MATERNAL AND CHILD HEALTH NURSING II
emotional preparation for childbearing
Framework for Maternal and Child
Health Nursing
A. Goals and Philosophies of Maternal and
Child Health Nursing
B. Trends related to Maternal and Child
Nursing Population
C. Statistical Terms used in MCHN
D. Trends in Healthcare Environment
E. Legal Considerations of MCN Practice
F. National Health Situation on MCN
G. Ethical Considerations of Practice in
MCHN
H. Genetic Counseling
Obstetrics
● Care of women during childbirth
● From the Greek word “obstare”, meaning
“to keep watch”.
Pediatrics
● From the Greek word “pais”, meaning
“child”.
Focus of MCN
● Major focus of nursing practice: care of
childbearing and childrearing families.
● To have healthy adults, you must have
healthy children.
● To have healthy children, it is important to
promote the health of the childbearing
woman and her family.
● Preconceptual and prenatal care are
essential to the health of a woman and a
fetus.
● It is also essential to a family’s
fetus.
● Supervision and support are needed for the
health of families as children grow.
● New support is necessary when children
reach maturity, plan for their own families,
and begin a new cycle.
● Role of the nurse in these phases: promote
healthy growth and development of the
child and family in both health and illness.
● Maternal and child health nursing is a
continuum, not two separate entities.
Primary Goal of Maternal and Child Health
Nursing
● Promotion and maintenance of optimal
family health to ensure cycles of optimal
childbearing and childrearing.
Goals of MCHN
● Preconceptual health care.
● Care of women during the three
trimesters of pregnancy and the
puerperium (6 weeks after childbirth or
the fourth trimester).
● Care of women during the perinatal
period (6 weeks before conception to 6
weeks after birth).
● Care of children from birth to
adolescence.
● Care in various hospital and home care
settings.
Philosophy of Maternal and Child Health
Nursing
1
● Family-centered; assessment must
always include both family and
individual.
● Community-centered; health of families
affects and is affected by the health of
communities.
● Evidence-based; means where critical
knowledge increases.
● Includes a high degree of independent
nursing functions; teaching and
counseling are major interventions.
● Advocate; Serves as an advocate to
protect the rights of all family members,
including the fetus.
● Important nursing roles: promoting
health and disease prevention; these
protect the health of the next generation.
● MCHN is a challenging role for nurses; it
is a major factor in keeping families well
and optimally functioning. The level of
family’s functioning affects the status of
the family member.
Family-Centered Approach
● Preferred focus of nursing care.
● The health of an individual and their
ability to function strongly influence the
health of family members and overall
family functioning.
Ida 4 Phases of Healthcare
● Health promotion: educating clients to
be aware of good health through
teaching and role modeling.
● Ex: Teaching women the importance
of rubella immunization before
pregnancy.
● Ex: Teaching children the importance
of safer sex practice.
● Health maintenance: intervening to
maintain health when risk of illness is
present.
● Ex: Encouraging women to come for
prenatal care.
● Ex: Turuan yung parents mag-alaga
ng bata and gawing safe place yung
bahay by assessing kung may
accident hazards sa loob.
● Health restoration: promptly diagnosing
and treating illness using intervention
that will return clients into wellness
rapidly.
● Ex: Caring for a woman during a
complication of pregnancy or a child
during an acute illness.
● Health rehabilitation: preventing further
complications from an illness; bringing an
ill client back to an optimal state of
wellness; helping a client to accept
inevitable death.
● Ex: Encouraging a woman with
gestational trophoblastic disease to
continue therapy.
Trends in MCHN Population
● Families are smaller in size
○ Fewer members are present as
support people in times of crisis
○ Role of Nurse - fulfill the role
● Increased single parent
○ Fewer financial resources esp.
woman.
○ Role of nurses - inform parents of
care options and back-up opinion
○ Lumalawak na yung pag-iisip natin
regarding sa culture ng Pinas.
● Increased mothers working outside the
home at least part time
2
 ○ Healthcare must be scheduled at
times as a working parent can care
for her own self/bring a child for
care
○ Role of nurses - discuss the
selection of childcare centers.
○ Sa Japan, aging population sila so
konti na lang yung bata,
Binabayaran mga babae para
mag-anak or magbuntis. Mas
pinaprioritize ng nanay yung work.
● Families are more mobile; increased
number of homeless women and children
○ Good interviewing and health
monitoring are necessary so a
health database can be
established for continuity of care
○ Sa Japan, binabayaran yung family
umalis para lumipat sa di gaanong
populated na lugar para
madecongest yung isang state
nila.
○ Yung pilipinas may Balik Probinsya
program.
● Child and intimate partner abuse
○ Screening for a child or intimate
partner abuse
○ Role of nurses - must be aware of
legal responsibilities for reporting
abuse
● Families are more health conscious
○ Provide health education
● Healthcare should respect cost
containment
○ Comprehensive care is necessary
for primary care settings because
referral to specialists may no
longer be an option
○ Health insurance is not available
to all families
○ Yung sinabi ni BBM: bakit
kailangan ilagay yung heart center
sa manila lang dapat dalhin sa iba’t
ibang parts ng pinas para di na
luluwas mga tao.
Filipino single mothers bear the brunt (burden/
impact) of covid19
● With the increasing number of covid19
cases and the down slope of economy,
single mothers suffer the most brunt
especially in providing for the needs of
their children while on community
quarantine.
● The Philippines has about 15 million solo
parents. 95% more or more than 14
million of whom are women (WHO 2021,
Department of Health and the University
of the Philippines-National Institute of
Health).
Statistical Terms Used to Report MCHN
Birth Rate
● Number of births per 1,000 population.
Fertility Rate
● Number of pregnancies per 1,000
women of childbearing age.
Fetal Death Rate
● Number of fetal deaths (weighing more
than 500 g) per 1,000 live births.
Neonatal Death Rate
● Number of deaths per 1,000 live births
occurring at birth or in the first 28 days of
life. Ilang bata ang namamatay sa first 28
days of life.
Perinatal Death Rate
3
● Number of deaths of fetuses weighing
more than 500 g and within the first 28
days of life per 1,000 live births. Fetus
that can live or viables.
Maternal Mortality Rate
● Number of maternal deaths per 100,00
live births that occur as a direct result of
the reproductive process. Eto yung
nanganak na babae na nasa reproductive
age.
Infant Mortality Rate
● Number of deaths per 1,000 live births
occurring at birth (one month) or in the
first 12 months of life.
Childhood Mortality Rate
● Number of deaths per 1,000 population
in children, 10 to 14 years of age. (1-4
years old)
Trends in Healthcare Environment
● Cost containment
● Increasing Alternative Settings and
Styles for Health Care - LDRP Rooms (
Labor - Delivery - Recovery -
Postpartum)
● Including Family in Health Care
● Increasing Intensive Care Units NICU (
Neonatal Intensive Care Unit) or ICN
(Intensive Care Nursery) PICU (Pediatric
Intensive Care Unit)
● Regionalizing Intensive Care
● Increasing the Use of Alternative
Treatment Modalities
● Increasing Reliance on Home Care
● Increasing Use of Technology
● Free Birthing
● LAMAS
Legal Considerations of MCN Practice
1. Identifying and Reporting Child Abuse
2. Child can bring a lawsuit when they reach
legal age.
3. Informed Consent for invasive procedure
and any risk that may harm the fetus.
4. In divorced or blended families, a nurse
has the right to give consent.
Ethical Considerations of Practice
● Conception Issues
● Abortion
● Fetal rights vs Rights of the mother
● Use of fetal tissue for research
● Resuscitation
● Number of procedures or degree of pain
that a child should ask to achieve better
health.
● Balance between modern technology and
quality of life.
National Health Situation on MCN
● PRE-COVID:
○ 2,600 women are dying every year due
to complications from pregnancy or
childbirth.
○ The maternal mortality cases in 2020
can increase up to 670 additional
deaths from the 2019 level (26%
increase).
● The annual total Filipino women of
reproductive age (15-49 years of age) who
do not use any contraception though they
do not want to become pregnant, can also
4
 increase by another 2.07 million by end
2020, 67% increase from 2019.
● Consequently, the total unintended
pregnancies in 2020 may reach 2.56
million, 751,000 more than last year (42%
increase).
Genetic & Genetic Counseling
● Nurses working in the field of obstetrics
must have a greater depth and breadth of
genetic knowledge over any other
subspecialty.
● In gestation, nurses should include
education on the effects of teratogens,
prenatal screening options, and prenatal
diagnosis.
● After delivery, early recognition of genetic
disorders is important for immediate
initiation of potentially life-saving
therapies.
● Preconception education is a critical
component of healthcare for women of
reproductive age.
● Counseling can still be useful in terms of
optimum pregnancy management in a
setting best able to cope with any
anticipated problems.
● Complex and multifaceted maternal and
fetal factors influence the consequences of
drugs, radiation, and chemical and
infectious agents to the developing fetus.
● Genetics:
○ A branch of biology concerned with the
study of genes, genetic variations, and
heredity in living organisms.
○ The scientific study of genes and
heredity—of how certain qualities or
traits are passed from parents to
offspring as a result of changes in DNA
sequence.
● Counseling:
○ A process of communicating between
two or more persons who meet to solve
a problem, resource a curse or take
decisions on various matters.
○ It is not a one way process where in the
counseling tells the client what to do
nor is it a forum for presentation of the
counselor’s value.
● Genetic Counseling:
○ The process of advising individuals and
families affected by or at risk of genetic
disorders to help them understand and
adapt to the medical, psychological, and
familial implications of genetic
contributions to disease.
○ Sheldon Reed proposed the
terminology “Genetic Counseling” in
1947.
○ The American Society of Human
Genetic defines “Genetic Counseling” as
a communication process, which deals
with human problems associated with
the occurrence or the risk of occurrence
of a genetic disorder in a family.
Purposes of Genetic Counseling
● Provide concrete, accurate information
about inherited disorders.
● Reassure people who are concerned that
their child may inherit a particular disorder
that the disorder will not occur.
● Allow people who are affected by
inherited disease to make informed
choices about future reproduction.
● Educate people about inherited disorder
and the process of inheritance.
● Offer support by skilled healthcare
professionals to people who are affected
by genetic disorders.
5
 Types of Genetic Counseling ● Families or pediatricians genetic
counseling when a child has features of
A. Prospective Genetic Counseling
an inherited condition.
● This allows for the true prevention of
● Any child who is born with more than one
disease.
defect, mental retardation or dysmorphic
● This requires identifying heterozygous
features has an increased chance of
individuals for any particular defect by
having a genetic syndrome.
screening.
● A common type of metal retardation in
● Explaining to them the risk of their
males for which genetic testing is
having affected children if they marry
available is Fragile X-Syndrome.
another heterozygote for the same gene.
● If heterozygous marriage can be
C. Adult Genetic Counseling
prevented or reduced, the prospects of
● Adults may seek genetic counseling when
giving birth to the affected child will
a person in the family decided to be
diminish.
tested for the presence of a known
○ Example: sickle cell anemia and
genetic condition, when an adult begins
thalassemia
exhibit in symptoms of an inherited
condition, or when there is a new
B. Retrospective Genetic Counseling
diagnosis of someone with an adult onset
● Most genetic counseling at present is
disorder in the family.
retrospective.
● In addition, the birth of a child with
● The hereditary disorder has already
obvious features of a genetic disease
occurred within the family.
leads to a diagnosis of a parent who is
○ Examples: metal retardation,
more mildly affected.
psychiatric illness, and inborn
● Genetic counseling for adults may lead to
errors of metabolism.
the consideration of pre-symptomatic
● The methods which could be suggested
genetic testing.
on the retrospective genetic counseling
are contraception, pregnancy
D. Cancer Genetic Counseling
termination, and sterilization
● A family history of early-onset breast
Areas of Genetic Counseling ovarian or colon cancer in multiple
A. Prenatal Genetic Counseling generations of family is a common reason
● Several different reasons a person are a person would seek a genetic counselor
couple may seek parental in genetic who works with people who have cancer.
counseling. ● While most cancer is not inherited, there
● If a woman is of age 35 years old or older are some families in which a dominant
and pregnant, then there is an increased gene is present and causing the disease.
chance that her fetus may have a change ● A genetic counselor is able to discuss the
in the number of chromosomes present. chances that the cancer in the family is
related to a dominantly inherited gene.
B. Pediatric Genetic Counseling

6
 ● The counselor can also discuss the option ● Newborn screening program in the
of testing for the breast and ovarian philippines currently includes screening
cancer genes. of the six disorders:
○ Congenital Hypothyroidism (CH)
Types of Genetic Screening ○ Congenital Adrenal Hyperplasia
(CAH)
A. Carrier Identification
○ Phenylketonuria (PKU) and
● Carrier screening is a genetic test used to
Galactosemia (GAL)
determine if a healthy person is a carrier
○ Glucose 6 Phosphate
of a recessive genetic disease.
Dehydrogenase (G6PD)
● It provides life lasting information about
Deficiency
an individual's reproductive risk and their
○ Maple Syrup Urine Disease
chances of having a child with a genetic
(MSUD)
disease.
D. Forensic Screening (Paternity Test)
B. Prenatal Diagnosis
● A DNA paternity test is nearly 100%
● Prenatal genetic counseling is provided
accurate at determining whether a man is
for all prospective parents
another person's biological father
● ideally before conception to assess risk
● DNA test can use check swabs or blood
factors for congenital disorders
test
● You must have a test on in a medical
Methods of Prenatal Diagnosis
settings if you need results for legal
1. Imaging ultrasound (MRI)
reasons
2. Fluid analysis (amniocentesis and
● Prenatal paternity test can determine
cordocentesis)
fatherhood during pregnancy
3. Fetal tissue analysis (chorionic villus
sampling or CVS) Steps of Genetic Counseling
4. Maternal serum test (α-fetoprotein 1. Diagnostic
screening or AFP, triple test, and quad ● To complete an accurate diagnosis the
test) following procedure should be followed:
5. Maternal cervix (fluid bacterial culture) ○ Present and relevant history
○ Family history including siblings
C. Newborn Screening and other relatives
● Newborn screening is a public health ■ Kindly note if there is any
program aimed at the early identification other person in the family
of infants who are affected by certain with a similar problem
genetic metabolic or infectious ○ Obstetric history
conditions. ■ Include exposure to
● Early identification and timely teratogen such drugs and
intervention can lead to significant x-rays
reduction of morbidity, mortality, and ○ History of abortion or any
associated disabilities in affected infants. stillbirth

7
 ○ Enquiry should be made about 4. Providing support to help the family deal
consanguinity as it increases the with the emotional impact of a birth
risk especially in autosomal defect.
recessive disorders 5. Coordinate services of other
2. Prognosis professionals, such as social workers,
● Pedigree charting physical and occupational therapist,
● Estimation of risk: psychologist, and dietician.
○ To estimate it one requires to take
into account following points
■ Mode of inheritance
■ Analysis of pedigree or
family tree
■ Results of various tests
Treatment
● This important functioning involves
various factors such as:
○ Psychology of the patient
○ The emotional stress on their
prevailing circumstances
○ Attitude of family members
towards the patients
○ Educational, social, and financial
background of the family
○ Gaining confidence of consultants
in subsequent meetings during
follow-up
○ Ethical, moral, and legal
implications involve in the process
○ Above all, communication skills to
transmit vaccine and effective
manner
■ Making them more
acceptable and palatable
Roles of a Nurse in Genetic Counseling
1. Guiding a woman or couple through
prenatal diagnosis.
2. Helping parents make decisions in regard
to abnormal prenatal diagnostic results.
3. Assisting parents who have had a child
with a birth defect to locate needed
service and support.