Obstetrics- care of women during childbirth MCN - the care of childbearing and
childrearing families.◦ Primary goal
promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing.
Goals and Philosophies
Antepartum Intrapartum
Postpartum
Newborn Nursery
Family-centered Community-centered Evidence-based Advocate to protect the rights of all
family members, including the fetus Health promotion and disease prevention
Philosophy of MCN
Advanced-practice Options in Maternal-
Newborn Nursing Certified Registered Nurse (RNC)- national certification examination
Nurse Practitioner (NP): expanded role as women’s health NP or family NPClinical Nurse Specialist (CNS)
Certified Nurse Midwife (CNM)- certified by the American College of Nurse-Midwives (ACNM)
Health promotion ◦ client education on the importance of health
maintenance◦ importance of prenatal care compliance and
neonatal care
Phases of Health Care
Health restoration ◦ prompt diagnosis and treatment on complications
of pregnancy Health rehabilitation
◦ prevention of further complications, ill client back to optimal health or helping a client to accept inevitable death (molar pregnancy to continue therapy)
Phases of Health Care
Healthy People 2010
Defines health care priorities Guide progress toward the ultimate goal of
optimal health Goals:
◦ To increase the quality and years of healthy life◦ To eliminate health disparities within America’s
population
Healthy People 2010 (cont’d)
Comprehensive set of 467 measurable disease prevention and health promotion objectives
28 focus areas Leading health indicators
Three Levels of Prevention
Primary prevention◦ Health promotion
Secondary prevention◦ Early identification and prompt treatment
Tertiary prevention◦ Restore health
Be mindful of the following:◦ Standards of Care◦ Institutional Policies◦ Ethical Implications◦ Nurse Practice Acts in your State
Legal and Ethical Issues in OB
“Unseen client” Emancipated minors
◦ clients who are not of legal age who are considered mature minors (age 11 to 17)
Patient Confidentiality Considered “normal events”
Legal Considerations
Wrongful birth ◦ the birth of disabled child when parents would
have chosen to end the pregnancy if they had been informed about the disability during the pregnancy.
Wrongful life- ◦ a claim that negligent prenatal testing on the
part of the health care provider resulted in the birth of an un-perfect child.
Legal….
Rights of mother vs. Rights of fetus Heroic measures vs. Comfort care High risks behaviors Methods of resolving infertility Human stem cell research Health of the mother and fetus @ risk
Controversial Issues in OB
Smaller families Single parents Working mothers Domestic Violence Sexual Abuse More health conscious
Trends in MCN
Have the right to refuse to assist Qualified replacement is available Maternal rights supersede those of the fetus
prior to viability and the reverse is true after viability
Nursing Responsibility
Freebirthing ◦ refers to women giving birth without any health
care provider supervision AKA: unassisted birth or couples birth Sources of knowledge:
◦ from books and internet and then arrange to give birth at home in complete privacy
Freebirthing
Birth is a normal function of women An orgasmic experience Increase the ability to bond with the
newborn Lack of health insurance Lack of information about patient rights
Reasons for Unassisted Birth
Traditional Family Definition of Family
◦ Emotional closeness◦ Defined membership◦ Joined together by marriage, blood, adoption, or
residence in the same household
Care of the Family
Dyad Family◦ two people together without children (newly
wed couple) Cohabitation Family
◦ heterosexual couples with children but unmarried
Nuclear Family◦ traditional, Married with children
Types of Family
Polygamous Family◦ marriage with multiple wives
Extended Family◦ multigenerational family
Single Parent Family Blended Family-
◦ remarriage or reconstituted family
Types of Family
Communal Family◦ formed by groups of people who choose to live
together Gay or Lesbian Family
◦ same sex living together
Types of Family
To help provide care to the grandchildren As a peacemaker to resolve conflicts
between grandchildren and parents To maintain involvement in family life
Grandparent Role Function
Stage 1: Beginning families Stage 2: Childbearing families Stage 3: Families with Pre-School
Children Stage 4: Families with School-aged
children
Duvall’s Eight Stage Family Life Cycle 1979
Stage 5: Families with Teenagers Stage 6: Families Launching Young Adults Stage 7: Middle-aged Parents Stage 8: Retirement and old age
Duvall’s Eight Stage Family Life Cycle 1979
Taking a Sexual history1. Explain purpose of interview2. Use direct eye contact unless it is culturally
unacceptable3. Ask open ended questions4. Clarify terminology5. Proceed from easier to more difficult topics
Taking Care of Women
6. Be alert to body language7. Listen and react in a non-judgmental manner8. Use teachable moments to educate9. Do not assume the women is heterosexual10. Be respectful
Taking Care of Women
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