Maternal health refers to women’s health during their pregnancy, childbirth as well as in their postpartum period. To many women, maternal health impacts positively as they view maternity as a gratifying experience; to others, it has negative impacts resulting in a period of ill health and death to women, children, and at times, both (“Maternal Health | IDPH”, 2020). Maternal morbidity and mortality can directly result from hemorrhage, infections, dangerous abortions, increased blood pressure and obstructed labor. Maternal health is not only a requirement for social harmony and augmented productivity; to many families, societies, community service providers and the Treasury, it reduces costs and burden. Investing smartly on maternal health impacts positively by reinforcing the general healthcare system as well as increasing the cost-efficiency of the resources assigned to heath sectors (Panel A.P., 2010). Investing in maternal health impacts on the political and economic sense. Failing on investing on maternal health is not only irresponsible but also immoral; it is extremely counterproductive, undermines national development and growth.
According to the World Health Organization, regarding maternal mortality, about 810 women died in 2017 as a result of pregnancy and childbirth complications every single day (“Maternal mortality”, 2019). Ninety-four percent of these deaths happened in both low and lower-middle-income countries, mostly caused by hemorrhage, hypertension, and other indirect causes resulting from interaction amid pregnancy and pre-existing health conditions. Additionally, 295,000 women died in the same years. 86 percent approximately 254,000 deaths resulted from Southern Asia and Sub-Saharan Africa with the Sub-Saharan Africa accounting for 196,000 of the total deaths. On the other hand, the (MMR) maternal mortality ratio (Number of maternal deaths per 100,000 live births) amid 2000 and 2017 decreased significantly by 38 percent in the whole world (“Maternal mortality”, 2019). In low-income countries, the risk of a woman dying as a result of maternal-connected cause in her lifetime is around 130 times higher equated to one living in developed countries.
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Many countries have shown progress by augmenting the accessibility of maternal healthcare, but on the other hand, internal and external forces face maternal healthcare. Indirect and direct costs are one force that is in play (Panel, A. P., 2010). Professional healthcare access in recent years remains too high for many women in these low and lower-middle-income countries. Fees for using the facilities, paying for services, and buying drugs are high enough, making women not to seek healthcare. On the other hand, even with cost not being an obstacle, access to maternal healthcare is also another force acting towards maternal healthcare. Countries like in Africa face health-worker crises with a shortage of personnel, nurses, and midwives resulting the women receiving low-quality maternal healthcare (Panel, A. P., 2010). Poor infrastructure is also another force resulting in the growth of the problem. In most of the low and lower-middle-income countries, infrastructure and transportation is an obstacle to effective maternal healthcare delivery. With clinics in rural areas being far away and poor roads due to poor terrain and others being impossible due to rains and mud, death to mothers is inevitable.
Actions have been put in place to reduce morbidity and mortality. Prenatal consultations are one of the actions employed working an ideal opportunity of identifying the risks pregnant women are exposed to. This counseling works in equipping women and their families by recognizing signs related to obstetric complications and on the ways to respond promptly (Figueiredo et al., 2018). Additionally, prenatal care, including access to folic supplements, testing for HIV, prevention of malaria, and diabetes assessment among others in a cheap way, has proved to reduce morbidity and mortality during pregnancy and childbirth. Primary prevention measures such as physical examinations, laboratory tests, and imaging prevent the problem of maternal morbidity and mortality by identifying risks before they happen to mothers and their children before childbirth.
Additionally, actions like nutritional interventions are employed in addressing the problem. Developing countries face widespread malnutrition creating the need for nutritional interventions. Complications can occur to malnourished mothers that may result in death in their pregnancy and childbirth (Figueiredo et al., 2018). Also, malnutrition may result in low birth weight and the failure of children to grow at the normal rate resulting in increased disease rates and early death. As a primary prevention level, introducing nutrition programs educating pregnant mothers and the whole population on the dangers of malnutrition results in significant effects on maternal mortality. More, so, research has stipulated that taking food rich in Vitamin A and vitamin A supplements have shown reduced morbidity and mortality among pregnant ladies.
The use of skilled attendance during childbirth is also an action taken in preventing the problem of morbidity and mortality during childbirth and has proved effective in these situations. As a primary prevention level, skilled attendance helps by the input of skillful services during labor as well as in delivery, and when in complications, they enable the accessibility of a higher level of obstetric care (Lucas et al., 2003). Skilled attendants have the capability of recognizing the onset of complications, thus performing crucial interventions, starts treatment as well as supervising the referrals of mothers to babies for interventions beyond their competence.
Community Health Nurses (CHN) roles include providing treatment to patients, offering education to the community members on how to maintain their health as a way of decreasing the occurrences of deaths and diseases. Additionally, they plan assemblies, give-out leaflets, administer health screenings, distribute medications as well as administering immunizations (“The Nurse’s Role in Community Health | NSU Online”, 2017). On the other hand, public health nurses (PHN) roles include integrating community participation and knowledge regarding the whole population with individual clinical understandings of the health and illness practices of people and families encompassing the population (“Public Health Nursing Manual | Local Public Health Agencies | Health & Senior Services”, 2020). They assist in translating and articulating experiences regarding health and illness in varied, often susceptible persons and families in the population to health planners as well as policymakers, thus supporting members of the community in expressing their problems. They are knowledgeable in multiple intervention strategies ranging from the ones pertinent to the whole population to those for individuals and families. They help in deciphering knowledge obtained from health and social sciences to individuals and population groups through targeted interventions, agendas, and support.
When ethical principles conflict with each other, clinical situations arise. Abortion is one of the ethical issues. It is one of the fiercely discussed political issues separating people into two camps: pro-choice and pro-life. Pro-choice acts in supporting women in deciding their reproductive functions by basing them on their moral and ethical beliefs (Aderemi, 2016), on the other hand, pro-life groups strongly feel that the act of abortion involves murder hence depriving the fetus basic life rights. To clients considering abortion, nurses need to clarify their values as well as beliefs while at the same time, being able to provide non-biased care before they assume duty for patients considering abortion. Nurse’s decisions of caring or refusing to care for such patients’ distress unity of the staff, stimulates staffing choices while still challenging the moral concepts of duty.
Substance abuse is also another ethical issue faced when solving a problem. Substance abuse can cause fetal injuries when woken are involved in it, resulting in ethical implications. Courts have sentenced pregnant women causing harm to their fetuses. Many of the courts ask for reports of evidence supporting prenatal exposure to drugs leading to charges of negligence and endangerment against the women at times. The approach is punitive to fetal injuries hence raising ethical and legal queries regarding the degree of control by the government fitting the safety of the child (Aderemi, 2016). Selective reduction is also an ethical consideration. Inducing ovulation and in-vitro fertilization might result in multifetal pregnancies at times. If the woman’s ability to carrying them is overwhelmed, selective termination of one or more of the fetuses may be recommended by physicians. Ethical issues similar to those of abortion, in this case, arises with the case being further complicated in this situation since these are anticipated, desired children.
In solving the issues especially, the one regarding postpartum hemorrhage, I would propose using primary interventions to be used to empty the bladder and enable the uterine massage by stimulating the contractions. In this situation, assessing the uterus as well as its contractility, is easy. Uterine massage is highly endorsed by the world health organization. To evaluate the effectiveness of the intervention, using the number of stopped postpartum hemorrhage is effective in its evaluation.
Another intervention is the use of maternal waiting home facilities enabling the delivery of antenatal care and emergency obstetric care in preventing obstructed labor. It helps in solving high-risk pregnancies and enhance easy access to those living in remote areas. The effectiveness of this intervention would be evaluated by assessing the number of high-risk pregnancies intercepted and the number of successful deliveries for the case of remote areas.
In conclusion, maternal health is essential to saving the lives of the mothers and children and, in some cases, both. It is, therefore, necessary for the health sector to invest in delivering the best maternal health to prevent occurrences of these events. Health workers should employ the necessary interventions while at the same time, considering the ethical issues in play to enable the delivery of the best services to help in saving lives. Investing in health system infrastructure, implementation of interventions to their maximum and training the health workers as well as patient education improves the health outcomes to both children and their mothers. Therefore, it is necessary to invest in it.
References
Aderemi, R. (2016). Ethical Issues in Maternal and Child Health Nursing: Challenges Faced By Maternal and Child Health Nurses and Strategies for Decision Making. International Journal Of Medicine And Biomedical Research, 5(2), 67-76. https://doi.org/10.14194/ijmbr.5.2.3
Figueiredo, K., Gonçalves, G., Batista, H., Akerman, M., Pinheiro, W., & Nascimento, V. (2018). Actions of primary health care professionals to reduce maternal mortality in the Brazilian Northeast. International Journal For Equity In Health, 17(1). https://doi.org/10.1186/s12939-018-0817-x
Lucas, A. O., Stoll, B. J., & Bale, J. R. (Eds.). (2003). Improving birth outcomes: meeting the challenge in the developing world. National Academies Press.
Maternal Health | IDPH. Dph.illinois.gov. (2020). Retrieved 19 April 2020, from http://dph.illinois.gov/topics-services/life-stages-populations/maternal-child-family-health-services/maternal-health.
Maternal mortality. Who.int. (2019). Retrieved 19 April 2020, from https://www.who.int/news-room/fact-sheets/detail/maternal-mortality.
Panel, A. P. (2010). Maternal health. Geneva: Investing in the Lifeline of Healthy Societies and Economies Policy Brief, Africa Progress Panel.
Public Health Nursing Manual | Local Public Health Agencies | Health & Senior Services. Health.mo.gov. (2020). Retrieved 19 April 2020, from https://health.mo.gov/living/lpha/phnursing/phnroles.php.
The Nurse’s Role in Community Health | NSU Online. Northeastern State University Online. (2017). Retrieved 19 April 2020, from https://nursingonline.nsuok.edu/articles/rnbsn/nurses-role-in-community-health.aspx.
