Trends in Midwifery

TRENDS IN THE MIDWIFERY AND OBSTETRICAL NURSING

Changes in social structure, variations in family lifestyle

• It has altered health care priorities for maternal and child health nurses. Today, client advocacy, an increased focus on health education, and new nursing roles are ways in which nurses have adapted to these changes.

Cost Containment

• Cost containment refers to systems of health care delivery that focus on reducing the cost of health care by closely monitoring the cost of personnel, use and brands of supplies, length of hospital stays, number of procedures carried out, and number of referrals requested.

Expanded roles for nurses

• Increasing nursing responsibility for assessment and professional judgment and providing expanded roles for nurse practitioners, such as the nurse-midwife.

Family Centered Care

• More natural childbirth environment where partners, family members may remain in a homelike environment, and participate in the childbirth experience
• By adopting a view of pregnancy, childbirth as a family event, nurses can be instrumental in including family members in care and consult family members about a plan of care and provide clear health teaching so that family members can monitor their own care

Access to Health Care

• Strong predictors of access to quality health care include having health insurance, a higher income level, and a regular primary care provider or other source of ongoing health care. Use of clinical preventive services, such as early prenatal care, can serve as indicators of access to quality health care services. The objectives selected to measure progress in this area are:
• Increase the proportion of persons with health insurance.
• Increase the proportion of persons who have a specific source of ongoing care.
• Increase the proportion of pregnant women who begin prenatal care in the first trimester of pregnancy

Shortening Hospital Stays

• Women who have begun preterm labor stay in the hospital while labor is halted and then are allowed to return home on medication with continued monitoring.
• Routine hospital stay for mothers and newborns after an uncomplicated birth is now 2 days or less.
• Short-term hospital stays require intensive health teaching by the nursing staff and follow-up by home care or community health nurses.

Increased Use of Alternative Treatment Modalities

• There is a growing tendency to consult alternative forms of therapy, such as acupuncture or therapeutic touch, in addition to, or instead of, traditional health care providers. Nurses have an increasing obligation to be aware of complementary or alternative therapies.

Increased Use of Technology

• The field of assisted reproduction (e.g., in vitro fertilization), seeking information on the Internet, and monitoring fetal heart rates by Doppler ultra sonography are other examples.
• In addition to learning these technologies, maternal and child health nurses must be able to explain their use and their advantages to clients. Otherwise, clients may find new technologies more frightening than helpful to them.