I and 2 other classmates researched the maternal population and presented before our class about what we learned. Our presentation included a definition of the population; important maternal developmental tasks; cultural, community, safety, vulnerability, and primary nursing concerns with this population; the history of standard practices with the maternal population and informatics; the nurse's role with this population; community resources, barriers to accessing health care, latest evidenced based practices, and NCLEX style questions for review.

1. Maternal
Population
Amber Klein, Veronica
Behm, Jessica King

2. Definition
Nursing care provided to women and their families during pregnancy and
parturition and through the first days of postpartum.
Postpartum maternity nursing includes the supervision of mother’s care of their
newborn.

3. Developmental tasks
First trimester
Acceptance of the pregnancy
Second trimester
Acceptance of the baby
Third trimester
Preparation for parenthood

4. Communities
Cultural, family, and diversity-related concerns in providing adequate care:
Poverty (low income)
Inadequate access to health care (prenatal care)
Education level
Language barriers
Lack of support systems
Lack of nutrition in culturally traditional foods
Unhealthy traditions

5. Economics
Funding options for those who need financial assistance:
Medicaid
WIC
CAPWN reproductive health
Food stamps
Government housing
State-funded daycare

6. Informatics
NE ranked 35 out of 51 on 2011 final teen birth rates among females aged 15-19.
Number of births to females under age 20 in Nebraska: 1,745
Number of births to females under age 20 in the U.S: 333,746
○ Birth rate per 1,000 females age 15-19:
■ In NE 27.2
■ In the U.S. 31.3
● Maternal Mortality Ratio in the US
○ 28 deaths per 100,000 live births as of 2013 (Worldbank)
○ The US is ranked 136th out of 184 countries around the world (CIA 2011)

7. Safety
Emergency preparedness always starts with having a plan. For pregnant mothers, a few things they should
have prepared beforehand include:
A birth plan and hospital bag prepared
A plan for where to go if they would be evacuated from their home area
An emergency packet of health information
The materials to safely deliver the baby if necessary
Their vaccines should be to date, particularly in the event of bioterrorism
The priority is making sure that the mother and the baby are safe. Additionally, the CDC recommends
having a kit of emergency supplies in your home; such as, clean towels, sheets, clean scissors, sterile gloves,
sanitary pads, diapers, and instructions for infant-rescue breathing
The environmental issues for this population is that they should not be around any chemical hazards,

8. Systems
17l6: New York City was the first to require midwives to be licensed. Midwives were the primary attendee at a birth as there were not
very many doctors around in colonial times and men did not attend births as that would have been considered indecent. Women faced
birth a great deal of fear of death rather than joy and excited anticipation in those days.
1828: The word "obstetrician" was formed from the Latin, meaning "to stand before."
1894: The first cesarean section was performed in Boston
1920: As a result of an article written by Dr. Joseph DeLee, published in the American Journal of Obstetrics and Gynecology, the
common attitude towards labor and delivery became about trying save women from the “evils” that are “natural labor”. DeLee proposed
that specialist obstetricians should sedate women at the onset of labor, allow the cervix to dilate, give either during the second stage of
labor, cut an episiotomy, deliver the baby with forceps, extract the placenta, give medications for the uterus to contract and repair the
episiotomy. This indeed became the routine care. During this time maternal mortality reached a plateau, with a high of 600 to 700
deaths per 100,000 births, between 1900 and 1930. By 1933 it was determined that either women were receiving inadequate or no
prenatal care or excessive intervention was taking place and was often improperly performed.
1960: 97% of births occurred in hospitals.
1980: The ACNM developed guidelines for establishing "alternative" birthing services and dropped a negative homebirth statement
(originally approved in 1971) in favor of a statement that endorsed practice in all settings.

9. To provide well-rounded patient care, the RN will work with:
Obstetricians
Anesthesiologists
Certified Nurse Midwives
Pediatricians
Social workers
Lactation consultants
Nutritionists
and other nurses
Systems Continued

10. Prevention
Prenatal care is the #1 Prevention of pregnancy related comorbidities
Prevention in the maternal population includes prevention of the following pregnancy induced conditions
and ensuring a healthy pregnancy.
Hypertension and heart disease
Diabetes
Depression
Genetic conditions
Sexually transmitted diseases (STDs)
Tobacco use and alcohol abuse
Inadequate nutrition
Unhealthy weight
Denial with pregnancy or personal/financial situations may keep these clients from seeking this help.

11. Leadership
Participation
planning and making decisions regarding pregnancy
Equity
No discrimination during prenatal care
Access
Able to use available resources
Rights
Equal opportunity to healthcare during pregnancy

12. Evidence Based Practice
The USPFTF recommends (Grade A) that pregnant women be screened with a
urine culture at 12-16 weeks gestation for asymptomatic bacteriuria to reduce
the incidence of pyelonephritis and low birth-weight babies (Evidence
summary: asymptomatic bacteriuria in adults: screening, 2014).
The USPFTF also recommends (Grade B) screening asymptomatic pregnant
women for Gestational Diabetes Mellitus (GDM) after 24 weeks gestation.
Treating GDM reduces the likelihood of an LGA baby and reduced the risk of
developing preeclampsia (Hartling, et al. 2012).
The AAFP recommends that Misoprostol (Cytotec) should not be used for cervical
preparation or induction of labor in the third trimester of pregnancy for women
with a prior cesarean birth. (King et al., 2015)

13. Vulnerability
Health determinants include:
Physical environment
Social environment
Genetics
Individual behavior
Access to healthcare
Negative stigma and marginalization can occur if the mother:
Is obese
Is a non-compliant diabetic
Has had minimal to no prenatal care

14. Main Role of Nurse
The main role of the nurse is to
Support pregnant women through labor and delivery with education,
encouragement, and coaching
Monitor the mother’s blood pressure, contraction patterns and other vitals
Monitor fetal heart rate
Formulate and implement a care plan
And communicate with other healthcare professionals such as doctors, NP’s,
midwives, anesthetist, etc.

15. Main Nursing Concern
Mother seeking prenatal care
Safety of the mother and baby
Nutrition of mother and baby
Bonding after birth
Advocating for the mother and baby

16. Community Resources
WIC
Medicaid
Low income housing
Food Stamps
CAPWN
Birthing classes
Lactation consultant
Daycare

17. NCLEX #1
The nurse notes that the uterine fundus of a client who is postpartum is two
fingerbreadths above the umbilicus, deviated to the right of the midline, and firm.
This finding indicates which of the following?
A.Uterine bleeding
B.Bowel Obstruction
C.Bladder distention
D.Urinary tract infection

18. NCLEX #1
The nurse notes that the uterine fundus of a client who is postpartum is two
fingerbreadths above the umbilicus, deviated to the right of the midline, and firm.
This finding indicates which of the following?
A.Uterine bleeding
B.Bowel Obstruction
C. Bladder distention
D.Urinary tract infection

19. NCLEX #2
A nurse is caring for an adolescent client who is at 24 weeks of gestation and obtains
prenatal care at the local clinic. The nurse should document which of the following
psychosocial nursing goals for the remainder of the pregnancy?
A.Teach problem-solving skills related to choosing birth control
B.Help reorganize self concept and formulate a new identity as a parent
C.Persuade the client to relinquish the newborn for adoption and complete high
school
D.Encourage the client to apply to government agencies that will provide
assistance

20. NCLEX #2
A nurse is caring for an adolescent client who is at 24 weeks of gestation and obtains
prenatal care at the local clinic. The nurse should document which of the following
psychosocial nursing goals for the remainder of the pregnancy?
A.Teach problem-solving skills related to choosing birth control
B. Help reorganize self concept and formulate a new identity
as a parent
C.Persuade the client to relinquish the newborn for adoption and complete high
school
D.Encourage the client to apply to government agencies that will provide

21. Activity with the class
http://www.parents.com/pregnancy/giving-birth/preparing-for-labor/choose-
your-own-birth-adventure/
Guess the MMR rank

22. Resources
https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health
medical-dictionary.thefreedictionary.com
US Department of Health and Human Services
Midwiferytoday.com
http://www.emergency.cdc.gov/preparedness/pregnantfactsheet.asp

23. References
Cia.gov,. (2015). The World Factbook. Retrieved 2 November 2015, from https://www.cia.gov/library/publications/the-world-
factbook/rankorder/2223rank.html
Data.worldbank.org,. (2015). Maternal mortality ratio (modeled estimate, per 100,000 live births) | Data | Table. Retrieved 2
November 2015, from
http://data.worldbank.org/indicator/SH.STA.MMRT?order=wbapi_data_value_2013+wbapi_data_value+wbapi_data_value-
first&sort=desc
Evidence summary: asymptomatic bacteriuria in adults: screening. U.S. Preventive Services Task Force. October 2014.
http://www.uspreventiveservicestaskforce.org/Page/Document/evidence-summary11/asymptomatic-bacteriuria-in-adults-
screening
Hartling L, Dryden DM, Gurthrie A, Muise M, Vandermeer B, Aktary WM, Pasichnyk D, Seida JC, Donovan L. Screening
and diagnosing gestational diabetes mellitus. Evidence report/technology assesment no. 210. (Prepared by the University of
Alberta Evidence-based Practice Center under contract no. 290-2007-10021-I.) AHRQ publication no. 12(13)-E021-EF.
Rockville, MD: Agency for Healthcare Research and Quality. October 2012.
www.effectivehealthcare.ahrq.gov/reports/final.cfm
King, V., Fontaine, P., Atwood, L., Powers, E., Leeman, L., & Ecker, J. et al. (2015). Clinical Practice Guideline Executive
Summary: Labor After Cesarean/Planned Vaginal Birth After Cesarean. The Annals Of Family Medicine, 13(1), 80-81.
http://dx.doi.org/10.1370/afm.1738