Maternal and Child Health Nursing Overview

Maternal and Child Health Nursing (MCHN) is a vital specialty that focuses on the comprehensive care of women throughout the unique stages of pregnancy, childbirth, and the immediate postpartum period, as well as the health and well-being of their newborns. This field seamlessly integrates elements of obstetric nursing, where healthcare professionals actively monitor and provide support to expectant mothers throughout their pregnancies and during labor and delivery. In pediatric nursing, the emphasis shifts to safeguarding and promoting the health of children from birth until they reach the age of 18 years, ensuring they meet developmental milestones and receive appropriate medical care.

Perinatal care, a crucial component of MCHN, begins before childbirth and extends through the first year after the birth of a child, emphasizing the necessity of early interventions for both mother and infant, addressing factors such as nutrition, mental health, and preventive care measures. The overarching goal of Maternal and Child Health Nursing is to empower and support childbearing families, fostering optimal health outcomes that encompass the physical, emotional, and social dimensions of family well-being.

• Optimal health is the state of complete physical, mental, and social well-being.
• It's the highest level of health and well-being an individual can achieve.

Scope of Maternal and Child Health Nursing Practice

• Includes preconceptual health care.
• Care of women during the three trimesters of pregnancy
  • 1st trimester: months 1-3
  • 2nd trimester: months 4-6
  • 3rd trimester: months 7-9
• Care of women during the puerperium (4th trimester), which is 6 weeks after childbirth.
• Care of infants during the perinatal period (6 weeks before and after conception).
• Care of children from birth to adolescence
  • Neonatal period (first 28 days of life)
  • Infancy (1-12 months)
  • Adolescence (10-18 years old)
• Care in varied settings, including birthing homes, PICUs, and homes.

Philosophies of MCN

• MCN is family-centered; assessments need to include both family and individual assessments.
• MCN is community-centered, with family health depending on and influencing the health of communities.
• MCN is evidence-based due to increasing critical knowledge.
• MCN involves independent nursing functions because teaching and counseling are major interventions.
• MCN nurses/advocates protect the rights of family members, including the fetus.
• Health promotion and disease intervention protect the new generation's health.
• MCN is a challenging role for nurses.
• In all settings, nurses place the family at the center of care, because the health status of family members is impacted by how well the family functions. This approach helps nurses understand individuals and families, providing holistic care.

Framework for MCN

• Nursing Process (ADPIE)
• Evidence-Based Practice
• Nursing Research
• Nursing Theory

4 Phases of Health Care

• Health Promotion
• Health Maintenance
• Health Restoration
• Health Rehabilitation

Health Promotion

• Educating clients about good health through teaching and role modeling.
• Examples include family planning, safe sex practices, and immunizations.

Health Maintenance

• Intervening to maintain health when illness risk is present.
• Examples include encouraging prenatal care and childproofing homes.

Health Restoration

• Diagnosing and treating illness through interventions that return clients to wellness quickly.

Health Rehabilitation

• Preventing complications from illness.
• Bringing clients back to an optimal state of wellness.
• Helping clients accept inevitable death.
• Encouraging continuous therapies and medications.

Trends in Maternal and Child Health Nursing Population

• Client advocacy: Protects and advances clients' and families' interests.

• Trends in family structure and support: Fewer family members as support people in times of crisis; increased single parents (95% being women); smaller families.

• Nursing implications: Nurses fulfill support roles, inform parents of care options, and establish care continuity, including during child-care selection.

• Trends in increased mothers working outside the home, increased family mobility, and more homeless women and children; implications for scheduling care times, providing health care services for more mobile populations, and determining care centers.

• Screening for child or intimate partner abuse

• Providing health education for greater health awareness.

• Trends in health care cost containment

• Comprehensive care is necessary for primary care settings due to limited referrals to specialists, and lacking health insurance.

Measuring Maternal and Child Health

• Birth Rate: Number of births per 1,000 population
• Fertility Rate: Number of pregnancies per 1,000 women of childbearing age.
• Fetal Death Rate: Number of fetal deaths weighing more than 500 grams per 1,000 live births .
• Neonatal Death Rate: Number of deaths in neonates (1-28 days of life) per 1,000 live births.
• Perinatal Death Rate: Number of deaths of fetuses weighing >500 grams and within the first 28 days of life per 1,000 births. - Perinatal Period: 6 weeks before and 6 weeks after childbirth.
• Infant Mortality Rate: Number of deaths in infants (1st 12 months) per 1,000 live births.
• Childhood Mortality Rate: Number of deaths per 1,000 population in children (1-4 years).
• Maternal Mortality Rate: Number of maternal deaths per 100,000 live births which result from the reproductive process.

Trends in Health Care Environment

• Cost Containment: Closely monitoring personnel, supplies, length of stays, procedures, and referrals to reduce costs while maintaining quality care.
• Increasing Alternative Settings/Styles for Health Care: Birthing rooms, retail clinics, and home-based services to reduce hospital stays.
• Including Family in Health Care: Including family members in the care of mothers and children.
• Increasing Intensive Care Units: NICUs, ICUs, and pediatric intensive care units.
• Regionalizing Intensive Care: Transferring premature infants to regional hospitals.
• Increasing Use of Alternative Treatment Methods: Acupuncture, therapeutic touch, and herbal remedies.
• Increasing Reliance on Home Care: Reducing hospital stays through home health care.
• Increasing Use of Technology: Using internet, charting in computers, and dopplers.
• Free Birthing: Deliveries without health care provider supervision.
• Breathing techniques (LAMAS)

Legal Considerations of Maternal and Child Nursing Practice

• Identifying and reporting child abuse.
• Children's right to sue when they reach legal age.
• Informed consent for invasive procedures and any risk to the fetus.
• Nurses' rights to consent in divorced or blended families.
• Nurses' legal responsibility to protect clients' rights by documenting them, and justifying their actions given legal responsibilities.

Ethical Considerations of MCN Practice

• Conception Issues (In Vitro Fertilization, Embryo Transfer, Cloning, Stem Cell Research, Surrogate Mothers)
• Abortion
• Fetal Rights vs. Rights of Mother
• Use of Fetal Tissue for Research
• Resuscitation
• Number of procedures or degree of pain.
• Balance between modern technology and quality of life.