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INTRODUCTION TO CONCEPTS OF OBSTETRICAL AND

GYNECOLOGICAL NURSING

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1. INTRODUCTION
2. DEFINITION
3. CONCEPTS OF MIDWIFERY AND
OBSTETRICAL NURSING
4. CONCEPT OF MIDWIFERY
5. HISTORICAL PERSPECTIVES
6. HALLMARKS OF MIDWIFERY
7. SCOPE OF MATERNITY NURSING
8. OBJECTIVES OF MATERNITY
NURSING
9. CURRENT TRENDS OF MIDWIFERY
10. CONTEMPORARY ISSUES IN OBSTETRICS
11. ETHICAL AND LEGAL ASPECTS
- Ethics
- Ethical principles
- Patient rights
- Ethical aspects in obstetrics
- Law
- Functions of law in nursing
- Tort law
- Medico-legal aspects in obstetrics
12. ROLE OF OBSTETRICAL NURSE

I. INTRODUCTION

The study of child bearing is the study of a process that has taken place throughout human
history. Child bearing is normal and natural occurrence. Maternity nursing focuses on the
care of the child bearing women and their families through all stages of pregnancy and
childbirth, as well as the first 6 weeks after birth. The Latin word obstetrix means midwife,
one who assist the woman during childbirth. ‘Mid’ means ‘with’, ‘wif’ means ‘woman’. The
Greek word ‘Gyno’ means ‘woman’ and ‘Logia’ means ‘study’, study of women or the
science of women.

II. DEFINITIONS

Obstetrics :

Obstetrics is the branch of medical science concerned with pregnancy, childbirth and the
postpartum period

Gynaecology :

Gynecology is the branch of medicine that deals with the diseases and routine physical care
of the reproductive system of women

Midwife :

According to ICM (International Confederation of Midwife), Midwife is a person has been


regularly admitted to a midwifery program, fully recognized in the country in which it is
located, has successfully completed the prescribed course of studies in midwifery, and has
acquired the requisite qualification to be registered and or legally licenced to practice
midwifery

Midwifery :

Midwifery is the art and science of caring for women undergoing normal pregnancy, labor
and the period following child birth.

III. CONCEPTS OF MIDWIFERY AND OBSTETRICAL NURSING

1. Obstetrix and midwifery are two distinct, but overlapping fields of medical knowledge
and practice with focus on care of pregnant and labouring woman
2. Obstetrics focus on problems and difficulties of pregnancy and labor. Midwifery
emphasises a normalcy of pregnancy while acknowledging the vulnerability associated
with the reproductive process
3. Midwifery arises from the social and physical support women traditionally given to one
another, while obstetrics developed gradually as a combination of medical tradition
practiced in ancient Greece and Rom and the rise of modern anatomical research and
surgery developed in pre-modern Europe
4. In the 21st century, obstetrics is increasingly technological in its orientation and focussed
on the pathology of pregnancy while midwifery continues to maintain its emphasis on the
normalcy of pregnancy and the importance of providing pregnant and labouring woman
with practical and emotional support

IV. CONCEPT OF MIDWIFERY

1. Partnership with the women to promote selfcare and health of the mothers, infants and
families
2. Respect for human dignity and for woman as person with full human rights; advocacy for
woman so that their voices are heard
3. Cultural sensitivity, including working with woman and health care providers to
overcome those cultural practices that harm women and babies
4. A focus on health promotion and disease prevention that views pregnancy as a normal
life event

V. HISTORICAL PERSPECTIVES OF MIDWIFERY

In the changing scenario of health care system of today’s world, the trends in midwifery and
obstetrical nursing are also changing

1. Midwifery is as old as history of human species. Archeological evidence of a woman


squatting in child birth supported by another woman from behind demonstrates
evidence from 500 BC
2. 460 BC : Hippocrates, the father of scientific medicine, organized trained and
supervised midwives
3. 384-322 BC : Aristotle the father of embryology, described the uterus and female
pelvic organs
4. 2nd Centuary (101-200 BC) : Soranus was the first to specialize in Obstetrics and
Gynecology. He used the vaginal speculum and advised cord care
5. 1452-1519 : Leonarda da vinci made anatomical drawings of pregnant uterus
6. 1513 : the first book on midwifery was printed in Germany based on the teachings of
Soranus
7. In 16th and 17th century (1500-1700), systematic study of human anatomy and
recovery of ancient medical knowledge encouraged the growth of obstetrics and
gynecology
8. 1815 : Ida Scudder set up training of dais in India
9. 1847 : James Young Simpson, Scortland used ether for internal podalic version and
birth, the first reported use of obstetric anesthesia
10. Louise Pasteur in 1879 wrote a thesis on puerperal sepsis demonstrating the presence
of streptococci in lochia
11. The first antenatal clinic was started about the time of the first world war (1914-1918)
12. In 1943, the programs for training dias and ANM started on the basis of report of
Bhor committee
13. Chamberlen in 1947, designed obstetric forceps
14. 1947 : INC combined nursing and midwifery courses into a single course
15. During the first five year plan (1951), more than 200 MCH centers were started in
different states in India
16. 1953 : Vesalius opened the full term pregnant uterus in lower animal, and
demonstrated uterus as a single chamber organ
17. 1953 : Virginia Apgar, an anesthesiologist, published APGAR scoring system of
neonatal assessment
18. 1958 : Ian Donald, was the first to report clinical use of USG to examine the fetus
19. 1973 : Abortion legalized
20. In 1992, CSSM- immunization, vitamin A, oral rehydration therapy, safe motherhood,
antenatal check up, TT, safe delivery, anemia control programme etc (to improve
MCH care)
21. In 2005, NRHM - mission seeks to improve rural health care delivery system
22. In 2005, RCH II – focus on maternal morbidity and mortality rate

VI. HALLMARKS OF MIDWIFERY

The art and science of midwifery are characterized by these hallmarks

 Recognition of pregnancy, birth and menopause are normal physiological and


developmental processes
 Advocacy of non-intervention in the absence of complications
 Incorporation of scientific evidence into clinical practice
 Promotion of family centered care
 Empowerment of women as partners in health care
 Facilitation of healthy family and interpersonal relationship
 Promotion of continuity of care
 Health promotion, disease prevention and health education
 Promotion of a public health care perspective
 Care of vulnerable population
 Advocacy for informed choice, shared decision making and the right to self
determination
 Cultural competence (ability to interact effectively with people of different culture)
 Familiarity with common alternative and complimentary therapies
 Skilful communication, guidance and counselling
 Therapeutic value of human presence
 Collaboration with other members of health care team

VII. SCOPE OF MATERNITY NURSING

 Wellness orientation : mother and family becoming aware of antepartum, intrapartum,


postpartum & neonatal care and making choices toward a healthy and fulfilling life
 Preventive care : At the beginning of 20th century, IMR was over 100 per 1000 live
birth. To lower this, health care shifted from treatment focus to preventive one.
 High quality care : Maternity care today is profession of high quality that maintains
the safety of the chid and mother.
 Family centered care : focus on the family as the patient. Empowering the family to
develop competence, confidence and control over their own lives. Nursing plays a key
role in facilitating this process especially as it relates to holistic health
 Shortened hospital stay
 Professional options :
- RN
- Nurse practitioner (NP)
- Certified nurse midwife (CNM)
- Clinical nurse specialist (CNS)

VIII. OBJECTIVES OF MATERNITY NURSING


The objectives of maternal and child health nursing are;

1. Pre-conceptional care; to help the mother and family make the transition to
parenthood is the best way possible
2. To prepare and educate all expectant mothers
3. To provide care of woman during three trimesters of pregnancy
4. To support and protect physiological processes and healthy outcomes
5. To provide education about the care of the child and about their growth and
development

IX. CURRENT TRENDS OF MIDWIFERY

The maternal and child population is constantly changing along with changes in social
structure, variations in family life style, increased health care costs, improvement of medical
technology etc.

1. Changes in social structure and variations in family life style : more single parent
families, high cost of having and rising children, expense more than family income,
more women work outside the home etc has impact in midwifery
2. Technological advances : As the technology has revolutionized and increasingly
sophisticated in today’s world, it has become necessary for the nursing personnel to
have thorough knowledge of the new technology being used. Due to this
advancement, ‘the hands on care’ of the client is reduced, so also the qualities of
nursing care. Today, fetal monitoring has progressed from the use of fetoscope to
electronic fetal monitors.
3. Increase in high risk pregnancies : due to life style changes, pollution,
communicable diseases etc
4. Increased cost of high tech-care : As the high and sophisticated technology is being
introduced into today’s world, the cost are also increasing for the procedures such as
USG, fetal monitoring etc, the couple has to pay good amount of money
5. Changing patterns of child birth : As the early marriage practices still continue, the
younger mothers face increased risk of complications during pregnancy. Due to
increasing number of working women until they are in thirties, they also face similar
complications during pregnancy
6. Perinatal risk factors : The problem of society are reflected in risks; among them are
AIDS in mothers and newborns. Low Birth Weight account for about 30-40% of live
births in developing countries. Maternal age is also a risk factor.
7. Family centered care : Maternity care today has enhanced to family centered care.
Interactions and bonding takes high priotity and much anticipatory counselling is
offered
8. Families are not as extended : nowadays, fewer family members are there as support
people in a time of crisis, therefore nurses need to care for family
9. Increasing access for health care : people have increased access for health care even
from very early stage of pregnancy, from preconception stage itself
10. Increased use of alternative treatment modalities : hence nurses have to be aware
of such therapies
11. Increasing alternative settings and style of health care : partners and family
members are invited to stay with the woman, providing natural childbirth environment
in labor room
12. Increased emphasis on preventive care : focussing more on prevention aspects
13. Rising caesarean birth rates : USG has come for prenatal monitoring and evaluation
for fetal condition and thus increased rate of caesarean section immediately if there is
any variations from normal condition
14. Early discharge : in earlier days, women were hospitalised for longer duration and
physical activity was increased very gradually. Now however the health care
personnel have realized the importance of early return to the normal activities, thus
shortened the hospital stay also.
15. Role of fathers : with increased societal emphasis on shared parenting and the
recognition of parental bonding. Many fathers are active in care giving and enjoy the
closeness it brings.
16. Water birth : this method promotes relaxation of abdominal and uterine muscles, and
warmth of water cause less discomfort. Also the duration of first stage of labor can be
shortened
17. Expanded roles of nurses : nurse midwife, nurse practitioner etc
18. Midwifery as a separate profession : it has a body of knowledge and many countries
have taken midwifery as a separate profession like nursing profession

X. CONTEMPORARY/ CURRENT ISSUES IN OBSTETRICS


 Problem of medication : nurses provide medication to the client. Ethical and legal
issues can occur during giving medications such as wrong medication and dosage,
wrong route and wrong time
 Failure in monitoring of the client : it is the responsibility of the nurse to monitor the
client regularly depending upon the condition of the client. Failure of this can result in
legal issues
 Failure to report changes in the patient : nurses do the regular monitoring and
assessment of the client. During assessment nurse may notice changes in the client’s
condition, which is to be brought in notice of the physician
 Abortion : many abortions are performed illegally. Nurses have the right to refuse to
assist in the procedure of abortion
 Preconception sex selection for non-medical purposes : preconception sex selection
refers to any procedure attempting to influence the sex of offspring before pregnancy.
It is mainly done when the parent carries an ‘X’ chromosome linked genetic disorder.
But nowadays only embryos of desired sex can be transferred.
 Embryo research : embryonic stem cells offer hope for new therapies, but their use in
research has been debated
 Donation of genetic material for human reproduction, during artificial reproductive
techniques
 Surrogacy : it is an arrangement, often supported by a legal agreement whereby a
woman agrees to become pregnant, carry the pregnancy to due term, and give birth to
a child/children, all of this for another person/persons, who are ultimately become the
parent of the newborn child.
 Issues in nursing care of newborns : sensitive issues can occur with the care of
newborns since nurses have many responsibilities for the newborn such as newborn
care, cord care etc along with care of mothers.
 Uninformed consent : it is important to inform the mother before doing any
procedures. Patient should be informed everything prior itself
 Violation of the right to privacy : patient’s right for privacy should be considered
while performing the nursing care activities, violation of rights create issues
 Lack of confidentiality : in patient’s details create issues

XI. ETHICAL AND LEGAL ASPECTS IN OBSTETRICS


ETHICAL ASPECTS

Ethics is a set of moral principles that govern a person’s behaviour or the conducting of an
activity. It deals with good and bad behaviour. Application of ethical principles to health care
is called bioethics.

Ethical principles

The goal of ethical midwifery is to do the right thing for the right reason, knowing how to
make good decisions as well as why there decisions were made constitutes ethical midwifery
practice

 Beneficence : act in the best interest of the patient. It requires one to act in a way that
is expected to produce the greater balance of benefits over harms
 Non maleficence : it means that health professionals should prevent causing harm
 Autonomy : acknowledge and carry out the value based preferences of patient, give
respect to the rights of the individual (informed consent)
 Justice : show fairness towards the patients and treat them impartially. No unfair
discriminations and medical benefits should be properly weighed.
 Fidelity : show faithfulness to the patients and gain the belief of patients. Practicing
faithfully within the boundaries of the state and law
 Veracity : telling the truth. Be truthful towards the patient and give them accurate
information
 Confidentiality : it is the state of being confidential, and it is the basis of trust between
health personnel and patient

Patient rights

 The right to be treated with respect and dignity without reference to age, marital
status, socio-economic status, ethnicity, nationality, political, physical, mental or
religious status
 The right to use informed choice in care, by having access to relevant information
upon which decisions are made
 The right to freedom from coercion in decision making
 The right to accept or refuse treatment
 The right to full disclosure of financial factors involved in her care
 The right to know who will participate in her care and obtain additional consultation
of her choice
 The right to not to be abandoned, neglected or discharged room care without an
opportunity to find other health care provider
 The right to absolute privacy except where this right is prevented by law

(Continuation is in paper notes…)

XII. ROLE OF OBSTETRICAL NURSE

A midwife provide care to a woman and her family in all crucial times such as preconception
care, care during antenatal, intranatal as well as postnatal period

 Direct care provider : midwives are the ideal providers of health promotion services
for women, giving direct care according to the needs during antenatal, intranatal and
postnatal periods
 Counsellor : giving proper guidance and counselling to support the mother and
family psychologically during the time of stress and difficulty in adaptation
 Teacher : nurse should give timely education based on their need, also teaching
regarding pregnancy, labor, physiological changes, pain management, breast feeding,
newborn care, diet, family planning etc
 Advocate : encourage client’s awareness, talk about rights and responsibilities of
client, make informed decisions, ensure utilization of health care resources and
convey client’s special needs with the physician (advocate between the client and
health care delivery system)
 Clinician : nurse act as clinician by assessing mothers during admission, assessing
fetal wellbeing, deriving history collection, maintain adequate antenatal record during
each visit, performing antenatal, intranatal and postnatal assessment, recording
partograph, initiating breast feeding, assessment of newborn etc
 Nurse manager : prioritize the client’s needs, give care with minimum input and
maximum output, coordinate care facilities and maintain midwifery care standards
 Nurse researcher : encourage evidence based practice in midwifery, participate and
conduct midwifery research, evaluate the current protocol and recent research
findings for their application in practice
 Clinical nurse specialist : is an expert in midwifery who serves as a role model for
excellence in knowledge and clinical practice of midwifery
 As a political activist : nurse serves as an active member of professional organization
and implement all governmental programmes for MCH care. Also keeps a track of
current health care policies regarding woman’s health and updated with issues related
to woman’s health.
 As a change agent : nurse midwife encourages woman empowerment, stimulates
awareness among women, writing letter to mass media regarding women’s issues and
action taken.
 Communicator : midwife act as the link between couple and the doctor,
communicates with the expectant mother regarding various aspects of motherhood,
also informs family members regardingbirth of the child and immediate requirements
after the birth of the child
 Supervisor : the midwife make sure that maternity services to the client and family
run effectively and efficiently
 Coordinator : the midwife is recognized as a responsible and accountable
professional who works in partnership with women to give the necessary support, care
and advice during pregnancy, labor and postpartum period, to conduct births on the
midwife’s own responsibility and to provide care for the newborn
 Evaluator : the midwife is responsible to evaluate the deliverance of high level
continuous midwifery care to the women, then evaluating the satisfaction of the
mother and family
 Decision maker : midwife also has involved in shared decision making along with
doctors during antenatal, intranatal and postnatal periods by keeping the mother at the
centre of their care
 Recorder and reporter : information recorded by nurse in the patient’s chart gives
valuable data to other health care providers and easy to understand what is going on
with the patient. It is also a legal evidence.