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GYNECOLOGICAL NURSING
I. INTRODUCTION
The study of child bearing is the study of a process that has taken place throughout human
history. Child bearing is normal and natural occurrence. Maternity nursing focuses on the
care of the child bearing women and their families through all stages of pregnancy and
childbirth, as well as the first 6 weeks after birth. The Latin word obstetrix means midwife,
one who assist the woman during childbirth. ‘Mid’ means ‘with’, ‘wif’ means ‘woman’. The
Greek word ‘Gyno’ means ‘woman’ and ‘Logia’ means ‘study’, study of women or the
science of women.
II. DEFINITIONS
Obstetrics :
Obstetrics is the branch of medical science concerned with pregnancy, childbirth and the
postpartum period
Gynaecology :
Gynecology is the branch of medicine that deals with the diseases and routine physical care
of the reproductive system of women
Midwife :
Midwifery :
Midwifery is the art and science of caring for women undergoing normal pregnancy, labor
and the period following child birth.
1. Obstetrix and midwifery are two distinct, but overlapping fields of medical knowledge
and practice with focus on care of pregnant and labouring woman
2. Obstetrics focus on problems and difficulties of pregnancy and labor. Midwifery
emphasises a normalcy of pregnancy while acknowledging the vulnerability associated
with the reproductive process
3. Midwifery arises from the social and physical support women traditionally given to one
another, while obstetrics developed gradually as a combination of medical tradition
practiced in ancient Greece and Rom and the rise of modern anatomical research and
surgery developed in pre-modern Europe
4. In the 21st century, obstetrics is increasingly technological in its orientation and focussed
on the pathology of pregnancy while midwifery continues to maintain its emphasis on the
normalcy of pregnancy and the importance of providing pregnant and labouring woman
with practical and emotional support
1. Partnership with the women to promote selfcare and health of the mothers, infants and
families
2. Respect for human dignity and for woman as person with full human rights; advocacy for
woman so that their voices are heard
3. Cultural sensitivity, including working with woman and health care providers to
overcome those cultural practices that harm women and babies
4. A focus on health promotion and disease prevention that views pregnancy as a normal
life event
In the changing scenario of health care system of today’s world, the trends in midwifery and
obstetrical nursing are also changing
1. Pre-conceptional care; to help the mother and family make the transition to
parenthood is the best way possible
2. To prepare and educate all expectant mothers
3. To provide care of woman during three trimesters of pregnancy
4. To support and protect physiological processes and healthy outcomes
5. To provide education about the care of the child and about their growth and
development
The maternal and child population is constantly changing along with changes in social
structure, variations in family life style, increased health care costs, improvement of medical
technology etc.
1. Changes in social structure and variations in family life style : more single parent
families, high cost of having and rising children, expense more than family income,
more women work outside the home etc has impact in midwifery
2. Technological advances : As the technology has revolutionized and increasingly
sophisticated in today’s world, it has become necessary for the nursing personnel to
have thorough knowledge of the new technology being used. Due to this
advancement, ‘the hands on care’ of the client is reduced, so also the qualities of
nursing care. Today, fetal monitoring has progressed from the use of fetoscope to
electronic fetal monitors.
3. Increase in high risk pregnancies : due to life style changes, pollution,
communicable diseases etc
4. Increased cost of high tech-care : As the high and sophisticated technology is being
introduced into today’s world, the cost are also increasing for the procedures such as
USG, fetal monitoring etc, the couple has to pay good amount of money
5. Changing patterns of child birth : As the early marriage practices still continue, the
younger mothers face increased risk of complications during pregnancy. Due to
increasing number of working women until they are in thirties, they also face similar
complications during pregnancy
6. Perinatal risk factors : The problem of society are reflected in risks; among them are
AIDS in mothers and newborns. Low Birth Weight account for about 30-40% of live
births in developing countries. Maternal age is also a risk factor.
7. Family centered care : Maternity care today has enhanced to family centered care.
Interactions and bonding takes high priotity and much anticipatory counselling is
offered
8. Families are not as extended : nowadays, fewer family members are there as support
people in a time of crisis, therefore nurses need to care for family
9. Increasing access for health care : people have increased access for health care even
from very early stage of pregnancy, from preconception stage itself
10. Increased use of alternative treatment modalities : hence nurses have to be aware
of such therapies
11. Increasing alternative settings and style of health care : partners and family
members are invited to stay with the woman, providing natural childbirth environment
in labor room
12. Increased emphasis on preventive care : focussing more on prevention aspects
13. Rising caesarean birth rates : USG has come for prenatal monitoring and evaluation
for fetal condition and thus increased rate of caesarean section immediately if there is
any variations from normal condition
14. Early discharge : in earlier days, women were hospitalised for longer duration and
physical activity was increased very gradually. Now however the health care
personnel have realized the importance of early return to the normal activities, thus
shortened the hospital stay also.
15. Role of fathers : with increased societal emphasis on shared parenting and the
recognition of parental bonding. Many fathers are active in care giving and enjoy the
closeness it brings.
16. Water birth : this method promotes relaxation of abdominal and uterine muscles, and
warmth of water cause less discomfort. Also the duration of first stage of labor can be
shortened
17. Expanded roles of nurses : nurse midwife, nurse practitioner etc
18. Midwifery as a separate profession : it has a body of knowledge and many countries
have taken midwifery as a separate profession like nursing profession
Ethics is a set of moral principles that govern a person’s behaviour or the conducting of an
activity. It deals with good and bad behaviour. Application of ethical principles to health care
is called bioethics.
Ethical principles
The goal of ethical midwifery is to do the right thing for the right reason, knowing how to
make good decisions as well as why there decisions were made constitutes ethical midwifery
practice
Beneficence : act in the best interest of the patient. It requires one to act in a way that
is expected to produce the greater balance of benefits over harms
Non maleficence : it means that health professionals should prevent causing harm
Autonomy : acknowledge and carry out the value based preferences of patient, give
respect to the rights of the individual (informed consent)
Justice : show fairness towards the patients and treat them impartially. No unfair
discriminations and medical benefits should be properly weighed.
Fidelity : show faithfulness to the patients and gain the belief of patients. Practicing
faithfully within the boundaries of the state and law
Veracity : telling the truth. Be truthful towards the patient and give them accurate
information
Confidentiality : it is the state of being confidential, and it is the basis of trust between
health personnel and patient
Patient rights
The right to be treated with respect and dignity without reference to age, marital
status, socio-economic status, ethnicity, nationality, political, physical, mental or
religious status
The right to use informed choice in care, by having access to relevant information
upon which decisions are made
The right to freedom from coercion in decision making
The right to accept or refuse treatment
The right to full disclosure of financial factors involved in her care
The right to know who will participate in her care and obtain additional consultation
of her choice
The right to not to be abandoned, neglected or discharged room care without an
opportunity to find other health care provider
The right to absolute privacy except where this right is prevented by law
A midwife provide care to a woman and her family in all crucial times such as preconception
care, care during antenatal, intranatal as well as postnatal period
Direct care provider : midwives are the ideal providers of health promotion services
for women, giving direct care according to the needs during antenatal, intranatal and
postnatal periods
Counsellor : giving proper guidance and counselling to support the mother and
family psychologically during the time of stress and difficulty in adaptation
Teacher : nurse should give timely education based on their need, also teaching
regarding pregnancy, labor, physiological changes, pain management, breast feeding,
newborn care, diet, family planning etc
Advocate : encourage client’s awareness, talk about rights and responsibilities of
client, make informed decisions, ensure utilization of health care resources and
convey client’s special needs with the physician (advocate between the client and
health care delivery system)
Clinician : nurse act as clinician by assessing mothers during admission, assessing
fetal wellbeing, deriving history collection, maintain adequate antenatal record during
each visit, performing antenatal, intranatal and postnatal assessment, recording
partograph, initiating breast feeding, assessment of newborn etc
Nurse manager : prioritize the client’s needs, give care with minimum input and
maximum output, coordinate care facilities and maintain midwifery care standards
Nurse researcher : encourage evidence based practice in midwifery, participate and
conduct midwifery research, evaluate the current protocol and recent research
findings for their application in practice
Clinical nurse specialist : is an expert in midwifery who serves as a role model for
excellence in knowledge and clinical practice of midwifery
As a political activist : nurse serves as an active member of professional organization
and implement all governmental programmes for MCH care. Also keeps a track of
current health care policies regarding woman’s health and updated with issues related
to woman’s health.
As a change agent : nurse midwife encourages woman empowerment, stimulates
awareness among women, writing letter to mass media regarding women’s issues and
action taken.
Communicator : midwife act as the link between couple and the doctor,
communicates with the expectant mother regarding various aspects of motherhood,
also informs family members regardingbirth of the child and immediate requirements
after the birth of the child
Supervisor : the midwife make sure that maternity services to the client and family
run effectively and efficiently
Coordinator : the midwife is recognized as a responsible and accountable
professional who works in partnership with women to give the necessary support, care
and advice during pregnancy, labor and postpartum period, to conduct births on the
midwife’s own responsibility and to provide care for the newborn
Evaluator : the midwife is responsible to evaluate the deliverance of high level
continuous midwifery care to the women, then evaluating the satisfaction of the
mother and family
Decision maker : midwife also has involved in shared decision making along with
doctors during antenatal, intranatal and postnatal periods by keeping the mother at the
centre of their care
Recorder and reporter : information recorded by nurse in the patient’s chart gives
valuable data to other health care providers and easy to understand what is going on
with the patient. It is also a legal evidence.