Intro to Maternal Child Health Flashcards
Factors affecting change in women’s health care
-Changes in childbirth methods
-Social trends
-Changes in health care system
-Federal/state regulations
Childbirth in America timeline
-1700s: men didn’t attend births, women feared death, midwives used
-1800s: shift from midwives to doctors, puerperal fever, 1st C-section, x-ray developed
-1900s: twilight sleep, nurseries, amniocentesis, home births
-2000s: C-sections common, midwives used (safest birth attendants), childbirth classes
Recent changes in state regulations
-2021: Texas passed most restrictive ban which ended most access after 6 weeks gestation
-2022: Texas’s Women’s Health Protection Act did not pass
Historical development of maternal nursing
-Colonial America: childbirth was difficult and dangerous
-1900s: physician-assisted births; midwives for those who couldn’t afford a doctor, doctors didn’t wash hands
-1950s: intro of natural birth practices
-Current: Return of midwives and doulas (certified provider for emotional and advocacy support) and both covered by insurance; birthing choices based on preferences of family
Core concepts of maternal nursing
-Childbirth is a normal, healthy event in life of family
-Childbirth affects entire family and relationships will change (divorce, teen moms)
-Families are capable of making decisions about own care
-Mothers and newborns should stay together
Family structures in today’s society: nuclear family
-Husband, wife, children in same household
-Less common due to divorce
Family structures in today’s society: binuclear family
-Child who is a member of 2 families due to joint custody
-Parenting is considered a “joint venture”
-Always works better when the interests of the child are put 1st and above the parents’ needs and desires
Family structures in today’s society: single-parent family
-1 parent is responsible for care of the children
-May result from death, divorce, desertion, birth outside marriage, or adoption
-Likely to face challenges d/t economic, social, personal restraints
-1 person serves as homemaker, caregiver, and financial provider
Family structures in today’s society: commuter family
-Adults in family live and work apart for professional or financial reasons, often leaving the daily care of children to 1 parent
-Similar to single-parent family
Family structures in today’s society: step or blended family
-Adults w/ children from previous marriages or from the new marriage
-May lead to family conflict d/t different expectations on part of the children and adults
-May have different views r/t child care and health
Family structures in today’s society: extended family
-Nuclear family and grandparents, cousins, aunts, and uncles
-Need to identify the decision-maker and primary caretaker of the children
-Popular in some cultures, such as Hispanic and Asian cultures
Family structures in today’s society: LGBTI family
-Adults of same sex living together w/ or w/o children
-May face negative attitudes
-Are part of American fabric
-Public policy has not kept up w/ changing reality of American family
Family structures in today’s society: communal family
-Group of ppl living together to raise children
-Unrelated by blood or marriage
-May face negative attitudes
-Need to determine the decision-maker and caretaker of children
Family structures in today’s society: foster family
-Temporary family for children
-May include foster family’s children in home
-Foster children more likely to have unmet health needs and chronic health problems
Family structures in today’s society: grandparents-as-parent family
-Grandparents raising their grandchildren
-May increase risk for physical, financial, emotional stress
-May lead to confusion and emotional stress for child if biological parents are in and out of life
Family structures in today’s society: adolescent family
-Teenage parents
-At greater risk for health problems during L&D
-More likely to have premature infants
-Still need support from family
Types of mortality rate
-Maternal: # of deaths of any cause during pregnancy
-Fetal: # of fetal deaths (over 20 weeks in gestation, don’t count stillborns/miscarriages prior) in 1k births
-Neonatal: # of infant deaths (within 28 days of life) in 1k births
-Infant: # of infant deaths (1-12 months of life) in 1k births
Groups with higher infant mortality rates
-African American
-American Indian/Alaska Native
March of Dimes
-Most infant deaths occur in neonatal period
-Causes: birth defects, prematurity/low BW, SIDS, maternal complications, RDS
Morbidity
-No state has adequately addressed the issues of reproductive health and violence against women
-Limited research on health conditions that affect women
-Too many women lack health insurance
-ACA holds great promise for women’s health care
Morbidity vs mortality
-Morbidity: health conditions
-Mortality: # of deaths from health conditions
Factors affecting maternal health: genetics
-Genetic determination: influence on physical characteristics, personal attributes, behaviors
-Race: some variations considered a disordered in certain races
Factors affecting maternal health: society
-Roles: important for development self-concept
-Socioeconomic status: poverty/homelessness
-Violence: DV
-Community: schools, peers, neighborhoods
Factors affecting maternal health: health status and lifestyle
-Developmental level and disease distribution: variable w/ age
-Nutrition: deficiencies/excesses
-Choices: exercise, smoking, drugs, alcohol
-Environmental exposure (lead in paint of old homes)
-Stress/coping: PTSD, support systems
Factors affecting maternal health: health care cost containment
-Reduce costs and length of hospital stays
-Increased awareness of cost of supplies and services
-Access to services
-Preventive care focus: education
-Continuum of care focus: provision of more efficient and effective services
Factors affecting maternal health: empowerment of health care consumers
-Increase in responsibility over decisions
-Desire for information and autonomy
-Respect for family’s views and concerns
Barriers to health care
-Finances: lack of health insurance, poverty
-Transportation: lack of vehicles, inability to use public transportation
-Language/culture: difficulties in communications, beliefs r/t tx
-Delivery system: earlier discharge, possible limits for specialty care, clinic hours, negative attitudes toward poor or culturally diverse families by workers
-Health literacy: lack of ability to obtain or process health info
Examples of beliefs and practices of cultural groups
-Illness is God’s will or fate
-Unwelcoming of Western medicine
-Distrust of health system
-Refusal of blood products or products derived from animals
-Indications for dietary and nutritious needs
-Accommodation for time to practice prayer
-Modesty or privacy concerns
-Childbirth is role of women
-Eating clay, dirt, and sand relieve nausea
-Superstitions regarding photographing pregnant parent or buying infant clothing before birth
-Views on birth control
-Decisions may be left to men
Legal/ethical issues in maternal health care
-Abortion: nurse’s personal beliefs vs professional duty
-Substance abuse: fetal injury, possible charges of negligence/child endangerment
-IUD therapy: medical tech vs nature, better QOL via surgery
-Maternal-fetal conflict: fetal care is an ethical issue
Stem cell research
-Goal is to relieve human suffering
-Ethical concerns vary depending on origin of stem cells
-Controversy focuses on use of embryonic stem cells
-Umbilical cord blood banking is vast source of primitive hematopoietic stem and progenitor cells available for clinical application
Informed consent
-Ensuring form completed w/ signatures
-Nurse serves as witness to signature process (also signs form)
-Determining client/family understanding of what they are signing through asking questions
-Decision-maker must be of legal age, w/ full civil rights, and must be competent
-Info is presented in a simple, concise manner
-Decisions must be voluntary
HIPPA
-Federal law
-Protects health insurance coverage for workers when they change or lose jobs
-Requires DHHS to establish national standards for electronic transmissions of health info
-Promotes security and privacy of health care info
-Exceptions exist, such as in cases of suspicion of abuse
RADAR acronym
-R: routinely screen every client for abuse
-A: affirm feelings and assess abuse
-D: document findings
-R: review options and make referrals
Disparities in pregnancy-related mortalities
-Black population have a significantly higher mortality rate compared to others communities
-Includes educated black people
SBAR in black women
-Be mindful of implicit bias
-Black community may experience racism from HCPs
-Advocate for pt when other workers exemplify prejudice
ACA meaning
Case management meaning
CNM meaning
-Certified nurse midwife
Women’s response to continuous labor support
-Improves birth outcomes
-Benefit from one-to-one support during labor
-Support is most effective when provided by someone other than a staff member
-Assigning same nurse to mother is also beneficial
