A GLIMPSE AT MATERNITY NURSING in the 21st CENTURY

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A GLIMPSE AT MATERNITY NURSING in the 21st
CENTURY

• K. L. Ringgenberg, RNC, MSN, WHNP
• Shanghai Jiao Tong University SON
• April 5, 2006

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Maternity Nursing in the 21st Century

• Antepartum Care
• Intrapartum Care
• Technology 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 as
  the 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 of antepartum
  care.
• 2nd Century-warned against violent movements to
  prevent ROM, sexual intercourse 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- continued

• 20th Century-at the turn of the century, 50 of
  births in US conducted by midwives

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Home to Hospital-History

• 1900 lt5 USA babies born in hospital
• 1940 50
• 1970 99
• 2005 99

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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 USA
• 1989-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 died
  before 1st birthday
• 2000s-infant mortality rate7/1000 USA
• lt1950s-infant mortality rate 300/1000 China
• 2001-33/1000 in China (reportedly as low as
  5/1000 in Beijing and Shanghai)

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20th Century Influences

• High infant maternal mortality rates
• 1914-coined term nurse midwife
• Today-nurse midwife is defined as a RN with an
  advanced certification and masters degree in
  midwifery
• 1925-Childrens Bureau in the US recommended
  antepartum care to decrease 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 Panel examined prenatal
  care-recommendations made
• 1950-2000-improvements in mortality due to
  changes in meds, antibiotics, blood products,
  nutrition-not prenatal care itself.

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21st Century- Major Shifts caused by

• Managed care
• Rise of collaborative health care teams
• Malpractice crises
• Increased concerns for antepartum care and
  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 and prenatal
  diagnosis
• Evidence-based care
• Efforts to meet goals of Healthy People 2010 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 process
• Vaginal Delivery
• Cesarean Section

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Where do delivers occur?

• 96-Hospital
• 2.4-Birthing Centers
• 1-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 lt10
• Great Britain 20
• USA 24-27
• HK 50 in private hospitals
• China 50 in some hospitals
• The jury is still out!!!

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Global Look

• 70 on average-births attended by CNM in Western
  Europe
• 85-Holland (which WHO designates as ideal or 1
  ranking)
• 10-United States
• Refer to previous stats on mortality/morbidities.

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Nurse-Midwifery

• Midwifery model-care that safeguard the birth
  process as natural and holistic.
• Medical (or illness) model-care is based on birth
  is more of a disease state.
• Intrapartum/neonatal mortality rate same for
  birth center or hospital (term/low risk)

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Certified Nurse Midwife

• Registered Nurse
• Advanced Practice Nurse (APN)
• Masters degree in Nursing
• Specializing in Midwifery
• Credentialing necessary for state licensing

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Defining Attributes

• CNM-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 in collaboration
  with a physician

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CNMs associated with-

• Personalized care
• High-touch
• Low-tech
• Comforting care
• Alternative approaches

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Competencies

• Obtain admission history physical
• Assessments of mother and fetus
• Order or initiate tests, medications or
  procedures
• Perform ongoing exams of labor status
• Attend the delivery

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Attending labor and birth

• Provide safe, satisfying care
• Patient and family are active participants
• Informed consent
• Appropriate use of technology

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Activities

• Evaluation
• Comfort
• Assistance
• Support
• Reassurance
• Management of complications

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Settings

• Home
• Birthing Centers
• Hospitals-Labor, Delivery Recovery Rooms (LDR),
  LDRP (post-partum), Single room maternity care,
  Birthing rooms

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Technology for the 21st Center

• Birthing rooms
• Delivery rooms
• Operative 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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Electronic Fetal Monitoring

• Intermittent or continuous assessment of fetal
  heart rate (FHR) and uterine activity (UA)
• Goal- to assist in identifying the fetus at risk

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EFM
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EFM

• External (indirect) method
• Internal (direct)

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Antepartum testing with EFM

• NST-non-stress test
• CST-contraction stress test
• BPP-biophysical profile
• All assess fetal well-being

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Intrapartum EFM

• External-tocodynamometer and transducer
• Internal-spiral electrode and intrauterine
  pressure catheter
• Fetal pulse oximetry

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Emerging EFM Technology

• Computer analysis
• Lack of clear definitions and standards at this
  point of fetal heart 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, ob unit,
  L D

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Indications

• Maternal diseases
• Multiple gestations
• Fetal growth
• Establishment of fetal age
• Placental location and grading
• Assess fetal well-being (BPP)
• Pre-term labor-cervical lengths

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Its a Girl!!!
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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
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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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Flight Nurse
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Genetics

• Human Genome Project
• Relationship to Maternity Nursing
• Advanced maternal age
• Patterns of inheritance
• Prenatal testing
• Genetic counseling
• Ethics and other

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Telemedicine

• Telemetry
• Monitoring-FHR
• Computer
• Ultrasound images
• Telephone

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Informatics

• IT
• Computers
• Patient access to information
• Nursing informatics

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Automated Medication Dispensing Machines

• Cut down on errors
• Bar codes
• Chart medications
• Labor saving
• And more

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Summary

• Past, present, future antepartum care aspects
• Intrapartum care in the 21st Century as it
  relates to nursing and CNM
• Technology today in maternity nursing 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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