1.3: Standards of Maternal, Newborn, and Gynecologic Nursing Care
By the end of this section, you will be able to:
- Define the patients seeking gynecologic and obstetric care
- Discuss the history of gynecologic and obstetric care in the United States
- Contrast the history of childbirth to contemporary childbirth in the United States
Women’s health care was defined in 1997 by the Expert Panel on Women’s Health of the American Academy of Nursing as health promotion, maintenance, and restoration of physical, psychologic, and social well-being of women throughout the lifespan (Nichols, 2000). Maternal, newborn, and gynecologic nursing has evolved over the last century. Reproductive care became more accessible and persons AFAB fought for equity in health-care research, treatment, and shared decision making. Nurses and nursing organizations supported this evolution in standards for women’s health care.
Who Are the Patients Seeking Gynecologic and Obstetric Care?
People seeking gynecologic and obstetric care can be of any age, race, education level, or marital status. The American College of Obstetricians and Gynecologists (ACOG) suggests persons AFAB see a gynecologic health-care provider between the ages of 13 and 15 to discuss normal hormonal changes and menstrual cycle issues (Cummings, 2022). The American Academy of Pediatrics and ACOG (2017) also suggest that people should see an obstetric health-care provider at or before the 12th week of pregnancy. Older persons AFAB will seek care for menopause and screening exams.
Most OB-GYN patients are cisgender (that is, their gender identity aligns with their sex assigned at birth) and heterosexual. But LGBTQIA+, including transgender, and nonbinary persons can seek care with an OB-GYN provider. In practice, only about 50 percent of transgender men routinely see a gynecologic provider (Aliabadi, 2022). A transgender man is a man who was assigned female at birth. Gynecologic providers can provide testosterone , birth control, STI testing and treatment, Pap smears, breast exam s, and health promotion education (Aliabadi, 2022). Obstetric providers can care for transgender men if they choose to become pregnant and start a family. Nurses can provide education on health-care screening, hormones, support groups, and birth control options, along with the interactions those medications can have when taken with other medications (Hanson & Haddad, 2023). For more information on caring for transgender patients, see Chapter 2 Culturally Competent Nursing Care.
History of Women’s Reproductive Rights in the United States
The history of women’s reproductive rights in the United States began in the 1900s when Margaret Sanger fought for women to have the right to access contraception (Nichols, 2020). This fight for reproductive rights continued in the 1960s and 1970s as The Women’s Health Movement and other activist groups supported the Supreme Court decision of Roe v. Wade , allowing the legalization of abortion (Nichols, 2000), though that ruling was later overturned in June 2022. The common goal of those activists in the 1970s was the demand for improved, nonsexist health care for all women (Nichols, 2000). Activists also advocated for inclusion of persons AFAB in research to provide new treatments, medications, and vaccinations. Consequently, in 2006, the human papillomavirus (HPV) vaccination was produced ( National Institutes of Health [NIH], n.d.-a).
History of Childbirth in the United States
Birth among pioneer women in the 1700s took place in homes and was attended by a woman’s lay female friends and relatives and a midwife or nurse (McCool & Simeone, 2002). Childbirth for the Mohawk and Mohican Indians was more solitary. People of these tribes would go to a secluded place near a stream and prepare a shelter with provisions as they waited for the birth alone (Roy Rosenzweig Center for History and New Media, 2018).
Birth was noninterventional, and maternal deaths during childbirth declined in the 1800s and 1900s; however, when birth moved into hospitals, postpartum infection occurred more often and was traced back to contamination from physicians’ unwashed hands (McCool & Simeone, 2002). In the 1900s, birthing persons who wanted labor pain relief gave birth in hospitals and had an increased risk of dying from infection. Many of the infectious risks were mitigated with the utilization of evidence-based practice and emphasizing hand washing. The transition of birth from home to the hospital changed the focus of supporting the birthing person during unmedicated labor to pain control and disease care (McCool & Simeone, 2002). This medical model is the same model used in most U.S. hospitals today.
Evolution of Maternal Health Care
The Women’s Health Movement helped change childbirth practices in the 1960s and 1970s; it focused on less medical intervention and encouraged husbands or partners to be present during childbirth (Nichols, 2020). This movement was part of the larger women’s movement in the United States (Figure 1.3). During this time, Lamaze International and the International Childbirth Education Association were formed with the goals of advocating for choice during childbirth and preparing parents for birth through education (Nichols, 2000). In the 1980s, many hospitals changed from traditional maternity care to a more family-centered care and began to offer childbirth education classes (Nichols, 2000).
Evolution of Maternal-Newborn Nursing
The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) has been a leader in the evolution of maternal-newborn nursing practices. The organization focuses on promoting diversity in the profession and advocates regarding issues that impact nurses that care for women and newborns while maintaining a commitment to research and education in the field. The mission is to “Empower and support nurses caring for women, newborns, and their families through research, education, and advocacy” (AWHONN, 2021a, para 2). Nichols (2000) described the core concepts in women’s health nursing as:
- recognizing the diversity of women’s health needs
- emphasizing empowerment through informed participation in one’s health care
- acknowledging the importance of research in gender differences in disease and response to drugs
- recognizing the need for a multidisciplinary team approach
- striving for symmetry in provider-patient relationships
- providing access to information
- engaging in shared decision making
- striving for change
Providers caring for women increased in number and demand. Nurses were able to become certified in their respective specialties.
Contemporary Childbirth
When birth moved from home to the hospital setting, those giving birth were no longer supported by grandmothers, sisters, friends, or partners. Instead, they were alone without their partner in an unfamiliar medical space and possibly under the influence of a powerful medication (a mixture of morphine and scopolamine that caused memory loss in the birthing parent and neonatal respiratory depression in the newborn) referred to as “twilight sleep.” The combination of these factors caused birthing patients to feel vulnerable and afraid. Therefore, in the 1960s, childbirth education became a way to empower pregnant persons and prepare them for what to expect in childbirth (Walker et al, 2009).
The Age of First Pregnancy
In the 1970s, the average age of a person’s first pregnancy was 21.4 years, whereas the average age of first pregnancy in 2021 was 27.3 years (CDC, 2002; Schaeffer & Aragao, 2023). Speculation is that people delay pregnancy to stay in the workforce or to attend college. In the 1970s, people had more than three children, while in 2020, the average was two children (Schaeffer & Aragao, 2023).
Moving from the rigidity of the 1950s and 1960s, gender roles have given way to more flexible approaches to parenting. Fathers are more involved in childrearing and household chores, while many mothers hold leadership positions and are the primary breadwinners for their families (Jensen, 2023). Birthing families have become more educated and desire more supportive, family-centered care during labor and birth.
Contemporary childbirth has become more medicalized, as seen in increased labor induction s, planned cesarean birth s, and routine use of medical interventions (Jansen et al., 2013). Some pregnant persons became dissatisfied with this type of pregnancy care, and up to 50 percent of pregnant persons seek adjunct care from complementary medicine practitioners (Steel et al., 2019). Reasons for patients using complementary medicine practitioners include lack of continuity in care provider, lack of empowerment, lack of personal autonomy and decision making, and increased use of medications and interventions in childbirth (Steel et al., 2019). The American College of Obstetricians and Gynecologists (2019a) released a committee opinion regarding approaches to limit interventions during labor and birth. The committee opinion acknowledged that laboring patients who have continuous one-to-one emotional care have improved labor outcomes; routine interventions such as amniotomy, continuous electronic fetal monitoring, and continuous intravenous fluid administration are not necessary for low-risk patients; and birthing facilities should have family-centric interventions, such as clear drapes during a cesarean birth. Contemporary childbirth educators, nurses, and health-care providers are working to improve autonomy and individualized care for the laboring person. For further information on childbirth education , see Chapter 14 Childbirth Education Options.
Family-Centered Care
The set of principles that guide health-care delivery according to the strengths and needs of the person, family, and community, promoting involvement of family in informed decision making is considered family-centered care (Franck & O’Brien, 2019). This model views the birthing parent and infant as a couplet cared for as one unit. Family-centered care can be seen in multiple areas of maternal-child nursing. For example, neonatal intensive care unit s (NICUs) adopted family-centered care and found that by focusing on parent-NICU team communication and education, parents’ stress, anxiety, and depressive symptoms decreased (Franck & O’Brien, 2019). Family-centered cesarean births were introduced to increase maternal satisfaction, breast-feeding initiation, and maternal physical well-being (Schorn et al., 2015). Family-centered cesarean birth includes preparing the laboring person and partner prior to the cesarean, encouraging the birthing parent to bring music of their choice, making sure the support person is present, allowing the birthing person and support person to view the birth, placing the newborn skin-to-skin on the birthing parent, and initiating breastfeeding if possible (Schorn et al., 2015).
Culturally Competent Care
In the United States, maternal, fetal, and infant mortality rates differ greatly among races, with Black people having the highest mortality rates (Hoyert, 2023). Transgender men and nonbinary persons have poorer outcomes than cisgender persons and higher rates of discrimination in the health care system. To address these issues, health-care providers, nurses, and hospitals have adopted standards to improve cultural competence, such as using gender-affirming language, nurse/health-care provider training, and use of the four major components of cultural competence . Cultural sensitivity components consist of awareness of personal bias, attitude of openness to differing views or opinions, knowledge of different cultures, and skills to manage differences effectively (BCT Partners, 2021). You can read more about cultural competence in Chapter 2 Culturally Competent Nursing Care.
The Centers for Disease Control and Prevention (CDC) uses a monitoring system to share and better understand the risk factors for pregnancy-related deaths. Visit the CDC website to review its data on pregnancy-related deaths from 1987 through 2019 and mortality ratio by race/ethnicity from 2017 through 2019.