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Perinatal nurses play a critical role in the care of, advocacy for, and research with Black women in the perinatal period. Despite awareness of inequities in the perinatal health care system that stem from racism in the United States, many nurses report feeling detached from the crisis. In this critical commentary, we provide a five-step nursing action guide to address this health disparity that is aligned with the Future of Nursing report and the American Nurses Association Code of Ethics. We recommend nursing activities in each step: understand drivers of health inequities among Black women, reflect on implicit bias, use respectful care frameworks with Black women, conduct ethical research, and advocate for change. The article includes a sharable and printable action sheet that can be used in the work environment to remind nurses of their roles in enacting change., Competing Interests: Conflict Of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2023 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the relationship between postpartum education and knowledge of postbirth warning signs among women in Ghana., Design: Cross-sectional survey., Setting: Tamale West Hospital in Tamale Metropolitan Area, Ghana., Participants: Women (N = 151) who gave birth to healthy newborns and were admitted to the postnatal ward., Methods: We collected data from surveys distributed in the hospital. The survey included items for sociodemographic characteristics, obstetric history, postpartum education provided, and knowledge of nine common postbirth warning signs. We used descriptive statistics and multivariate logistic regression models to analyze the data., Results: Participants reported knowing an average of 5.2 of 9 (SD = 2.84) postbirth warning signs. Severe bleeding (94.70%, n = 143), fever (82.12%, n = 124), and severe headache (72.19%, n = 109) were the postbirth warning signs most frequently identified by participants. Swelling in the leg (37.09%, n = 56) and thoughts of hurting oneself (33.11%, n = 50) were the postbirth warning signs least frequently identified by participants. Knowledge about postbirth warning signs was positively associated with reports of receiving educational handouts on the postnatal ward (adjusted OR = 4.64, 95% confidence interval [1.27, 17.04]) and reports that four or more postpartum complications were taught before hospital discharge (adjusted OR = 27.97, 95% confidence interval [7.55, 103.57]) compared to zero to three postpartum complications., Conclusion: All women need comprehensive discharge education on the warning signs of complications after birth. Promoting knowledge of postbirth warning signs can decrease delays in seeking care and contribute to the reduction of maternal mortality in Ghana., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2023 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To examine variation in nursing resources across three different types of maternity units in five regions of the United States., Design: Cross-sectional descriptive., Setting: Maternity units in hospitals in 48 states and the District of Columbia that participated in the 2016 National Database of Nursing Quality Indicator survey., Participants: Staff nurses (N = 19,486) who worked in 707 maternity units., Methods: We conducted a secondary analysis of survey data examining nursing resources (work environment, staffing, education, specialty certification) by type of maternity unit, including labor and delivery, labor/delivery/recovery/postpartum, and postpartum. We used descriptive statistics and analysis of variance., Results: Participants worked in 707 units (269 labor and delivery units, 164 labor/delivery/recovery/postpartum units, and 274 postpartum units) in 444 hospitals. The work environment was not significantly different across unit types (mean = 2.89-2.94, p = .27). Staffing, education, and specialty certification varied significantly across the unit types (p ≤ .001). In terms of staffing, postpartum units had, on average, almost twice the number of patients per nurse as labor and delivery units (7.51 patients/nurse vs. 4.01 patients/nurse, p ≤ .001) and 1.5 times more patients than labor/delivery/recovery/postpartum units (5.04 patients/nurse vs. 4.01 patients/nurse, p ≤ .001)., Conclusion: Nursing resources varied significantly across types of maternity units and regions of the United States. This variation suggests that improving nursing resources may be a system-level target for improving maternity care in the United States., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2022 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To explore the experiences of parents with an integrated maternity and neonatal ward designed to empower parents by providing family-integrated care (FICare) to mother-newborn couplets in single-family rooms., Design: A qualitative analysis with a contextual constructivist approach., Setting: An integrated maternity and neonatal level 2 ward designed to empower parents in a teaching hospital in Amsterdam, the Netherlands. Maternity and neonatal care, up to and including highly complex care, is provided to mother-newborn couplets in single-family rooms according to the principles of FICare., Participants: Twenty-seven mothers and nine fathers of newborns who were hospitalized for at least 7 days., Methods: We held four focus group discussions and eight semistructured interviews 1 to 3 months after discharge of the newborn to explore which experiences (mechanisms) facilitated or impeded aspects of parent empowerment (outcomes) under which specific conditions of the integrated infrastructure (contexts). We used the realist evaluation model to analyze the data., Results: Our analysis revealed five themes of parent empowerment (outcomes): Feeling Respected, Gaining Self-Management Tools, Insights Into the Newborn's Condition, Perceived Control, and Self-Efficacy. For each theme, participants reported facilitating and impeding experiences (mechanisms) that were initiated and influenced by the combination of single-family rooms, couplet care, rooming-in, and FICare (contexts). Unrestricted physical proximity to their newborns, 24 hours per day, in a safe private environment offered parents intensive learning experiences through active participation in care. It helped them to achieve independent parenthood at the time of discharge, but it also generated challenges such as power conflicts with the staff; prioritizing care for themselves, siblings, or the newborn; feelings of isolation; and lack of sleep., Conclusion: Providing FICare to mother-newborn couplets in single-family rooms offers parents an intensive learning context for independent parenthood at the time of discharge. Health care professionals should be aware of the challenges and facilitators experienced by parents in the context of close physical proximity to their newborns 24 hours per day in single-family rooms. This awareness will allow them to better support parents in their empowerment process toward independent parenthood at the time of discharge., (Copyright © 2020 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce., Design: Cross-sectional survey study., Setting: Maternity care units within rural hospitals in nine U.S. states., Participants: Maternity care unit managers., Methods: We calculated descriptive statistics to characterize the rural maternity care nursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals., Results: Of the 263 hospitals, 51% were low volume (<300 annual births) and 49% were high volume (≥300 annual births). Among low-volume hospitals, 78% used a shared nurse staff model. In contrast, 31% of high-volume hospitals used a shared nurse staff model. Respondents praised the teamwork, dedication, and skill of their maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses., Conclusion: Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals., (Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the current knowledge of postpartum women's sleep patterns, sleep disturbances, consequences of sleep disturbances, and known strategies for prevention in order to provide best practice recommendations for health care providers., Data Sources: A literature search from 1969 through February 2008 was conducted using the CINHL, Index of Allied Health Literature, Ovid, PsycINFO, and PubMed electronic databases in addition to reference lists from selected articles and other key references. Search terms included sleep, postpartum, sleep deprivation, and sleep disturbance., Study Selection: A critical review of all relevant articles from the data sources was conducted with attention to the needs of postpartum women's sleep and implications for health care providers., Data Extraction: Literature was reviewed and organized into groups with similar characteristics., Data Synthesis: An integrative review of the literature summarized the current state of research related to sleep alterations in postpartum women., Conclusions: Postpartum women experience altered sleep patterns that may lead to sleep disturbances. The most common reasons for sleep disturbances are related to newborn sleep and feeding patterns. Although present, the relationships among sleep disturbance, fatigue, and depression in postpartum women lack clarity due to their ambiguous definitions and the variety of the studies conducted. Providers should encourage prenatal education that assists the couple in developing strategies for decreasing postpartum sleep deprivation. Alterations of in-hospital care and home care should be incorporated to improve the new family's sleep patterns.

Objective: To conceptualize women's and their partners' experiences and ways of handling the situation before, during, and after second trimester ultrasound examination with the diagnosis of a nonviable fetus., Design: A grounded theory study., Setting: A Swedish regional hospital., Participants: Nine women and 6 men (n=15) were interviewed within a year of the event., Results: The core category was Unexpected change in life. Four categories that were encompassed by the core category emerged: (a) Deceived by a false sense of security; (b) Confronting reality; (c) Grieving; and (d) Reorientation., Conclusion: These parents were unprepared for the diagnosis of a nonviable fetus. In addition to the crisis reaction, they realized that the sense of security they had experienced was false. As different care givers were involved, the need for a care plan was evident. Support from care givers was a very important factor.

Objective: To examine preterm, near-term, and term mothers' self-reported quality of life in the early postpartum period., Design: Prospective, longitudinal repeated measures design., Setting: Four medical centers in the Midwest., Patients/participants: A convenience sample of 184 mothers of either a preterm, near-term, or term infant., Main Outcome Measure: Maternal Postpartum Quality of Life tool., Results: Mothers of preterm infants scored significantly lower on the subscale psychological/baby of the Maternal Postpartum Quality of Life tool compared to mothers of near-term and term infants., Conclusions: Infant gestational age at birth has relevance for maternal quality of life during the postpartum period. Health care professionals need to be cognizant relative to infant gestational age and individualize nursing care.

As a rule, mothers are the primary caregivers of infants regardless of employment or marital status. Thus, any factors that impact mothering affect the infant and have public health significance. National attention is now focused on postpartum depression, a major variable affecting mothering. The impact of postpartum depression on the various components of the maternal role is described. Recommendations for health care practice include screening for depression across the first postpartum year and developing a strong network for mental health referrals., ((c) 2006, AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses)

Objective: To explore the feasibility of using motivational interviewing to promote sustained breastfeeding by increasing a mother's intent to breastfeed for 6 months and increasing her breastfeeding self-efficacy., Design: A longitudinal experimental two-group design with repeated measures was selected to explore the feasibility of using motivational interviewing to promote sustained breastfeeding in primiparous mothers., Setting: Three Western rural community hospital sites., Participants: Convenience sample of 73 primiparous breastfeeding mothers ranging between the ages of 19 and 38, M = 25 (SD = 4.5)., Main Outcome Measure: Mothers reported the date of their last day of breastfeeding, defined as any breastfeeding during the previous 24-hour period. Breastfeeding behavior was confirmed at each visit by infant test weights., Results: The motivational interviewing group (M = 98.1 days, SD = 75.2) breastfed longer than the comparison group (M= 80.7 days, SD = 71.9); however, this difference was not significant, t(69) = 0.991, p = .325, Cohen's d = 0.24, related to the variability in the sample., Conclusions: Although not a statistically significant difference, the mean number of days that mothers in the intervention group breastfed was 98 days compared to the mean of 81 days by the comparison group; therefore, motivational interviewing may be useful as a strategy to test in a comprehensive intervention plan.

Objective: To provide a concept analysis of effective breastfeeding., Data Sources: Medline and CINAHL electronic databases, reference lists from selected articles, and 7 breastfeeding assessment tools. Search terms included the following: breastfeeding and effective, adequate, successful., Study Selection: Literature was selected according to whether the concept of effective breastfeeding was defined or described., Data Extraction: Literature was reviewed and data organized as definitions or descriptions, with descriptions grouped into categories sharing similar characteristics., Data Synthesis: Four characteristics were chosen as essential attributes of effective breastfeeding: positioning, latch, sucking, and milk transfer., Conclusions: The concept of effective breastfeeding requires further concept development to define and describe effective positioning, latch, sucking, and milk transfer. Future research is needed to determine the relationships between the antecedents, attributes, and consequences of effective breastfeeding.

Objectives: To measure actual and instructed preoperative fasting durations in women undergoing scheduled cesarean birth, to compare these times with national guidelines for healthy patients undergoing elective procedures, and to describe discomforts associated with preoperative fasting., Design: One group, nonexperimental, comparative, descriptive., Setting: Nonprofit private medical center in Texas with 6,000 births/year., Patients: Convenience sample of 51 hospitalized postpartum women., Interventions: Participants were interviewed an average of 44 hours after their cesarean birth, and their medical records were reviewed for fasting information., Main Outcome Measures: Duration of actual and instructed fasting, comparison with national guidelines, and ratings of thirst and hunger., Results: The participants fasted from liquids and solids an average of 11 and 13 hours, respectively. Both actual and instructed fasting durations were significantly longer than national guidelines. Most participants (70%) were instructed to be nulla per os after midnight whether they were to have a.m. or p.m. surgery. Thirst and hunger scores averaged 5 and 4, respectively, on a 0-10 scale., Conclusion: Patients having scheduled cesarean birth fast for unnecessarily long periods. Nurses should be knowledgeable about evidence-based preoperative fasting practices and collaborate with physicians to implement them.

Objective: To describe the meaning of the childbirth experience to Orthodox Jewish women living in Canada., Design: In this phenomenologic study, audiotaped interviews were conducted. Tapes were transcribed verbatim and analyzed for emergent themes. Demographic data also were collected., Setting and Participants: Thirty Orthodox Jewish women who had given birth to healthy full-term newborns at a university-affiliated Jewish hospital in Montreal, Canada, participated in the study. Data were collected within 2 weeks after childbirth, either in the mother's postpartum hospital room or in her home., Results: The following themes reflecting spiritual/cultural dimensions of the childbirth experience were identified: (a) birth as a significant life event, (b) birth as a bittersweet paradox, (c) the spiritual dimensions of giving birth, (d) the importance of obedience to rabbinical law, and (e) a sense of support and affirmation., Conclusion: This study documents cultural, religious, and spiritual dimensions of the childbirth experience of Orthodox Jewish women living in Canada. Knowledge and appreciation of the multiple dimensions of childbirth reflected by this study's findings can contribute to holistic and culturally competent nursing care of women and newborns.

In this era of consistent global migration, cultural competency is necessary in all aspects of the care nurses provide to families. Cultural competency is particularly significant in maternal-newborn nursing because childbirth, as one of life's most significant events, is culturally shaped and socially constructed. In this article, a framework is provided to enable nurses to focus on several global phenomena and thus provide care that is more culturally sensitive, congruent with the client's needs, and competent. Suggestions for integrating cultural issues into nursing curricula are offered.

When pregnant women acquire primary herpes simplex genital infections or experience recurrent infections around the time of delivery, the risk of transmitting the disease to their newborns is significant. This perinatal transmission can result in a serious neonatal illness. Issues surrounding screening, treatment, and mode of delivery to prevent perinatal transmission often are confusing and controversial. Nurses delivering care to childbearing women and their newborns must be aware of the current information to give accurate and helpful information and support. Nurses also need to understand the effect this disease has both physiologically and psychosocially on women with primary infections, recurrent infections, and women at risk of acquiring the infection during pregnancy.

Parvovirus B19 is a common, self-limiting, usually benign childhood virus that causes erythema infectiosum, also known as fifth disease. Acute infection in pregnancy can cause B19 infection in the fetus, leading to nonimmune fetal hydrops or fetal loss, depending on gestational age at the time of infection. Susceptibility to parvovirus B19 infection should be determined in selected pregnant women at high risk for exposure, and counseling should be provided regarding prevention, testing, and treatment options if exposed.

Objective: To review the literature on breastfeeding initiation and duration and to delineate effective strategies for promoting positive breastfeeding behaviors., Data Sources: Computerized searches on MEDLINE, CINAHL, and the Cochrane Library., Study Selection: Articles from indexed journals relevant to the objective and published after 1990 (except for classic findings) were reviewed. Although a myriad of pertinent articles was located, referenced citations were limited to three per point. When article selection was required for a specific point, preferences were given to (a) randomized controlled trials; (b) meta-analyses; (c) studies with the largest, most representative samples; and (d) investigations conducted in North America., Data Extraction: Data were extracted and organized under the following headings: benefits of breastfeeding, breastfeeding initiation and duration, personal characteristics, attitudinal and intrapersonal characteristics, hospital policies and intrapartum experience, sources of support, breastfeeding interventions, and review implications., Data Synthesis: Although the health benefits of breastfeeding are well documented and initiation rates have increased over the past 20 years, most mothers wean before the recommended 6-months postpartum because of perceived difficulties with breastfeeding rather than due to maternal choice. Women least likely to breastfeed are those who are young, have a low income, belong to an ethnic minority, are unsupported, are employed full-time, decided to breastfeed during or late in pregnancy, have negative attitudes toward breastfeeding, and have low confidence in their ability to breastfeed. Support from the mother's partner or a nonprofessional greatly increases the likelihood of positive breastfeeding behaviors. Health care professionals can be a negative source of support if their lack of knowledge results in inaccurate or inconsistent advice. Furthermore, a number of hospital routines are potentially detrimental to breastfeeding. Although professional interventions that enhance the usual care mothers receive increase breastfeeding duration to 2 months, these supportive strategies have limited long-term effects. Peer support interventions also promote positive breastfeeding behaviors and should be considered., Conclusions: A promising intervention is the complementation of professional services with peer support from a mother experienced in breastfeeding. This lay support appears to be an effective intervention with socially disadvantaged women.

Tobacco use during pregnancy continues to cause health problems for women and children. Nurses can facilitate smoking cessation during pregnancy through the use of tobacco control guidelines and counseling tailored to pregnant women. In this article, the Treating Tobacco Use and Dependence: Clinical Practice Guideline is reviewed; the Smoke Free Families program, which is tailored for pregnancy, stage matched, and includes second-hand smoke control assistance, is described; and two models for integrating smoking cessation counseling into prenatal services are offered.

The U.S. and international breastfeeding policies over the past 80 years present a pattern of increased protection for women and children that influences breastfeeding acceptance. These begin with the Maternity Protection Convention of the International Labor Organization in 1919 and continue through the relatively recent establishment of the U.S. Breastfeeding Committee. State and U.S. federal laws lag well behind international action, and the U.S. record on adopting international initiatives is poor. Nurses can play an influential role in consciousness raising, policy development, and advocacy for breastfeeding support.

Objective: Insufficient breast milk is a major reason why mothers give up breastfeeding and may be related to low levels of maternal confidence. This study explored the relationship between parenting self-efficacy (PES) and perception of insufficient breast milk., Design: Cross-sectional descriptive correlational study., Setting: Four private primary care pediatric practices in the northern United States., Participants: Sixty breastfeeding mothers of infants ages 1 to 11 weeks., Procedures: Mothers were recruited during well-baby pediatric visits. They returned completed questionnaires by mail. Data were analyzed using descriptive statistics, t tests, and multiple regression analysis., Main Outcome Measure: The Perception of Insufficient Milk (PIM) questionnaire, an investigator-developed instrument., Results: There was a significant correlation (r = .487, p < .01) between the self-efficacy and perceived insufficient milk scores. Regression analysis revealed that 23% of the variance in PIM was explained by PES, after maternal age, education, and parity had been taken into account., Conclusions: Although further research is needed to refine the measurement of perceived insufficient milk and differentiate breastfeeding self-efficacy from general parenting self-efficacy, nursing interventions to enhance self-efficacy may improve mothers' confidence in the adequacy of their milk supply.

Objective: To test the effectiveness of acetaminophen for pain management during and after circumcision., Design: A randomized, double-blind, placebo controlled, pretest-posttest design., Setting: Level III nursery at a Midwestern hospital., Participants: Sixty full-term newborns, whose mothers had uncomplicated pregnancies and vaginal deliveries., Interventions: Administration of 10 mg/kg acetaminophen or placebo 1 hour before circumcision., Main Outcome Measures: Behaviors (clarity of cues and responsiveness) were observed in newborns during a feeding interaction, and pain distress (percentage of time crying and heart rate) was assessed during and after the circumcision., Results: ANCOVA revealed significant group differences in subscales of the NCAFS (Nursing Child Assessment Feeding Scale) for newborns, whereas statistically significant differences for mothers were found in the sensitivity to cues and social-emotional growth-fostering scales. A significant increase in heart rate and crying time during the circumcision was noted; however, no significant difference was observed between groups. At the diaper change after the circumcision, the percentage of cry did suggest an effect from the analgesia., Conclusions: These findings reinforce the reciprocal, synchronous nature of mother-infant interactions during the early postpartum period and the need for pain control after circumcision to promote neonatal comfort and improve mother-infant interaction.

In the 20th century, infant and maternal mortality declined dramatically and the life span and quality of life for women and infants increased. At the end of the century, the rate of decline slowed and policy makers began to look for new ways to address the problem. A significant challenge now is to eliminate the persistent disparities in maternal and infant health among various racial and ethnic groups, particularly between black and white women and infants. To improve perinatal outcomes, programs are needed that focus on community-based interventions that reduce infant mortality across all racial and ethnic groups. Two promising programs that are expected to receive additional federal funding through the Children's Health Act are the Fetal and Infant Mortality Review Program and home visiting programs. Expansion of these programs may provide the vehicle to reduce disparities in maternal and infant mortality and morbidity. New programs are needed to meet the ambitious goals of Healthy People 2010.

Objective: The purpose of this meta-analysis was to statistically summarize the results of independent quantitative studies regarding the relationship between social support and adolescent mothers' interactions with their infants., Data Sources: The following sources were selected from 1980 to 1999: citations from bibliographies of previously located articles, dissertations abstracts, the Social Sciences Citation Indexes, and researchers at a regional conference; online sources used were CINHAL, MEDLINE, ERIC, Psych Lit, and Social Work Abstracts., Study Selection: Of a potential sample of 31 studies, 14 were excluded because they did not meet the sampling criteria, and 4 were deleted as outliers. The final sample consisted of 13 studies., Data Extraction: Each study was coded for methodologic and substantive variables, including quality indicators., Data Synthesis: Most of the studies were cross sectional in design and used a variety of measures. Together, the studies included a sample of 823 mothers., Conclusions: A medium effect size and a significant relationship between social support of adolescent mothers and their interactions with their infants were established. No difference was found in the relationship when support was provided by the family or through a network.

Objective: To describe the lived experience of women who have been diagnosed with idiopathic premature ovarian failure (POF)., Design: Phenomenology was used to achieve the purpose. Women were asked to share their experiences in living with premature ovarian failure during an approximately 1-hour interview. The interviews were tape-recorded, transcribed, and analyzed for emergent themes., Setting: Interviews were conducted in the participants' homes and in a conference room in a hospital., Participants: The six participants were drawn from a multicultural sample of women with idiopathic POF., Results: The women in this study expressed anger at their health care providers for their perceived lack of quality care they had experienced and at the insurance industry for its lack of reimbursement for fertility interventions; they expressed depression and sadness at the prospective outcome of the diagnosis, mixed emotions regarding their significant others, and sadness and resignation about their menopausal symptoms., Conclusions: Health care providers who create an environment in which women and their significant others will feel supported in asking questions, be assured that their concerns are taken seriously, and be provided with the physical and emotional resources they need can help these women to continue to build and live their lives.

Obstetric risk has important implications for reporting and benchmarking quality in today's managed health care environment. Administrative data, including diagnosis related group (DRG) information collected by hospitals, is used by payers and governmental groups for reimbursement, monitoring quality, and setting financial rates. Obstetric conditions that affect the patient experience are coded but do not often contribute to the overall DRG assignment. This strategy, therefore, may provide comparisons that are misleading to consumers and payers. Additionally, financial rates often do not provide adequate reimbursement for the cost incurred in caring for high-risk patients. Finally, risk prediction strategies have historically been used to both identify vulnerable patients for early management and make more equitable comparisons of groups of patients.

Objective: To describe maternal attachment to twin fetuses and determine whether such attachment differs between the twins., Design: A descriptive, correlational, nonexperimental design was used to collect data on a convenience sample of high-risk and low-risk women pregnant with twins., Setting: Questionnaires were distributed or mailed by presidents of parents of multiples clubs to interested participants. Participants mailed the questionnaires back to the researcher via stamped return envelope., Participants: During a 14-month period, 214 eligible women from 41 states and the District of Columbia completed the survey instruments., Main Outcome Measure: The Prenatal Attachment Inventory., Results: Pregnant women reported greater attachment to Twin B than to Twin A., Conclusion: Pregnant women may be more attached to Twin B (typically the nonpresenting fetus) because this twin may be easier to see and touch. While the mean attachment scores between twins differed, the size of the difference was small. Further study is needed to determine the predictive value and clinical significance of this finding for future mother-infant relationships.

Objective: To describe how mothers of preterm infants who are learning to nipple feed view their own and their infant's role in the feeding process., Design: Descriptive, comparative study., Setting: Two neonatal intensive-care units (NICU) in the Midwest., Participants: A convenience sample of 22 mothers of very-low-birth-weight infants., Main Outcome Measures: Interviews were rated for mothers' level of thinking about their co-regulatory role in their infants' feeding on a 6-point scale. The higher the score the more flexible, contingent, adaptive, and reflective the mother's thinking is regarding her infant's and her own behavior during feeding. High and low scores were compared using paired t tests., Results: The co-regulation scores ranged from 1 to 6, with a mean score of 3.3 (SD = 1.4). Mothers scoring higher on the co-regulation measure were significantly older and their infants were younger gestationally at birth. Their infants tended toward having been in the NICU for a longer period of time and spending more days on oxygen., Conclusions: Understanding feeding from the parents' perspective can guide clinicians as they support the development of parents' feeding skills. Intervention, rather than beginning with how to feed, may need to begin with how to take the infant's perspective, how to explore infant behavior that is novel, and ways of viewing the process of feeding as co-regulated.

Pregnancy-associated breast cancer (PABC) and pregnancy subsequent to breast cancer are two areas of concern facing women of childbearing age. The current approach to the management of PABC is to treat the cancer with some modification because of the pregnancy. The clinical management of both PABC and pregnancy occurring after breast cancer in young survivors, with emphasis on issues in clinical decision making, clinical management, and client education and support, are addressed.

Adolescent pregnancy and abortion rates in the Netherlands, France, and Germany are lower than rates in the United States and the mean age of sexual debut is later. Contributing factors include philosophical differences about the rights and responsibilities of adolescents, access to contraceptives, sexuality education, and mass media campaigns. The data used in this article were gathered from meetings with health care providers in the three European countries studied and from published reports. While it is not possible to impose practices from one society upon another, nurses in North America may want to consider implementing some of these ideas in their practices.

Relief of breast engorgement on the Sabbath is a challenge for the Sabbath-observant Jewish client. Many Sabbath laws limit the methods of care for the engorged breastfeeding woman. With a familiarity of the laws of the Sabbath, the health care provider can better address the needs of the engorged Sabbath-observant Jewish woman. In this article, interventions are proposed that mitigate or preclude violation of the Sabbath.

By understanding how a breast pump works, the nurse can suggest a pump best suited to meet the needs of the mother and her infant. When the infant is well, issues of cost and convenience can be the priority; when the infant is ill, primary considerations are how negative pressure is created, maintained, and released and how pathogens are controlled. Understanding these mechanisms helps solve technical problems that contribute to malfunction or maternal discomfort.

Objective: To identify the presence of residual blood and organic matter on "clean" stethoscopes in maternal-infant units., Design: In this retrospective, nonexperimental study, stethoscopes were tested using qualitative measurements., Setting: Using a nonprobability sampling technique, 11 acute care hospitals in a three-state area of the southwestern United States were studied., Participants: All stethoscopes found on the maternal-infant units were included, for a total sample size of 97., Instruments: A hand-held 10-power lens was used to visually rank the amount of organic buildup, and the phenolphthalein test was used to detect residual blood on the stethoscope., Results: Of 97 clean infant stethoscopes, 80% of labor and delivery and 72% of nursery stethoscopes had organic buildup on the diaphragm. Both areas had similar rates of organic buildup, chi2 (1, N = 97) = 1.00, p = ns. Nursery areas did have significantly lower rates of residual blood than stethoscopes from labor and delivery, phi2 (1, N = 97) = 9.89, p = .002. Seventy-six percent of labor and delivery stethoscopes were positive for blood, as compared to 46% of nursery stethoscopes., Conclusions: Traditional methods for cleaning stethoscopes used in labor and delivery and nursery areas are ineffective in removing blood and other body fluids from the stethoscope.

Objective: To understand the consequences when mothers experience fatigue throughout the first 18 months after birth., Design: Secondary analysis of data from a longitudinal study. Fatigue was measured five times between birth and 18 months after delivery., Setting: Data for the longitudinal study were collected in different settings (hospital, telephone, and homes)., Participants: White mothers who delivered full-term neonates of normal birth weight in a community hospital (N=229)., Main Outcome Measures: Persistent fatigue was operationally defined as the report of at least one symptom of fatigue at all five time periods. The association between persistent fatigue and performance outcomes (maternal health, infant health, and infant development) was tested., Results: Results were significant using alpha of .05. Persistent fatigue is associated with perceived maternal health and infant development at 18 months but not infant health., Conclusions: Findings suggest that persistent fatigue may have a negative effect on performance outcomes for mothers and infants. Assessment for fatigue symptoms should be part of each nursing contact and interpreted as a pattern. Helping mothers choose methods of symptom relief and energy conservation can benefit both the mother and the infant.

The breastfeeding mother whose infant is at risk for lactation failure that may lead to dehydration, weight loss, and hyperbilirubinemia can be assisted and supported in the home by maternal-child nurses, certified as lactation consultants, working collaboratively with the attending physician, midwife, or nurse practitioner. In this article, case reports illustrate interventions carried out in the home. Risk factors and clinical indicators of breastfeeding problems usually are present before hospital discharge. Health care providers should be on the alert for them so that management strategies can be started immediately after hospital discharge to ensure good patient outcomes.

Objective: To improve health outcomes in a vulnerable population of adolescent mothers and their infants., Design: Effects of an intensive early intervention program (EIP) are compared with those of traditional public health nursing (TPHN) care., Setting: A large California county with urban and rural communities, an ethnically diverse population, and a high teen birth rate., Participants: One hundred twenty-one young mothers and their children from impoverished and predominantly minority backgrounds., Interventions: During pregnancy and through 1 year postpartum, participants (n=63) in the EIP were provided with 4 prenatal classes and approximately 17 home visits by specially trained public health nurses. Interventions addressed health issues, sexuality and family planning, life skills, the maternal role, and social support systems. Participants in TPHN (n=58) received three home visits (for intake, prenatal care, and postpartum/well-baby care information)., Main Outcome Measures: Antepartum, intrapartum, and newborn medical records; maternal responses to written questionnaires; and nurse interviews., Results: Early program outcomes indicate reduced premature birth rates for both groups compared with national data on adolescent mothers, and fewer days of infant hospitalization during the first 6 weeks postpartum for the EIP participants., Conclusion: Public health nurse care (both traditional and intensive) significantly improved perinatal outcomes; the intensive intervention significantly reduced the number of infant hospitalization days.

Modifications of the Fatigue Symptoms Checklist can be used clinically to assess fatigue during the childbearing year. Data from a series of studies provide beginning norms that can be used to interpret clinical scores and point to the potential importance of assessments to pregnancy complications and maternal performance. Consistent with North American Nursing Diagnosis Association (NANDA) definition of fatigue and the theory of unpleasant symptoms, fatigue and performance are important phenomena critical to the experience of pregnancy and assumption of the maternal role.

Objective: To describe reported patterns of postpartum physical activity and to identify benefits or risks associated with postpartum physical activity at 6 weeks postpartum., Design: Secondary analysis of longitudinal data collected prenatally and postpartum in a study of obstetric outcomes at a midwestern tertiary-care center and its ambulatory satellite and hospital clinics., Participants: One thousand three women completed a questionnaire at the 6-week postpartum clinic visit. Mean age was 29.7 years, and mean education level was 15.3 years., Variables of Interest: Participation in vigorous exercise, change in postpartum activity level, postpartum weight retention, infant feeding method, maternal postpartum adaptation, and participation in activities for fun., Results: Nearly 35% reported doing vigorous exercise with a modal frequency of three times per week. More active women had retained significantly less weight (8.6 lb [3.9 kg]) than their less active counterparts (11.3 lb [5.1 kg]). Vigorous exercisers demonstrated a consistent pattern of better scores on measures of postpartum adaptation and were more likely than nonexercisers to participate in fun activities, such as socializing, hobbies, and entertainment. Breastfeeding was not adversely affected by vigorous exercise., Conclusions: These exploratory results indicate that physical and psychologic benefits may accrue to postpartum women who are able to exercise vigorously and avoid decreasing their usual level of activity. A prospective randomized test of this relationship is warranted. Although positive outcomes of physical activity have been demonstrated in the population at large, exercise has rarely been an element in postpartum care plans. Nurses who care for women after childbirth should assess women's exercise goals and support them in their desired activities.

Objective: To examine the influences of inhospital administration of breast milk replacements and receipt of formula samples on lactation duration among women planning postpartum employment., Design: Prospective design., Setting: Telephone interviews conducted prenatally and at 6 weeks, 3 months, and 6 months post-partum., Participants: Sixty-nine participants entered the study; 53 completed all scheduled interviews., Main Outcome Measures: Incidence and type of in-hospital human milk replacement, incidence and sources of formula samples, incidence of breastfeeding at 6 weeks postpartum, and duration of lactation., Results: During hospitalization, 19% of infants received formula; the incidence of breastfeeding at 6 weeks and duration of breastfeeding were significantly shorter in these infants compared with infants who were not fed formula. Fifty-nine percent of participants received formula samples from the hospital, 30% received samples from a physician's office, and 51% received samples by mail. Receipt of formula samples by mail was associated with reduced incidence of breastfeeding at 6 weeks and shortened duration of lactation., Conclusions: Early formula feeding and receipt of formula samples by mail may be barriers to lactation in women employed outside the home.

Objective: To compare maternal and live birth outcomes of women who received consultation services between 1990 and 1993 from the Wisconsin occupational reproductive health nurse consultant (76% of whom were solvent-exposed) and a sample of women and their offspring selected randomly from birth certificate records drawn from the same years., Design: Historical cohort study., Setting: Consultations occurred primarily through telephone contacts with pregnant women workers in Wisconsin. Birth certificate records were used to obtain additional information., Participants: The convenience sample of largely solvent-exposed clients was compared with a random sample of women identified through birth records., Main Outcome Measures: Relative risk (RR) estimates., Results: Confounding by race, prenatal care, and gestational diabetes was controlled by stratification. Logistic regression was used to control for age differences. Clients had elevated RR estimates for pregnancy-induced hypertension (RR = 2.4) and hydramnios (RR = 5.2), and their offspring were more likely to have 5-minute Apgar scores less than 8 (RR = 3.6). All other outcomes that were examined, including prematurity, low birth weight, and birth defects, were similar between groups., Conclusions: Most maternal and live birth outcomes were similar between the clients who sought consultation and the random sample of women. The current study supports previous research, which shows an elevated risk of pregnancy-induced hypertension associated with solvent exposure in women. The increased risk of hydramnios found in this largely solvent-exposed cohort was not found in the literature.