"Yes, I can bond." Reflections of autistic women's mothering experiences in the early postpartum period.

BACKGROUND: Autism is a neurodevelopmental condition affecting communication and social interaction. Much of the research regarding childbirth and motherhood is focused on non-autistic women. Autistic mothers may experience challenges communicating their needs to health care professionals and find aspects of the hospital environment distressing, indicating a need for more informed practice. OBJECTIVE: To describe the experiences of autistic women bonding with their newborns after delivery in an acute care setting. DESIGN: The study used a qualitative interpretative description design with data analysis using the method described by Knafl and Webster. The study explored the women's childbirth experiences in the early postpartum period. METHOD: Interviews were conducted using a semi-structured interview guide. The women were interviewed in a setting of their choosing and included in person meetings, meetings over Skype, over the telephone, or via Facebook messenger. Twenty-four women ages 29-65 years participated in the study. The women were from the United States, the United Kingdom, and Australia. All women gave birth to a healthy term newborn in an acute care setting. RESULTS: Three major themes emerged from the data: having difficulty communicating, feeling stressed in an uncertain environment, and being an autistic mother. CONCLUSION: The autistic mothers in the study expressed love and concern for their babies. Some women described needing more time to recover physically and emotionally before assuming care of the newborn. The stress of childbirth left them exhausted and the demands of caring for a newborn could be overwhelming for some women. Miscommunication during labor affected some of the women's ability to trust the nurses caring for them and, in two cases, left the women feeling judged as mothers.

Relationships Among Neighborhood Poverty, Access to Healthy Food, and Diabetes Self-Management in Women Who Received Perinatal Nurse Home Visits.

OBJECTIVE: To examine the relationships among neighborhood poverty, access to healthy food, and diabetes self-management in pregnant women in an urban setting who received perinatal nurse home visits. DESIGN: Exploratory descriptive secondary analysis of existing individual-level and neighborhood-level data. SETTING: Philadelphia, Pennsylvania, United States. PARTICIPANTS: Women who were pregnant, had diabetes, and were enrolled in the citywide perinatal nurse home visiting program because of their diabetes (N = 264). METHODS: We retrieved neighborhood-level aggregated data on poverty and access to healthy food from PolicyMap, a geographic information system. We retrieved individual-level data from a clinical research database. Access to healthy food was operationalized at the individual level by reported use of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). We operationalized diabetes self-management as good or poor glycemic control. We conducted descriptive and logistic regression analyses. RESULTS: We found no relationship between neighborhood-level poverty and neighborhood-level access to healthy food with women's glycemic control. However, at the individual level, use of the WIC program was associated with glycemic control (p = .034). Participants who reported not using this program were two times more likely to have poor glycemic control than those who did (OR = 2.045, 95% confidence interval [1.003, 2.045]). CONCLUSION: It is important to understand how the complex interplay between neighborhoods and individual factors of poverty and access to healthy food influences health outcomes among pregnant women. The WIC program may mediate neighborhood influence on diabetes self-management. Future research is warranted on how this program and nurse home visiting services can optimize maternal health outcomes among women who have diabetes during pregnancy.

Knowledge of and Attitudes Toward Perinatal Home Visiting in Women with High-Risk Pregnancies.

INTRODUCTION: Published research indicates that some perinatal home visiting programs are highly effective. However, there is a dearth of information regarding how these services apply to women experiencing a high-risk pregnancy. The aim of this study was to determine the potential acceptability of home visiting services within this vulnerable population and identify what services women want. METHODS: Four focus groups (N = 32) were conducted with a population of low-income, pregnant individuals in medically underserved central Georgia (United States). Participants were evaluated based on their current exposure to home visiting, receptiveness to home visiting, and reasons for apprehension regarding home visiting. RESULTS: The results of this study were mixed, with women expressing both interest in and reluctance about home visiting programs. Themes of distrust and fear of judgment or persecution existed. Women also varied with regard to what home visiting services they would like offered. Those discussed included assistance with maternal or infant medical needs, maternal function tasks, household tasks, and child care. DISCUSSION: Home visiting programs can be effective for improving maternal and child health outcomes. However, not all home visiting programs effectively reach their target population. More research is needed to determine what women who have high-risk conditions during pregnancy want help with and how to increase receptiveness. The results of this study could be informative to health care providers who treat persons with high-risk conditions in identifying adjunctive services for those in need of additional support.

Promotion of Maternal-Infant Mental Health and Trauma-Informed Care During the COVID-19 Pandemic.

The COVID-19 pandemic has led to disruptions in health care in the perinatal period and women's childbirth experiences. Organizations that represent health care professionals have responded with general practice guidelines for pregnant women, but limited attention has been devoted to mental health in the perinatal period during a pandemic. Evidence suggests that in this context, significant psychological distress may have the potential for long-term psychological harm for mothers and infants. For infants, this risk may extend into early childhood. In this commentary, we present recommendations for practice, research, and policy related to mental health in the perinatal period. These recommendations include the use of a trauma-informed framework to promote social support and infant attachment, use of technology and telehealth, and assessment for mental health needs and experiences of violence.

High Ambient Temperature and Infant Mortality in Philadelphia, Pennsylvania: A Case-Crossover Study.

OBJECTIVE: To quantify the association between heat and infant mortality and identify factors that influence infant vulnerability to heat. METHODS: We conducted a time-stratified case-crossover analysis of associations between ambient temperature and infant mortality in Philadelphia, Pennsylvania, during the warm months of 2000 through 2015. We used conditional logistic regression models to estimate associations of infant mortality with daily temperatures on the day of death (lag 0) and for averaging periods of 0 to 1 to 0 to 3 days before the day of death. We explored modification of associations by individual and census tract-level characteristics and by amounts of green space. RESULTS: Risk of infant mortality increased by 22.4% (95% confidence interval [CI] = 5.0%, 42.6%) for every 1°C increase in minimum daily temperature over 23.9°C on the day of death. We observed limited evidence of effect modification across strata of the covariates. CONCLUSIONS: Our results contribute to a growing body of evidence that infants are a subpopulation that is particularly vulnerable to climate change effects. Further research using large data sets is critically needed to elucidate modifiable factors that may protect infants against heat vulnerability.

Beyond bus fare: deconstructing prenatal care travel among low-income urban mothers through a mix methods GIS study.

OBJECTIVE: Guided by critical theory, this study illustrates the value of interpretative mapping to deconstruct bus travel to publicly funded prenatal care in a city marked by health and social inequities. METHODS: This mixed methods study used GIS maps based on 61,305 births to study the known barrier of transportation to prenatal care among urban mothers most at risk for preterm birth. RESULTS: Among 350 census tracts, 36 census tracts had preterm rates between 25 -36.9%. Modeling travel time for the case vignette for routine prenatal care took 21 visits to different geographically located facilities. This burden increased to 32 visits if the case vignette was high-risk. CONCLUSIONS: Interpretative GIS mapping is an important tool to ground truth spatially linked data into real world meanings. Promoting optimal health requires innovative and feasible approaches that take into consideration daily maternal functioning as pregnant mothers care for their children and themselves.

Family Care Curriculum: A Parenting Support Program for Families Experiencing Homelessness.

Purpose In the United States, families with children characterize the fastest growing portion of the homeless population. Parenting for families experiencing homelessness presents unique challenges since families facing homelessness are disproportionately more likely to experience a myriad of interpersonal and contextual stressors that heighten the risk of parents engaging in suboptimal parenting approaches. This article describes the development and implementation of the Family Care Curriculum (FCC) train-the-trainer parenting support program specifically designed to support positive parenting in families experiencing homelessness. Description The FCC is a 6-week theory-based parenting intervention aimed to create positive shifts in parental attitudes to enhance sensitive and nurturing parenting and positive parent-child relationships. FCC assists parents in reflecting on how their own experiences contribute to some of their parenting beliefs, patterns, and behaviors. Parents are coached to imagine and understand the emotions, attachment, and developmental needs behind their children's behaviors so they can maintain empathic and nurturing parenting responses in the context of cumulative and chronic stress. Parents are supported through learning to engage in self-care. A unique and important feature of the FCC is the inclusion of a culturally sensitive approach that takes into consideration the effects of racism, classism, and oppression on parent-child relationships. Conclusion FCC was designed, implemented, and championed by expert providers in the fields of family therapy, social work, and pediatrics to support parents experiencing homelessness. FCC adds to the body of effective attachment-based, trauma-informed, and culturally sensitive parenting interventions for improving parent-child relations and family health amongst vulnerable populations.

Using Geographic Information Systems to Visualize Relationships Between Perinatal Outcomes and Neighborhood Characteristics When Planning Community Interventions.

OBJECTIVE: To describe maternal morbidity, birth outcomes, and neighborhood characteristics of urban women from a racially segregated city with the use of a geographic information system (GIS). DESIGN: Exploratory neighborhood-level study. Existing birth certificate data were linked and aggregated to neighborhood-level data for spatial analyses. SETTING: Southern city in New Jersey. SAMPLE: Women and their 7,858 live births that occurred between 2009 and 2013. METHODS: Secondary analyses of extant sources were conducted. Maternal health and newborn birth outcomes were geocoded and then aggregated to the neighborhood level for further exploratory spatial analyses through our GIS database. An iterative process was used to generate meaningful visual representations of the data through maps of maternal and infant health in 19 neighborhoods. RESULTS: The racial and ethnic residential segregation and neighborhood patterns of associations of adverse birth outcomes with poverty and crime were illustrated in GIS maps. In 43% of the births, women had a documented medical risk. Significantly more preterm births occurred for Black women (p < .01) and women older than 35 years of age (p = .01). The rate of diabetes was greater in Hispanic women, and the rate of pregnancy-related hypertensive disorders was greater in Black women. CONCLUSION: Data-driven maps can provide clear evidence of maternal and infant health and health needs based on the neighborhoods where mothers live. This research is important so that maternity care providers can understand contextual factors that affect mothers in their communities and guide the design of interventions.

Human papillomavirus vaccination uptake and completion as a preventive health measure among female adolescents.

BACKGROUND: National coverage for the human papillomavirus (HPV) vaccine falls short of the targeted goals for Healthy People 2020 with disparities in completion rates noted in minority adolescent female populations. The purpose of this study was to provide a review of the literature on HPV vaccination uptake and completion rates among female minority adolescents as well as a discussion of the financial and policy dimensions of HPV vaccination with implications that impact uptake and completion rates. METHODS: By reviewing the literature, the authors show that the two human papillomavirus (HPV) vaccines, Gardasil and Cervarix, have presented unprecedented opportunities to prevent morbidity and mortality from cervical cancer. CONCLUSION: The authors recommend that nurses and advanced practice nurses take an active role at the point of care to educate families about HPV vaccination. Nursing interventions for practice changes are provided to improve vaccination initiation and completion rates in disadvantaged populations.

Nurse practitioner faculty research: Results from the 2012 National Organization of Nurse Practitioner Faculties Survey.

PURPOSE: To better understand the research capacity and productivity of nurse practitioner (NP) faculty, a study was conducted to describe the types of research that have been and are being completed by National Organization of Nurse Practitioner Faculties (NONPF) members. DATA SOURCES: A web-based survey was developed with input from members of the NONPF Research Special Interest Group and the NONPF Board. This 23-question survey included demographic, academic degree, NP population focus, and research-related questions. Three e-mails were sent to NONPF members over a 10-week period of time (late December 2012 to early February 2013). CONCLUSIONS: Respondents (N = 344) in the sample were Advanced Practice Registered Nurses with either a Masters, Doctor of Nursing Practice, DNS or PhD as their highest academic degree. Study results demonstrated that current NP faculty research includes a wide breadth of clinical areas studied, types of methodologies used, variety of funding mechanisms, and successful publication records. IMPLICATIONS FOR PRACTICE: Because NP faculty conduct a wide array of research on clinically relevant topics, and demonstrate successful funding and publication track records, they are poised to continue to be leaders in healthcare research.

Focusing on maternal health beyond breastfeeding and depression during the first year postpartum.

Nursing experts reviewed publications between 2003 and 2013 to identify practices for the care of women during the recovery year after childbirth. They focused on maternal transition, role and function, and psychosocial support. Findings indicated that clarification of the psychosocial meanings of childbirth and motherhood and family support systems that strengthen or hinder optimal wellness and functioning are needed. In addition, evidence is required to promote healthy transitions during this transition year.

Feeding tolerance in preterm infants on noninvasive respiratory support.

To evaluate differences in feeding tolerance between infants maintained on continuous positive airway pressure (CPAP) and those receiving high-flow (nasal) cannula (HFC) with or without CPAP. This is a retrospective, cross-sectional study. Two groups of very low-birth-weight infants (750-1500 g) were compared on the basis of respiratory support: (1) infants born between the January 2002 and December 2004 treated with CPAP; and (2) infants born between January 2005 and December 2006 treated with HFC with or without CPAP. The groups were compared to determine which of the two attained full feedings sooner. Successful achievement of full feedings was measured in days from birth and defined by discontinuation of hyperalimentation-supplementation and attainment of 120 mL/kg/d of enteral feedings. A total of 185 infants met inclusion criteria (103 who received CPAP exclusively and 82 who received HFC with or without CPAP). There was no statistical difference in time to full enteral feedings between the 2 groups. There was also no difference in time of initiation of oral feeding or days to full oral feedings between 2 groups. The use of HFC was not associated with changes in feeding tolerance in premature infants. Further studies are needed to investigate efficacy and potential advantages and disadvantages to the use of HFC in the very low-birth-weight infant population.

The relationship between personal knowledge and decision self-efficacy in choosing trial of labor after cesarean.

INTRODUCTION: The number of women in the United States giving birth via cesarean remains high as the number of vaginal births after cesarean (VBAC) declines. The purpose of this study was to explore how personal knowledge and decision self-efficacy of women who had a prior cesarean birth affected their decision about mode of birth in a subsequent pregnancy. METHODS: A sample of 45 pregnant women with a history of a prior cesarean birth between 10 and 22 weeks' gestation were surveyed to assess their knowledge of the risks and benefits of trial of labor after cesarean (TOLAC) and elective repeat cesarean delivery (ERCD), and their degree of decision self-efficacy related to their choice of mode of birth for the present pregnancy. RESULTS: Decision self-efficacy was not a significant predictor of choice for mode of birth (P = 0.58). Knowledge scores of women who chose ERCD ranged from 0 to 10 (mean [SD], 4.64 [2.94]). Of women who chose TOLAC, knowledge scores ranged from 0 to 13 (mean [SD], 5.90 [3.64]) out of a total possible score of 14. Knowledge was found to be a significant factor in the decision-making process for mode of birth (P = 0.03). Among women who were deemed to have high knowledge, 55% chose TOLAC, whereas 24% of women with high knowledge chose ERCD. The likelihood of a woman with high knowledge scores choosing a TOLAC was 3.9 (95% confidence interval [CI], 1.09-13.81) times the odds of a woman with low knowledge scores choosing ERCD. DISCUSSION: In this study, more knowledge about the risks and benefits of TOLAC and ERCD was found to be positively associated with the decision for TOLAC. This finding is important for health care providers when counseling women who have had a prior cesarean about their choices regarding mode of birth during a subsequent pregnancy. Supplying women with complete and accurate information about the risks and benefits of both choices may help increase the number of women who opt for TOLAC.

Drug shortages and the burden of access to care: a critical issue affecting patients with cancer.

Pharmaceutical drug shortages are multifaceted and complex problems that affect all aspects of health care, including patients, caregivers, healthcare providers, third-party payers, the pharmaceutical industry, and regulators. Drug shortages have increased significantly since 2000, which cause increases in healthcare costs and compromised patient care. New government regulations have led the U.S. Food and Drug Administration to focus efforts on updating policies and improving regulation of the pharmaceutical industry to limit and avoid drug shortages. This article discusses the current issues surrounding the pharmaceutical drug shortage and the implications for patients and healthcare providers. A review of the literature presents the multidimensional impact of the pharmaceutical drug shortage, and the analysis shows patients who are most burdened by drug shortages and have experienced substandard care, increased cost of care, and compromised quality of health care.

Maternal psychosocial determinants of fetal and infant health and the National Children's Study.

The purpose of this article is to inform perinatal nurses about the longitudinal National Children's Study (NCS), which was mandated by Congress. The NCS was designed to follow infants from before birth to age 21, and researchers propose to study 100,000 children. This complex and extensive study will provide especially relevant information to perinatal nurses in practice, teaching, and research.

The placenta as a research biospecimen.

The placenta provides a unique opportunity to study the prenatal environment of the fetus to better understand subsequent infant and child health and illness. In this article we describe the role of the placenta as a research biospecimen, including placental morphology and cytokine biomarkers. Because of the role of the placenta in contemporary research, members of the perinatal health care team involved in birth have an important role in advancing science.

Pregnancy intention and contraceptive use at six months postpartum among women with recent preterm delivery.

OBJECTIVE: To describe pregnancy intention and contraceptive use among women with a recent delivery that occurred at 35 weeks gestation or fewer and who were enrolled in a large-scale randomized control trial. DESIGN: In this descriptive study we used data from assessments conducted at 6 months postpartum as part of a randomized controlled clinical trial, the Philadelphia Collaborative Preterm Prevention Project (PCPPP). PARTICIPANTS AND SETTING: Participants were recruited following a preterm birth (PTB) in one of the 12 urban birth hospitals. All women enrolled in PCPPP, who completed their 6-month postpartum assessment, and who were sexually active at the time of that assessment (n = 566), were included in the analysis. METHODS: Data were collected during face-to-face interviews. Study questionnaires included questions about participants' plans for the timing of subsequent pregnancies, contraceptive behaviors, and other health variables. RESULTS: Nearly all of the participants (90.1%, n = 509) reported they did not want to get pregnant within one year of the index PTB. However, more than one half of these women (54.6%) reported contraceptive practices of low or moderate effectiveness. Most predictive of intending another pregnancy within the year was the death of the index PTB infant (odds ratio [OR]= 18.2,95% confidence interval [CI] [8.9, 37.0]). CONCLUSIONS: Discordant pregnancy intention and contraceptive use were reported among this group of mothers of PTB infants who are at particularly high risk for a poor outcome of any subsequent pregnancy. The findings highlight the need for further investigation of the causes, correlates, and consequences of discordant pregnancy intentions and contraceptive practices.

Using a pedagogical approach to integrate evidence-based teaching in an undergraduate women's health course.

BACKGROUND: Evidence-based practice (EBP) is promoted as a foundation for nursing practice. However, the 2005 U.S. survey of nurses revealed that they do not have requisite skills for EBP. PURPOSE AND GOALS: To evaluate a pedagogical approach aimed at (1) fostering undergraduate nursing students EBP competencies, and (2) identifying gaps in the literature to direct future women's health research. METHODS: A secondary analysis of data abstracted from required EBP clinical journals for an undergraduate women's health course in which students (n = 198) were asked to find evidence to answer their clinical questions. Content analysis was used to identify main themes of the topics of inquiry. RESULTS: Students identified 1,808 clinical questions and 30.3% (n = 547) of these could not be answered or supported by evidence in the literature. CONCLUSIONS: This assignment was an important teaching and assessment tool for EBP. Questions reflected critical thinking and quest for in-depth knowledge to support nursing practice. Some students lacked skills in searching databases and a significant number of knowledge gaps were identified that can direct women's health research.

Using geographical information systems to explore disparities in preterm birth rates among foreign-born and U.S.-born Black mothers.

OBJECTIVE: To examine spatial patterns of neighborhood contextual factors of stress with preterm birth (PTB) and nativity (foreign-born and U.S.-born) among Black mothers. DESIGN: Descriptive geographic-spatial research. SETTING & PARTICIPANTS: Births to Philadelphia residents during 2003-2005 in the context of Philadelphia residential neighborhoods (N = 350) were studied. METHODS: All data were aggregated to neighborhood levels (census tracts). Maps were created to assess geographic-spatial patterns. A geographic information system (GIS) database was created that imported geo-coded data on births, crime (assaults with guns and domestic abuse), poverty, race, and nativity (foreign-born vs. U.S.-born). RESULTS: Clear visual patterns of "bad" neighborhoods emerged and were significantly associated with higher prevalence of PTB for foreign-born Black and U.S.-born Black mothers (p < .0001). CONCLUSIONS: This study demonstrated how GIS visually clarified important spatial patterns of adverse living conditions and PTB prevalence. Nurses can use GIS to better understand living environments of mothers and their families and to target interventions in geographical areas with the greatest service needs. Further research on individual and contextual factors is warranted to address the observed health disparities among the heterogeneous groups of foreign-born Black mothers. Despite limitations of aggregate data, it is clear that where mothers live matters. This has important implications for nursing practice and policy.