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Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Preprocedural Ultrasound For Labor Neuraxial Anesthesia: Evidence-Based Practice Recommendations, Nicholas Anderson

Doctor of Nursing Practice Scholarly Projects

Central neuraxial blockade (CNB) is the most widely used method of anesthesia provided to laboring patients and includes epidural, spinal, combined spinal-epidural, and caudal techniques. Studies have shown that using preprocedural ultrasound is a safe and effective tool to facilitate the placement of neuraxial needles, especially in patients with predicted difficulty. With the prevalence of obesity increasing, laboring patients with predicted difficulty of neuraxial needle placement is increasing as well. In addition, the traditional method of palpation and visualization of anatomical landmarks to place neuraxial needles can produce inaccurate results due to inconsistencies between patients. Use of preprocedural ultrasound to …

Comparison Of Pre And Post Foley Catheter Bishop’S Score: A Retrospective Record Review At Aga Khan University Hospital Karachi, Pakistan, Ayesha Malik, Sheikh Irfan Ahmed, Farheen Yousuf, Azra Amerjee, Sumaira Naz, Safna Naozer Virji Safna Naozer Virji

Department of Obstetrics & Gynaecology

Objective: To compare pre and post Foley's catheter Bishop Score during labour induction.
Methods: This study was a retrospective study conducted at the Aga Khan University Hospital Karachi, Pakistan after approval from ethical review board. All women who underwent induction of labour with Foley's Catheter at gestation of 37 weeks or more from September 2014-October 2015 were included. Data was entered and analyzed in Statistical Package for Social Sciences (SPSS) version 19.0. The comparison between pre and post Foley's catheter Bishop Score during labour induction will be calculated by Wilcoxon sign test.
Results: There were 981 cases of inductions of …

Occupational Therapy For Perinatal Women: An Online Educational Course, Rachel Killorin, Steven M. Gerardi, Sabina Khan

Summer 2023 Virtual OTD Capstone Symposium

A freely accessible website and online educational course was developed to inform occupational therapy practitioners and maternal healthcare professionals about the role that occupational therapy has on the perinatal healthcare team. Perinatal Occupational Therapy. https://www.perinataloccupationaltherapy.com/

Factors Associated With Postpartum Care During The Fourth Stage Of Labor In Nepal: A Hospital-Based Cross-Sectional Study, Ashok Kumar Paudel, Muni Raj Chhetri, Ambika Baniya, Mamta Chhetri, Aafrin Gurung

Journal of Social, Behavioral, and Health Sciences

Postnatal care is an important part of maternal and neonatal care, and life-threatening complications can occur during the postpartum period. Empirical information on the level of postpartum care services is generally scarce in Nepal. Key elements of postpartum care during the fourth stage of labor include providing proper nutrition, promoting breastfeeding, and helping the mother manage any physical discomforts or challenges that may arise. This study investigated the level of postpartum care services delivered during the fourth stage of labor in a tertiary-level hospital in the Chitwan district of Nepal. A descriptive cross-sectional hospital-based study was conducted among 148 women …

Educating Nursing Staff On Evidence-Based Maternal Positioning To Promote Fetal Descent During The First And Second Stages Of Labor, Daniela Gonzalez Acosta

Master's Projects and Capstones

This project aims to educate labor and delivery nurses on evidence-based maternal labor positions that promote fetal descent in the first and second stages of labor. In a labor and delivery unit in the San Francisco Bay Area Silicon Valley region, there is a gap in nurse knowledge relating to labor positions. Evidence supports upright and flexible sacrum positions, along with frequent repositioning promotes shorter labor duration, decreased vaginal tearing, and decreased rate of cesarean section deliveries.

A quality improvement project was conducted through education implementation using evidence-based practices utilizing a PDSA cycle for a semester. Educational content was created …

Educating Labor And Delivery Nurses On Evidence-Based Birthing Positions To Promote Fetal Descent During First And Second Stage Labor, Sophia Nguyen

Master's Projects and Capstones

The goal of this project was to increase confidence of labor and delivery nurses in utilizing evidence-supported birth positions during the first and second stages of labor in order to aid in fetal descent and labor progression. Current statistics demonstrate climbing trends in cesarean deliveries, which have been associated with increased maternal morbidity and mortality. One nurse intervention that can reduce failure to progress, a main contributor to cesarean sections, is the use of various evidence-supported maternal birth positions such as ambulation, assisted squat, sitting, backwards sitting, lunging, throne, side-lying with peanut ball, hands-and-knees, and throne position. This evidence-based practice …

Infant Care Education To Pregnant Women Before The Parental Role Transition, Alyssa Johnson

Occupational Therapy Doctoral Student Capstone Posters

This capstone focused on the role occupational therapy can play among expectant mothers. The experience was completed at a Cleveland-based community, Zelie's Home, where women receive support as they embrace motherhood. A program manual and informational handouts were distributed with a goal of educating pregnant women on infant care techniques.

Investigating Association Between Sociographic Factors And Rates Of Urine Drug Screening In Patients Admitted To Labor And Delivery: A Retrospective Analysis, Erin Manglardi, Donna Boucher

North Florida Division Research Day 2023

No abstract provided.

Prevention Of Perineal Tearing During Childbirth: A Literature Review, Victoria Manzo

Honors Undergraduate Theses

Perineal lacerations can be caused by a variety of risk factors such as a large fetal head circumference, birthing positions that place strain on the sacrum, and first-time births. Preventing perineal tears can be challenging for laboring women. Exploring the possible prevention methods to decrease the severity of perineal tearing or preventing it altogether can be beneficial for laboring women's physical and mental health. The primary purpose of this literature review was to examine which interventions are most likely to prevent perineal tearing during childbirth. The secondary purpose was to evaluate natural perineal tears in comparison to surgical incision, or …

Healthcare Against Exploitation: Empowering Clinics To Identify And Support Human Trafficking Survivors, Daniel Mitchell

Family Medicine Clerkship Student Projects

No abstract provided.

Evidence-Based Guidelines For Intrapartum Maternal Hydration Assessment And Management: A Scoping Review, Lauren Kearney, Alison Craswell, Nellie Dick, Debbie Massey, Rachael Nugent

Research outputs 2022 to 2026

Problem: Inconsistent practice relating to intrapartum hydration assessment and management is reported, and potential harm exists for laboring women and birthing persons. Background: Labor and birth are physically demanding, and adequate nutrition and hydration are essential for labor progress. A lack of clear consensus on intrapartum hydration assessment and management during labor and birth currently exists. In addition, there is an inconsistent approach to managing hydration, often including a mixture of intravenous and oral fluids that are poorly monitored. Aim: The aim of this scoping review was to identify and collate evidence-based guidelines for intrapartum hydration assessment and management of …

Implementation Of Staff Education To Standardize Use Of Positions During The First Stage Of Labor, Kelsey Jo Koch

Master's Projects and Capstones

The aim of this project was to assess whether supplemental education on labor positioning for Labor and Delivery nurses would increase the nurses’ confidence in utilizing patient positioning to promote fetal descent and progress labor. Previous research suggests that upright, mobile positions during the first stage of labor have various benefits, including reduced cesarean rates, shorter lengths of labor, and less epidural usage. However, a major barrier to maximizing these benefits is a gap in knowledge among Labor and Delivery nurses, resulting in inconsistent use of various positions. This improvement project addresses this problem at a large community hospital in …

Association Between Breastfeeding, Oxytocin, And Risk Of Postpartum Hemorrhage, Jordan Davis, Sophia Nelson

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Rates of maternal morbidity and mortality are far too high in the United States compared to other developed countries. Additionally, breastfeeding is often poorly prioritized, leading to a negative community connotation and low rates of exclusive breastfeeding. The purpose of this study was to compile the available research on breastfeeding initiation and its association with risk for postpartum hemorrhage. Fifteen peer-reviewed articles were collected from databases and other scholarly articles and screened for correlation between breastfeeding and maternal health risk. Overall, many articles suggest that skin-to-skin contact and early initiation of breastfeeding may be the most effective way to reduce …

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility And Acceptability Study, Joshua Carr

Dissertations

Background/Purpose: Interest in remifentanil patient controlled analgesia (RPCA) as a treatment for labor pain has increased due to its unique pharmacodynamics and effectiveness on pain control among parturients. Despite its promise, RPCA remains infrequently used in the US. The purpose of this study was to 1) examine the implementation and acceptability of a new RPCA protocol in the labor and delivery ward of a mid-sized hospital, and 2) identify the attitudes and beliefs of healthcare workers in a real-world clinical setting.

Theoretical/Conceptual Framework: The holistic nature of Comfort Theory can account for the proposed mechanisms contributing to the …

Does Dance Therapy During Active Labor Reduce Labor Pain?, Sarah E. Naber

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine “Does dance therapy during active labor decrease labor pain?”

STUDY DESIGN: A systematic review of two randomized control trials and a cohort study that were published in English between 2014 and 2020.

DATA SOURCES: Three studies were obtained from PubMed, Alt HealthWatch, and AMED. They were all published in peer-reviewed journals and chosen based on their relevance to the clinical question proposed.

OUTCOMES MEASURED: The main outcome measured in all three studies is pain during active labor. Pain was measured in all studies using the visual analog scale (VAS). …

Nursing Perceptions For Utilizing Essential Oil Application In Labor And The Effect Of Targeted Education, Joni R. Beckham

Electronic Theses and Dissertations

This Doctor of Nursing Practice project was implemented to determine how a nurse’s perception of aromatherapy influences their decision to provide aromatherapy for patients during labor and the effect of targeted education on a nurse’s perception. The purpose of this project was to determine how nurses view the use of aromatherapy resources at their disposal and the likelihood that they would offer the intervention to their patients. This project provided education to increase nurses’ confidence in providing optimal care to patients using a traditional and holistic avenue of aromatherapy while determining if education can positively influence nurses to support essential …

Why Can’T I Have A Choice Of Companion During Labor? Barriers To Implementation Of Companion Presence, Anul Shifa Maknojia, Azwa Malik

Journal of Asian Midwives (JAM)

Companionship during labor gives comfort and reassurance to laboring women. Couples should experience this pivotal part of life together for its successful accomplishment. They bestow maternal support and ensure psychological wellbeing. However, there are some health care facilities who don’t permit the woman to bring a companion. The common barriers for not allowing companions during labor are: the utilization of traditional methods by companions, improper architectural layout, various ethnicities, and policies of hospitals. Thus, practical and realistic actions should be taken as discussed in the paper. Therefore, a laboring woman can utilize the choice of a companion during labor.

Bladder Management Post Epidural Anesthesia: Impact On The Second Stage Of Labor, Megan Hedgcorth

Dissertations

Abstract

Problem

Currently, no national practice guidelines or organizations suggest the use of continuous bladder catheterization during labor for women receiving epidural anesthesia (DeSevo & Semeraro, 2010). Despite there being no national practice guidelines supporting the use of continuous bladder catheterization, many labor and delivery units still utilize this method for bladder drainage following epidural anesthesia in labor. The purpose of this project is to evaluate if the type of bladder management post-epidural anesthesia affects the length of the second stage of labor and the mode of delivery after implementation of new intermittent catheterization pilot.

Methods

This quality improvement project …

Ums_Hr_Covid-19 Memorandum Of Understandings, University Of Maine System

Office of Human Resources

Copies of individual Memorandum of Understandings between the University of Maine System and the Associated C.O.L.T. Staff of the University of Maine (ACSUM) regarding COVID, Associated Faculties of the Universities of Maine (AFUM), Police, Maine Part-Time Faculty Association (PATFA), Teamsters Union Local #340, Service & Maintenance Unit (Teamsters), and Universities of Maine Professional Staff Association (UMPSA).

Understanding How Mothers Perceive Doulas During Childbirth, Eva J. Huff

Chancellor’s Honors Program Projects

No abstract provided.

Employment Security In Egypt In Light Of The Covid-19 Pandemic: Rethinking Policies And Practices, Heba M. Khalil, Kareem Megahed

Faculty Journal Articles

Crises such as COVID-19’s have inequitable impacts on different countries, various population groups and diverse sectors of society and the economy. Areas of work and employment were met with a lot of challenges worldwide, and in particular in countries like Egypt with a large sector of vulnerable and precarious workers. This policy paper addresses the question of employment security both in response to crises such as COVID-19, and on the long term. To do so, the research maps ‘vulnerable work’, including informal labor, labor in the gig economy, self-employed and other types of precarious work. It then assesses Egypt’s policy …

Mindfulness: How It Affects Pregnancy, Labor And Delivery, Olivia R. Snipes

OUR Journal: ODU Undergraduate Research Journal

Pregnancy is a very physical and mental process during which many women face a wide variety of complications. The influx of hormones that happens during pregnancy has the ability to make pregnant women more susceptible to depression, anxiety and other stress related illnesses. High levels of stress can negatively affect the mother and unborn child and potentially the mother-child relationship. Many women prefer not to take the pharmaceutical route when coping with stress, anxiety and depression while pregnant. As a result, mindfulness practices have been utilized as an alternative method to reduce the negative effects of these complications and lower …

Non-Pharmacological Pain Managment In Labor: A Systematic Review, Angela Young, Madison Shipe, Madeline Smith

Williams Honors College, Honors Research Projects

During childbirth, women experience labor pain throughout the three stages of labor. The first stage is where the contractions start and end which creates the need for a form of pain management. Various techniques are used to manage first stage labor pains. The use of non-pharmacological methods is becoming more prevalent because natural births are becoming more popular and pharmacological interventions have side effects and drug interactions. The purpose of this paper is to conduct a systematic review of the literature comparing non-pharmacological pain management methods in women during the first stage of labor. This will answer the PICOT question: …

Lessons From An Evidence-Based Medicine Exploration: When Transparency And Sensitivity (Analyses) Can Change The Take-Home Message, Nadi N. Kaonga, Toby Fitzgerald

Journal of Maine Medical Center

No abstract provided.

Intrapartum Ultrasound To Predict Vaginal Labor In Primigravida, Alaa Eldeen F. Elhalaby, Hesham A. Ammar, Mohamed A. S. Kandil, Mohamed E. Anter, Shady M. S. Amin

Menoufia Medical Journal

Objectives To evaluate head–perineum distance (HPD) and angle of progression (AOP) as predictors of successful vaginal delivery in the active phase of first stage of labor in primigravida. Background Intrapartum ultrasonography has enabled further understanding of the complex physiology of childbirth. It has been shown to provide objective information on the dynamics of different stages of labor and may also be used to assess the mode of delivery. Patients and methods This prospective cohort study was conducted at obstetrics departments of Om El-Masryeen General Hospital, Giza, Egypt, from November 2018 to March 2019. This study included 80 pregnant women in …

How Did Medicaid Expansion Affect The Provider Labor Market?, Aaron Wu

Honors Theses

One provision of the Affordable Care Act was to expand Medicaid eligibility for a greater number of low-income patients. The resulting increase in demand for care was largely explored, but the effect of the 2014 Medicaid expansion on the physician and advanced practitioner labor market has not been well researched by economists. Using pooled cross-sectional data from the 2010 – 2018 American Community Surveys, this paper examines whether the Medicaid expansion has caused notable changes in physician, physician assistant, and nurse practitioner hours, compensation, and overall employment. The literature shows that practices that employ nurse practitioners are far more likely …

Pain Control Options For The Parturient: Pamphlet Development For Patient Education, Alyssa R. Jimerson

Doctor of Nursing Practice Projects

Epidural analgesia has traditionally been requested by the parturient population as the primary choice of pain control during labor, despite the availability of other viable options (Pitter & Preston, 2001). Viable pain control options available during labor include, neuraxial anesthesia, peripheral nerve blocks, pharmacological, and non-pharmacological measures. Lack of education regarding the availability of various pain control options for parturient women is identified as a cause of missed pain relief opportunities (Vargens, Silva, & Progianti, 2013). The purpose of this project was to develop a pamphlet prototype for an obstetrics department at a tertiary care center in central Illinois, explaining …

Discharge Opioid Guidelines For The Postpartum Woman, Chelsea Marie Pierce

Doctor of Nursing Practice Projects

In spite of the alarming opioid abuse epidemic, the number of opioids prescribed to women who give birth has been overlooked and underregulated. In a large metropolitan hospital that has over 3,500 deliveries a year, this problem was identified through first-hand encounter and data collection from an electronic medical record. Women in the postpartum period were prescribed an unnecessary number of opioids upon discharge. The goal of this project was to create guidelines that would decrease opioid use and increase the overall well-being of postpartum women. Guidelines were based off of type of delivery and women were not allotted more …

Enhancing Perceptions Of Labor Experiences Through Evidence-Based Education, Sherrie Fontenot

MSN Capstone Projects

The cesarean section (C-section) rate has risen dramatically in the past several decades both in the United States and throughout the world. Domestically, the C-section rate has risen from 4.5% in 1965 to 32.2% in 2014 (National Partnership for Women & Families [NPWF], 2016a). Worldwide, roughly 19% of births occur via C-Section (Betrán et al., 2016). Concurrently, the induction rate has also increased, doubling in the United States between 1990 – 1998 (Davey & King, 2016). As of 2014, about 23% of all women had their labors induced in the United States (NPWF, 2016b). Furthermore, the trend toward electively inducing …