeated exposure to stress.

• Stress induces the secretion of cortisol, norepinephrine, and epinephrine

• High amounts over time may lead to physiological effect of higher systolic and diastolic blood pressures, high cholesterol levels, HbA1c, and increased waist- to-hip ratio.

• Leads to greater physiological wear and tear (aging biologically faster)

Differences in perinatal outcomes show black women had higher rates of (racial disparities in birth outcomes in canada):

• Stillbirths

• Preterm births

• Caesarean sections

• Higher risk of
   gestational diabetes,
   preeclampsia,
   placental abruption,
   low birth weight,
   small for gestational age

Obstetric racism (Scott & Davis, 2021,p. 682)

• Obstetric racism highlights the forms of violence and abuse that medical personnel— and potentially any personnel within medical ninstitutions—routinely perpetrate against Black women

Sexual orientation, gender identity and pregnancy

• Many lesbian, gay, and transgender couples become parents

• Intersecting identities of sexual orientation, gender identity, and race expose racialized 2SLGBTQ people to unique forms of discrimination and stigma

• They deserve respectful care during the childbearing experience as well as during health screening and wellness care

• Have the same range of reproductive interests as cis people, and many are at childbearing age at the time of transition

• Masculinizing and feminizing hormone therapy can have temporary and long-term impacts on fertility

• HCPs need to discuss both birth control and fertility preservation prior to the initiation of hormone therapy.

  
  

Cultural considerations-Female Genital Mutilation (FGM)

• Female genital mutilation (FGM) involves the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons

• Practiced in more than 45 countries, with most of these countries being in Africa

Assess for potential Female genital mutilation during initial prenatal visit, before exam

• Clear documentation of extent of cutting

• Listening to how the client refers to this; using same terms when providing care

• Non-stigmatizing, culturally safe care

• Providing information throughout pregnancy

• Ensuring privacy during exams

• Providing rationale for health provider actions

• Ensuring that woman and family understand why this request cannot legally be met by HCP

Meaning of pregnancy

• What meaning does pregnancy, childbirth and parenthood have for people.

• What is relationship between how someone became pregnant & the meaning of the pregnancy for them

• What assumptions does society have about pregnancy, childbirth and parenthood
  ▪ Who do we see as pregnant?
  ▪ Who do we see as a ‘parent’?
  ▪ How do we view people who are NOT parents?

• The impact of pregnancy and parenthood for individuals, families, communities and society.

Principles of Family-Centred Maternity and Newborn Care (public health agency of canada, 2017)

• family centred approach is optimal

• pregnancy and birth are normal, healthy processes

• Early parent-infant attachment is critical for development and healthy family growth

• family-centred maternal and newborn care is informed by research, applies to all care environments, requires a holistic approach, and involves collaboration among care providers

• culturally- appropriate care is important in multicultural society

• indigenous peoples have distinctive needs during pregnancy and birth

• care as close to home as possible is ideal

• Individualized maternal and newborn care is recommended

• women and families require knowledge about care, play an integral role in decision making

• attitudes and language of health care providers have an impact on a family’s experience of maternal and newborn case

• family centred maternal and newborn care respects reproductive rights, functions within a system that needs ongoing evaluation, best practices from global settings may offer valuable options for canadian consideration

Trauma and Violence-Informed Care

• Trauma and violence-informed approaches are policies and practices that recognize the connections between violence, trauma, negative health outcomes and behaviours.

• Focus to minimize the potential for harm and re- traumatization, and to enhance safety, control and resilience for all clients

Trauma and Violence-Informed Care purpose

• To increase attention on the impact of violence on people's lives and well-being

• To reduce harm

• To improve system responses for everyone

Four Principles for implementing TVIC approaches

• Understand trauma and violence and their impacts on people’s lives and behaviours

• Create emotionally and physically safe environments

• Foster opportunities for choice, collaboration, and connection

• Provide a strengths-based and capacity-building approach to support patient coping and resilience

Understand trauma and violence and their impacts on people’s lives and behaviours (Four Principles for implementing TVIC approaches)

• Acknowledge the root causes of trauma without probing.

• Listen, believe, and validate victims’ experiences.

• Recognize their strengths.

• Express concern.

Create emotionally and physically safe environments (Four Principles for implementing TVIC approaches)

• Communicate in non-judgmental ways so that people feel deserving, understood, recognized, and accepted.

• Foster an authentic sense of connection to build trust.

• Provide clear information and consistent expectations about services and programs.

• Encourage patients to bring a supportive person with them to meetings or appointments.

Foster opportunities for choice, collaboration, and connection(Four Principles for implementing TVIC approaches)

• Provide choices for treatment and services and consider the choices together.

• Communicate openly and without judgement.

• Provide the space for patients to express their feelings freely.

• Listen carefully to the patient’s words and check in to make sure that you have understood correctly.

Provide a strengths-based and capacity-building approach to support patient coping and resilience(Four Principles for implementing TVIC approaches)

• Help patients identify their strengths, through techniques such as motivational interviewing, a communication technique that improves engagement and empowerment.

• Acknowledge the effects of historical and structural conditions on peoples’ lives.

• Help people understand that their responses are normal.

• Teach and model skills for recognizing triggers, such as calming, centering, and staying present

Cultural safety

• Highlights power imbalances in health care relationships

Cultural humility

• Process of self-reflection to raise awareness of personal and systemic biases

How can I SPEAK UP against racism

• set limits

• practice and prepare

• express your concerns

• apologise

• keep improving

• uncover and learn

• persuade others

Inclusive language

• Consider the impact of using inclusive versus non- inclusive language during pregnancy

• Use inclusive terms such as pregnant people (inclusive) versus pregnant women; parent (inclusive) versus mother or father

• Ask client which pronouns they prefer and which words they use to describe their body

• Use the client’s preferred words in a respectful & professional manner (eg: breastfeeding versus chestfeeding)

Healthy babes healthy children program is free, voluntary and an OHIP card is not
required. HBHC supports individuals & families with:

• Having a healthy pregnancy

• Developing a positive relationship with baby and children

• Promoting child’s growth and development

• Connecting to resources and programs within the community

• Working together to give child the best start in life

Services provided by healthy babies healthy children public health nurses include:

• Frequent and intensive home visiting

• Support and health teaching during the prenatal period

• Breastfeeding and infant/child feeding support and teaching

• Health promotion teaching

• Referrals to community programs and health services

• Service coordination

Perinatal nurses

• Work collaboratively with childbearing individuals and families from the preconception to postpartum period

Pediatric nurses

• Care for children from birth up to age 18 years

Work settings (Perinatal and pediatric nursing)

• Hospitals, community, home, & clinics,

• Public Health Nurses: Healthy Babies, Healthy Children Program

Nurses (Perinatal healthcare providers)

• Public Health Nurse: Healthy Babies, Healthy Children, Nurse-Family Partnership

• Hospital Postpartum Nurse

• Labour & Delivery Nurse

Midwives (Perinatal healthcare providers)

• Indigenous midwives: Seventh Generation & Toronto Birth Center

• Ontario midwives

• Non-insured clients: Access Alliance Non-Insured Clinic

Obstricians (Perinatal healthcare providers)

physicians delivering babies in hospital

Doulas/birth workers (Perinatal healthcare providers)

• Indigenous Biidaaban Doula Collective

• Ontario Black Doula Society

• Birthmark Doulas (low-cost/free services)

• Queer Spectrum Birth Doulas

CASN Entry-to-Practice Competencies for Nursing Care of the Childbearing Family for Baccalaureate Programs in Nursing

• Core competencies related to the nursing care of childbearing families that all baccalaureate nursing students in Canada should acquire over the course of their undergraduate education.

• Set of knowledge, skills, and attitudes that all new nursing graduates should possess related to care of this population, regardless of the specialty area of nursing in which they may elect to practice, while also ensuring that they have the foundation needed to work in perinatal or related areas of nursing.

• Do not replace jurisdictional entry-to-practice guidelines, but rather to offer national, consensus-based guidelines regarding the depth and breadth of the coverage for all entry-level registered nurses related to nursing with childbearing families in Canada.