OB Lectures 1-3

Changes in Childbirth Methods

• The involvement of support persons like Certified Nurse Midwives (CNMs) and doulas enhances childbirth experiences.
• Birth settings have diversified, allowing for options such as home births and birth centers.
• Hospital stays post-delivery have become shorter, emphasizing the importance of outpatient care.

Family Centered Care

• Childbearing is viewed as a normal, healthy process deserving of supportive care.
• Collaborative decision-making involves families in the care process.
• Health care providers should be sensitive to different cultural beliefs and practices.

Prenatal and Postpartum Care

• Early and adequate prenatal care is crucial for preventing complications.
• Home births may pose higher risks due to potential delays in medical care.
• Postpartum care encompasses six weeks post-delivery, involving various support options like clinics, phone consults, and home visits.
• Postpartum depression (PPD) is common, significantly affecting the mother and family dynamics.

Factors Contributing to Preterm Birth

• High-risk behaviors include smoking, hypertension, unhealthy weight, diabetes, and previous preterm births.
• Multiple pregnancies also increase the likelihood of preterm birth.

Mortality and Morbidity

• Maternal mortality rates have doubled since 2019, with 700-900 deaths annually related to pregnancy.
• Fetal mortality occurs after 20 weeks, while neonatal mortality refers to deaths within the first 28 days, and infant mortality within the first year.
• Morbidity can arise from chronic conditions like cardiovascular disease or diabetes and is influenced by lifestyle factors and environmental hazards.

Prioritizing Maternal and Newborn Health

• Family dynamics and changes in parental roles impact health outcomes.
• Communication styles and signs of abuse should be assessed steadily.
• Non-traditional family structures require open-mindedness from healthcare providers.

Intimate Partner Violence and Screening

• Universal screening for intimate partner violence is essential for all patients.
• Establishing trust is crucial; direct questions should be asked to assess safety.
• The cycle of violence includes tension building, physical abuse, reconciliation, and repetition.

Sexual Violence Response

• Sexual assault requires specially trained Sexual Assault Nurse Examiners (SANE).
• Victims should receive coordinated care, evidence collection, and support for PTSD or counseling if needed.

Complementary and Alternative Medicine

• Focuses on holistic treatment approaches, including aromatherapy, herbal medicine, and acupuncture.

Understanding Infertility

• Defined as unable to conceive after 12 months of unprotected intercourse.
• Types of infertility include primary (never pregnant) and secondary (previous pregnancies but unable to carry to term).

Postpartum Assessments and Nursing Care

• The physical assessment framework (BUBBLE-EE): Breast, Uterus, Bowels, Bladder, Lochia, Episiotomy, Extremities, Emotional status.
• Lochia stages include Rubra (dark red), Serosa (pinkish), and Alba (yellowish), requiring careful monitoring for signs of infection.

Postpartum Nursing Interventions

• Prioritize pain management, assess for sources of discomfort, and implement both pharmacologic and non-pharmacologic interventions.
• Encourage postpartum education regarding self-care, infant feeding methods, and support for family adjustment.

Cardiovascular and Respiratory Adaptations in Newborns

• Newborns experience significant cardiovascular changes at birth, with vital signs typically showing a heart rate of 110-160 bpm.
• Respiratory rates should be noted as 30-60 breaths per minute, with normal variations in breathing patterns expected.

Thermoregulation in Newborns

• Newborns are vulnerable to heat loss due to thin skin and a large surface area.
• Skin-to-skin contact is essential for temperature regulation and attachment.

Hepatic and GI Adaptations

• The liver is responsible for bilirubin conjugation, critical for avoiding jaundice in newborns.
• Normal bowel elimination includes meconium followed by transitional stools to help prevent bilirubin buildup.

Immune and Neurologic Adaptations

• Newborns rely on passive immunity from maternal antibodies while developing their immune responses.
• Sensory capabilities and reflexes are established early; newborns exhibit predictable periods of alertness and sleep patterns.

Preparing for Discharge

• Educate mothers on newborn care, developmental milestones, signs of illness, and postpartum changes.
• Ensure moms receive necessary immunizations, such as TDAP and rubella vancomycin, and understand rh immunoglobulin administration post-delivery if RH negative.