Nursing Midwifery Commons^™

The Efficacy Of Transversus Abdominis Plane Block As An Adjunct To Spinal Anesthesia For Cesarean Delivery: An Evidence Synthesis And Implementation Toolkit, Alyssa Hebert, Alex Potts, Gabriela Robertson

Graduate Theses, Dissertations, and Capstones

Postoperative pain hinders cesarean delivery recovery and overall patient experience. Although spinal anesthesia with intrathecal opioids remains the standard of practice, associated side effects and concerns regarding opioid exposure highlight the need for effective opioid-sparing strategies. Anesthesia providers play a critical role in advancing postoperative pain management through evidence-based protocol development, provider education, and interdisciplinary collaboration to optimize maternal outcomes. The transversus abdominis plane (TAP) block provides somatic analgesia to the anterior abdominal wall by targeting the thoracolumbar nerves (T6–L1) and has increasingly been incorporated into multimodal postoperative pain management strategies for abdominal surgery. Nevertheless, a gap remains in obstetric …

Standardizing Gestational Diabetes Mellitus Education To Improve Patient Knowledge And Care Consistency In A Prenatal Clinic Setting, Wynn Zara

Master's Projects and Capstones

The gestational diabetes mellitus (GDM) group visit framework aims to improve consistency of GDM education by standardizing referral processes, educational materials, staff workflows, and patient communication. Although evidence-based GDM education supports patient self-management and improved maternal-fetal outcomes, variability in education delivery contributed to inconsistent care within the outpatient maternal-fetal medicine setting. This quality improvement project was conducted in an outpatient maternal-fetal medicine clinic in Santa Clara County serving pregnant patients diagnosed with GDM. To address this gap, a standardized GDM group visit framework was developed and implemented using structured educational resources, referral criteria, and communication workflows. The intervention was evaluated …

Integrating Matrescence Into Birth Worker Practice: A Practice Improvement Project, Kelsey B. Green

Doctor of Nursing Practice (DNP) Projects

Background: Perinatal mood and anxiety disorders (PMADs) affect 20–25% of mothers worldwide and are a leading cause of maternal complications. Stigma, fragmented care, and limited provider training leave families vulnerable, while birth workers offer trusted, continuous support.

Problem: Birth workers' maternal mental health (MMH) training is minimal and often excludes matrescence, the developmental transition to motherhood, limiting their ability to distinguish normal adjustment from clinical PMADs and delaying intervention.

Methods: A single-group, pre-/post-test design evaluated a matrescence-informed workshop at Roots Community Health's 2nd Annual Symposium. Anonymous surveys measured knowledge, attitudes, and confidence, analyzed with Mann–Whitney U, Wilcoxon signed-rank tests, and …

Birth Satisfaction, As Measured By The Birth Satisfaction Scale–Revised (Bss-R), And Its Role In Predicting Breastfeeding Duration, Maternal-Infant Attachment, And Postpartum Depression, Molly Parker

University Honors Theses

Birth satisfaction has been consistently associated with improved maternal outcomes such as reduced postpartum depression (PPD), stronger maternal-infant attachment, and longer breastfeeding duration. However, the extent to which birth satisfaction independently predicts these outcomes remains unclear. This study examined whether birth satisfaction, as measured by the Birth Satisfaction Scale–Revised (BSS-R), predicts postpartum depression, maternal-infant attachment, and breastfeeding duration in a longitudinal cohort.

Data were drawn from the Prenatal Environmental And Child Health (PEACH) study. Birth satisfaction was assessed at 12 months postpartum using the BSS-R. Postpartum depression was measured using the Edinburgh Postnatal Depression Scale (EPDS), maternal-infant attachment using the …

Breastfeeding Promotion For Infants With Neonatal Abstinence Syndrome (Nas), Olivia Czerwonka

Evidence-Based Practice Project Reports

Neonatal abstinence syndrome (NAS) is the exposure in utero to drugs with the incidence in the United States increasing from 4 to 6.3 per 1000 births (Wei et al., 2023). The purpose of this quality improvement project was to implement a breastfeeding support intervention to increase breastfeeding frequency and reduce hospital length of stay of newborns with NAS. A tailored multicomponent guideline based upon the current Ten Steps to Successful Breastfeeding as established by WHO and UNICEF (2017) was implemented. Mothers of infants diagnosed with NAS were recruited using convenience sampling from a Northwest Indiana Hospital. Key stakeholders within the …

Community Perceptions Of A Hospital-Based Doula Program In Mobile, Alabama, Sarah Laney

Honors Theses

Background: The maternal mortality ratio in the United States is much higher than the mortality rate for women who live in other countries with similar Human Development Index scores. Black women are more likely to die than their white counterparts. Most of these deaths are preventable. Patients feel like they are being ignored, or that they are not being seen. Doula care is a possible solution to these problems.

Purpose: The purpose of this study was to assess patient understanding and perception of doulas as well as comparing desire for doulas to demographics and past experiences to search for relationships. …

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

All Electronic Theses and Dissertations

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

All Electronic Theses and Dissertations

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

All Electronic Theses and Dissertations

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 …

Comparing Nurse-Led Holistic Pain Relief Strategies And Sole Pharmacological Use In Enhancing Maternal Satisfaction, Reducing Pain, And Lowering Obstetric Interventions During Childbirth, Jessica C. Moore

Nursing | Senior Theses

Background: Childbirth has become heavily reliant on pharmacological management and obstetric interventions such as epidural use, labor induction, and cesarean deliveries (C-sections) even among low-risk pregnancies. While necessary in some cases, excessive reliance on pharmacological interventions can negatively impact the experience of birthing as a whole. Non-pharmacological interventions (NPIs) such as breathing techniques, positioning, hydrotherapy, massage, aromatherapy and continuous support have shown to be effective in reducing pain and supporting physiologic labor. The gaps in education and lack of standard implementation result in inconsistent application in practice. Purpose: This research proposal aims to evaluate the effectiveness of nurse-led NPIs compared …

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

All Electronic Theses and Dissertations

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

All Electronic Theses and Dissertations

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

All Electronic Theses and Dissertations

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

All Electronic Theses and Dissertations

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

All Electronic Theses and Dissertations

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

All Electronic Theses and Dissertations

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 …

Evaluating The Effectiveness Of Nurse-Led Prenatal Education On Maternal Outcomes And Labor Satisfaction, Alexis Boris

Honors Undergraduate Theses

Prenatal education has been a long-time major component of maternal healthcare, which has been known to impact expectant mothers and their level of preparedness during the labor and birthing process. Nurses have historically been key educators in the maternity field, due to their accessibility, education, and holistic approach in the healthcare system. Despite their recognition as vital educators in this field and the importance of maternal prenatal education, maternal healthcare is still affected by many modern-day factors, such as access to healthcare and education, health disparities, and negative childbirth experiences. This integrative literature review aims to evaluate the overall effectiveness …

The Knowledge, Experiences, And Attitudes Of Nurses Regarding Trauma-Informed Care For Sexually Abused Intrapartum Patients, Kayleigh Mcgraw

Honors Undergraduate Theses

Labor and delivery nurses care for women from diverse backgrounds who are preparing for a life-changing event, often marked by fear, excitement, sadness, and joy. However, 1 in 5 women in the United States have experienced rape or attempted rape, and for these survivors, labor can become re-traumatizing. Many report flashbacks, dissociation, and a sense of “being back in the rape” during childbirth. Research further links prior sexual assault to unplanned cesareans, traumatic births, and childbirth-related PTSD. Trauma-informed care (TIC) provides a framework to reduce these risks by encouraging providers to understand trauma, recognize signs of distress, and act to …

The Development Of A Midwifery Specific Tool To Identify The Barriers And Enablers To Change Within The Midwifery Setting, Sara Davis

Theses: Doctorates and Masters

Despite being well-positioned to identify service gaps and propose improvements, many midwives lack the knowledge, skills, confidence, or tools to effect practice change. Implementation science (IS) offers a structured approach to moving evidence-based innovations into practice; however, existing IS theories, models, and frameworks do not reflect the unique context of midwifery practice. The first step in the intentional implementation of an evidence-based practice innovation is to conduct a context assessment to identify factors that may facilitate or impede its uptake. There are numerous evidence-based checklists for this, but none capture all the influences on midwifery practice environments.

In this study, …

Improving Interdisciplinary Communication And Collaboration With The Standardization Of Doula Care Through An Informatics Tool, Shela Le

Master's Projects and Capstones

Objective: The 22-bed Labor and Delivery (L&D) unit lacks a standardized model to introduce doulas, clarify their scope of practice, or communicate the value of the services they provide. To address this gap, the team implemented a standardized doula awareness poster that included each doula’s name, photo, years of experience, and personal interests. Aim: The goal is to enhance visibility and promote integration of doula support to strengthen team collaboration and patient engagement. Methods: A pre- and post-implementation survey was distributed exclusively to the volunteer doulas. After the doula awareness poster was displayed for a month, a post-survey assessed these …

Standardizing Care: Strengthening Dka Protocol Implementation Among Emergency Department Nurses, Toni Joy Angelique Biliran Miculob

Master's Projects and Capstones

Objective: The objective of this project was to address the inconsistent understanding and utilization of the Diabetic Ketoacidosis (DKA) protocol in a high-acuity emergency department within a large hospital system, where baseline survey results showed that 84% of nurses found the DKA order set confusing and only 15% felt “very comfortable” applying it.

Aim: The aim was to improve nurse clarity, confidence, and consistency in using the DKA protocol to support timely, evidence-based management of this high-risk, time-sensitive condition.

Methods: The intervention consisted of brief, targeted education delivered during pre-shift huddles across day and night shifts, focusing …

Matrescence: An Emerging Concept For Birth Worker Practice, Kelsey B. Green

DNP Qualifying Manuscripts

The maternal mental health (MMH) crisis, affecting up to 25% of birthing individuals, is exacerbated by significant gaps in perinatal support. While birth workers are uniquely positioned to provide care, they often lack specialized training beyond basic screening checklists to address the complex transition to motherhood, defined as matrescence. This clinical innovation proposal outlines a matrescence-informed educational curriculum, guided by the Comprehensive Model of Mental Health during the Perinatal Period. The intervention is designed to build tangible, implementable skills, training birth workers to: (1) operationalize matrescence as a psychoeducational tool to normalize distress; (2) use clinical differentiation to distinguish the …

Exploring Factors Informing The Choice Of Caesarean Sections Among Couples, And Healthcare Workers: A Case Of The Nairobi Hospital, Kenya, Mercy Mukubwa

MSc in Advanced Practice Midwifery

Background: A caesarean section (C/S) is a lifesaving procedure to reduce maternal and newborn morbidity and mortality. It is associated with more risks compared to a vaginal birth. The rates of C/S have been on an upward trend globally and are expected to continue to rise further. C/S predisposes neonates to poor outcomes, some of which could be life-threatening compared to vaginal birth. Similarly, C/S mothers are at greater risk for serious complications.

Objective: The primary objective of this study was to investigate the factors influencing the decision to undergo a caesarean section among couples and healthcare workers …

Association Of Covid-19 Status With Maternal And Neonatal Outcomes Among Pregnant Women At Mombasa County Referral Hospital, Kenya, Salome Mghoi Rajab

MSc in Advanced Practice Midwifery

Background: COVID-19 pandemic has raised global concern regarding maternal and neonatal health owing to physiological and immunological changes that may heighten disease severity. Despite the global evidence linking COVID-19 infection with unfavorable pregnancy outcomes, data from Sub-Saharan Africa remain limited. This leaves an essential vacuum in our understanding of how COVID-19 status affects maternal and neonatal outcomes in counties like Mombasa, where health-care system problems may alter risks. Vertical transmission remains a puzzle to be solved.

Aim: To assess the association of COVID-19 status on maternal and neonatal outcomes between March 2020 to March 2022.

Methodology: A …

Reducing Nulliparous, Term, Singleton, Vertex Cesarean Birth Rate, Roseanna Juarez

Master's Projects and Capstones

Abstract

Problem: Cesarean birth rates for nulliparous, term, singleton, vertex (NTSV) pregnancies in the United States continue to exceed the Healthy People 2030 goal of 23.6%, resulting in preventable maternal and neonatal complications and higher healthcare costs.

Context: This quality improvement (QI) initiative was conducted in a high-acuity labor and delivery unit in California’s Central Valley, an area characterized by maternal health disparities, high rates of comorbidities, and limited access to prenatal care. The goal was to reduce the NTSV cesarean rate to 18.0% by July 31, 2025.

Interventions: Guided by Kotter’s 8-Step Change Theory and the Plan-Do-Study-Act (PDSA) framework, …

Implementation Of The Modified Early Obstetric Warning System (Meows) In Obstetric Patients Within A Level Iv Maternal Care Facility, Mei M. Stalder

Student Scholarly Projects

Practice Problem: Incidences of increasing maternal morbidity and mortality are often preceded by a period of unrecognized deterioration. The lack of an obstetric early warning system in a high-risk Level IV Maternal Care Facility further contributed to delayed identification and intervention of deteriorating mothers.

PICOT: The PICOT question that guided this DNP project was, in obstetric patients, 18-years or older (P), does the Modified Early Obstetric Warning System (MEOWS) (I), compared to current standard practice (C), affect the number of patients transferred to the ICU (O) within a six-week time frame (T)?

Evidence: Nine evidence-based articles were included in this …

Prevalence And Risk Factors Associated With Postpartum Hemorrhage Among Postpartum Women In Selected Health Facilities In Machakos County - A Case-Control Study, Daniel Kyalo Muthiani

MSc in Advanced Practice Midwifery

Background: Postpartum hemorrhage (PPH) refers to blood loss ≥500mls after vaginal birth and ≥1000mls after cesarean section. PPH is of concern in low and middle-income countries and is estimated to cause maternal mortality every 10 minutes, with a prevalence of 25% and 34% in Uganda and Kenya, respectively. Despite efforts to address this issue, the prevalence of PPH remains high and is associated with maternal and fetal risk factors that can present along the continuum of birth. Understanding the risk factors is necessary in designing appropriate interventions for their prevention.

Objective: To determine the prevalence, maternal and fetal risk factors …

Birth Planning, Audrey K. Gill, Kacie J. Easley

Student Scholarship & Creative Works

This is an informative presentation completed using evidence based practice regarding the importance of birth planning and the use of birth plans. It is used as a tool to educate nurses and healthcare providers about the benefits of implementing birth plan education into their patients portfolio. The birth plan is a written document that involves the collaborative efforts between nurses/healthcare providers and future mothers. It is used in order to personalize and improve the birthing experience for patients. This presentation uses qualitative research, quantitative research, and theoretical framework in order to deem positive results with the implementation of birth plans.

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

All Electronic Theses and Dissertations

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

All Electronic Theses and Dissertations

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 …