Journal of Midwifery & Women's Health

Listening

Frances E. Likis — 2010-03-01

One of the American College of Nurse-Midwives' blue and white “Listen to Women” buttons sits on my desk. I've given several more away over the years because it is such an important message for clinicians and patients. There are only three words, but together they are very powerful. In reading the articles in this issue, that slogan and the significance of listening keep coming to mind.

Antidepressant Medication Use in Pregnancy

Barbara Hackley — 2010-03-01

Depression has been estimated to occur in approximately 12% of women, making it one of the most commonly encountered medical conditions affecting pregnancy. Yet many health care providers feel unprepared to manage this condition in pregnancy. This article provides women's health providers the background needed to effectively manage depression and in particular focuses on the use of antidepressant medication in pregnancy.

Factors Associated With Non-Normal Birth Outcomes for Low-Risk Women in an Inner-City Hospital

Anne M. McDermott — 2010-03-01

Introduction: The purpose of this study was to examine factors associated with normal versus non-normal birth outcomes for low-risk women who were admitted for care in spontaneous labor.Methods: The birth records of 93 women were reviewed.Results: At the completion of the fourth stage of labor, 61% of births (n = 57) met the criteria for normal, while 39% of births (n = 36) had non-normal outcomes. On bivariate analysis, variables associated with non-normal outcomes included nulliparity (odds ratio [OR], 9.10; 95% confidence interval [CI], 3–28; P < .0001), lower average centimeters of dilation at admission (t-score 4.422; P < .001), use of pharmacologic pain relief, including narcotics and epidural anesthesia (OR, 5.03; 95% CI, 2–16; P = .005), and birth attended by a physician versus a certified nurse-midwife (OR, 3.60; 95% CI, 2–9; P = .004). In a multivariate analysis, nulliparity (OR, 6.07; 95% CI, 2–19; P = .002) and lower average centimeters of dilation at admission (OR, 0.63; 95% CI, 0.5–0.9; P = .005) were independently associated with non-normal outcome.Discussion: The development of clinical guidelines aimed at reducing admissions of women in early labor may reduce non-normal outcomes, particularly for nulliparous women.

The Coping With Labor Algorithm: An Alternate Pain Assessment Tool for the Laboring Woman

Leissa Roberts, Brenda Gulliver, Janet Fisher, Kristin G. Cloyes — 2010-03-01

The documentation of pain in the labor and delivery setting is one of the essential tasks of all health care providers who care for women in labor. The Joint Commission standards mandate regular pain assessments, but compliance with this mandate in the highly unique patient population of laboring woman is problematic when using the standard 0 to 10 Numeric Rating Scale. Labor pain is always unique given the various contributing physiologic, emotional, social, and cultural components. This article describes the work of a process improvement group to create an alternative pain assessment tool named the Coping With Labor Algorithm. The group, consisting of nurses and nurse-midwives, used the FOCUS format and Deming's “Plan, Do, Check, and Act” cycle to create a formalized assessment tool for use with laboring women. The Coping With Labor Algorithm is currently in use in the labor unit of a large tertiary care facility, which successfully passed a Joint Commission inspection while using the coping algorithm. The value of the coping algorithm is two-fold: it provides a mechanism for pain documentation, and it provides nursing care suggestions for the laboring woman. This article reports nurses' perceptions of the tool.

“Midwives Are Nice, But . . .”: Perceptions of Midwifery and Childbirth in an Undergraduate Class

Sharon Bernecki DeJoy — 2010-03-01

Introduction: The purpose of this study was to explore college students' beliefs about childbirth and midwifery.Methods: A critical qualitative analysis was used to identify common themes that occurred in an online class discussion about midwifery.Results: This population of 459 college students drew on the larger social discourse of the medical model of childbirth to frame their discussion of childbirth and midwives. Common beliefs that emerged from class discussions included the perceived dangerous nature of childbirth, the necessity for technologic interventions in childbirth, and doubts about the quality of midwifery training and practice.Discussion: To promote midwifery among this population, advocates should continue public education efforts through a variety of media and communication strategies, with an emphasis on the safety of midwifery care.

Lesbian Couples Seeking Pregnancy With Donor Insemination

Elisabeth “Boo” Markus, Amanda Weingarten, Yira Duplessi, Judith Jones — 2010-03-01

S.S. is a healthy, 29-year-old nulligravida who comes to the clinic with her female partner, M.S., seeking advice on becoming pregnant through the use of donor sperm from a cryobank. S.S. has been charting her fertility signs for 3 months, and both she and her partner are very excited about the prospect of becoming parents. They have done some research into donor sperm, but have questions about the different types of donor sperm available, whether to pursue intracervical or intrauterine insemination, and if the insemination should be done at home or in the clinic. They report that they have been to an obstetrician-gynecologist seeking care. The physician was unfamiliar with donor insemination and referred them to a fertility clinic for preconception counseling. The physicians at the fertility clinic recommended that the couple pursue pregnancy using ultrasound to detect follicle growth, followed by a human chorionic gonadotropin trigger shot and then intrauterine insemination in the clinic 24 hours later. The couple felt that these interventions were unnecessary at this point, because they did not have a known fertility problem.

Assessing Certified Nurse-Midwives' Attitudes Towards Planned Home Birth

Saraswathi Vedam, Jessica Aaker, Kathrin Stoll — 2010-03-01

Introduction: Certified nurse-midwives (CNMs) and certified midwives (CMs) are prepared for care in many settings and could increase access to planned home birth for American women. However, only 4% of American College of Nurse-Midwives members offer the home as a birth setting. CNMs'/CMs' attitudes towards birth place and the factors underlying their choice of practice site are largely unstudied. This article describes the development, content validation, and psychometric testing of an instrument to assess the attitudes of CNMs towards planned home birth.Methods: A scale was designed to measure Provider Attitudes to Planned Home Birth (PAPHB). Item generation was informed by literature review and a systematic expert panel appraisal. Reliability and validity of the scale were evaluated with a sample of 1893 CNMs.Results: Expert review indicated high relevancy and clarity of the scale items (scale-content validity index, 0.93). Construct validity was assessed using the Cattell scree test and factor analysis. The resultant 1-factor, attitude scale had strong internal consistency (Cronbach α = .94). The average PAPHB scale score among CNMs was 78.77 (range, 20–100; standard deviation, 15.9), with significant differences in attitude scores according to clinical home birth experience, educational background, and external barriers reported by CNMs.Discussion: The PAPHB scale is a reliable and valid instrument for the measurement of attitudes towards home birth. It can be used to assess the impact of education, environment, and clinical experiences on maternity practice choices.

The Long-Term Effects of Prenatal Nicotine Exposure on Neurologic Development

Jane Blood-Siegfried, Elizabeth K. Rende — 2010-03-01

A large body of documented evidence has found that smoking during pregnancy is harmful to both the mother and the fetus. Prenatal exposure to nicotine in various forms alters neurologic development in experimental animals and may increase the risk for neurologic conditions in humans. There is a positive association between maternal smoking and sudden infant death syndrome (SIDS); however, the connection between nicotine addiction, depression, attention disorders, and learning and behavior problems in humans is not straightforward. Nicotine's action on the production and function of neurotransmitters makes it a prime suspect in the pathology of these diseases. Nicotine accentuates neurotransmitter function in adults but desensitizes these functions in prenatally exposed infants and children. This desensitization causes an abnormal response throughout the lifespan. Furthermore, nicotine use by adolescents and adults can alleviate some of the symptoms caused by these neurotransmitter problems while they increase the risk for nicotine addiction. Although nicotine replacement drugs are used by pregnant women, there is no clear indication that they improve outcomes during pregnancy, and they may add to the damage that occurs to the developing neurologic system in the fetus. Understanding the effects of nicotine exposure is important in providing safe care for pregnant women, children, and families and for developing appropriate smoking cessation programs during pregnancy.

Return on Investment for Essential Obstetric Care Training in Ghana: Do Trained Public Sector Midwives Deliver Postabortion Care?

Kathryn Andersen Clark, Ellen H.M. Mitchell, Patrick Kuma Aboagye — 2010-03-01

Introduction: In Ghana, the provision of postabortion care (PAC) by trained midwives is critical to the efficient and cost-effective reduction of unsafe abortion morbidity and mortality.Methods: We performed a secondary analysis of provider data from a representative sample of Ghanaian health facilities in order to consider the determinants of PAC provision among both physicians and midwives.Results: In the previous 5 years, more than 58% of providers had participated in at least one type of essential obstetric training. Overall, 28% of clinicians were offering PAC services (80% of physicians as compared to 20% of midwives). Bivariately, the provision of PAC services was associated with in-service training. After adjusting for select provider and facility characteristics, PAC/MVA training, working in a facility with the National Reproductive Health Standards and Policy available, and not working in a publicly run facility were associated with midwives offering PAC services.Discussion: Although the provision of PAC by midwives is an efficient and cost-effective strategy for reducing maternal morbidity and mortality, clinical training of midwives leads to a lower yield of PAC providers when compared to physicians. Policy and practice should continue to support PAC expansion by trained midwives in the public sector and by understanding the barriers to provision of services by midwives working in public facilities.

Health Care and Social Service Providers' Descriptions of Pacific Islander Mothers' Breastfeeding Patterns

Jeanie L. Flood, Joan E. Dodgson — 2010-03-01

Introduction: Despite recommendations and numerous health benefits attributed to breastfeeding, rates in the United States are below desired levels, particularly within vulnerable populations. In Hawaií, breastfeeding rates are higher than national averages except in Native Hawaiian and other Pacific Islander populations. Health care and social service providers are integral to successful breastfeeding promotion efforts. They are in an ideal position to reflect on the context in which their clients live and on its relationship to breastfeeding activities. The aim of this study was to describe health care and social service providers' perceptions of the influences on the breastfeeding patterns of Pacific Islander women.Methods: Focus ethnographic methods were used to collect interview data from health care and social service providers (N=20) serving Native Hawaiian and Pacific Islander women in one rural community. An iterative analysis process of coding and categorizing, followed by conceptual abstraction into patterns, was completed.Results: Four patterns emerged: shaped by connections, lived unfamiliarity, stressed by circumstance, and missed opportunities. Participants' insights concerning the needs of this population yielded population-specific issues and health care system issues affecting breastfeeding promotion. A number of gaps in breastfeeding services were identified.Discussion: Sociocultural, maternal knowledge, and workload barriers to successful breastfeeding predominated providers' perspectives. Broader system and community level issues were implied, but not directly addressed. The nature of successful breastfeeding support and promotion requires inclusion of this broader level perspective.

Are Postpartum Women in Denmark Being Given Helpful Information About Urinary Incontinence and Pelvic Floor Exercises?

Inge Lise Hermansen, Bev O'Connell, Cadeyrn J. Gaskin — 2010-03-01

Introduction: The aim of this study was to determine where and from whom postpartum women recalled receiving information about urinary incontinence (UI) and pelvic floor exercises (PFEs), the helpfulness of this information, and their preferred sources of help with UI.Methods: Women who had recently given birth in a Danish hospital (N = 439) were mailed a survey that elicited information about their experiences of receiving information about UI and PFEs.Results: Surveys were returned from 266 women, representing a response rate of 61%. Although almost all participants recalled receiving information about PFEs (95%), only half (55%) recalled being provided with information about UI. Midwives were the health care professionals who most commonly provided women with information about UI (33%) and PFEs (55%). Women generally perceived the information as being helpful, with the information from physiotherapists obtaining the highest mean ratings for helpfulness. Postpartum women indicated that they would prefer to consult with continence nurses or general nurses if they experienced UI. Health care professionals did not consistently provide postpartum women with information on UI and PFEs.Discussion: A coordinated multidisciplinary approach is needed to ensure that women are adequately informed about the risk of developing UI after childbirth and the ways in which this condition can be managed or resolved.

Frozen Hope: Fertility Preservation for Women With Cancer

2010-03-01

Young women diagnosed with cancer have the option of preserving their fertility by using assisted reproductive technology (ART) techniques prior to undergoing cancer treatment. This article presents a composite case of a young woman with cancer who had many unanswered emotional and ethical questions about her future as a parent. Fertility preservation techniques, including preimplantation genetic diagnosis (PGD), and related patient education are described. Current literature regarding reproductive counseling for cancer survivors is reviewed. Resources for providing psychosocial support for decisions about fertility preservation are lagging behind the rapid pace of scientific advancements in cancer treatment and ART. As more young women are surviving cancer and taking steps to preserve fertility, there is great need for the provision of psychologic support services and the establishment of ethical guidelines to aid them on this path. Women's health care providers can provide support to cancer survivors facing fertility and parenting issues by becoming knowledgeable about the long-term aspects of decision making and developing educational materials and guidelines for these patients.

Power, Control, and the “Difficult” Patient: Hidden Dimensions to Caring for Survivors of Sexual Abuse

Asheley Cockrell Skinner — 2010-03-01

Ten years ago, pregnant with my first child, I took my first steps on the journey that would show how tightly woven are trauma and birth and the power of the providers that guide you through them. As if I spoke a different language than those I encountered, I felt isolated and unable to express any of my needs or feelings. Being one of the many women who have survived sexual abuse, an unrecognized layer of complexity affected both my relationships with my providers and the outcomes I experienced.

Current Resources for Evidence-Based Practice, March/April 2010

R. Rima Jolivet — 2010-03-01

Published simultaneously in Journal of Obstetric, Gynecologic & Neonatal Nursing 2010;39(2).

A Global Perspective on the Status of Women's Reproductive Health

Sharon Bond — 2010-03-01

Editor's Note:

Safe Motherhood: A Human Right

Sharon Bond — 2010-03-01

Milliez examines safe motherhood from an ethical standpoint drawn from principles established by the 1948 Universal Declaration of Human Rights, which states, “Everyone has the right to a standard of living adequate for the health and well-being of him/herself, and his/her family, including food, clothing, medical care, and necessary social services.” In 2006, these principles remain fully supported by the United Nations Educational, Scientific and Cultural Organization (UNESCO). Milliez reminds us that differences in maternal mortality rates (MMRs) are staggering between developed and low-resource nations. For example, while the MMR in Europe is between two and eight individuals per 100,000 live births, in Sierra Leone, Afghanistan, Malawi, Angola, and Niger, the MMR ranges from more than one and half (1.6) to two individuals per 100 live births. The MMR in India is greater over the course of 1 week than in all of Europe per year.

Progress Toward Eradicating Harmful Practices Imposed on Girls and Women is Slow

Sharon Bond — 2010-03-01

Since 1958, the United Nation's Economic and Social Council, and later, the Commission on the Status of Women, identified a wide range of behaviors considered harmful against girls and women. These practices include female genital mutilation (FGM), dowry and bride price, early marriage and pregnancy, nutritional taboos and practices related to pregnancy and childbirth, preference for sons, female infanticide, wife burning and battering, rape, incest, trafficking, and prostitution. Because these topics are so broad and far reaching, the authors focus their article on progress made against FGM over the last 50 years.

Migration To Escape War Adversely Affects the Health of Women and Children

Sharon Bond — 2010-03-01

The most common reasons why populations migrate generally relate to socioeconomic needs—seeking employment or moving from rural to urban areas in search of better jobs or lifestyles. However, in many parts of the world, where regional wars and tribal conflicts have been ongoing for decades, the majority of those forced to migrate are women and children escaping ravages of war. Data from the United Nations Population Division show that women have been migrating as often as men for the last 40 years, and internationally, women comprised 50% of those who migrated in 2005.

Defeating Cervical Cancer on a Global Scale is not Only Possible, It is Imperative!

Sharon Bond — 2010-03-01

With cervical cancer claiming the lives of more than 250,000 women annually around the world, significant improvements in women's health will be achieved if cervical cancer can be brought under control. Reducing cervical cancer deaths and associated disabilities not only improves the health of women but also the health and well-being of families since women are the primary caretakers of children and families. This article explores the ramifications of cervical cancer prevention, detection, and treatment from the perspective of human rights within the context of primary prevention to secondary and tertiary disease states.

Abnormal Uterine Bleeding

2010-03-01

Abnormal uterine (womb) bleeding is a common problem in women. Abnormal uterine bleeding can occur as either a change in your normal menstrual period or as bleeding in between your normal menses.

Induction of Vaginal Birth after Cesarean Using Intracervical Foley Bulb

Tani Corey — 2010-03-01

I enjoyed reading the article entitled, “Induction of Vaginal Birth after Cesarean Using Intracervical Foley Bulb.” I have frequently used this method for cervical ripening, but have never considered it as a stand-alone form of induction. It is a good option to consider for women with a history of cesarean who do not want to assume the additional risk of uterotonics. However, there is a discrepancy between the stated American College of Obstetrician and Gynecologists (ACOG) recommendations and what is actually in the ACOG bulletin that is referenced.

Author Reply

Susan Lewis — 2010-03-01

Thank you for expressing your concerns about our article. I have reviewed the American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin from 2004 again. While I agree the word “discouragement” is a strong interpretation and the word “oxytocin” is not used in the summary of recommendations, some of the studies referred to in the document found an increased risk of uterine rupture with the use of oxytocin as compared to elective repeat cesarean or spontaneous labor. This evidence has contributed to women choosing and/or being counseled to have elective repeat cesareans.

Choosing Where To Have Your Baby

K. Michelle Doyle, Midwives Alliance of New York — 2010-03-01

As a proud member both of the American College of Nurse-Midwives (ACNM) and Midwives Alliance of New York and the new owner of an independent midwifery practice offering home birth services, I was very excited to see the Share With Women handout in the September/October 2009 issue of the Journal of Midwifery & Women's Health. “Choosing Where to Have Your Baby” promised to be a wonderful resource to share with my clients.

Editor Reply

Frances E. Likis — 2010-03-01

Thank you for your interest in the recent Share with Women on choosing a place for birth. The purpose of the handout is to provide an overview of the options for where to give birth, and not to promote or focus on a specific setting. The content was developed and reviewed by certified nurse-midwives (CNMs) and a certified professional midwife (CPM) who collectively have experience in all three birth settings: home birth, birth center, and hospital. The recommended indications for consultation, collaboration, and referral of care that are listed in the handbook on home birth by the American College of Nurse-Midwives (ACNM) were used to identify relative and absolute contraindications to giving birth at home or in a birth center.

JMWH Peer Reviewers 2009

2010-03-01

The Editorial Board of the Journal of Midwifery and Women's Health extends appreciation and thanks to those who were active as peer reviewers for the Journal in 2009. The expert evaluations and recommendations that peer reviewers provide are an essential component of our publication process. We appreciate the generous commitment of time and expertise that these persons have given us this year as we work to maintain the Journal's standards.

Antidepressant Medication use in Pregnancy (#2009/101)

2010-03-01

Guidelines for Perinatal Care

Jan M. Kriebs — 2010-03-01

There are some books about which every midwife should be aware, whether they are on one's own bookshelf or not. Guidelines for Perinatal Care is such a reference. Both the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) strongly support regionalized perinatal care, and this book describes care based on that paradigm. The book's scope encompasses most aspects of inpatient care for mothers and newborns, as well as transport, infection control, and personnel.

Mini-Medications and Mothers' Milk

Anna M. Kinkead — 2010-03-01

Certified nurse-midwives (CNMs) now enjoy prescriptive authority in all 50 states, and certified midwives (CMs) have prescriptive authority in two states. With this in mind, this title holds both interest and relevance to midwives. While the primary text, Medications and mothers' milk: A manual of lactational pharmacology, is now in its 13th edition, this pocket-sized volume is the first of its kind. As clearly stated in the preface, this volume is intended as a companion book, not a substitute for the primary work. Described as a point-of-care reference, this book was written in response to health care providers who expressed the desire for a more portable reference. Thomas W. Hale is a leading expert with international renown in the field of lactational pharmacology.

Deliver Me From Pain: Anesthesia and Birth in America

Donna Harvel Balo — 2010-03-01

“Of all the bitterly contested obstetric treatments of the past 160 years, the administration of anesthesia for labor pain has prompted the longest lasting disagreement.” Thus begins Deliver Me From Pain: Anesthesia and Birth in America. Is birth primarily a basic physiologic normal and natural social occurrence or a potentially pathologic event from which women must be rescued?

Labor and Delivery Nursing: A Guide to Evidence-Based Practice

Jamie Bourgeois — 2010-03-01

This clinical text is geared toward new labor and delivery nurses and provides evidence-based information needed to care for laboring women. Labor and Delivery Nursing also contains suggestions for nursing staff orientation to the hospital birthing unit. Practical information includes items needed for vaginal and cesarean birth, what to anticipate for each stage of labor, and new staff orientation checklists. The authors also present information on nursing tasks and scope of practice related to procedures and monitoring, including discussion of who is responsible for tasks such as placing a fetal scalp electrode or clearing epidural pump tubing.

2010-03-01

Editorial Board

2010-03-01

Society Page

2010-03-01

Information for Readers

2010-03-01

Journal of Midwifery & Women's Health

Listening

Antidepressant Medication Use in Pregnancy

Factors Associated With Non-Normal Birth Outcomes for Low-Risk Women in an Inner-City Hospital

The Coping With Labor Algorithm: An Alternate Pain Assessment Tool for the Laboring Woman

“Midwives Are Nice, But . . .”: Perceptions of Midwifery and Childbirth in an Undergraduate Class

Lesbian Couples Seeking Pregnancy With Donor Insemination

Assessing Certified Nurse-Midwives' Attitudes Towards Planned Home Birth

The Long-Term Effects of Prenatal Nicotine Exposure on Neurologic Development

Return on Investment for Essential Obstetric Care Training in Ghana: Do Trained Public Sector Midwives Deliver Postabortion Care?

Health Care and Social Service Providers' Descriptions of Pacific Islander Mothers' Breastfeeding Patterns

Are Postpartum Women in Denmark Being Given Helpful Information About Urinary Incontinence and Pelvic Floor Exercises?

Frozen Hope: Fertility Preservation for Women With Cancer

Power, Control, and the “Difficult” Patient: Hidden Dimensions to Caring for Survivors of Sexual Abuse

Current Resources for Evidence-Based Practice, March/April 2010

A Global Perspective on the Status of Women's Reproductive Health

Safe Motherhood: A Human Right

Progress Toward Eradicating Harmful Practices Imposed on Girls and Women is Slow

Migration To Escape War Adversely Affects the Health of Women and Children

Defeating Cervical Cancer on a Global Scale is not Only Possible, It is Imperative!

Abnormal Uterine Bleeding

Induction of Vaginal Birth after Cesarean Using Intracervical Foley Bulb

Author Reply

Choosing Where To Have Your Baby

Editor Reply

JMWH Peer Reviewers 2009

Antidepressant Medication use in Pregnancy (#2009/101)

Guidelines for Perinatal Care

Mini-Medications and Mothers' Milk

Deliver Me From Pain: Anesthesia and Birth in America

Labor and Delivery Nursing: A Guide to Evidence-Based Practice

Table of Contents

Editorial Board

Society Page

Information for Readers