MODULE 1
Maternal and Child Health Nursing
Medical term:
Obstetric
- a branch of medical science that deals
with pregnancy, childbirth, and the
postpartum period.
- taken from Greek work Obstare, which
means “to keep watch".
Pediatrics
- a branch of medicine dealing with the
health and medical care of infants,
children, and adolescents from birth up
to the age of 18
- from the Greek word Pais, meaning
"child".
In Maternity and Child Health Nursing,
- Nurses are partner in care and not just
keeping watch.
- Not only the child but also the family.
Maternal and Child Health Nursing
- Maternal and Child Health Nursing
defined as, “the nursing specialty that
deals with the care of women throughout
their pregnancy and childbirth and the
care of their newborn children" . (NCBI,
2017).
Maternal and Child Health
- Refer to philo-mother and child
relationship to one another and
consideration of the entire family as well
as the culture and socioeconomic
environment as framework of the patient
(CHNS, Philippines, 2000)
FRAMEWORK FOR MATERNAL AND CHILD
HEALTH NURSING
A. GOALS AND PHILOSOPHIES OF
MATERNAL AND CHILD HEALTH NURSING
Primary Goal:
The promotion and Maintenance of optimal
family health.
Specific objectives of MCH Care
- focuses on the reduction of maternal,
perinatal, infant and childhood mortality
and morbidity and the promotion of
reproductive health and the physical and
psychosocial development of the child
and adolescent within the family.
Goals of MCHN (ages covered are large,
concerns & goals also are broad, the scope
of MCN are as follows:
1. Preconceptual Health Care
2. Care of women during
3 trimesters of pregnancy
➢ Ist trimester (1st - 3rd month)
➢ 2nd trimester (4th-6th month);
➢ 3rd trimester (7th - 9th month)
3. Care of women during Puerperium or
4th Trimester (6 weeks after
childbirth)
4. Care of infants during Perinatal
Period (6 weeks before conception
and 6 weeks after birth)
5. Care of children from birth to
adolescence
➢ Neonatal (28 days of life);
➢ Infancy (1 - 12 months):
➢ Adolescence (after 18 y/o).
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 6. Care in settings as varied as the - the systematic investigation of problems
that have implications for nursing
➢ birthing room
practice & usually carried out by nurses.
➢ the PICU, and
➢ the home. QSEN Competencies:
1. Patient Centered
1. Nursing Process - patient is the source of control
and full partner in the provision of
2. Nursing Theory compassionate and coordinated care
based on respect for the patient's
3. Quality & Safety education for Nurses
preferences, values, and needs.
4. Evidence-Based Practice 2. Teamwork & Collaboration
- effective interprofessional teams,
5. Nursing research
fostering open communication, mutual
Four Phases of Health care respect & shared decision making for
quality patient care.
➢ Health Promotion 3. .Evidence-Based Practice
➢ Health Maintenance - integrate the best current
➢ Health Restoration evidence with clinical expertise &
➢ Health Rehabilitation patient/family preferences and values for
Nursing process delivery of optimal health care.
4. Quality Improvement (QI)
- organized series of steps to ensure - use data to monitor the outcomes
quality and consistency of care of care & use improvement methods to
(Carpenito, 2012). design and test changes to continuously
Nursing theory improve the quality and safety of health
care systems.
- designed to offer helpful ways to view 5. Safety
clients so nursing activities can be - minimize risk of harm to patients
created to best meet client needs. and providers through both system
QSEN (Quality and Safety Education for effectiveness and individual
Nurses) performance.
6. Informatics
- to improve quality of nursing care, with - nurses use information and
six competencies; technology to communicate, manage
1. Patient centered; knowledge. Mitigate error, & support
2. Teamwork collaboration decision making.
3. Evidenced-based Practice
4. Quality Improvement (QI) MAJOR PHILOSOPHCAL ASSUMPTIONS
5. Safety OF MATERNAL & CHILD HEALTH NURSING
6. Informatics Maternal and child health nursing is;
Nursing Research o Family centered.
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 o Community centered
o Evidenced Based
o Challenging role for nurses
o Part of the continuum of the total life
o cycle.
o Personal, cultural and religious attitudes
and beliefs influence the meaning of
pregnancy for individuals.
What is a family?
FAMILY - a group of people related by blood,
marriage, or adoption living together, (USCB,
2010).
Most Important Role of Parents
- To room-in and give total care
to their newborn.
Community Centered
Important Nursing Role
- Empower communities with knowledge
and mobilize them to improve their
health practices. Encourage them to
make their own decisions and provide
informed consent.

FAMILY= is the center of care, the primary unit Philosophy of MCN

of care. - Encourage them to make their own
➢ Family's function is so importanzo health decisions and provide informed consent.
status of its members (Papp, 2012). Important Role of the community in
➢ Healthy family establish an environment Maintaining Health
conducive to growth and health thus
promotes behavior sustaining family - Working at the community level to
members during crises. promote healthy living brings the
➢ Health of individual and their ability to greatest health benefits to the greatest
function as member of family can number of people.
strongly influence and improve overall
family functioning.
Philosophy of MCN
➢ Family centered approach enables
nurses to better understand individuals
and their effect on others and I turn,
provide holistic care.
FAMILY -CENTERED APPROACH
Important Nursing Role
- Encourage parents to do much for their
child as they wish like feeding, bathing,
giving oral medications This can provide
comfortable, secure influences on their
child.
- Is the conscientious, explicit, and
Philosophy of MCN judicious use of current best evidence in
- This can provide comfortable, secure making decisions about the care of
influences on their child. patients (Falk, et al., 2012).
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 - Evidence-based maternity care uses the
best available research on the safety
and effectiveness of specific practices to
help guide maternity care decisions and
to facilitate optimal outcomes in mothers
and newborns
- A combination of research, clinical
expertise, and patient preferences or
values.
- Helps to move health care actions from
"just traditional” to a more solid, and
therefore safer, scientific basis.
Challenging Role for Nurses
Some of the most difficult ethical quandaries in
health care today are those that involve
children and their families’ examples include:
• Conception issues, especially those
related to in vitro fertilization, embryo
transfer, ownership of frozen oocytes or
sperm, and surrogate motherhood;
• Abortion, particularly partial-birth
abortion;
• Fetal rights versus rights of the mother;
• Stem cell research:
• Resuscitation; (for how long should it be
continued?)
• Number of procedures or degree of pain
a child should be asked to endure to
achieve a degree of better health;
• Balance between modern technology
and quality of life;
• Difficulty maintaining confidentiality of
records when there are multiple
caregivers:
Part of the continuum of the total life cycle.
• The cycle repeats & the new
generation of support
becomes necessary.
• As children grow, families need continued
health supervision & support to ensure
children remain well.
• As teenager & young adults reach maturity
& begin to plan for their families.
Personal, cultural and religious attitudes
and beliefs influence the meaning of
pregnancy for individuals.
• Maternal and child clients do not fit
easily into in any set of molds,
• Varying family structures, cultural
backgrounds, socioeconomic levels,
and individual circumstances lead to
unique and diverse client.
Health Care Technology
- Immunization;
- New Fertility Drugs & Fertility
techniques;
- Ability to delay preterm birth;
Specific genes responsible for
children's health disorders are
identified.
- Stem cell therapy;
Health care may be more advanced, but
it is still not accessible to everyone.
B. Maternal and Child Health
Goals and Standards.
2020 National Health Goals .
- In 1979 - US Public Health Service
first formulated health care
objectives for the nation.
- In 2010, new goals to be achieved
by 2020 were set (US DOH & HS,
2010).
Two Main National Goals are:
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 1. Increase quality and years of health life.
2. Eliminate health disparities.
Global Health Goals: (UN & WHO
Millennium Health Goals in 2000)
1. End poverty and hunger.
2. Achieve universal primary education.
3. Promote gender equality and empower
women.
4. Reduce child mortality.
5. Improve maternal health.
6. Combat HIV/AIDS, malaria and other
disease.
7. Ensure environmental sustainability.
8. Develop a global partnership for
development.
2020 National Health Goals:
- Concentrate on improving the health of
women & children.
- Increasing health of these 2 population
can have a long-range effects on
general health.
Nursing Theories
C. Theories Related to Maternal and
Child Nursing
What are Nursing Theories?
- Nursing theories are organized bodies of
knowledge to define what nursing is,
what nurses do, and why they do it
- Nursing theories provide a way to define
nursing as a unique discipline that is
separate from other disciplines (e.g.,
medicine).
- It is a framework of concepts and the
purposes intended to guide nursing
practice at a more concrete and specific
level.
1. "Environmental Theory" as "the act of
utilizing the patient's environment to
assist him in his recovery". by Florence
Nightingale,1860.
2. "Adaptation Model of Nursing",
stresses that an important role of the
nurse is to help patients adapt to change
caused by illness or other stresses, was
developed by Sister Callista Roy in
1976
3. "Nursing Need Theory", conceptualized
nurse's role as assisting sick or healthy
individuals to gain independence in
meeting 14 fundamental needs, by
Virginia Henderson, 1955.
4. "Theory of Human Caring", developed
the philosophy of caring, highlighted
humanistic aspects of nursing as they
intertwine with scientific knowledge and
nursing practice, by Jean Watson, 1979.
5. "Comfort Theory", explains comfort as a
fundamental need of all human beings for
relief, ease, or transcendence arising
from health care situations that are
stressful, by Katharine Kolcaba, 1994,
6. "Maternal Role Attainment Theory",
Nurses are the health professionals
having the most sustained and intense
interaction with women in the maternity
cycle, by Ramona Mercer, 2020.
D. Role and Responsibilities of a
Maternal and Child Nurse.
1. Consider family as a whole and as
partner of care.
2. Serves as an advocate to protect the
rights of all family
3. Demonstrates a high degree of
independent nursing.
4. Promotes health and disease
prevention.
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 5. Serves as an important resources for
families during childbearing and
childrearing
6. Respect personal, cultural, & religious
attitudes and beliefs.
7. Encourages developmental
stimulation during both health and
illness.
8. Assesses families for strengths.
9. Encourage family bonding
10. Encourage early hospital discharge.
11. Encourage families to reach out to
their community
MEASURING MATERNAL AND CHILD
HEALTH
Common Statistical Terms Used to Report
Maternal and Child Health.
• Birth rate. The number of births per
1000 population. •
• Fertility rate. The number of
pregnancies per 1000 women of
childbearing age.
• Fetal death rate. The number of fetal
deaths (over 500g) per 1000 live births.
• Neonatal death rate. The number of
deaths per 1000 live births occurring at
birth or in the first 28 days of life.
• Perinatal death rate, the number of
deaths during the perinatal time period
(beginning when the fetus reaches
500g, about week 20 of pregnancy, and
ending about 4 to 6 weeks after birth); it
is the sum of the fetal and neonatal
rates.
• Maternal mortality rate, the number of
maternal deaths per 100,000 live births
that occur as a direct result of the
reproductive process.
• Infant mortality rate. the number of
deaths per 1000 live births occurring at
birth or in the first 12 months of life
• Childhood mortality rate, the number of
deaths per 1000 population in children
aged I to 14 years.
➢ The current birth rate for Philippines in
2021 is 19.978 births per 1000 people, a
0.99% decline from 2020.
➢ US birth rate fell by 4% in 2020, the
sharpest decline in nearly 50 years, per
CDC data from May, 2021.
➢ Fertility rate is low in countries where
there is famine because of poor nutrition
make conceiving difficult.
➢ Fetal death rate is important in
evaluating the health of the nation, it
reflects the overall quality of maternal
health & whether services like prenatal
care are available.
➢ Neonatal death rate reflects not only the
quality of available care to women
during pregnancy & childbirth but also
the quality of care available to infants
during the first month of life.
➢ Infant mortality rate is a good index of its
general health because it measures
quality of pregnancy care, overall
nutrition, as well as infant health and
available care.
E. WHO'S 17 SUSTAINABLE
DEVELOPMENT GOALS
GOAL 1: No Poverty
GOAL 2: Zero Hunger
GOAL 3: Good Health and Well-being
GOAL 4: Quality Education
GOAL 5: Gender Equality
GOAL 6: Clean Water and Sanitation
GOAL 7: Affordable and Clean Energy
GOAL 8: Decent Work and Economic
Growth
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 GOAL 9: Industry, Innovation and
Infrastructure
GOAL 10: Reduced Inequality
GOAL 11: Sustainable Cities and
Communities
GOAL 12: Responsible Consumption and
Production
GOAL 13: Climate Action
GOAL 14: Life Below Water
GOAL 15: Life on Land
GOAL 16: Peace and Justice Strong
Institutions
GOAL 17: Partnerships to achieve the Goal
MODULE 2
A. Concept of Unitive and Procreative
Health
Genesis 1:31 And God saw everything that he
had made, and, behold, it was very good.
What is sex?
- Sexual activity, including specifically
sexual intercourse.
What is a sexual intercourse?
- is a reproductive act in which the male
reproductive organ (in humans and other
higher animals) enters the female
reproductive tract.
What is human sexuality?
- is all those things that go with being
male or female, including physical &
emotional differences. They are all part
of being human.
➢ "Two becoming one flesh", that's the
UNITIVE purpose of our sexuality
➢ "Increase & multiply", that the
PROCREATIVE purpose "to becoming
one flesh" Is part of the life-long
commitment that is MARRIAGE
➢ Marriage is when a man and a woman
unite "as one flesh", Sex is UNITIVE.
➢ Marriage needs to be open to the
possibility of having children, Sex is
PROCREATIVE
Hebrew 13:4. "May marriage be honorable
in every way and may the marriage be
immaculate. For only God will judge
fornications and present when the natural
adulterers."
Good moral object of any moral sexual act
is threefold:
• Marital,
• Unitive and,
• Procreative
We can consider this to be one word object
with three components (as God is one yet
three.)
Marital meaning is only present sexual act
occurs between a man and a woman
married to each other.
Any knowingly chosen sexual act that is
deprived of the marital meaning is
intrinsically evil and always
In order to be moral, the chosen act must
have three (3) good sources;
1. Only good intention
2. Only good moral object
3. Any reasonably anticipated =
Consequences must not outweigh
the reasonably anticipated good
consequences.
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 Each source is judged to be good or
based on the love of God, neighbor &
self.
Nursing Care Planning: "Based on the
Healthy People 2020 and Maternal and Child
Health".
► Increase the percentage of adult smokers
aged 18 years and older attempting to stop
smoking.
► Increase the proportion of young children
who are screened for an autism spectrum
disorder (ASD) and other developmental
delays by 24 months of age.
► Reduce postpartum relapse of smoking
among women who quit smoking during
pregnancy.
► Increase the proportion of children with
special health care needs who receive their
care in family-centered, comprehensive, and
coordinated environments.
► Increase the rate of infants who are
breastfed until 6 months.
► Reduce physical violence directed at women
by male partners to no more than 27 per 1000
couples.
Nursing Process: For Family Health
Promotion
1. Assessment
- Assess the structure, function, the
strength and challenges of families.
- Can provide information how family cope
during calm and stressful events.
- Can reveal current health situation.
- Vital to the understanding of what
pregnancy or childhood illness meant to
family members.
2. Nursing Diagnoses
• Formulated for families in relation to
their ability to handle stress.
• Provide positive environment for growth
and development of members.
Example:
1. Impaired parenting related to
unplanned pregnancy.
2. Interrupted family processes related
to emergency hospital admission of the
oldest child.
3. Ineffective family coping mechanisms
related to an inability to adjust to the
mother's illness during pregnancy
4. Health seeking behaviors related to
the birth of a first child.
3. Outcome Identification & Planning.
• Both family and community
centered
• Appropriate and desired by all family
members.
4. Implementation
• The flow is smooth if family agreed to
the plan and will support each other.
• Encourage to agree to the plan so no
indirect opposition and or
counterproductive to the plan.
Family Types:
1. The Dyad Family - two people living
together without children. Are generally viewed
as temporary arrangement.
Positive aspects: Companionship, possibly
shared resources.
Potential negative aspects: can result in a
sense of loss when the relationship ends.
2. The Cohabitation Family-composed of
couples, perhaps with children, who live
together but remain unmarried.
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 Positive aspect: Companionship, possibly
financial security, encourage a
monogamous relationship.
Potential negative aspects: As with dyad
families, may result in a feeling of loss if only
short term and the break-up isn't desired by
both parents
3. The Nuclear Family - composed of
husband, wife and children, traditional family
and most common family structure worldwide.
Positive aspect: Support for family: sense
of security.
Potential negative aspects: May lack
support people in a crisis situation
4. The Polygamous Family - a marriage with
multiple wives or husband.
Polygyny (one man with several wives);
Polyandry (one wife with more than one
husband)
Positive aspects: Companionship; shared
resources.
Possible negative aspect: Not sanction by
law; disapproval by community, decreased
values of women
5. The Extended Multigenerational) Family -
includes such as grandmother grandfather,
aunts, uncles, cousins and grandchildren.
Positive aspect: Many people for child care
and member support.
Possible negative aspect: Resources
maybe stretched thin because of few wages
earners.
6. The Single-Parent Family-play a large role
in childrearing, low income is often a
problem encountered mostly by single-
parent families especially if woman is head
of the family.
Positive aspect: Ability to offer a unique
and strong parent-child bond.
Possible negative aspect: Resources may
be limited
7. The Blended Family - a remarriage or
reconstituted family. A divorced or widowed
person with children, marries someone who
also have children
Positive aspect. Increased security and
resources exposure to different customs and
culture may help children become more
adaptable to new situations.
Possible negative aspect: Rivalry or
competition among children; difficult
adjusting to a stepparent.
8. The Gay or Lesbian Family - Gay or
lesbian live together as partners for
companionship, financial security, and sexual
fulfillment, or form the same structure as a
nuclear family
Positive aspect: Provides advantages to a
nuclear family.
Possible negative aspect: May suffer
discrimination formy neighbors who do not
thoroughly approve or accept this family
type.
9. The Foster Family - children whose parents
can no longer care for them placed in a foster
or substitute home. Foster parents may have
children of their own, receive renumeration for
the care of the foster child.
Positive aspect: Prevents children from
being raised in large orphanage settings.
Possible negative aspects insecurity and
inability to establish meaningful relationships
because of frequent moves
10. The Adoptive Family - families of a great
many types (nuclear, extended,
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cohabitation, single-parent, gay/lesbian)
adopt children. Adopting not only brings
unusual joy and fulfillment to a family but
can offer a number of challenges for both
the adopting parents and the child.
Positive aspect: Children grow up well
cared for and experiencing a sense of love;
a woman who relinquishes her child for
adoption can feel a sense of relief her baby
will have lifestyle better than what she could
provide
Possible negative aspect: Divorce of the
adopting parents can be devastating if the
child views himself as the cause of the
separation or as a child unable to find a
secure family for a second time.
Family Function and Role
1. Nurturer: Primary caregiver
2. The Provider - brings in the
bulk of family income
3. The Decision Maker - makes
decision
4. The Financial Manager -
supervises family finances
5. The Health Manager - makes
health care decisions.
6. The Problem Solver – provide
solution to problems.
7. The Gatekeeper – determines
what information will be
released from family.
8. The Environmentalist -
responsible for recycling and not
wasting electricity or water
9. The Culture bearer - maintains
family & community customs so
children can develop a sense
where they belong in history;
Important Roles and Responsibilities of
Mothers
1. One of the most meaningful roles that
a mother plays is the role of nurturer.
2. Giving Proper Environment for Right
Development.
3. Child's Behavioral Development
4. Instils Trust and Security
5. Family Bonding
6. Be kind, Loving and Caring
7. Be Thoughtful and Sensitive
8. Positive Attitude
9. Role of Routine and Discipline in Life
10. Hard Work
➢ Mothers in the Bible are depicted
as honorable beings worthy of the
love and respect of their children
and the entire community.
➢ A woman, Mary, brought the
savior, Jesus Christ, into the
world, and in this regard, every
mother in the world is believed to
be connected to Mother Mary.
• Mothers play a critical role in the
first three years of a child's
development; it provides babies
with two things: protection from
stress and emotional regulation.
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The Reproduction and Development will become part of the digestive
Process tract.
• On the other side, the amnion fills
• Vagina carries the female's
with fluid and will surround the
menstrual flow outside the body,
embryo as it develops, Other cell
receives the male penis during
groups initiate the placenta and
intercourse, and serves as the
umbilical cord, which will bring in
birth canal during labor.
nutrients and eliminate waste.
1. Fertilization: A Sperm and an Egg
3. In Eight Weeks, the Embryo
Form a Zygote.
Develops; By the End of Week 10 It
• Sperm cell penetrates and Becomes a Fetus
fertilizes an egg,
• 15 days after conception marks
• 23 chromosomes from the sperm
the beginning of the embryonic
pair with 23 chromosomes in the
period.
egg, forming a 46-chromosome
• Embryo contains a flat embryonic
cell called a zygote.
disc differentiates into 3 layers: the
• Zygote starts to divide and endoderm, the mesoderm, and the
multiply, Travels toward the uterus
ectoderm.
it divides to become a blastocyst.
• All organs of the human body
2. The Zygote Becomes an Embryo: derive from these three tissues.
Development Prior to and During They begin to curve and fold and
Implantation to form an oblong body.
• By week 4, the embryo has a
• Fertilized egg, or zygote, takes
distinct head and tail and a
five days to reach the uterus from
beating heart.
the uterine tube.
• Over 6 weeks, limbs, eyes, brain
• Zygote divides and develops into a
regions, and vertebrae form.
blastocyst, with an inner mass of
cells and a protective outer ring. • Primitive versions of all body
systems appear.
• Blastocyst attaches to the wall of
the uterus and gradually implants End of week 10, the embryo is a fetus.
itself into the uterine lining. During
implantation, its cells differentiate
further.
• At day 15 after conception, the
cells that will form the embryo
become an embryonic disc. The
yolk sac, on one side of the disc,
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