Nursing Midwifery Commons^™

The Impact Of Home Birth Integration On Maternal-Neonatal Outcomes And Patient Satisfaction: An Integrative Review, Mary E. Hillaker, Jennifer K. Jacobitz

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Introduction: Home birth is a safe option for low-risk populations. As awareness of home birth increases, so do the families choosing home birth. Governing bodies recommend well integrated maternal health systems, yet the impact of level of integration on perinatal outcomes and patient satisfaction has not been specifically examined. The purpose of this integrative review is to identify the impact home birth integration has on maternal and neonatal outcomes, patient satisfaction, and how communities can improve their integration level.
Methods: A keyword search of current literature was conducted using CINAHL, PubMed, and Scopus databases. An additional hand search of 2 …

Dosage Considerations For Aspirin Therapy To Prevent Preeclampsia In Pregnancy, Melissa S. Haraway

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Introduction: Preeclampsia remains the leading cause of maternal and neonatal mortality worldwide despite extensive and ongoing research on the subject. The use of aspirin therapy to reduce preeclampsia in pregnancy is widely researched and accepted into practice, however, optimal dosing is still debated. The purpose of this review is to identify which dosage of aspirin therapy offers the most effective reduction in preeclampsia without increasing the risk of postpartum hemorrhage.
Methods: The following databases were searched using the framework methodology by Whittemore and Knafl: CINAHL, PubMed, ScienceDirect, Scopus, ProQuest, and Citations. The search criteria limited articles to five years old …

Methods To Reduce Recurrent Pregnancy Loss: An Integrative Review, Jolene J. Davis

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This integrative review explores interventions that may improve live birth rates or pregnancy outcomes for individuals experiencing recurrent pregnancy loss (RPL). Approximately 5% of couples experience RPL, and limited evidence contributes to inconsistent clinical recommendations for this population. A literature search was conducted using CINAHL, PubMed, and Nursing and Allied Health Collection. Inclusion criteria consisted of primary research studies published in English from 2016 to 2026 that evaluated preventative interventions aimed at improving live birth rates or pregnancy outcomes in individuals with RPL. Exclusion criteria included infertility unrelated to RPL, single miscarriage, animal subjects, in vitro fertilization-related studies, or studies …

Non-Pharmacological Interventions For The Management And Prevention Of Hypertensive Disorders In Pregnancy: A Review Of The Literature, Shenelle K. Smith, Laurena E. Lepp

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Hypertensive disorders of pregnancy (HDP), including preeclampsia (PE), are a leading cause of maternal and perinatal morbidity and mortality worldwide. In the United States, rates of HDP continue to rise and are associated with preterm birth, fetal growth restriction, and long-term cardiovascular disease. Current management focuses only on low-dose aspirin for prevention. Surveillance and timely delivery remain the only definitive treatment for preeclampsia. This highlights a critical gap in prevention. Emerging evidence suggests that non-pharmacological interventions–particularly nutrition, physical activity, and lifestyle modification–may reduce the risk and severity of HDP. These approaches align with midwifery models of care emphasizing prevention, education, …

Fear Of Childbirth As A Perinatal Comorbidity: An Integrative Review, Michelle T. Mcmanus, Ashely N. Payne

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Fear of childbirth (FOC) and tokophobia have a significant impact on one in every five pregnant women and is associated with enhanced levels of anxiety, depression, pre-traumatic stress, and has led to increased requests for elective cesarean sections. Given the influence that it has on birth mode and perceived birth experience as well as postpartum wellbeing, it stands to reason that FOC represents an often-overlooked aspect of perinatal mental health.
This capstone reviews cohort, cross-sectional, randomized, and quasi-experimental studies examining prevalence, correlations, and consequences of FOC. It evaluates antenatal education, midwife-led support, and cognitive behavioral therapy as potential interventions. Outcomes …

Elevated Bmi And The Effect On Breastfeeding Duration In Postpartum Individuals: An Integrative Review, Abigail E. Mobilia, Kirstin A. Wyly

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Introduction: It has been well documented that exclusive breastfeeding provides benefits for infants and postpartum individuals, yet rates remain suboptimal in the United States, particularly among those with elevated pre-pregnancy body mass index (BMI). Evidence suggests that elevated BMI is associated with shorter breastfeeding duration and may be influenced by physiologic, social, and structural factors. This integrative review synthesizes existing literature to clarify the relationship between elevated BMI and exclusive breastfeeding duration among postpartum individuals.
Methods: An integrative review was conducted following Whittemore and Knafl’s (2005) framework and PRISMA 2020 guidelines. A systematic search of PubMed, CINAHL, and Nursing & …

Gestational Diabetes Mellitus And Its Psychological Impacts During Pregnancy And Postpartum, Nehemie B. Hypolite, Charline Fast

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Introduction: This review explores the link between gestational diabetes (GDM) and psychological outcomes. GDM affects 8–10% of pregnancies and is typically diagnosed at 24–28 weeks. This burden leads to anxiety, depression, and fear. Postpartum concerns often persist for mother and infant.

Methods: Whittemore and Knafl’s (2005) method was used to synthesize data. The research databases included CINAHL and PubMed. Covidence supported screening and PRISMA diagram development. Key search terms included “anxiety and GDM,” “depression and GDM,” “GDM and postpartum depression,” “gestational diabetes,” and “pregnancy.” Inclusion criteria included full-text articles published after 2010, original studies, patients undergoing diabetic treatment (medication and/or …

The Impact Of Patient-Centered Care On Women With Infertility And Pregnancy Loss: An Integrative Review, Kaidynce R. Sweazy

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Introduction: Infertility affects roughly 17.5% of adults worldwide, while pregnancy loss occurs in up to 30% of pregnancies. These reproductive traumas increase the risk of developing a mental health disorder, such as anxiety, depression, or post-traumatic stress disorder (PTSD). The purpose of this review is to identify the influence of patient-centered care on psychological outcomes and experiences of care in women with infertility and pregnancy loss.
Methods: A literature search of the PubMed and Cinahl databases was conducted for original studies published from January 2016 to January 2026 that address the psychological outcomes and/or experiences of women who experienced infertility …

The Placenta & Covid-19: Histological Changes & Clinical Implications, Melissa F. Paul, Allyson J. Zadlo Sensor

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Introduction: The COVID-19 pandemic presented the medical community with complex and novel challenges, not the least of which is how to optimize prenatal and postnatal care for pregnant individuals who have been infected. At present, seven years have elapsed, and despite definitive research demonstrating adverse outcomes associated with placental changes, no professional consensus has been reached.
Methods: This integrative review includes studies involving pregnant individuals with confirmed SARS-CoV-2 infection, who recovered during the same pregnancy, and their infants. An examination of the data available reveals a triad of placental pathologies (chronic histiocytic intervillositis, perivillous fibrin deposition, and trophoblast necrosis) that …

The Role Of Maternal Position During The Second Stage Of Labor On Reducing Perineal Injury: An Integrative Review, Ericka L. Dalton, Tabatha Ruth Erlandson

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Introduction: Perineal lacerations remain a common occurrence amongst vaginal deliveries. While there are some recommendations for supportive techniques throughout the literature, position is typically not included in these. Perineal trauma can have a lasting effect on the individual and increase health care costs. The purpose of this review is to identify what birthing positions are most effective at preventing perineal injury.

Methods: A formalized search of the literature was conducted via PubMed, CINAHL, Google Scholar, and SCOPUS databases. Of the 344 articles identified, 22 original studies met the inclusion and exclusion criteria for this review. A literature matrix and quality …

Facilitators And Barriers To Interprofessional Collaboration Between Physicians And Midwives: An Integrative Review, Kathy D. Lambright, Anesha E. Martin

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Introduction: Early models of interprofessional collaborative care suggest that when there is a collaboration between midwives and physicians, the outcomes for mothers and babies are improved. The purpose of this integrative review of the relevant literature is to identify the facilitators and barriers to collaborative relationships between physicians and midwives.

Methods: A keyword search was done using the Science Direct, PubMed, and CINAHL databases. Inclusion criteria were that they must be original research, identify facilitators and barriers in interprofessional collaborative relationships, and include healthcare professionals involved in maternity care. The database search yielded a total of 348 articles, which were …

Freestanding Birth Centers-Safety And Efficacy Related To Maternal And Neonatal Outcomes: An Integrative Review, Nicole Lynn Muzik, Casey Renee Workman

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Introduction: The goal of this literature review is to determine the safety of community birth by evaluating if low-risk pregnant women at term, who deliver in the community setting, specifically at freestanding birth centers, have comparable or lower maternal and neonatal morbidity and mortality outcomes, than low-risk women who deliver at an in-hospital birthing facility.

Methods: The authors of this integrative review retrieved original research articles from computerized databases (Nursing and Allied Health, PubMed, and CINAHL), as well as online journal hand searching, followed by cited reference searching. A total of 48 articles underwent a full-text review, and a total …

Telehealth In The Postpartum Period: An Integrative Review, Ann Elizabeth Niedermayer, Laura Orrock

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Introduction: Improving postpartum care by addressing the steep decline in postpartum care utilization is important to maternal and newborn health. This integrative review explores the use of telehealth in the postpartum period and its impact on improving health outcomes and access to care.

Methods: A literature search identified original studies published between 2018 and 2025 in PubMed, CINAHL, Scopus, and ScienceDirect to learn about the use of telehealth in postpartum care. Reference lists of included articles were screened, and a hand search of three applicable journals was also conducted. The search identified 1187 studies after duplicates were removed, of which …

Genetic Insights Into Methylenetetrahydrofolate Reductase Polymorphisms And Inherited Thrombophilia: Advancing Precision Screening And Therapeutic Interventions To Optimize Perinatal Outcomes, Taylar Hash

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Introduction: Methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and inherited thrombophilia, such as Factor V Leiden and Prothrombin G20210A, have been implicated in adverse pregnancy outcomes, including recurrent pregnancy loss, preeclampsia, fetal growth restriction, and preterm birth. This integrative review explores how genetic insights into MTHFR polymorphisms and inherited thrombophilia can guide precision medicine, including both screening and therapeutic intervention, to optimize perinatal outcomes. Methods: An integrative literature review was conducted following Whittemore and Knafl’s methodology. Research databases including PubMed, CINAHL, Scopus, and ScienceDirect were searched for studies published or translated to English within the last twenty years that examined MTHFR polymorphisms, …

Facilitators And Barriers To Reducing Maternal Mortality Rates In Non-Hispanic Black Women: An Integrative Review, Melissa Marie Andersson, Elizabeth L. Goes

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Introduction - Black maternal mortality remains a crucial public health crisis in the United States despite a plethora of research on the incidence. This presents in the persistent disparities in health outcomes between Black and White mothers and newborns. While numerous studies have explored isolated factors contributing to this issue, few have synthesized the full scope of barriers and facilitators influencing Black maternal health outcomes in the United States specifically.

Research Aim - This integrative review aims to identify and organize the key facilitators and barriers to reducing Black maternal mortality in the United States using the socio-ecological model as …

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

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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

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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

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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

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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 …

Maintaining Postpartum Bleeding: Effects Of Tranexamic Acid, Shenider Dufort

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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

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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

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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

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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

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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

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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

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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 …

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

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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 …

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

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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: …