UNIT 1:

FOUNDATIONS OF
MATERNITY
NURSING
 PERINATAL NURSING
WHAT IS THE ROLE OF THE PERINATAL NURSE?
•PROMOTE THE PHYSICAL, EMOTIONAL, SOCIAL, AND
SPIRITUAL WELL-BEING OF THE WHOLE FAMILY
•WORK COLLABORATIVELY WITH CHILD-BEARING WOMEN
AND THEIR FAMILIES THROUGHOUT THE CHILD-BEARING
YEAR, FROM PRECONCEPTION THROUGH PREGNANCY AND
CHILDBIRTH, AND OVER THE POSTPARTUM TRANSITION
PERIOD
•CARE FOR CHILD-BEARING WOMEN AND FAMILIES IN MANY
SETTINGS, INCLUDING THE HOSPITAL, THE HOME, AND A
VARIETY OF AMBULATORY AND COMMUNITY SETTINGS
 GUIDING PRINCIPLES OF FAMILY-
CENTERED MATERNITY AND
•
NEWBORN CARE
A FAMILY CENTERED APPROACH TO MATERNAL AND NEWBORN CARE IS
OPTIMAL
• PREGNANCY AND BIRTH ARE NORMAL, HEALTHY PROCESSES
• CULTURALLY APPROPRIATE CARE IS IMPORTANT IN A MULTICULTURAL
SOCIETY
• PREGNANCY & BIRTH ARE UNIQUE FOR EACH WOMAN
• MAIN OBJECTIVE: HAVE HEALTHY MOM AND BABY
• BASED ON RESEARCH EVIDENCE
• RESPECTS REPRODUCTIVE RIGHTS
• INFORMED CHOICES HEALTH CARE PROVIDERS ATTITUDES AND LANGUAGE
HAVE AN IMPACT ON A FAMILY’S EXPERIENCE
• INFORMED CHOICES: NEED TO KNOW
• HEALTH CARE PROVIDERS ATTITUDES AND LANGUAGE HAVE AN IMPACT ON
A FAMILY’S EXPERIENCE
 VALUES AND GUIDING
PRINCIPLES OF THE PERINATAL
NURSE
**THIS CAN BE FOUND IN BOX 4-1 OF YOUR TEXTBOOK
•CARING: FOSTER CARING RELATIONSHIPS WITH WOMEN AND FAMILIES
•HEALTH AND WELL-BEING- PROMOTE HEALTH AND WELL BEING
•INFORMED DECISION MAKING: HAVE A HOLISTIC VIEW OF WOMEN AND
FAMILIES AND RESPECT THEIR CAPACITY TO SET GOALS AND MAKE DECISIONS
•DIGNITY: STRIVE TO POSITIVELY INFLUENCE THE CHILDBEARING EXPERIENCE
•CONFIDENTIALITY: MAINTAIN TRUST OF WOMEN AND FAMILIES
•JUSTICE: SAFEGUARD HUMAN RIGHTS, EQUITY, AND FAIRNESS
•ACCOUNTABILITY – ACT WITH INTEGRITY AND IN A MANNER CONSISTENT
WITH THEIR PROFESSIONAL RESPONSIBILITIES AND STANDARDS OF PRACTICE
•QUALITY PRACTICE ENVIRONMENT – ADVOCATE FOR SAFE, SUPPORTIVE AND
RESPECTFUL WORK ENVIRONMENTS
 VULNERABLE POPULATIONS
IN THE COMMUNITY
INDIGENOUS WOMEN:
PERINATAL MORBIDITY AND MORTALITY RATES ARE
HIGHER IN INDIGENOUS POPULATIONS
IMMIGRANT AND REFUGEE WOMEN:
SOME IMMIGRANT AND REFUGEE WOMEN HAVE
HIGHER RATES OF CHRONIC DISEASE, INCLUDING
DIABETES AND AIDS. AS A RESULT THEY HAVE HIGHER
RATES OF:
- PRETERM LABOR,
-GESTATIONAL HYPERTENSION,
-INTRAUTERINE GROWTH RESTRICTION
 VULNERABLE POPULATIONS IN
THE COMMUNITY
HOMELESS WOMEN
AT RISK FOR PREGNANCY COMPLICATIONS DUE TO
LACK OF:
- PRENATAL CARE, POOR NUTRITION, STRESS,
EXPOSURE TO VIOLENCE

LGBTQ PATIENTS
MANY LESBIAN, GAY, AND TRANSSEXUAL COUPLES
MAY BECOME PARENTS AND DESERVE RESPECTFUL CARE
DURING THE CHILDBEARING EXPERIENCE AS WELL AS
DURING HEALTH SCREENING AND WELLNESS CARE.
 ROLE AND SCOPE OF THE LPN

WHO ARE SOME MEMBERS OF THE INTER-DISCIPLINARY TEAM IN

MATERNITY NURSING? MIDWIFE, OBSTETRICIAN, PEDIATRICIAN,
DIETICIAN, SOCIAL WORKER, SPIRITUAL CARE WORKER, DOULAS,
NICU STAFF, PARENTS AND FAMILY

WHAT IS THE ROLE OF THE LPN IN THE FOLLOWING MATERNITY

SETTINGS?
•URBAN SETTING – POST PARTUM TEACHING AND CARE,
ANTEPARTUM CARE
•RURAL SETTING – MUCH MORE INVOLVED DO ALL CARE
•COMMUNITY SETTING – PUBLIC HEALTH CLINIC, DOCTORS OFFICE
 EVIDENCE BASED PRACTICE

• “EVIDENCE-INFORMED PRACTICE, OR PROVIDING

NURSING CARE THAT IS GUIDED BY EVIDENCE GAINED
THROUGH MANY FORMS OF RESEARCH, IS INCREASINGLY
EMPHASIZED IN THE NURSING PROFESSION.”
 EVIDENCED BASED PRACTICE
COCHRANE PREGNANCY AND CHILDBIRTH DATABASE
• OVERSEES UP TO DATE, SYSTEMATIC REVIEWS OF
RANDOMIZED CONTROL TRIALS AND SHARES THE REVIEWS
• THESE TYPES OF STUDIES PROVIDE RELIABLE EVIDENCE
ABOUT THE EFFECTS OF MATERNITY CARE

MOST OF OUR PRACTICE IS EVIDENCE BASED. EITHER

THROUGH RESEARCH OR THROUGH PAST PRACTICES WITH
GOOD OUTCOMES.
COMMON PERINATAL HEALTH
INDICATORS:
MEASURING MATERNAL &
CHILD HEALTH
 BIRTH RATE:
# OF LIVE BIRTHS/1000 POPULATION
Births and total fertility rate, by province and territory (Fertility rate)
  2009 2010 2011 2012 2013

  total fertility rate

Canada 1.67 1.63 1.61 1.61 1.59
Newfoundland and
Labrador
1.59 1.58 1.45 1.37 1.43
Prince Edward Island
1.69 1.62 1.62 1.51 1.63
Nova Scotia 1.50 1.47 1.47 1.50 1.46
New Brunswick 1.59 1.58 1.54 1.57 1.57
Quebec 1.74 1.71 1.69 1.67 1.65
Ontario 1.56 1.53 1.52 1.55 1.51
Manitoba 1.98 1.92 1.86 1.93 1.91
Saskatchewan 2.06 2.03 1.99 2.00 1.94
Alberta 1.89 1.83 1.81 1.76 1.73
British Columbia 1.50 1.43 1.42 1.43 1.41
Yukon 1.66 1.60 1.73 1.68 1.54
Northwest Territories
2.06 1.98 1.97 1.93 1.88
Nunavut 3.24 3.00 2.97 2.85 3.04

Note: Total fertility rate is the average number of children per woman.

Source: Statistics Canada, CANSIM, table 102-4505.
Last modified: 2016-10-26.
INFANT MORTALITY:
 TEN LEADING CAUSES OF INFANT
MORTALITY IN CANADA
SOURCE: STATISTICS CANADA, CANADIAN VITAL
STATISTICS, DEATH DATABASE (CANSIM TABLE 102-0562).
CAUSE RANK NUMBE
R
Congenital malformations, deformations and 1 420
chromosomal abnormalities
Disorders related to short gestation and low birth 2 250
weight, not elsewhere classified
Newborn affected by maternal complications of 3 184
pregnancy 
Newborn affected by complications of placenta, cord 4 121
and membranes
Sudden infant death syndrome 5 114
Intrauterine hypoxia and birth asphyxia 6 59
Neonatal hemorrhages 7 51
Bacterial sepsis of newborn 8 42
Newborn affected by other complications of labour 9 34
 INFANT MORTALITY
• FROM 1960 TO 1996 INFANT MORTALITY RATES DROPPED
FROM 27.3/1000 LIVE BIRTHS TO 5.4/1000 LIVE BIRTHS AND
TENDS TO STAY AROUND THE 5.1 /1000 LIVE BIRTHS.
• JAPAN 2.2
• CANADA 4.9
• USA 6.0
• HAITI 52.44
• INFANT MORTALITY IS HIGH IN UNDERDEVELOPED
COUNTRIES AND/OR COUNTRIES AT WAR.
 FETAL DEATH RATE:

CAUSES:
•PREMATURE LABOUR
•MATERNAL ILLNESS
•MATERNAL MALNUTRITION
•FETAL FACTORS SUCH AS CHROMOSOMAL
DISORDERS, POOR PLACENTAL ATTACHMENT.
 NEONATAL MORTALITY RATE:

CAUSES:
•PREMATURITY, CONGENITAL ISSUES, OTHER.
•THE NEONATAL DEATH RATE REFLECTS THE QUALITY OF
PRENATAL CARE, CARE IN LABOUR AND CARE OF THE NEWBORN.

•# CAUSE: PREMATURITY
•WHAT IS THE NUMBER 1 CAUSE OF NEONATAL DEATH?
CONGENITAL ABNORMALITIES
 PERINATAL MORTALITY RATE

• NUMBER OF STILLBIRTHS AND NUMBER OF NEONATAL

DEATHS PER 1000 LIVE BIRTHS **EXAM
• BABY COULD HAVE DIED IN UTERO OR COULD DIE AT
ANY OTHER POINT UP UNTIL 28 DAYS AFTER BIRTH. **
FETAL AND NEONATAL
• THE PERINATAL DEATH RATE INCLUDES THE FETAL
DEATH RATE AND THE NEONATAL DEATH RATE.
 MORTALITY & DEATH RATE
Term Definition
Infant Mortality # of deaths of
children under 1
year of age/ 1000
births
Fetal Death Rate Death in utero of
fetus weighing 500g
or more
Neonatal Death Rate Death of infant
within first 28 days
of life
Perinatal Death Rate Stillborn and deaths * Includes fetal &
of newborn within neonatal death
first 28 days of life rate
 MATERNAL MORBIDITY
• THE WHO ORGANIZATION DEFINES MATERNAL MORBIDITY AS “ANY
HEALTH CONDITION ATTRIBUTED TO AND/OR AGGRAVATED BY
PREGNANCY AND CHILDBIRTH THAT HAS A NEGATIVE IMPACT ON THE
WOMAN'S WELLBEING”.
• IN 2011 THE RATE OF SEVERE MATERNAL MORBIDITY IN CANADA WAS
15.4 / 1000 DELIVERIES!
• THE MOST COMMON SEVERE MATERNAL MORBIDITIES INCLUDE:
• BLOOD TRANSFUSIONS
• POST-PARTUM HEMORRHAGE
• HYSTERECTOMY
• CARDIAC ARREST
• MYOCARDIAL INFARCTION
• PULMONARY EDEMA
• PUEPERAL SEPSIS
• UTERINE RUPTURE
• ECLAMPSIA
 MATERNAL MORTALITY RATE:
NUMBER OF MATERNAL DEATHS /100,000 LIVE BIRTHS

DEFINITION OF MATERNAL MORTALITY RATE IN

CANADA:
DEATH AS A RESULT OF THE REPRODUCTIVE PROCESS OR
WITHIN 42 DAYS OF THE TERMINATION OF THE PREGNANCY.
(DOES NOT INCLUDE ACCIDENTAL DEATH OR INCIDENTAL DEATH )

ALTHOUGH THE OVERALL NUMBER OF MATERNAL DEATHS IS

SMALL, THIS REMAINS A SIGNIFICANT PROBLEM. A HIGH
PROPORTION OF THESE DEATHS ARE PREVENTABLE,
PRIMARILY THROUGH ACCESS TO AND USE OF PRENATAL
SERVICES!
MATERNAL MORTALITY COMPARISON
(2015)
SOURCE:
HTTP://DATA.WORLDBANK.ORG/INDICATOR/SH.STA.MMRT

• AFGHANISTAN 396
• SIERRA LEONE 1360
• SOMOLIA 732
• INDIA 200
• PHILIPPINES 114
• GREECE 3
• CANADA 7
• NORWAY 5
 TRENDS IN MATERNITY

• - CHILDBEARING DELAYED UNTIL 35 YEARS OR OLDER

• TEEN PREG. STEADILY DECREASING
• SIGNIFICANT VARIATIONS IN BIRTH RATES ACROSS COUNTRY
• INCREASE IN MULTIPLE BIRTHS
• BREASTFEEDING INITIATION RATES INCREASING IN CANADA
• C-SECTION RATES IN ALBERTA INCREASING: 17% IN 1995 TO
28% IN 2009
• 98% OF BIRTHS TAKE PLACE IN HOSPITALS
 REVIEW

• WHAT IS THE TIME FRAME FOR THE NEONATAL DEATH RATE:

• LESS THAN 28 DAYS: NEONATAL
DEFINITION OF FETAL DEATH
FETAL DEATH: OVER 500G IN UTERAL
• IN UTERAL AND NEONAT: PERINATAL

WHAT IS THE LEDING CAUSE OF NEONATAL DEATH?

CONGENITAL DISEASES