Test 1 Notes Week 1Introduction to Maternal Child Care
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.
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
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.
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
Nurse Practitioner
RN with advanced preparation
• Women’s health nurse practitioners (WHNPs) provide wellness-focused,
primary, reproductive, and gynecologic care throughout the lifespan, starting at
adolescence.
• Neonatal nurse practitioners (NNPs) assist in the care of high-risk newborns
in the immediate post-birth care or in a neonatal intensive care unit (NICU).
Midwife
,Direct–Entry Midwife, Certified Midwife (CM), or Certified Professional Midwife
(CPM)
• Recognized as legal practitioners in some U.S. states
• May deliver babies in hospitals and homes depending on training and state
regulations
• Not as common as Certified Nurse Midwife (CNM)
• In the U.S., national certification is available for the Certified Professional
Midwife, but national midwifery licensing does not exist as it does in many
other countries
Hospital Levels Related to Maternity Care
• Level III
• highest level of care
• able to care for high-risk moms and infants
• Level II
• midlevel
• Typically, 32 weeks and above can receive care
• Level I
• low risk clients
Environments
• Labor-Delivery-Recovery Room (LDR)
• The client labors, delivers and recovers in the same room but is
transferred to a postpartum (PP) unit.
• Labor-Deliver-Recovery-Postpartum Room (LDRP)
• The client labors, delivers, and recovers in the same room.
• The client stays the duration of their 2-4 day stay.
• Birth center
• It may offer tub births and not require as much medical
monitoring.
• Home births
• Physicians and midwives who specialize in home births prepare the
home birth setting and follow certain protocols of their own.
Phases of Labor Terminology
• antepartum: before labor
• intrapartum: during labor
• postpartum: after delivery
Birth Support
• Mothers benefit from having support during the delivery and at home. The
support person may vary based on the relationship with the mom. The person
can be:
• the father of the baby
• a relative or friend
, • a doula (trained labor support)
• a sibling
• The presence of children at birth is controversial.
• They may attend all or part of labor and birth with provider
approval.
• Client education
• Many classes provide instructions on infant care and Lamaze.
• Client teaching can help with emotional and physical pain
support.
There are five core measures specific to perinatal care.
• Decrease the rate of elective deliveries.
• Decrease the rate of Cesarean births.
• Increase the rate of antenatal administration of steroids in preterm labor.
• Decrease the rate of newborns with septicemia or bacteremia.
• Increase the rate of exclusive breastfeeding.
Nurses play an active role in supporting these core measures.
• Reducing the rate of elective deliveries
• Encouraging prenatal classes and educating parents can reduce elective
deliveries.
• Women will see the importance of carrying their baby to term.
• Cesarean (C)-section
• Nurses can provide labor support (position changes/pain relief), teach
about drug use, and protect patients who may be abused, which can
cause risk for injury and the need for surgery.
• Preterm labor
• Nurses can collaborate with high-risk providers to provide care that
helps sustain the pregnancy.
• Clients should be notified about the risk of delivering newborns.
• Complications could include respiratory and infection.
• Decrease rate of infection
• Nurses can administer maternal and newborn antibiotics as needed
and use personal protective equipment (PPE) appropriately.
• Increase the rate of breastfeeding
• Nurses can teach breastfeeding classes and general breast care, along
with connecting clients with lactation consultants.
Some examples of social determinants (Healthy People, n.d.) include:
• availability of resources to meet daily needs (safe housing, local food markets)
• access to educational, economic, and job opportunities
• access to health care services (insurance, providers)
• public transportation options (bus, train, car)
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.
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
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.
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
Nurse Practitioner
RN with advanced preparation
• Women’s health nurse practitioners (WHNPs) provide wellness-focused,
primary, reproductive, and gynecologic care throughout the lifespan, starting at
adolescence.
• Neonatal nurse practitioners (NNPs) assist in the care of high-risk newborns
in the immediate post-birth care or in a neonatal intensive care unit (NICU).
Midwife
,Direct–Entry Midwife, Certified Midwife (CM), or Certified Professional Midwife
(CPM)
• Recognized as legal practitioners in some U.S. states
• May deliver babies in hospitals and homes depending on training and state
regulations
• Not as common as Certified Nurse Midwife (CNM)
• In the U.S., national certification is available for the Certified Professional
Midwife, but national midwifery licensing does not exist as it does in many
other countries
Hospital Levels Related to Maternity Care
• Level III
• highest level of care
• able to care for high-risk moms and infants
• Level II
• midlevel
• Typically, 32 weeks and above can receive care
• Level I
• low risk clients
Environments
• Labor-Delivery-Recovery Room (LDR)
• The client labors, delivers and recovers in the same room but is
transferred to a postpartum (PP) unit.
• Labor-Deliver-Recovery-Postpartum Room (LDRP)
• The client labors, delivers, and recovers in the same room.
• The client stays the duration of their 2-4 day stay.
• Birth center
• It may offer tub births and not require as much medical
monitoring.
• Home births
• Physicians and midwives who specialize in home births prepare the
home birth setting and follow certain protocols of their own.
Phases of Labor Terminology
• antepartum: before labor
• intrapartum: during labor
• postpartum: after delivery
Birth Support
• Mothers benefit from having support during the delivery and at home. The
support person may vary based on the relationship with the mom. The person
can be:
• the father of the baby
• a relative or friend
, • a doula (trained labor support)
• a sibling
• The presence of children at birth is controversial.
• They may attend all or part of labor and birth with provider
approval.
• Client education
• Many classes provide instructions on infant care and Lamaze.
• Client teaching can help with emotional and physical pain
support.
There are five core measures specific to perinatal care.
• Decrease the rate of elective deliveries.
• Decrease the rate of Cesarean births.
• Increase the rate of antenatal administration of steroids in preterm labor.
• Decrease the rate of newborns with septicemia or bacteremia.
• Increase the rate of exclusive breastfeeding.
Nurses play an active role in supporting these core measures.
• Reducing the rate of elective deliveries
• Encouraging prenatal classes and educating parents can reduce elective
deliveries.
• Women will see the importance of carrying their baby to term.
• Cesarean (C)-section
• Nurses can provide labor support (position changes/pain relief), teach
about drug use, and protect patients who may be abused, which can
cause risk for injury and the need for surgery.
• Preterm labor
• Nurses can collaborate with high-risk providers to provide care that
helps sustain the pregnancy.
• Clients should be notified about the risk of delivering newborns.
• Complications could include respiratory and infection.
• Decrease rate of infection
• Nurses can administer maternal and newborn antibiotics as needed
and use personal protective equipment (PPE) appropriately.
• Increase the rate of breastfeeding
• Nurses can teach breastfeeding classes and general breast care, along
with connecting clients with lactation consultants.
Some examples of social determinants (Healthy People, n.d.) include:
• availability of resources to meet daily needs (safe housing, local food markets)
• access to educational, economic, and job opportunities
• access to health care services (insurance, providers)
• public transportation options (bus, train, car)
