Medicine and Health Sciences Commons^™

Rural Maternal Care Crisis & Strained Workforce: An Integrative Review Revealing Factors In The Rural Maternal Care Crisis, Taylor F. High Elk

All Electronic Theses and Dissertations

Introduction: The United States is comprised of 75% rural areas and settings (American College of Obstetricians and Gynecologists (2014). Nearly five million women in the US do not have access to maternity care in the county in which they reside (Uribe-Leitz et al., 2022). Purpose: The purpose of this integrative review is to assess the hospitals that provide maternity care in rural settings, the procedures performed in these locations, and the maternal care workforce in the rural obstetric setting. The goal of this research is to identify why there is a lack of maternity care in the rural setting, and …

Virtual Visits In Prenatal Care: An Integrative Review, Katrina Wu, Christina Lopez, Michelle Nichols

Graduate School Faculty Publications

Introduction: Addressing gaps in access to prenatal care is an important step to reversing rising rates of maternal and neonatal morbidity and mortality and invites the exploration of innovative care models. This integrative review of published literature explores the patient, health care provider, and organizational experience of integrating virtual visits in prenatal care.

Methods: A literature search to identify original studies and quality improvement projects published between 2010 and 2020 was conducted in PubMed, Scopus, CINAHL, and Google Scholar using keywords associated with both telemedicine and prenatal care. Inclusion criteria specified articles pertaining to synchronous virtual visits between pregnant patients …

An Investigation Into The Use Of An Herbal Labor Induction Tincture Containing Black Cohosh, Cramp Bark, Partridgeberry, And Motherwort On Contractile Responses Produced From Isolated Strips Of Mouse Uterine Tissues, Clayton Neuenschwander, Katrina Wu, Teresa F. Degolier

Biological Sciences Faculty Publications

Introduction: Alternative solutions in the form of herbal remedies meant to ease or expedite the process of labor have often been pursued and administered but have seldom been quantitatively tested for efficacy. Published research has shown some validation for some commonly used herbs such as blue cohosh (Caulophyllum thalictroides), red raspberry (Rubus idaeus), castor bean (Ricinus communis) and evening primrose (Oenothera biennis) on isolated mouse uterine strips. Methods: This study tested an array of herbs used by midwives in a labor induction tincture, which included black cohosh (Actaea racemosa), cramp bark (Viburnum opulus), partridgeberry (Mitchella repens), and motherwort (Leonurus cardiaca). …

Hydration And Nutrition During Labor, Muna Abdi, Katie Cooper

All Electronic Theses and Dissertations

Background/Purpose: Historically women have birthed in their own homes. As birth moved to the hospital, concerns surrounding gastric aspiration following general anesthesia led to restrictive intake policies for laboring women. Current professional recommendations vary regarding nutritional intake in labor. The purpose of this paper is to determine whether there are differences in maternal outcomes when different forms of hydration and nutrition are used during labor. Theoretical Framework: Neuman’s Systems Model was the theoretical framework used to guide the research process. This model includes four systems (client-client, environment, health, and nursing) which work together to promote holistic wellness. Methods: A thorough …

Postplacental Intrauterine Device Insertion: Efficacy And Barriers, Tommi Amanda Ladd Carrell

All Electronic Theses and Dissertations

As many as half of all women do not attend postpartum care and receive desired family planning care. Left with little to no resources for obtaining contraception, many go on to have subsequent unplanned pregnancies. The American College of Obstetricians and Gynecologists has stated that offering long-term, reversible contraception at the time of birth should be considered for these women, yet adoption of this procedure remains low. This literature review will evaluate the efficacy and advantages of postplacental intrauterine device placement and barriers to implementing the procedure.

Perineal Massage Or Warm Compress To Decrease Perineal Trauma In Second Stage Of Labor, Amanda Condon, Colleen Williams

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this review of research is to determine if the use of perineal massage or warm compress in the second stage of labor decreases perineal trauma, including spontaneous lacerations or the need for an episiotomy. Theoretical Framework: Betty Neuman’s Systems Model asserts that each person will interact with the environment with their own set of variables. Neuman’s Systems Model focuses on maintaining health with the prevention of three categories of stressors: primary, secondary and tertiary. Nurse-midwives work to prevent perineal trauma by considering what interventions strengthen the defense of each women to the environment stressors of physiologic …

Benefits And Risk Associated With Physical Exercise During The Antenatal Period, Corrie Crump, Brittany Freeman

All Electronic Theses and Dissertations

Background/Purpose: There are many misconceptions, uncertainties, and false narratives pertaining to how much physical activity and what types of activities are safe in pregnancy. This purpose of this critical literature review was to provide more guidance on evidence-based recommendations for what activity and how much activity is considered safe, and shed light on the proven benefits being physically active provides. Additionally, the literature was reviewed to assess the benefits of exercise during pregnancy as it pertains to maternal morbidity. Theoretical Framework: Dorothea Orem’s Theory on Self-Care Deficit explains the importance of self-care, and focuses on the individual’s ability to perform …

Maintaining Postpartum Bleeding: Effects Of Tranexamic Acid, Shenider Dufort

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this literature appraisal is to determine the effectiveness of tranexamic acid (TXA) and its ability to stabilize postpartum bleeding. TXA is an antifibrinolytic pharmacologic drug found to reduce blood loss associated with trauma and patients undergoing major surgeries. When administered in combination with other uterotonics, the World Health Organization predicts the prophylactic use of TXA could globally improve the morbidity and mortality rates associated with postpartum hemorrhaging. Theoretical Framework: Kurt Lewin’s change theory was used in the development of this literature review. The Lewin change theory emphasizes the importance of change and development within a medical …

The Resilient Midwife, Sarah M. Dorsey

All Electronic Theses and Dissertations

Midwives have been shown to significantly improve birth outcomes; the World Health Organization proposes that 83% of maternal deaths, newborn deaths, and stillbirths could be prevented through midwifery care. However, burnout level in this profession is high; a 2017 survey of U.S. certified nurse-midwives and certified midwives revealed that 40.6% of these professionals were suffering from burnout. The purpose of this paper is to identify strategies to facilitate resilience and decrease burnout in the midwifery professionMethods: 1427 articles were screened to yield twenty research studies relevant to improving resiliency and decreasing burnout the midwifery profession. The twenty articles were summarized …

Telehealth Use During The Prenatal Period: Strengths And Limitations, Adrian M. Goblisch, Tessa L. Hand

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this paper is to examine the risks and benefits of telehealth use during the prenatal period. With the increasing use of technology to provide healthcare, especially during the COVID-19 pandemic, it is critical to examine the implications this care modality has on individuals and the community. Theoretical Framework: Katharine Kolcaba’s Comfort Theory was applied to the topic of telehealth use in the prenatal period. This theory explains that there is an immediate experience of strengthening when relief, ease, and transcendence are met and that an individual is more likely to exhibit health-seeking behaviors when comfort in …

The Effectiveness Of Comprehensive Sexual Education For Teens: An Exploration Of The Advantages And Disadvantages, Crystal L. Iddings, Danielle J. Wadsworth

All Electronic Theses and Dissertations

Background/Purpose: The teen pregnancy rate in the United States was18.8 per 1000 in 2017. Although this is an all-time low for teen pregnancy in the United States, it is still the highest rate among developed countries. This literature review aimed to reveal the advantages and disadvantages of comprehensive sexual health education. Theoretical Framework: In 1947, Kurt Lewin identified three stages to the Change Theory which people go through while making change: unfreezing, change, freeze (or refreeze). These three major concepts are the force that pushes forward for change to occur. Methods: Twenty research articles were critically reviewed with the purpose …

Dance: The Movement Supporting Safe, Sovereign And Satisfying Birth Experiences, Lisa Marie Morgan

All Electronic Theses and Dissertations

Labor dance utilizes upright positioning, hands and knees position, use of the rebozo and other alternative labor and birth positions as a traditional means of taking advantage of gravity and increasing the pelvic diameter in labor and birth. Despite recommendations by the American College of Nurse-Midwives (ACNM) and the American College of Obstetricians and Gynecologists (ACOG) supporting such positions, promotion and use of labor dance remain in the margins of labor and birth experiences for most women. This literature review finds that labor dance increases safety, sovereignty and satisfaction in the labor and birth experience for women. Further, this simple …

Evaluating The Impact Of Volunteer And Facility Provided Doula Support In The Intrapartum Period On Maternal, Neonatal, And Psychosocial Outcomes In The Hospital Setting, Kayla Puent, Keirsta Marie Ragels

All Electronic Theses and Dissertations

Background/Purpose: The unacceptably high maternal mortality rate in the United States has demanded a call to action for evaluation and implementation of efforts to improve both maternal and neonatal outcomes. Low-resource and low-socioeconomic populations are at a higher risk of experiencing adverse birth outcomes. Doulas have continuously been recognized as key tools in improving outcomes, but not all birthing persons have access to them. The positive impact of continuous labor support in improving outcomes is recognized by the American College of Obstetricians, American College of Nurse-Midwives, the Society for Maternal-Fetal Medicine, and the March of Dimes. The purpose of this …

Breastfeeding Education And Support For Marginalized Women To Increase Exclusive Breastfeeding Rates, Kelsea J. Rush, Leah Vogel

All Electronic Theses and Dissertations

Background/Purpose: Marginalized women have significantly lower rates of breastfeeding initiation and duration and also experience significant health disparities when compared to non-marginalized populations. Breastfeeding has positive health benefits to both mother and child and could help to reduce these disparities. The purpose of this critical appraisal of the literature was to determine the effects of additional breastfeeding education and support on breastfeeding among marginalized groups of women. Theoretical Framework: Ramona Mercer’s Maternal Role Attainment Theory was used as a framework for the literature review by following the four stages of attainment; anticipatory, formal, informal, and personal. Methods: Twenty relevant, scholarly …

Adolescents & Long Acting Reversible Contraception, Nicole Elizabeth Amstutz, Jessica Kesterson

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this literature appraisal is to assess adolescent access to long-acting reversible contraception (LARCs). Theoretical Framework: The Health Belief Model (HBM) helps describe the psychological and behavioral underpinnings of how one cares for one’s health. The HBM can be applied to how adolescents perceive the risks associated with unprotected intercourse compared to the perceived benefits of LARC usage. The HBM considers the benefits, barriers, risk of susceptibility, risk severity, self-efficacy, and cues to the action of adopting positive health interventions in one’s life (Jones et al., 2016). Methods: Twenty-four relevant articles from the literature were appraised. Results/Findings: …

Supporting Physiologic Labor: Effects Of Hydrotherapy On Labor Outcomes, Ashley Y. Blaine

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this literature analysis was to identify the effects of hydrotherapy use in the first stage of labor. Although hydrotherapy has been well-studied and its benefits well documented, it is use in labor still remains under-utilized in the United States. There has been a recent rise in medical intervention in labor and a coinciding rising cesarean section rate. In an effort to promote physiologic labor, both the American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM) have issued statements supporting hydrotherapy use during labor. Theoretical Framework: Katherine Kolcaba’s Theory of Comfort provides …

Neonatal Outcomes In Planned Community Birth Settings, Catherine E. Binger, Kaitlin Kinkoph

All Electronic Theses and Dissertations

Background/Purpose: The safety of community births is a common point of discussion, especially in regard to neonates. Planned community births are supported for low risk, informed patients by the ACNM. The purpose of this literature review was to understand neonatal morbidity and mortality in planned community birth settings. Theoretical Framework: Orlando’s Nursing Theory focuses on immediate patient needs and promotes growth of nurses in unstable environments. This theory applies the competency of the nurse’s practice and the satisfaction of the patient. The Orlando Nursing Theory will be applied and explored as a framework in relation to neonatal outcomes in different …

Optimal Nutrition In Pregnancy, Monica G. Daugherty

All Electronic Theses and Dissertations

This review provides valuable evidence for nurse-midwives about the major role that nutrition plays in the well being of the mother-infant dyad. Nutrition affects the pregnancy, maternal outcomes, and neonatal outcomes. Education about nutrition provided by nurse-midwives can help shape women’s experiences in a positive manner, safeguarding their pregnancy, their future, and their children’s future.

Reducing Preterm Birth For Women Of Color Through Group Prenatal Care, Laura C. Early, Aubrey Monson

All Electronic Theses and Dissertations

The purpose of this paper is to critically review the literature to examine if group prenatal care can reduce preterm birth rates in women of color compared to individual prenatal care.

Lifestyle Changes For Women With Gestational Diabetes, Brooklyn Feustel Elkan, Kristen Mccammon

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this paper was to evaluate the current literature to see if there was a common thread in treatment/prevention of the progression of gestational diabetes in pregnant women. Theoretical Framework: Dorthea Orem’s theory, The Self-Care Deficit Theory, was the theoretical framework used in this critical review of the literature. This theory asserts that patients should be self-reliant and responsible for their healthcare. This is achieved by providers giving them options and advice based on evidence to change their lifestyle and take control. This directly relates to managing GDM, because providers can only counsel the patients on changes, …

Marijuana Use In Pregnancy And The Effects On The Fetus/Infant, Amy Rebecca Hurst, Malia Smylie

All Electronic Theses and Dissertations

The purpose of this paper is to critically examine the literature and evidence that is available surrounding pre-pregnancy and prenatal use of marijuana and the effects it has on the developing fetus/infant. It was found that across most findings that further research needs to be done on the use of marijuana prior to pregnancy, during pregnancy, and postpartum. It has also been found that screening and counseling needs to be done and focused on prior to pregnancy and during pregnancy and postpartum. Healthcare professionals have the opportunity to establish a trusting relationship with their patients and to be able to …

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 …

Variations To Labor, Maternal, And Neonatal Outcomes Related To Oral Intake During Labor, Amanda J. Stepper

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this critical review of literature was to examine the risks and benefits of oral intake during labor and determine if oral intake is beneficial in promoting and supporting positive labor outcomes and maternal satisfaction without increasing risk associated with aspiration and poor birth outcomes. Theoretical/Conceptual Framework: Maslow’s hierarchy of needs was used to guide this literature review. Abraham Maslow’s theory on the hierarchy of needs determined that basic human needs must be met before needs of a higher order are addressed. Methods: Twenty research articles that were applicable to the scope of oral intake during labor …

Epidural Analgesia Effect In Labor And Delivery, Deka A. Abdulle

All Electronic Theses and Dissertations

Epidural analgesia has an impact on duration of labor, type of delivery and the neonate. Good research data supports epidural analgesia shorts first stage of labor, lengthens second stage, increases instrumental delivery but no increased risk for cesarean delivery. Epidural analgesia has no effect on neonatal Apgar scores but decreases initiating and duration of breastfeeding.

The Effect Of Amniotomy On Labor Progression, Lauren Marie Casey, Eric Johann Judd Ii

All Electronic Theses and Dissertations

Background/Purpose: Amniotomy has been a tool used for over 50 years to progress labor. This literature review researches the effects that amniotomy has on active labor progression. Theoretical Framework: The theoretical framework selected for this literature review was The System’s Model by Betty Neuman. This theory focuses on the effects that internal and external forces have on health. This was selected because of the effects that amniotomy can have on labor progression. Methods: For this review, the 20 articles were selected following a search in The Cumulative Index to Nursing and Allied Health Literature (CINAHL), CINAHL Plus, Cochrane Database of …

The Effect Of Integrative Medicine Practices On The Use Of Obstetric Intervention In Labor And Delivery, Rachel Cochran

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this paper is to review scholarly writings to discern if the use of integrative medicine practices affects the use of obstetric intervention in labor and delivery. Theoretical Framework: The Theory of Human Caring by Jean Watson will be used as the theoretical structure of this literature review. Watson’s theory places caring at the center of all activities, decisions, and practices within the discipline of nursing and emphasizes a journey of caring for the whole person. Methods: Nineteen research articles were critically reviewed with the purpose of determining whether the use of specific integrative medicine practices affects …

How Nurse-Midwives Can Best Support Families Who Have Experienced Perinatal Loss, Tina Marie Egner, Jennifer J. Kluck

All Electronic Theses and Dissertations

Background/Purpose: Although perinatal loss remains a common occurrence and nurse-midwives are instrumental in this care, the American College of Nurse-Midwives has yet to issue a position statement or professional care guidelines for providers. The purpose of the paper is to explore the literature to answer the research question: how can nurse-midwives best support families who have experienced a perinatal loss? The specific focal areas will examine best practices for providers based on current evidence. Theoretical Framework: Kristen Swanson’s (1991) Theory of Caring will serve as the conceptual framework to address the research question. Swanson’s middle range nursing theory of caring …

The Impact Of Midwifery Care On Racial Disparities In African American Women And Infants, Madeline Grace Englund, Antionette Renee Estis

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this paper is to critically examine scholarly writings to understand the history and current manifestations of racism in maternal and perinatal outcomes and reproductive health care and to provide insight on how midwives can be impactful to the health disparities that impact Black women and infants. Theoretical Framework: Dr. David Williams created a framework for understanding the relationship between race and health. Understanding the differential distribution of adverse health consequences within racial groups is essential to developing effective solutions to these problems. Race is constructed of biological factors, social, and economic structures by which groups live …

Labor Induction Methods And Their Impact On Duration Of Labor And Rate Of Cesarean Section, Ashley M. Golinghorst

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this paper is to critically review current literature regarding current methods for labor induction and their impact on the duration of labor and rate of cesarean section. Theoretical Framework: Imogene King’s Theory of Goal Attainment is the framework used for this literature appraisal. King’s theory focuses on the dynamic interacting systems for goal attainment (Gonzalo, 2011). Methods: Twenty-one original research articles involving labor induction methods were critically reviewed. Additionally, six systematic reviews involving labor induction methods were also included. Results/Findings: Labor induction is associated with an overall increased risk of cesarean section. Intravenous oxytocin use alone …

The Fertile Window, Ashley Joy Jensen

All Electronic Theses and Dissertations

Purpose: The purpose of this paper is to examine various biological indicators and tracking methods to determine which are the most accurate in identifying the fertility window for reproductive-aged women. Results: Whether the woman has regular or irregular cycles is a major determinant of what method can be successfully utilized. Additionally, the woman’s desire to achieve a pregnancy and her preference regarding intensity of the necessary training are significant factors in choosing a method. Use of two biologic indicators is discussed as some research points to this being the most effective. Finally, recommended web and mobile applications are discussed with …