Maternal Newborn Nursing

Every mother-baby admission begins with the prenatal and birth record. The nurse reviews maternal history, laboratory results, medications, and labor events, then translates each finding into a postpartum risk (hemorrhage, infection, hypertension, VTE, mood disorder) and a newborn risk (hypoglycemia, sepsis, jaundice, withdrawal, birth injury).

Example: a patient who gave birth to twins at 35 weeks, later had one term birth, and has no losses is G2 T1 P1 A0 L3. Prior obstetric events predict recurrence: previous PPH, shoulder dystocia, preeclampsia, preterm birth, or a prior infant with GBS disease (which mandates intrapartum GBS prophylaxis regardless of current culture). A prior cesarean raises the risk of placenta previa, placenta accreta spectrum, and uterine rupture.

• Prenatal genetic screening and diagnostic testing are offered to all pregnant patients regardless of age; age alone no longer defines who is offered testing.
• Preexisting conditions (diabetes, chronic hypertension, thyroid disease, seizure disorders, lupus, cardiac disease, mental health disorders) carry forward into the postpartum period and often require medication changes after birth.
• Psychosocial screening at intake and again postpartum: depression and anxiety, intimate partner violence (screen privately, without the partner present), substance use, housing and food insecurity, transportation, and social support. Positive screens trigger referral, not judgment.
• Cultural and religious considerations: use a qualified medical interpreter (never a family member or child for clinical teaching); ask about dietary customs, postpartum rest practices, modesty, and infant care traditions; plan in advance for a patient who declines blood products (for example, cell salvage, early uterotonics, and documented informed refusal).

• Additional energy need is about 340 kcal/day in the second trimester and about 450 kcal/day in the third; none in the first.
• Folic acid 400 mcg daily starting at least 1 month before conception prevents neural tube defects; 4 mg daily after a prior NTD-affected pregnancy. Iron need rises to 27 mg/day. Limit caffeine to under 200 mg/day; avoid high-mercury fish, unpasteurized dairy, and undercooked meat (Listeria, Toxoplasma).
• Obesity (BMI 30 or higher): GDM, preeclampsia, cesarean, wound infection, VTE, PPH, and delayed lactogenesis II. Newborn: macrosomia, birth injury, hypoglycemia, NTDs, stillbirth. Postpartum: early lactation support, wound checks, VTE prophylaxis, appropriately sized equipment.
• Bariatric surgery: pregnancy is usually deferred 12–24 months after surgery. Watch for deficiencies of iron, vitamin B₁₂, folate, vitamin D, and calcium. After gastric bypass, an oral glucose load can cause dumping syndrome, so GDM is screened with home glucose monitoring instead. Newborn: higher risk of SGA; maternal B₁₂ deficiency can affect a breastfed infant.

Pregnancies conceived with ART (ovulation induction, IVF) have higher rates of multiple gestation, preterm birth, low birth weight, preeclampsia, GDM, placenta previa and accreta spectrum, and cesarean birth, with a small increase in some congenital anomalies. Parents may have heightened anxiety and grief from prior losses; recognize this "precious pregnancy" dynamic, support bonding, and screen for postpartum mood disorders. Donor gametes or a gestational carrier raise legal and family-role questions addressed in Chapter 10.