A Glimpse at Maternity Nursing in The

8/14/2019 A Glimpse at Maternity Nursing in The

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A GLIMPSE AT

MATERNITY NURSING

in the 21st CENTURY

K. L. Ringgenberg, RNC, MSN, WHNPShanghai Jiao Tong University SON

April 5, 2006


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Maternity Nursing in the

21st Century

Antepartum Care

Intrapartum CareTechnology in OB


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Partum

Parturition: birth

Partum: regarding time period to the birth

Antepartum: before birth or prenatal

Intrapartum: during the birth process

Postpartum: after the birth (usually regarded asthe first 30 days)


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Antepartum Care in the 21st

Century

Care beginning before the birth

Prenatal care


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History of Antepartum Care

Prior to 1925, no formal practice ofantepartum care.

2nd Century-warned against violent

movements to prevent ROM, sexualintercourse harmful to pregnancy

1513-first published OB text (Germany)

1700s-forceps invented, male midwife

developed theories for midwives in London 1700s into 1800s-births attended by

female community in US due to price


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History- continued20th Century-at the turn of the

century, 50% of births in USconducted by midwives


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Home to Hospital-History

1900


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Fast Facts-Maternal

1900-maternal death rate 6-9/1000 USA

40% of those deaths were due to infection

2004-death rate at ~8-9/100,000 USA1989-maternal death rate in China

95/100,000

2004-48.3/100,000


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Fast Facts-Infants

1900-30% of infants in USA major cities diedbefore 1st birthday

2000s-infant mortality rate~7/1000 USA


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20th

Century Influences High infant & maternal mortality rates

1914-coined term nurse midwife

Today-nurse midwife is defined as a RNwith an advanced certification andmasters degree in midwifery

1925-Childrens Bureau in the US

recommended antepartum care todecrease mortality rates


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20th

Century Influences 1965-Nurse Practitioner role (Peds)

1972-NP role expanded to OB/GYN

1989-US Public Health Panelexamined prenatal care-recommendations made

1950-2000-improvements inmortality due to changes in meds,antibiotics, blood products, nutrition-not prenatal care itself.


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21st Century- Major Shifts

caused byManaged care

Rise of collaborative health care teams

Malpractice crises

Increased concerns for antepartum careand quality of care

Internet and computer technology


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21st Century- more factors

Increased maternal age

ART-assisted reproductive technologies

Advances in genetic counseling andprenatal diagnosis

Evidence-based care

Efforts to meet goals of Healthy People2010 and Safe Motherhood Initiatives in

developing countries Rising awareness of CAM (complimentary

& alternative medicines)


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Twins 4/1000


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West Triplets 1/7,000-10,000


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Skopec Quads 1/600,000


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Intrapartum Care in the 21st

Century

Care provided during the birth

processVaginal Delivery

Cesarean Section


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Where do delivers occur?96%-Hospital

2.4%-Birthing Centers1%-Home

*Delivers in US by CNMs


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Cesarean Sections

C/S rates are at an all time high.

Rates vary from country to country.

Some examples: Netherlands


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Global Look 70% on average-births attended by

CNM in Western Europe

85%-Holland (which WHO designatesas ideal or #1 ranking)

10%-United States

Refer to previous stats onmortality/morbidities.


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Nurse-MidwiferyMidwifery model-care that safeguard the birth

process as natural and holistic.

Medical (or illness) model-care is based on birthis more of a disease state.

Intrapartum/neonatal mortality rate same forbirth center or hospital (term/low risk)


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Certified Nurse MidwifeRegistered Nurse

Advanced Practice Nurse (APN)Masters degree in Nursing

Specializing in Midwifery

Credentialing necessary forstate licensing


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Defining AttributesCNM-provides prenatal & gyn care to

normal healthy (low risk) women; do

delivers and postpartum care.

Practice in hospital setting, clinics,birthing centers and homes

May practice independently or incollaboration with a physician


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CNMs associated with-Personalized care

High-touchLow-tech

Comforting care

Alternative approaches


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CompetenciesObtain admission history & physical

Assessments of mother and fetus

Order or initiate tests, medications orprocedures

Perform ongoing exams of labor status

Attend the delivery


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Attending labor and birthProvide safe, satisfying care

Patient and family are activeparticipants

Informed consent

Appropriate use of technology


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ActivitiesEvaluation

ComfortAssistance

Support

Reassurance

Management of complications


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SettingsHome

Birthing CentersHospitals-Labor, Delivery &

Recovery Rooms (LDR), LDRP

(post-partum), Single roommaternity care, Birthing rooms


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Technology for the 21st

CenterBirthing rooms

Delivery roomsOperative suites


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Birthing Suite


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C-Section Rooms


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Latest Technologies Electronic Fetal Monitoring (EFM)

Ultrasonography

Infusion pumps

Electronic monitoring devices:

1. Non-invasive

2. Invasive


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Fetal Surgeries


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EFM


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EFM

External (indirect) method

Internal (direct)


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Antepartum testing with

EFMNST-non-stress test

CST-contraction stress testBPP-biophysical profile

All assess fetal well-being


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Intrapartum EFM

External-tocodynamometer

and transducer Internal-spiral electrode andintrauterine pressure catheter

Fetal pulse oximetry


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Emerging EFM Technology

Computer analysis

Lack of clear definitions andstandards at this point of fetalheart rate patterns, however,

due to come out this year


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Electronic Health Record

Computers

Paperless charts Integrates all aspects of

assessment, intervention and

evaluation


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Doppler


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Ultrasonography

Done at all stages of pregnancy

Transvaginal or transabdominal approach

Done for maternal or fetal indications

Done in office, clinic, mobile centers, obunit, L & D


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Indications

Maternal diseases

Multiple gestations

Fetal growthEstablishment of fetal age

Placental location and grading

Assess fetal well-being (BPP)Pre-term labor-cervical lengths


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3-D & 4-D Ultrasound


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3-D Early Gestation


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S/D Ratios


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Pulse Oximetry


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V/S Monitors

El t i B/P M it


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Electronic B/P Monitor


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Critically Ill OB

Continuous cardiac monitoring

Invasive hemodynamic monitoring

CVP

Arterial lines

Pulmonary artery lines Ventilator


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OB Critical Care Unit


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Flight Nurses


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Genetics

Human Genome Project

Relationship to Maternity Nursing

Advanced maternal agePatterns of inheritance

Prenatal testing

Genetic counselingEthics and other


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Informatics

IT

ComputersPatient access to information

Nursing informatics


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Automated Medication

Dispensing MachinesCut down on errors

Bar codesChart medications

Labor saving

And more


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Summary

Past, present, future antepartum careaspects

Intrapartum care in the 21st Centuryas it relates to nursing and CNM

Technology today in maternitynursing with a glimpse into the future

as well


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What is in your nursing

future for the 21st

Century?


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Questions or comments?


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Documents

A Glimpse at Maternity Nursing in The