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Maternity Nursing
Introduction:
The aim of maternity nursing care is to
have an ideal pregnancy result in a
healthy mother, baby and family unit
(drugs & tobacco, AIDS, STD,
violence.
Maternity nsg focuses on the care of
childbearing women and their families
through all stages of pregnancy and
childbirth, as well as the 1st 4 weeks
after birth.
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Definitions
Obstetric
It is the surgical specialty, branch of
medicine, dealing with the care of women and
their children during pregnancy (prenatal
period), childbirth and the postnatal period.
Midwifery is the non-surgical equivalent.
Gynaecology
Gynecology is coming from the Greek
word gynaikos, meaning woman. It is the
medical practice dealing with the health of the
female reproductive system (uterus, vagina,
and ovaries) as well as the male reproductive
organs. Literally, outside medicine, it means
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"the science of women". It is the counterpart to
andrology, which deals with medical issues
specific to the male reproductive system.
Almost all modern gynecologists are also
obstetricians.
Maternity Nursing
It is a delivery of nursing care to women
and their families during pregnancy and
parturition and through the first days of
the puerperium.
Maternity nursing includes extensive
instruction of mothers in the usual
behavior and needs of a newborn,
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expected patterns of G&D of the infant
during the first week.
It is concern with all aspects of maternity
care and focused on helping pregnant
women and families to meet health needs
associated with child bearing experience,
Maternal needs are those associated with:-
1) Avoiding and achieving pregnancies
by supported mother to make informed
decision.
2) Maintaining, Monitoring, or
Interrupting pregnancy
3) Pregnancy-related problems such as
gestational diabetes mellitus.
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4) The normal anatomic, physiologic and
psychological adaptation to pregnancy
and childbirth.
5) The care of mothers in labour and
delivery, as well as emotional support in
labor and delivery.
6) Ongoing observation for the onset of
abnormal signs or symptoms.
Maternity nurses are influencing:
- Quality and cost of care
- Environment in which care is given
- Social issues that affect the health &
welfare of clients and their families
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Maternity nursing includes prevention,
cure and rehabilitation. Nurses
interventions are directed toward:
a. promoting and maintaining health
b.early Dx and effective Rx
c. minimizing maternal and infant disability
d.encouraging and enabling clients and their
families to make informed decision
(counselling, teaching).
Roles of maternity nurse
1) Care Giver: holistic concept includes
creating an appropriate climate therapeutic
relationship for helping pregnant women.
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2) Teacher and Counsellor: maternity
preventive approach by teaching and
counselling; maternal self care and infant
care, BF, SBE, nutrition, ---
3) Advocator: The nurse encourages the
mothers to become aware of her health
care rights and responsibilities. Nurse is in
a position to explain, interpret, defend and
protect patient's rights according to
holistic approach of nursing health care
delivery (bio-psychosocial and spiritual
aspect).
4) Manager:
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The nurse participates in the management
of nursing care by:
Prioritizing patient’s needs
Directing the goals and intervention
toward prioritized patient’s needs
Organizing the delivery of care to
maximum benefit and minimum
expenses in time and material (cost
effectiveness).
5) Researcher:
Nursing research can improve the
quality of care that resulting provision
of efficient nursing care with a
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minimum cost to patient. Evidence
Based practice; evaluate findings.
Nurse-Patient Relationship:
Establishing an open, interactive and
therapeutic nurse-patient relationship is
essential for delivery of maternity nursing care
through application of nursing process as the
following:-
1. Assessment Stage:
Assessing patient health status
(physical and emotional health)
accurately. 9
Assessing women response to the
anatomical, physiological and
psychological changes associated with
pregnancy
Pregnancy status
Determining the women’s perceptions
and present level of adaptation to
pregnancy, childbearing and
parenthood.
Influence of life experience, value,
and beliefs of pregnancy related
behaviours.
2. Nursing Diagnosis Stage:
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Identifying client's level of
knowledge, actual and potential
individualized client needs and
problems in order to accomplish
mutual goals; accuracy of Dx depends
on the comprehensiveness of the
available data base.
3. Planning Stage:
Maternity nurse collaborates with the
client to establish mutual patient-
center goal.
Essential steps of planning phase are
prioritizing the nursing diagnosis and
selecting nursing intervention that will 11
be help the patient to achieve the
goals.
4. Implementation Stage:
This is the stage of put the plan into
action (goal directed care)
The maternity nurse initiates and
completes the intervention designed to
help patient to achieve the goals and
demonstrate the specified outcome
criteria
5. Evaluation Stage:
This stage involves reassessing client
status and behavior to determine the
progress toward the goals.12
To evaluate the progress and the effect
of nursing intervention, the maturity
nurse should compare the current
status, abilities and knowledge with
the previous assessment.
Terms related to pregnancy
Gestation: refers to the period of time
between conception and birth during
which the fetus grows and develops inside
the mother's womb.
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Gestational period: the time interval of a
gestation plus 2 weeks
Gestational age is calculated using
mothers’ date of the last normal menstrual
period (LMP) to estimate the length of
pregnancy at the time of infants’ born. To
calculate this, according to Nägele’s Rule,
add 7 days and then subtract 3 months
from LMP after adding one year.
Subsequently gestational age reflects the
length of time gestation plus 2 weeks that
the baby has spent developing in the
womb.
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Trimesters: A pregnancy is also counted in
terms of trimesters roughly divided into 3-
month segments: First trimester: First day
of LMP through 12 completed weeks;
Second trimester: 13 weeks through 27
completed weeks; Third trimester: 28
weeks through 40 completed weeks.
Multiple gestation: A pregnancy with
more than one fetus
Gravida (refers to pregnancy): a women
who is pregnant regardless of the outcome
of pregnancy
Nulligravida: a woman who is not now
and never has been pregnant.
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Primigravida: a woman pregnant for the
first time.
Multigravida: a woman who has had two
pregnancies or more.
Grand multigravida: a women that has
been pregnant for 5 or more times
Para (refers to delivery): the number of
times a woman has given birth
Nullipara: A woman who has not
completed a pregnancy with a
fetus/foetuses who have reached the stage
of viability (20/24 weeks of gestation;
500g).
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Primipara: A woman who has given birth
after 20 weeks of gestation one time.
Multipara: A woman who has had 2 or
more pregnancies.
Grand multipara: a woman who has given
birth 5 or more times.
1) Examples:
1.A woman pregnant for the first time is a
primigravida and is described as Gravida
1 Para 0.
2.A woman who has two abortions and
has no viable children is described as
Gravida 2 Para 0.
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GTPAL acronym: is a more
comprehensive system for notation of
obstetrical history. This system goes
further and designates numbers of term
infants, preterm infants, abortions, and
living children using the acronym GTPAL
as follows:
G= gravida
T = number of term infants born (after
37 weeks’ gestation)
P = number of preterm infants born
(between 20 weeks’ gestation and 37
weeks’ gestation)
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A = number of pregnancies ending
before 20 weeks’ gestation, either
spontaneous or induced (abortion)
L = the number of children currently
living.
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