Health Promotion and Its Necessity for Nursing Specialty of Maternity

“Because sanitation has so many effects across all aspects of development – it affects education, it affects health, it affects maternal mortality and infant mortality, it affects labor – it’s all these things, so it becomes a political football. Nobody has full responsibility.”

~ Rose George

Introduction

As the quote above highlights, health promotion may be one of the most important aspects of health care across all types of practice, specialties, and the work of individual practitioners. Sanitation may just be a part of health promotion, but the quote highlights a crucial aspect of the role of nurses in any specialty: promoting healthy practices can make a huge difference in the health outcome of patients. This is apparent in a wide range of specialty practices within nursing, but this short discussion paper and review of literature assesses the importance of health promotion within the specialty of maternity (also sometimes called obstetrics-pediatrics). In order to adequately approach this topic, the discussion paper takes the question of health promotion within maternity as a specialty in three steps. First, the review of literature examines maternity as a nursing specialty, including the role of the nurse within the specialty, the history of the specialty, and the future of nursing within maternity. Second, the paper turns to health promotion as a whole, discussing the definition of health promotion, the role of health promotion in the Canadian healthcare system, and the nursing role in health promotion. Finally, the paper connects these two concepts to discuss how health promotion is linked with maternity as a specialty practice – this includes an evidence-based article discussing the effectiveness of health promotion and intervention. While this is not an exhaustive account of health promotion in maternity care, let alone in nursing care as a whole, the literature review provides key insights for practitioners looking for validation that health promotion in their role is a needed function.

Literature Review

Maternity as a Nursing Specialty

First of all, it is important to understand how maternity fits within nursing as a whole. The care for pregnant women is clearly a crucial aspect of nursing, and is therefore considered its own specialty within the field. This section of the review answers what the role of the nurse is within this specialty, who his or her clients are in this role, the rewards and challenges within this specialty, and both the history and future for maternity within nursing. First of all, one academic journal article works as a comparative study of care given by both nurses and physicians during maternity and labor (Johantgen et al., 2012). This article opens with the importance of nursing to maternity: “The care of childbearing women and their newborns is the most common reason for hospitalization in the United States … Although the majority of women and their newborns are healthy with low risk of poor outcomes, obstetrical care in the United States primarily takes place in hospitals with enhanced technology and use of invasive procedures” (JOhantgen et al., 2012, 74). In this way, the role of the nurse within the maternity specialty is both to provide the healthcare that these women need and to work as a personable force.

Nurses can also have the specific role of delivering a baby in the maternity specialty, as midwifery care is an aspect of nursing that can be carried out by those who are certified both as nurses and midwives (Johantgen et al., 2012, 74). With this aspect of the role in mind, the clients of a maternity nurse are pregnant women and even women who wish to become pregnant, from the time of conception all the way up until the child is born. The history of nursing and midwifery related to maternal care has been a slow move toward the prevalence of nurses in being directly involved in births: as of 2009, nearly eight percent of all births are attended by nurse-midwives, which make up the vast majority (94.3%) of births attended by midwives as a whole (Johantgen, 2012, 74). Another aspect of the nursing role in maternity is advocacy; as one journal article states, “Creating woman-centered maternity care meant negotiating tensions and barriers in medically focused maternity settings and look for opportunities for advocacy and woman-empowerment” (Giarratano, 2003, 18). Much of this responsibility falls to nurses and trained midwives.

In this way, nursing in maternity involves a great many rewards and challenges. For instance, the major reward of working within the maternal specialty as a nurse is to see a mother go from being first pregnant to bearing their child, a joy that is unparallel in the world of nursing. In contrast, one of the major challenges with working within this specialty is balancing the type of support to give mothers; Bianchi and Adam (2009) identify these types of support as advocacy, emotional, physical, and instructional support. Much like doctors, nurses must learn how to balance all four of these types of care into one. With this role and the rise of nurse midwives in recent decades, the future of nursing within the specialty of maternity looks like it will continue to both complement and support the role of the physician in maternal care, particularly when it comes to giving birth. Finally, this nursing specialty is recognized by the Canadian Nurses Association (CAN), as the association lists some of the work settings of a certified nurse as family planning clinics, prenatal and well-baby clinics, and maternity wards in hospitals (CAN, 2016).

Health Promotion

The second issue that this review discussion is concerned with is health promotion, at least as far as it concerns nursing practice. As one source states, “Nurses play an important role in promoting public health,” with the traditional focus of health promotion within nursing “on disease prevention and changing the behavior of individuals with respect to their health” (Kemppainen, Tossavainen & Turunen, 2012, 1). In other words, nurses are essentially first responders when it comes to health promotion. Within the Canadian healthcare system, the role of nurses in health promotion is to apply their multi-disciplinary experience and medical knowhow to their interactions with patients. Within a healthcare system as large as that in Canada, this may be more difficult given the organizational and bureaucratic nature of the system, as will be discussed below. However, this does not make the role of a nurse in health promotion any less important and arguably instead makes it more important, since they may be the only contact that patients have with health education.

Connection

The final step in this discussion is to connect the maternity as a nursing specialty with the practices of health promotion described above. Since the role of nurses within the maternity specialty is essentially holistic – meaning it is the responsibility of nurse practitioners to not only ensure the health of the baby but the mother – health promotion should be an integral part of nursing practice within the specialty. As one professional source states, “As a key member of the health care team, the nurse has an important role to play in health promotion and related activities” (NCHK, 2006, 1). In other words, nurses have an integral role in health promotion in maternity cases, just as they do with any medical specialty. Another academic journal concludes, “Although the [nurse] midwife has always had a role in public health, there is now an explicit need for the profession to direct its attention to teenage pregnancy, smoking cessation, drug awareness and domestic violence…much of the role of the [nurse] midwife during pregnancy is in health promotion” (Beldon & Crozier, 2005, 216). The range of responsibility within health promotion during maternity care ranges from the more general, such as the promotion of an adequate transfer of care within healthcare facilities, to the specific, such as encouraging women to quit smoking during pregnancy.

On the more specific side, nurse practitioners can encourage women to take preventative measures for the health of their child. As one source states, “Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, low birthweight, preterm birth and has serious long-term health implications for women and babies” (Lumley et al., 2009, n.p.). Specific interventions that nurses can act upon include “cognitive behavior and motivational interviewing; offering incentives; interventions based on stages of change; giving feedback to the mothers on fetal health status or nicotine by-products measurements; nicotine replacement therapy, bupropion or other medications” (Lumley et al., 2009, n.p.). In this way, encouraging smoking cessation is both one of the most important and most practical steps that a nurse can take toward health promotion within the maternity specialty. More generally, nurses can also engage in health promotion by making a smooth transition from maternity-related health services to child services once the child is born. One empirical study found issues with this transfer of care, with key problems including “communication between professionals and services and transfer of client information, issues related to staff shortages, early maternity discharge, limited interface between private and public health systems and tension around role boundaries” (Psaila et al., 2014, n.p.). If it is a nurse’s role to ensure the holistic health of both mother and child, then it is also the role of the nurse to advocate for the continued health of the mother and child after they leave his or her direct care. The two articles discussed above are just a couple of examples of evidenced-based resources that can provide nurses with specific and practicable resources for engaging in health promotion within the maternity specialty.

Conclusion

The discussion above has discussed health promotion within the nursing specialty of maternity in three specific steps: first by defining the specialty itself, second by addressing health promotion as a whole, and finally by connecting the two preceding discussions in order to address how nurses can enact health promotion within the specialty of maternity. Overall, the discussion has shown that health promotion should be considered one of the most important responsibilities of a maternity nurse or midwife, as it has a direct impact on both mother and child. While this discussion is not exhaustive, the evidence-based articles presented above provide a good starting point for any nurse.