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There is—or should be—a seamless connection between obstetric and pediatric nursing care and teaching. The inclusion of the concept of microbiomes as they influence maternity and newborn care is the beginning of an effort to suture this obvious seam that exists between maternity and pediatric care.
The goal of maternity care education has expanded to include the nursing care and interventions that have a long-term effect on the adult health of the newborn infant. This expanded focus can result in the reduction of non-communicable diseases in developed and undeveloped countries and therefore have a positive impact on global health.
For example, at a 2017 International Meeting for Autism Research, discussion included how smoking during pregnancy may alter the developing eggs in her female fetus which can then cause an abnormality in the grandchild of the smoker, especially related to the Autism Spectrum Disorder. There is also evidence that the human microbiome plays a role in the development of various obstetrical syndromes that also influences the health of the newborn as an adult. The mode of delivery, vaginal or cesarean section, influences the composition of the infants’ microbiome that influences the health of the newborn as an adult (Mascatt 2016). Breastfeeding also contributes to the transfer of healthy microbiota to the newborn.
In current pediatric care, the management of pediatric obesity (a prevalent problem today), usually starts in the pediatric arena with efforts to alter the child’s diet and exercise patterns to treat the child’s obesity to avoid negative health outcomes as an adult. This approach to care is like starting treatment “midflight” instead of attacking the origin of the problem of pediatric obesity. The problem lies in the various phases of prenatal care of the mother that influence the microbiomes she will pass on to her newborn, which will affect diet preferences and metabolism of the newborn as a child and adult.
These phases of pregnancy include preconceptual care, prenatal care, intrapartal care, postpartal care, and interconceptual care (time between pregnancies).
Preconceptual care is often combined with prenatal care and most useful in planned pregnancies. Interconceptual care is an extension of postpartum care beyond six weeks and is currently most often provided to women who plan to become pregnant again after a previous problem pregnancy. Some current insurance coverages limit the availability of preconceptual or interconceptual visits except in fertility problems or fertility treatment plans. However, the nurse in community or general clinic settings have contact with women in these phases of pregnancy and can utilize “teaching moments” to achieve the goals of maternity care education wherever the opportunity presents!
The future of maternity and pediatric health lies in the understanding of how the management of maternity patients in each phase of pregnancy influence the microbiota of the pregnant woman who pass these on to the newborn that will have an influence on its health as an adult. Every nursing intervention during each phase of pregnancy can support or alter the microbiome of the pregnant woman: the woman’s lifestyle; antibiotic, recreational and OTC drug use; stress; pain; diet; the use of probiotics or prebiotics; the timing of introduction of new foods to the infant, etc. These all have an influence on the microbiota that affect the health of the pregnant woman, the newborn infant and the adults of the next generation. Therefore, nurses must be made aware of microbiomes and their role in patient care interventions and teaching of the maternity patient.
All nursing students should have detailed maternity and pediatric content in their educational program at all levels. The LPN/LVN graduate is encouraged to enter the ladder program of ADN nursing schools and the ADN graduate completes nursing education to the Bachelors level to meet the I.O.M. mandate for all nurses to have Bachelors’ degree in the near future. The Maternity nursing course and clinical contact is brief in LPN/LVN programs but often not repeated in the ladder portion of the ADN program; therefore, strong maternity content in the brief LPN/LVN Maternity/Pediatric course is essential to the practicing nurse at every level.
This basic understanding applied to the nursing care, skills, teaching and guidance of the maternity patient in all phases of the pregnancy cycle will result in a positive outcome of pregnancy and a healthy newborn who can grow to be a healthy adult.
For faculty who feel they should limit maternity content due to difficulty finding clinical placement in maternity units for LPN/LVN students, an option may be utilizing sites within the community or clinics that can provide contact with women in the various phases of pregnancy. Allowing students to focus on helping these patients build healthy microbiota for their upcoming planned pregnancies by guiding their lifestyle, medication use, diets, etc. to prepare them to have a healthy pregnancy outcome may meet some of the clinical course objectives of maternity care.
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