Health Promotion & Maintenance: Ante/Intra/Postpartum and Newborn Care (OB)

a. Introduction

Antepartum, intrapartum, postpartum, and newborn care are critical elements of obstetric
care that promote and maintain the health and well-being of the mother and fetus/newborn during
pregnancy, childbirth, and after delivery (Jolly et al., 2019). The goal is to guarantee the well-
being and health of the pregnant mother and the baby during the journey. Health promotion and
maintenance refer to interventions/activities that aim to maintain and bolster an individual’s
overall well-being and health through screening and prevention programs, health education, and
lifestyle interventions, such as healthy eating and exercise. Evidence suggests that health
promotion and maintenance are integral to ante/intra/postpartum and newborn care; they can
guarantee the health and well-being of pregnant mother and their newborns. Health promotion
and maintenance can prevent complications and improve outcomes for the mother and child by
identifying and addressing risk factors before, during, and after childbirth. It can improve
outcomes for both the mother and the child, empower women, and lower healthcare costs.
This capstone evidence-based practice paper’s purpose is five-fold: (1) explore the
importance of health promotion & maintenance for ante/intra/postpartum and newborn care, (2)
identify health disparities, inequities, and interventions related to the concepts, (3) examine legal
& ethical considerations and interventions challenges, (4) identify an interdisciplinary team that
will participate in implementing an intervention(s) targeting to improve the health and well-being
of the mother and child, and (5) discuss the quality improvements that will result from health
promotion & maintenance for ante/intra/postpartum and newborn care.

b. Importance

3

For healthcare professionals, especially gynecologists and obstetrics,
ante/intra/postpartum and newborn care are critical areas of practice that require necessary
thinking skills, specialized knowledge, ethical considerations, and interdisciplinary collaboration.
The concepts can equip obstetrics, gynecologists, and other professionals with the technical skills
and expertise to provide adequate care to the mother and child during pregnancy, childbirth, and
after delivery. This knowledge includes understanding newborn care, neonatal resuscitation,
skin-to-skin contact, childbirth practices, ethical decision-making, and pregnancy complications
and solutions, among others. For the mother and child, ante/intra/postpartum and newborn care
can guarantee equity, quality, safety, cost-effectiveness, and better healthcare outcomes.
However, failure to provide antepartum, intrapartum, postpartum, and newborn care can
negatively affect healthcare providers and patients. For gynecologists and obstetrics, a lack of
critical thinking and ethical decision-making skills results in medical errors and other negative
consequences, leading to potential lawsuits, termination, and reputational damage. For mothers,
lack of pre/intra/postpartum can result in complications before, during, and after childbirth, such
as postpartum hemorrhage, pre-eclampsia, gestational diabetes, postpartum depression, and
death. It can affect mother-child bonding, breastfeeding, and the growth and development of the
child. It can also lead to complications like respiratory distress syndrome, neonatal diabetes,
jaundice, and death. In 2017, the World Health Organization estimated that 810 women died
from preventable deaths related to childbirth and pregnancy globally. Another 2.5 million
children are estimated to die annually within the first month of life, while 2.6 million are
stillbirth (World Health Organization, 2017).

c. Healthcare Disparities, Inequities, and Interventions

4
Patient populations that may be negatively affected by the concept include pregnant
women with limited access to prenatal care; women with chronic conditions like heart disease,
hypertension, and diabetes; women with mental health disorders like PTSD, anxiety, and
depression; newborns with medical complications like respiratory distress syndrome and
congenital heart defects; and women with limited social and economic support during
pre/intra/postpartum care. Healthcare resources that can potentially support evidence-based
professional practice related to ante/intra/postpartum and newborn care in the US include the
American College of Obstetricians and Gynecologists (ACOG), the American Academy of
Pediatrics (AAP), the National Institute of Child Health and Human Development (NICHD), and
the Centers for Disease Control and Prevention (CDC), the Code of Ethics for Nurses, among
others.
Racial/ethnic disparities in infant and maternal health exist in the United States. In 2022,
pregnancy-related deaths among American Indian and Alaska Native (AIAN) and African
American women were nearly three to two times higher, respectively, than White women (26.2
and 41.4 vs. 13.7 per 100,000). AIAN, Native Hawaiian and Other Pacific Islander (NHOPI),
and African American also have reportedly higher percentages of low birthweight births and
preterm births for which they obtained no or late prenatal care than White women (Hill, Artiga,
& Ranji, 2022). Healthcare promotion and maintenance is one potential solution to address racial
healthcare disparities.
Three evidence-based practice interventions include (1) increasing access to
pre/intra/postpartum and newborn care services for racial minorities, (2) addressing implicit bias
and discrimination in healthcare, and (3) promoting health and increasing awareness through
education. Health promotion and increasing awareness of the best available resources and

5
services for pre/intra/postpartum and newborn care should be prioritized. Research has shown
that low health literacy is among the primary reasons women from racial minorities never seek
appropriate maternal and childcare support services during and after pregnancy (Lee et al.,
2018). Potential patient education considerations include informing mothers about the
importance of pre/intra/postpartum and newborn care, including attending prenatal care,
exercise, proper nutrition, signs of labor and delivery, breastfeeding, and pain management. The
second educational consideration involves enlightening mothers about resources and services
available in the community, including insurance, prenatal and antenatal care, emotional recovery,
postpartum nutrition, and care, among others.

d. Legal & Ethical Considerations and Intervention Challenges
One potential ethical issue concerning pre/intra/postpartum and newborn care involves
informed consent. A possible legal implication includes a lawsuit due to a medical error
occurring during the delivery of pre/intra/postpartum and newborn care (National Academies of
Sciences, Engineering, and Medicine et al., 2020). One strategy to address the issue of informed
consent is ensuring healthcare providers seek proper permission from patients before initiating
medical treatment. At the same time, clinicians can avoid or prevent medical errors by following
the established professional standards and guidelines. Lack of adequate resources (including
insurance coverage, infrastructure, and finances) is one anticipated challenge in preventing
disparities associated with pre/intra/postpartum and newborn care. Lack of buy-in, commitment,
and support from healthcare organizations and clinicians is an anticipated challenge that can
impede addressing issues when they arise.

e. Participants and Interdisciplinary Approach

6
Patients (mothers and newborns) and healthcare providers (gynecologists, obstetrics,
nurse midwives, pediatricians, labor & delivery nurses, nutritionists, physical therapists,
postpartum nurses, lactation consultants, doulas, and nutritionists) are the participants that will
be involved in the implementation of the intervention. Healthcare providers are responsible for
delivering pre/intra/postpartum and newborn care, while mothers and newborns are the
recipients. Pediatricians and obstetricians/gynecologists are the two members outside nursing
that will be critical in implementing the proposed intervention. Pediatricians are physicians
specializing in the care for children, infants, and newborns while obstetricians/gynecologists
specialize in women’s pregnancy care and reproductive health. Involving these interdisciplinary
members is beneficial because of their potential to improve healthcare outcomes. These members
bring professional expertise, knowledge, and experience beyond nursing. Additionally, the two
professionals can enhance communication, collaboration, and care coordination (Baecher-Lind et
al., 2019).

f. Quality Improvement

For patients (pregnant mothers and newborns), health promotion and maintenance
involving pre/intra/postpartum and newborn care can improve healthcare outcomes by lowering
health complications and mortalities during pregnancy and during and after childbirth. Potential
complications for newborns include respiratory distress syndrome, low birth weight, neonatal
diabetes, and jaundice. Possible mother complications may include postpartum depression, pre-
eclampsia, gestational diabetes, placental previa, premature labor, postpartum hemorrhage,
perineal tear, and mastitis. For the nursing profession, addressing complications related to
pre/intra/postpartum and newborn care can improve patient outcomes, lower the overall burden
and cost of medical errors, improve organizational reputation and improve the demand for

7
nursing services, provide professional development opportunities, enhance job satisfaction, and
foster interdisciplinary collaboration. Organizational policies are guidelines are classic examples
of resources that can be utilized to improve patient outcomes in clinical settings. The Code of
Ethics for Nurses is an example of a resource used to increase professional nurse knowledge and
promote clinical professional practice (American Nurses Association, n.d.).

g. Conclusion

This capstone project explores the importance of health promotion & maintenance for
ante/intra/postpartum and newborn care; identifies health disparities, inequities, and
interventions related to the concepts; and examines legal & ethical considerations and
interventions for addressing potential challenges. Healthcare resources that can potentially
support evidence-based professional practice related to ante/intra/postpartum and newborn care
in the US include the American College of Obstetricians and Gynecologists (ACOG), the
American Academy of Pediatrics (AAP), the National Institute of Child Health and Human
Development (NICHD), and the Centers for Disease Control and Prevention (CDC), the Code of
Ethics for Nurses, among others. For patients (mothers and newborns), health promotion and
maintenance in ante/intra/postpartum and newborn care can lower complications like low
birthweight and mortalities. The benefits to healthcare providers include improved job
satisfaction, quality and safety of care, and reduce lawsuits.

8

References

American Nurses Association. (n.d.). View the Code of Ethics for nurses.
https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-
for-nurses/
Baecher-Lind, L., Fleming, A. C., Bhargava, R., Cox, S. N., Everett, E. N., et al. (2019).
Enhancing interprofessional collaboration and interprofessional education in women’s
health. Medical Education Online, 27(1).
https://doi.org/10.1080/10872981.2022.2107419
Hill, L., Artiga, S., & Ranji, U. (2022, Nov 1). Racial disparities in maternal and infant health:
Current status and efforts to address them. KFF. https://www.kff.org/racial-equity-and-
health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-
and-efforts-to-address-them/
Jolly, Y., Aminu, M., Mgawadere, F., & Broek, N. (2019). “We are the ones who should make
the decision” – knowledge and understanding of the rights-based approach to maternity
care among women and healthcare providers. BMC Pregnancy and Childbirth, 19(42).
https://doi.org/10.1186/s12884-019-2189-7
Lee, J., Murry, N., Ko, J., & Kim, M. T. (2018). Exploring the Relationship between Maternal
Health Literacy, Parenting Self-Efficacy, and Early Parenting Practices among Low-
Income Mothers with Infants. Journal of Health Care for the Poor and Underserved,
29(4), 1455-1471. doi: 10.1353/hpu.2018.0106
National Academies of Sciences, Engineering, and Medicine, et al. (2020). Birth settings in
America: Outcomes, quality, access, and choice. National Academies Press.

9

World Health Organization. (2017). Maternal mortality.
https://apps.who.int/iris/bitstream/handle/10665/329886/WHO-RHR-19.20-eng.pdf