Maternal, Child Health and Neonatal Nursing Commons^™

Reducing Postpartum Hemorrhage Rates At Maine Medical Center, Meaghan Smith, Colette Dumais, Tracey E. Mcmillan, Carrie Comeau, Mandy Wallace, Jenelle Boulanger, Jodi-Lynne Vaughn, Kelly Ouellette, Natalia Johnson, Suneela Nayak, Rebecca Brookes

Operations Transformation

In the United States, approximately 700 women die each year from pregnancy related deaths and the most frequent cause of preventable maternal mortality is obstetric hemorrhage. The postpartum hemorrhage (PPH) rate at Maine Medical Center (MMC) is three times the national average. At our facility we care for the most complex patients in the State and we must decrease our rate to accurately reflect our expertise, knowledge and skills.

The Factors Associated With Caesarean Section At A Rural Hospital In Southwestern Uganda: A Cross-Sectional Study, Lilian Nuwabaine, Mathius Amperiize, Patience Annet Nakalega

School of Nursing & Midwifery, East Africa

Background

Globally, the overall prevalence of caesarean section (CS) is estimated at 18.6%, with 27% in high-income countries and 6% in low- and middle-income countries. There is an increase in trends of CS in Uganda from 8.5% in 2012 to 11% in 2016. No studies have been carried out to account for the high rates of CS at Kisiizi Hospital in Uganda. This study determined the proportion and factors associated with CS delivery at a rural hospital in southwestern Uganda.

Methods

This was a cross-sectional study of 321 immediate postnatal women in a rural hospital in southwestern Uganda. A structured …

Association Between Early Prostacyclin Therapy And Extracorporeal Life Support Use In Patients With Congenital Diaphragmatic Hernia, Akila B Ramaraj, Samuel E Rice-Townsend, Carrie L Foster, Delphine Yung, Emma O Jackson, Ashley H Ebanks, Matthew T Harting, Rebecca A Stark, Congenital Diaphragmatic Hernia Study Group

Faculty, Staff and Student Publications

IMPORTANCE: Prostacyclin (PGI2) is a therapeutic option to treat congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension in neonates. Its use may decrease the need for extracorporeal life support (ECLS).

OBJECTIVE: To evaluate the association of early PGI2 therapy with ECLS use and outcomes among patients with CDH.

DESIGN, SETTING, AND PARTICIPANTS: This was a cohort study from the CDH Study Group (CDHSG) registry of patients born from January 2007 to December 2019. Patients were from 88 different tertiary pediatric referral centers worldwide that contributed data to the CDHSG. Patients were included in the study if they were admitted within the first …

Benefits Of Using An Upright Laboring Position As Compared To Supine In The Second Stage Of Labor And The Impact On The Use Of Assisted Devices, Chelsey Cook

Master of Science in Nursing Family Nurse Practitioner

Abstract: This paper explores the conclusion that women and their infants are at an increased risk for harm when assisted devices are used during the second stage of labor. Traditional practices involving a supine position during pushing have been associated with an elevated likelihood of assisted delivery, necessitating interventions such as forceps, vacuum extraction, or episiotomy. However, emerging evidence suggests that adopting an upright position during labor may help decrease the need for these interventions and positively impact maternal and fetal outcomes.

Although comprehensive research on this topic is limited, the available evidence supports the benefits of an upright position …

Amniotic Fluid Embolism Diagnosis & Treatment Pathway, Jeremy May

Doctor of Nursing Practice Projects

Access to care in rural areas can prove difficult for any patient, but especially for the expecting mother. Healthcare providers in these rural settings often lack the staffing and experience to effectively recognize and treat rare obstetric emergencies. Amniotic fluid embolism (AFE) is a rare medical emergency that requires healthcare providers to rapidly diagnose, monitor, and treat the sequela of resulting symptoms in the obstetric patient. After a literature review, a teaching session was developed and implemented as part of the annual training for 20 nursing staff at a small 50-bed rural hospital in central California. An 8-question pre-test was …

Mantram For Mamas: A Pilot Study For Postpartum Women, Ritamarie Smedile

Dissertations

Objective: This pilot study launched an online Mantram Repetition Program (oMRP) using a virtual health portal that aimed to explore online portal accessibility, oMRP acceptance, and overall interface satisfaction among a sample of postpartum women.

Background: Postpartum depression remains one of the most common and severe childbirth complications, affecting more than 13% of women during the first three months after childbirth. Cognitive or behavioral talk therapy sessions and medication are the most frequently recommended treatments to alleviate symptoms. Although effective, women tend not to enroll or adhere to these modalities, suggesting they need alternative treatment plans. A possible alternative, mirroring …

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 …

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

Master's Projects and Capstones

This project aims to increase the confidence of nurses using birthing positions to aid with mobility to assist with fetal descent and decrease the duration of labor in the first and second stages of labor. Lack of mobility and increased duration of labor are associated with the use of cesarean sections, which is an invasive surgery with potential complications. A knowledge gap in a South Bay Area hospital exists in current evidence-based birthing positions. Recent evidence shows that flexible sacrum positions, which are any upright positions that take the weight off the sacrum, promote vaginal deliveries, and improve birthing outcomes. …

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 …

Implementing Nurse Education On Evidence-Based Birthing Positions For First And Second Stages Of Labor To Promote Fetal Descent, Momoko Ueda

Master's Projects and Capstones

Cesarean deliveries can increase the risk of maternal and newborn complications. A cost-effective method to reduce unnecessary cesarean deliveries is through maternal repositioning during the first and second stages of labor. Research has shown that flexible sacrum positions such as standing, squatting, kneeling, lunging, hands and knees, side-lying, and use of a peanut ball reduces the duration of labor, lowers rates of cesarean deliveries, and promotes fetal descent. This project aims to increase nurse confidence in these evidence-based labor positions by implementing nurse education in the labor and delivery unit at a Bay Area County hospital. A pre-survey identified current …

Educating Nursing Staff On Evidence-Based Maternal Positioning To Promote Fetal Descent During The First And Second Stages Of Labor, Mary Ray Fouad

Master's Projects and Capstones

The aim of this project was to determine whether educating Labor and Delivery (L&D) nurses on maternal positions would increase their confidence their implementation to reduce the risk of cesarean sections (c-sections, CS) and progress the first and second stages of labor. Previous studies have shown that upright positions reduce the length of both labor stages by promoting more effective uterine contractions. Although L&D nurses may be familiar with the labor positions, they may not have confidence in their utilization as the education and practice of the birthing positions is not standardized. At a Bay Area county hospital, L&D nurses …

Implementing An Infant-Driven Feeding Practice Model, Ann P. Nguyen

Doctor of Nursing Practice (DNP) Projects

Neonatal feeding practices have been the focus of many quality improvement studies due to large variations in care practices. Traditionally, the model for neonatal feeding has been a volume-based approach, one that focuses on a prescribed quantity consumed rather than the infant’s physiologic and developmental maturity (Fry et al., 2018). Recent literature has emphasized the benefits of a more developmentally supportive feeding approach in neonatal intensive care units (NICU), the infant-driven feeding model (IDF).

The IDF model focuses on individualized care, quality of the feed, and continuous assessment of feeding cues both before and during the feeding experience. Current literature …

Provision Of Formal Education To Nursing Staff: Kangaroo Mother Care Within Maternal-Child Units, Jessica Holly

Doctor of Nursing Practice Scholarly Project

Kangaroo mother care (KMC) is an evidence-based intervention that improves neonatal outcomes and reduces mortality in infants. KMC is not fully integrated into local hospital maternal-child departments and nursing professionals do not have a standard education offering concerning KMC. While the use of KMC is not entirely absent, nursing knowledge and understanding of its correct execution leads to lesser occurrences of KMC initiation. This scholarly project addresses nursing knowledge as a practice quality improvement. A literature review was completed, including searches through CINAHL, Merck Manuals, MEDLINE Plus Health Information, ProQuest, and UpToDate. A pretest, educational video, and posttest were then …

Introducing A Trauma-Informed Care Model To Address Racial Disparities In Perinatal Outcomes Among African American Women, Mariah K. White

Honors College Theses

Racial disparities in maternal and infant health have remained an issue within the United States despite efforts to advance and improve our health system. Most maternal deaths are preventable, especially with early and adequate maternal care. Infant mortality occurs for several reasons, but inadequate care usage increases the risk for adverse outcomes. Prenatal care usage within the United States has been inadequate for numerous years, most commonly among African American women, despite its known benefit. Low prenatal care usage among African American women can be attributed to community barriers, social injustices, trauma, discrimination, and health care mistrust. Trauma is common …

Exploring The Effects Of Psychosocial Factors And Relationships To Postpartum Depression Symptoms Among Iranian Immigrant Women Living In Canada: A Cross-Sectional Study, Monica Gola

Electronic Theses and Dissertations

Introduction: Immigrant women’s health garners attention as migration creates changes in social networks and parenting needs. The effect of psychosocial factors, such as maternal self-efficacy, measured by ability to manage parenting responsibilities, social support and cultural postpartum practices on postpartum depression symptoms are not well known in Canadian immigrant women. Methodology: A cross-sectional descriptive survey design guided by Bandura’s Reciprocal Determinism was used to explore the relationships between psychosocial factors including: maternal self-efficacy, social support, cultural postpartum practices; and symptoms of postpartum depression (PPD) among recent Iranian immigrant women living in Canada. Results: A total of 114 participants completed the …

Improving Access To Community Resources For Mothers In Southern New Jersey, Ariana Blake, Josalynn Maree, Nayarith Lopez, Vanessa Pizutelli

Rowan-Virtua Research Day

Maternal mortality rates have skyrocketed across the nation. New Jersey specifically has one of the highest rates across all 50 states. According to the New Jersey Maternal Health Report, southern New Jersey has the highest maternal mortality ratio, with 91% of the maternal deaths throughout New Jersey between 2016-2018 being preventable. It is crucial that families are receiving support during pregnancy and postpartum from the health care system and their community in order to reduce this trend. Acenda Integrated Health’s Connecting NJ aims to provide community support by connecting expectant mothers and families with children under the age of 3 …

University Campus Breastfeeding, Knowledge, And Perceptions Of Support: An Exploratory Study, Allison L. Scott, Ann W. Lambert, Chih-Hsuan Wang, Kelly V. Johnson, Jessica Weiss, Tony Stankus

The Eleanor Mann School of Nursing Faculty Publications and Presentations

Breastfeeding is often considered principally a biological issue but success is impacted by the socio-ecological environment of the lactating parent. Identifying current attitudes towards breastfeeding is essential in the effort toward normalizing breastfeeding in communities, including university campuses. The study explored campus community knowledge, awareness, and attitudes about breastfeeding, including available resources and applicable laws on two university campuses in the southern United States. This cross-sectional, self-reporting study utilized the Iowa Infant Feeding Attitude Scale and an adaptation of the Breastfeeding Behavior Questionnaire to survey a convenience sample. Results revealed decreased awareness of protective laws, availability of private lactation space, …

Expanding Labor Support Education To Nurses Caring For Women In Labor, Ana L. Viera-Martinez

Doctoral Projects

The ability to provide emotional and physical support to a patient during one of the most significant moments of her life is a privilege afforded to intrapartum nurses who attend to laboring and delivering mothers. Labor support improves birth outcomes, reduces cesarean birth rates, and decreases anesthesia use. More labor support education needs to be made available to intrapartum nurses. Within the hospital context, this quality improvement (QI) project investigated the effects of educating intrapartum nurses about labor support and providing them with hands-on training. Surveys, including the Self-Efficacy Labor Support Scale, were as given pre- and post-education to evaluate …

Improving Breastfeeding Rates Through Education, Julianna Youssef

Doctoral Projects

Background: Breastfeeding is beneficial for newborn babies, but there are many challenges that new mothers face that prevent them from exclusively breastfeeding.
Objective: To evaluate if re-educational training in RN’s and LVN’s is an effective way to increase the exclusive breastfeeding rates in the hospital setting.
Methods: We utilized a pretest/post-test quasi-experimental design and had the goal sample size was about 50 nurses. The nurses were given an educational PowerPoint at a monthly staff meeting. Pretests were given to the staff immediately before and posttests two weeks later. Additionally, exclusive breastfeeding rates were monitored for the three months before the …

The Association Of Apgar Score Outcomes With The Number Of Midwife Antenatal Care Visits Among Infants Born To Rohingya Refugees In Cox’S Bazar, Bangladesh, Vickie Doss

Capstone Experience: Master of Public Health

A cross-sectional study was conducted at the HOPE Foundation for Women and Children of Bangladesh Field Hospital in Cox’s Bazar, Bangladesh, to examine the relationship between the number of antenatal care visits (ANCV) and Apgar scores. This study aims to explore the association between the number of ANCV and Apgar scores in neonates born to Rohingya refugee women. The medical records at HOPE Field Hospital of 182 post-delivery Rohingya women in the Mhodhurchora refugee camp were collected through a medical chart review to

obtain the number of ANCV and 1-minute and 5-minute Apgar scores. The Apgar scoring system is a …