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Maternal Newborn Nursing

1.1 Current Trends in Women’s Health Care

Maternal Newborn Nursing1.1 Current Trends in Women’s Health Care

Learning Objectives

By the end of this section, you will be able to:

  • Discuss the goals of Healthy People 2030 for improvement of the health of persons AFAB
  • Explain morbidity and mortality of persons AFAB and children and quality improvements to address their health status
  • Recognize taboos in the health care of persons AFAB
  • Describe how persons AFAB advocate for themselves

Health care evolves as new information is provided by research and new treatments become available. Organizations focused on health promotion and disease prevention can provide goals and objectives to guide the public in improving self-care and well-being. U.S. statistics on morbidity and mortality are published yearly and scrutinized by researchers and health-care providers to make improvements. Many quality improvement initiatives are implemented to address these poor outcomes. Recognizing taboos and stigma related to reproductive health can improve outcomes for persons AFAB. As taboos are addressed and education is provided to the public, persons AFAB continue to advocate for positive changes to create positive outcomes.

Healthy People 2030

The U.S. Office of Disease Prevention and Health Promotion reviews data regarding the health of the nation to identify conditions negatively affecting the population and creating objectives to address these conditions. Healthy People 2030 (n.d.) is a set of evidence-based objectives aimed at improving health and wellness. Evidence-based care refers to utilizing research to guide decisions and interventions to provide the safest, most effective care. Nurses and health-care providers use these guidelines to provide the most up-to-date care.

Healthy People 2030 (n.d.) objectives address health conditions such as addiction, heart disease, obesity, pregnancy, and sexually transmitted infections (STIs). Objectives also address health behaviors such as child development, family planning, preventive care, vaccinations, and violence prevention. Populations addressed in the objectives range from children to adolescents to older adults, as well as LGBTQIA+ persons and people with disabilities. Many settings such as global health, schools, hospital services, and the workplace are covered. The objectives also address social determinants of health that affect economics, education, health-care access, neighborhoods, and communities.

Many objectives are dedicated to the health and wellness of persons AFAB, including pregnancy, childbirth, violence protection, and gender inequity. The nurse uses these objectives to help educate people regarding health promotion and disease prevention. Patient education based on these objectives can help prevent cervical cancer, heart disease, and adolescent pregnancies, as well as elevate the health and wellness of persons assigned female at birth (Healthy People 2030, n.d.). Refer to Chapter 3 Health Promotion, Disease and Injury Prevention, and Well-Person Care for further discussion of Healthy People 2030.

Health Status of Women and Children

In 2021, the top three leading causes of death in the United States for persons AFAB were heart disease, cancer, and stroke; 10 percent of persons AFAB smoked cigarettes; and 42.1 percent were obese (Centers for Disease Control and Prevention [CDC], 2023b). Persons AFAB have unique health issues involving pregnancy, childbirth, menopause, osteoporosis, and physical violence. The nurse must be aware of social disparities and differing access to health care when educating and caring for these patients.

Morbidity and Mortality

Morbidity and mortality are terms used in epidemiology. Morbidity is a term used to describe a specific condition or disease affecting people. Mortality is a term used to describe the number of deaths due to a specific condition or disease. These terms are usually reported as a ratio or rate. The results are used to evaluate the health of a population to investigate the cause of the death or illness.

Maternal Mortality

The death of a person while pregnant or within 42 days of birth or termination of pregnancy that was not accidental is called maternal mortality (Hoyert, 2023). The maternal mortality rate in the United States for 2021 was 32.9 deaths per 100,000 births (Hoyert, 2023). The World Health Organization (WHO; 2023) reported more maternal mortality in low-income countries; causes for those deaths include severe bleeding, infections, hypertension (preeclampsia and eclampsia), complications from delivery, and unsafe abortions. In the United States, maternal mortality occurred 2.6 times more often in non-Hispanic Black persons than in non-Hispanic White persons (Hoyert, 2023), and overall the United States has the highest maternal mortality rate of any developed country. Figure 1.2 summarizes maternal death by ethnicity. Research from 2017 to 2019 from 36 states has also shown that more than 80 percent of pregnancy-related deaths were preventable (CDC, 2022a). Table 1.1 lists causes of preventable maternal deaths. Nurses caring for pregnant patients should be aware of the causes of preventable maternal deaths and help develop guidelines to mitigate those risks.

A graph depicts maternal death rate by ethnicity from 2018 to 2020. In 2020, Black patients’ maternal mortality rate was 55.3. Overall patients’ mortality rate was 23.8. White patients’ mortality rate was 19.1. Hispanic patients’ mortality rate was 18.2.
Figure 1.2 Maternal Death Rate by Ethnicity The maternal mortality rate (number of deaths per 100,000 births) is strikingly increased for Black non-Hispanic persons in the United States (Buchholz, 2022). (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)
Cause of Preventable Death Persons Who Died from This Cause (%)
Mental health conditions (e.g., suicide, overdose/poisoning related to substance use disorder) 22.7
Hemorrhage (excludes aneurysms or stroke) 13.7
Cardiac and coronary conditions (e.g., coronary artery disease, pulmonary hypertension [HTN], congenital valve and heart disease, HTN/cardiovascular disease, and Marfan syndrome; excludes cardiomyopathy and HTN disorders of pregnancy) 12.8
Infection 9.2
Embolism-thrombotic 8.7
Cardiomyopathy 8.5
Hypertensive disorders of pregnancy 6.5
Anaphylactoid syndrome of pregnancy (previously known as amniotic fluid embolism) 3.8
Injury (homicide, poisoning, unknown cause of intent of injury) 3.6
Cerebrovascular accident 2.5
Cancer 1.9
Metabolic/endocrine conditions 1.2
Pulmonary conditions 1.2
Table 1.1 Preventable Pregnancy-Related Deaths (Trost et al., 2022)

Fetal Mortality

The intrauterine demise of the fetus at any gestational age is called fetal mortality; however, most states in the United States require reporting those deaths occurring only at and after 20 weeks’ gestation (Gregory et al., 2022). The U.S. fetal mortality rate for 2020 was 5.74 deaths per 100,000 for the population overall and 10.34 deaths per 100,000 Black people (Gregory et al., 2022). The top reasons for fetal death included death of unknown cause; complications with the placenta, cord, or membranes; maternal complications of pregnancy; maternal conditions unrelated to pregnancy; and congenital malformations (Gregory et al., 2022).

Infant Mortality

The death of an infant before their first birthday is called infant mortality. In 2020, the U.S. infant mortality rate was 5.4 deaths per 1,000 births, and the most common causes of infant mortality included birth defects, preterm/low birth weight birth, sudden unexplained infant death syndrome (SUIDS), injuries, and maternal pregnancy complications (CDC, 2022b). Infant mortality also skews higher in non-Hispanic Black people, with 10.6 deaths per 1,000 births in 2020 (CDC, 2022b).

Childhood Mortality and Morbidity

The death of a child under 5 years of age is called childhood mortality. In 2021, the childhood mortality rate was 25 deaths per 100,000 people in the United States, with the most common causes being accidents, congenital malformations and chromosomal abnormalities, and homicide (CDC, 2023a). The WHO (n.d.-b) revealed a worldwide reduction in childhood mortality from 12.8 million in 1990 to 5 million in 2021. The most common causes of childhood morbidity (illness) worldwide are congenital anomalies, injuries, and noncommunicable diseases (WHO, n.d.-a).

Cultural Context

Maternal Mortality in Pakistan

Omer et al. (2021) published a paper on the social and cultural practices in Pakistan that affect maternal mortality. Pakistan, the fifth most populated country in the world, has a maternal mortality rate of 140 deaths per 100,000 births. Culture and religion play a role in this high mortality rate. Muslim women many times use “faith-based” health-care providers instead of medically trained providers. Also, Pakistan is a patriarchal society, and women are treated as subordinates with little or no say in their reproductive health. They lack autonomy to seek health care and often lack transportation to areas with medical facilities. The Three Delays Model explains that complications of pregnancy could be avoided if the following were not delayed:

  • delay in making the decision to seek care
  • delay in reaching a health-care facility
  • delay in receiving the required maternal health care

It is important for nurses to consider the cultural background of their pregnant patients.

Quality Improvement Measures

In 2020, the Surgeon General’s Call to Action to Improve Maternal Health suggested that everyone could contribute to lowering the maternal mortality rate by following these suggestions:

  • Recognize the need to address mental and physical health across the life course—starting with young girls and adolescents and extending through childbearing age.
  • Support healthy behaviors that improve women’s health, such as breast-feeding, smoking cessation, and physical activity.
  • Recognize and address factors that are associated with overall health and well-being, including those related to social determinants of health.
  • Understand that maternal health disparities exist in the United States, including geographic, racial, and ethnic disparities, and work to address them.
  • Acknowledge that maternal age and chronic conditions such as hypertension, obesity, and diabetes are risk factors for poor maternal health.
  • Learn about early “warning signs” of potential health issues that can occur at any time during pregnancy or in the year after delivery.
  • Work collaboratively to recognize the unique needs of women with disabilities and include this population of women in existing efforts to reduce maternal health disparities.

Nurses can help decrease maternal mortality by providing their patients with education on these suggestions.

Destigmatizing Topics in Women’s Health Care

Many sensitive topics exist in women’s health care, such as abortion and birth control. These sensitivities are related to religious affiliation, infertility related to cultural norms and expectations, and menstrual problems related to concepts of modesty. Not only does the public shy away from discussing these issues, but persons AFAB may be afraid to seek help for these issues when necessary. In response to this problem, many organizations and groups are advocating for policy changes and improved public education. For example, the Kenyan Policy on Menstrual Hygiene Management attempts to debunk taboos and stigmas by providing education to destigmatize menstruation (Olson et al., 2022). In the United States, access to reliable contraceptives is a vital tool to reduce unintended pregnancies and to plan for safe, healthy pregnancies. The American Care Act requires that insurance plans make contraceptives available to women at no out-of-pocket cost (Planned Parenthood, 2018).The rate of teen pregnancy has decreased with the accessibility of birth control. Sexual dysfunction is rarely discussed but impacts people’s lives and relationships. Some providers are using the 5 A’s model of Ask, Advise, Assess, Assist, Arrange Follow-up to ensure that the topic of sexual dysfunction is always discussed at a health-care visit, removing the burden of initiating this conversation from the patient (Arthur et al., 2022). Teen Health Mississippi, an educational website for teens, addresses several taboos surrounding birth control, including “If you get on birth control, it means you get around,” and “A woman should not carry condoms because it’s not ladylike” (Travis, 2020). Nurses can help destigmatize these taboos and educate their patients on the normality of these situations. Nurses can also provide support and resources to help their patients.

Women Advocating for Themselves

Some conditions such as heart disease and cancer are diagnosed later in persons AFAB than in persons assigned male at birth (AMAB), and persons AFAB are being educated to advocate for themselves. Self-advocacy is the ability to overcome challenges in health care in which a person’s preferences, needs, and values are met (Thomas et al., 2021). An article discussing cardiovascular health suggested for persons AFAB to:

  • pay attention to what their body is telling them;
  • make sure their health-care provider listens to them;
  • ask questions about treatment; and
  • gather support from friends, families, and health groups (Doner, 2022).

Persons who self-advocate can improve their quality of life and possibly reduce health-care disparities (Thomas et al., 2021). The nurse can assist the patient to advocate for themselves by encouraging questions and discussing expectations of health treatment plans.

New Generations, New Expectations

The new generation of persons AFAB who are seeking health care have expectations of being treated fairly, being presented information for informed consent, having their health-care information remain private and confidential, and being a part of the decision-making process (American Hospital Association, n.d.). A survey of persons born between 1981 and 1996 found that 93 percent want a relationship with their provider; however, 85 percent of those surveyed felt health-care providers cared about them only when they were ill (American Hospital Association, n.d.). The survey also found that this population wanted holistic health to be supported, for providers to support their total well-being, and for providers to produce a relevant, personalized experience. Nurses are taught to listen to patients, support their decisions, and provide information for health promotion and disease prevention and can meet the needs of this new generation.

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