SG# 1SG# 1Family, Conception, Fetal Family, Conception, Fetal

Development and the Development and the Nursing RoleNursing Role

Including:Including:

1)1)Childbirth (Power-Point)Childbirth (Power-Point)

2)2)Family Statistics (Notes)Family Statistics (Notes)

3)3)Fetal Circulation (Review)Fetal Circulation (Review)

4)4)Fetal Development (Power-Fetal Development (Power-Point)Point)

5)5)Diagnostic Tests (Power-Diagnostic Tests (Power-Point)Point)

ChildbirthChildbirthBy Professor Pat DillonBy Professor Pat Dillon

HistoryHistory

There is little very early history:There is little very early history:• Ancient beliefs looked upon the pregnant Ancient beliefs looked upon the pregnant

woman as woman as uncleanunclean • In the 1700s English physicians In the 1700s English physicians W. Smellie and and

W. Hunter first described the mechanisms of first described the mechanisms of labor. labor.

They discussed conjugate diameters of the boney perlvis They discussed conjugate diameters of the boney perlvis and Hunter discovered the concept of fetal circulation. and Hunter discovered the concept of fetal circulation.

Both invented the procedure of aiding a delivery using Both invented the procedure of aiding a delivery using forceps..

• In 1762, In 1762, W. ShippenW. Shippen established a school for established a school for midwifery in Philadelphia which took men and midwifery in Philadelphia which took men and women applicants.women applicants.

Sairy Gamp CharacterSairy Gamp Character• Before the 1900's few Before the 1900's few

babies were born in babies were born in hospitals, mostly the hospitals, mostly the poor and the unwed, poor and the unwed, tended by convicts tended by convicts and alcoholics and alcoholics (Charles Dickens, Martin Chuzzlewit ,1844)

THE LYING-IN THE LYING-IN HOSPITALHOSPITAL

• The “lying-in” hospital, prior to the latter The “lying-in” hospital, prior to the latter part of the last century, was viewed as part of the last century, was viewed as one of the worst places for patients.one of the worst places for patients.

• According to M. Vogel (author): According to M. Vogel (author): "Maternity care would be among the last "Maternity care would be among the last reasons the comfortable classes entered reasons the comfortable classes entered hospitals. In the late nineteenth century, hospitals. In the late nineteenth century, women still considered that childbirth women still considered that childbirth could and should be performed even in could and should be performed even in the simplest and poorest of homes. the simplest and poorest of homes. Hospitals offered no specialized Hospitals offered no specialized paraphernalia or contrivances; puerperal paraphernalia or contrivances; puerperal fever was rampant in them and maternal fever was rampant in them and maternal mortality was high."mortality was high."

THE LYING-IN THE LYING-IN HOSPITALHOSPITAL

• For this reason, only the most desperate women For this reason, only the most desperate women entered hospitals to have children. And perhaps the entered hospitals to have children. And perhaps the major cause of this desperation was illegitimacy. major cause of this desperation was illegitimacy.

• Small lying-ins, often no more than a few rooms in Small lying-ins, often no more than a few rooms in a tenement or boarding house, kept by midwives or a tenement or boarding house, kept by midwives or the unscrupulous or untrained, served those the unscrupulous or untrained, served those seeking to "hide their shame" or having absolutely seeking to "hide their shame" or having absolutely no alternative. no alternative.

• Vogel has also noted that these lying-ins and the Vogel has also noted that these lying-ins and the baby farms that sometimes accompanied them baby farms that sometimes accompanied them were seen as accessories to vice and degradation, were seen as accessories to vice and degradation, and as adjuncts to brothels. and as adjuncts to brothels.

• Licensed and respectable lying-ins existed, but Licensed and respectable lying-ins existed, but their patients too were "unfortunate women," often their patients too were "unfortunate women," often "utterly destitute of money and friends." "utterly destitute of money and friends."

The Lying-In Hospitals The Lying-In Hospitals (cont.)(cont.)• Hospitalization for childbirth was linked Hospitalization for childbirth was linked

to the rise of the obstetrician. to the rise of the obstetrician.

• Once the specter of puerperal fever was Once the specter of puerperal fever was largely banished and when hospital-largely banished and when hospital-based obstetricians developed new based obstetricians developed new medical skills, and the hospitals' image medical skills, and the hospitals' image improved, women of all classes began to improved, women of all classes began to use hospitals for difficult birth and use hospitals for difficult birth and gradually came to consider it a safer, gradually came to consider it a safer, more comfortable, and cleaner place more comfortable, and cleaner place than their homes for all deliveries. than their homes for all deliveries.

• Many mothers and infants died of what Many mothers and infants died of what was called was called "childbed fever" or puerperal or puerperal fever (also known as postpartum fever, fever (also known as postpartum fever, this is a serious infection that occurs this is a serious infection that occurs following the trauma of birth.).following the trauma of birth.).

• In the 1840s, in a Vienna general hospital, In the 1840s, in a Vienna general hospital, Ignaz Semmelweis noted the low mortality Ignaz Semmelweis noted the low mortality in births assisted by midwives as opposed in births assisted by midwives as opposed to those deliveries assisted by obstetritiansto those deliveries assisted by obstetritians

• Investigations determined that the Investigations determined that the contaminating source resulting in much of contaminating source resulting in much of the septicemia in mothers and infants was the septicemia in mothers and infants was in actuality coming from the contaminated in actuality coming from the contaminated hands of the physicians.hands of the physicians.

What outcome do you think What outcome do you think resulted from this increase resulted from this increase

in puerperal infection?in puerperal infection?

…… It made the It made the healthcare system look healthcare system look at what should change at what should change

in order to decrease the in order to decrease the rate of infection.rate of infection.

• Until the early 20th century, Until the early 20th century, newborns remained with their newborns remained with their mothers after the hospital birth. mothers after the hospital birth.

• Soon problems such as severe Soon problems such as severe diarrhea, scarlet fever, diptheria diarrhea, scarlet fever, diptheria and other communicable and other communicable diseases began to result in a diseases began to result in a large number of maternal and large number of maternal and infant deaths. infant deaths.

•To decrease the incidence of To decrease the incidence of these communicable diseases, these communicable diseases, the concept of the "the concept of the "newborn newborn nurserynursery" was realized. " was realized.

•This separation of newborn and This separation of newborn and mother, and especially those mother, and especially those visitors from outside the hospital visitors from outside the hospital setting was instituted with the setting was instituted with the hopes of preventing the spread hopes of preventing the spread of infection of infection

• By the mid 20th century, most women had their By the mid 20th century, most women had their babies in hospitalsbabies in hospitals. Labor and delivery in hospitals . Labor and delivery in hospitals continued to be treated as if it were a medical problem continued to be treated as if it were a medical problem treated solely by the obstetrician and hospitals staff. treated solely by the obstetrician and hospitals staff.

• Frequently mothers were Frequently mothers were separated from their separated from their babiesbabies for hours after birth and they were kept in the for hours after birth and they were kept in the nurseries except when they were scheduled to be fed. nurseries except when they were scheduled to be fed. Everything was very routine. Everything was very routine.

• VisitorsVisitors, including the father in the beginning, were , including the father in the beginning, were not allowednot allowed in the rooms when the baby was with the in the rooms when the baby was with the mother. Later when fathers were allowed in, they had mother. Later when fathers were allowed in, they had to wear gowns, masks and gloves to prevent exposing to wear gowns, masks and gloves to prevent exposing the baby to the germs from outside the wards. the baby to the germs from outside the wards.

• Postpartum days lasted about 10 daysPostpartum days lasted about 10 days and the and the mother was frequently on complete mother was frequently on complete bedrestbedrest. There . There was little, if any, teaching at that time given to the was little, if any, teaching at that time given to the mother about her care or that of her infant. mother about her care or that of her infant.

Some other early events:Some other early events:• 1700s English physicians W. Smellie and W. 1700s English physicians W. Smellie and W.

Hunter first described the mechanisms of labor Hunter first described the mechanisms of labor and also introduced forceps delivery. and also introduced forceps delivery.

• In 1762, W. Shippen established a school for In 1762, W. Shippen established a school for midwifery in Philadelphia which took men and midwifery in Philadelphia which took men and women applicants.women applicants.

• Also in the mid 1800s, A young English Also in the mid 1800s, A young English physucian, James Simpson , was experimenting physucian, James Simpson , was experimenting with a new chemical that when inhaled would with a new chemical that when inhaled would decrease the pain of childbirth. The use of this decrease the pain of childbirth. The use of this new drug, chloroform , was highly questioned new drug, chloroform , was highly questioned until it was used by Queen Victoria during the until it was used by Queen Victoria during the birth of her son, Prince Leopold, in 1853. birth of her son, Prince Leopold, in 1853.

• Mary Breckinridge was considered Mary Breckinridge was considered the first pioner of the first pioner of midwiferymidwifery in the in the US. Initially, she founded the US. Initially, she founded the Frontier Nursing Service (FNS) in Frontier Nursing Service (FNS) in Kentucky in the early 1920s Kentucky in the early 1920s traveling by horseback to families traveling by horseback to families who were isolated in areas high in who were isolated in areas high in the Appalachian mountains. the Appalachian mountains.

• Advocates for changes in childbirth Advocates for changes in childbirth techniques and including the family in this techniques and including the family in this process were French obstetrician process were French obstetrician

Dr. Dr. Ferdinand LamazeFerdinand Lamaze (early 1950s (early 1950s developed a method of psychoprophylaxis developed a method of psychoprophylaxis in childbirth, emphasizing pain in childbirth, emphasizing pain management through relaxation and management through relaxation and breathing exercises), Grantly Dick-Read breathing exercises), Grantly Dick-Read (an English obstetrician who advocated (an English obstetrician who advocated painless, natural childbirth), Arnold painless, natural childbirth), Arnold Gessell (child develpmental theorist Gessell (child develpmental theorist supported rooming-in for baby and supported rooming-in for baby and mother), Robert Bradley (in the late 1940 mother), Robert Bradley (in the late 1940 - advocated Natural Chilbirth)and John - advocated Natural Chilbirth)and John Bowlby (a psychiatrist known for his Bowlby (a psychiatrist known for his development of Attachment Theory and development of Attachment Theory and described the tragic affects of maternal described the tragic affects of maternal deprivation). deprivation).

• In the late In the late 1950s, the first 1950s, the first family-centered carefamily-centered care was was evident in the Family Centered evident in the Family Centered Maternity Care Program which Maternity Care Program which was established by St. Mary's was established by St. Mary's Hospital in Evansville, Indiana. Hospital in Evansville, Indiana.

• The concept described a The concept described a hospital that could provide hospital that could provide both professional services to both professional services to the father, mother and infant the father, mother and infant and a home-like environment and a home-like environment that would enhance the quality that would enhance the quality of the family.of the family.

INOVATIONSINOVATIONS

• By the By the 1960s1960s, consumers, feminists and self-, consumers, feminists and self-help groups made people look at childcare help groups made people look at childcare and medical management more closely. and medical management more closely. Couples began demanding assistance in Couples began demanding assistance in childbirth and not control by their physicians childbirth and not control by their physicians and nurses. They searched for alternatives to and nurses. They searched for alternatives to traditional management including using traditional management including using midwives and having homebirths. The health midwives and having homebirths. The health care system responded positively to care system responded positively to consumers’ demands by modifying hospital consumers’ demands by modifying hospital practices and policies, and offering practices and policies, and offering alternatives to conventional childbirth. alternatives to conventional childbirth.

• Today, the focus is on the family. No Today, the focus is on the family. No longer just bystanders, fathers now are longer just bystanders, fathers now are active participants in their children's active participants in their children's births. Fathers can even remain in most births. Fathers can even remain in most hospitals if a Cesarean Section is planned.hospitals if a Cesarean Section is planned.

• Analgesics and anesthetics are Analgesics and anesthetics are administered if needed, monitored closely administered if needed, monitored closely and keep to a minimum. and keep to a minimum.

• Alternate methods of relieving pain Alternate methods of relieving pain though the use of patterned breathing though the use of patterned breathing (Lamaze Childbirth), hypnosis and (Lamaze Childbirth), hypnosis and relaxation exercises (Grantly-Dick Read relaxation exercises (Grantly-Dick Read Method) are utilized. Method) are utilized.

FAMILYFAMILY&&

STATISTICSSTATISTICS

STATISTICAL TERMSSTATISTICAL TERMS• The health care system depends on The health care system depends on statisticsstatistics

(collection and analysis of pertinent numerical data) to (collection and analysis of pertinent numerical data) to assist in perfecting client needs, determining how to assist in perfecting client needs, determining how to allocate resources and evaluating effectiveness of allocate resources and evaluating effectiveness of interventions and treatments. interventions and treatments.

• Two types are Two types are descriptivedescriptive (summarizing data/facts) and (summarizing data/facts) and inferentialinferential statistics (enable investigators to draw statistics (enable investigators to draw conclusions or inferences in a population and generate conclusions or inferences in a population and generate theories). theories).

• In maternity, statistical samples of pregnant women In maternity, statistical samples of pregnant women help us to determine whether the findings are related help us to determine whether the findings are related to to time frame of prenatal care, maternal nutrition, use time frame of prenatal care, maternal nutrition, use of fetal monitoring or other factors that can be of fetal monitoring or other factors that can be associated with maternal-fetal survival.associated with maternal-fetal survival. Statistical Statistical theories applied to nursing can result in changes theories applied to nursing can result in changes contributing to better health care and outcomes for the contributing to better health care and outcomes for the client.client.

Implications For NursingImplications For Nursing• Use of the nursing process applied to statistics to Use of the nursing process applied to statistics to

determine populations at risk, establish a data determine populations at risk, establish a data base for different client populations, evaluate the base for different client populations, evaluate the success of specific nursing interventions and success of specific nursing interventions and determine priorities.determine priorities.

• ----- ----- Birth RateBirth Rate is the number of live births per is the number of live births per 1000 in the general population.1000 in the general population.

• ----- ----- Birth WeightsBirth Weights are collected as inferential are collected as inferential statistics to determine factors that affect weights statistics to determine factors that affect weights in various age and racial groups (weight below in various age and racial groups (weight below 5lbs is frequently associated with prematurity or 5lbs is frequently associated with prematurity or small for gestational age (SGA) infantssmall for gestational age (SGA) infants. .

THE END!THE END!

….. Fetal Circulation next!….. Fetal Circulation next!