Care of the Childbearing Family

1. Care of the Childbearing Family

2. Nursing Roles • RNC – national certification exam • NP – nurse practitioner; family, women’s health, high risk obstetrics, neonatal • CNS – clinical nurse specialists – master’s degree with expertise in a specific clinical area • CNM – certified nurse midwife – educated I nursing and midwifery

3. A Little OB History • 1700’s - women died at childbirth; delivered at home by a female midwife; no men were allowed . • 1800’s - Shift from midwives to physicians for middle class; word “obstetrician” was formed meaning “to stand before”; childbirth fever was an epidemic. 1894 - first C/S done in Boston 1895 - first X-ray used to assess pelvic size

4. History cont • 1900’s - Twilight sleep used in US for labor • 1940’s- 50-75% deliveries were in hospital; nurseries were developed so mom could sleep off drugs • 1970-1980’s - Back to basics; Lamaze and relaxation used; C/S (C-Section) rate about 5% • 1980 - 1990’s - Freestanding birthing centers, home deliveries • 2000 – Midwives and doulas are popular; Childbirth classes popular; Elective deliveries

5. Contemporary OB • Family centered care = delivery of safe, satisfying, quality healthcare that focuses on and adapts to the physical and psychosocial needs of the family.

6. Contemporary Childbirth • Family-centered childbirth - emphasis on the family • Consumer society – increased medical knowledge • Consumer-based healthcare – focuses on health promotion, illness prevention, and responsibility for one’s health • Women make informed and responsible choices regarding health

7. Our Goal Give essential information to care for women and their families Assist them to make right choices safely and with confidence Advocacy and support of nurses

8. Basic Principles of Family Centered Care • Childbirth considered normal or healthy • Affects entire family - creates change in relationships. Doesn’t matter # of children a family has. • Families are capable of making decisions about their own care if given adequate information and professional support.

9. Healthcare IndicatorsHow are we judged? Healthy people 2010 reduce maternal and fetal deaths increase numbers that receive early prenatal care AWHONN, NANN, ANA increase childbirth class attendance reduce C/S rate reduce preterm births promote folic acid intake (400mg/day), back to sleep campaign (to prevent Sudden Infant Death) and neonatal screening reduce drug and alcohol use during pregnancy increase breastfeeding rates

10. Standards of Nursing Care • Establish minimum criteria for competent, proficient delivery of nursing care • Based on what a reasonably prudent nurse with similar education/experience would do

11. Other Indicators • Birth rate – number of live births per 1000 people • Infant mortality – number of deaths of infants under one year of age per 1000 live births • Maternal mortality – number of deaths from any cause during the pregnancy cycle (includes 42 days post partum) per 100,000 live births.

12. Indicator Issues • The US ranks 21st in maternal deaths and 27th infant deaths. • Mortality and Morbidity - decreased as a result: • increased emphasis on hygiene • good nutrition • Exercise • prenatal care • Women and infants have complications at significant rates • US most medically and technologically advanced nation - highest per capita spending on healthcare in the world, yet current mortality rates indicate need for improvement.

14. Current Issues and Trends • Soaring healthcare cost • 40 million without insurance • Lost in the managed care maze • Length of hospital stay • Loss of provider continuity of care • Demographic changes • Profound growth of technology and information • Shortages of trained health care professionals • Health prevention

15. Ethical Issues in Maternity Care • Maternal-Fetal Conflict (whose more important?) • Abortion (Rape? What is appropriate?) • Intrauterine Fetal Surgery (Should they be done) • Reproductive Assistance • Embryonic Stem Cell Research • The Human Genome Project • Cord Blood Banking

16. Social Issues • Poverty • Limited access to care • Violence against women • Family • Culture

17. Critical Thinking • Evidenced Based Practice • Nursing Research • Clinical Pathways • Statistical Data • 3 resp. of nurses: • To recognize what works, what doesn't, conflicting evidence • To use data in own clinical work to evaluate outcome • To integrate these practices into own work

18. Legal Considerations • OB practice • Normal surgery = pt has 7yrs to sue • Baby has 7yrs after they turn 21yrs to sue = 28yrs to sue • Scope of Practice (consider malpractice ins req’d) • Standards of Care • Policy and Procedure • JCAHO • Evidenced Based Practice • Organizations that guide care

19. Informed Consent • A legal concept that protects a client’s right to autonomy and self-determination by specifying that no action may be taken without that person’s prior understanding and freely given consent. • To touch a person without consent (except in an emergency) constitutes battery. • The person who is ultimately responsible for the treatment or procedure should provide the information necessary to obtain informed consent. • The nurses role is to just witness the signature*of the individual giving consent. • * The pt only signed the permit • Oral consent is legal, but written is easier proof for court • Some States let an underage pregnant woman give consent for her baby and some States for her and her baby.