Study Notes: Maternal-Newborn & Women's Health Nursing

Introduction to Maternal-Newborn & Women's Health Nursing

• Author: Lauren Patterson

• Course focus: Maternal-newborn and women's health nursing principles, standards, and issues across care settings

Maternal Mortality

• Definition: Death of a person while pregnant or within 42 days of birth or termination of pregnancy that was not accidental

• 2021 data: $32.9$ deaths per $100{,}000$ births

• Racial disparity: $2.6\times$ more often in non-Hispanic Black patients than non-Hispanic White patients

• Preventability: $80\%$ of pregnancy-related deaths were preventable

• Common contributing conditions:

  • Mental health conditions

  • Hemorrhage

  • Cardiac/coronary conditions

  • Infection

  • Embolism

  • Cardiomyopathy

  • Hypertension (HTN)

  • Anaphylactoid syndrome

  • Injury

  • Cerebrovascular accident (CVA)

  • Cancer

  • Metabolic/endocrine conditions

  • Respiratory conditions

Fetal / Infant Mortality

• Fetal mortality definition: Any gestation OR after 20 weeks gestation

• Rate: $5.74\text{ per }100{,}000$

• Common causes/categories:

  • Unknown cause

  • Complications with placenta/cord/membranes

  • Maternal complications related to pregnancy

  • Maternal complications not related to pregnancy

  • Congenital malformations

• Infant mortality definition: Before first birthday

• Rate: $5.4\text{ per }1{,}000$

• Common causes/categories:

  • Birth defects

  • Preterm/low birth weight (LBW)

  • Sudden infant death syndrome (SIDS)

  • Injuries

  • Maternal pregnancy complications

Quality Improvement Measures

• Address mental and physical health across the life course: start with young girls and adolescents; extend through childbearing age

• Promote healthy behaviors that improve women’s health: breastfeeding, smoking cessation, physical activity

• Address social determinants of health and other factors affecting overall health and well-being

• Recognize maternal health disparities in the United States (geographic, racial, ethnic) and work to address them

• Acknowledge risk factors such as maternal age and chronic conditions (hypertension, obesity, diabetes)

• Learn early warning signs of potential health issues during pregnancy or in the year after delivery

• Collaborate to recognize and include women with disabilities in disparities-reduction efforts

Destigmatizing Topics

• Abortion

• Birth control

• Religious affiliation

• Infertility

• Menstruation

Health Care & Reproductive Rights in the US

• Who is seeking care?

  • Age 13–15 to discuss menstruation/contraception

  • 12th week of pregnancy

  • Menopause/screening

• Women’s Reproductive Rights

• Maternal Health Care

• Pathways: Home to hospital

• AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses)

• Partner support

Contemporary Child Birth Education

• Education

• Complementary providers

• Family-centered care

• Culturally competent care

Levels of Care

• Birth Center

• Level 1: Basic care

• Level 2: Specialty care

• Level 3: Subspecialty care

• Level 4: Regional Perinatal Health Care Center

Standards of Practice

• Organizations and standards:

  • American Nurses Association (ANA)

  • State Board of Nursing (SBON)

  • Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Standards

• Common issues:

  • Error of omission

  • Lack of staffing, resources, teamwork, and communication

• Risk Management

• Core competencies (6):

  • Patient-centered care

  • Teamwork

  • Evidence-based practice

  • Quality improvement

  • Safety

  • Informatics

• QSEN (Quality and Safety Education for Nurses)

Legal Issues

• High rates of litigation

• Why? factors contributing to lawsuits

• Most common errors for which health care team members are sued:

  • Improper administration of mag sulfate, heparin, oxytocin, and/or insulin

  • Failure to assess/monitor for medication/intervention side effects

  • Improper use of equipment

  • Poor/inadequate communication

  • Failure to act as a patient advocate

  • Failure to follow provider orders

  • Failure to verify informed consent

Ethical Issues

• Surrogacy

• Female genital mutilation & cutting (FGMC)

• Informed consent

• Autonomy

• Abortion

• Perinatal research

• Maternal-fetal conflict