OB Wk1 Ch1 Perspectives on maternal, newborn, and women's healthcare (Exam prep)

Overview and Learning Objectives

• Examine the factors that affect maternal, newborn, and women’s health.
• Evaluate how society and culture can influence the health of women and their families.
• Distinguish the health care barriers affecting women and their families.
• Review the ethical and legal issues that may arise when caring for women and their families.

Role of Nurses and Evidence-Based Practice

• Nurses are agents of change, especially in the maternal-child health field; nurses have many obligations.
• Changes are driven by Focus of Evidence-Based Nursing Practice (EBNP):
  • Use of research to establish and implement a plan of care.
  • Use of a problem-solving approach to make clinical decisions.
  • Use of various resources to collect, interpret, integrate, and validate research-derived evidence for use in practice.

Policy Making, Racism, and Social Determinants of Health

• Who makes policy? (policy topics and stakeholders; slide prompts reflection; slide shows a policy context)
• MATERNAL OUTCOMES MATTER – keynote themes:
  • BLACK LIVES MATTER; REPRODUCTIVE JUSTICE; racism is a risk factor; human rights framework outside health care.
  • Social determinants of health influence outcomes beyond clinical care.
  • RACISM and bias are linked to disparities in maternal/infant health; need for equity-focused policy actions.
  • Efforts to address root causes (e.g., historical racism, inequitable policies) are essential for improving maternal outcomes.
  • Initiatives referenced include NJ Health/Wealth disparity awareness and a broader public health framing.
• SYSTEMS and POLICY framing:
  • Recognize root causes; address white supremacy/frame biases; undo harmful policies; hold systems accountable.
  • Racial equity lens and accountability for maternal outcomes.
  • Public health messaging and policy advocacy as part of healthcare improvement.

Engaging with Policymakers

• Top tips for policy engagement:
  • Collaborate with other researchers for stronger policy influence.
  • Speak policymakers’ language to deliver impactful research communication.
  • Start early when building relationships with policymakers.
  • Maintain relationships with policymakers for lasting impact.
  • Think like a policymaker; context matters—make research timely and relevant.
  • Actively engage policymakers every step of the way.
  • Engage policymakers across departments, ministries, and sectors.
• Context: ensure research is timely and relevant to policy windows; cross-sector engagement is important.

How well is the USA doing? International and U.S. Maternal Health Metrics

• Claim: Maternal mortality in the U.S. far outstrips that of other industrialized nations.
• International comparisons (Deaths per 100,000 live births):
  • France: $7$
  • UK: $6.5$
  • Australia: $4.8$
  • Switzerland: data not clearly shown in transcript
  • Sweden, Germany, Norway, Canada, Netherlands, New Zealand: data not clearly shown in transcript
• The slide notes inequalities across borders and within countries threaten newborn health; highest rates are found in Africa and Asia.
• Summary: substantial international gap; U.S. mortality is higher relative to many peers; social determinants and systemic factors contribute to disparities.

State-level Maternal Mortality Rates (2018–2021)

• The transcript provides a list of state-level maternal mortality rates (per 100,000 births) with several entries shown. Values (where present in transcript) include:
  • Washington: $20.4$
  • Oregon: $16.4$
  • Massachusetts: $15.3$
  • Wisconsin: $11.6$
  • New York: $21.7$
  • Nevada: $21.7$
  • Nebraska: $26.2$
  • Iowa: $20.2$
  • California: $10.1$
  • Arizona: $31.4$
  • New Mexico: $30.2$
  • Oklahoma: $30.3$
  • Mississippi: $43.5$
  • Alabama: $41.4$
  • Georgia: $33.9$
  • Kentucky: $38.4$
  • Tennessee: $41.7$
  • Delaware: $26.5$
  • South Carolina: $32.7$
  • Maryland: $21.2$
  • Texas: $28.1$
  • Louisiana: $39.0$
  • Florida: $26.3$
  • Illinois: $31.1$
  • New Jersey: $25.7$
  • North Carolina: $29.1$
  • Indiana: $23.8$
  • Utah: $16.1$
  • Colorado: $15.2$
  • Connecticut: $16.7$
  • (Additional states with data listed as n/a or partially shown in transcript.)
• Note: The transcript contains garbled/missing values for several states; the numbers above reflect the data as presented in the transcript where legible.

Black Maternal Health Disparities

• The transcript notes that the black maternal death ratio is significantly higher than that of whites; exact ratio is not provided in the slides.
• Emphasizes racial disparities in maternal health outcomes and the need for equity-oriented care and policy action.

Morbidity and Preventive Health and Healthy People 2030

• Morbidity: disease state or condition—no state has focused enough attention on preventive measures.
• Many women lack health insurance coverage.
• Healthy People 2030 holds great promise for women’s health with emphasis on access to preventive health care.
• See reference to Healthy People on preterm births (pg 672 in the source).

Factors Impacting Women’s Health: Health Status, Lifestyle, and Environment

• Health status and lifestyle are key factors; additional influences include:
  • Developmental level and disease distribution.
  • Nutrition: deficiencies or excesses.
  • Lifestyle choices: exercise; tobacco, drugs, or alcohol use.
  • Environmental exposure.
  • Social roles and socioeconomic status.
  • Communities and violence.
  • Media influence.
  • Stress and coping: exposure to traumatic events, crises, inadequate support systems, violence.
  • Family information needs and participation in decision-making.
  • Respect for family views; considering client, partner, and parents as important participants in care decisions.

Social Determinants of Health Framework (Figure 6)

• Health disparities are driven by social and economic inequities rooted in historic and ongoing racism and discrimination.
• Core determinants and domains include:
  • Economic Stability (employment, income, expenses, debt, medical bills)
  • Neighborhood and Physical Environment (housing, transportation, parks, walkability)
  • Education (literacy, language, early childhood education)
  • Food Security and Social Context
  • Health Care System (coverage, access to providers and pharmacies, culturally appropriate care, quality of care)
  • Social Context and Policy (racism, discrimination, policing/justice policy)
• Additional drivers: access to linguistically and culturally appropriate care; overall policy environment.
• Outcome measures include health status, mortality, morbidity, life expectancy, health care expenditures, functional limitations.

Barriers to Health Care

• Finances: limited or no health insurance; poverty.
• Transportation: lack of a car; difficulty using public transportation; need to bring children to visits.
• Language and culture: communication barriers; beliefs about treatment.
• Health care delivery system: earlier discharge; possible limits for specialty care; clinic hours; negative attitudes toward poor or culturally diverse families by some health care providers.

Early Prenatal Care and Risk Factors for Late Presentation

• Early prenatal care is the biggest safeguard against poor outcomes in Maternal-Child Health.
• Table 1: Risk factors for late presentation to prenatal care (
  • Adolescence
  • Delayed recognition of pregnancy
  • Greater multiparity
  • Immigrant status
  • Lack of preexisting obstetric care provider
  • Low level of education
  • Lower socioeconomic status
  • Membership in a specific group of marginalized persons*
  • Minority or nonwhite ethnic group
  • Nontraditional perception of the value of prenatal care
  • Poor reproductive health knowledge
  • Primiparous with complex medical history
  • Undocumented immigrant status
  • Unemployment
  • Uninsured
  • Note: Patients who are refugees, homeless, asylum-seeking, or with a history of substance abuse or intimate partner violence.)

Nursing Practice: Screening and Early Intervention

• RNs can make a difference by screening patients.
• Message: "ONE PATIENT AT A TIME" — emphasis on individual assessment and timely interventions.

Legal and Ethical Issues in Maternal and Women’s Health Care

• Abortion: legal, social, and political issue; nurses may struggle with personal beliefs vs professional duty.
• Substance abuse: fetal injury risk if pregnant; possible charges of negligence and child endangerment.
• Intrauterine therapy: medical technology versus natural processes; better quality of life via surgical intervention.
• Maternal–Fetal Conflict: fetal care involves ethical considerations; referenced as a topic (pg 25 in source).

Birth Rights and Informed Consent

• Birth Rights: Know all options; say “no” and be heard.
• 01 Birth vaginally.
• 02 Labor in the way that works for me.
• 03 Have my basic needs met.
• 04 Ask people to leave.
• 05 Not be touched.
• 06 Change doctors, midwives, or nurses.
• 07 [text appears truncated in transcript; likely additional rights]
• Resource: Birth Rights PDF: https://birthrightsbar.org/resources/Documents/Birth Rights.pdf

Informed Consent – Nurse’s Responsibility

• Informed consent responsibilities include:
  • Invasive procedures require consent.
  • Ensure consent form is completed with signatures.
  • Serve as witness to the signature process.
  • Determine client/family basic understanding of what they are signing through appropriate questions.

Case Question: Informed Consent for a Minor

• Scenario: A 12-year-old child hospitalized for internal injuries after a motor vehicle crash.
• Question: For which medical treatment would informed consent be required beyond the initial admission consent? Select all that apply:
  • Diagnostic imaging
  • Cardiac monitoring
  • Blood testing
  • Spinal tap
• General principle: Additional informed consent is typically needed for invasive procedures or procedures with added risk or sedation beyond what was covered at admission.
• Likely correct selections (practice rationale):
  • Spinal tap (invasive procedure requiring explicit consent).
  • Diagnostic imaging with contrast or invasive aspect, or imaging that involves a procedure beyond routine imaging (institution policy may require separate consent).
• Note: Blood testing and standard cardiac monitoring are often covered by the initial consent or hospital policy, but some policies may require separate consent for specific tests or procedures; always verify with local policy and legal requirements.

References

• Birth Rights resource: https://birthrightsbar.org/resources/Documents/Birth Rights.pdf