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TRENDS IN MIDWIFERY AND

OBSTETRICAL NURSING
Introduction
The maternal and child population is constantly changing along with change in social
structure variations in family style, increased health care cost, improvement in
medical technology and changing patterns of illness. Some of the social changes that
have occurred in the last 20-30 years have altered health providers.
 Families are smaller in size than in previous decades. Children are more likely to
be born and raised in nontraditional groupings such as:
 Single parent families can be result of unwed parenthood or divorce & mostly
headed by the mother.
 Blended families formed by the marriage of two adult who have children
from previous union.
 An increasing number of mothers work outside the home.
 Abuse is more common than ever before.
 Families are more health conscious than previously.

1. Economic issues and trends

The cost of having and raising children continues to increase faster than family
income. As cost has increased and as moiré women work outside the home, the
number of children in a typical family has decreased. More women of child bearing
age are employed outside the home than ever before. Most commonly they work
because of economic necessity. Single parents are even more likely to experience
difficulty in coping with demands.

2. Trends related to technology

Advance in technology had led to change in every aspect of our lives. It affects us as
individuals families, society or culture and even the approach of child bearing.
Technology allows diagnosing and treating serious deformities and diseases. Specific
areas where advance in technology affect child bearing include fertility concerns,
genetic counseling and antepartum or intra partum diagnostic testing.
Fertility concerns: In the past, conception was a somewhat random event; today
conception can be much better controlled. Pregnancies can be planned, infertile
women or men can be become parents and unwanted pregnancies can be prevented
or terminated. Technology can help women who are unable to conceive have a
child. Procedures such as in vitro fertilization, artificial insemination and surrogate
mother are current options and new techniques under study.
Genetic counseling: Genetic counseling enables to look at the genetic structure of
individuals and predict the like hood of occurrence of gene related disorders.
Before genetic testing was available, a couple essentially took a risk each time
pregnancy occurred.

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 Diagnostic testing: The number and types of diagnostic tests used in medicine and
especially in maternity care have grown dramatically such as ultra sound
examination. The technology helps in early diagnosis and treatment of problems.
3. Demographic issues and trends:
Shift in population distribution occurs as large cities provide the greatest opportunities
and convenience. Therefore they attract more people and most of maternity services
are concentrated in urban areas.
 Availability of maternal care: In cities number of hospitals are staffed and
equipped to provide care to high risk maternity clients. Modern hospital offers
more care for the child bearing women than available in the past. More facilities
today provides some form of family centered care, with birthing rooms that
encourages more supportive family friendly approach to the child birth.
 Increased cultural diversity: New population introduces new concerns in relation
to indigenous infection agents, uncommon diseases & unfamiliar disorders. New
cultures introduce unique beliefs and practices and child birth.
 Vital statistics: Some statistics have the highest level of significance for
identifying trends that will have impact on maternity nursing. The statistics include
birth rates and morbidity rates.
 Maternal mortality: there is reduction in maternal mortality rates due to
improvement in medical management, early detection of disorders and
prevention of complications and better hospital facilities.
 Birth rates: in India the birth rate is increasing. Birth rates also vary
according to age and racial groups.
 Number of low birth weight infants: the number of LBW babies has not
decreased.
 Infant mortality rates: the number of deaths of infants under one year of age
per 1000 live births. To effect change in mortality rate, the focus must shift
from high technology medical interventions to improving access to preventive
care.

4. Trends in health care settings:

 Managed care: is a system of health care delivery that focus on reducing the cost
of health care through close monitoring. Before managed care, health care
insurance paid separately for each procedures or piece of equipment the client
received. Under managed care the agency receive a certain sum of money for the
client care.
 Alternative setting: the alternative system provides families with increase control
in birth experience and options for birth surrounding unavailable in hospital. It also
increase nursing responsibility for assessment and professional judgment and
provides expanded role for nurse practitioner. This promotes a holistic, family
centered approach to maternal and child health care.
 Community based care: A shift in setting care institution to the home has been
occurring. Even child bearing women at risk are cared for in the home.

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 Shortening hospital stay: routine hospitalization for mothers and new born after
an uncomplicated delivery is now 2 days or less. Short term hospitalization
requires intensive health teaching from maternity nurses.

5. Trends of patient involvement, self care and focus on health care:

In the present scenario clients no longer passively accept and comply with the advice
of health care providers, rather they demand information and take advice roles.
Maternity patients are usually well and thus their care focuses on enhancing health
and wellness. Visit to health care providers presents opportunities to address topics
such as nutrition, education, stress management, smoking cessation, alcohol and drug
treatment etc.
6. Other trends:
 Increase in high risk pregnancies: The number of high risk pregnancies has
increased which means that a greater number of women are risk for pregnancy out
comes.
 Escalating drugs used has contributed incidence of prematurity, LBW,
congenital defects, learning disabilities and withdrawal symptoms in infants.
 Alcohol use in pregnancy has been associated with miscarriage, mental
retardation, LBW babies etc.
 The two most frequently reported maternal medical risk factors are
hypertension associated with pregnancy and diabetics.
 High cost of health care: Health care is one of the fastest growing sectors. A shift
in demographic and increased emphasis of high cost technology etc, contribute to
high cost of care.
 Limited access to care: the most significant barrier to assess is the inability to pay.
Lack of transportation and dependent care are other barriers.
 Family centered care: the emphasizes here is on the delivery of professional
health care that fosters family unity while maintaining the physical safety of the
child bearing unit- the mother, father and the infant. The nurses counsels and
educate all age group.
 Labor, delivery, recovery and post partum care (LDRP): LDRP also called single
room maternity care was devised as a replacement for traditional maternity unit. In
it the mother labors, delivers and recovers in the same room and the same bed. The
LDRP has the advantage of providing comprehensive care with single setting.
 Mother baby couplet care: here one nurse care for the post partum mother and her
new born as a single unit. It focuses and adapts to both the physical and
psychological needs of the mother, the family and the neonate and fosters family
unity.
Conclusion
The maternal and child population is constantly changing along with change in social
structure, variation in family style, increased health care cost, improvement in medical
technology and change in pattern of illness. It is important that know about the new
trends in midwifery and obstetrics for better treatment and prevention of diseases.
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