Experiences of pregnancy complications: Voices from central Haiti.

The purpose of this study was to explore the lived experience of pregnancy/birth complications in central Haiti from the perspectives of skilled birth attendants (saj fanm), traditional birth attendants (matwons), and postpartum mothers. Hermeneutic phenomenology guided the study. With the assistance of a Creole-English translator, four saj fanm, ten matwons, and seven postpartum mothers were interviewed. Their stories explain barriers and challenges to safe motherhood-serious limitations in transportation, staffing, and lack of the most basic of material resources, but also illustrate tremendous resiliency, spirituality, power of partnerships, and commonsense solutions to problems impacting maternal/newborn health in central Haiti. Haiti has one the world's highest maternal and neonatal mortality, and findings of this study provide perspective of this reality from those most affected by it-Haitian mothers and front-line maternity workers.

Breastfeeding, skin-to-skin contact, and mother-infant interactions over infants' first three months.

The effects of skin-to-skin contact (SSC) on the maintenance of mothers' decision to breastfeed, the effects of breastfeeding and SSC on mother-infant interactions, and whether maternal depressive symptoms mediate these effects were investigated over infants' first 3 months. When infants were 1 week, 1 month, 2 months, and 3 months of age, mothers in the SSC and control groups reported the type of infant feeding provided and completed the Edinburgh Postnatal Depression Scale (EPDS; J.L. Cox, J.M. Holden, & R. Sagovsky, 1987); mother-infant interactions were coded on the Nursing Child Assessment Feeding Scale (NCAFS; G. Summer & A. Spietz, 1994). Percentage of breastfeeding dyads in the SSC group was stable over the 3 months; yet, fewer dyads in the control group were breastfeeding at the 2- and 3-month visits than at the 1-week visit. Breastfeeding dyads had higher NCAFS Caregiver subscale scores, indicating more positive maternal interactions, at 1 week, 2 months, and 3 months. NCAFS scores did not differ for the SSC and control groups. EPDS scores did not mediate the effect of SSC on breastfeeding or breastfeeding on NCAFS Caregiver subscale scores.

Congenital cytomegalovirus: implications for maternal-child nursing.

Congenital cytomegalovirus (CMV) is a leading infectious cause of neurodevelopmental disorders in children. Despite its prevalence and devastating consequences, there is limited public and professional awareness about it. This practice-focused article presents two stories describing the family experience of congenital CMV; a literature review describing incidence and epidemiology of congenital CMV; sequelae including infection; the extent of public awareness about congenital CMV; and risk reduction approaches. Implications for maternal-child nurses, whose work uniquely situates them with populations of childbearing women, are discussed.

The language of violence in mental health: shifting the paradigm to the language of peace.

Language used in health care, particularly with vulnerable populations such as those with mental illness, is often violent, rising from historical prejudices and politics of power over others. This creates disharmony and distrust between health care providers and patients and families. Peace involves relationships that nurture ongoing harmony, trust, and constructive solutions. In this descriptive philosophical article, we discuss connections between and among the concepts of peace, health, relational ethics, in relation to nurses' responsibilities, current health care realities, and the language of nursing. We propose a shift in discourse within nurse-patient relationships from oppressive and stigmatizing language to the discourse of peace.

Time to disable the labels that disable: the power of words in nursing and health care with women, children, and families.

Nursing is grounded in communication with others, yet rarely are the words critiqued. Despite an ethical call to honor diversity, promote empowerment, and to do no harm, some of the language used in health care reflects historical prejudices, reductionism, and/or the overarching authority of medical or moral models. This article exposes some of the "harsh words" nurses sometimes unconsciously use, and it suggests alternatives. Influenced by an ethic of social justice and the ethic of relationship with others, an attempt will be made to explore nursing language with women and children. Implications for nursing philosophy and practice will be discussed.

Effect of mother/infant skin-to-skin contact on postpartum depressive symptoms and maternal physiological stress.

OBJECTIVE: To investigate the effect of mother/infant skin-to-skin contact (SSC) on mothers' postpartum depressive symptoms during the first 3 postpartum months and their physiological stress during the first postpartum month. DESIGN: Longitudinal quasi-experiment. SETTING: Data were collected during home visits. PARTICIPANTS: Mothers in the SSC group (n = 30) provided approximately 5 hours per day of SSC with their infants in the infants' first week and then more than 2 hours per day until the infants were age one month. Mothers in the control group (n = 60) provided little or no SSC. All mothers had full-term infants. METHODS: Mothers completed self-report depression scales when infants were 1 week, 1 month, 2 months, and 3 months of age. RESULTS: Compared to mothers in the control group, mothers in the SSC group had lower scores on the depression scales when the infants were one week and marginally lower scores when the infants were one month; when the infants were age 2 and 3 months, there were no differences between groups in the mothers' depression scores. Over their infants' first month, mothers in the SSC group had a greater reduction in their salivary cortisol than mothers in the control group. CONCLUSION: Mother/infant SSC benefits mothers by reducing their depressive symptoms and physiological stress in the postpartum period.

Occupational hazards for pregnant nurses.

OVERVIEW: Depending on her working environment, specific immunities, and stage of pregnancy, a pregnant nurse may find it difficult to avoid teratogenic and fetotoxic exposures, as well as working conditions that could jeopardize her pregnancy. A clinical review of the occupational hazards faced by pregnant nurses can be useful to the concerned nurse or health care system, as can suggestions on ways to reduce risk and a list of pertinent occupational safety resources.

Working with children in end-of-life decision making.

Traditionally, physicians and parents made decisions about children's health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children - of diverse levels of cognitive development - are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning children's 'best interest'. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families.

Toward understanding the connections between infant jaundice and infant feeding.

Parents face a paradox when they are told: Breast is best; bottle-feeding is hazardous to health. But breast-fed babies are more likely to become severely jaundiced than bottle-fed babies, and severe jaundice can lead to brain damage. This article will explore the natural physiology of jaundice with a focus on breast-feeding-associated jaundice, primary prevention of hyperbilirubinemia, and current evidence-based recommendations about feeding jaundice breast-fed infants.