lOMoARcPSD| 63525276
Week 1 Edapt Introduction to Maternal Child Nursing
Maternity care has changed over the years to increase the emphasis on safety and quality of care.
Many expectant mothers have other health concerns such as obesity, high blood pressure, and even substance
abuse. Their socioeconomic status can have an impact on their pregnancy, along with their cultural preferences.
Abuse and human trafficking may be other risks that these women face during this period of their lives.
This concept will explore some of the trends in maternal child nursing and how nurses can positively influence
healthcare outcomes. Critical thinking and evidence-based practice must be used, and nurses should also make
sure that the client is involved in their own care.
Planning Care
When planning maternal child care for a client, nurses and providers must take into consideration the specific
needs of the client.
Match the following service types of care with the clients and the experience they would best serve.
Evidence-based
practice / Service
type of care The care is provided based on the latest research and recommendations to promote safety
and positive health outcomes.
Level I facility Low-risk clients, in a hospital setting
LDR room
Mom labors, delivers and recovers in the same room, but is transferred to a postpartum unit.
Birth centers Tub births and births may not require as much medical monitoring.
Home births Specialized physicians and midwives deliver within a client’s residence.
Level II facility
Typically, care is provided for clients 32 weeks gestation in a hospital setting.
LRDP room Mom labors, delivers and recovers in the same room and stays for 2-4 days.
Level III facility Highest-risk moms and their infant(s), in a hospital setting
1
, lOMoARcPSD| 63525276
Family-Centered Care
Most families now recognize that they have choices in the childbirth experience. What are the basic principles of
family-centered care?
Family dynamics are impacted by childbirth.
Childbirth is typically a normal, healthy event.
A focus on family or the support person(s) should be maintained.
Clients can be involved in decision making.
Maternal Mortality
Which factors will help to reduce maternal mortality in the United States? Select all that apply.
Use of a specialized antepartum maternity clinic
Delivery by a certified nurse midwife (CNM)
Birthing plans
Availability of high-risk, maternal-infant care centers
Home delivery
Changes in Maternity Care
Changes in Maternity Care Over Time
Prior to the twentieth century (before 1901)
• Deliveries happened at home; “granny midwives” were in attendance
• High rates of maternal and infant death, both at home and in hospitals
• Postpartum hemorrhage, postpartum infection, toxemia, prematurity, dehydration r/t diarrhea,
contagious diseases
20th century developments
• Increase in physician assisted births in hospitals
• By 1960, 90% of all births in the U.S. were in hospitals
• Lay midwifery became increasingly illegal
• Women’s role in delivery became passive; doctors delivered
• Twilight sleep; narcotic and scopolamine
• Continued problems with poor maternal nutrition, infection, inadequate prenatal care
& cost issues
Birthing Risks
When reviewing nursing history, which factors led to increased mortality rates and negative pregnancy outcomes?
Select all that apply.
Poor maternal nutrition
Short hospital stays
Women were passive in the delivery process
Communicable diseases
Risk of hemorrhaging post-delivery
Mortality and Funding
Despite technological advances and the move from home to hospital, maternal and infant mortality rates in the
United States have declined slowly. In addition, statistics of U.S. infant mortality rates still show a wide disparity in
outcomes among races.
2
, lOMoARcPSD| 63525276
Due to these high mortality rates, the federal government became involved. Programs to support the health of
mothers, infants, and young children were developed and supported. However, rural areas are still at risk due to a
lack of obstetrics (OB) care and a need for nurses.
Care Impact
How funding impacted care:
• Insurance companies paid hospitals a fixed amount (of insurance coverage) for a specific
condition.
• The facilities absorbed the extra costs if needed or kept the extra money if they could provide
care cheaper. This resulted in:
• the decreased lengths of hospital stay
• shorter stay = less money spent on care = greater profit
• Capitated care, which is an employer or government who is providing insurance, paid a set
amount to a specific physician group to care for individuals. Example: public aid
• Additional resources were developed to reduce mortality and control costs, including:
• Case management
• Outcomes management
• Clinical pathways
Current Practices
All of these impacts on care in history have resulted in current practices, such as:
Length of stay
• vaginal discharged at 48 hours
• cesarean section discharged at 96 hours
Home visits
• If leaving at or before 24 hours, home visits may be provided.
Discharge teaching issues
• Lack of time with clients and the quality of information can affect the value of discharge
teaching.
Decreased access to care
• Some women still have difficulty seeing specialists or picking providers if they are out of network.
Evidence-Based Practice
Nurses strive to provide care that is based on the latest evidence.
• Women in the United States are more likely to die from childbirth than women living in other
developed countries.
The maternal mortality rate in the U.S. for 2018 was 17.4 maternal deaths per
100,000 live births. • Wide racial/ethnic gaps exist between non-Hispanic black (37.1 per 100,000
live births), non-Hispanic white (14.7), and Hispanic (11.8) women, which is
consistent with earlier data.
• The maternal mortality rate for women aged 40 and over (81.9 per 100,000 live births) is nearly 8
times that for women under age 25 (10.6).
This research and evidence has led to the following changes over the years:
More family involvement in birth
Keeping infants with mothers after delivery
Fostering family unity while maintaining safety
3
, lOMoARcPSD| 63525276
Nurses play a major role in pregnancy care.
Mandating a minimum length of stay post-delivery and providing follow up care.
Planning Care
Evidence has shown that certain clients are at higher risk for injury during pregnancy, labor, and delivery. Multiple
healthcare organizations are trying to find ways to reduce the factors that contribute to poor outcomes. Based on
the evidence, which practices improve maternal/newborn outcomes? Select all that apply. Fostering family unity
while maintaining safety
More family involvement in birth
Minimal nursing role in pregnancy care
Mandated minimum length of stay and home visits
Keeping infants with mothers after delivery
Maternal Child Health Care Providers
In addition to physicians, there are other members of the healthcare team who provide excellent care for mothers
and children. Nurses can pursue additional education to obtain their Advanced Practice Nursing (APN) licenses.
Each provider must practice within their scope of practice or there may be increased risks to moms and babies.
Staff Nurse
RN license and may hold additional certifications
• Care for clients in obstetrics (OB) offices
• Care for clients in labor and delivery and mother-baby units, including medication administration,
assessments, circulate cesarean (C)-sections
• Teach prenatal classes
• Complete home visits/outpatient services
Doula
Certified professional
• Provide continuous emotional, physical, and informational support to mothers before, during, and after
childbirth
• Trained in labor support
• Cannot administer medications, monitor baby, monitor labor, deliver a baby, or have any input in medical
decisions
• May work in a birthing center, hospital, and/or with home births
Lactation Consultant
RN license and certification
• Specialized support for breastfeeding
• Inpatient and outpatient services
Certified Nurse Midwife
Registered nurses (RNs) who have completed a program of study and clinical experience
• Provide complete care during pregnancy, childbirth, and the postpartum period
• Counsel and support the childbearing family
• Provide annual well-woman exams
• Approach to childbirth is noninterventionist and supportive
• May work in a birthing center, hospital, or client home
4
Week 1 Edapt Introduction to Maternal Child Nursing
Maternity care has changed over the years to increase the emphasis on safety and quality of care.
Many expectant mothers have other health concerns such as obesity, high blood pressure, and even substance
abuse. Their socioeconomic status can have an impact on their pregnancy, along with their cultural preferences.
Abuse and human trafficking may be other risks that these women face during this period of their lives.
This concept will explore some of the trends in maternal child nursing and how nurses can positively influence
healthcare outcomes. Critical thinking and evidence-based practice must be used, and nurses should also make
sure that the client is involved in their own care.
Planning Care
When planning maternal child care for a client, nurses and providers must take into consideration the specific
needs of the client.
Match the following service types of care with the clients and the experience they would best serve.
Evidence-based
practice / Service
type of care The care is provided based on the latest research and recommendations to promote safety
and positive health outcomes.
Level I facility Low-risk clients, in a hospital setting
LDR room
Mom labors, delivers and recovers in the same room, but is transferred to a postpartum unit.
Birth centers Tub births and births may not require as much medical monitoring.
Home births Specialized physicians and midwives deliver within a client’s residence.
Level II facility
Typically, care is provided for clients 32 weeks gestation in a hospital setting.
LRDP room Mom labors, delivers and recovers in the same room and stays for 2-4 days.
Level III facility Highest-risk moms and their infant(s), in a hospital setting
1
, lOMoARcPSD| 63525276
Family-Centered Care
Most families now recognize that they have choices in the childbirth experience. What are the basic principles of
family-centered care?
Family dynamics are impacted by childbirth.
Childbirth is typically a normal, healthy event.
A focus on family or the support person(s) should be maintained.
Clients can be involved in decision making.
Maternal Mortality
Which factors will help to reduce maternal mortality in the United States? Select all that apply.
Use of a specialized antepartum maternity clinic
Delivery by a certified nurse midwife (CNM)
Birthing plans
Availability of high-risk, maternal-infant care centers
Home delivery
Changes in Maternity Care
Changes in Maternity Care Over Time
Prior to the twentieth century (before 1901)
• Deliveries happened at home; “granny midwives” were in attendance
• High rates of maternal and infant death, both at home and in hospitals
• Postpartum hemorrhage, postpartum infection, toxemia, prematurity, dehydration r/t diarrhea,
contagious diseases
20th century developments
• Increase in physician assisted births in hospitals
• By 1960, 90% of all births in the U.S. were in hospitals
• Lay midwifery became increasingly illegal
• Women’s role in delivery became passive; doctors delivered
• Twilight sleep; narcotic and scopolamine
• Continued problems with poor maternal nutrition, infection, inadequate prenatal care
& cost issues
Birthing Risks
When reviewing nursing history, which factors led to increased mortality rates and negative pregnancy outcomes?
Select all that apply.
Poor maternal nutrition
Short hospital stays
Women were passive in the delivery process
Communicable diseases
Risk of hemorrhaging post-delivery
Mortality and Funding
Despite technological advances and the move from home to hospital, maternal and infant mortality rates in the
United States have declined slowly. In addition, statistics of U.S. infant mortality rates still show a wide disparity in
outcomes among races.
2
, lOMoARcPSD| 63525276
Due to these high mortality rates, the federal government became involved. Programs to support the health of
mothers, infants, and young children were developed and supported. However, rural areas are still at risk due to a
lack of obstetrics (OB) care and a need for nurses.
Care Impact
How funding impacted care:
• Insurance companies paid hospitals a fixed amount (of insurance coverage) for a specific
condition.
• The facilities absorbed the extra costs if needed or kept the extra money if they could provide
care cheaper. This resulted in:
• the decreased lengths of hospital stay
• shorter stay = less money spent on care = greater profit
• Capitated care, which is an employer or government who is providing insurance, paid a set
amount to a specific physician group to care for individuals. Example: public aid
• Additional resources were developed to reduce mortality and control costs, including:
• Case management
• Outcomes management
• Clinical pathways
Current Practices
All of these impacts on care in history have resulted in current practices, such as:
Length of stay
• vaginal discharged at 48 hours
• cesarean section discharged at 96 hours
Home visits
• If leaving at or before 24 hours, home visits may be provided.
Discharge teaching issues
• Lack of time with clients and the quality of information can affect the value of discharge
teaching.
Decreased access to care
• Some women still have difficulty seeing specialists or picking providers if they are out of network.
Evidence-Based Practice
Nurses strive to provide care that is based on the latest evidence.
• Women in the United States are more likely to die from childbirth than women living in other
developed countries.
The maternal mortality rate in the U.S. for 2018 was 17.4 maternal deaths per
100,000 live births. • Wide racial/ethnic gaps exist between non-Hispanic black (37.1 per 100,000
live births), non-Hispanic white (14.7), and Hispanic (11.8) women, which is
consistent with earlier data.
• The maternal mortality rate for women aged 40 and over (81.9 per 100,000 live births) is nearly 8
times that for women under age 25 (10.6).
This research and evidence has led to the following changes over the years:
More family involvement in birth
Keeping infants with mothers after delivery
Fostering family unity while maintaining safety
3
, lOMoARcPSD| 63525276
Nurses play a major role in pregnancy care.
Mandating a minimum length of stay post-delivery and providing follow up care.
Planning Care
Evidence has shown that certain clients are at higher risk for injury during pregnancy, labor, and delivery. Multiple
healthcare organizations are trying to find ways to reduce the factors that contribute to poor outcomes. Based on
the evidence, which practices improve maternal/newborn outcomes? Select all that apply. Fostering family unity
while maintaining safety
More family involvement in birth
Minimal nursing role in pregnancy care
Mandated minimum length of stay and home visits
Keeping infants with mothers after delivery
Maternal Child Health Care Providers
In addition to physicians, there are other members of the healthcare team who provide excellent care for mothers
and children. Nurses can pursue additional education to obtain their Advanced Practice Nursing (APN) licenses.
Each provider must practice within their scope of practice or there may be increased risks to moms and babies.
Staff Nurse
RN license and may hold additional certifications
• Care for clients in obstetrics (OB) offices
• Care for clients in labor and delivery and mother-baby units, including medication administration,
assessments, circulate cesarean (C)-sections
• Teach prenatal classes
• Complete home visits/outpatient services
Doula
Certified professional
• Provide continuous emotional, physical, and informational support to mothers before, during, and after
childbirth
• Trained in labor support
• Cannot administer medications, monitor baby, monitor labor, deliver a baby, or have any input in medical
decisions
• May work in a birthing center, hospital, and/or with home births
Lactation Consultant
RN license and certification
• Specialized support for breastfeeding
• Inpatient and outpatient services
Certified Nurse Midwife
Registered nurses (RNs) who have completed a program of study and clinical experience
• Provide complete care during pregnancy, childbirth, and the postpartum period
• Counsel and support the childbearing family
• Provide annual well-woman exams
• Approach to childbirth is noninterventionist and supportive
• May work in a birthing center, hospital, or client home
4
