Historical Changes in Maternity
-Before the 20th century mostly lay midwives
Resulted in high mortality rates
-Discovery of hygienic practice, forcep as... [Show More] sisted delivery, medication for pain and medication for induction drastically changed the field and mortality rates
-By 1960 most births were in hospitals and the nurses role was to assist the physician
Healthy People 2020
Focus is to improve health over the life span
MCH reduce infant and maternal mortality
Focus on preconception health and health behaviors for better outcomes and less complications
Defining family
Values- "System of ideas, attitudes and beliefs"
Power and decision making- "Potential or actual ability to change the behavior of other family members"
Roles- "What individuals in a particular situation should do in order to meet their own or another's expectations of them"
family centered care
safe, quality care that recognizes and adapts to both the physical and psychosocial needs of the family
Cultural Competence
Nurses should be knowledgeable about childbearing beliefs and practices of other cultures
Awareness and acceptance of cultural differences
Self awareness
Understanding of dynamics of cultural differences
Knowledge of client's family culture
Adaption of services to support client's culture
MATERNITY NURSE'S ROLE
Care Provider
Teacher
Collaborator
Researcher
Advocate!
Sexuality
1. Capacity for sexual feelings.
2. A person's sexual orientation or preference
-Adolescent sexuality refers to the thoughts, feelings and behaviors related to one's sexual identity
-Refers to a person's perceptions, thoughts, feelings, and behaviors related to sexual identity
-Begins at birth, develops throughout the life span
gender vs. sexuality
Gender- Biological, physiologic characteristics, genetics (XX, XY, and variations)
Gender Identity
The psychological sense of being male (masculine) or female (feminine) or intersexed (anatomy and identity don't match)
sexuality- Multiple meanings
Sexual Orientation
"enduring emotional, romantic, sexual or affectional attraction to another person."
Importance of Sexual Assessment
-Allows client to talk about sex
-Provides an opportunity to educate
and address myths
-It provides a more complete picture of the client
Client perspective:
Identify and recognize personal issues
Opportunity to discuss issues or expectations
Initiate change
Clinician perspective:
Give direction to clinical interventions
Give risk reduction messages
Education
Key Factors of a Sexual Assessment
Ability to perform and enjoy sexual activity
Sexual satisfaction
Sexual activity (past, present, future)
Number and types of partners
Sexual practices
STD infection risk/history of infections
THE "ONE MINUTE" SEXUAL ASSESSMENT
What are you doing to protect yourself from HIV and other STIs?
What are you doing to prevent unplanned pregnancy?
Sexually Transmitted Infections
Frequently diagnosed STI's
Chlamydia
Genital Herpes
Gonorrhea
Genital Warts
HPV
Trichomoniasis
Syphillis
HIV/AIDS
Health Promotion for women
Promote Health, prevent illness, lifestyle choices
Contraception
Breast Examination
Mammography
Pelvic examination
Contraception
Nurse role is that of family planning and counselor
Important to remember education must be culturally and religiously appropriate and sensitive.
Multiple types of contraception ranging from hormonal control to permanent sterilization
Should consider safety, protection from STIs, effectiveness, acceptability, convenience and expense.
Social Issues in Maternal Child Health
Homelessness, Poverty , Inadequate Care, Violence against women
Maternal Physiologic Adaptations to Pregnancy
-Respiratory System
-Cardiovascular System
-Blood volume, cardiac output, blood pressure and peripheral resistance
-Breasts
-Tubercles of Montgomery and colostrum
-Uterus, cervix, vagina and ovaries
-Chadwick's sign, Goodell's sign, Braxton Hicks Contractions, Lightening and Bloody Show
-Urinary System
-Gastrointestinal System
-N&V, heartburn, constipation, hemorrhoids
-Musculoskeletal System
-Posture, center of gravity, lordosis, diastasis recti
-Skin and Hair
-Linea negra, cholasma, striae
More Maternal Physiologic Adaptations to Pregnancy
-Metabolism
-Weight gain, increase insulin production
Endocrine system
-Progesterone- most important hormone of pregnancy
Produced from fully developed placenta, has multiple functions
-Estrogen - has numerous functions during pregnancy
-Stimulates uterine growth
Causes breast, skin, and mucous membrane changes
-Human Chorionic Gonadotropin- (hCG) produced by trophoblastic cells that surround the embryo in early pregnancy
-Causes a positive pregnancy test
Stimulates the corpus luteum to produce estrogen and progesterone until that placenta is fully developed
Recommended maternal weight gain
Depends on maternal BMI and pre-pregnant nutritional state:
- BMI < 18.5 Rec. 28-40 lbs
- BMI 18.5-24.9 (normal) Rec. 25-35 lbs
- BMI 25-29.9 Rec. 15-25 lbs
- BMI > 30 Rec. 11-20 lbs
Pattern of maternal weight gain is important too
maternal weight gain
11 lb = Fetus, placenta, amniotic fluid
2 lb = Uterus
4 lb = Increased blood volume
3 lb = Breast tissue
5-10 lbs = Maternal stores
Maternal nutritional requirements
300 additional calories per day!
Need Folic acid and Iron supplements
Need for almost all nutrients increases during pregnancy - additional requirements for both mother and fetus
Prenatal vitamins?
Postpartum nutritional considerations
-Postpartum physiologic changes....
-Breastfeeding mothers need increased nutrients
-Sufficient calories ands fluid volume will enhance milk volume
-Increased calories to 500 more than pre-pregnancy requirement
-2500-2700 cal/day
-Nutrients - protein and calcium
-Avoid foods that she suspects may cause GI distress in the newborn
Antepartum Assessment
Obstetric History - including GP (TPAL)
Menstrual History- Use Nagele's Rule to estimate EDD
Medical History
Social Situation
Family and Father of Baby History
Physical Exam - Pages 201-207
GTPAL
NAGELE'S RULE
1st day of LMP Nov 21
Subtract 3 mon - 3 months
____________
Aug 21
Add 7 days + 7 days
____________
EDB /EDD/EDC Aug 28 (of next yr)
Psychosocial Adjustments in Pregnancy
Acceptance of the pregnancy
Identifying with the role of mother
Evaluating and Reordering relationships between herself & her mother; herself & her partner
Ensuring safe passage for herself & her baby
Prenatal fear of loss of control & self esteem in labor
More Psychosocial Adjustments in Pregnancy
Who and what are important to consider in a psychosocial assessment for pregnancy?
Paternal Adaptation
Grandparent Adaptation
Sibling Adaptation
Maternal Age
Culture/Religious Beliefs
Social Situations/socioeconomic status
Family Structure
Education Level
A client told the nurse the doctor had written down that she had experienced quickening. When explaining this to the woman, the nurse uses the knowledge that quickening is?
A. the cheese-like secretions that cover the fetus.
B. the first sensation of fetal movement.
C. the production of a surface-active lipid necessary for the neonate to breathe.
D. an excessive amount of amniotic fluid. [Show Less]
