1.2 Standards of Maternal, Newborn, and Gynecologic Nursing Care

Who Are the Patients Seeking Gynecologic and Obstetric Care?

People seeking gynecologic and obstetric care can be of any age, race, education level, or marital status. The American College of Obstetricians and Gynecologists (ACOG) suggests persons AFAB see a gynecologic health-care provider between the ages of 13 and 15 to discuss normal hormonal changes and menstrual cycle issues (Cummings, 2022). The American Academy of Pediatrics and ACOG (2017) also suggest that people should see an obstetric health-care provider at or before the 12th week of pregnancy. Older persons AFAB will seek care for menopause and screening exams.

Most OB-GYN patients are cisgender (that is, their gender identity aligns with their sex assigned at birth) and heterosexual. But LGBTQIA+, including transgender, and nonbinary persons can seek care with an OB-GYN provider. In practice, only about 50 percent of transgender men routinely see a gynecologic provider (Aliabadi, 2022). A transgender man is a man who was assigned female at birth. Gynecologic providers can provide testosterone, birth control, STI testing and treatment, Pap smears, breast exams, and health promotion education (Aliabadi, 2022). Obstetric providers can care for transgender men if they choose to become pregnant and start a family. Nurses can provide education on health-care screening, hormones, support groups, and birth control options, along with the interactions those medications can have when taken with other medications (Hanson & Haddad, 2023). For more information on caring for transgender patients, see Chapter 2 Culturally Competent Nursing Care.

History of Women’s Reproductive Rights in the United States

The history of women’s reproductive rights in the United States began in the 1900s when Margaret Sanger fought for women to have the right to access contraception (Nichols, 2020). This fight for reproductive rights continued in the 1960s and 1970s as The Women’s Health Movement and other activist groups supported the Supreme Court decision of Roe v. Wade, allowing the legalization of abortion (Nichols, 2000), though that ruling was later overturned in June 2022. The common goal of those activists in the 1970s was the demand for improved, nonsexist health care for all women (Nichols, 2000). Activists also advocated for inclusion of persons AFAB in research to provide new treatments, medications, and vaccinations. Consequently, in 2006, the human papillomavirus (HPV) vaccination was produced (National Institutes of Health [NIH], n.d.-a).

History of Childbirth in the United States

Birth among pioneer women in the 1700s took place in homes and was attended by a woman’s lay female friends and relatives and a midwife or nurse (McCool & Simeone, 2002). Childbirth for the Mohawk and Mohican Indians was more solitary. People of these tribes would go to a secluded place near a stream and prepare a shelter with provisions as they waited for the birth alone (Roy Rosenzweig Center for History and New Media, 2018).

Birth was noninterventional, and maternal deaths during childbirth declined in the 1800s and 1900s; however, when birth moved into hospitals, postpartum infection occurred more often and was traced back to contamination from physicians’ unwashed hands (McCool & Simeone, 2002). In the 1900s, birthing persons who wanted labor pain relief gave birth in hospitals and had an increased risk of dying from infection. Many of the infectious risks were mitigated with the utilization of evidence-based practice and emphasizing hand washing. The transition of birth from home to the hospital changed the focus of supporting the birthing person during unmedicated labor to pain control and disease care (McCool & Simeone, 2002). This medical model is the same model used in most U.S. hospitals today.

Evolution of Maternal Health Care

The Women’s Health Movement helped change childbirth practices in the 1960s and 1970s; it focused on less medical intervention and encouraged husbands or partners to be present during childbirth (Nichols, 2020). This movement was part of the larger women’s movement in the United States (Figure 1.3). During this time, Lamaze International and the International Childbirth Education Association were formed with the goals of advocating for choice during childbirth and preparing parents for birth through education (Nichols, 2000). In the 1980s, many hospitals changed from traditional maternity care to a more family-centered care and began to offer childbirth education classes (Nichols, 2000).

Figure 1.3 The U.S. Women’s Movement Women in the 1960s fought for equal rights and liberation from discrimination. (credit: "Women's Lib" March, Washington, D.C., by Warren K. Leffler, 1970/Library of Congress, Public Domain)

Contemporary Childbirth

When birth moved from home to the hospital setting, those giving birth were no longer supported by grandmothers, sisters, friends, or partners. Instead, they were alone without their partner in an unfamiliar medical space and possibly under the influence of a powerful medication (a mixture of morphine and scopolamine that caused memory loss in the birthing parent and neonatal respiratory depression in the newborn) referred to as “twilight sleep.” The combination of these factors caused birthing patients to feel vulnerable and afraid. Therefore, in the 1960s, childbirth education became a way to empower pregnant persons and prepare them for what to expect in childbirth (Walker et al, 2009).

Moving from the rigidity of the 1950s and 1960s, gender roles have given way to more flexible approaches to parenting. Fathers are more involved in childrearing and household chores, while many mothers hold leadership positions and are the primary breadwinners for their families (Jensen, 2023). Birthing families have become more educated and desire more supportive, family-centered care during labor and birth.

Contemporary childbirth has become more medicalized, as seen in increased labor inductions, planned cesarean births, and routine use of medical interventions (Jansen et al., 2013). Some pregnant persons became dissatisfied with this type of pregnancy care, and up to 50 percent of pregnant persons seek adjunct care from complementary medicine practitioners (Steel et al., 2019). Reasons for patients using complementary medicine practitioners include lack of continuity in care provider, lack of empowerment, lack of personal autonomy and decision making, and increased use of medications and interventions in childbirth (Steel et al., 2019). The American College of Obstetricians and Gynecologists (2019a) released a committee opinion regarding approaches to limit interventions during labor and birth. The committee opinion acknowledged that laboring patients who have continuous one-to-one emotional care have improved labor outcomes; routine interventions such as amniotomy, continuous electronic fetal monitoring, and continuous intravenous fluid administration are not necessary for low-risk patients; and birthing facilities should have family-centric interventions, such as clear drapes during a cesarean birth. Contemporary childbirth educators, nurses, and health-care providers are working to improve autonomy and individualized care for the laboring person. For further information on childbirth education, see Chapter 14 Childbirth Education Options.