Intro to OB PP 1 lecture student version (2).ppt

8/10/2019 Intro to OB PP 1 lecture student version (2).ppt

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Maternal ChildNursingLecture 1


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Childbearing in 20th Century

Pre 1900s: Birth @ home with assistance ofmidwives. Physicians involved for serious problems.

natural event

Maternal & infant mortality high.

Main causes of maternal death: post partum

hemorrhage, post partum infection (aka puerperalsepsis or childbed fever), toxemia

Primary causes of infant death: prematurity,dehydration d/t diarrhea, & contagious diseases.

1900 -1930s: Obstetrical training of physicians &

use of forcepsbrought deliveries to hospitals.


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1940s - 1950s:

80% women gave birth in hospitals.

Male physicians . No midwives.

Heavy drugs (demerol) twilight sleep for labor & delivery.General for C/S

Fathers not allowed in DR; waiting rooms to protect

them from gruesome reality of childbirth.

Dr. Ferdinand Lamaze (France) childbirth without pain AKALamaze Method. Breathing patterns, relaxationtechniques, concentration on focal point. Monitrice akaDoula/coach. Lamaze method popular in US - 1950s.

Dr. Bradley[USA-1955] supported natural childbirth. Noanesthesia, fathers in DR, breastfeeding. 12 weeks of

classes.


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1960s: Women wanted ^ control over their bodies. Tookchildbirth education classes & FOB present. Hospital

deliveries were norm.

19701980s: Change from cold, sterile hospitalenvironment to warmer setting [family present].

Birthing rooms

Epidural anesthesiawomen awake for vaginal & C/S. Natural childbirth still popularbut more women opting

for pain relief during labor & delivery. Fathers present formost types of deliveries except C/S.

Rooming in popular. M/B together for entire hospitalstay.


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Present: Focus is family; fathers active participants.

Analgesia/anesthetic agents monitored/used more.

Shorter hospital stay; Sibling visits encouraged.

Midwives or physicians used.

Infant stays with mother in DR to initiate breast feeding.

Childbirth Ed popular- allows couple to make informedchoices about labor & delivery experience.

"Family-centered maternity care" popular marketingstrategy.

^ fear of pain & perineal trama. More C/Ss as a result.

C/S rate ^ from 10% 197040% 2009 in USA. Less episiotomies.


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Goal of maternity staff: promote meaningful experience for childbearing family

Ensure health of mother & child. Birth is significant life event.

Honor birth wishes of couple.

Family centered care respects autonomy of family

members; approaches childbirth decisions in non-judgmental manner.

FOCUS: teach new mother self/infant care.Independent function of RN


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GovernmentPrograms High rates of maternal & infant mortality in early 1900s

among poor set stage for federal involvement in maternitycare.

In 1921, Sheppard-Towner Act provided funds for state-managed programs for mothers & children.

Other programs followed. Partially solved mortality problem; distribution of health

care remained unequal.

physicians practiced in urban/suburban areas; women inrural & inner city less access to health care.

Ongoing problem of unequal health care allowed nursesto expand their roles for advanced practice.


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1935: Social Security Act established system of grants forhealth & welfare programs. Included aid for dependent

mothers/children.

1963-1964: mandate established thru Children's Bureauof DOH & Human Services to establish 2 Maternity/InfantCare Projects in each state.

In New York City, a Maternal, Infant & Reproductive HealthProgram began.

1984, Bureau of Maternity Services & Family Planning:

* Community-based health education programs. Since then, high-risk communities have comprehensive

case management services, intensivecounseling/education/home visits.


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1972: Supplemental Food ProgramWIC

Women, infants, & children created as 2-yearpilot program [1972] thru amendment to Child

Nutrition Act of 1966. Permanent in 1975.

established during time of ^ public concernabout malnutrition among low-income mothers &

children.

delivers early nutrition & health intervention

during critical times of growth & development Used as prevention tool


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4criteria:Categorical :Women:

1)pregnant

2) postpartum (up to 6 mos > delivery)

3) breastfeeding Infants -1stbirthday. Children-5thbirthday.

Residential : live in State in which they apply

Income: income at or below State standard

Nutrition risk: medical and/or dietary-based conditions.

ie. Anemia, underweight


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How many get WIC?

> 7 million people each month (current) In 1974, [first year] 88,000 people participated.

Children largest category of WIC participants.

WIC program available in each State, District ofColumbia, 33 Indian Tribal Organizations, Puerto Rico,Virgin Islands, American Samoa, and Guam.

WIC foods include: iron-fortified infant formula and infantcereal, iron-fortified adult cereal, vitamin C-rich fruitand/or vegetable juice, eggs, milk, cheese, peanutbutter, dried beans or peas, tuna fish and carrots.

Special infant formulas.


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PCAPPrenatal Care Assistance Program -

Medicaid program run by NYSDOH

prenatal care for uninsured mothers at/below poverty

Medicaid Obstetrical and Maternal Services (MOMS)

provides complete pregnancy services where PCAP

centers are not located. No cost to participate.

Offers:

Rout inepregnancy check-ups, lab work, specialists

Hospital careduring pregnancy/delivery

HIVcounseling/testing Helpin applying for WIC & low or no cost health ins.

Full health care for mom until 2 months after delivery

Health carefor baby for 1 year after birth

Fam i ly planning services


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Suffolk County Perinatal Coalition

A community based organization dedicated to:

Educating expectant mothers to deliver healthy babies.

Promoting community's goal to achieve healthy birthoutcomes, prevent infant mortality, low birth weight &prematurity throughout Suffolk County.

Works with SCDOH. Founded 1985 by coalition of maternal health providers

committed to reducing infant mortality & birthcomplications.

Suffolk Perinatal Coalition475 East Main Street Suite 20

Patchogue, NY 11772Tel: 631.475.5400; [email protected]
mailto:[email protected]:[email protected]:[email protected]


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Maternal Mortality: deaths from any cause R/T

pregnancy & 42 days PP /100,000 births. 2005 = 15.1/100,000 live births.

1900s rate 600/100,000 live births.African Americanwomens rate of death in US was more than 4 times rate

for white women (2001)

Overall decline attributed to improved prenatal,intrapartal, postpartum care & specialized healthcarepersonnel.


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Healthy People 2010 Goals

National agenda to improve health care

Distribute health care equally among all ethnic/racial groups

Earlier prenatal care

High technology [3rdlevel NICU] < 32 wks.

US ranks 23rdfor infant mortality d/t Hi rate LBW infants

83.4% - prenatal care in 1sttrimester (2002)

3.9% - prenatal care in 3rdtrimester or NONE at all [1998]

8.1 million children without health insurance (2007)

43.9 million people without health ins (2006) 27.4% children covered by Medicaid, & other govt programs

African Americans, Hispanic, and Native American women less likelyto receive early and adequate prenatal care


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Standards of Nursing Care

Standards for Nursing care of women andchildren set by AWHONN: The Association ofWomens Health, Obstetric, & Neonatal Nurses.

Assesses family for strengths/needs

Encourages use of community resources; rooming in

Respects diversity in families; Encourages family-oriented care

Promotes using evidence-based practice as basis for nursinginterventions [research studies]

ANAstandards of practice for maternal-child nursing

2010 National Patient Safety Goals JCAHO


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Ethical Issues

Maternity Nursing = family-centered.

Conflicts with following topics:

Abortion (fetal rights vs. rights of mother esp.with 2nd & 3rd trimester ABs)

Embryonic Stem Cell Research Cord Blood Banking

Terminating Life Support - To resuscitate ornot with very young fetus < 23 wks. Not

viable. Looks at quality of life issues. Conception issues involving surrogate

mothers, embryo transfer, cloning.

Reproductive Assistance Technology [ART]


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Ethical Issues

RN can help clients face difficult decisions

by providing factual information,

supportive listening, by helping familyclarify values.

Maternal health care has both legal &

ethical considerations more than withother areas of healthcare b/c of presence

of both fetus & mother


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The Family

Family - U.S. Census Bureau 2008 - 2 or morepeople joined by marriage, birth, or adoptionliving together

How well family works together against potentialthreats depends on its structure & function.

2 Basic Family Structures:

Family of Orientation: Family one is born into.

Family of Procreation: Family one establishes.


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Specific Family Types

Nucleartraditional husband, wife & children

Extendedincludes nuclear plus grandparents, aunts,or uncles, etc. living together..

Advantages: support, childcare options, role models

Single-Parent : Approx. 50-60% of families w. school-age

children; 15% headed by males.D/T ^^ in divorce & common practice of women

raising children alone.

Disadvantages:

Lack of support (childcare)

Limited finances

Role straintrying to fulfill maternal & paternal roles

Mental & physical strain


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FAMILY FUNCTION:

Ability to meet needs of its membersthru developmental transitions (grows/changes).

*Each new generation adapts values &

traditions from previous generations. *When doing family assessment - identify

behaviors that are strengths and

deficiencies.


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FAMILY LIFE CYCLES: Duvall 1977

Oldest child marks stage family is at

Marriage & family

Early child-bearing family

Pre-school child family

School-age child Adolescent child

Launching Center (most difficult- disruption of familyunit)

Family of middle years (empty nest) Family in retirement age


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Community Assessment

Look at surrounding community - tells how vulnerable itis to disease & mental/social problems.

Poverty level & many young children strongly assoc. w.

^ community health needs.

Increased abuse in families. D/t ^ stress & better reporting.

NURSE RESPONSIBILITIES: Be aware that it exists in all communities.

Careful screening of abuse


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Suffolk County is Very Diverse

~ 1.5 million residents

8% African American

13% Hispanic/Latino

4% Asian American

1% American Indian

74% White


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SCDOH Clinics - even more diverse

55% Latino/Hispanic

17% Black

2% Asian (1% Asian Indian)

19% White

2009 3rdquarter Health Information Systems


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Importance of Cultural Competence..

U.S. demographics are changing.

Health disparities exist between ethnic groups

Health care organizations require increased,

documented cultural competence.

Cultural competence enriches professional nursing

practice.

What is Culture?

Distinct way of life that characterizes particular

community of people.

Includes learned practices, beliefs, values, customs

passed through generations.

Provides sense of identity


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Acculturation Integration into mainstream culture

Depends on age at time of arrival, reason for moving tonew area and residence in predominantly ethnicneighborhood

Generally takes three generations in USA (Spector, 2000)

Ethnocentrism Ethnocentrism belief that ones own culture is best.

Providers must be aware of own ethnocentrism.

Cultural Perspectives

depends on if you are member of culture or observer ofculture


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Cultural Traditions

Functional traditionenhances health and well-being Neutral tradition neither enhances nor harms health and

well-being

Non-functional - potentially harmful

Cultural Characteristics

Individual vs. group identity Decision-making

Eye contact Being polite

Family oriented Time orientation

Fathers participation at birth Nutrition

No Male hcp Pregnancy as healthy

natural state


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Female Genital Mutilation:

Curb sexual desire of girls/women and preserve "sexual honor" before

marriage. It is irreversible and extremely painful, and is usually done to

young girls.


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Instruments Used


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Common Cultural Beliefs

Hot and cold: Illness d/t imbalance -causes body to behot/cold. Needs balancing to correct illness.

Chinese theory ying/yang similar

Pregnancy- hot: consume cold foods

Post Partum- cold: consume hot foods

Example: Vietnamese culture: spinach, melons, beans[pregnancy] and soup w. chili peppers, salty fish, meat w.herbs & wine [post partum]

Iron supplement = considered hot

Found in parts of Asia, India, Latin America

Evil Eye Theory: 80% worlds population believes in this.Hispanics term mal ojo - belief that certain actionsinvite evil spirits to cause illness/death.


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Ways to Relate to Other Cultures

Common practices

Avoiding people from other cultures

Refusing to recognize cultural differences

Recognizing differences, but feeling own way is

superior (ethnocentrism)

Best practice

Acknowledging and seeking to understand cultural

differences


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Cultural Assessment

Where were you born?

How long have you lived in theUnited States?

Who are your major support

people?

Childbearing Assessment

What are your religious

practices? Food preferences?

Economic situation?

What languages do you speak

and read?

How would you like to manage

labor pain?

Who will provide laborsupport?

Who will care for the baby?

Do you use contraception?

What does childbearing represent to

you?

How do you view childbearing?Are there any maternal precautions or

restrictions?

Is birth a private or social experience?


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Assessment Techniques Use conversational approach.

Ask open-ended questions. Integrate cultural and childbearing assessments.

Listen with interest.

Nonjudgmental

Interpreters: Interpreters communicate verbally.

Should be female

Should not be family member

Can work with written communication. Maintain strict confidentiality.

Do not paraphrase

Use Translator Phone

Intro to OB PP 1 lecture student version (2).ppt

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