LEARNING OBJECTIVES

1. Identify the goals and philosophy of maternal and child health nursing.
2. How has the scope of nursing changed in maternal and child health nursing.
3. Discuss the implications of the common standards of maternal and child health nursing
and the health goals for the nation for maternal and child health nursing.
4. Use critical thinking to identify areas of care that could benefit from additional
research or application of evidence-based practice.
5. Apply concepts of family centered care to maternal and child health nursing.
6. Integrate knowledge of trends in maternal and child health care with the nursing
process to achieve quality maternal and child health nursing care.
Goals and Philosophies of Maternal and Child Health Nursing
Obstetrics- Care of woman during childbirth; derived from Greek word “obstare”
Pediatrics –derived from Greek word, “pais” (child)
A.) Focus of MCN – Care of childbearing and childrearing families.
B.)Primary Goal of MCN – Promotion and maintenance of Optimal Family Health.
C.)Goals of MCN are broad b/c the scope of practice or range of practice includes the ff:
1. Preconceptual Health Care
2. Care of women during 3 trimesters of pregnancy
1st trimester (1st – 3rd month)
2nd trimester (4th – 6th month)

3rd trimester (7th – 9th month)

Care of women during Puerperium or 4th Trimester (6 weeks after childbirth)
Care of infants during Perinatal Period (6 weeks before conception and 6 weeks after birth)
Care of children from birth to adolescence
Neonatal (28 days of life); Infancy (1 – 12 months); Adolescence (after 18 y/o)
Care in settings as varied as the birthing room, the PICU, and the home

Philosophies of MCN
MCN is Family Centered; assessment must include both family and individual assessment.
MCN is Community Centered; health of families depends on & influences
the health of communities.
MCN is Evidence Based because critical knowledge increases
MCN includes independent nursing functions because teaching & counselling
are major interventions.
MCN Nurse, Advocate (protects the rights of family members, including fetus)
Health Promotion and Disease Prevention to protect health of new generation.
MCN is a challenging role for nurses
In all settings and types of care, keeping the family at the center of care or
considering family as the primary unit of care is an essential goal because the level of
a family’s functioning affects the health status of its members. A family centered
approach enables nurses to better understand individuals and their effect on
others, and in turn, to provide holistic care.
Framework for MCN
-Nursing Process (ADPIE)
-Evidence Based Practice
-Nursing Research
-Nursing Theory
 D. Phases of Health Care

Health Promotion
-Educating clients to be aware of good health through teaching and role modelling
Ex. Family planning, teach the importance of safe sex practice, importance of immunizations
-Health Maintenance
Intervening to maintain health when risk of illness is present
Ex. Encourage prenatal care, importance of safeguarding homes by
childproofing it against poisoning

Health Restoration
Diagnosing and treating illness using interventions that will return client to wellness fast
Ex. Care of child during illness, care of woman during pregnancy complications
Health Rehabilitation
Preventing further complications from an illness
Bringing client back to an optimal state of wellness
-Helping client accept inevitable death
Ex. Encourage continuous therapies and medications
What is the Goal of Maternal and Child Health
The primary goal of maternal and child health nursing care can be stated simply
as the promotion and maintenance of optimal family health to ensure cycles of
optimal childbearing and childrearing. The range of practice includes
Preconceptual health care
• Care of women during three trimesters of pregnancy and the puerperium
(the 6 weeks after childbirth, sometimes termed the fourth trimester of pregnancy)
• Care of children during the perinatal period (6 weeks before conception to 6 weeks after birth)
• Care of children from birth through adolescence
• Care in settings as varied as the birthing room, the pediatric intensive care unit,
and the home In all settings and types of care, keeping the family at the center of
care delivery is an essential goal.
Pregnancy can be a time of great excitement to the patient, but it can also be a time of
danger, and there are certain serious illnesses of pregnancy to be aware of
Previous Obstetric History
A good starting point is to ask about number of children the patient has
given birth to. Next, sensitively ask about miscarriages, stillbirths,
ectopics and terminations.
Term Pregnancies
For each previous pregnancy carried beyond 24 weeks, inquire about the following:
Gestation– previous preterm labour is a risk factor for
subsequent preterm labour.
Mode of delivery – spontaneous vaginal, assisted vaginal or Caesarean
Gender
Birth weight – a previous small for gestational age (SGA) baby
increases the risk of a subsequent one
Complications – e.g. pre-eclampsia, gestational hypertension,
gestational diabetes, obstetric anal sphincter injury
(3rd, 4th degree tears), post-partum haemorrhage.
Assisted reproductive therapies (ART) – e.g. ovulation induction with clomiphene, IVF
Care providers – was the patient’s care completely with a midwife or was there
previous obstetric input, if so, why
ART pregnancies are often conceived after a long period of time and after much
psychological distress; it is important to be aware of this. In addition, use of
ARTs can increase the risk of pre-eclampsia during pregnancy.
Other Pregnancies
For pregnancies not carried beyond 24 weeks, inquire about
Gestation – miscarriages can be classified into early pregnancy (12 weeks or less)
or second trimester (13-24 weeks).
Miscarriages – outcome (spontaneous, medical management, surgical
management – evacuation of retained products of conception).
Terminations – method of management: medical or surgical.
Uidentified causes of miscarriage / stillbirth – e.g. abnormal parental karyotype, fetal anomaly.
For ectopic pregnancies, ask about:
Site of the ectopic
Management: expectant (monitoring of serum hCG levels), medical
(methotrexate injection), surgical (laparoscopy or laparotomy; salpingectomy
(removal of tube) or -otomy (cutting of tube and suctioning of trophoblastic tissue,
Gravidity and Parity
Gravidity is the total number of pregnancies, regardless of outcome.Parity is the total number of
pregnancies carried over the threshold of viability (24+0 in the UK).
Examples [Macleod’s 2005, p.212]:
Patient is currently pregnant; had two previous deliveries = G3 P2uPatient
is not pregnant, had one previous delivery = G1 P1
Patient is currently pregnant, had one previous delivery and one previous
miscarriage =G3 P1+1 (the +1 refers to a pregnancy not carried to 24+0).
Patient is not currently pregnant, had a live birth and a stillbirth
(death of fetus after 24+0) = G2 P2
Patient is not pregnant, had a twin pregnancy resulting in two live births = G1 P1
Current Pregnancy
First, ask about the gestational age of the pregnancy. Gestation is described
as weeks+days (e.g. 8+4; 30+7; 40+12 – post-dates)
The last menstrual period date (LMP) can be used to estimate gestation,
with Naegele’s rule the most common method (to the first day of the LMP add 1 year,
subtract 3 months, add 7 days). This can be imprecise, as it requires accurate recall
of LMP dates as well as regular menstruation.
First, ask about the gestational age of the pregnancy. Gestation is described as
weeks+days (e.g. 8+4; 30+7; 40+12 – post-dates).
The last menstrual period date (LMP) can be used to estimate gestation,
with Naegele’s rule the most common method (to the first day of the LMP add 1 year,
subtract 3 months, add 7 days). This can be imprecise, as it requires accurate
recall of LMP dates as well as regular menstruation.
In the history of current pregnancy, ask about:
Has there been use of folate prior to conception and currently
Agreed estimated date of delivery (EDD): this date is when the woman will be 40+0.
Singleton or multiple gestation.
Uptake and results of Down’s syndrome screening (if scanned between 11+0 and 13+6).
At 18+0 to 20+6, women are offered a scan to check for fetal anomalies.
Be sure to review the findings of this scan:
Fetal anomalies– presence or absence.
Placenta position– check it is clear of the internal os.
Amniotic fluid index– oligohydroaminos, normal or polyhydraminos
Estimated fetal weight– parameter for growth

Ask the usual questions about past medical history, abdominal or

pelvic surgery and mental health conditions. Remember that the medical
co-morbidities that are most likely to affect women of childbearing age include:
Asthma
Cystic fibrosis
Epilepsy
Hypertension (older women)
Congenital heart disease
Diabetes – check if type 1 or type 2
Systemic autoimmune disease e.g. systemic lupus erythematosus (SLE), rheumatoid arthritis
Haemoglobinopathies: sickle-cell disease, thalassaemias
Blood-borne viruses: HIV, hepatitis B, hepatitis C
Mental Health
Mental health is extremely important – in the Saving Mothers’ Lives report
covering 2011-2013, it was identified that nearly 25% of deaths occurring six
months to a year post-partum were due to psychiatric causes. The same report advised
the following as ‘red flags’ to arranging urgent senior psychiatric assessment:
Recent significant change in mental state or emergence of new symptoms
New thoughts or acts of violent self-harm
New and persistent expressions of incompetency as a mother, or of estrangement from the infant.
Inquire about previous psychiatric disorder, to include depression, anxiety disorders,
bipolar affective disorder, schizophrenia, previous self-harm or suicide attempts.
Drug History
In addition to asking about drug allergies and intolerances, be aware that the
embryonic (first 12 weeks) period of pregnancy is thought to be the time of most
sensitivity for drugs to cause fetal structural defects (teratogenicity). Thus,
inquire about drugs taken around conception and during the first 12 weeks.
Inquire about drugs currently being taken (include herbal/complementary therapies).
Ask about illicit drugs and alcohol – recommend the patient to stop these drugs, and
to offer referral to help-to-quit services too,
Recommend that the patient takes 400μg folic acidper day for the first 12 weeks,
to reduce the chance of the baby developing a neural tube defect.
Family History
Although not usually regarded as a substantial part of the obstetric history,
there is increasing evidence that certain conditions are associated with adverse
pregnancy outcomes.
Conditions such as cystic fibrosis and sickle-cell disease are heritable –the patient should
be counselled as to the risk of her baby developing these conditions
(based on the parental genotypes).
A family history of type 2 diabetes in a first degree relative is considered a risk factor for
developing gestational diabetes
Social History
Pregnancy can be a time of great elation, intense anxiety – and quite possible
a mixture of anything and everything between. Ask the patient about her thoughts
of the pregnancy; be sensitive if the pregnancy is unplanned.
Ask about current / previous occupation, and plans for returning to work (or otherwise).
Inquire about home circumstances: e.g. who does the patient live with – partner / spouse?
Children in the home? Ask also about support networks, e.g. parents / in-laws,
neighbours, friends
Inquire about financial circumstances– the cost of caring for a child in
addition to being out of work can potentially have an adverse impact on
the patient’s ability to cope financially. Is the patient eligible for social
security / child benefit payments?
Ask about smoking – how many per day; what drug (tobacco, cannabis, others);
duration of smoking. Would the patient like to quit, and would they like help with this?
Reiterate the association between smoking and small-for-gestational-age babies and
offer her help to quit. It is also important to remember that at least once during
the course of the pregnancy, women should be asked whether they are victim to domestic abuse
B. Definitions related to sexuality:
Gender identity –sense of femininity or masculinity
2-4 yrs/3 yrs gender identity develops.
Role identity –attitudes, behaviors and attributes that differentiate roles
Sex –biologic male or female status. Sometimes referred to a specific
sexual behavior such as sexual intercourse.
Sexuality -behavior of being boy or girl, male or female man/ woman.
Entity life long dynamic change. - developed at the moment of conception.
I. Identify the Anatomy and Physiology of the Reproductive System
1.External value or pretender-Mons pubis/veneris-pad of fatty tissues that lies
over the symphysis pubis covered by skin and at puberty covered by pubic hair
that serves as cushion or protection to the symphysis pubis.
Urinary Meatus– small opening of urethra, serves for urination
Skenes glands/or paraurethral gland – mucus secreting subs for lubrication
Hymen – covers vaginal orifice, membranous  tissue
Vaginal orifice – external opening of vagina
Bartholene’s glands- paravaginal gland or vulvo vaginal gland
- 2 small mucus secreting alkaline subs.
Alkaline – neutralizes acidity of vagina
Ph of vagina- acidic
Doderleins bacillus – responsible for acidity of vagina
Carumculae mystiformes-healing
Perineum – muscular structure – loc – lower vagina & anus.
Internal a. vagina – female organ of copulation, passageway of mens & fetus,
3 – 4inches or 8 – 10 cm long, dilated canal
Rugae – permits stretching without tearing
b.Uterus- Organ of mens is a hollow, thick walled muscular organ
•Size- 1x2x3
•Shape: nonpregnant- pear shaped
pregnant – ovoid
•Weight - nonpregnant – 50 -60 g
–pregnant – 1,000g
Pregnant/ Involution of uterus:
•4th stage of labor – 1000g
•2 weeks after delivery – 500g
•3 weeks after delivery - 300 g•5-6 weeks after delivery - returns to original,
Three parts of the uterus
a.fundus- upper cylindrical layer
b.corpus/body - upper triangular layer
c.cervix - lower cylindrical layer
Isthmus - lower uterine segment during pregnancy
Cornua-junction between fundus & interstitial
Muscular compositions: there are three main muscle layers which make
expansion possible in every direction.
1.Endometrium- inside uterus, lines the nonpregnant uterus. Muscle
layer for menstruation. Sloughs during menstruation.
* Decidua- thick layer.
* Endometriosis-proliferation of endometrial lining outside uterus. Common site: ovary.
S/sx: dysmennorhea, low back pain. Dx: biopsy, laparoscopy Meds: 1.
Danazole (Danocrene)
a. to stop mens
b. inhibit ovulation
2. Lupreulide (Lupron) –inhibit FSH/LH production
2. Myometrium – largest part of the uterus, muscle layer for delivery process
- Its smooth muscles are considered to be the living ligature of the body.
- Power of labor, responsible for contraction of the uterus
3. Perimetrium – protects entire uterus
C. Ovaries – 2 female sex glands, almond shaped. - Ext- vestibule - Int – ovaries
Functions: 1.Oogenesis 2. ovulation 3. Production of hormones
Fallopian tubes – 2-3 inches long that serves as apassageway of the sperm
from the uterus to the ampulla or the passageway of the mature ovum or
fertilized ovum from the ampulla to the uterus.
4 significant segments
1. Infundibulum – distal part of FT, trumpet or funnel shaped, swollen at ovulation
2. Ampulla – outer 3rd or 2nd half, site of fertilization
3. Isthmus –site of sterilization– bilateral tubal ligation
4. Interstitial – site of ectopic pregnancy– most dangerous
In all species of animals, including the human species, sexual behavior is
directed by a complex interplay between hormone actions in the brain that give rise to
sexual arousal and physical experiences with a sexual reward. In most animals,
sexual activity and responses are primarily a matter of biology.
Initial responses:
Vasocongestion – congestion of blood vessels
Myotonia – increase muscle tension
Excitement Phase – (sign present in both sexes, moderate increase in HR, RR,BP, sex
flush, nipple erection) – erotic stimuli cause increase sexual tension, lasts minutes to hours.
Plateau Phase – (accelerated V/S) – increasing & sustained tension nearing orgasm.
Lasts 30 seconds – 3 minutes.
Orgasm –(involuntary spasm throughout body, peak v/s) involuntary release of sexual
tension with physiologic or psychologic release, immeasurable peak of sexual experience.
May last 2 – 10 sec-most affected are is pelvic area.
Resolution– (v/s return to normal, genitals return to pre-excitement phase)
Refractory Period–the only period present in males, wherein he cannot be restimulated
for about 10-15 minutes

Stages of Fetal Growth and Development

1-3 days travel of zygote – mitotic cell division begins( 2-4-8-16 cells) 3-6 days-enters the utrine
cavity and lies free for the duration prior to implantation(morulla stage) 6-7 days- Implantation of
blastocyst.(Blastula,blastodermic vesicle).The usual site of implantation son the upper third of
posterior wall of uterus
Pre-embryonic Stage
a. Zygote- fertilized ovum. Lifespan of zygote – from fertilization to 2 months
b. Morula – mulberry-like ball with 16 – 50 cells, 4 days free floating & multiplication
c. Blastocyst – enlarging cells that forms a cavity that later becomes the embryo. Blastocyst –
covering of blastocyst that later becomes placenta & trophoblast
d. Implantation/ Nidation- occurs after fertilization 7 – 10 days.When ovum borrows into
the uterine wall, slight bleeding occur which maybe mistaken for scanty menstruation also called  
implantation bleeding.
7-8 day the throphoblastic cells differentiate into two types:
a. The inner cytothrophoblast or langhans layer
b. The outer syncytiogrophoblast.The implanted ovum increases in size because of
further development of the syncytiotroboblast.
9-10 day the syncytiothrophoblst develops into a complex network of protoplasmic
strans enclosing irregular fluid filled spaces or lacunae which anastromose or joint with one.
11-12 day – maternal blood enters the lacunae which later become the intervillous space
12-13 day-the forerunners of the chorionic will begin to form a chorionic villus is a ginger
like stucture arising from throphoblast which is the one in contact with materal blood and
intervillous space
14-15 day- ( end of second week) Maternal circulation in the previously opened maternal
sinuses is established.
16-17 day- Blood vessels develop in the chorionic villus.Maternal and fetal circulation
already intact and funtioning.Unless some abnormal breakdown  of the placenta occurs,fetal
and maternal blood never mix.
Decidua – thickened endometrium ( Latin – falling off)
3 PARTS
* Basalis (base) part of endometrium located under fetus where placenta is delivered.
Also a portion beneath the fertilize ovum.
* Capsularies – encapsulate the fetus or covers the ovum and shuts it off from the rest of the
uterine cavity.
* Vera – remaining portion of endometrium. The main cavity of the uterus.
Chorionic Villi- 10 – 11th day, finger life projections
3 vessels: A – unoxygenated blood V – O2 blood A – unoxygenated blood
* Wharton’s jelly – protects cord
* Chorionic villi sampling (CVS) – removal of tissue sample from the fetal portion
of the developing placenta for