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.

Quality of labour and uncomplicated delivery care: a formative assessment of selected health facilities in Ebonyi and Kogi States, Nigeria.

Maternal Child Survival Program (MCSP) worked in Ebonyi and Kogi States between 2014 to 2018 to improve quality of maternal, child and newborn health care. A formative assessment was conducted in selected health facilities to examine the quality of care received by mothers and their newborns at all stages of normal birth on the day of birth. Health providers attending deliveries at 13 facilities in the two states were observed by trained health professionals. Forty health facilities with a high volume of at least 50 Antenatal Care visits per month and deliveries were purposively selected from 120 quality improvement health facilities. Screening for danger signs at admission was conducted for only 10.5% cases in labor and providers adhered to most recommended infection prevention standards but only washed hands before birth in 19.5% of cases. Chlorhexidine gel was applied to the newborn's umbilical stump in only 2% cases while partograph was used in 32% of the cases. No newborns received the full package of essential care. Potentially harmful practices were observed especially holding newborn babies upside down in 32% cases. Improved provider training and mentoring in high-quality care on the day of birth and strengthened supportive supervision may help to reduce maternal and newborn morbidity and mortality.

Planning for high-risk maternity patients: A new approach.

Having a plan in place before an expectant mother comes to the healthcare facility for delivery is an important step toward quality care. Read about how one medical center in New Jersey launched an initiative to identify high-risk expectant mothers early and plan accordingly months ahead of their delivery date.

Behind the Scenes: Publishing in the Maternal and Child Health Journal.

The Editors of the Maternal and Child Health Journal offer an inside look at publishing in the journal, including advice for potential authors and reviewers.

Maternity and postpartum care: perspectives.

EBN Perspectives brings together key issues from the commentaries in one of our nursing topic themes.

The Island of Alternatives: Power, Medical Science, and "Gentle Birthing" in Socialist Czechoslovakia.

Beginning in the early 1980s, medical experts and birthing women increasingly voiced criticism of what had long been the technocratic, depersonalized nature of obstetric treatment in Czechoslovakia, despite the limited opportunities for them to do so publicly. A few maternity hospitals responded to the complaints by introducing radically different regimens of care. This article examines the history of one reformist project that took place in the small town of Ostrov nad Ohrí. Ostrov means "island" in Czech and, during the last decade of Communist rule in Czechoslovakia, the Ostrov hospital became an island of alternative obstetric care, embracing Leboyer's method of "gentle birthing," acupuncture, fathers in delivery rooms, and assorted technological innovations that aimed to spark fundamental change in familial and social relationships, and humanize childbirth. While many medical professionals decried these reforms as nonsensical and dangerous, a number of parents-to-be flocked to Ostrov to give birth, circumventing the official rules mandating that they receive healthcare in their area of residence. This proactive consumerist behavior among expectant parents, in tandem with the call of some physicians for more attention to individual and family needs, despite the opposing official political discourse, is evidence of a grassroots movement for market-oriented principles in healthcare that reflected broader societal change during the last decade of the Communist regime.

ICNP® terminology subset for care of women and children experiencing breastfeeding. / Subconjunto terminológico da CIPE® para assistência à mulher e à criança em processo de amamentação.

OBJECTIVE: To describe the development of a terminology subset of the International Classification for Nursing Practice for care of women and children in process of breastfeeding. METHOD: Methodological study developed in six stages according to the guidelines recommended by the International Council of Nurses. RESULTS: Seventy-four nursing diagnoses/outcomes and 213 nursing interventions were performed and classified according to the theoretical model Interactive Theory of Breastfeeding. CONCLUSION: The subset is expected to safely and systematically steer nurses that work in this area, promoting the implementation of the nursing process and quality of care, focusing on women, children and families that are experiencing the breastfeeding process.

Standing out: overcoming fear.

The BloodtoBaby campaign provides midwives, students and others involved in the childbirth continuum with clear evidence based tools to teach women and families about the benefits of delayed cord clamping (DCC). Gaining sponsorship has enabled these educational tools to be distributed free of charge, shipped as far afield as New Zealand, South Africa, Palestine and across the UK. Developing the BloodtoBaby campaign has been incredibly empowering and, of course, rewarding. I am truly appreciative not just of its success but also, importantly, the journey itself and the personal knowledge I have gained. I've been faced with challenges and asked myself many questions but, unexpectedly, I have uncovered many personal treasures and I'd like to share those with you.

[Study of two indicators of difficulty in initiating maternal breastfeeding : maternal fatigue and suboptimal infant breastfeeding behaviour]. / Étude de deux indicateurs de difficulté de mise en place de l'allaitement maternel : la fatigue maternelle et le comportement non optimal du bébé au sein.

The problems with setting up breastfeading are common and are associated with a heightened risk of weening. The main motives brought up by the mothers for early weening were fatigue and the suboptimal infant breastfeeding behaviour (SIBB). The goal of this study is to describe the fatigue levels of breastfeading women who gave birth to healthy full term babies in a hospital setting and the SIBB. This study also examines the relation between these two variables. This descriptive correlational and cross-sectional study was conducted with breasfeeding women who gave birth to healthy, full term, single babies at the CHU in Moncton between June and September 2013. Fatigue Continuum Form and Infant Breastfeeding Assesement Tool were each used to measure fatigue and SIBB. Analysis was done using Spearman's correlation coefficient (r) and bivariate associations where measured using the chi-square test (χ2). Sixty-four mother child dyads were included in this study. 64.1 % of mothers experienced moderate fatigue. Maternal fatigue was associated with parity (p=0,003), the mothers' level of education (p=0,043), the child's birth weight (p=0,035), the delay before introducing the breast (p=0,001) and the frequency of feedings on D0 (p=0,037). The prevalence of SIBB was 57.8 % on day 0 (D0) and 25 % on day 1 (D1). SIBB is associated with a frequency of less than eight feedings in the first 24 hours (D0 (p=0,001) and D1(p=0,003)), to the primiparity (D1) (p=0,046), nipple types (D1) (p=0,010), previous breastfeeding experience (D1) (p=0,046). Skin on skin contact in the delivery room (D1) (p=0,041) and the delay before the first introduction to the breast (D1) (p=0,027). À significant correlation was noted between maternal fatigue and SIBB on D0 (r=0,196 ; p=0,029) and between SIBB on D0 and on D1 (r=0,661 ; p<0.001). A special supervision of mother-child dyads that are at risk is necessary in order to benefit from extra support during hospital stays and following their discharge from the hospital.

Comparing primiparous and multiparous mothers in a nurse home visiting prevention program.

BACKGROUND: An important yet overlooked feature of prominent prevention programs serving expectant mothers is the exclusion of women with children. This study examines mothers (n = 3,260) participating in a program without parity exclusion criteria, and compares demographic characteristics, risk status, service use, and child maltreatment outcomes. METHODS: A longitudinal, prospective study comparing primiparous (n = 1,890) and multiparous (n = 1,370) mothers participating in a nurse home visiting program. Patient groups are compared using bivariate and multivariate methods. RESULTS: Comparison by parity shows multiparous mothers had higher cumulative risk scores and individual risk factors related to maternal and child health, behavioral health, and violence exposure. Multiparous mothers were more likely to seek out services themselves and to initiate services later in the postnatal period. A significant trend exists among more children and greater caregiver stress, maternal depression, and child maltreatment. Multivariate models indicate infants of multiparous mothers have a higher risk (hazard ratio = 1.49) for later reports of child maltreatment. CONCLUSIONS: As compared with primiparous mothers, multiparous mothers were at higher risk but had similar levels of service use. Programs limited to primiparous mothers are missing a critical opportunity for prevention. Programs serving multiparous mothers should incorporate strategies to directly address caregiver stress and postpartum depression.

Effect of foot and hand massage in post-cesarean section pain control: a randomized control trial.

One of the problems for mothers in the post-cesarean section period is pain, which disturbs the early relationship between mothers and newborns; timely pain management prevents the side effects of pain, facilitates the recovery of patient, reduces the costs of treatment by minimizing or eliminating the mother's distress, and increases mother-infant interactions. The aim of this study was to determine the effect of hand and foot massage on post-cesarean section pain. This study is a randomized and controlled trial which was performed in Mustafa Khomeini Hospital, Elam, Iran, April 1 to July 30, 2011; it was carried out on 80 pregnant women who had an elective cesarean section and met inclusion criteria for study. The visual analog scale was used to determine the pain intensity before, immediately, and 90 minutes after conducting 5 minutes of foot and hand massage. Vital signs were measured and recorded. The pain intensity was found to be reduced after intervention compared with the intensity before the intervention (p < .001). Also, there was a significant difference between groups in terms of the pain intensity and requests for analgesic (p < .001). According to these findings, the foot and hand massage can be considered as a complementary method to reduce the pain of cesarean section effectively and to decrease the amount of medications and their side effects.

The 'active ingredients' for successful community engagement with disadvantaged expectant and new mothers: a qualitative comparative analysis.

AIMS: To explore which conditions of community engagement are implicated in effective interventions targeting disadvantaged pregnant women and new mothers. BACKGROUND: Adaptive experiences during pregnancy and the early years are key to reducing health inequalities in women and children worldwide. Public health nurses, health visitors and community midwives are well placed to address such disadvantage, often using community engagement strategies. Such interventions are complex; however, and we need to better understand which aspects of community engagement are aligned with effectiveness. DESIGN: Qualitative comparative analysis conducted in 2013, of trials data included in a recently published systematic review. METHODS: Two reviewers agreed on relevant conditions from 24 maternity or early years intervention studies examining four models of community engagement. Effect size estimates were converted into 'fuzzy' effectiveness categories and truth tables were constructed. Using fsQCA software, Boolean minimization identified solution sets. Random effects multiple regression and fsQCA were conducted to rule out risk of methodological bias. RESULTS/FINDINGS: Studies focused on antenatal, immunization, breastfeeding and early professional intervention outcomes. Peer delivery (consistency 0·83; unique coverage 0·63); and mother-professional collaboration (consistency 0·833; unique coverage 0·21) were moderately aligned with effective interventions. Community-identified health need plus consultation/collaboration in intervention design and leading on delivery were weakly aligned with 'not effective' interventions (consistency 0·78; unique coverage 0·29). CONCLUSIONS: For disadvantaged new and expectant mothers, peer or collaborative delivery models could be used in interventions. A need exists to design and test community engagement interventions in other areas of maternity and early years care and to further evaluate models of empowerment.

Psychosocial interventions for substance use during pregnancy.

Psychosocial and behavioral interventions are used to address substance use and dependence during pregnancy, having particular value when providers and pregnant women are seeking to minimize drug exposures to the fetus. Numerous factors, including difficulty recruiting participants and the ethical challenges to conducting randomized controlled trials with women during pregnancy, have limited research in this area. The existing literature, however, does contain early investigations into the practicality and efficacy of contingency management, motivational support, and cognitive behavioral therapies adapted for pregnant women. This article describes these approaches to treatment, summarizes programmatic examples, and highlights the role nurses may play with this special population.

Identification and management of prescription drug abuse in pregnancy.

Prescription drug abuse is a growing problem in the United States and many other countries. Estimates of prescription drug abuse rates during pregnancy range from 5% to 20%. The primary prescription drugs designated as controlled drugs with abuse potential in pregnancy are opiates prescribed for pain, benzodiazepines prescribed for anxiety, and stimulants prescribed for attention-deficit/hyperactivity disorder. Prescription drugs are obtained for abuse through diversion methods, such as purchasing them from others or by doctor shopping. The use of prescription drugs puts both the mother and the fetus at high risk during pregnancy. Identification of women who are abusing prescription drugs is important so that treatment can be ensured. It is crucial for healthcare professionals to use a multidisciplinary approach and be supportive and maintain a good rapport with pregnant women who abuse prescription drugs. Management includes inpatient hospitalization for detoxification and withdrawal symptoms, and in the case of opiate abuse, opiate maintenance is recommended for pregnant women for the duration of their pregnancy to reduce relapse rates and improve maternal and fetal outcomes. Other recommendations include referral for support groups and supportive housing.

Assumptions and advice: mothers and Queensland well-baby clinics. A review.

In 20th century Australia, free well-baby clinics were run by maternal and child health nurses, although the funding and organisational structure varied from state to state. It was assumed that women who attended followed the advice assiduously; yet attendance did not necessarily equate to practice. In Queensland, the state government's free Maternal and Child Welfare Service (MCW) advised mothers on infant feeding and care through well-baby clinics throughout the state, a correspondence section for mothers in remote areas and a railcar clinic to some western towns, under the state government's policy of covering every mother and baby in Queensland. Women in Queensland, as in other states, were exposed to other influences on how to feed babies and often exercised agency in making their own decisions according to their circumstances and their own judgment. This review will place research from Queensland on women's reasons for attending the clinics and adherence to the advice provided, during the period 1920-1965, within a wider context. This includes research on barriers to following advice, counselling versus imparting information and the mother's self-efficacy. The message for today is that adherence to advice still cannot be assumed and mothers' own circumstances need to be factored in.

Identifying parents with learning disabilities.

People with learning disabilities are likely to need additional support when accessing healthcare and, for those who are parents, receiving support at an early stage may help them to keep their child. Health professionals who have contact with expectant mothers early on in their pregnancies are well placed to identify support needs. Providing timely support may be a challenge, particularly if the mother has not been known to learning disability services. This article discusses whether screening tools may offer nurses a quick, easy way of identifying people with learning disabilities.

Promoting cultural humility during labor and birth: putting theory into action during PRONTO obstetric and neonatal emergency training.

Maternal and neonatal mortality in Northern Guatemala, a region with a high percentage of indigenous people, is disproportionately high. Initiatives to improve quality of care at local health facilities equipped for births, and increasing the number of births attended at these facilities will help address this problem. PRONTO (Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) is a low-tech, high-fidelity, simulation-based, provider-to-provider training in the management of obstetric and neonatal emergencies. This program has been successfully tested and implemented in Mexico. PRONTO will now be implemented in Guatemala as part of an initiative to decrease maternal and perinatal mortality. Guatemalan health authorities have requested that the training include training on cultural humility and humanized birth. This article describes the process of curricular adaptation to satisfy this request. The PRONTO team adapted the existing program through 4 steps: (a) analysis of the problem and context through a review of qualitative data and stakeholder interviews, (b) literature review and adoption of a theoretical framework regarding cultural humility and adult learning, (c) adaptation of the curriculum and design of new activities and simulations, and (d) implementation of adapted and expanded curriculum and further refinement in response to participant response.

Breastfeeding success in infants with giant omphalocele.

Infants born with a giant omphalocele often require multiple surgeries requiring a lengthy hospital stay. These vulnerable infants may experience a long period of being NPO (nothing by mouth), followed by slowly advancing to enteral feeds. Human milk is the ideal method of nutrition for all infants and should be used to initiate enteral feeds in infants recovering from omphalocele closure surgeries. Human milk provides immunological, nutritional, and developmental benefits for high-risk infants and may play a critical role in preventing associated morbidities often associated with infants born with giant omphalocele. Because of the stress of hospitalization, mother-infant dyads should be targeted to receive extensive lactation support, which can help ensure maintenance of milk supply and successful transition to breastfeeding once the infant is healthy enough to do so. Two case studies are presented as exemplars, demonstrating that the provision of human milk for even the most vulnerable infants can be achieved.

Community-based participatory research and the challenges of qualitative analysis enacted by lay, nurse, and academic researchers.

There are multiple challenges in adhering to the principles of community-based participatory research (CBPR), especially when there is a wide range of academic preparation within the research team. This is particularly evident in the analysis phase of qualitative research. We describe the process of conducting qualitative analysis of data on community perceptions of public maternity care in the Dominican Republic, in a cross-cultural, CBPR study. Analysis advanced through a process of experiential and conversational learning. Community involvement in analysis provided lay researchers an imperative for improvements in maternity care, nurses a new perspective about humanized care, and academic researchers a deeper understanding of how to create the conditions to enable conversational learning.