Introduction to

Maternal Health Nursing

1st Lecture
Maternal Health Nursing
Learning Outcomes:
1. Identify the goals and philosophy of maternal health
nursing.
2. Apply concepts of family centered care to maternal
health nursing.
3. Describe the scope, competencies; and roles for nurses
in maternal health nursing.
4. Define common statistical terms used to report maternal
& neonatal health
5. Discuss the ethical & legal issues that may arise when
caring for women & their families.

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Introduction _The Determinants of Women’s Health
Biological Determinants
 Iron-deficient anemia related to menstruation or inability to consume proper amounts of iron.
 Complications of pregnancy: Eclampsia /preeclampsia, uterine prolapse, fistula, PPH.
 Increased susceptibility to some infections
 Conditions, such as ovarian cancer, specific to women.

Social Determinants
 Related to gender norms and roles:
 Male dominance leads to physical and sexual abuse
 Cooking with poor ventilation contributes to respiratory disease
 Low social status limits access to health care

The Cost and Consequences of Women’s Health Problems

 Violence (Intimate Partner Violence_IPV), STIs, tend to isolate women socially.
 When a woman dies in childbirth, her family is typically left without a primary caregiver.
 Substantial economic costs from women’s health issues.

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 The Burden of Health Conditions for Women

Maternal Morbidity and Mortality Unsafe Abortion

 Estimates suggest that there are about • A “safe” abortion is one performed
289,000 maternal deaths per year by a trained healthcare provider,
 99% of maternal deaths occur in low- and with proper equipment, technique,
middle-income countries. and sanitary standards.
 20% of maternal deaths are from indirect
causes, 80% are from direct causes. • 13% of total maternal deaths that
 Risk factors include general health and occur annually worldwide are due to
nutrition, level of education and income, unsafe abortions.
location, age, and having a skilled birth
attendant present

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 The Goal & Philosophy of MNH
The overall goal of maternal and newborn nursing is to:

 Promote and maintain optimal health of the woman and her family.
Scope of practice typically associated with childbearing. It includes

 Care of the woman before pregnancy (premarital; preconception), care of the woman and her
fetus during pregnancy (antenatal; natal), care of the woman after pregnancy (postnatal;
premenopausal; menopause), and care of the newborn, usually during the first 6 weeks-3
months after birth.

Family-Centered care is the delivery of safe, satisfying, high-quality health care that focuses on to
the physical and psychosocial needs of the family.
The basic principles of family-centered care are:
 Birth is viewed as a normal life event rather than a medical procedure.
 Families are capable of making decisions about their own care if given adequate information
and professional support)
 Labor, delivery, recovery, and postpartum [LDRP] spaces) aimed at keeping families together
during the childbirth experience (rooming in)
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Definition of Maternity & Neonatal Health Nurse (MNHN)

 Role of MNHNurses fill a variety of roles in helping clients to live healthier

lives by providing direct care, emotional support, comfort, information &
health education, advice, advocacy, support, and counseling.
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 Childbirth in Jordan-Where we are?

 Doctors replaced midwives for low-risk birth (trend to birthing medicated,

intervening childbirth).
 Hospital replaced home for low-risk birth (97-99% of all women gave birth in
hospitals)
 Hospital staff replaced family as birth support, then science proved birth safer if
family present (Men did not attend births)
 Lithotomy replaced vertical birth position, then science proved vertical position
was better.
 The central nursery replaced the mother, then science proved that rooming in
was superior (the first 20 min necessary for maternal attachment).

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  Fertility Rate: The number of pregnancies per 1000 women of childbearing
age (15-49 years): FR in 2023=3.7

 Neonatal Mortality (Death) Rate: The number of deaths per 1000 live births
occurring in the first 28 days of life: NMR in 2023= 9/1000 live births
Statistical
 Infant Mortality Rate: The number of deaths per 100 live births occurring in
Terms the first 12 months of life ( IMR in 2023= 14/1000 live birth.
Used to  Maternal Mortality Rate: the number of maternal deaths per 100 000 women
Report of reproductive age (woman’s death while pregnant, or within 42 days of
termination of pregnancy, from any cause related to, or aggravated by, the
MNH pregnancy or its management, but not from accidental or incidental causes).

 Maternal mortality ratio: the number of maternal death per 100,000 live
births. It reflects the woman’s basic health status, her access to health care, and
the quality of service that she receives (MMR in 2021= 85.2 per 100,000 live
births.

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 Maternal Mortality Rate- MMR
 The average age and median of dead women were 32.5 years, with a
maximum age of 45 years old and a minimum age of 19 years old. (The
latter can be explained by the fact that the median age at first birth in Jordan
is about 25 years old. )

 Most dead women (51.3%) were multiparous (have 2 children or more ).

 The majority (75%) of maternal deaths took place during the postpartum
period (Postpartum Haemorrhage-PPH). While deaths taking place in
less than 24 hours after delivery. 100% of cases were considered
avoidable.

This finding  Most deaths cases (63.8%) underwent a caesarean delivery (The overall
highlights the gap in rate of CS was 37.5% (16.3% for emergency CS and 21.2% for planned CS)
providing medical among Jordanian women.
care that leads to
 70% of cases had live birth neonates, and the remaining 30% had a deadly
fatal outcomes.
outcome.
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“Three Delays Model” by Thaddeus and Maine (1994)

*Jordan’s National Maternal Mortality Report 2021

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 Maternal Morbidity
Many women- survive after pregnancy, abortion, childbirth and
unsafe induced abortion in spite of experiencing the same kinds of
complications which cause the death of others.

They may suffer temporary or permanent disability or ill health as a

result of these complications which-include.
- Medical conditions:
 Anemia.
 High blood pressure

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Legal and Ethical Issues in Maternal, Newborn,
and Women’s Health Care

Abortion: Pro-choice and pro-life. The pro-choice group supports the right of
any woman to make decisions about her reproductive functions
based on her own moral and ethical beliefs. The pro-life group
feels strongly that abortion is killing and deprives the fetus of the
basic right to life.

The ANA’s Code of Ethics for Nurses (2005) supports the nurse’s
right to refuse to care for a client undergoing an abortion if the
nurse ethically opposes the procedure. Nurses need to make their
values and beliefs known to their managers before the situation occurs
so that alternative staffing arrangements can be made.

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Legal and Ethical Issues in Maternal, Newborn, and
Women’s Health Care

Substance Abuse: Substance abuse for any person is a problem, but

when it involves a pregnant woman, substance
abuse can cause fetal injury and thus has legal and
ethical implications. In some instances, courts have
issued jail sentences to pregnant women who caused
harm to their fetuses. It may lead to charges of
negligence and child endangerment against the
pregnant woman.

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 Legal and Ethical Issues in Maternal, Newborn,
and Women’s Health Care

Fetal Therapy: Foetal rights versus Mother rights

Intrauterine foetal surgery is a procedure that involves
opening the uterus during pregnancy, performing a surgery,
and replacing the fetus in the uterus. Some argue that
medical technology should not interfere with nature, and
thus this intervention should not take place. Others would
argue that the surgical intervention improves the child’s
quality of life.

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 Legal and Ethical Issues- Informed Consent

 It occurs prior to initiation of the procedure or specific care. The physician is

responsible for informing the client about the procedure and obtaining consent by
providing a detailed description of the procedure or treatment, its potential risks and
benefits, and alternative methods available.
 The nurse’s responsibility related to informed consent includes:
• Ensuring that the consent form is completed with signatures from the client
• Serving as a witness to the signature process
• Determining whether the client understands what she is signing by asking her pertinent
questions
 In an emergency, a verbal consent, via the telephone, may be obtained. Two
witnesses must also be listening simultaneously and must sign the consent form,
indicating that consent was received via telephone.
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 Legal and Ethical Issues
Refusal of Medical Treatment:

All clients have the right to refuse medical treatment, based on Bill
of Rights. Ideally, medical care without informed consent should be
used only when the client’s life is in danger. Clients may refuse
treatment if it conflicts with their religious or cultural beliefs. In
these cases, it is important to educate the client and family about the
importance of the recommended treatment without forcing the client to
agree. Sometimes common ground may be reached between the
family’s religious or cultural beliefs and the health care team’s
recommendations. Communication and education are the keys in
this situation.

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 Legal and Ethical Issues- Confidentiality
 Client information should always be kept confidential this need to establish national
standards for electronic transmission of health information including information on a
client’s chart.

 In maternal and newborn health care, information is shared only with the client,
husband, parents, legal guardians, or individuals as established in writing by the
client.

 Exceptions to confidentiality exist. For example, suspicion of physical or sexual abuse

and injuries caused by a criminal act must be reported. The health care provider must
also follow public health laws related to reporting certain infectious diseases.

 If health care information must be disclosed by law, the client must be informed
that this will occur
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 Legal and Ethical Issues-Cont.
 Conception issues, especially those related to in vitro fertilization
(IVF), embryo transfer, ownership of frozen oocytes or sperm,
cloning ‫استنساخ‬, stem cell research, and surrogate mothers ‫االم البديلة‬

 Use of fetal tissue for research

 Resuscitation (for how long should it be continued?) & Postmortem

cesarean

The balance between modern technology and quality of life

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Maternity and Childhood Nursing Department