Maternal/Child Nursing

Maternal/Child Nursing NR48 - Spring 2005 Professor J. Anderson MA RN Professor M. Hanna MS, RNC, WNHP

OUTLINE Maternity Nursing Transition to History of Childbirth Biostatistical Terminology Standards of Practice Family Culture Parenthood

Maternity Nursing The care of the childbearing woman and her family through all stages of pregnancy and childbirth, including the first four weeks after birth.

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History of Childbirth 1800 & 1900s: women delivered at home. Pregnancy was not considered an “illness”. 20th century: Hospitals became the place for delivery. 1938: 50% of birth- at home 1955: 5% of births – at home 1970s: witnessed a change in place and method of delivery. Lamaze and home births became popular. 1990s – “Drive thru” delivery - as per insurance company.

New Generation Today’s population – more educated, women have many choices in where and how, and who will deliver their babies. Birthing rooms, free-standing birth centers, home births. Midwives and physicians deliver. Nursing care is family-centered – each transition to parenthood for all members. “Drive-thru” delivery”:discharging mother & baby within 24 hours as per insurance companies…..until there were many re-admissions. New legislation requires mother & baby stay 48 hours after delivery.

Short stay maternity care advantages Allows more time for family to bond with new member. Facilitates resumption of “home routine”. Decreased exposure to pathogens within the hospital environment.

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Short stay maternity care disadvantages Parents feel unprepared for new roles. Mother feels fatigued and may be in pain. Decreased time for learning, teaching plan Unseen complications of mother and NB. ‘Crisis potential’ for families.

Biostatistical Terminology Abortus- an embryo removed or expelled at 20 weeks gestation or less. Birthrate- number of live births in one year per 1000 population. Maternal mortality rate- # of deaths from births & complications of pregnancy, CB or puerperium (42 days after termination)per 100,000 live births. Stillbirth – at birth, infant who demonstrates no signs of life (breathing, heartbeat or voluntary muscle movements.

Infant mortality rate - IMR Number of deaths of infants under one year of age per 1000 live births (used as a common indicator of adequacy of prenatal care and health of a nation as a whole. U.S.- ranked 21st in lowest IMR Canada – 15th Iceland – 4/1000 Japan – 4.7/1000 WHY? …..Access to prenatal care

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Standards of Practice published for women’s health & child nursing

AWHONN: Association of Women’s Health, Obstetrical and Neonatal Nursing

NANN: National Association of Neonatal Nurses

ANA: American Nurses Association

Family Structure - individuals with socially recognized status & position, who interact with one another on regular basis. Different types of families: Nuclear-Conjugal: H, W, CHILDREN – household Single-parent Binuclear - allows parents to continue the parenting role while terminating the spousal unit.(i.e. divorce - as reorganization of family vs family dissolution.

Different types of families:cont’d Reconstituted (blended) stepfamilies(combined) children from a previous marriage come together. Extended-3 or more generations of family. Alternative family- polygamy (exists in some countries); communal - share common ownership of property & goods, gay/lesbian.

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Family Functions


Biologic: reproduction




Economic: ensure financial security




Educational: teaching of skills.




Psychologic: provide an environment that promote personality development.




Sociocultural: socialization of children, values, tradition, and language.

Duvall’s Developmental Stages of the Family Marriage & Family Family: with Infants with Preschoolers with Schoolchildren with Adolescents

Launching Centers Family Middle-Years Family Retirement Age Family

Family Stress Theory Stress: body’s reaction to any stimulus; can be adaptive or maladaptive - is the nonspecific response of the body to any demand. Eustress: type of STRESS that results in positive outcomes. “Stimulating” (not harmful). Distress: stressors evoke an ineffective response-->distress is experienced. Ex:(maladaptive stress)

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Family Stress Theory Conditioning factors: INTERNAL- reliance on the family group, greater sharing of feelings,thoughts, time & activities.

EXTERNAL - using social support systems, increasing links to the community, seeking information.

Factors affecting consequences of stress: produce growth & improve family functioning if the outcome is RESOLUTION. DISSOLUTION or continued conflict

Crisis: when a family experiences too many stressors for it to cope adequately. For adaptation to occur, a change in family structure and/or interaction is necessary.

“Maturational crisis” - expected developmental stressor event – ‘BIRTH’. Although expected & normal, ‘BIRTH’ - a transition point, has the potential to change a family’s stress level.

“Situational” crisis - unanticipated event that poses a threat to an individuals’ psychosocial or psychological well being. Non-normative (unexpected) stressor event --> “complicated pregnancy”. These events - highly stressful, require the interventions of nurses who understand family stress management. Goal: to promote functional equilibrium to client & family.

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“All cultures recognize pregnancy as a special transition period, and many have particular customs and beliefs that dictate activity and behavior during pregnancy”. (Andrews and Boyle, 1995)

National Health Goals: to ensure a healthy outcome for families Inadequate parenting due to a dysfunctional family structure or lack of community resources can contribute to poor pregnancy outcomes & poor child-rearing practice. A. lower the current baseline of 25.2 children/1,000 who are maltreated. B. Reduce physical abuse directed at women to no more that 27/1,000. (current baseline 30/1,000)

Culture “The sum of beliefs, practices, habits, likes, dislikes, norms, customs, and rituals that we have learned from our families” (Spector, 1991). Taboo: Norms: Cultural relativity:

Chinese-only drink warm liquids p delivery Jewish-no baby shower,no foretelling baby’s name Hassidic Jew-only women may give care(midwife), father not allowed to watch birth, Mikvah. Hindu-oppose artificial insemination; no tubal ligations

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Culture Hispanic- frightening to have pelvic exam by male health provider. BR x 3 days p birth. Loud behavior in labor. Italian- open scissors kept under mattress to ward off evil spirits; spin NB upside down if it has days and nights mixed up.

Nursing Care Be aware of cultural values & beliefs Always use an interpreter Health education materials should be culturally and linguistically appropriate Accommodate nursing care to each culture View each patient & family individually

12 QUALITIES OF A STRONG FAMILY Commitment Appreciation Time Purpose Congruence Communication Family rules, values & beliefs

Coping strategies Problem-solving Positive outlook Flexibility & adaptability Balance

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Transition to Parenthood STRESSOR? (Maturational or Situational) CRISIS? Parent education classes Previous experience Father involvement Other stressors Marital tension

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