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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

A GLIMPSE AT MATERNITY NURSING in the 21st CENTURY

K. L. Ringgenberg, RNC, MSN, WHNP

Shanghai Jiao Tong University SON

April 5, 2006

maternity nursing in the 21 st century
Maternity Nursing in the 21st Century
  • Antepartum Care
  • Intrapartum Care
  • Technology in OB
partum
“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)
antepartum care in the 21 st century
Antepartum Care in the 21st Century
  • Care beginning before the birth
  • “Prenatal” care
history of antepartum care
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
history continued
History- continued
  • 20th Century-at the turn of the century, 50% of births in US conducted by midwives
home to hospital history
Home to Hospital-History
  • 1900 <5% USA babies born in hospital
  • 1940 50%
  • 1970 99%
  • 2005 99%
fast facts maternal
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
fast facts infants
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)
20 th century influences
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
20 th century influences11
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.
21 st century major shifts caused by
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
21 st century more factors
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)
intrapartum care in the 21 st century
Intrapartum Care in the 21st Century
  • Care provided during the birth process
  • Vaginal Delivery
  • Cesarean Section
where do delivers occur
Where do delivers occur?
  • 96%-Hospital
  • 2.4%-Birthing Centers
  • 1%-Home

*Delivers in US by CNMs

cesarean sections
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!!!
global look
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.
nurse midwifery
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)
certified nurse midwife
Certified Nurse Midwife
  • Registered Nurse
  • Advanced Practice Nurse (APN)
  • Master’s degree in Nursing
  • Specializing in Midwifery
  • Credentialing necessary for state licensing
defining attributes
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
cnms associated with
CNMs associated with-
  • Personalized care
  • High-touch
  • Low-tech
  • Comforting care
  • Alternative approaches
competencies
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
attending labor and birth
Attending labor and birth
  • Provide safe, satisfying care
  • Patient and family are active participants
  • Informed consent
  • Appropriate use of technology
activities
Activities
  • Evaluation
  • Comfort
  • Assistance
  • Support
  • Reassurance
  • Management of complications
settings
Settings
  • Home
  • Birthing Centers
  • Hospitals-Labor, Delivery & Recovery Rooms (LDR), LDRP (post-partum), Single room maternity care, Birthing rooms
technology for the 21 st center
Technology for the 21st Center
  • Birthing rooms
  • Delivery rooms
  • Operative suites
latest technologies
Latest Technologies
  • Electronic Fetal Monitoring (EFM)
  • Ultrasonography
  • Infusion pumps
  • Electronic monitoring devices:

1. Non-invasive

2. Invasive

electronic fetal monitoring
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
slide40
EFM
  • External (indirect) method
  • Internal (direct)
antepartum testing with efm
Antepartum testing with EFM
  • NST-non-stress test
  • CST-contraction stress test
  • BPP-biophysical profile

All assess fetal well-being

intrapartum efm
Intrapartum EFM
  • External-tocodynamometer and transducer
  • Internal-spiral electrode and intrauterine pressure catheter
  • Fetal pulse oximetry
emerging efm technology
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
electronic health record
Electronic Health Record
  • Computers
  • Paperless charts
  • Integrates all aspects of assessment, intervention and evaluation
ultrasonography
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
indications
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
critically ill ob
Critically Ill OB
  • Continuous cardiac monitoring
  • Invasive hemodynamic monitoring
  • CVP
  • Arterial lines
  • Pulmonary artery lines
  • Ventilator
genetics
Genetics
  • Human Genome Project
  • Relationship to Maternity Nursing
  • Advanced maternal age
  • Patterns of inheritance
  • Prenatal testing
  • Genetic counseling
  • Ethics and other
telemedicine
Telemedicine
  • Telemetry
  • Monitoring-FHR
  • Computer
  • Ultrasound images
  • Telephone
informatics
Informatics
  • IT
  • Computers
  • Patient access to information
  • Nursing informatics
automated medication dispensing machines
Automated Medication Dispensing Machines
  • Cut down on errors
  • Bar codes
  • Chart medications
  • Labor saving
  • And more
summary
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