Ethico-Legal Considerations

and Issues in the Care of the

Sick Mother and Child
Louiegi L. Garcia, RN
LEARNING OBJECTIVES
• Adhere to ethico-legal considerations when providing safe, quality
nursing care to mother and child at risk.
• Apply ethical reasoning and decision making process to address
situations of ethical distress and moral dilemma.
• Adhere to established norms of conduct based on the Philippine
Nursing Law and other legal, regulatory, and institutional
requirements relevant to safe nursing practice.
• Protect clients’ rights based on “Patient’s Bill of Right and
Obligations
• Implement strategies/policies related to informed consent as it
applies in multiple contexts.
OUTCOMES-BASED EDUCATION ACTIVITY:
FACILITATED DEBATE
FACILITATED DEBATE: MECHANICS
• Two (2) teams will serve as the debaters.
• There will be two (2) topics chosen via snowball from a list of four (4)
topics.
• A Coin Toss method will determine the PRO and ANTI teams.
• Each team will be given one (1) full minute to give their insights and
arguments. The other team then is expected to rebuttal the
arguments given by the first team. Each topic will be given a
maximum of 30 minutes.
• The facilitator (Clinical Instructor) shall decide if the teams have
presented all arguments and no further debate is needed.
• A copy of the RUBRICS and LIST OF TOPICS will be provided.
Topic Guide for the Debate
Ethico-Legal Considerations and Issues in the
Care of the Sick Mother and Child
• Assisted Reproductive Techniques
• Alternatives to Childbirth
• Protection of Women from Domestic Violence
• Protection of women against sexual harassment
Terminologies
• Infertility- inability to conceive a child or sustain a
pregnancy to birth.
• Infertile- couples who did not become pregnant after at
least 1 year or unprotected sex.
• Subfertility- more appropriate term; some couples may
still have the potential to conceive but are just less able
to conceive without additional help
Fertility Assessment
• Health history
• Physical assessment
• Fertility testing
• Is there sperm of good quality
and number available?
• Are ova (eggs) available?
• Is it possible for the sperm and
egg to meet in a receptive
environment?
 Factors that Cause Male Subfertility
• Limited sperm count C-H-A-R-O-T
• Normal: 33-46M sperm per mL, • Congenital Abnormalities
or 50M sperm per ejaculation
• Normal: 50% motile sperm • Hormonal affectations
• Normal: 33% normal shape • Autoimmunity
• Obstruction or impaired • Radioactive exposure
sperm motility • Obstruction in the male
• Ejaculation problems reproductive system
• Erectile dysfunction • There is disturbance in
spermatogenesis
 Factors that Cause Female Subfertility
• Cervical and vaginal factors
• Uterine factors such as tumor
• Problems in ova transport
• Anovulation
• Limited production of
hormones (FSH/LH)
UNEXPLAINED SUBFERTILITY
Subfertility of no known cause happen in small percentage of
couples. It may be that the problem of one partner alone is not
significant, but when combined with the problems of the
other partner creates subfertility
Assisted Reproductive Techniques
• Pre-implantation Genetic Diagnosis
• Alternative Insemination
• Surrogate Embryo Transfer
• In Vitro Fertilization
• Gamete Intrafallopian and Zygote
Intrafallopian Transfer
 Preimplantation Genetic Diagnosis
• Recognition and close inspection of differences in
sperm and oocytes
• Done through individual retrieval of oocytes and their
fertilization under laboratory conditions
Alternative Insemination
• The instillation of sperm from a mastubatory
sample into the female reproductive trace by
means of a cannula to aid conception at the time
of ovulation
• Can be instilled in the cervix or uterus
• Concerns:
• The male partner has no sperm or has inadequate sperm
count
• Woman has vaginal or cervical factors that interfere with
sperm motility
Surrogate Embryo Transfer
• An assisted reproductive technique for a woman who
does not produce ova.
• Ova is donated by a friend, relative, or anonymous
donor.
• At the time of ovulation, the donor’s ova is removed by
an ultrasound-guided procedure then fertilized in a
laboratory by the recipient woman’s partner’s sperm
• It is then placed in the recipient’s uterus by embryonic
transfer.
In Vitro Fertilization
• Most often used for couple who have not been able to
conceive because the woman has obstructed or
damaged fallopian tubes
• One or more mature oocytes are removed by a
laparascopic procedure and are then fertilized in the
laboratory
• Zygote is place in the uterus afterwards for maturation
 Gamete Intrafallopian and Zygote
Intrafallopian Transfer
Gamete Intra-Fallopian Transfer (GIFT)
• Ova are obtained from the ovaries like in IVF, but are
instilled back into the fallopian tube within hours for
fertilization to happen
Zygote Intra-Fallopian Transfer (ZIFT)
• Same with IVF, egg is fertilized in the laboratory
• But like GIFT, fertilized egg is returned into the patent
fallopian tube
Alternatives to Childbirth
• Surrogate Mothers- woman who agrees to carry
pregnancy to term for a subfertile couple or an LBGT couple
• Adoption- alternative for couples with genetic-related health
conditions or health conditions that would make pregnancy high
risk
• Child-free Living- available for both fertile and subfertile
couples who have been through the rigors and frustrations of
subfertility testing and unsuccessful treatment regimen
Thank you!