For the last 21 years I have had the honor of teaching Maternal-Newborn Nursing to pre-licensure nurses, firstly in Australia, and now in the United States. As a midwife I have always seen it is a wonderful opportunity to lay important foundations based on a midwifery philosophy, for all nursing students. Even though some pre-licensure programs have, for various reasons, eliminated clinical maternity courses from their curriculum, I have always argued for the presence of maternity care courses. My students have always valued their clinical experiences with childbearing families, ultimately seeing pregnancy, birth and the postpartum from the perspective of health rather than illness. Over the years, students have often shared with me the emotional impact of their maternity care experiences – many have described them as life-changing. There is something special about being unexpectedly swept into someone’s birth story, holding a newborn for the first time or supporting a new mother as she embarks on breastfeeding her baby. My students have experienced the joy of teaching new mothers and supporting families when they are most vulnerable. They have also come to appreciate the importance of increasing opportunities for women to experience physiological rather than surgical birth, simply through being immersed in the environment. Regardless of their future specialty directions, maternity nursing is a great opportunity to open up the eyes of students to the important principles of care needed by childbearing families, in all areas of the healthcare system.
I am thinking about this today because tomorrow, yet again, my maternity course begins for a new cohort of students. It is something I look forward to each year, and is always a time for me to reflect upon current issues in maternity care, from both local and global perspectives. As an international scholar, I firmly believe that it is critical to bring a global perspective into the classroom – even if nursing credentials are viewed through a national lens. I try to instill in my students that we can all learn from the practices of other countries and cultures, and that we should be open-minded when it comes to alternative ways of achieving good outcomes for patients and families alike.
Over the last few weeks, I have been busily revising lesson plans for the next learning adventure! I have gathered together the best EBN commentaries, located the latest international clinical guidelines, reflected on current trends and compiled the latest statistics. I am often amazed by the speed of change, and it is a constant battle to remain up-to-date with the latest in maternity care. Life-long learning can be time consuming.
Recently, as I was exploring trends in prenatal screening and care to discuss with the students this week, I saw firsthand the rapid pace of change. Zika virus suddenly came into view, and I had to find out more. Although not an entirely new problem, Zika has been recently thrust into the spotlight, due possible links with severe fetal abnormalities (eg. microcephaly). Preventative measures for pregnant women seem primarily focused on avoiding bites from mosquitoes that carry the virus and through the use of condoms during sexual activity. The Centers for Disease Control (CDC) in the U.S. have produced resources to inform patients and providers about this new threat to fetal welfare http://www.cdc.gov/zika/about/index.html. The potential severity of Zika virus disease in pregnant women has necessitated a rapid response from providers, compelling them to adopt recommended measures in order to reduce the impact on pregnant women, or on those planning pregnancy. Declared a “public health emergency of international concern (PHEIC)” only a matter of weeks ago, (on February 1st of this year), there are concerns about the likelihood that Zika will continue to spread. The current link to the CDC contains up-to-date clinical practice guidelines, provider tools and algorithms, and educational resources for pregnant women and their families. (http://www.cdc.gov/zika/pregnancy/index.html).
As evidence of new health risks and remedies flow around the internet and inform our practice on what seems to be an almost daily basis, it can be challenging to keep up. We need to prepare nurses and midwives to be flexible, open, and responsive to constant change and to the many grey areas where evidence is not yet available.
As I begin class tomorrow, I will openly admit to my students that although I have been a nurse and a midwife for a long time, I am not the font of all knowledge. I will expect them to ask me questions that we do not have the answers to – yet. What I do know, however, is that over the next 14 weeks, my students and I will embark on a great learning journey together, and that new evidence will no doubt come to light during our sessions. As life-long learners, practitioners, and educators, we will never give up on our search for the best evidence for maternity care practice.
Allison Shorten RN RM PhD
Yale University School of Nursing