Maternity Care Notes

Intro to Maternity Care

Objectives

• Plan nursing care for the child-bearing family.
• Examine contemporary issues and trends in family-centered nursing.
• Examine health considerations related to the client with female reproductive health needs.
• Evaluate the concepts of contraception and infertility in family planning.

21st Century Maternity Nursing

• Maternity Nursing: Focuses on childbearing women and their families.
• Preconception: The period prior to conceiving.
• Prenatal or Antepartum: Pregnancy, which lasts approximately 40 weeks.
• Intrapartum: Labor and birth.
• Postpartum: The period from birth to 6 weeks.

Advances in the Care of Mothers & Infants (~changes over last 150 years)

• Early 1900s:
  • More standardized care for women and childbirth.
  • Childbirth classes and first milk bank.
  • Improvements in birth control and feminine products.
• Mid 1900s:
  • Lamaze education.
  • Birth control pill introduced.
  • Research on causes of birth defects.
  • NAACOG founded.
  • Mammograms
• Late 1900s:
  • Home pregnancy kits.
  • Family & Medical Leave Act.
  • Newborns’ & Mothers’ Health Act.
  • Emergency contraception.
• Early 2000s-current day:
  • Affordable Care Act.
  • HPV vaccine.
  • Further research on the affect of viruses to fetus/neonate

Health Disparities

• Current Data:
  • Vulnerable populations.
  • Race as a significant factor.
• Efforts to Reduce:
  • HRSA Health Disparity Collaboratives: Providing care for those without healthcare coverage.
  • Office of Minority Health: Prioritization of disparities.
  • National Institutes of Health (NIH): Research and educational materials.
  • CDC: Tracking trends of health disparities and inequalities, measuring progress on elimination of disparities.
  • US Dept Health & Human Services: Reducing disparities through promoting evidence-based programs and integrated approaches & best practice

Contemporary Issues and Trends

• Healthy People 2030
  • Science-based goals every 10 years.
  • Focuses on improving the health of Americans.
• Global Goals
  • United Nations
  • Focus on sustainable development goals throughout the world.
  • Related to eliminating poverty and sustaining the environment.

Contemporary Issues and Trends (cont.)

• Problems with the US Health Care System
  • Structure of delivery system.
  • Fragmented Care
  • Costs
  • Reducing medical errors
    • Institute of Medicine (IOM)
  • High cost of health care
    • Causes
      • Insurance coverage
      • Limited access to care
      • Inability to pay
  • Health care reform
    • Affordable Care Act – provided some protections

Contemporary Issues and Trends (cont.)

• Low Birth Weight & Preterm Birth:
  • Increased risk of morbidity & mortality.
• Infant Mortality:
  • Rate increasing.
  • Health disparities are a factor.
• Leading Causes
• Maternal Mortality:
  • Increases.
  • Health disparities & other factors.
• Causes
• Maternal Morbidity:
  • Factors influencing.
• Outcomes
• High Risk Pregnancy
• Obesity:
  • Increases medical risk factors.

Contemporary Issues and Trends (cont.)

• Birthing practices
  • Prenatal care leads to better pregnancy outcomes through early risk assessment and promotion of healthy behavior.
  • Primary Care Providers: Physicians, Midwives.
  • Birth Centers & Hospitals.
  • Birthing centers.
  • Home births.
  • Family Centered Care: Includes partners, siblings, extended family.
    • Assist with delivery.
    • Skin to skin immediately after birth.
  • Early discharge necessitates increased follow up or home care, making efficient and focused teaching important.

Trends in Nursing Practice

• Standards of Practice & Legal Issues in Delivery of Care
  • Prevention of errors in nursing care
    • The Joint Commission (TJC) "Do Not Use" list
  • Standards per nurse specialty
    • ANA
    • AWHONN
    • ACNM
    • NANN
  • Sentinel events:
    • Results in death, permanent harm, or severe temporary harm
  • Failure to rescue:
    • Not recognizing or acting on distress
• Standards of Care for Women & Newborns
  • Assessment
  • Diagnosis
  • Outcome identification
  • Planning
  • Implementation
  • Evaluation

Trends in Nursing Practice - Ethical Issues

• Ethical Issues in Perinatal Nursing and Women’s Health Care
  • Technology and scientific advances
    • Advanced fertility treatments
    • Older age at conception
    • Chronic disease or illness
  • Costs of care
  • Disparities in options due to low income or health coverage
  • Increased options with contraception
  • Informed consent
    • Options and allocation of resources

The Family, Culture, and Home Care

• Defining Family
  • Primary unit of socialization
  • Focus of health care delivery for maternal & newborn nurses
• Family Organization & Structure
  • Traditional family unit has changed
• Family in Society
  • Racial & ethnic diversity
  • Important to provide respectful, compassionate care

Theoretic Approaches to Understanding Families

• Family assessment
  • Health-promotion
  • Identifying the structural, developmental, & functional aspects of family
  • Focus on interaction of individuals within the family
    • Low-risk family: Promoting healthy birth outcomes
    • High-risk family: Illness care needs

Theoretic Approaches to Understanding Families

• Genogram
• Ecomap
• Family Assessment
  • Structural
  • Developmental
  • Functional

The Family in a Cultural Context

• Childbearing Beliefs & Practices
  • Culturally competent care
    • Appropriate communication includes interpreters (oral) and translators (written).
  • Personal Space
    • Awareness of varied degrees of space
    • Lack of awareness can heighten anxiety
  • Time Orientation
    • Orientation to past, present, or future
    • Varies by culture and may be focused on day-to-day survival.
  • Family Roles
    • Positions in the larger family system
    • Affected by social class and cultural norms