Unit 1: Dimensions of Maternal and Child Health Nursing

Objectives:
1. Discuss the development of maternal and child health services internationally and
nationally, indicating contributions made by medical pioneers and related organizations.
2. Explain the related maternal and child health concepts.
3. Discuss national trends in maternal and child health in relation to birth, infant and
maternal mortality and morbidity, current maternal and child health services.
4. Outline international, regional and national goals of maternal and child health.
5. Identify strategies to achieve national goals and objectives.
6. Identify issues under national maternal and child health.
7. Identify the age group focus for maternal and child health care.
8. Outline the components of a national maternal and child health programme.
9. Explain the role of the nurse in maternal and child health.
Historical Development of Maternal and Child Health
International
Prehistorically the care provided to childbearing families was based on customs, beliefs, relig ion
and taboos. Medicine men and priest attended to families.
Earliest medical records date 2200BC
Hippocratic Era
Discarded superstition, magic and religious rites.
1st- 4th Century
Squatting position for delivery established
Only women were allowed to attend women in labor
5th - 15th Century
Practice returned to old ways.
16th Century
Delivery in bed was advocated.
Suturing of perineum established.
First school in midwifery started.
1633: inauguration of first male midwife.
17th Century
Sir Richard founded first Maternity Hospital (Queen Charlotte).
Zabdriel Boylston introduced small pox inoculation
18th Century
First Childrens Hospital founded in Paris (1802).
First childrens Hospital founded in America (1855).
1818-1865: Ignaz Semmelireis implemented hand washing.
1822-1895: Louis Pasteur introduced the germ theory.
1827-1912: Joseph Lister implemented the use of antiseptics and wound dressing techniques.
1867-1940: Lillian Wald founded infant welfare centers and schools for mothers.
1893: Milk stations introduced and developed by Dr. Jacobi.
1850: First indication of antenatal clinic occurred in Dublin
19 Century
1909: Bill passed re: Childrens Welfare Bereau.

Related maternal and child health concepts

WHO defines Maternal and Child Health as:
Promotive, preventive, curative and rehabilitative health care for mothers and children, and thus
includes maternal health, family planning, child health, handicapped children, adolescents and
health aspects of all children.
Maternity Nursing focuses on the care of childbearing women and their families through all-stages
of pregnancy and childbirth.
Midwifery: branch of medicine that deals with the care of pregnant women before, during and after
the delivery of an infant.
Midwife: a person trained in a recognized institution and registered to manage the care of mother
and child.
Antenatal: period from conception to the onset of labor
Intranatal: period from the onset of labor to delivery of the fetus
Postnatal: period after delivery.
Peurperium: period between termination of labor and the return of the reproductive organs to their
pre-pregnant state.
Gravid: pregnant or pertaining to pregnancy.
Nulligravida: a woman who has never been pregnant.
Primagravida: A woman who is pregnant for the first time.
Multigravida: A woman who has been pregnant less than 5 times
Grande Multigravida: A woman who has been pregnant 5 or more times, not necessarily giving
birth.
Parity: Number of times a woman has given birth to a child live or still born exc luding abortions,
represented by the letter P or para.
Nullipara: a woman who has not delivered a viable infant.
Primapara: a woman having delivered 1 child.
Multipara: A woman who has delivered less than 5 times.
Grande Multipara: a woman who has given birth 5 or more times.
Involution: the return of the uterus to its pre-pregnant state.
Partogram: a graph used to chart the progress of labor.
Vital Statistics: Figures describing rates of occurrence for events.
Live birth: the complete expulsion of a fetus, irrespective of the duration of pregnancy, which there
is evidence of life.
Still birth/fetal death: death prior to the expulsion of the fetus.
Birth rate: number of live births per thousand population.
Mortality statistics: the incidence or number of individuals who have died over a specific period of
time.

Maternal Mortality rate: the number of maternal deaths per thousand live births.
Infant Mortality: number of deaths per 1000 live births after the first 28 days and during the first
year of life.
Neonatal Mortality: the number of neonatal deaths per 1000 live births.
Childhood Mortality: The number of deaths per thousand population in children, 1-14 yrs.
Morbidity Statistics: the prevalence of a specific illness in the population at a particular time.
Low birth weight: less than 2500g.
Trends in Maternal and Child Health
1. Families are smaller in size than in previous decades.
2. Single home parenting is increasing.
3. Increasing number of women working.
4. Abuse of women and children is more common.
5. Women having children at younger age.
6. Abuse of women and children are more common.
7. Families are more health conscious.
8. Cost containment.
9. Older women having children.
International, regional and national goals of Maternal and Child Health.
International & Regional
1. Improve the health status of women, adolescents and children through development of
national and institutional networks for interdisciplinary and collaborative research,
education and training.
2. Consolidate health and social service professionals.
3. Gain an understanding of psychosocial and cultural determinants of the health status of a
population.
4. Formulate a base for the generation of health policies to meet the need of the population.
5. Improve communication between countries.
National
Goal: Improve the quality of the health care delivery system to women, adolescents and children.
Objectives:
1. To arrange clinic sessions to maximize the medical personnel.
2. To offer comprehensive child health services to all child health clinics.
3. Ensure all children are triaged and seated according to their conditions.
4. Mandatory screening for all children 4 weeks, 5 months, then yearly until 5 years; women
during antenatal period for anemia and sickle cell trait.
Strategies to achieve goals
1. Research
2. Education
3. Community-centered approach
4. Interdisciplinary approach
5. Risk approach
Issues under Maternal and Child Health
1. Pre-conceptual health
2. Post-conceptual health
3. Fertility
4. Family Planning
5. Infant and maternal mortality reduction.
6. Lactation management
7. Adolescent comprehensive health care.
8. School Health

Focus of Maternal and Child Health Care

1.
Females of childbearing age.
2.
Children: infancy to adolescent
Components of a National Maternal and Child Health Program
1.

Preventive Services
Infants, children and adolescents
Women of child bearing age (15-45 yr.)

2.

Therapeutic Care

3.

Support Services

4.

Community Resource Agencies

5.

Interdisciplinary team services

Components of Maternal Health

1. Antenatal Care
Ensure adequate health care for every pregnant woman.
Identifies high-risk pregnancies early with prompt referrals.
2. Intranatal Care
Ensure that all women have a safe delivery and that services meet the needs of
mother and family.
3. Postnatal Care
Ensure all women receive comprehensive care within the first 10 days post deliv ery.
4. Cancer Detection
Ensures education and screening for early detection.
5. Abortion
Comprehensive care post abortion.
6. Family Planning
Promotes contraceptive use at all levels within parameters of law.
Components of Child Health Care
1. Child health clinics: (well baby clinic & sick baby clinic)
Monthly visit for the first six months of life
Quarterly visits from six months to two years.
Annual visits from 2-5 years of age.
2. Immunization
3. Pre-school children assessment
4. Dental health
5. School health

Role of the Nurse in maternal and child health

Use the laws relating to MCH as a guide for practice

Promote aims and objectives of MCH.

Implement effective communication skills in retrieving data and fostering therapeutic rapport.

Health promotion, detection and monitoring of all women in childbearing age and all groups of
children.

Conduct physical examination.

Ensure continuity of care.

Documentation

Education

Liaison with other professionals thus facilitating prompt referral.

Application of the Nursing Process utilizing the self-care and needs theory.

Counselor/anticipatory guidance.

Application of diagnostic and clinical nursing skills.

Role model.

Patient/Family Advocate.

References
Lowdermilk, D.L. Perry, S.E. (2004). Maternity & womens health care. (8th ed.). St. Louis: Mosby
Elsevier.
Murray, S. S., & McKinney, E. S. (2006). Foundations of maternal-newborn nursing. (4th ed.). St.
Louis: Mosby, Saunders & Elsevier.
Orshan, S. A. (2008). Maternity, newborn, and womens health nursing: Comprehensive care
across the lifespan. Philadelphia: Lippincott, Williams & Wilkins.
Scott - Ricci, S. (2007). Essentials of maternity, newnorn and womens health nursing.
Philadelphia: Lippincott, Williams & Wilkins.