Celiac disease and preterm and/or low birthweight births.

Celiac disease (CD) is a genetically determined autoimmune condition, with an estimated worldwide prevalence of 1%. CD may be diagnosed or undiagnosed, but is usually identified through tests of specific antibodies and duodenal endoscopy. Treatment is the elimination of gluten from the diet. This article reviews six studies examining the relationship between CD and preterm (PTB) and/or low birth weight (LBW) births. Women previously identified with CD had pregnancy outcomes similar to women without CD. Undiagnosed CD, however, was associated with LBW in four of the six studies, and PTB in two studies. No increase in PTB or LBW birth was found in two studies. In these review of the literature, undiagnosed CD was most likely to result in increased risk of PTB or LBW. Nurses, nurse midwives, and nurse practitioners can play an important role in identifying and educating women with CD in the preconception and prenatal periods as well as during well woman health visits to potentially reduce PTB and LBW births in women with CD.

A model of recovering medical errors in the coronary care unit.

OBJECTIVE: The purpose of this study was to explore the thoughts, interpersonal processes, and actions used by nurses who had recently intervened to protect coronary care unit (CCU) patients from potential medical errors. METHODS: The study used semistructured interviews conducted with 18 very experienced CCU nurses in two academic medical centers. Content analysis was used to code and analyze text segments. Core codes were used for developing an empirically derived model. RESULTS: There were more than 1000 data bits of accounts of involvement in the near-miss events, thought processes and actions surrounding the events, communication strategies used, feelings, outcomes, reflection about the event and consequences, and environment/context in which the events occurred. A three-stage temporally ordered model illustrates the process of recovering medical errors. In stage one, the presence of the evolving clinical scenario and nursing knowledge and expertise plus the CCU context are the antecedents that lead to processes and actions of identification, interruption, and correction of the error in stage two. Outcomes of whether or not the near miss was recovered lead to an adverse event (or not), and reflections on the process and outcome lead to the nurse's feelings about the event in stage three. CONCLUSIONS: The model can guide nursing administration, practice, education, and research to recognize and value this responsibility, to teach others, and to test strategies to enhance the vital nursing role of recovering near-miss events that leads to safer and better patient care.

Follow-up care for infants with chronic lung disease: a randomized comparison of community- and center-based models.

OBJECTIVES: Premature infants with chronic lung disease benefit from comprehensive care, which typically is based in tertiary medical centers. When such centers are not easily accessible, alternative models of care are needed. The purpose of this work was to compare community-based follow-up, provided via telephone contacts, to traditional center-based follow-up of premature infants with chronic lung disease. PATIENTS AND METHODS: After discharge from neonatal intensive care, 150 premature infants with chronic lung disease were randomly assigned to either community-based (n = 75) or center-based (n = 75) follow-up. In community-based follow-up, a nurse specialist maintained telephone contact with the infant's primary caregiver and health care providers. Center-based follow-up consisted of visits to a medical center-based multidisciplinary clinic staffed by a neonatologist, a nurse specialist, and a social worker. The outcomes of interest were Bayley Scales of Infant Development mental developmental index and psychomotor developmental index, Vineland Adaptive Behavioral Composite, and growth delay (weight for length <5th percentile) at 1-year adjusted age and respiratory rehospitalizations through 1-year adjusted age. RESULTS: In each randomization group, 73 infants survived, and 69 were evaluated at 1-year adjusted age. The median mental development index (corrected for gestational age) was 90 for both groups. The median psychomotor developmental index was 82 for the center-based group and 81 for the community-based group. The median Vineland Adaptive Behavioral Composite was 100 and 102 for the center-based and community-based groups, respectively. In the center-based and community-based groups, respectively, the proportions with growth delay were 13% and 26%, and the proportions rehospitalized for respiratory illness were 33% and 29%. CONCLUSIONS: Infants randomly assigned to community-based, as compared with those randomly assigned to center-based follow-up, had similar developmental and health outcomes. The former approach might be a preferred alternative for families in rural settings or families for whom access to a tertiary care medical center is difficult.

Increasing cesarean birth rates: a clash of cultures?

Cesarean birth rates in the United States reached a high of 27.6% in 2003, a 6% increase over 2002. A cultural conflict appears to exist between the views of those who believe that birth is normal and many cesareans are unnecessary and the views of those who feel that higher rates are justifiable. Childbirth educators can share cultural concepts of normal birth in their classroom.

Listening to women at risk for preterm birth.

Frequently missing from discussions of the high rates of preterm and low birthweight births in the United States are the voices of pregnant women. In this article, we share the voices of low-income pregnant women who were participants in a 5-year randomized clinical study of nurse telephone intervention to reduce preterm birth. Data were gathered from three sources: a log kept by the study nurses in which they recorded events as they occurred; a telephone survey of randomly selected participants using a structured interview after the program was completed; and spontaneous comments from notes and letters written by study participants. Patients commonly perceived barriers to care, and related them to the nurses. The most frequent barriers concerned communication: miscommunication and misunderstanding between a woman and provider; miscommunication and misunderstanding involving providers giving conflicting information to patients; inaccurate information from provider to patient; failure of a provider to respond to a patient's request for information; and a general feeling among patients that providers were unsympathetic or uncaring. The perspectives of these women raise important questions for nurses and for other healthcare providers about the way we communicate both information and attitudes of caring to pregnant women.

Perceptions of nurses and mothers in four studies of the peripartum period.

How individuals perceive themselves and how they are perceived by others are an important part of the relationships between childbirth educators, nurses, other health-care providers, and the families they serve. In this paper, four studies are reviewed. One study focused on labor nurses' perception of their roles. Three other studies, each using a different research strategy, examined mothers' perceptions of their experiences during the peripartum period.

Cesarean birth from three research perspectives.

Issues surrounding cesarean birth are of interest to researchers from varied disciplines and nations. In this column, three studies that examine aspects of cesarean birth are reviewed. One study presented a review of 11 studies and found differences in the perceptions of white and minority mothers toward labor, vaginal birth, and cesarean birth. In a second study on infant outcomes, Japanese researchers found differences in transient tachypnea in infants born in the first half of the 37th week gestation and those born in the second half of the 37th week and the 38th week of gestation. In a third study conducted in Norway, researchers found more complications when cesarean birth occurred at advanced dilation. The three studies' implications for childbirth educators are discussed.

Preterm labor and birth: what have we learned in the past two decades?

Preterm births in the United States reached a 20-year high of 11.9% in 2001. Preterm and low-birth-weight births are the end result of multiple pathways. This article examines two decades of multidisciplinary research related to preterm birth from both individual and ecologic perspectives. The difficulties in identifying women who will have preterm birth, risk factors amenable to change in the preconception and prenatal periods, and strategies for intervention are described, along with maternal treatment to improve infant outcomes. Future directions for nursing practice and research are suggested.

Current studies on two separate topics: breastfeeding postpartum length of hospital stay.

IN THIS COLUMN, THE AUTHOR EXAMINES RECENT RESEARCH ON TWO SEPARATE TOPICS: 1) breastfeeding; 2) postpartum length of hospital stay. Recent studies suggest long-term effects of breastfeeding that benefit both mother and infant. Benefits include a reduced risk of breast cancer in breastfeeding mothers and a reduced level of total and LDH cholesterol in adults who were breastfed as infants. Infants of mothers with maternal asthma had lower rates of asthma if the mother breastfed. In a study of women in the United States who planned to breastfeed, those mothers who breastfed exclusively and planned to breastfeed more than three months were more likely to achieve their goals than mothers who planned to combine breast and human-milk substitute feeds and to breastfeed less than three months.In a Canadian study, shortened postpartum stays led to increased re-admission to hospital for mothers with cesarean births. In contrast, in a Massachusetts study, shortened postpartum stays did not lead to an increase in infant visits for urgent care. However, the Massachusetts study did not reflect a decrease in maternity-related costs associated with shortened length of postpartum stay.

Recent research questions the values of routine intervention.

Under appropriate circumstances, intervention in labor and birth can be valuable, even lifesaving. But interventions can also become routine procedures. This paper reviews three recent studies in which the focus of research is common interventions: electronic fetal monitoring and epidural anesthesia. A fourth study reviewed here examines the effect of previous vaginal birth and fetal weight on the success of vaginal birth after cesarean.

When Parents Ask ... about Preterm Birth, Breastfeeding Success, Breast Cancer, or Waterbirth.

IN THIS COLUMN, THE AUTHOR REVIEWS RESEARCH ON FOUR SEPARATE TOPICS: the prevention of preterm birth, the effect of epidurals on breastfeeding success, the possible protective effect of lactation on breast cancer, and laboring in water. In two separate studies-a multisite study in the United States and a second study from Brazil-natural progesterone was shown to significantly reduce the incidence of preterm birth in women at high risk. A third study conducted in the United Kingdom examined the effect of clindamycin on preventing infection that can lead to preterm birth. A group of studies related to lactation found that early breastfeeding was more successful in women who did not have epidural anesthesia. In a Korean study, the lifetime duration of breastfeeding was associated with a significant reduction in breast cancer. Concerning waterbirth, Swiss researchers found that, when a woman labored in water, she regulated both water temperature and bathing duration to ensure that her body temperature and that of the fetus remained within a normal physiological range.

Complementary and alternative therapies.

Complementary and alternative therapies are increasingly used by many pregnant women in the United States; however, limited research is available on many therapies. The number of studies should increase with the establishment of the National Center for Complementary and Alternative Medicine by the National Institutes of Health. This column reviews recent studies of both herbal medicines and alternative therapies used in pregnancy.

Reducing the rate of cesarean birth.

This column examines recent research that illustrates the varying perspectives of cesarean birth and vaginal birth.

Misoprostol-is more research needed?

Misoprostol (Cytotec) is a synthetic prostaglandin E1 analogue that was designed for the prevention and treatment of peptic ulcer associated with the use of nonsteroidal anti-inflammatory drugs. In obstetrics, misoprostol has been administered for induction of first and second trimester abortion, for induction of labor in the third trimester, and to control postpartum hemorrhage. None of these uses has been approved by the Food and Drug Administration. Nevertheless, misoprostol is widely used in the United States and throughout the world. Advantages are cited as reduced rate of cesareans, shorter time from induction to birth and, particularly in developing countries, lower cost, oral, vaginal or rectal administration, and stability without refrigeration. Disadvantages are uterine hyperstimulation and, in rare instances, uterine rupture and death. Mothers should be informed of both the risks and the possible benefits of misoprostol. Further research with large samples is necessary to determine whether the risks outweigh any possible benefits.

Preterm birth: a continuing challenge.

Although preterm birth has been a major focus of study for the past two decades by health care providers in several disciplines, it remains more prevalent in the United States than in many developed countries and continues to be a prime reason for infant death (mortality) and illness (morbidity). In the past 10 years, preterm rates have risen in the United States from 10.6% in 1990 to 11.6% in 2000. Low birthweight rates have increased from 7.0% in 1990 to 7.6% in 2000. This column reviews recent studies addressing preterm and low birthweight births, including changing demographics, the role of assisted reproductive technology, smoking, domestic violence, the experience of women, and treatment strategies.