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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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