Maternal-Infant Nursing Review
Dr. Deborah H. Smith, CNM, RNC-MNN and Dr. Judith Rogers-Fruiterman, RN
Updated April 2024
Embedded Files
"Gouda" by TeunSpaans, used under CC BY SA 3.0/Cropped from original
Maternity and women’s health encompasses obstetrical care, women’s health care, and the role of nurses and significant advances made in women’s health care. Factors that influence women’s health care and will include health care disparities, social determinants of health, and the national agenda to improve women’s health as represented by the Healthy People 2030 goals. Additionally, preparing nurses to best serve in women’s health care roles will include greater inclusion of interprofessional education.
Description and Objectives
Description and Objectives
The focus of this review is on the nursing management of families during the childbearing phase of the life cycle. This review aims to develop knowledge and skills essential in providing holistic family-centered care to childbearing clients/families. It encompasses the entire childbearing process from preconception through pregnancy, birth, and postpartum periods. The content progresses from normal to high-risk information within each phase of the childbearing period. Use of critical thinking and evidence-based practice are incorporated and emphasized in all aspects of practice to ensure the best possible outcome.
This review is an accumulation of free resources available along with practical knowledge from experienced maternity care providers. It will provide information for the nursing student or novice nurse.
Included in this resource are
Worksheets to organize information while studying
Let's Practice! questions or case studies
Goals of this resource are
Describe effective, family-centered care to childbearing clients and their families with emphasis on patient safety and quality assurance.
Apply health assessment skills to plan and evaluate care of newborns, mothers, and their families.
Analyze the social, cultural, economic, genetic, and spiritual influences on the health care needs of childbearing families as well as family dynamics and integrate them in the nursing process.
Assess learning needs of clients and families
Describe treatment modalities and nursing interventions appropriate to the care of childbearing clients and their newborns.
Differentiate between normal and abnormal patterns of anatomical, physiological, and psychosocial changes during the childbearing period.
Incorporate ethical and legal principles into maternal-newborn nursing practice in order to safeguard the rights of clients, families, and health care providers.
Syllabus
Syllabus
Fertility Management
Fertility Management
Discuss the normal menstrual cycle and ovulation
Compare various methods of contraception.
Identify the advantages and disadvantages of commonly used methods of contraception.
List common causes of infertility.
Discuss the psychosocial impact of infertility.
Identify common diagnoses and treatments for infertility.
Examine the various ethical and legal considerations of assisted reproductive therapies for infertility.
Describe the techniques used for medical and surgical interruption of pregnancy.
Discuss the various ethical and legal considerations of elective termination of pregnancy
Summarize the process of fertilization.
Pregnancy and Prenatal Care
Pregnancy and Prenatal Care
Describe the development, structure, and functions of the placenta.
Describe the composition and functions of amniotic fluid.
Identify three organs or tissues arising from each of the three primary germ layers.
Summarize the growth and development of the embryo and fetus.
Identify the potential effects of teratogens during vulnerable periods of embryonic and fetal development.
Relate selected congenital defects to stage of fetal development.
Describe the strategies confirming pregnancy and estimating the date of birth.
Determine gravidity and parity using the two- and five-digit systems.
Explain the expected maternal anatomic and physiologic adaptations to pregnancy.
Differentiate among presumptive, probable, and positive signs of pregnancy.
Identify the maternal hormones produced during pregnancy, their target organs, and their major effects on pregnancy.
Summarize the physical, psychosocial, and behavioral changes that usually occur as the mother and other family members adapt to pregnancy.
Outline the patterns of health care used to assess maternal and fetal health status at initial and follow-up visits during pregnancy.
Select the typical nursing assessments, diagnoses, interventions, and methods of evaluation in providing care for the pregnant woman.
Discuss recommendations for maternal weight gain during pregnancy.
Compare the recommended level of intake of energy sources, protein, and key vitamins and minerals during pregnancy and lactation.
Examine the role of nutritional supplements during pregnancy.
List nutritional risk factors during pregnancy.
Assess nutritional status during pregnancy.
Care of the Woman During Labor and Delivery
Care of the Woman During Labor and Delivery
Explain the five major factors that affect the labor process.
Describe the anatomic structure of the bony pelvis.
Explain the significance of the size and position of the fetal head during labor and birth.
Summarize the cardinal movements of the mechanism of labor for a vertex presentation.
Examine the maternal anatomic and physiologic adaptations to labor.
Describe factors thought to contribute to the onset of labor.
Describe fetal adaptations to labor.
Identify nonpharmacologic strategies, including breathing and relaxation techniques, used to enhance relaxation and promote comfort during labor and birth.
Compare pharmacologic methods used to relieve discomfort in different stages of labor and for vaginal or cesarean birth.
Discuss the effects of medication management for the mother and its effect on the newborn both during and after birth.
Explain the nurse's role and responsibilities while providing care for a woman receiving analgesia or anesthesia during labor.
Identify typical signs of normal and abnormal fetal heart rate (FHR) patterns.
Compare FHR monitoring performed by intermittent auscultation with external and internal electronic methods.
Explain the baseline FHR and evaluate periodic changes.
Describe nursing measures that can be used to maintain FHR patterns within normal limits.
Differentiate among the nursing interventions used for managing specific FHR patterns, including tachycardia and bradycardia, absent or minimal variability, and late and variable decelerations.
Review the documentation of the monitoring process necessary.
Review the data included in the initial assessment of the woman in labor.
Describe the ongoing assessment of maternal progress during the first, second, third, and fourth stages of labor.
Recognize the physical and psychosocial findings indicative of maternal progress during labor.
Describe fetal assessment during labor.
By Hey Paul Studios
Care of the Woman During Postpartum
Care of the Woman During Postpartum
"A Syrian refugee and her newborn baby at a clinic in Ramtha, Jordan" by DFID - UK Department for International Development used under CC BY SA 2.0/Cropped from original
Describe the anatomic and physiologic changes that occur during the postpartum period.
Identify characteristics of uterine involution and lochial flow, and describe ways to measure them.
Describe components of a systematic postpartum assessment.
Recognize signs of potential complications in the postpartum woman.
Identify parental and infant behaviors that facilitate and those that inhibit parental attachment.
Examine the process of becoming a mother and becoming a father.
Compare maternal adjustment and paternal adjustment to parenthood.
Describe sibling adjustment.
Discuss grandparent adaptation.
Care of the Newborn
Care of the Newborn
Analyze the physiologic adaptations that the neonate must make during the transition from the intrauterine to the extrauterine environment.
Describe the behavioral adaptations that are characteristic of the newborn during the transition period.
Explain the mechanisms of thermoregulation in the neonate and the potential consequences of hypothermia and hyperthermia.
Recognize newborn reflexes, and differentiate characteristic responses from abnormal responses.
Explain the purpose and components of the Apgar score.
Describe how to perform a physical assessment of a newborn.
Describe how to perform a gestational age assessment of a newborn.
Compare the characteristics of the preterm, late preterm, early term, and post-term neonate.
Explain the elements of a safe environment.
Discuss phototherapy and the guidelines for teaching parents about this treatment.
Explain the purposes and methods for circumcision, the postoperative care of the circumcised infant, and parent teaching regarding circumcision.
Evaluate pain in the newborn based on physiologic changes and behavioral observations.
Discuss pharmacologic and nonpharmacologic interventions to reduce neonatal pain.
Review anticipatory guidance nurses provide to parents before discharge.
Describe current recommendations for infant feeding.
Describe anatomic and physiologic aspects of breastfeeding.
Recognize newborn feeding-readiness cues.
Explain maternal and infant indicators of effective breastfeeding.
Compare powdered, concentrated, and ready-to-use forms of commercial infant formula.
Differentiate between physiologic and pathologic jaundice in the newborn.
Compare Rh and ABO incompatibility and the implications for neonatal outcomes.
Explain nursing management to prevent the pathologic consequences of hyperbilirubinemia.
Complications in Pregnancy
Complications in Pregnancy
“A Pregnant Woman” by Swangerschatt, used under CC BY SA 2.0/Cropped from original
Discuss signs and symptoms, possible complications, and management of miscarriage, ectopic pregnancy, cervical insufficiency, and hydatidiform mole.
Compare and contrast placenta previa and placental abruption in relation to signs and symptoms, complications, and management.
Discuss the diagnosis and management of disseminated intravascular coagulation.
Differentiate the types of diabetes mellitus and their respective risk factors in pregnancy.
Compare insulin requirements during pregnancy, postpartum, and with lactation.
Identify maternal and fetal risks or complications associated with diabetes in pregnancy.
Explain the effects of hyperemesis gravidarum on maternal and fetal well-being.
Discuss management of the woman with hyperemesis gravidarum.
Explain the effects of thyroid disorders on pregnancy.
Compare the management of a pregnant woman with hyperthyroidism with one who has hypothyroidism.
Complications in Labor and Delivery
Complications in Labor and Delivery
Describe mental health disorders occurring in the perinatal period, including mood disorders, anxiety disorders, post-traumatic stress disorder, and bipolar disorder.
Compare postpartum blues, postpartum depression, and postpartum psychosis, including risk factors, assessment, and management.
Examine substance abuse during pregnancy, including prevalence, barriers to treatment, legal considerations, and commonly abused drugs.
Discuss the care of pregnant women who use, abuse, or are dependent on alcohol or illicit or prescription drugs.
Differentiate between preterm birth and low birth weight.
Describe the criteria for very preterm, early preterm, late preterm and the implications of each.
Discuss major risk factors associated with preterm birth.
Analyze current interventions to prevent spontaneous preterm birth.
Discuss the use of tocolytics and antenatal glucocorticoids for management of preterm labor.
Design a nursing care plan for women with preterm premature rupture of the membranes (preterm PROM).
Explain the care of a woman with postterm pregnancy.
Summarize the nursing care for a trial of labor, the induction and augmentation of labor, forceps- and vacuum-assisted birth, cesarean birth, and vaginal birth after a cesarean birth (VBAC).
Discuss obstetric emergencies and their appropriate management.
“Kangaroo Mother Care” by Tom Adriasenssen, used under CC BY-SA 2.0/Cropped from original
Complications in the Postpartum Woman
Complications in the Postpartum Woman
“Alvas Cultural Jamboree Flower" by M Rahil, used under CC BY-SA 4.0/Cropped from original
Identify the causes, signs and symptoms, and medical and nursing management of postpartum hemorrhage.
Describe hemorrhagic shock as a complication of postpartum hemorrhage, including management and hazards of therapy.
Differentiate the causes of postpartum infection.
Summarize assessment and care of women with postpartum infection.
Describe thromboembolic disorders, including incidence, etiology, signs and symptoms, and management.
Complications in the Newborn
Complications in the Newborn
Compare characteristics of preterm, late preterm, early term, and postterm neonates.
Discuss respiratory distress syndrome and the approach to treatment.
Discuss the pathophysiology of retinopathy of prematurity and bronchopulmonary dysplasia and the risk factors that predispose preterm infants to these problems.
Analyze the pathophysiology of meconium aspiration syndrome and its clinical signs.
Discuss the needs of parents of high risk infants.
Describe assessment and care of infants with soft-tissue, skeletal, and nervous system injuries resulting from birth trauma.
Develop a plan of care for a neonate of a mother with diabetes.
Describe in detail the assessment of a newborn with a suspected infection.
Analyze fetal and neonatal effects of maternal substance abuse during pregnancy.
Describe the assessment and care of a newborn experiencing drug withdrawal (neonatal abstinence syndrome); include the infant's family.
“Jumeaux Sous Couveuse ” by Max Mbakop, used under CC BY-SA 4.0/Cropped from original
About the Authors
About the Authors
Dr. Deborah H. Smith, CNM, RNC-MNN,
Dr. Deborah H. Smith, CNM, RNC-MNN,
Deborah Smith, CNM, DNP grew up on the Gulf Beaches in St. Petersburg, Florida. She received her Bachelors in Nursing from the University of South Florida in 1991. She worked as a maternity nurse in Melbourne, Florida and Atlanta, Georgia. Debbie practiced as a Certified Nurse-Midwife delivering babies at Northside Hospital in Atlanta, Georgia until 2003 at which time she moved to Northern Virginia. She began teaching at various institutions in 2006 and resumed nurse-midwifery practice when she joined Arlington Women’s Center in 2014. She began working with the medical staff at the VHC Health OB/GYN office in 2020. She taught at Marymount University between 2012-2024. She currently works as a CNM with Hibiscus Women's Center in Melbourne, Florida.
Teaching Areas
Obstetrics
Gynecology
Nursing Fundamentals
Health Assessment
Simulation
Research Interests
Pregnancy
Prenatal Care
Medication Administration and Calculations for Nursing
Publications/ Lectures
AACN Transform 2022 - Co-Presenter: Confidence Level with Dosage Calculation (December 2022)
13th Annual McGinley- Rice Symposium: Face of the Person who is Socially Isolated - Presenter and Panelist - Increasing Access Using an RN for Virtual Prenatal Care (October 2022)
5th Annual Nursing World Conference – Poster “Increasing Access Using a Hybrid of Prenatal Care” (October 2021)
Nurse Educator article “Teaching Medication Calculation: A Contextual Approach” (2021)
Clinical Simulations for the Advanced Practice Nurse: A Comprehensive Guide for Faculty, Students, and Simulation Staff – Chapter 12 (2020)
Dr. Judith Rogers-Fruiterman, RN
Dr. Judith Rogers-Fruiterman, RN
Over the course of her 40-year career in nursing and hospital administration, Dr. Rogers has held a variety of academic positions as well as executive positions in Women’s Health Care, acute-care hospital leadership and senior services. Most notably, while serving as president of Holy Cross Hospital she supervised the development and advancement of the seniors program of Holy Cross Hospital, including the opening of the first Seniors Emergency Room in the United States, followed by the Seniors Ambulatory Surgery Center.
Dr. Rogers received her PhD degree from George Mason University in Fairfax, Virginia. In addition to having served as associate faculty for the Georgetown University Hospital Center for clinical bioethics, she is the author/editor of several clinical texts as well as having served as a guest lecturer on the topic of advancing senior care for the Erickson School for Aging Studies at the University of Maryland. In addition, Dr. Rogers; work on improving the care of seniors has contributed to the innovation project of the Agency for Healthcare Research and Quality, part of the U.S. government efforts to support new and advancing approaches to health care delivery services.
Awards
2001 Georgetown University Hospital Nurse of the Year Award Women’s Services
2002 Georgetown University Hospital Nurse of the Year Award Women’s
Services
2006 George Mason University Nursing Research Dissertation Award
2010 Nursing Spectrum Regional Nurse Leader of the Year Nominee
Teaching Areas
Women’s Health
Leadership
Introduction to Professional Nursing Practice
Pharmacology
Research Interests
Senior Care and Home Health
Publications
Narayan, M. C., Rea, K., Cressy, M. M., Rogers, J., Preuss, B. C., Drenkard, K., & Miklancie, M. (2002). Searching for Nursing’s Future: The Future Search Process for Turning Vision into Reality. Nursing Management.
Rogers, J. (2004). Cancers of the Reproductive System. In L. Neal & S. Guillett (Eds.), Care of the adult with a chronic illness (pp. 532-552). St. Louis, Missouri: Elsevier.
Rogers, J. (2009). Emergency Care: A New Model. Health Progress, 90(6).
Presentations
Rogers, J. (2008). Are We Really Prepared? Lessons Learned From Nurses Responding to the September 11 th Attack. 2008 AWHONN Annual Convention in Los Angeles, CA.Rogers, J. (2009). Innovative Approaches to Aging Services in an Acute Care World: Designing a New Model of Emergency Care for Seniors. 2009 Catholic Health Assembly in New Orleans, LA.
Rogers, J. (2012 & 2013). Innovative Approaches to Aging Services in an Acute Care World: Creating a Sustainable Model. 2012 & 2013 Ontario Hospital Association General Meeting, Ontario, Canada.
Rogers, J. (2014). Holy Cross Hospital Seniors Emergency Department. Health Care Innovations AHRQ Webinar and Video.
Rogers, J. (2014). ). Holy Cross Hospital Seniors Emergency Department. Patient and Family Centered Care. 2014 Partnership for Patients as the Patient & Family Engagement Webinar and Video.
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