Nursing Programme
Introduction to Maternity Care
Please complete the workbook by:
- Complete the workbook by answering the questions in the square box appropriate to Master level study.
- Using up-to-date information and references, ideally references should be within 10 years period. Harward referencing please.
- All the information should be UK-based.
- Please use reliable sources and references.
INTRODUCTION TO MATERNITY CARE WORKBOOK
Work Book Aims
This work book aims to provide an understanding of the needs of the pregnant women and her baby and the issues that impact upon their health needs. On completion of this workbook you will understand:
- the roles played by the following health professionals in the health of the pregnant woman.
- health promotion in pregnancy – nutrition and exercise
- drug and alcohol issues and the impact on the unborn child
- antenatal screening needs and the potential impact on the parents
- pregnancy terms, impact of hormonal changes, miscarriage
- the main roles of these health professionals in supporting the health of the new mother and baby
- preventing pregnancy
- perinatal mental illness and the impact on the parents and child
1). ROLES OF HEALTH PROFESSIONALS
1a). Identify the roles played by the following health professionals in the health of the pregnant woman.
Community Midwife
Practice nurse
Obstetrician
GP
2). HEALTH PROMOTION
The health of the mother can affect the health of the developing baby. An important role of the health professionals involved in the care of a pregnant woman is to ensure provision of health advice/promotion. If you are involved in the care of a pregnant woman it may be useful for you to know about specific health issues that may affect pregnant women and recommended guidance. The National Institute of Clinical Excellence (NICE 2010) have produced comprehensive and updated guidelines on health promotion in antenatal care.
Please read these documents to inform your knowledge in this area and answer the questions below:
NICE clinical guideline: Antenatal care 62 (2010)
Can be accessed at https://www.nice.org.uk/guidance/cg62
NICE clinical guideline: Maternal and Child Nutrition http://guidance.nice.org.uk/PH11 (2008)
Hairon N (2008) Advice on maternal nutrition aims to cut health inequalities. Nursing Times. 1 Vol 104 No 13
NUTRITION
Identify:
2a). An aspect of pre-pregnancy nutrition which may impact upon the fertility of the woman or the early stages of the pregnancy.
2b). An aspect of nutrition during pregnancy which can have a significant impact on the health or development of the embryo or foetus.
EXERCISE
Please read https://www.rcog.org.uk/en/news/rcog-statement-on-exercise-during-pregnancy-and-pre-eclampsia/
2c). What is the current advice on exercise for pregnant women?
DRUG AND ALCOHOL ISSUES
During your training you may come across pregnant mothers who have alcohol and substance abuse issues so it is important you have some basic knowledge about the effects of these substances on the unborn child and what help and support mothers may require.
FETAL ALCOHOL SYNDROME/EFFECTS
2d) Explore the terms foetal alcohol syndrome/effects and discuss the effect of heavy alcohol use on the developing fetus and the implications for birth and development.
DRUG USE IN PREGNANCY
2e). Explore the use of illicit drugs in pregnancy and the possible effects on the unborn baby. How can a mother who uses substances or alcohol be supported by health professionals during her pregnancy?
USEFUL READING
Johnson K Gerada C Greenough A: Substance misuse during pregnancy British Journal Psychiatry 2003, 183:187-189. http://bjp.rcpsych.org/content/183/3/187
Leggate J Supporting vulnerable women during pregnancy: Nursing times 2008 pp.30-31
The Drugscope website has a useful guide for pregnant women (‘pregnant and ….using drugs and alcohol’) http://www.drugwise.org.uk/wp-content/uploads/Drug-use-in-pregnancy.pdf
3). ANTENATAL SCREENING
The ability to detect abnormalities during pregnancy provides information for the health professionals and the expectant mother.
You may be working with an expectant mother and her partner who are choosing whether to have antenatal screening or not. Of course her midwife will be responsible for guiding her through this process and it is important that the expectant mother has informed choice. However, it is important that you have some knowledge of the tests available and the potential physical and psychological consequences of such tests.
Currently the National Health Service offers The NHS Fetal Anomaly Screening Programme which has responsibility for developing, implementing and maintaining a high quality, uniform screening programme for all pregnant women in England.
All women should be offered:
- A screening test for Down’s syndrome that meets agreed national standards
- An ultrasound scan between 18 – 20 weeks 6 days to check for physical abnormalities in their unborn baby (11 conditions screened for during the 18+0to 20+6 fetal anomaly ultrasound scan).
- Information to help them decide if they want screening or not
This information can be accessed on The NHS Fetal Anomaly Screening
Programme website
http://fetalanomaly.screening.nhs.uk/
What is the difference between a screening and a diagnostic test?
- A screening test in pregnancy cannot give the pregnant women a yes/no answer as to whether their baby has a condition. It can only tell you what the chances are of the baby being affected. Screening tests in pregnancy include blood tests and ultrasound scans.
- A diagnostic test in pregnancy can tell the pregnant women whether the baby has a condition or not. Diagnostic tests in pregnancy include Chorionic villus sampling, amniocentesis and ultrasound scans*.
3a) Give 2 examples of screening tests carried out at the 18+0 to 20+6 fetal anomaly ultrasound scan, explaining why the screening is used and any associated risks.
3b) Explain the following diagnostic tests, any associated risks and potential psychological implications for the expectant mother/partner.
- Chorionic villus sampling (CVS)
- Amniocentesis
4). PREGNANCY
Terminology:
4a) Find out what the terms below mean and write a short sentence on each.
| Term | Definition |
| Trimester
|
|
| Para
|
|
| Gravida
|
|
| HCG
|
|
| Antenatal
|
|
| Intrapartum
|
|
| Postnatal
|
|
| Rhesus factor
|
|
| Post-partum
|
|
| Puerperium
|
|
| Amniotic cavity
|
|
| Embryo
|
|
| Foetus
|
|
| Pre-eclampsia
|
|
| Ectopic pregnancy
|
HORMONES
4b) Briefly identify the main roles of oestrogens and progesterone during pregnancy.
MISCARRIAGE
4c) Explain what a miscarriage is and the effect this may have on a pregnant women/couple – where can they get support from?
LABOUR
4d) What signs or symptoms might lead the pregnant woman to think that she was in labour?
4e) Explain what a breech birth is and its implications?
4f) What checks are made on the baby as soon as it is born and why?
5) ROLES OF HEALTH PROFESSIONALS
5a) Identify the main roles of these health professionals in supporting the health of the new mother and baby.
Midwife –
GP –
Health visitor –
What other kinds of support are available for new parents?
6) PREVENTING PREGNANCY
Avoiding unplanned pregnancy is a priority for many women ( and their partners) and it is important that the couple are encouraged to discuss contraception soon after the birth of their child to prevent any unwanted pregnancy.
6a) Where can advice about contraception be obtained? Consider whether this advice is accessible to women from different social or cultural backgrounds.
6b) What factors may affect a woman’s choice of contraception?
7) PERINATAL MENTAL ILLNESS
Having a baby can be a life changing experience for the mother and father and impact upon the extended family or friendship group. Although it can be a time of real happiness, it is also an exhausting and demanding time.
Perinatal mental illness (PMI) places emphasis on the importance of psychiatric disorder in pregnancy and postpartum. It stems from perinatal psychiatry, a specialist branch of psychiatry dedicated to research, care and treatment of mothers with pre-existing (i.e. preconception) psychiatric illness as well as those arising during pregnancy and after. PMI is both a nationally and internationally accepted term; it relates to the effects of mental illness and the implications of treatment on the fetus, breastfeeding and neonatal/child development (Royal College of Psychiatrists (RCPsych) 2000a). This revised terminology highlights the range of mental illness that can affect women during the childbearing years. This means the ubiquitous and erroneous label ‘postnatal depression’ (PND) is now an outmoded nomenclature, which ‘reinforces the view that depression following childbirth is somehow different from depression at other times’ (National Institute for Health and Clinical Excellence 2007: 38).
Extract from Raynor (2010)
7a) Write a paragraph about depression after child birth – how is it diagnosed and treated? What risk factors may there be present in the mother’s life to increase the likelihood of the development of depression and what support can be given to the mother/carers? What can the effect be on the baby?
7b) Write a paragraph about puerperal psychosis – how is it diagnosed and treated and what support can be given to the mother/carers.
7c) The NICE guidelines (CG45) advise health professionals in primary care and secondary care to ‘screen’ for potential post natal depression by asking 3 questions. What are these questions?
Suggested reading
Currid, T (2004) Improving perinatal mental health care. Nursing Standard, 19, 3, 40-43.
NICE Guidelines CG192 : Antenatal and postnatal mental health: Clinical management and service guidance 2007
https://www.nice.org.uk/guidance/cg192
Raynor M England C Carole (2010) Psychology for Midwives Maidenhead: Open University Press
(This is available as an e – book in the library).
WELL DONE – YOU HAVE REACHED THE END OF THE WORKBOOK!
USEFUL WEBSITES
Department of Health – http://www.dh.gov.uk/en/index.htm
Healthtalk Online – has some videos of parent’s experiences of screening
http://www.healthtalkonline.org/Pregnancy_children/Antenatal_Screening
National Institute for Clinical Excellence – Intrapartum Care Pathway (CG190) can be accessed at https://www.nice.org.uk/guidance/cg190
National Service Framework for Children, Young People and Maternity Services – core standards
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4090566.pdf
Royal College of Obstetricians and Gynaecologists
USEFUL READING
Currid, T (2004) Improving perinatal mental health care. Nursing Standard, 19, 3, 40-43.
Doucet S Jones I Letourneau N et al. (2011). Interventions for the prevention
and treatment of postpartum psychosis: a systematic review. Archives of
Women’s Mental Health. 14(2) 89-98
Ghodse H (2010) Drugs and Addictive Behaviour A Guide to Treatment 4th Edition (Chapter 10) Cambridge: Cambridge University Press
Goldberg, G (2003) Nutrition in pregnancy: the facts and fallacies. Nursing Standard, 17, 19, 39–42.
Jones I Smith S (2009) Puerperal Psychosis: Identifying and caring for
women at risk. Advances in Psychiatric Treatment. 15: 411-418.
Leifer, G (2005) Maternity nursing. Philadelphia, Saunders
O’Connor V, and Kovacs G (2003) Obstetrics, gynaecology and women’s health, Cambridge University Press, Cambridge.
Pearce C Easton K. (2005) Management of complications of early pregnancy. Nursing Standard, 19, 34, 56-64.
Petersen T and McBride A (Eds) (2002) Working with Substance Misusers A Guide to Theory and Practice (Chapter 24) London: Routledge
Sit D Rothschild AJ and Wisner KL (2006). A Review of Postpartum
Psychosis. Journal of Women’s Health. 15(4): 352-368.
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