A Novel Nonhormonal Treatment for Vasomotor Symptoms of Menopause.

Vasomotor symptoms of menopause, more commonly called hot flashes and night sweats, affect up to 80% of individuals going through the menopausal transition. Hormone therapy with estrogen and often progesterone is the most effective treatment for these symptoms. Many people, however, cannot take estrogen or do not want to take hormones. Many individuals seek nonhormonal, over-the-counter treatment options that have little safety and efficacy information to support their use. In March 2023, the U.S. Food and Drug Administration approved fezolinetant (Veozah), a neurokinin 3 receptor antagonist for the treatment of vasomotor symptoms of menopause. This article presents an overview of fezolinetant, including appropriate usage, adverse effects, its use in special populations, and implications for nursing practice.

Low-Intervention Birth Suites Within a Community Hospital: An Innovative Approach to Perinatal Services.

Perinatal care leaders at a community hospital located in the Denver, Colorado metropolitan area searched for an innovative way to provide a low-intervention option that promoted physiologic birth for women seeking intrapartum care. This reasonably priced project focused on the transformation of traditional labor and delivery rooms into birth suites and included installation of birth slings, full-size beds with home-like mattresses, new sleep sofas for the partners, and the removal of computer screens and electronic fetal monitors. In addition, the team wrote a specific birth suite policy, provided nurse education focused on intermittent auscultation and labor support techniques, and developed a birth suite curriculum for patient education. This innovative model of care demonstrated outcomes similar to those seen in community-based birth centers and received positive feedback from families who labored and gave birth in these suites. In the instance when the birth suite is no longer the appropriate environment for intrapartum care secondary to risk factors, a woman's preference, or obstetric emergency management, this model allows for expeditious transfer of the woman or newborn to a location where an appropriate higher level of care can be provided. Converting 2 labor and delivery rooms to low-intervention birth suites required minimal funding and enabled a community hospital in Colorado to expand its perinatal services to women who are seeking low-intervention birth options that promote physiologic birth.

Reducing the Primary Cesarean Birth Rate: A Quality Improvement Project.

INTRODUCTION: Research continues to support vaginal birth as the safest mode of childbirth, but despite this, cesarean birth has become the most common surgical procedure performed on women. The rate has increased 500% since the 1970s without a corresponding improvement in maternal or neonatal outcomes. A Colorado community hospital recognized that its primary cesarean birth rate was higher than national and state benchmark levels. To reduce this rate, the hospital collaborated with its largest maternity care provider group to implement a select number of physiologic birth practices and measure improvement in outcomes. PROCESS: Using a pre- and postprocess measure study design, the quality improvement project team identified and implemented 3 physiologic birth parameters over a 12-month period that have been shown to promote vaginal birth. These included reducing elective induction of labor in women less than 41 weeks' gestation; standardizing triage to admit women at greater than or equal to 4 cm dilation; and increasing the use of intermittent auscultation as opposed to continuous fetal monitoring for fetal surveillance. The team also calculated each obstetrician-gynecologist's primary cesarean birth rate monthly and delivered these rates to the providers. OUTCOMES: Outcomes showed that the provider group decreased its primary cesarean birth rate from 28.9% to 12.2% in the 12-month postprocess measure period. The 57.8% decrease is statistically significant (odds ratio [OR], 0.345; z = 6.52, P < .001; 95% confidence interval [CI], 0.249-0.479). DISCUSSION: While this quality improvement project cannot be translated to other settings, promotion of physiologic birth practices, along with audit and feedback, had a statistically significant impact on the primary cesarean birth rate for this provider group and, consequently, on the community hospital where they attend births.