Lisa Heelan, MSN, FNP-BC Family Health Promotion 1 Maternity Nursing Lisa Heelan, MSN, FNP-BC Family Health Promotion 1

Learning Objectives Evaluate contemporary issues and trends in maternity nursing Examine the Healthy People 2010 goals related to maternal and newborn care & outcomes Describe the main characteristics of contemporary family forms Be knowledgeable in the main components of what is needed in obtaining a family assessment

Relate the role of culture in caring for childbearing families Discuss cultural competence in relation to one’s own nursing practice List the components of prenatal care Interpret the role & benefits of a doula

Birth in America 1900: 95% of all births took place at home 1939: 50% of all births at home 1955: 95% of all births in the hospital Wolf, 2009

Childbirth is the #1 reason for all hospitalizations

100 babies born in Pennsylvania * 12 will be born preterm * 3 will die before reaching their first birthday * 4 will be born with a birth defects * 8 will be born low birth weight March of Dimes

Report Card http://marchofdimes.com/aboutus/49267_62035.asp

http://www. healthypeople. gov/document/html/volume2/16mich http://www.healthypeople.gov/document/html/volume2/16mich.htm#_Toc494699663

What to expect during a prenatal visit…. http://www.youtube.com/watch?v=qZqGZLwDfdE

Listening to Mother’s Survey http://www.childbirthconnection.org/article.asp?ck=10396

Prenatal Care Education Treatment for medical conditions or risk reduction Risk Assessment Each component can contribute to reductions in perinatal illness, disability and death by identifying and mitigating potential complications

Frequency of Prenatal Visits Every 4 weeks until 28 weeks gestation Every 2 weeks until 36 weeks gestation Weekly until delivery

Antepartal Nursing Interventions Being knowledgeable in the normal changes of pregnancy Instructing in signs & symptoms that indicate a problem may be developing Providing appropriate information for self care measures Referring when necessary

Nursing in a Home Care Setting Can be used for women who have difficulty in accessing the healthcare system Most often used for women with prenatal complications that can be managed without hospitalization.

Attitude about pregnancy Exercise Rest Smoking Traveling First Trimester Topics Danger signs of spontaneous abortion Fetal growth development Employment Early pregnancy classes

Infants tend to have lower birth weights Infants have a higher incidence of preterm birth

The Faces of Fetal Alcohol Syndrome Growth Retardation Facial Anomalies Major Cause of mental retardation

Even moderate alcohol intake is contraindicated Increased incidence of lowered birth weight Some neurologic effects such as Attention Deficit Disorder No Safe level of drinking during pregnancy has been identified

Live Viruses (like rubella) should not be given to pregnant women Vaccines using killed viruses may be used

Exercise during pregnancy 30 minutes daily and stop when fatigued No balance activities No exercising in supine position Pulse rates < 140/min

Nursing Pearls of Wisdom At each prenatal visit, focus your teaching on changes or possible discomforts the woman might encounter during the coming month and the next trimester.

The importance of support during labor---having a doula http://www.youtube.com/watch?v=16uFf02NYb4 http://www.youtube.com/watch?v=HfOBVPZg94Y

We Are Family

Types of Families Nuclear Cohabiting parent Married-parent Single-Parent Childless Married blended Extended Gay & Lesbian The primary institution in society that preserves & transmits culture.

What basic information should be included in a Family Assessment?

Family Assessment Name, age, sex and family relationship of all people residing in the household Family type, structure roles and values Cultural associations Religious affiliations Language Support network

Friedman Family Assessment Model Identifying data History of family Environmental data Family structure Family functions Family stress & coping

Culture is not just something the client possesses; it is something that all humans possess. It is learned….

Ethnocentrism Conviction that the values and beliefs of one’s own cultural group are the best ones or the only acceptable ones

Are there cultural influences on childbearing and rearing?

Beliefs regarding pregnancy Amish Appalachian African- Amercan Chinese Mexican Arab

Refers to behaviors or things that are avoided Taboos Refers to behaviors or things that are avoided What is avoided in your family?

“Ask not what disease the person has, but rather, what person the disease has.”

Develop cultural competence by becoming knowledgeable about the cultural practices of local groups where you work and live.

Cultural Humility: Lifelong process of self reflection and awareness with a respectful attitude toward diverse points of view.

It’s all about relationships…..

And Respect…which comes full circle

Questions to ask…. What do you think you should do to remain healthy during pregnancy? What healing methods have you tried? What do you think will help?

Who do you want with you during your labor? How will family members participate in your pregnancy, childbirth & parenting? What do you and your family expect from the nurses caring for you?

L= Listen E=Explain A=Acknowledge R=Recommend N=Negotiate

References Center for Disease Control, US Department of Health and Human Services. (2010). Healthy People 2010, 2nd edition. 16-62. Retrieved from http://www.healthypeople.gov/Document/HTML/Volume 2/16MICH.htm#Toc494699662 Declercq, E., Sakala, C., Corry, M., & Applebaum, S. (2006). Listening to mothers 11: Report of the second national US Survey of women’s childbearing experiences. Retrieved from http://www.childbirthconnection.org/pdf.asp?PDFDownload=LTM11_report

Epstein, R. (2010). Get me out: A history of childbirth. New York: W.W. Norton & Company Fadiman, A. (1997). The spirit catches you and you fall down: A Hmong child, her American doctors & the collision of the cultures. New York: Farrar, Straus & Giroux Lowdermilk, D. & Perry, S. (2007). Maternity & women’s health care. (9th edition). St. Louis: Mosby Elsevier Wolf, J. (2009). Deliver me from pain. Baltimore: The John Hopkins University Press