Maternal EBP & Patient Rights

Contemporary Maternal EBP (Evidence-Based Practice)

• Practices should be identified based on evidence, conflicting findings, or lack of evidence.
• Use data to assess patient outcomes.
• Integrate scientific research into practice.

Guiding Nursing Practice

• Policies, procedures, guidelines, and standards shape nursing care.
• Standards of Nursing Care ensure quality and consistency.

Patient Rights

• Informed consent must include risks, benefits, success probability, alternatives, consequences of no treatment, and right to refuse.
• Written consent preferred; oral consent is legal.
• Parents have authority until the child is 18, an emancipated minor, or a minor parent.
• Spousal consent is needed for sterilization or life-threatening fetal decisions.
• Right to privacy includes protection from public scrutiny.
• Limited exposure of the patient's body.
• Information should be shared only with involved healthcare professionals.
• Authorization is required from the patient or surrogate.
• Confidentiality is essential for trust in provider-patient relationships and is governed by privileged communication laws.
• The Federal Patient Self-Determination Act allows patients to express treatment preferences and create advance directives.

Scope of Practice

• Advanced practice nurses include NPs, CNSs, CRNAs, and CNMs.
• Scope defined by state nurse practice acts.
• Scope includes collaboration, diagnosis, prescribing, and delegation.
• Following policies is essential to maintain licensure.

Descriptive vs. Inferential Statistics

• Descriptive statistics describe and summarize data in a clear, concise way.
• Inferential statistics analyze relationships between variables and draw conclusions.

Cultural Concepts

• Assimilation is fully adopting a new culture, leading to changes in clothing, diet, or language.
• Acculturation involves modifying one's culture to fit within a new/dominant culture while maintaining other traditions.
• Ethnocentrism is the conviction that the values and beliefs of one's own culture are the only acceptable ones.

Caring for Culturally Diverse Patients

• Nurses should consider health beliefs, approaches, and practices when caring for culturally diverse patients.
• Magico-Religious Belief links illness to supernatural forces, with healing through prayer, rituals, and faith.
• The Biomedical (Western) Model explains illness by physiology and science.
• The Holistic Health Model states that health depends on balance or natural harmony (hot/cold theory).
• Spirituality is a personal connection with a higher power, and nurses should provide spiritually sensitive care.

Culturally Influenced Responses

• Nurses should consider culturally influenced responses when caring for culturally diverse patients.
• Language barriers can be overcome by using professional interpreters, not family members, for communication.
• Nonverbal cues such as posture, gestures, facial expressions, eye contact, and silence should be considered.
• The appropriate personal/social distance varies by culture and should be respected.
• Time orientation differs among cultures, prioritizing past, present, or future differently.
• Nutrition: Cultural food restrictions and preparation methods should be considered.

Childbearing Practices

• Beliefs about the importance of children vary, with US families often having one or two children while worldwide, many have as many as possible.
• Beliefs about pregnancy: some cultures favor mothers with boys, and pregnancy is seen as either a medical condition or a natural event where protective precautions may be followed.
• Taboos involve avoidance of certain actions such as naming a baby before birth or setting up a nursery.

Complementary and Alternative Medicine (CAM)

• Nurses must document CAM use, assess safety, and support research.
• Homeopathy involves using tiny doses of substances that cause illness in healthy people.
• Naturopathy utilizes natural remedies like nutrition, exercise, and botanicals.
• Traditional Chinese Medicine (TCM) involves balancing energy (chi) through acupuncture, herbs, tai chi, and moxibustion.
• Mind-Body Therapies include biofeedback, where the mind controls the body, and hypnosis, which causes deep relaxation for mental/physical effects.

Additional CAM Therapies:

• Guided Imagery & Visualization is used.
• Chiropractic Care focuses on the link between body structure and function.
• Massage Therapy involves soft tissue manipulation, including pregnancy and labor massage.
• Herbal Therapies are regulated under the Dietary Supplement Health Education Act (not FDA-approved).
• Therapeutic Touch is an energy healing concept
• Other CAMs: Ayurveda, meditation, reflexology, hydrotherapy, yoga, aromatherapy, music therapy, reiki

Female Anatomy

• The Perineal Body is tissue between the vagina and anus, often the site of episiotomy/laceration
• The vagina is passage for sperm, fetus, and menstrual blood, and protects against trauma and infection.
• The Fundus is the top of the uterus; hard/firm and rises above the belly button in pregnancy.
• The Uterus is a hollow, thick-walled organ in the pelvic cavity.
• Fallopian Tubes transport the ovum to the uterus and are the site of fertilization.
• The Bony Pelvis supports and protects pelvic organs.

Ovarian Cycle

• Follicular Phase (Days 1-14): A Graafian follicle develops by day 14, controlled by FSH and LH secreted by the anterior pituitary
  • Body temperature rises after ovulation
• Luteal Phase (Days 15-28): Begins after ovum leaves follicle, and if fertilized, hCG is secreted.

Menstruation (Uterine) Cycle

• Menstrual Phase (Days 1-6): Shedding of the endometrial lining, low in estrogen
• Proliferative Phase (Days 7-14): Estrogen increases, and endometrial glands enlarge
• Secretory Phase: The uterus becomes more vascular to prepare for implantation.
• Ischemic Phase (If No Fertilization): Corpus luteum degenerates, and menstrual flow begins.

Fertilization

• Ova are fertile for 12-24 hours.
• Sperm are fertile for 72 hours.
• Ovulation occurs around day 14.

Hormonal Roles

• Estrogen develops female secondary sex characteristics, matures ovarian follicles, and peaks during the proliferative phase.
• Progesterone, secreted by the corpus luteum, maintains the uterine environment ("Hormone of pregnancy").
• Estrogen levels increase during the proliferative and follicular phases, right before ovulation.
• Both estrogen and progesterone increase during the secretory and luteal phases, after ovulation.
• Progesterone levels are highest around day 20, during the secretory and luteal phases.

Role of amniotic fluid

• Allows fetal movement, regulates temperature, protects fetus, promotes growth and development.
• Normal amniotic fluid is slightly alkaline.
• Abnormal variations: Oligohydramnios (too little) leads to decreased fetal movement and contractions.
• Hydramnios/polyhydramnios (too much) can affect maternal lung capacity and mobility.

Chromosomal Structure

• Somatic Cells are Diploid (46 chromosomes, 23 pairs).
• Chromosomes: 22 autosomes + 1 sex chromosome pair (XX or XY).

The umbilicial cord

• The umbilical cord provides circulation from the placenta to the fetus and delivers oxygenated blood.
• The umbilical cord has one vein and two arteries (AVA).
• Wharton's Jelly is a thick, slimy substance protecting AVA.

Placenta function

• The placenta facilitates metabolic/nutrient exchange.
• The Maternal Side (Dirty Duncan) is the decidua basalis, red and fleshy.
• The Fetal Side (Shiny Schultze) is covered by the amnion, shiny and gray.
• It stores glycogen and iron.
• It breaks down substances like epinephrine and histamine.
• It produces glycogen, fatty acids, and enzymes.

Fetal development Milestones (20, 24 weeks)

• 20 Weeks: Quickening felt, brown fat develops (skin less transparent), and nipples appear.
• 24 Weeks: Eyes complete, vernix caseosa covers skin, and alveoli begin forming.
• 28 Weeks: eyes open/close, surfactant forms for breathing, and baby is ½ of final length.
• 32 Weeks: fingernails/toenails present, fat increases, and skin is less wrinkled and red.

Amniocentesis:

• It is a diagnostic test for genetic, metabolic, and DNA abnormalities and defects that can be detected in neural tube function
• It Performed using ultrasound-guided needle aspiration of amniotic fluid.
• Indications for amniocentesis include maternal age ≥ 35 years, abnormal screening or genetic test results, previous child with chromosomal abnormality, parent with balanced translocation, mother carrying X-linked disease, both parents carrying autosomal recessive disease, family history of neural tube defects, fetus with major/minor anomalies on ultrasound, women with positive serum screening results (e.g., NIPT), and maternal infectious disease transmission concerns.
• Risk factors include vaginal spotting & cramping, amniotic fluid leakage, chorioamnionitis, and early amniocentesis leading to a higher risk of pregnancy loss.

Signs of Pregnancy

• Subjective (Presumptive) includes changes such as amenorrhea, nausea/vomiting, fatigue, frequent urination, breast changes, and quickening.
• Objective (Probable) changes include Hegar's sign, Braxton Hicks contractions, abdominal striae, uterine souffle, skin pigmentation changes, ballottement, and fundal height.
• Diagnostic (Positive) changes include fetal heartbeat, fetal movement felt by the examiner, and ultrasound visualization of the fetus.

Psychological Changes

• Mother experiences ambivalence, introversion, mood swings, and body image changes.
• Acceptance stages: in the 1st trimester the baby may not seem real, in the 2nd trimester quickening makes the pregnancy feel more real, and in the 3rd trimester physical discomfort and nesting instincts occur.
• Father/Partner may experience Couvade Syndrome, experiencing pregnancy-like symptoms.

What is "quickening"?

• Quickening is the mother's perception of fetal movement, occurring around 16-20 weeks.
• Increased peristalsis, flatus, abdominal muscle contractions, and shifting of abdominal contents.

System Changes in Pregnancy - Reproductive System

• Goodell Sign is the softening of the cervix, occurring around 4-6 weeks, also Chadwick Sign is a bluish-purple discoloration, occurring around 6-8 weeks.
• Other changes include increased vascularization and thickening
• Changes to breast with Darkened areola, prominent veins, striae

System Changes in Pregnancy - Respiratory system

• Increased oxygen demand occurs, and breathing shifts from abdominal to thoracic.
• Nasal congestion increases due to increased blood flow.

System Changes in Pregnancy - Cardiovascular System

• Blood volume increases by 40-50%, and BP slightly decreases
• Supine hypotensive syndrome occurs when lying on the back compresses the vena cava, leading to decreased CO, dizziness, and fainting.

System Changes in Pregnancy - Urinary Tract

• Pressure on the bladder causes frequent urination.

System Changes in Pregnancy - Skin and Hair

• Hyperpigmentation: facial chloasma (melasma gravidarum) occurs, along with a linea nigra (dark line on the abdomen) and striae.

System Changes in Pregnancy - Musculoskeletal system

• Pelvic joints relax causing a waddling gait because. Also, the is lordosis (inward curve of lower back).

System Changes in Pregnancy - Metabolic

• :weight gain occurs, Underweight women should gain 28-40 lbs, average weight women should gain 25-35 lbs, and overweight women Should gain 15-20 lbs.
• Recommendation for weight gain: 0.5-2.0 kg (1.1-4.4 lbs) in the first trimester and 0.45 kg/week (1 lb) in the second & third trimesters.
• the Pituitary gland Produces prolactin for lactation.
• Hormones of Pregnancy, hCG → Maintains early pregnancy
• hPL → Affects maternal metabolism
• Estrogen → Uterine growth, breast development
• Progesterone → Maintains pregnancy
• Relaxin → Increases joint mobility for labor

Terms

• Antepartum = Time between conception and labor
• Intrapartum = From labor onset to birth
• Postpartum = After birth until pre-pregnancy state
• Gestation = Weeks since LMP
• Abortion = Birth before 20 weeks
• Preterm Labor = Labor after 20 weeks but before completion of 37 weeks
• Postterm Labor = After 42 weeks
• Gravida = Total pregnancies, including current
• Nulligravida = Never pregnant
• Primigravida = First pregnancy
• Multigravida = Two or more pregnancies
• Para = Births past 20 weeks (alive or not)
• Nullipara = Never given birth past 20 weeks
• Primipara = One birth past 20 weeks
• Multipara= Two or more births past 20 weeks
• Stillbirth = Fetus born dead after 20 weeks

GTPAL

• G: gravida (pregnancy counts, +1 for current)
• P: Para/Preterm (# of births, dead or alive)
• T: Term (baby at full term 37 weeks)
• A: Abortion (miscarriages)
• L: Living (kids at home)

Estimated Due Date

• (EDD) – Näegele's Rule:First day of LMP - 3 months + 7 days = EDB
• Not accurate for irregularities, like an irregular cycle or if amenorrhea is present.

Danger Signs of Pregnancy (call HCP:)

• Gush of fluid from vagina should be reported, vaginal bleeding, abdominal pain
• Fever should be reported, as well as Dizziness
• Persistent nausea/vomiting should be reported, in additon to Severe headache
• Hyperreflexia and Edema should be reported
• Seizures/convulsions and Epigastric pain are another danger sign

Signs of Preterm Labor

• Menstrual-like cramps and Dull low backache
• Pelvic pressure or pain
• Vaginal discharge changes

Normal vital signs and lab values of pregnant patients

• Normal temperature: 97 F - 99.6 F
• Pulse: 60 - 100 bpm
• RR: 12 - 20 breaths/min & Hemoglobin: 12-16 g/dL

Immunizations in Pregnancy

• MMR and Varicella (chickenpox) are Attenuated live viruses that are NOT to be given during pregnancy

Types of births:

• Indication is of the pelvis is too small, or there is fetal distress
• Vaginal Birth After Cesarean (VBAC) May happen if and only if Previous C-section due to fetal distress, OR no uterine damage

First trimester

• Acupressure, dietary changes aid nausea
• Frequent bathroom breaks maintain hydration
• Fatigue can happen if their are increases in hormones

Second and Third Trimesters

• Sexual activity usually happens in the 2nd trimester
• Heartburn is present and it may happen if there are changes to foods

Ankle edema

• elevation of legs improves fluid retention as well as wearing constricting stockings

In Pregnancy

• Faintness or fatigue
• Changes positions slowly, sit straight, warm beverage, relaxation techniques
• Hemorrhoids are common too and may caused from constipation

Teen pregnancy risks include

• Teenage fear of telling parents and not getting good nutritional care

Ultrasounds in Pregnancy

• Limited: Identifies specific issues (fetal presentation, cardiac motion).
• Standard: Done in the second or third trimester for full fetal anatomy and growth

U/S Screening Components:

Fetal Status with checking the cardiac motion

• Checks the Fetal Number, Fetal Presentation, Anatomy, and if they are growing with the Gestational Age

Third Trimester Fetal Surveillance

• NonStress Test Assesses fetal heart rate (FHR)
• Reactive NST (Normal): Has a heart rate between an elevated resting rate
• Nonreactive NST (Abnormal) the heart rate is stagnant with not enough movement

###Placental Maturity Factors:

• Factors such as smoking and post term pregnancys can mature and cause aging or even reduction
• Factors can be preeclampsia and or gestational diabities

Type 1 Diabetic patients in Pregnancy

• Early pregnancy where insulin needs to be decreased and or increased in the second half

Hypertensive Disorders in Pregnancy:

• Preeclampsia/Eclampsia that have symptoms of headaches, visual changes, or epigatric pain

Gestational Diabetes (GDM)

• Glucose intolerance or severity during early pregnancy, that is tested in 2 steps

Infections During Pregnancy:

• Transmitted virally and or from herpes simplex

Genetic disorder that can cause genetic defect is Genetic disorder affecting hemoglobin synthesis

Explore contemporary maternal evidence-based practices for quality patient care. Understand policies, patient rights, and informed consent. Learn how nursing standards ensure consistent healthcare.