Trends In Maternal Health Care

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Current trends in maternal health care

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The vision for women and their health-The International Confederation of Midwives, Healthy People 2010-Maternal, Infant and child health, United Nations Millennium Development Goals-8 total goals, Intergrative Health Care-complimentary and alternative therapies combined with conventional

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What are the problems with US health care delivery system?

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Structure of the system, reducing medical errors, high cost of health care, limited access to care, efforts to reduce health disparities

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Trends in fertility and birth rate

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reflect women's needs for health care

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Low birth weight and preterm birth

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risk for morbidity and mortality increase for newborns weighing < 5lbs 8oz

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Infant mortality in the US

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common indicator of prenatal care and the health of a nation as a whole is the infant mortality rate

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International trends in infant mortality

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US ranks 29th, while Canada ranks 25th compared to other industrialized nations, US has high rate of LBW infants

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Maternal mortality trends

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worldwide approx. 1400 women die each day of problems r/t pregnancy or childbirth, hemorrhage leading cause of death

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Increase in high risk pregnancies

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greater number of women are at risk for poor pregnancy outcomes, drug use, ETOH use, obesity

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High technology care

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advances in scientific knowledge and large numbers of high risk pregnancies, telemedicine, these technologic advances have contributed to higher health care costs

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View of women

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must be viewed holistically and in context in which they live, physical, mental and social factors must be considered, "incompetent cervix", "failure to progress" (these phrases may imply failure or inadequacy of the woman)

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Safe motherhood

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maternal mortality and morbidity is a measure of nation's commitment to the status of women and their health, half of maternal death could be prevented with better access to care, better quality care and positive changes in health and lifestyle habits

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Leading causes of pregnancy-related deaths

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hemorrhage, blood clots, HTN, infection, stroke, amniotic fluid embolism, and heart muscle disease

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Childbirth practices

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prenatal care may promote better pregnancy outcomes by providing early risk assessment and promoting healthy behaviors, choosing physicians or nurse-midwives as PCP, families being present for labor and birth, neonatal security, follow-up or home care

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Community based care

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technology available in hospital now found at home, home health care

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Involving consumers and promoting self-management

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has potential to reduce health care costs, maternity care especially suited for self-management

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Health literacy

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must be assessed routinely to recognize a problem and accomodate pts with limited literacy skills

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Breastfeeding in the workplace

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making provisions for women returning to work after childbirth, lactation rooms

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International concerns

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female genital mutilation, women who have undergone procedure are significantly more likely to have adverse obstetric outcomes

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Evidence-based practice

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practitioner must use the best available information on which to base their interventions

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Organizations who include an evidence-based approach to practice-maternal child

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Association of Women's Health, Obstetrics, and Neonatal Nurses (AWHONN), Cochrane Pregnancy and Childbirth Database, Joanna Briggs Institute, WHO

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Standards of practice in perinatal nursing can be found

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ANA, AWHONN, ACNM, NANN

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Risk management

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system of checks and balances to minimize risk of injury

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Sentinel events

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unexpected occurence involving death or serious injury, signal need for immediate investigation and response, reportable sentinel events include: maternal death r/t process of birth, any perinatal death not r/t congenital condition in an infant with a birth wt > 2500g and infant discharged to wrong family

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Failure to rescue

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evaluation of quality indicators of nursing care relative to outcomes

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Ethical guidelines for nursing research in perinatal nursing

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must protect rights of human subjects, ensure that subjects are fully informed and aware of rights, analysis of risks and benefits to both mother and fetus, follow ANA ethical guidelines in conduct, dissemination, and implementation of nursing research

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Family in cultural and community context

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Family structure and function are influenced by culturally related health beliefs and values, these factors have power to affect maternal and child health outcomes, recognize these influences

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Defining the family

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forms a social network, potent support system

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Emphasis in working with families

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wellness and empowerment to achieve control over their lives

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Family nursing

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morally and ethically obligated to include families in health care, focus on relationships not just individuals, become competent in both assessing and intervening with family members

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Understanding families

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use theories to guide practice, beliefs may conflict with principles of Western health care management, nurses must possess a degree of personal openness and acceptance, work with a families in a way that is respectful and adapts to their ways of learning and communicating

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Childbearing beliefs and practices

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communication, use of interpreters, personal space, time orientation, family roles

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Developing cultural competence

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ability to think, feel, and act in ways that acknowledge respect and build on ethnic, sociocultural, and linguistic delivery, act in ways that meed needs of pts and are respectful of ways and traditions different from one's own

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CRASH course in cultural competence

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C-Culture
R-show Respect
A-Assess/Affirm differences
S-show Sensitivity/Self-awareness
H-do it all with Humanity

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Implications for nursing-cultural competence

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all cultures maintain behavioral norms for each stage of perinatal cycle, evolve from culture's view of how to stay healthy and prevent illness, nurses must understand how others perceive life events, pts have right to expect that their health care needs are met and culture will be respected