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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 …

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 …

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 …

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 …

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.

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

Chancellor’s Honors Program Projects

No abstract provided.

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: …

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 …

The Effects Of Sexual Abuse On Birth: Obstetric Outcomes, Maternal Experience, And Professional Intervention, Katelyn Alexandra Neufeld, Patricia Nguyen

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this literature review is to determine how a past history of sexual abuse impacts labor and birth and what strategies can be used to help mitigate retraumatization. The desire is that this review will encourage further studies and the creation of guidelines and interventions to be used in maternal care settings. Theoretical Framework: The Neuman Systems Model is a theoretical framework utilized in this paper. It provides a framework for identifying stressors, assessing a patient's response, developing strategies/treatments to move women back toward stability, and adapting practices to reduce triggers from occurring in the first place …

Clinical Practice Patient Education Guideline For Elective Induction Of Labor, Allison Keleske

Walden Dissertations and Doctoral Studies

In 2018, the state of Florida had a cesarean section birth rate of 38.3% which was the 3rd highest in the nation with the national average being 31.9%. Elective induction of labor (EIOL) involves the initiation of labor for convenience and not because of medical necessity. EIOL carries risks for the mother and fetus, including an unplanned cesarean section. The problem identified in this project was the lack of informed decision-making by pregnant women related to risks, benefits, and management of EIOL. Using the Informed Decision-Making through Engagement Model, the purpose of the project was to develop an evidence-based clinical …

Prenatal Yoga In Pregnancy, Ashleigh Clingenpeel

Senior Honors Theses

Prenatal yoga has emerged as an advisable, beneficial, and supportive addition to birth preparation. Many studies have linked participation in prenatal yoga with both maternal and infant benefits. Physical benefits for the mother include decreased labor time, decreased labor pain, and improved comfort during pregnancy. Significant emotional and mental effects have also been correlated, such as lowered rates of depression and anxiety, increased self-efficacy in labor, and easier transitions into the postpartum period. Finally, prenatal yoga has demonstrated benefits to the neonate, with a greater number of vaginal deliveries, which are less traumatic for the infant, an increase in gestational …

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility Pilot Project, Joshua Aaron Carr

Doctor of Nursing Practice Final Manuscripts

Labor pain is a significant source of anxiety for most pregnant women. Parturients who are excluded from epidural analgesia (EA), the most common and most effective technique to reduce this pain, deserve access to the next best choice. Remifentanil patient controlled analgesia (RPCA), due to its fast onset, short half-life and demonstrated effect at reducing pain and boosting satisfaction is the next best option when compared to EA. Adoption of this strategy represents an opportunity to help bring this evidence based technique into a mainstream health system. This project reports on the first stage of a pilot project to bring …

Perceptions And Experiences Of Skilled Birth Attendants On Using A Newly Developed Strap-On Electronic Fetal Heart Rate Monitor In Tanzania, Sara Rivenes Lafontan, Hussein Kidanto, Hege L. Ersdal, Columba Mbekenga, Johanne Sundby

School of Nursing & Midwifery, East Africa

Background: Regular fetal heart rate monitoring during labor can drastically reduce fresh stillbirths and neonatal mortality through early detection and management of fetal distress. Fetal monitoring in low-resource settings is often inadequate. An electronic strap-on fetal heart rate monitor called Moyo was introduced in Tanzania to improve intrapartum fetal heart rate monitoring. There is limited knowledge about how skilled birth attendants in low-resource settings perceive using new technology in routine labor care. This study aimed to explore the attitude and perceptions of skilled birth attendants using Moyo in Dar es Salaam, Tanzania.

Methods: A qualitative design was used to collect …

The Effectiveness Of Non-Pharmacological Touch Therapies In Labor, Heather Rice

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this paper is to critically analyze literature in order to determine the effectiveness of non-pharmacological touch therapies during labor. The touch therapies included in this literature review are acupuncture, acupressure, massage, and sterile water injections. The specific outcomes studies are labor pain, duration of labor, labor progress, mode of delivery, maternal satisfaction, and neonatal outcomes. Theoretical Framework: The Modeling and Role Modeling Theory can be used as a foundation for the utilization of non-pharmacological touch therapies in labor. This theory is a self-care model based on the clinical perception of the world and adaptations to stressors …

Midwives’ Perceptions On Using A Fetoscope And Doppler For Fetal Heart Rate Assessments During Labor: A Qualitative Study In Rural Tanzania, Paschal Francis Mdoe, Hege Langli Ersdal, Estomih Mduma, Robert Moshiro, Hussein Kidanto, Columba Mbekenga

School of Nursing & Midwifery, East Africa

Background: The Doppler is thought to be more comfortable and effective compared to the fetoscope for assessing the fetal heart rate (FHR) during labor. However, in a rural Tanzanian hospital, midwives who had easy access to both devices mostly used fetoscope. This study explored midwives’ perception of factors influencing their preference for using either a Pinard fetoscope or a FreePlay wind-up Doppler for intermittent FHR monitoring.

Methods: Midwives who had worked for at least 6 months in the labor ward were recruited. Focus group discussion (FGD) was used to collect data. Five FGDs were conducted between December 2015 and February …

Rem Initiative To Develop Educational Strategies For Inductions Of Labor, Chandra Evette Jones-Worthing

Walden Dissertations and Doctoral Studies

Inductions of labor that occur prior to 39 weeks' gestation can pose increased risks for the mother-baby dyad. In the target setting, there is a gap in knowledge among the pregnant women about options for delivery, hospital policies and procedures, and what to expect in the labor and delivery experience. Because of this gap in knowledge, the pregnant patient is unable to make informed decisions regarding her needs, expectations, and care. This lack of knowledge has resulted in a 40-50% rate of inductions of labor at the target site, which is well above the 2014 national average of 25%. In …

Childbirth Education In Jordan: Content, Feasibility And Challenges Of Implementing A Childbirth Education Program In Jordan, Fatima Malkawi Ms

FIU Electronic Theses and Dissertations

No childbirth education (CE) programs are available in the public sectors in Jordan. Many studies from Jordan recommended that pregnant women be educated about their health needs during pregnancy and childbirth. From the literature, CE programs were found to have positive effects on pregnancy and childbirth outcomes. Four focus groups with pregnant women, midwives and physicians were conducted to examine the perceptions of pregnant women, midwives and physicians regarding the content, feasibility, and challenges of implementing a CE program in Jordan. The 4 focus groups, two with pregnant women (one group with 8 primiparous women and one group with 6 …

Reducing Perineal Tears: The Effect Of Pushing Methods And Length Of 2nd Stage Of Labor, Kristen A. Mohre, Jessica A. Wall, Chien-Yueh Lee

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

Objective: To evaluate the current literature evidence for the effects of either instructed or spontaneous pushing on perineal laceration incidence during delivery and the duration of second stage of labor.

Background: Lacerations (tears) of the perineum are common among women during delivery, increasing pain, infection risk, and other problems for women. Furthermore, prolonged second stage of labor has been shown a risk factor for lacerations. Pushing methods could have an effect on the incidence of lacerations and duration of second stage of labor.

Methods: Thorough search of online databases for the highest levels of evidence relating to the topic within …

Use Of The Peanut Ball To Decrease First And Second Stages Of Labor, Carol L. Payton

Graduate Theses, Dissertations, and Capstones

The purpose for this capstone project was to use a Peanut Ball, to mimic a sitting or squatting position, for decreasing length of first and second stages of labor. In addition, this project was designed to incorporate qualitative data on women’s perception of using the Peanut Ball during labor. The project question was “For laboring women, will use of a Peanut Ball for positioning, as compared to no use of a Peanut Ball, decrease length of first and/or second stages of labor?” The results included a significantly longer second stage of labor in the intervention group (75.63 minutes) when compared …

Induced And Spontaneous Labor Education: Evaluation, Knowledge, And Intent To Discuss Options In Pregnant Women, Kathleen Hartzell, Katherine Bartolotta

Williams Honors College, Honors Research Projects

Labor inductions are increasing worldwide, with rates continuing to rise each year. Currently 30% of labors in the United States result from inductions. The purpose of the study was to examine the effect of an educational intervention about induced and spontaneous labor on knowledge and intent to discuss options with health providers in pregnant women. This study was guided by the health-belief model which explains that people’s beliefs about how a health care decision may affect their lives affect how they make the decisions. This study was conducted using a quantitative and descriptive design with pre and post paper and …

Effects Of Comfort Education On Maternal Comfort And Labor Pain, Abby E. Garlock

Nursing Theses and Capstone Projects

A lack of understanding regarding the relationship between comfort education and maternal comfort experienced during labor exists within current literature. This project examined the effects of providing education regarding comfort and comfort options available in the hospital setting on level of maternal comfort during labor. A quasi-experimental pretest/posttest comparison group design was used for this project, in which a convenience sample of 80 participants was randomly assigned into a standard care control group or an educational intervention group. Providing comfort education during admission to the labor and delivery unit did not increase comfort scores or decrease pain scores in the …

Pushing Techniques Used By Midwives When Providing Second Stage Labor Care, Kathryn Osborne

Dissertations (1934 -)

A growing body of evidence suggests that spontaneous pushing during the second stage of labor results in better outcomes than directed pushing, which usually involves repeated use of the Valsalva maneuver. However, birth attendants in the United States (U.S.) continue to use directive methods when caring for women in the second stage of labor. This study used quantitative methods with the Theory of Diffusion of Innovations as a framework to identify and describe the practices used by certified nurse-midwives and certified midwives, practicing in the U.S., when caring for women in second stage labor. Data were gathered using a questionnaire …