Ethico-Moral Consideration of Maternal and
Child Practice
Ethico-Moral– Branch of Philosophy w/c
determines right and wrong
 Ethos – comes from Greek work w/c
means character/culture
 Moral – personal/private interpretation
from what is good and bad.
Ethical principles
 Autonomy – the right/freedom to decide
(the patient has the right to refuse
despite the explanation of the
nurse) Example: surgery, or any
procedure
 Nonmaleficence – the duty not to
harm/cause harm or inflict harm to
others (harm maybe physical, financial
or social)
 Beneficence- for the goodness and
welfare of the clients
 Justice – equality/fairness in terms of
resources/personnel
 Veracity – the act of truthfulness
 Fidelity – faithfulness/loyalty to clients
Moral Principles:
 Golden Rule
 The principle of Totality
 Epikia
 One who acts through as agent is
herself responsible – (instrument to the
crime)
 No one is obliged to betray herself
 The end does not justify the means
 Defects of nature maybe corrected
 If one is willing to cooperate in the act,
no justice is done to him
 A little more or a little less does not
change the substance of an act.
 No one is held to impossible
Ethical Issue on Maternal and Child Practice
Conception Issues
 Invitro fertilization
- In vitro fertilization is a process of
fertilization where an egg is combined with
sperm outside the body.The process
involves monitoring and stimulating a
woman's ovulatory process, removing an
ovum or ova from the woman's ovaries and
letting sperm fertilize them in a liquid in a
laboratory.
 Embryo transfer
- Embryo transfer refers to a step in the
process of assisted reproduction in which
embryos are placed into the uterus of a
female with the intent to establish a
pregnancy. This technique, may be used in
humans or in animals, in which situations
the goals may vary.
 Ownership of oocytes or sperm
 Surrogate motherhood
- practice in which a woman ( surrogate
mother) bears a child for a couple unable
to produce children in the usual way,
usually because the wife is infertile or
otherwise unable to undergo pregnancy.
 Pregnancy termination
- An abortion (termination) is the medical
process of ending a pregnancy so it does
not result in the birth of a baby. Depending
on how many weeks you have
been pregnant, the pregnancy can be
ended by taking medication or by having a
surgical procedure.
 Stem cell research
- is the area of research that studies the
properties of stem cells and their potential
use in medicine. As stem cells are the
source of all tissues, understanding their
properties helps in our understanding of the
healthy and diseased body's development
and homeostasis.
 Resuscitation
- the action or process of reviving someone
from unconsciousness or apparent death.
Difficulty on maintaining confidentiality of
records when there are multiple of
caregivers.
ETHICAL AND SOCIAL ISSUES IN
PRENATAL NURSING
• Ethical issues across the child bearing ages
are multiple and complex. Nursing is a
process that involves judgement and action
with the aim of maintaining, promoting and
restoring balance in human system. The
need for judgement and action brought
about the moral questions of right or wrong
 of duty. The end purpose of nursing is the
welfare of other human beings.
ETHICAL PRINCIPLES AND FRAMEWORKS
• Ethical principles are a set of rules that can
be applied to all situations. They provide a
framework for helping nurses and others
evaluate ethical issues.
• Ethical and social issues affecting the
health of pregnant women and their fetus
are increasingly complex. Some of the
complexity arises from technological
advances in reproductive technology,
maternity care, and neonatal care. Nurses
are autonomous professionals who are
required to provide ethically competent
care.
Some ethical principles related to patient
care include:
• Autonomy: The right to self
determination
• Respect for others: Principle that all
persons are equally valued
• Beneficence: Obligation to do good
• Nonmaleficence: Obligation to do no
harm
• Justice: Principle of equal treatment of
others or that others be treated fairly
• Fidelity: Faithfulness or obligation to
keep promises
• Veracity: Obligation to tell the truth
• Utility: The greatest good for the
individual or an action that is valued
Ethical principles that guide ethical action
include four primary moral principles:
respect for beneficence, non-maleficence,
justice, and autonomy, which upholds the rights
of individuals and families. A key way for
nurses to respect autonomy is through support
of childbearing women, including adolescent
women.
Ethical Issues and Challenges in Maternal
and Child Health Nursing
• Maternal and child health issues often
involve conflicts in which a woman
behaves in a way that may cause harm
to her fetus or is disapproved of by
some or most members of society.
Conflicts between a mother and fetus
occur when the mother’s needs,
behavior, or wishes may injure the fetus.
The most obvious instances involve:
• Abortion
• Assisted reproduction (artificial
insemination, invitro fertilization and
embryo transfer, and surrogate
parenthood)
• Selective reduction in multifetal pregnancy
• Intrauterine treatment of fetal conditions
• Substance abuse
• Refusal to follow the advice of caregivers
ABORTION
• It has become a hotly debated political
issue that separates people into two camps:
prochoice and pro-life.
 The pro-choice group supports the right
of any woman to make decisions about
her reproductive functions based on her
own moral and ethical beliefs.
 The prolife group feels strongly that
abortion is murder and deprives the fetus
of the basic right to life.
 Abortion is a complex issue, and the
controversy is not only in the public arena:
many nurses struggle with the conflict
between their personal convictions and
their professional duty.
 Nurses need to clarify their personal
values and beliefs on this issue and must
be able to provide non biased care before
assuming responsibility for clients who
might be in a position to consider abortion.
Their decision to care for or refuse to care
for such clients affects staff unity,
influences staffing decisions, and
challenges the ethical concept of duty.
 The ANA’s Code of Ethics for Nurses
upholds the nurse’s right to refuse to care
for a client undergoing an abortion if the
nurse ethically opposes the procedure.
 Nurses need to make their values and
beliefs known to their managers before the
situation occurs so that alternative staffing
arrangements can be made.
  Open communication and acceptance of
the personal beliefs of others can promote
a comfortable working environment.
Nurses need to understand abortion laws
and the conflicting beliefs that divide
society on this issue.
SUBSTANCE ABUSE
- Substance abuse for any person is a
problem, but when it involves a pregnant
woman, substance abuse can cause fetal
injury and thus has legal and ethical
implications.
- In some instances, courts have issued jail
sentences to pregnant women who caused
harm to their fetuses. Many state laws
require reporting evidence of prenatal drug
exposure, which may lead to charges of
negligence and child endangerment against
the pregnant woman.
- This punitive approach to fetal injury raises
ethical and legal questions about the
degree of governmental control that is
appropriate in the interests of child safety.
FETAL THERAPY
• Fetal therapy is becoming more common
as techniques improve and knowledge
grows.
• Although the risks to the fetus and the
mother are both great, fetal therapy may
be used to correct anatomic lesions.
• Some argue that medical technology
should not interfere with nature, and thus
this intervention should not take place.
Others would argue that the surgical
intervention improves the child’s quality of
life.
• Nurses play an important supportive role
in caring and advocating for clients and
their families.
• As the use of technology grows, situations
will surface more frequently that test a
nurse’s belief system.
• Encouraging open discussions to
address emotional issues and differences
of opinion among staff members is healthy
and increases tolerance for differing points
of view.
INFORMED CONSENT
Informed consent has four key components:
• Disclosure
• Comprehension
• Competency
• Voluntariness
It occurs prior to initiation of the
procedure or specific care and addresses the
legal and ethical requirement of informing the
client about the procedure.
REFUSAL OF MEDICAL TREATMENT
• Refusal of treatment may occur when the
treatment conflicts with religious or cultural
beliefs. In these cases, it is important to
educate the client and family about the
importance of the recommended treatment
without coercing or forcing the client to
agree.
• Sometimes common ground may be
reached between the family’s religious or
cultural beliefs and the health care team’s
recommendations.
• Communication and education are the keys
in this situation.
• If providing medical treatment may save a
child’s life, health care providers and the
judicial system strive to advocate for the
child.
• The state has an overriding interest in the
health and welfare of the child and can
order that medical treatment proceed
without a signed informed consent. This is
referred to as parens patriae (the state has
a right and a duty to protect children).
• Parents may refuse treatment if they
perceive that their child’s quality of life will
be significantly impaired by the medical
care that is offered. If the parents refuse
treatment but the health care team feels the
treatment is reasonable and warranted, the
case should be referred to the institution’s
ethics committee. If the issue remains
unresolved, then the judicial system
becomes involved.
CONFIDENTIALITY
• With the establishment of the Health
Insurance Portability and Accountability Act
(HIPAA) of 1996, the confidentiality of
 health care information is now mandated by
law.
• In maternal and child health care,
information is shared only with the client,
legal partner, parents, legal guardians, or
individuals as established in writing by the
client or the child’s parents.
• This law promotes the security and privacy
of health care and health information for all
clients. Client information should always be
kept confidential in the context of the state
law, as well as the institution’s policies.
SELECTIVE REDUCTION
- Induced ovulation and invitro fertilization
sometimes result in multifetal pregnancies.
If the number of exceeds the woman's
ability to carry them to the point where they
can survive outside the uterus, physician
may recommend selectively terminating one
or more fetuses.
- In these situations, the ethical dilemmas are
much the same as they are for abortion.
Further complicating the issue is that these
are long awaited, desired children.
INTRAUTERINE TREATMENT OF FETAL
CONDITIONS
- Advances in intrauterine diagnosis of fetal
malformations have led to new, although
still experimental, development in
intrauterine fetal surgery aimed at improving
fetal outcomes. These new treatments
raised ethical and legal questions about
maternal vs fetal rights.
• Who has the right to give consent?
• Can a court of law override the mother's
wish if she says ''no‘’?
- Similar ethical dilemma arises during labor
if a mother refuses caesarian section
although it is clearly (in the judgement of
the health care provider) in the best interest
of her fetus.
MANDATED CONTRACEPTION
- The availability of contraception that does
not require taking a regular oral dose, such
as using a hormone-releasing patch or
having hormone injections, has led to
speculation about whether certain women
should be forced to use this method of birth
control. Requiring contraception has been
used as a condition of probation, allowing
women accused of child abuse to avoid jail
terms.
- Some people believe that mandated
contraception is a reasonable way to
prevent additional births to women who are
considered unsuitable parents and
decrease government expenses for
dependent children.
- Requiring poor women to use contraception
to limit the money spent supporting them is
legally and ethically questionable and does
not address the obligations of the children’s
father.
- Such practice interferes with a woman’s
constitutional rights to privacy, reproduction,
refusal of medical treatment, and freedom
from cruel and unusual punishment. In
addition, medication may pose health risks
to the woman.
- Access to free or low-cost information on
family planning would be more appropriate
and ethical.
FETAL INJURY
• If a mother’s actions cause injury to her
fetus, the question of whether she should
be restrained or prosecuted has legal and
ethical implications.
• In some instances, courts have issued jail
sentences to women who have caused or
who may cause injury to the fetus. This
response punishes the woman and places
her in a situation in which she cannot
further harm the fetus.
• In other cases, women have been forced
to undergo cesarean births against their
will when physicians have testified that
such procedure was necessary to prevent
injury to the fetus.
INFERTILITY TREATMENT
- Perinatal technology has found ways for
some previously infertile couples to bear
children. Many techniques are more
successful, but ethical concerns include the
high cost and overall low success of some
infertility treatments.
- Other ethical concerns focus on the fate of
unused embryos.
 • Should they be frozen for later use by
the woman or someone else or used in
genetic research?
• What if the parents divorce or die?
• Who should make these decisions?
- In multiple pregnancies with more fetuses
than can be expected to survive intact,
reduction surgery may be used to destroy
one or more fetuses for the benefit of those
remaining.
CONTRACEPTION
Reproductive Life Planning
- It includes all the decisions an individual or
couple make about whether and when to
have children, how many children to have,
and how they are spaced
Natural Family Planning
- Also called periodic abstinence methods, as
name implies, methods involve no
introduction of chemical or foreign material
into the body
Abstinence
- Abstinence or refraining from sexual
relations, the most effective way to prevent
STIs. It may be difficult to adhere to
abstinence.
Periodic abstinence
- Periodic abstinence is a method to avoid
pregnancy by avoiding sex on days a
woman may conceive.
Coitus Interruptus
- Coitus interruptus (withdrawal) is one of the
oldest known methods of contraception.
The couple proceeds with coitus until the
moment of ejaculation. Then, the man
withdraws and spermatozoa are emitted
outside the vagina.
Postcoital Douching
- Douching following intercourse, no matter
what solution is used, is ineffective as a
contraceptive measure as sperm may be
present in cervical mucus as quickly as 90
seconds after ejaculation, long before
douching could be accomplished.
Calendar (Rhythm) Method
- The calendar method requires a couple to
abstain from coitus on the days of a
menstrual cycle when the woman is most
likely to conceive.
Basal Body Temperature Methods
- Or the temperature of her body at rest
- To use this method, the woman takes her
temperature, either orally or with a tympanic
thermometer, each morning immediately
after waking before she rises from bed or
undertakes any activity
Cervical Mucus Method
- Before ovulation each month, the cervical
mucus is thick and does not stretch when
pulled between thumb and finger. Just
before ovulation, mucus secretion
increases. On the day of ovulation, it
becomes copious, thin, watery, and
transparent.
Two-Day Method
- A woman assesses for vaginal secretions
daily. If she feels secretions for 2 days in a
row, she avoids coitus that day and the day
following as the presence of secretions
suggests fertility
Symptothermal Method
- Combination of cervical mucus and BBT
Methods
- 3 days after the rise of temperature
Standard Days Method: Cycle Beads
- This method is designed for women who
have menstrual cycles between 26 and 32
days.
- Purchases a circle of beads that helps her
predict fertile days.

Ovulation Detection
- Predict ovulation by the use of an over-the-
counter ovulation detection kit. These kit
detect the midcycle surge of luteinizing
hormone (LH) that can be detected in urine
12 to 24 hours before ovulation.
- 98 to 100% accurate
- Expensive
Marquette Method
- This method combines the use of ovulation
detection with other signs of ovulation
(cervical mucus, BBT, cervix position and
softness)
Barrier Methods
- Are forms of birth control that place a
chemical of latex barrier between the cervix
and advancing sperm so sperm cannot
reach and fertilize an ovum.
Spermicides
- A spermicide is an agent that causes the
death of spermatozoa before they can enter
the cervix.
- Spermicides not only actively kill sperm but
also chance the vaginal pH to a strong acid
level, a condition not conducive to sperm
survival
Male and Female Condoms
- Male condom is a latex rubber or synthetic
sheath that is placed over the erect penis
before coitus to trap sperm.
- Female condoms are sheaths made of latex
or polyurethane, prelubricated with a
spermicide so, similarly to male condoms,
they offer protection against conception as
well as STIs, including HIV.
Diaphragms
- It is a circular rubber disk that is placed over
the cervix before intercourse to
mechanically halt the passage of sperm.
Cervical Caps
- It is made of soft rubber shaped like a
thimble, which fits snugly over the uterine
cervix.
Hormonal Contraception
- Hormonal contraceptives are, as the name
implies, hormones that when taken orally,
transdermally, intravaginally, or
intramuscularly, cause such fluctuations in
a normal menstrual cycle that ovulation or
sperm transport does not occur.
Oral Contraceptives
- Oral contraceptives, commonly known as
the pill, OCs or COCs, are composed of
carrying amounts of natural estrogen or
synthetic estrogen combined with a small
amount of synthetic progesterone.
- Combination of Oral Contraceptives
- Popular COCs in United States:
1. Monophasic pills – contain fixed
doses of both estrogen and progestin
throughout a 21-day cycle
2. Biphasic – or preparation that deliver
a constant amount of estrogen
throughout the cycle but varying
amounts of progestin
3. Triphasic and tetraphasic
preparations – which vary in both
estrogen and progestin content
throughout the cycle
Progestin-Only Pills (Mini Pills)
- Containing only progestins and must be
taken conscientiously every day. Without
estrogen, ovulation may occur, but because
the progestins have not allowed the
endometrium to develop fully or sperm to
freely access the cervix, fertilization and
implantation will not take place.
Estrogen/ Progesterone Transdermal Patch
- Transdermal Contraception refers to
patches that slowly but continuously release
a combination of estrogen and
progesterone.
Subdermal Hormone Implants
- A progestin-filled miniature rod no bigger
than a matchstick, estronogestrel implant
(Nexplanon) can be embedded just under
the skin on the inside of the upper arm
where it will slowly release progestin over 3
years.
Intramuscular injections
- A single intramuscular injection of depot
medroxyprogesterone acetate or DMPA
(Depo-Provera), a progesterone given
every 12 weeks, inhibits ovulation, alters
the endometrium, and thickens the cervical
mucus so sperm progress is difficult.
Intrauterine Devices
- An intrauterine device (IUD) is a small
plastic device that is inserted into the uterus
through the vagina. IUDs can be either
hormonal or nonhormonal.
- The device is inserted in a collapsed
position and then opens to its final shape in
the uterus when the inserter is withdrawn.
The woman may feel a sharp cramp as the
device is passed through the internal
cervical os, but she will not feel the IUD
after it is in place.
Surgical Methods of Reproductive Life
Planning
- It is often called “Sterilization” – includes
tubal ligation for women and vasectomy for
men
Vasectomy
- A small puncture wound (referred to as no-
scalpel technique) is made on scrotum. The
vas deferens on each side are then pulled
forward, cut and tied, cauterized, or
plugged, blocking the passage of
spermatozoa.
Tubal Ligation
- Sterilization of women could include
removal of the uterus or ovaries
(hysterectomy), but it usually refers to a
minor surgical procedure, such as tubal
ligation, where the fallopian tubes are
occluded by cautery, crushed, clamped, or
blocked, thereby preventing passage of
both sperm and ova
ADVANCES IN GENETICS AND GENETIC
TECHNOLOGY
Genetics
- Is the study of the way such disorders
occur, because genetics constantly
changing field of study, it is important for
nurses to keep current with new advances
so they can appreciate how a new
discovery will affect a family and a child’s
therapy child
- Twenty yrs ago for example most children
w/ cystic fibrosis (a disorder of lung and
pancreatic dysfunction) died in early
childhood. Today w/ good management,
such childhood live into adulthood because
the gene mutation that causes the disorder
has been identified, giving hope for an
eventual cure for this puzzling illness,
including a new view of counseling
New Technologies
- With the completion of the Human Genome
Project in 2003, scientists can now
access—and develop – ever more
sophisticated techniques to identify and
record the genetic contributions to common
complex illnesses
Computational Biology
- Ongoing genome projects are generating
vast amounts of DNA sequence
information, and because of this ever-
growing influx of data, researches are
increasingly relying on mathematical and
computational techniques to embedded
meaning into the data outputs
- Sophisticated mathematical concepts are
used to characterize the principles
 underlying biology at genetic, molecular and
cellular levels
- Computational biology includes the areas of
molecular cell biology that are embracing
the application of mathematical theory to
advance discovery. The Field includes
foundations in computer science, applied
mathematics, statistics, biochemistry,
chemistry, biophysics, molecular biology,
and genetics, among others
Epigenetics (including epigenetic
techniques)
- A relatively new area of research based on
the science of epigenetics is uncovering
how our environment interacts w/ certain
genes to switch them on/ off permanently/
alter their expression—much like a light-
switch dimmer
- Epigenetics is the study of changes in gene
activity that do not involve alterations to the
genetic code, yet are heritable. These
patterns of genes expression are governed
by cellular material—the epigenome – that
overlies the genome
Genome-Wide Association Studies
- Enable researchers to identify genes
involved in human illnesses and thereby
test for the association between genetic
polymorphism ( the recurrence within a
population of two or more discontinuous
genetic variants of a specific trait, such as
blood type) spread evenly over the entire
genome.
- GWAS search the genome for small
variations, called single nucleotide
polymorphisms (SNPs) that occur more
frequently in people with a particular illness
versus those w/out
- Once new genetic associations are
identified for a particular illness,
researchers can use the information to
develop better strategies to detect, treat
and prevent the disease
- Such studies are particularly useful in
finding genetic variations that contribute to
common, complex illnesses such as
arthritis, cancer, diabetes, heart disease
and psychiatric illnesses
Microarray Technology (DNA
MICROARRAY)
- Researchers use DNA microarrays to
measure the expression levels of large no.
of genes simultaneously
- Detect SNPs or genotype multiple regions
of a genome, for these tests, a collection of
microscopic DNA spots are attached to a
solid surface, and each DNA spots contains
specific DNA sequences (known probes)
- Since an array can contain tens of
thousands of probes, a microarray
experiment can accomplish many genetic
tests simultaneously
- Therefore, arrays have dramatically
accelerated many types of investigations
- Microarray technology brings new
knowledge about complex illnesses such as
cancer. Specifically, w/ the help of
microarray technology researchers can not
only classify tumours based on which
organs they reside, but also based on the
patterns of gene activity in the tumour cells.
This knowledge assists in the development
of new treatments targeted directly to each
specific type of cancer
Whole-Exome Sequencing
- Exome sequencing selectively sequences
the coding regions of the genome and is
sometimes used as an alternative to whole
genome sequencing
- Whole-exome sequencing is a cheaper,
faster, yet still efficient strategy for reading
the parts of the genome that researchers
believe are the most important for
diagnosing disease
- It is estimated that most disease-causing
mutations are found within the regions of
the genome that encode proteins.
- Whole-exome sequencing reads only the
parts of the human genome that encode
proteins (including untranslated regions of
RNA)
- Leaving other 99% of the genome unread (
in effect the technique is akin to a high-level
scan of the genome)