Effect of an Intensive Nurse Home Visiting Program on Adverse Birth Outcomes in a Medicaid-Eligible Population: A Randomized Clinical Trial.

Importance: Improving birth outcomes for low-income mothers is a public health priority. Intensive nurse home visiting has been proposed as an intervention to improve these outcomes. Objective: To determine the effect of an intensive nurse home visiting program on a composite outcome of preterm birth, low birth weight, small for gestational age, or perinatal mortality. Design, Setting, and Participants: This was a randomized clinical trial that included 5670 Medicaid-eligible, nulliparous pregnant individuals at less than 28 weeks' gestation, enrolled between April 1, 2016, and March 17, 2020, with follow-up through February 2021. Interventions: Participants were randomized 2:1 to Nurse Family Partnership program (n = 3806) or control (n = 1864). The program is an established model of nurse home visiting; regular visits begin prenatally and continue through 2 postnatal years. Nurses provide education, assessments, and goal-setting related to prenatal health, child health and development, and maternal life course. The control group received usual care services and a list of community resources. Neither staff nor participants were blinded to intervention group. Main Outcomes and Measures: There were 3 primary outcomes. This article reports on a composite of adverse birth outcomes: preterm birth, low birth weight, small for gestational age, or perinatal mortality based on vital records, Medicaid claims, and hospital discharge records through February 2021. The other primary outcomes of interbirth intervals of less than 21 months and major injury or concern for abuse or neglect in the child's first 24 months have not yet completed measurement. There were 54 secondary outcomes; those related to maternal and newborn health that have completed measurement included all elements of the composite plus birth weight, gestational length, large for gestational age, extremely preterm, very low birth weight, overnight neonatal intensive care unit admission, severe maternal morbidity, and cesarean delivery. Results: Among 5670 participants enrolled, 4966 (3319 intervention; 1647 control) were analyzed for the primary maternal and neonatal health outcome (median age, 21 years [1.2% non-Hispanic Asian, Indigenous, or Native Hawaiian and Pacific Islander; 5.7% Hispanic; 55.2% non-Hispanic Black; 34.8% non-Hispanic White; and 3.0% more than 1 race reported [non-Hispanic]). The incidence of the composite adverse birth outcome was 26.9% in the intervention group and 26.1% in the control group (adjusted between-group difference, 0.5% [95% CI, -2.1% to 3.1%]). Outcomes for the intervention group were not significantly better for any of the maternal and newborn health primary or secondary outcomes in the overall sample or in either of the prespecified subgroups. Conclusions and Relevance: In this South Carolina-based trial of Medicaid-eligible pregnant individuals, assignment to participate in an intensive nurse home visiting program did not significantly reduce the incidence of a composite of adverse birth outcomes. Evaluation of the overall effectiveness of this program is incomplete, pending assessment of early childhood and birth spacing outcomes. Trial Registration: ClinicalTrials.gov Identifier: NCT03360539.

Implementing Patient-Centered Trauma-Informed Care for the Perinatal Nurse.

Adverse childhood experiences and trauma significantly impact physical and mental health. Increased maternal perinatal depression/anxiety, preterm labor, and low birth weight, as well as infant morbidity and mortality, are some examples of the impact of trauma on perinatal health. Trauma-informed care begins with knowledge about trauma, the ability to recognize signs of a trauma response, responding to patients effectively, and resisting retraumatization. As holistic providers, perinatal nurses can create safe care environments, establish collaborative patient relationships based on trust, demonstrate compassion, offer patients options when possible to support patient autonomy, and provide resources for trauma survivors. This can prevent or reduce the negative impact of trauma and improve the health and well-being of infants, mothers, and future generations. This clinical article outlines key strategies for implementation of patient-centered trauma-informed perinatal nursing care.

Addressing Alcohol Use in Pregnancy.

Screening and brief counseling interventions are evidence-based approaches.

Atuação do enfermeiro a pacientes portadoras de síndrome hipertensiva específica da gestação / Nursing's action against patients with specific hypertensive management syndrome

Objetivo: Identificar a importância da assistência de enfermagem às gestantes com Síndrome Hipertensiva Gestacional. Método: Estudo bibliográfico, descritivo e exploratório, realizado busca no banco de dados da Biblioteca Virtual em Saúde (BVS), Sistema Latino-Americano e do Caribe de Informações em Ciências da Saúde (LILACS), Scientific Eletrônic Library Online (SCIELO) e Bancos de dados em enfermagem (BDENF). Resultados: A Síndrome Hipertensiva da Gravidez (SHEG) apresenta como uma das mais importantes complicações durante o ciclo gravídicopuerperal e a sua etiologia ainda permanece desconhecida. A pré-eclâmpsia evolui naturalmente e quando não tratada/interrompida a gestação, ocorre o desenvolvimento para as formas mais graves, especialmente, a eclampsia e a síndrome HELLP. É de grande importância que o profissional de enfermagem atue de forma mais efetiva e presente, para que as reais necessidades das pacientes sejam supridas, havendo melhora do quadro clínico e eventuais complicações sejam evitadas. Conclusões: A assistência efetiva durante o pré-natal, pelos profissionais, diminui os índices de SHEG em gestantes e as tiram do grupo de risco, principalmente as que possuem fatores predisponentes e etiológicos. Assim, é possível descrever a atuação do enfermeiro frente à patologia, observando a necessidade de um trabalho conjunto à uma equipe multidisciplinar para que ocorra um atendimento eficaz à gestante (AU)

This study aimed to identify and characterize the importance of nursing care for pregnant women with Gestational Hypertensive Syndrome. Method: Bibliographic,descriptive and exploratory study, searches the database of the Virtual Health Library (VHL), Latin American and Caribbean Health Sciences Information System (LILACS), Scientific Electronic Library Online (SCIELO) and Banks. of Nursing Data (BDENF). Results: Hypertensive Pregnancy Syndrome (SHEG) is one of the most important complications during the pregnancy-puerperal cycle and its etiology is still unknown. Preeclampsia evolves naturally and when untreated / interrupted pregnancy develops into the most severe forms, especially eclampsia and HELLP syndrome. It is of great importance that the nursing professional acts more effectively and present, so that the real needs of patients are met, with improvement of the clinical picture and eventual complications are avoided. Conclusions: The effective prenatal care by professionals reduces the rates of SHEG in pregnant women and remove them from the risk group, especially those with predisposing and etiological factors. Thus, it is possible to describe the role of nurses in the pathology, noting the need for a joint work with a multidisciplinary team for effective care to pregnant women (AU)

A Model of Group Prenatal Care for Patients with Prenatally Diagnosed Fetal Anomalies.

The model of group prenatal care was initially developed to include peer support and to improve education and health-promoting behaviors during pregnancy. This model has since been adapted for populations with unique educational needs. Mama Care is an adaptation of the CenteringPregnancy Model of prenatal care. Mama Care is situated within a national and international referral center for families with prenatally diagnosed fetal anomalies. In December 2013, the Center for Fetal Diagnosis and Treatment at Children's Hospital of Philadelphia began offering a model of group prenatal care to women whose pregnancies are affected by a prenatal diagnosis of a fetal anomaly. The model incorporates significant adaptations of CenteringPregnancy in order to accommodate these women, who typically transition their care from community-based settings to the Center for Fetal Diagnosis and Treatment in the late second or early third trimester. Unique challenges associated with caring for families within a referral center include a condensed visit schedule, complex social needs such as housing and psychosocial support, as well as an increased need for antenatal surveillance and frequent preterm birth. Outcomes of the program are favorable and suggest group prenatal care models can be developed to support the needs of patients with prenatally diagnosed fetal anomalies.

[Midwives' feelings about the post-partum care of women with severe mental illness: A qualitative analysis]. / Ressenti des sages-femmes dans la prise en charge en suites de couche des patientes avec troubles psychiques sévères : une analyse qualitative.

BACKGROUND: A significant proportion of women with Severe Mental Illness (SMI) will become mothers during their reproductive life. These pregnancies are, however, more at risk of psychiatric, obstetrical and neonatal complications (increased risks of post-partum depression, relapse, suicide, gestational diabetes, placental abnormalities or low birth weight). Midwives often feel isolated and resourceless when taking care of these women. Specialized units such as mother-infant psychiatric units or the Transversal Unit of Perinatal Care (UTAP) in the Grenoble Alpes University Hospital (CHUGA) enhance the coordination between psychiatric and obstetrical teams and have shown effectiveness in improving maternal and child outcomes. OBJECTIVES: i) to assess midwives' feelings about the postpartum care of women with SMI; ii) to determine UTAP's impact on this feeling and its determinants; iii) to look for unmet needs. METHODS: This study is a prospective, exploratory, qualitative analysis. Twenty midwives from Grenoble Alpes University Hospital who took care of one of the selected patients participated in this study. Two women had schizophrenia and one bipolar disorder. Interviews realized with a semi-structured guide were fully transcribed, anonymized and thematically analyzed. Topics have been structured according to the number of occurrences to build a thematic tree. RESULTS: Midwives felt insecure and resourceless when the postpartum care was unclear, insufficiently anticipated and in case of a danger for the women or the children. They felt uneasy when not feeling able to provide usual care to these patients (due to lack of specific knowledge about SMI and to the impossibility to consider their patient otherwise than through their pathology). Midwives felt at ease and secure when the postpartum care was anticipated. UTAP was identified as a resource for midwives. Specific training and improvements in the organization of the pre and post-natal care could improve midwives' feelings when taking care of women with SMI.

"Sos vos con el pensamiento": La experiencia vivida de la hospitalización de mujeres con embarazos de alto riesgo / "Are your voices with thought": The lived experience of the hospitalization of women with high-risk pregnancies

Objetivo: Develar el significado de la experiencia vivida de la hospitalización de mujeres con gestaciones de alto riesgo en una institución de salud en la ciudad de Medellín. Metodología: Esta es una investigación cualitativa realizada con el enfoque fenomenológico hermenéutico. La muestra fue definida por el criterio único de saturación a través de un muestreo de tipo intencional. Las participantes fueron cuatro mujeres que cumplieron con los criterios de inclusión. La recolección de la información se hizo mediante entrevista en profundidad, realizada en dos sesiones por participante, para un total de 8 entrevistas. De manera previa, se hizo un estudio exploratorio con una mujer que estuvo hospitalizada en otra institución, pero estos datos no forman parte de los resultados. El análisis de la información recopilada fue guiado por los cinco existenciales de Max Van Manen: cuerpo vivido, relación vivida, espacio vivido, tiempo vivido y cosas vividas. Resultados: Por medio de tres aproximaciones (holística, selectiva y línea a línea) se logró develar el mundo de cada una de las participantes a través de los cinco existenciales de Van Manen. En la experiencia cuerpo vivido, "Sos vos con el pensamiento", las mujeres relatan una lucha interna entre lo que sienten y lo que expresan. El significado de la relación vivida, Los tres otros, estuvo mediada por una conexión con un ser superior, ayudada por las relaciones con sus familiares y con el apoyo y la tranquilidad que les brindaba el personal de salud. Por su parte, el espacio vivido, transitando por los diferentes servicios, fue significativo ya que tuvo en cuenta el lugar y los sucesos ocurridos en el espacio, y estos permitieron percibir vivencias con diferentes matices. En cuanto a la experiencia tiempo vivido, el pasado que anticipa el futuro, se refiere a experiencias pasadas que influyen los sentimientos, pensamientos y las emociones del presente. Por último, las cosas vividas, (como, cuando me lo quitaban en la noche, que no me hacían monitoreo, sentía como una paz) expresan, en este caso, la molestia por el uso de los dispositivos médicos, pero entendiendo que eran necesarios para su cuidado. Conclusiones: El significado de la experiencia vivida de la hospitalización es relatado por las participantes como una lucha interna con sus pensamientos; esto desencadena en ellas una cascada de emociones en la que los acontecimientos hacen que, de manera abrupta, pasen de una emoción a otra. La incertidumbre se siente a lo largo de la experiencia, es parte del proceso y se expresa de diferentes formas. A su vez, el paso del tiempo les permite percibir, de forma corporal, las implicaciones de las situaciones, y altera la experiencia del espacio que están habitando. Las mujeres quieren ser reconocidas por la complejidad de su enfermedad y por su proceso de embarazo, reclaman que las hagan sentir únicas y especiales a través de un cuidado humanizado. (AU)

Objective: To reveal lived experience meaning from women at Inpatient care high-risk pregnancies in Healthcare Facility at Medellin city. Methodology: Qualitative research with a hermeneutical phenomenological approach proposed by Max Van Manen. The sample was defined by a single criterion of saturation and through intentional sampling. Our participants were four women who met the inclusion criteria. The information was collected through an in-depth interview, carried out in two sessions by each participant for a total of 8 interviews, these were carried out after the exploratory study was done, which included the participation of a woman who was hospitalized in another institution but she isn´t part of the data. The information analysis was guided by Max Van Manen's five existentialist, lived body, lived relationship, lived space, lived time and lived things. Results: Through three holistic, selective and line by line approaches it was possible to unveil the life's world from each one participants by means of the five existential's comprehension In the experience of the lived body, the women relate "Are you with voices with thought "an internal struggle between what they feel and express. The meaning lived relationship: "The three others" were mediated by a connection with a higher being aided by family relationships and the support and tranquility provided by health personnel, for their part, the lived space: Transiting through the different services It was significant according to the place and the events that occurred within the space that made this experience perceived with different nuances. The time lived: The past that anticipates the future, the past experiences influenced their feelings, thoughts and emotions of the present and the other part the things lived "When they took it off me at night, they didn't monitor me, it felt like a peace" meant feeling discomfort for the use of the devices but understanding that they were necessary for their care. Conclusions: Their lived experience meaning from inpatient setting is lived and related by the participants as an internal struggle with their thoughts which triggers a cascade of emotions where events make them abruptly transition from one emotion to another. Uncertainty is felt throughout the experience, it is part of the process and is expressed in different ways. In turn, the passage of time allows them to perceive the implications of situations in a bodily way, altering the experience of the space they are inhabiting. Women want to be recognized for the complexity of their disease and their pregnancy process, they demand that they make them feel unique and special through humanized care. (AU)

Case Report of Nursing Care for a Pregnant Woman With Cystic Fibrosis.

Life expectancy for individuals with cystic fibrosis (CF) has significantly increased during the last few decades, and subsequently, more women with CF are considering pregnancy. A detailed understanding of the management of pregnancy, specific pulmonary treatments, and necessary medications is essential to provide specialized care for women with CF. In this article, we present the physical and psychosocial aspects of care for pregnant women with CF and describe a case involving the planned pregnancy of a nulliparous woman with CF. We suggest vigilant monitoring for adequate nutrition, weight gain, and pulmonary function throughout pregnancy as implications for nursing care.

Substance Abuse Disorder: Prenatal, Intrapartum and Postpartum Care.

The growing opioid crisis in the United States affects childbearing women and their infants at an alarming rate. Substance use disorders in pregnancy have transitioned from a topic barely addressed to one that has become mainstream in the issue of pregnancy management. Opioid use can include appropriate use of a prescribed medication, the misuse of street drugs, and maintenance on an opioid agonist treatment such as methadone. Identifying this population of childbearing women is critical to be able to organize the appropriate resources and to provide a comprehensive multidisciplinary evidence-based plan of care. All clinicians need to be educated in identifying and caring for the growing population of women with substance use disorders. Each component of the continuum from prenatal care, labor and birth, and postpartum has challenges and issues that can have a positive or negative impact on the outcome of the pregnancy and the mother-infant relationship. Risk assessment, medication-assisted treatment, pain management, and fostering maternal-infant bonding are important considerations in the care of the woman with substance use disorder. Unbiased empathetic nurses are well positioned to strongly advocate and intervene on behalf of women with substance use disorder, which in turn will help to create positive outcomes for the mother and her baby.

Public health nurses' perinatal mental health training needs: A cross sectional survey.

AIM: To examine public health nurses' education, training, and professional support needs in perinatal mental health. BACKGROUND: Public health nurses have a key role in supporting maternal mental health including screening, support, referral, and decreasing stigmatization. DESIGN: A cross-sectional survey. METHODS: Data were collected from a convenience sample of Irish public health nurses (N = 105) from December 2016-February 2018. The anonymous postal survey consisted of the Perinatal Mental Health Questionnaire, Mental Illness: Clinician's Attitudes scale and Perinatal Mental Health Learning Needs questionnaire. RESULTS: Public health nurses reported good levels of knowledge (77.2%) and confidence (83.8%) in recognising women experiencing stress, anxiety and depression. They indicated less confidence in caring (50.5%) for women. The average score for the Mental Illness: Clinician's Attitudes scale was 35.9 (SD 5.9), suggesting positive attitudes towards women with significant mental illness. CONCLUSION: Public health nurses require educational opportunities to explore expressions of psychological distress across cultures and their own personal attitudes to mental health, systems of clinical supervision, and support pathways. IMPACT: Generating new knowledge on the importance of incorporating an attitude component in perinatal mental health education for public health nurses.

Management of Extracorporeal Membrane Oxygenation for Obstetric Patients: Concerns for Critical Care Nurses.

Critical care nurses are faced with many challenges, and one that is particularly stressful is caring for obstetric patients. This care can become more complex when the obstetric patient requires extracorporeal membrane oxygenation. It is imperative that critical care nurses have knowledge about this unique population, the expected physical changes of pregnancy, and the management of extracorporeal membrane oxygenation. Obstetric patients present unique challenges, and care is focused on the woman and her family. The purpose of this paper is to provide information for critical care nurses regarding care of obstetric patients who receive extracorporeal membrane oxygenation.

Factors influencing the adoption of health promoting behaviors in overweight pregnant women: a qualitative study.

BACKGROUND: The ability to adopt and implement health promotion behaviors is one of the most important determinants of health status. Various factors affect the successful changing of behaviors and choosing a healthy lifestyle. The present study aims at exploring the experiences of overweight pregnant women in terms of the factors influencing selection and adoption of health promoting behaviors during pregnancy. METHODS: This qualitative study reports the findings of individual and group in-depth interviews with 32 overweight pregnant women using semi-structured questions which was conducted in Tabriz-Iran in 2017 and lasted for 6 months. The data collection continued until the saturation of the data. Participants were selected using purposive sampling and study inclusion criteria. Interviews were recorded and transcribed. Thereafter, content analysis was made using MAXQDA v. 10. Strength of data was verified by both participants and external control. RESULTS: The reported effective factors led to identification of the two themes of two contextual perceived barriers and facilitators, which were classified into four main categories and nine subcategories: 1. Individual barriers (disabilities-additional needs in pregnancy and mental barriers) 2. Socio- environmental barriers (adverse effects of the environment, adverse effects of the relatives and financial pressures) 3. Individual facilitators (intrinsic incentives, abundance and individual skills) 4. Socio- environmental (social and family support, incentive environments, and raising awareness). CONCLUSION: The adoption of health behaviors and healthy lifestyle is under the mutual influence of individual characteristics and socio-environmental factors. What should be considered in planning and designing interventions is focused on removing barriers and strengthening facilitators, in particular by moderating social factors and taking into account individual needs and personal expectations.

Effects of prenatal education on complaints during pregnancy and on quality of life.

OBJECTIVE: The study was conducted to determine the effects of prenatal education on quality of life and complaints during pregnancy. METHODS: This study is a quasi-experimental research with a control group. Personal Information Form and Scale of Complaints during Pregnancy and their Effects on Quality of Life (SCPEQL) were used to collect the data. Thirty participants were included in both the control and the intervention groups (N = 60). RESULTS: The mean scores of SCPEQL of the intervention group was 46.2 ± 21.1 and the mean scores of SCPEQL of the control group was 99.8 ± 21.6 in 2nd trimester. In the 3rd trimester, the mean score of SCPEQL of the intervention group was 43.5 ± 16.4, and the mean score of SCPEQL of the control group was 108.0 ± 16.8. The difference between the groups was statistically significant in 2nd and 3rd trimesters (p < 0.05). CONCLUSION: Findings of the study suggest that providing prenatal education reduces complaints and increases quality of life of pregnant women. PRACTICE IMPLICATIONS: Assessing complaints during pregnancy by nurses is a part of the prenatal care. Therefore, nurses should evaluate pregnancy-related complaints. Quality of life should be increased by giving effective education about complaints during pregnancy.

Clinical Presentation and Treatment of Amniotic Fluid Embolism.

Obstetric emergencies often require intensive care intervention. Amniotic fluid embolism is a rare, unpredictable, and often catastrophic complication of pregnancy that is suspected in a woman who experiences cardiac arrest after a cesarean section. The condition occurs in approximately 1 in 40 000 births and has an average case-fatality rate of 16%. This complication may result from activation of an inflammatory response to fetal tissue in the maternal circulation. Risk factors may include maternal age over 35 years and conditions in which fluid can exchange between the maternal and fetal circulations. The presentation is abrupt, with profound cardiovascular and respiratory compromise, encephalopathy, fetal distress, and disseminated intravascular coagulopathy. Diagnosis is by exclusion and clinical presentation. Treatment is supportive, with a focus on reversal of hypoxia and hypotension, delivery of the fetus, and correction of coagulopathy. Staff debriefing and psychological support for the woman and family are vital.

Pulmonary Edema in Obstetrics: Essential Facts for Critical Care Nurses.

Pulmonary edema is an acute pregnancy complication that, if uncorrected, can result in increased maternal and fetal morbidity and mortality. Although pulmonary edema is relatively rare in the general obstetrics population, pregnant patients are at increased risk for pulmonary edema because of the physiologic changes of pregnancy. The risk may be exacerbated by certain pregnancy-related diseases, such as preeclampsia. Prompt identification and appropriate clinical management of pulmonary complications is critical to prevent adverse outcomes in pregnant patients. This article reviews the collaborative treatment of pulmonary edema in pregnant women with complex critical illnesses.