Introduction to Nursing Care of the Childbearing Family Molloy College Division of Nursing Introduction to Nursing Care of the Childbearing Family Ann Marie Paraszczuk 4/23/2017

Maternity nursing Maternity nursing focuses on women and their infants and families during childbearing cycle Nurses play an active role in shaping health care systems to be responsive to needs of contemporary women Tremendous advances in the care of mothers and infants 12

RNs in a Variety of Settings Inpatient and outpatient maternal-newborn facilities – nurses play major role in minimizing psychologic and physical distress associated with reproductive issues Client teaching Collaborative care – function as part of multidisciplinary health team (NPs, CNM)

Basic Principles of Family-Centered Care Childbirth is considered a normal, healthy event in the life of a family Childbirth impacts the entire family and relationships will change Families are capable of making decisions about their own care if given adequate information and professional support Flexibility, quality and individualized care for all family members (Phillips, 2003)

Past Trends in Childbirth 1700’s: birth at home attended by midwives 1800’s: shift from using midwives to doctors among middle class women 1900s: twilight sleep used on birthing women; nurseries started to care for newborns 1970’s and 1980’s: growing trend to return to non- medicated non-interventive childbirth Late 1900’s: homebirths/ birthing centers decline due to creation of LDRPs, short stays are the norm 2000’s: 48 to 96 hour stays are legislated

Current Trends in Childbirth Various setting for delivery –hospital most common Induction of labor is common practice One in 3-4 women undergo a surgical birth (cesarean) some by maternal request Childbirth classes abound in most communities

Current Problems Problems with U.S. health care delivery system Structure of the system Medical errors occur High cost of health care Limited access to care Significant health disparities exist 6

Barriers to Accessing Healthcare Financial barriers Transportation Language barriers Cultural barriers Clinical hours Poor attitudes of healthcare workers Need for Culturally/Spiritually Sensitive Care

Contemporary Issues and Trends Trends in fertility and birth rate Low birth weight and preterm birth Infant mortality in the U.S. Maternal mortality trends Increase in high risk pregnancies High technology care International concerns 5

Care during pregnancy and birth Involving consumers and promoting self-care Health literacy Breastfeeding in the workplace Culturally competent Care

Statistical Data Birth rate # of live births/1000 Maternal mortality rate: related death 42 days after delivery - # per 100,000 Increasing Infant mortality rate: deaths ↓1 yr - # per 1000 Unchanged with White lower than Black infants Adolescent pregnancy:fluctuating Infertility issues: Involve 20% of all women

Legal/Ethical Scope of practice Standards of nursing care Patient safety, privacy Informed consent _emancipated minors Maternal –fetal conflict Abortion Intrauterine fetal surgery Reproductive Assistance- Embryonic Stem cell research Cord blood banking

Social Issues Fetal injury – maternal substance abuse Access to healthcare or rationing Poverty/homelessness Domestic violence Teenage pregnancy

Evidence-based Practice Nursing interventions supported by current, valid research – emerging as a force in health care It provides a useful approach to problem solving/decision making; self-directed, patient-centered, life-long learning Builds on actions necessary to transform research findings into clinical practice

Evidence-based Practice Practice is evaluated issues are identified and addressed Outcomes improved as a result of quality improvement initiatives Nurses need to recognize which practices have conflicting findings as to their effect on client outcomes Market pressures also a force in use of evidence-based practice

Cultural Concepts Culture and Ethnicity Acculturation and assimilation Religion vs Spirituality

Culturally Influenced Responses Biological predisposition Values and beliefs Communication Patterns Language Personal space,touch Time orientation Family orientation

Cultural Influences Family Structure Childbearing & Childrearing Children’s importance and ideas re: pregnancy, health and infant feeding practices Developing cultural competence Self-awareness and accepting diversity Childbearing and child rearing practices p. 27 -28