~Maternal Newborn Nursing Today~ (Notes)

Big Picture: What This Chapter Is About

This chapter introduces maternal–newborn and reproductive health nursing, focusing on care across pregnancy, birth, postpartum, and the newborn period. It emphasizes health promotion, safety, advocacy, ethical/legal practice, and reducing disparities.

1. Maternal–Newborn & Reproductive Health Nursing

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

Goals of Care:

  • Promote health and well-being across reproductive years

  • Prevent complications

  • Support families and caregivers

  • Provide education and advocacy

Nurse’s Role:

  • Educator (prenatal, postpartum, newborn care)

  • Advocate (client wishes, safety, equity)

  • Care coordinator (interprofessional team)

  • Supporter (emotional, physical, psychosocial)

2. Fertility & Infertility

Fertility: Ability to conceive within 6–12 months without medical help.

Factors Affecting Fertility

Age

  • Fertility declines after ~32 years

  • ↓ number & quality of oocytes

  • ↑ miscarriage, fetal demise, complications after 35

BMI

  • BMI >27 → ovulatory dysfunction

  • BMI <17 → hormonal dysfunction → anovulation

Lifestyle

  • Smoking ↓ fertility

  • Vigorous exercise ↓ fertility if BMI <25

  • Healthy diet (whole grains, fruits/veg, fish, unsat fats) ↑ fertility

  • Folic acid ↑ fertility

Medical Conditions

  • Celiac disease → amenorrhea, infertility

Key Exam Focus: Identify risk factors (age, BMI extremes, smoking, excessive exercise)

3. Maternal Morbidity & Mortality

Maternal Morbidity: Health problems caused by pregnancy/birth
Severe Maternal Morbidity (SMM): Life-threatening complications
Maternal Mortality: Death during pregnancy or within 1 year postpartum related to pregnancy

Leading Causes

  • Mental health conditions (suicide, substance use) – #1

  • Postpartum hemorrhage (PPH)

  • Infection & sepsis

  • Cardiovascular disease (HTN, cardiomyopathy, embolism)

Postpartum Hemorrhage (PPH)

  • Vaginal birth: >500 mL blood loss

  • Cesarean: >1000 mL blood loss

Causes (4 Ts):

  • Tone: uterine atony (most common)

  • Trauma: lacerations

  • Tissue: retained placenta

  • Thrombin: bleeding disorders

4. Risk Factors for Poor Outcomes

  • Age >35

  • Preexisting conditions (HTN, diabetes, asthma, mental health)

  • Obesity

  • Smoking, alcohol, drugs (including marijuana)

  • Multiple gestation

  • Limited access to care

High-Risk Care: Managed by specialists (e.g., perinatologist)

5. Fetal & Infant Mortality

Fetal Mortality: Death after 20 weeks gestation

  • Causes: fetal anomalies, placental issues, maternal conditions

Infant Mortality: Death before age 1

  • Causes: congenital defects, prematurity, SUID, low birth weight

6. Racial & Social Disparities

  • Black clients: 2–3× higher maternal mortality

  • Contributing factors:

    • Structural racism

    • Implicit bias

    • Chronic conditions

    • Access & quality of care

Nursing Actions:

  • Implicit bias training

  • Following evidence-based guidelines

  • Advocacy & education

7. Healthy People 2030 Goals (HIGH YIELD)

  • ↓ Maternal mortality (goal: 15.7/100,000)

  • ↓ Severe maternal complications

  • ↓ Cesarean rates in low-risk clients

  • ↑ Postpartum depression screening

  • ↓ Preterm birth

  • ↑ Prenatal care & vaccination (Tdap)

  • ↓ Substance use in pregnancy

8. Therapeutic Communication & Relationships

Therapeutic Communication Includes:

  • Active listening

  • Open-ended questions

  • Respect & empathy

  • Silence when appropriate

  • Clarification & reflection

Benefits:

  • Better outcomes

  • Increased trust

  • Improved satisfaction

9. Health Promotion & Injury Prevention

  • Preconception counseling

  • Prenatal education

  • Postpartum & newborn safety teaching

  • Discharge education (warning signs)

  • Community involvement

Postpartum Care:

  • Support up to 12 weeks (ACOG)

  • Visit by 3 weeks + comprehensive visit by 12 weeks

10. Family-Centered vs Community-Based Care

Family-Centered Care:

  • Family as part of care team

  • Shared goals

  • Education for caregivers

  • Identify caregiver strain

Community-Based Care:

  • Home visits

  • Breastfeeding groups

  • Immunization clinics

  • Food banks & community programs

11. Midwifery & Home Births

Midwives:

  • CNM: RN + graduate degree

  • CM: Graduate degree, no RN

  • CPM: Non-RN, home birth focus

Benefits:

  • ↓ C-sections

  • ↓ interventions

  • ↑ satisfaction

Home Birth:

  • Appropriate for low-risk clients only

  • Requires emergency transfer plan

12. Legal & Ethical Practice

Legal:

  • Governed by Nursing Practice Act

  • High litigation risk in OB

  • Malpractice requires:

    • Duty

    • Breach

    • Harm

    • Causation

Ethical Principles:

  • Beneficence

  • Autonomy

  • Justice

  • Advocacy

  • Accountability

13. Abortion & Reproductive Rights

  • Therapeutic abortion: protects client’s health (e.g., ectopic pregnancy)

  • Laws vary by state

  • Medication abortion: mifepristone + misoprostol

Nursing Role:

  • Nonjudgmental care

  • Education & safety monitoring

14. Postpartum Mental Health

Postpartum Blues:

  • Very common (50%)

  • Starts 2–3 days postpartum

  • Resolves ≤2 weeks

Postpartum Depression:

  • 10–20%

  • Can last up to 1 year

  • Biggest risk factor: history of depression

Postpartum Psychosis (EMERGENCY):

  • Hallucinations

  • Delusions

  • Confusion

  • Risk of suicide/infanticide

Exam Tips

  • Focus on risk factors, definitions, and nursing actions

  • Know differences between blues vs depression vs psychosis

  • Expect priority & safety questions

  • Think: What would the nurse do FIRST?