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A GLIMPSE AT MATERNITY NURSING in the 21 st CENTURY

A GLIMPSE AT MATERNITY NURSING in the 21 st CENTURY . K. L. Ringgenberg, RNC, MSN, WHNP Shanghai Jiao Tong University SON April 5, 2006. Maternity Nursing in the 21 st Century. Antepartum Care Intrapartum Care Technology in OB. “ Partum”. Parturition : birth

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A GLIMPSE AT MATERNITY NURSING in the 21 st CENTURY

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  1. A GLIMPSE AT MATERNITY NURSING in the 21st CENTURY K. L. Ringgenberg, RNC, MSN, WHNP Shanghai Jiao Tong University SON April 5, 2006

  2. Maternity Nursing in the 21st Century • Antepartum Care • Intrapartum Care • Technology in OB

  3. “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)

  4. Antepartum Care in the 21st Century • Care beginning before the birth • “Prenatal” care

  5. 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

  6. History- continued • 20th Century-at the turn of the century, 50% of births in US conducted by midwives

  7. Home to Hospital-History • 1900 <5% USA babies born in hospital • 1940 50% • 1970 99% • 2005 99%

  8. 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

  9. Fast Facts-Infants • 1900-30% of infants in USA major cities died before 1st birthday • 2000s-infant mortality rate~7/1000 USA • <1950’s-infant mortality rate 300/1000 China • 2001-33/1000 in China (reportedly as low as 5/1000 in Beijing and Shanghai)

  10. 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 master’s degree in midwifery • 1925-Children’s Bureau in the US recommended antepartum care to decrease mortality rates

  11. 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.

  12. 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

  13. 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)

  14. Twins 4/1000

  15. West Triplets 1/7,000-10,000

  16. Skopec Quads 1/600,000

  17. Intrapartum Care in the 21st Century • Care provided during the birth process • Vaginal Delivery • Cesarean Section

  18. Where do delivers occur? • 96%-Hospital • 2.4%-Birthing Centers • 1%-Home *Delivers in US by CNMs

  19. Cesarean Sections • C/S rates are at an all time high. • Rates vary from country to country. • Some examples: • Netherlands <10% • Great Britain 20% • USA 24-27% • HK 50% in private hospitals • China ~50% in some hospitals • The jury is still out!!!

  20. 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.

  21. 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)

  22. Certified Nurse Midwife • Registered Nurse • Advanced Practice Nurse (APN) • Master’s degree in Nursing • Specializing in Midwifery • Credentialing necessary for state licensing

  23. 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

  24. CNMs associated with- • Personalized care • High-touch • Low-tech • Comforting care • Alternative approaches

  25. 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

  26. Attending labor and birth • Provide safe, satisfying care • Patient and family are active participants • Informed consent • Appropriate use of technology

  27. Activities • Evaluation • Comfort • Assistance • Support • Reassurance • Management of complications

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

  29. Technology for the 21st Center • Birthing rooms • Delivery rooms • Operative suites

  30. Birthing Suite

  31. C-Section Rooms

  32. Latest Technologies • Electronic Fetal Monitoring (EFM) • Ultrasonography • Infusion pumps • Electronic monitoring devices: 1. Non-invasive 2. Invasive

  33. Fetal Surgeries

  34. 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

  35. EFM

  36. EFM • External (indirect) method • Internal (direct)

  37. Antepartum testing with EFM • NST-non-stress test • CST-contraction stress test • BPP-biophysical profile All assess fetal well-being

  38. Intrapartum EFM • External-tocodynamometer and transducer • Internal-spiral electrode and intrauterine pressure catheter • Fetal pulse oximetry

  39. 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

  40. Electronic Health Record • Computers • Paperless charts • Integrates all aspects of assessment, intervention and evaluation

  41. Doppler

  42. 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

  43. 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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