MATERNITY LECTURE – PRELIM REVIEWER

CHAPTER 01 FRAMEWORK FOR MATERNAL AND CHILD GOAL OF MCN

HEALTH NURSING 1. Preconception Health Care.
OBSTETRICS 2. Care of women during 3 trimesters of
–CARE OF WOMAN DURING CHILDBIRTH pregnancy
1st 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 after birth)
5. Care of children from birth to adolescence,
Neonatal (28 days of life); Infancy
(1–12 months); Adolescence (after 18 y/o)
PEDIATRICS 6. Care in settings as varied as the birthing room,
the PICU, and the home.
-CARE OF INFANTS, CHILDREN & ADOLESCENTS-FROM
BIRTH TO THE AGE 18 PHILOSOPHIES OF MCN
1. MCN is Family Centered; assessment must
include both family and individual assessment
2. MCN is Community Centered; health of
families depends on & influences the health of
communities.
3. MCN is Evidence Based; because critical
knowledge increases 4.MCN; includes
independent nursing functions because teaching
& counselling are major interventions
FOCUS OF MCN 5. MCN Nurse, Advocate (protects the rights of
family members, including fetus)
1. CARE OF CHILDBEARING
6. Health Promotion and Disease Prevention; to
protect health of new generation.
7. MCN is a challenging role for nurses
FRAMEWORK FOR MCN
1. Nursing Process (ADPIE)
2. Evidence Based Practice
3. Nursing Research
4. Nursing Theory

2. CHILDREARING FAMILIES
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4 PHASES OF HEALTH CARE
1. Health Promotion- Educating clients to be
aware of good health through teaching and role
modeling.ex Family planning, teach the
importance of safe sex practice, importance of
immunizations.
2. Health Maintenance- Intervening to maintain
health when risk of illness is present Ex.
Encourage prenatal care, importance of
safeguarding homes by childproofing it against
poisoning
3. Health Restoration-Diagnosing and treating
illness using interventions that will return client
to wellness fast Ex. Care of child during illness,
care of woman during pregnancy
complications4.
4. Health Rehabilitation-Preventing further
complications from an illness. Bringing client
back to an optimal state of wellness
Helping client accept inevitable death.Ex
Encourage continuous therapies and
medications
TRENDS IN MATERNAL AND CHILD
HEALTH NURSING POPULATION
Client Advocacy–safeguarding and advancing the
interests of clients and their families.
1. Trends Nursing Implications Families are
smaller in size
Fewer family members are present as
support people in times of crisis
Role of Nurse:Fullfill the role
2. Increased Single Parents (most common
type of parent in US)
Fewer financial resources esp. woman
Role of Nurse:Inform parents of care
options and back – up opinion
3. Increased mothers working outside home
at least part –time (90%)
Healthcare must be scheduled at times a
working parent can care for her own self or
bring a child for care.
Role of Nurse: Discuss selection of child care
centers
4. Families are more mobile; increased no.of
homeless women & children
Good interviewing & health monitoring are
necessary so health
database can be established and continuity
of care.
• Child and Intimate Partner Abuse
Screening for child or intimate partner
abuse; Nurses must be aware
of legal responsibilities for reporting abuse.
• Families are more health conscious
Provide Health Education
• Health care should respect cost
containment
Comprehensive care is necessary in primary
care settings
because referral to specialists may no longer
be an option: Health
insurance is not available in all families.
MEASURING MATERNAL AND
CHILD HEALTH / STATISTICAL
TERMS USED TO REPORT
MATERNAL AND CHILD HEALTH
1. Birth Rate– no. of births per 1000
population
2. Fertility Rate–no. of pregnancies per 1000
women of childbearing age
3. Fetal Death Rate–no. of fetal deaths
weighing more than 500 g or more per
1000 live births
4. Neonatal Death Rate;Neonatal Period–1st
28 days of life; Infant is called Neonate
No. of deaths per 1000 live births occurring
in the 1st 28 days of life.
5. Perinatal Death Rate;Perinatal Period-6
weeks before conception and 6 weeks
after childbirth No. of deaths of fetuses
weighing > 500g and within the
first 28 days of life per 1000 birth
6. Infant Mortality Rate–no. of deaths per
1000 live births in the first 12 months of life.
7. Childhood Mortality rate–no. of deaths
per 1000 population in children; 1–14 y/o
8. Maternal Mortality Rate–no. of maternal
deaths per 100,000 live births that
occur as direct result of reproductive
process.
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TRENDS IN HEALTH CARE
ENVIRONMENT
1. COST CONTAINMENT
reducing the cost of health by closely
monitoring the cost of personnel, use and
brands
of supplies, length of hospital stays, no. of
procedures carried out, and no. of referrals
while maintaining quality care.
2. INCREASING ALTERNATIVE SETTINGS AND
STYLES FOR HEALTH CARE
LDRP Rooms(Labor–Delivery–Recovery–
Postpartum) a more natural childbirth
environment as a birthing room. Family
members are invited to stay to be a part of
childbirth.
• Retail Clinics or Emergent Care Clinics
located in shopping malls
• Ambulatory Clinics or at home to avoid
long hospital stays for women and children.
3. INCLUDING FAMILY IN HEALTH CARE
4. INCREASING INTENSIVE CARE UNITS;
NICU (Neonatal Intensive Care Unit) or ICN
(Intensive Care Nursery) PICU (Pediatric
Intensive Care Unit)
5. REGIONALIZING INTENSIVE CARE–
ex.Premature infant transferred to
regional hospital
6.INCREASING THE USE OF ALTERNATIVE
TREATMENT MODALITIES–alternative
method of therapies such as acupuncture
and therapeutic touch; herbal remedies
7.INCREASING RELIANCE ON HOME CARE–
decreased hospital stay
8.INCREASING USE OF TECHNOLOGY–use of
internet, charting in computer,
using Doppler
9.FREE BIRTHING–women giving birth
without health care provider
supervision; unassisted birth
10.LAMAS–breathing techniques
LEGAL CONSIDERATIONS OF MCN
PRACTICE
1. Identifying and Reporting Child Abuse
2. Child can bring a lawsuit when they reach
legal age
3. Informed Consent for invasive procedure
and any risk that may harm the fetus
4. In divorced or blended families, nurse has
the right to give consent
Note: Nurses are legally responsible to
protect the rights of their client and
documentation is essential to protect nurse
and justify his or her actions.
ETHICAL CONSIDERATIONS OF
PRACTICE
1. Conception Issues
• In Vitro Fertilization
• Embryo Transfer
• Cloning
• Stem Cell
• Surrogate Mothers
2. Research
• Abortion
• Fetal Rights vs Rights of the Mother
• Use of Fetal Tissue for Research
• Resuscitation
• No. of procedures or degree of pain that
a child should asked to achieve better
health
• Balance between modern technology
and quality of life
GENETIC ASSESSMENT
Laboratory method that looks for changes in
genes, gene expression, or
chromosomes in cells or tissue of a
person. These changes may be a sign of
a disease or condition, such as cancer.
Genetic tests are often done on a blood or
cheek swab sample. But they may also
be done on samples of hair, saliva, skin,
amniotic fluid (the fluid that surrounds a
fetus during pregnancy), or other tissue.
The sample is sent to a laboratory.
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3 MAIN TYPES OF GENETIC result disclosure, and psychosocial
support. This chapter familiarizes
ASSESSMENT
practitioners with the steps of the
1. chromosome studies,
genetic counseling process so that they
2. DNA studies- Tests for cancer susceptibility
can prepare families appropriately. The
3. Biochemical genetic studies.
chapter is a guide in determining when
GENETIC DISORDERS
to make a referral to a genetic counselor
• Genetic Disorders. Sickle Cell Disease.
and how to find a genetic counselor.
• Cystic fibrosis. Cystic Fibrosis Liver Disease.
• Brain, Nerves and Spine. Huntington's disease. GENETIC COUNSELING IS
• Cleft lip and palate. Cleft Lip and Palate PROVIDED IN A NUMBER OF
BENEFITS OF GENETIC TESTING DIFFERENT SETTINGS. THESE
Positive result can direct a person toward
INCLUDES
available prevention, monitoring, and
1. Diagnosis of disorders (e.g., diagnosis of
treatment options. Some test results can
a rare genetic syndrome in a child with
also help people make decisions about
multiple congenital anomalies).
having children. Newborn screening can
2. Providing advice to individuals and/or
identify genetic disorders early in life so
family members where a genetic
treatment can be started as early as
disorder has been diagnosed (e.g.,
possible
where a person/family member is
diagnosed with a genetic disorder such
GENETIC COUNSELING is a communication
as cystic fibrosis or Duchene muscular
process in which information about
dystrophy).
hereditary conditions is explained and
3. Providing predictive testing to an
discussed. Some pediatric cancers are
asymptomatic person at risk of a
hereditary, meaning they are due to a
genetic disorder (e.g., Huntington’s
genetic mutation present from birth.
disease, familial cancer including
When a genetic condition is hereditary,
hereditary breast and ovarian cancer
there may be a chance that others in the
syndromes, or a colon cancer
family will be affected. When a cancer is
syndrome).
part of a genetic syndrome, the child
4. Counseling in relation to prenatal
with cancer may be at greater risk to
screening and testing (e.g., where an
develop other medical conditions or
individual/couple is found to be
cancers. Knowing that there is a cancer
carrier(s) of autosomal or X-linked
predisposition syndrome in the family
disorders such as cystic fibrosis or fragile
may allow for monitoring and early
X syndrome or where there is a personal
treatment for the presenting child
or family history of a known genetic
and/or family members. Genetic testing
disorder, such as spinal muscular
is available for some pediatric cancer
atrophy or a chromosomal
predisposition syndromes. The genetic
translocation).
counseling process includes a detailed
5. Risk advice where a family member has a
evaluation and discussion of an
disorder that is rarely due to
individual child’s situation. The usual
mutation(s) in a single gene (e.g.,
elements of a genetic counseling session
autism, dementia, and mental illness).
are a detailed medical and family
6. Advice in relation to exposure of a
history, risk assessment for a hereditary
pregnant woman to a potentially
cancer predisposition syndrome,
teratogenic substance (e.g., X-rays and
discussion of genetic testing, informed
medications such as isotretinoin).
consent if genetic testing is performed,
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CARE OF PREGNANT WOMEN
What is prenatal care?
Prenatal care is when you get checkups from
a doctor, nurse, or midwife throughout your
pregnancy. It helps keep you and your future
baby healthy.
Why is prenatal care important?
Prenatal care is an important part of staying
healthy during pregnancy. Your doctor,
nurse, or midwife will monitor your future
baby’s development and do routine testing
to help find and prevent possible problems.
These regular checkups are also a great time
to learn how to ease any discomfort you may
be having, and ask any other questions about
your pregnancy and the birth of your future
baby.
When do I need to start having prenatal
care appointments?
You can start getting prenatal care as soon as
you know you’re pregnant. It’s actually best
to see a doctor BEFORE you get pregnant —
this is sometimes called pre-pregnancy care
or preconception planning. But if that’s not
possible, just begin prenatal visits as soon as
you can.
How often will I have prenatal care visits?
How often you’ll get prenatal care depends
on how far along your pregnancy is and how
high your risk is for complications. The
typical prenatal care schedule for someone
who’s 18-35 years old and healthy is:
 Every 4 or 6 weeks for the first 32
weeks
 Every 2 or 3 weeks for the 32nd-37th
weeks
 Every week from the 37th week until
delivery
Your doctor might ask you to come in for
check-ups more often if you have a high-risk
pregnancy.
DIAGNOSIS OF PREGNANCY
Women may suspect pregnancy when they
miss a menstrual period. Many women come
to the first prenatal visit after a positive
home pregnancy test. However, the clinical
diagno-sis of pregnancy before the second
missed period may be difficult in some
women. Physical variability, lack of
relax-ation, obesity, or tumors, for example,
may confound even the experienced
obstetrician or midwife. Accuracy is
impor-tant, however, because emotional,
social, medical, or legal consequences of an
inaccurate diagnosis, either positive or
negative, can be extremely serious. A correct
date for the last (normal) menstrual period
(LMP), the date of intercourse, and a basal
body temperature record may be of great
value in the accurate diagnosis of pregnancy.
SIGNS AND SYMPTOMS
Great variability is possible in the subjective and
objective symptoms of pregnancy. Therefore the
diagnosis of pregnancy may be uncertain for a
time. Many of the indicators of pregnancy are
clinically useful in the diagnosis of pregnancy,
and they are classified as presumptive, probable,
or positive.
Presumptive signs of pregnancy
• Amenorrhea (no period)
• Nausea — with or without vomiting.
• Breast enlargement and tenderness.
• Fatigue.
• Poor sleep.
• Back pain.
• Constipation.
• Food cravings and aversions.
PROBABLE SIGNS OF PREGNANCY
• Missed period. If you're in your childbearing years and
a week or more has passed without the start of an
expected menstrual cycle, you might be pregnant.
• Tender, swollen breasts. ...
• Nausea with or without vomiting. ...
• Increased urination. ...
• Fatigue.
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POSITIVE SIGNS OF PREGNANCY
 Fetal heart sounds,
 Ultrasound scanning of the fetus,
 Palpation of the entire fetus,
 Palpation of fetal movements,
 X-ray, and actual delivery of an infant.
ESTIMATING DATE OF BIRTH
Following the diagnosis of pregnancy, the woman's first
question usually concerns when she will give birth. This
date has traditionally been termed the estimated date of
confinement (EDC). To promote a more positive percep-
tion of both pregnancy and birth, however, the term esti-
mated date of birth (EDB) is usually used.
Becausemeeting the health need the precise date of
conception generally is unknown, several formulas or
rules of thumb have been suggested for calculating the
EDB. None of these guides are infallible, but
Nagele's rule is reasonably accurate and is the method
usually used.Nagele's rule is as follows: add 7 days to the
first day of the LMP, subtract 3 months, and add 1 year.
For example, if the first day of the LMP was July 10, 2002,
the EDB is April 17, 2003. In simple terms, add 7 days to
the LMP and count forward 9 months. Nagele's rule
assumes that the woman has a 28-day cycle and that the
pregnancy occurred on the fourteenth day. An
adjustment is in order if the cycle is longer or shorter
than 28 days. Approximately 4% to 10% of pregnant
women give birth spontaneously on the EDB; however,
most women give birth during the period extending from
7 days before to 7 days after the EDB.
HIGH RISK PREGNANCY
• A high-risk pregnancy is a pregnancy that
involves increased health risks for the pregnant
person, fetus or both. Certain health conditions
and your age (being over
• 35 or under 17 when pregnant) can make a
pregnancy high risk. These
• pregnancies require close monitoring to reduce
the chance of complications
SYMPTOMS AND CAUSES
What causes high-risk pregnancy?
Factors that make a pregnancy high risk include:
• Preexisting health conditions.
• Pregnancy-related health conditions.
• Lifestyle factors (including smoking, drug
addiction, alcohol abuse and exposure to certain toxins).
• Age (being over 35 or under 17 when pregnant).
WHAT ARE COMMON MEDICAL RISK
FACTORS FOR A HIGH-RISK PREGNANCY?
People with many preexisting conditions have increased health
risks during pregnancy. Some of these conditions include:
• Autoimmune diseases, such as lupus or multiple
sclerosis (MS).
• COVID-19.
• Diabetes.
• Fibroids.
• High blood pressure.
• HIV/AIDS.
• Kidney disease.
• Low body weight (BMI of less than 18.5).
• Mental health disorders, such as depression.
• Obesity.
• Polycystic ovary syndrome (PCOS).
• Thyroid disease.
• Blood clotting disorders.
PREGNANCY-RELATED HEALTH
CONDITIONS THAT CAN POSE RISKS TO THE
PREGNANT PERSON AND FETUS INCLUDE:
• Birth defects or genetic conditions in the
fetus.
• Poor growth in the fetus.
• Gestational diabetes.
• Multiple gestation (pregnancy with more
than one fetus, such as twins or triplets)
• Preeclampsia and eclampsia.
• Previous preterm labor or birth, or other
complications with previous pregnancies.
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WHAT ARE THE SIGNS AND SYMPTOMS OF
HIGH-RISK PREGNANCY?
• Abdominal pain that doesn’t go away.
• Chest pain.
• Dizziness or fainting.
• Extreme fatigue.
• The fetus's movement stopping or slowing.
• Fever over 100.4°F.
• Heart palpitations.
• Nausea and vomiting that’s worse than
normal morning sickness.
• Severe headache that won’t go away or gets
worse.
• Swelling, redness or pain in your face or
limbs.
• Thoughts about harming yourself or the
fetus.
• Trouble breathing.
• Vaginal bleeding or discharge
AT WHAT AGE IS A PREGNANCY
CONSIDERED HIGH RISK?
People who get pregnant for the first time after age 35
have high-risk pregnancies. Research suggests they’re
more likely to have complications than younger people.
These may include early pregnancy loss and pregnancy-
related health conditions such as gestational diabetes.
Young people under 17 also have high-risk pregnancies
because they may be:
• Anemic.
• Less likely to get thorough prenatal care.
• More likely to have premature labor or birth.
• Unaware they have sexually transmitted
infections (STIs).
• What are the potential complications of
high-risk pregnancy?
A high-risk pregnancy can be life-threatening for the
pregnant person or fetus. Serious complications can
include:
• Birth defects.
• Problems with the fetus's brain
development.
• Neonatal intensive care unit admission for
your baby.
• Intensive care unit admission for you.
• Miscarriage.
• Stillbirth.
DIAGNOSIS AND TESTS
How is high-risk pregnancy diagnosed and
monitored?
Getting early and thorough prenatal care is critical.
It’s the best way to detect and diagnose a high-risk
pregnancy. Be sure to tell your healthcare provider
about your health history and any past pregnancies.
If you do have a high-risk pregnancy, you may need
special monitoring throughout your pregnancy.
• Tests to monitor your health and the health
of the fetus may include:
• Blood and urine testing to check for genetic
conditions or certain congenital conditions
(birth defects).
• Ultrasonography, which uses sound waves to
create images of the fetus to screen for
congenital conditions.
• Monitoring to ensure the fetus is getting
enough oxygen, such as a biophysical profile,
which monitors their breathing, movements
and amniotic fluid using ultrasound, and a
non-stress test, which monitors their heart
rate.

• Preeclampsia (high blood pressure from

pregnancy).
• Eclampsia (seizure from pregnancy).
• Preterm delivery.
• Cesarean delivery (C-section).
• Excessive bleeding during labor and delivery,
or after birth.
• Low or high birth weight.
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MANAGEMENT AND TREATMENT
How is high-risk pregnancy managed?
Management for a high-risk pregnancy will depend on
your specific risk factors. Your care plan may include:
• Closer follow-up with your obstetrician.
• Consultation with a maternal fetal medicine
(high-risk pregnancy) specialist.
• Consultation with other medical specialists.
• More ultrasounds and closer fetal evaluation.
• Home blood pressure monitoring.
• Careful monitoring of medications used to
manage preexisting conditions.
If your health or the health of the fetus is in danger, your
healthcare provider may recommend labor induction or
a C-section.
PREVENTION
How can I prevent a high-risk pregnancy?
You can reduce your risk of pregnancy complications by:
• Avoiding drugs and alcohol.
• Identifying potential health risks before getting
pregnant. Tell your doctor about your familial
and personal medical history.
• Maintaining a healthy body weight before
pregnancy.
• Managing any preexisting health conditions you
may have.
• Making sure any long-term medications are safe
to take during pregnancy.
• Quitting smoking.
• Planning pregnancies between the ages of 18
and 34.
• Practicing safe sex.
OUTLOOK / PROGNOSIS
What’s the prognosis (outlook) for people with high-risk
pregnancy?
Many people who have high-risk pregnancies don’t
experience any problems and deliver healthy babies. But
they may be at a higher risk for health problems in the
future, including:
Complications during future pregnancies.
• Postpartum depression.
• High blood pressure.
• Cardiovascular disease.
• Type 2 diabetes.
• Stroke.
Some high-risk pregnancies can increase a child’s
risk of:
• Behavioral problems.
• Breathing disorders.
• Gastrointestinal diseases.
• Growth and developmental delays.
• Mental health conditions.
• Neurological disorders.
• Obesity and diabetes.
• Vision, hearing or dental problems.
When should I contact my doctor?
It’s possible for pregnancy-related complications to
occur up to six weeks after a pregnancy ends. Pay close
attention to your health. Alert your healthcare provider
right away if you notice anything abnormal.
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