Chapter 1:
Perspectives on Maternal and Child
Health Care
Historical Development: Maternal and
Newborn Health and Health Care
• Colonial America: women anxious about pregnancy
and feared death of newborn
• Early 1900s: physician-assisted births; midwives for
those who could not afford a doctor
• 1950s: introduction of natural childbirth practices
• Current: return of midwives and doulas; childbirth
choices based on what works best for mother, child,
and family
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Historical Development: Child Health and
Child Health Care
• 19th century
– Immigration led to increase in infectious
diseases and epidemics
– Public health efforts for safe milk supply and
compulsory vaccination programs
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Historical Development: Child Health and
Child Health Care (cont.)
• 20th century through 21st century
– Urban public health improvements → safer cities
– Decreased threat of childhood diseases
– Unintentional injuries surpassing disease as
leading cause of death for children >age 1
– Technologic advances → increase survival rates
but with chronic disabilities; earlier diagnosis
and treatment
–
National and international organizations for
children’s rights
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Evolution of Maternal and Newborn
Nursing
• Prior to World War II: hospitals for childbirth
• Shift in focus of care to teaching mothers about selfcare and infant care
• Breast-feeding and rooming-in
• 1960s‒1970s: home births, prepared childbirth,
father involvement, and nurse midwives
• Current practice: complex with increased
technology, threats of litigation, care under time,
and economic restraints
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Evolution of Pediatric Nursing
• 1870: first pediatric professorship to Abraham Jacobi
(father of pediatrics)
• Early 1900s
– Lillian Wald and Henry Street Settlement
– Nursing in public schools (1902)—Lina Rogers the
first full-time public school nurse
– First professional course in pediatric nursing at
Teachers’ College of Columbia University
• 1960s: nurse practitioner role
• 1980s: care emphasis on quality outcomes and cost
containment; development of maternal–child health
standards
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Question
Is the following statement True or False?
Natural childbirth classes were introduced in the early
1900s.
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Answer
False.
Natural childbirth practices were introduced in the
1950s.
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Health Status
• Evolution in the definition of health from the absence of
disease, measured by monitoring mortality and
morbidity, to a state of complete physical, mental, and
social well-being
• Mortality: number of people who have died over a
specific period
• Maternal mortality rate: annual number of deaths
from any cause during pregnancy or within 42 days
of termination/100,000 live births
– Rates for African American women higher than
any other ethnic group
– U.S. ranking: 50th
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Healthy People 2020
• Emphasis on health promotion and disease prevention
• Goals
– General health status
– Health-related quality of life and well-being
– Determinants of health
– Disparities
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Health Status (cont.)
• Fetal mortality rate: number of fetal deaths (20
weeks or older)/1,000 live births
– Maternal factors: malnutrition, disease, preterm
cervical dilation
– Fetal factors: chromosomal abnormalities, poor
placental attachment
– Major but often overlooked public health
problem
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Health Status (cont.)
• Neonatal mortality rate: number of infant deaths (in
first 28 days)/1,000 live births
– U.S. ranking: 41st in world
• Infant mortality rate: number of infant deaths (in
first 12 months)/1,000 live births
– U.S. ranking: 41st among industrialized nations
– Congenital anomalies: leading cause
– Low birth weight and prematurity: significant
predictors of infant mortality
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Health Status (cont.)
• Childhood mortality rate: number of deaths/100,000
population in children 1 to 14 years of age
– Leading cause
• Ages 1 to 4: unintentional injuries, then
congenital malformations
• Ages 5 to 14: unintentional injuries, then
cancer
– Other causes: suicide, homicide, diseases of the
heart, influenza, and pneumonia
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Health Status (cont.)
• Morbidity
– Measure of prevalence of specific illness in a
population over a given time; rates per 1,000
population
– Difficulty in defining and obtaining date
– Women’s health indicators
• Cardiovascular disease as the #1 cause of
death in women
• Cancer as the second leading cause of death
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Health Status (cont.)
• Childhood morbidity
– Key issues endangering children’s health:
obesity, environmental toxins, allergies, drug
abuse, child abuse and neglect, and mental
health problems
– Factors increasing morbidity: homelessness,
poverty, low birth weight, chronic health
disorders, foreign-born adoptions, day care
attendance, and barriers to health care
– Degree of disability most important aspect,
measured as number of days missed from school
or confined to bed
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Factors Affecting Maternal and Child
Health
• Family
• Genetics
• Society
• Culture
• Health status
• Lifestyle
• Access to health care
• Improvement diagnosis and treatments
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Positive or Negative Affects On Person
• Positively: promoting healthy growth and development
• Negatively: increasing the person’s health risks
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Factors Affecting Maternal and Child
Health: Family
• Family
– Definitions changing over time
– U.S. Census Bureau definition: a group of two or
more persons related by birth, marriage, or
adoption and living together
• Family theories and models
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Factors Affecting Maternal and Child
Health: Family (cont.)
• Family structure
– Organization of the family unit
– Members gained or lost through various events
– Traditional nuclear family no longer considered
the dominant family structure
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Question
Is the following statement True or False?
The definition of family and its structure have
remained fairly constant over the years.
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Answer
False.
The definition of family has changed over time, as has
the typical family structure. The traditional nuclear
family is no longer considered the dominant family
structure in today’s society.
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Factors Affecting Maternal and Child
Health: Family (cont.)
• Family roles and functions: providing physical and
emotional care, imparting rules and expected
behaviors of society through teaching and discipline
• Caregiver–child interaction: crucial to survival and
healthy development
• Parental roles: nurturer, provider, decision maker,
financial manager, problem solver, health manager,
gatekeeper
• Parenting styles: authoritarian, authoritative,
permissive, and uninvolved or rejecting-neglecting
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Factors Affecting Maternal and Child
Health: Family (cont.)
• Discipline: increasing desired behaviors and
decreasing or eliminating undesirable behaviors
• Strategies for effective discipline
– Positive, supportive, nurturing caregiver–child
relationship
– Positive reinforcement to increase desirable
behaviors
– Extinction or punishment to reduce or eliminate
undesirable behaviors
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Factors Affecting Maternal and Child
Health: Genetics
• Study of heredity and its variations
• Gender: established when sex chromosomes join
– Influence on physical characteristics, personal
attributes, and behaviors
– Some diseases more prevalent in a specific
gender
• Race: physical features distinguishing members of
particular group; some variations normal in a race
but considered a disorder in other races
• Temperament: child’s interaction with environment;
in turn has influence on others’ response
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Factors Affecting Maternal and Child
Health: Society
• Social roles: important for developing self-concept
• Socioeconomic status: relative position in society
(economic, occupational, and educational levels)
– Poverty
– Homelessness
• Causes: poverty and lack of available housing
• Negative impact on health and well-being
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Factors Affecting Maternal and Child
Health: Society (cont.)
• Media: images and information not always in
person’s best interest, such as risk-taking
behaviors and online threats (refer to Teaching
Guidelines 1.2)
• Violence: intimate partner violence, youth
violence, violent crimes, and school violence
• Community: schools and other community
centers, peer groups
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Factors Affecting Maternal and Child
Health: Culture
• Worldview integrating beliefs, values, language,
time, personal space, and view of the world shaping
a person’s actions and behaviors (refer to Table 1.4)
– Enculturation
– Cultural competence
• Cultural groups: sharing a commonality; typically
dominant and minority groups
– Ethnicity and ethnocentrism, leading to
stereotyping and labeling
– Cultural health practices
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Factors Affecting Maternal and Child
Health: Culture (cont.)
• Cultural groups (cont.)
– Changing cultural demographics: Hispanics as the
fastest growing population group followed by Asian
population
– Immigration due to employment and economic
opportunities, expanded human rights, educational
opportunities, and other types of freedoms and
opportunities
– Spirituality (belief in something greater than oneself
and faith affirming life positively) and religion
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Factors Affecting Maternal and Child
Health: Health Status and Lifestyle
• Developmental level and disease distribution:
variable with age
• Nutrition: deficiencies or excesses; childhood
obesity epidemic
• Lifestyle choices: exercise; use of tobacco, drugs, or
alcohol
• Environmental exposure: pollution, water or food
contamination
• Stress and coping: disasters, crises, inadequate
finances, inadequate support systems, violence,
normal problems with growth and development
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Question
Is the following statement True or False?
Ethnicity and culture are interchangeable terms.
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Answer
False.
Although the term ethnicity may be used
synonymously with culture, it is not the same.
Ethnicity refers to group membership by virtue of a
common ancestry. It is sometimes seen as the
classification of basic groups or divisions
differentiated by customs, characteristics, language,
or other similar distinguishing factors.
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Factors Affecting Maternal and Child
Health: Access to Health Care
• Continued change and evolution of health care
system delivery and financing
– Provision of health care within a limited resource
environment and access to services
– Health care insurance reimbursement
• Preventive care focus: anticipatory guidance and
education
• Continuum of care emphasis: provision of more
efficient and effective services
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Factors Affecting Maternal and Child Health:
Improvements in Diagnosis and Treatment
• Impact of technology and biomedicine leading to
diseases being diagnosed and treated earlier
• People now surviving situations that would have been
fatal, living beyond life expectancy for the illness or
functioning with chronic disabilities
• Nurses caring for clients at all stages along the health–
illness continuum
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Factors Affecting Maternal and Child Health Care:
Empowerment of Health Care Consumers
• Increase in responsibility by individuals and families
for their own health
• Family desire for information and participation in
decision-making process
• Respect for family’s views and concerns; addressing
issues and concerns; regard for client, partner, and
parents as important participants
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Barriers to Health Care
• Finances: limited or no health insurance; poverty
• Sociocultural barriers: lack of transportation; need
for both parents to work; knowledge, language, or
spiritual barriers
• Health care delivery system: cost containment
issues with insurance plans; earlier discharge;
possible limits for specialty care; clinic hours;
negative attitudes toward poor or culturally diverse
families by some health care providers
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Legal and Ethical Issues in Maternal and
Child Health Care
• Abortion: legal, social, and political issue; nurses
struggling with personal beliefs and professional
duty
• Substance abuse: fetal injury if woman is pregnant;
possible charges of negligence and child
endangerment
• Intrauterine therapy: medical technology versus
nature; better quality of life via surgical intervention
• Maternal–fetal conflict: beneficence and autonomy
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Legal and Ethical Issues in Maternal and
Child Health Care (cont.)
• Stem cell research and use of embryonic stem cells
• Umbilical cord blood banking: public versus private
banks
– Issue of consent—free versus coerced
– Ownership of stored umbilical cord
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Legal and Ethical Issues in Maternal and
Child Health Care (cont.)
• Informed consent
– Age of majority—18 years
– Parent or legal guardian for minors
– Nurse’s responsibility
• Ensuring form completed with signatures
• Serving as witness to signature process
• Determining client and family understanding
of what they are signing through appropriate
questions
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Legal and Ethical Issues in Maternal and
Child Health Care: Informed Consent
• Special situations with informed consent
– Parent unavailable, person in charge with
written permission from parent for emergency
treatment
– Verbal consent via telephone for emergency
– Emergency or urgent situations
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Legal and Ethical Issues in Maternal and Child
Health Care: Informed Consent (cont.)
• Exceptions to parental consent
– Mature minor (over age 14)
– Emancipated minor
• Armed services member
• Marriage or college attendance
• Court-determined emancipation
• Financial independence living apart from
parents
• Pregnancy; mother <18 years; runaway
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Legal and Ethical Issues in Maternal and
Child Health Care
• Assent: child’s participation in decision-making process
about health care
– Dependent on child’s developmental level, maturity,
and psychological state
– American Academy of Pediatrics recommendations
• Child with intellectual age of 7 years or older
competent to understand participation in research
and provide assent
• Dissent: binding if given by an adolescent 13 to 17 years
of age
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Legal and Ethical Issues in Maternal and
Child Health Care (cont.)
• Refusal of medical treatment
– All clients with the right to refuse medical treatment
– Parental autonomy for child as fundamental—parents
acting in the best interests of the child
– Possible conflicts related to religious or cultural
beliefs, child’s quality of life
– Sometimes considered a form of child neglect; use of
judicial system to advocate for child—parens patriae
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Question
Which age is considered the age of majority?
a. 14
b. 16
c. 18
d. 21
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Answer
c. 18
The age of majority or the age at which an individual
can legally provide consent for health care is 18
years of age.
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Legal and Ethical Issues in Maternal and
Child Health Care (cont.)
• Advance directives
– Do not resuscitate orders
– Baby Doe regulations
• Client’s rights
– Pregnancy—two rights: mother and fetus
– Child’s Bill of Rights
• Confidentiality: HIPAA; electronic transmission of
health information
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Legal and Ethical Issues in Maternal and
Child Health Care (cont.)
• Confidentiality
– HIPAA
– Exceptions: mandatory reporting for abuse,
injuries due to weapons or criminal acts,
infectious diseases, threat to an identifiable
person
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