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Objective: The objective of this scoping review was to investigate and describe what is reported on the role and scope of practice of midwives and registered nurses providing care for women with pregnancy complications prior to 20 weeks' gestation in acute clinical settings in Australia., Introduction: In many high-income countries, women experiencing unexpected complications in early pregnancy attend an acute care service, such as an emergency department, rather than a maternity or obstetric unit. This service structure can impact the care women receive and determine who provides it. Women and their partners, who are often experiencing emotional distress, have reported difficult experiences when accessing acute services, particularly emergency departments, which are not traditionally staffed by midwives. The role and scope of practice of both midwives and registered nurses providing acute early pregnancy care in most high-income countries, including Australia, is poorly reported. Documenting this area of practice is an important first step in facilitating ongoing research in this important aspect of pregnancy care., Inclusion Criteria: Published and gray literature that described the role and scope of practice of midwives and/or registered nurses providing care in acute early pregnancy settings in Australia were considered for this review., Methods: A scoping review of the literature was conducted following JBI methodological guidance and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A 3-step search strategy was conducted to explore evidence from databases and search engines, gray literature sources, and selected reference lists. The search was limited to sources published from 2005 until October 2023. The databases searched included MEDLINE (Ovid), MIDIRS (Ovid), JBI Evidence-based Practice Database (Ovid), CINAHL Ultimate (EBSCOhost), ProQuest Central, Web of Science Core Collection, Scopus, and Cochrane Library. Google and Google Scholar were also used to identify published studies. After screening, data were extracted from records selected for the final review, mapped, and analyzed using content analysis., Results: A total of 23 sources were selected for inclusion in the review, and these included primary research studies, conference abstracts, and gray literature, such as clinical guidance documents, academic theses, and websites, from January 2008 to October 2023. The most common setting for care provision was the emergency department. Midwives' and registered nurses' role and scope of practice in acute early pregnancy care in Australia can be categorized into 4 areas: physical care, psychosocial support, care coordination, and communication. Women's access to midwifery care at this time in pregnancy appears to be limited. Registered nurses, usually employed in emergency departments, have the most prominent role and scope in the provision of care for women with acute early pregnancy complications. Descriptions of midwives' practice focus more on psychosocial support and follow-up care, particularly in early pregnancy assessment service models., Conclusions: This review highlights the inconsistency in midwives' and registered nurses' role and scope in acute early pregnancy in Australia, a finding which is relevant to other international settings. Both professions could further fulfill role and scope capacity in the provision of supportive, individualized, and timely care for women and families accessing a range of acute early pregnancy services. Emergency departments are the usual practice domain of registered nurses who may be limited in terms of the scope of care they can provide to women with early pregnancy complications. Leaders of the midwifery profession should conduct further research into innovative service models that embed a role for midwives in all settings that provide care for pregnant women, regardless of stage of pregnancy., Review Registration: Open Science Framework https://osf.io/7zchu/., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on Behalf of JBI.)

Importance: Improving birth outcomes for low-income mothers is a public health priority. Intensive nurse home visiting has been proposed as an intervention to improve these outcomes., Objective: To determine the effect of an intensive nurse home visiting program on a composite outcome of preterm birth, low birth weight, small for gestational age, or perinatal mortality., Design, Setting, and Participants: This was a randomized clinical trial that included 5670 Medicaid-eligible, nulliparous pregnant individuals at less than 28 weeks' gestation, enrolled between April 1, 2016, and March 17, 2020, with follow-up through February 2021., Interventions: Participants were randomized 2:1 to Nurse Family Partnership program (n = 3806) or control (n = 1864). The program is an established model of nurse home visiting; regular visits begin prenatally and continue through 2 postnatal years. Nurses provide education, assessments, and goal-setting related to prenatal health, child health and development, and maternal life course. The control group received usual care services and a list of community resources. Neither staff nor participants were blinded to intervention group., Main Outcomes and Measures: There were 3 primary outcomes. This article reports on a composite of adverse birth outcomes: preterm birth, low birth weight, small for gestational age, or perinatal mortality based on vital records, Medicaid claims, and hospital discharge records through February 2021. The other primary outcomes of interbirth intervals of less than 21 months and major injury or concern for abuse or neglect in the child's first 24 months have not yet completed measurement. There were 54 secondary outcomes; those related to maternal and newborn health that have completed measurement included all elements of the composite plus birth weight, gestational length, large for gestational age, extremely preterm, very low birth weight, overnight neonatal intensive care unit admission, severe maternal morbidity, and cesarean delivery., Results: Among 5670 participants enrolled, 4966 (3319 intervention; 1647 control) were analyzed for the primary maternal and neonatal health outcome (median age, 21 years [1.2% non-Hispanic Asian, Indigenous, or Native Hawaiian and Pacific Islander; 5.7% Hispanic; 55.2% non-Hispanic Black; 34.8% non-Hispanic White; and 3.0% more than 1 race reported [non-Hispanic]). The incidence of the composite adverse birth outcome was 26.9% in the intervention group and 26.1% in the control group (adjusted between-group difference, 0.5% [95% CI, -2.1% to 3.1%]). Outcomes for the intervention group were not significantly better for any of the maternal and newborn health primary or secondary outcomes in the overall sample or in either of the prespecified subgroups., Conclusions and Relevance: In this South Carolina-based trial of Medicaid-eligible pregnant individuals, assignment to participate in an intensive nurse home visiting program did not significantly reduce the incidence of a composite of adverse birth outcomes. Evaluation of the overall effectiveness of this program is incomplete, pending assessment of early childhood and birth spacing outcomes., Trial Registration: ClinicalTrials.gov Identifier: NCT03360539.

Adverse childhood experiences and trauma significantly impact physical and mental health. Increased maternal perinatal depression/anxiety, preterm labor, and low birth weight, as well as infant morbidity and mortality, are some examples of the impact of trauma on perinatal health. Trauma-informed care begins with knowledge about trauma, the ability to recognize signs of a trauma response, responding to patients effectively, and resisting retraumatization. As holistic providers, perinatal nurses can create safe care environments, establish collaborative patient relationships based on trust, demonstrate compassion, offer patients options when possible to support patient autonomy, and provide resources for trauma survivors. This can prevent or reduce the negative impact of trauma and improve the health and well-being of infants, mothers, and future generations. This clinical article outlines key strategies for implementation of patient-centered trauma-informed perinatal nursing care.

Screening and brief counseling interventions are evidence-based approaches.

Background: A significant proportion of women with Severe Mental Illness (SMI) will become mothers during their reproductive life. These pregnancies are, however, more at risk of psychiatric, obstetrical and neonatal complications (increased risks of post-partum depression, relapse, suicide, gestational diabetes, placental abnormalities or low birth weight). Midwives often feel isolated and resourceless when taking care of these women. Specialized units such as mother-infant psychiatric units or the Transversal Unit of Perinatal Care (UTAP) in the Grenoble Alpes University Hospital (CHUGA) enhance the coordination between psychiatric and obstetrical teams and have shown effectiveness in improving maternal and child outcomes., Objectives: i) to assess midwives' feelings about the postpartum care of women with SMI; ii) to determine UTAP's impact on this feeling and its determinants; iii) to look for unmet needs., Methods: This study is a prospective, exploratory, qualitative analysis. Twenty midwives from Grenoble Alpes University Hospital who took care of one of the selected patients participated in this study. Two women had schizophrenia and one bipolar disorder. Interviews realized with a semi-structured guide were fully transcribed, anonymized and thematically analyzed. Topics have been structured according to the number of occurrences to build a thematic tree., Results: Midwives felt insecure and resourceless when the postpartum care was unclear, insufficiently anticipated and in case of a danger for the women or the children. They felt uneasy when not feeling able to provide usual care to these patients (due to lack of specific knowledge about SMI and to the impossibility to consider their patient otherwise than through their pathology). Midwives felt at ease and secure when the postpartum care was anticipated. UTAP was identified as a resource for midwives. Specific training and improvements in the organization of the pre and post-natal care could improve midwives' feelings when taking care of women with SMI., (Copyright © 2019 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

The model of group prenatal care was initially developed to include peer support and to improve education and health-promoting behaviors during pregnancy. This model has since been adapted for populations with unique educational needs. Mama Care is an adaptation of the CenteringPregnancy Model of prenatal care. Mama Care is situated within a national and international referral center for families with prenatally diagnosed fetal anomalies. In December 2013, the Center for Fetal Diagnosis and Treatment at Children's Hospital of Philadelphia began offering a model of group prenatal care to women whose pregnancies are affected by a prenatal diagnosis of a fetal anomaly. The model incorporates significant adaptations of CenteringPregnancy in order to accommodate these women, who typically transition their care from community-based settings to the Center for Fetal Diagnosis and Treatment in the late second or early third trimester. Unique challenges associated with caring for families within a referral center include a condensed visit schedule, complex social needs such as housing and psychosocial support, as well as an increased need for antenatal surveillance and frequent preterm birth. Outcomes of the program are favorable and suggest group prenatal care models can be developed to support the needs of patients with prenatally diagnosed fetal anomalies., (© 2020 by the American College of Nurse-Midwives.)

Life expectancy for individuals with cystic fibrosis (CF) has significantly increased during the last few decades, and subsequently, more women with CF are considering pregnancy. A detailed understanding of the management of pregnancy, specific pulmonary treatments, and necessary medications is essential to provide specialized care for women with CF. In this article, we present the physical and psychosocial aspects of care for pregnant women with CF and describe a case involving the planned pregnancy of a nulliparous woman with CF. We suggest vigilant monitoring for adequate nutrition, weight gain, and pulmonary function throughout pregnancy as implications for nursing care., (Copyright © 2019. Published by Elsevier Inc.)

Aim: To examine public health nurses' education, training, and professional support needs in perinatal mental health., Background: Public health nurses have a key role in supporting maternal mental health including screening, support, referral, and decreasing stigmatization., Design: A cross-sectional survey., Methods: Data were collected from a convenience sample of Irish public health nurses (N = 105) from December 2016-February 2018. The anonymous postal survey consisted of the Perinatal Mental Health Questionnaire, Mental Illness: Clinician's Attitudes scale and Perinatal Mental Health Learning Needs questionnaire., Results: Public health nurses reported good levels of knowledge (77.2%) and confidence (83.8%) in recognising women experiencing stress, anxiety and depression. They indicated less confidence in caring (50.5%) for women. The average score for the Mental Illness: Clinician's Attitudes scale was 35.9 (SD 5.9), suggesting positive attitudes towards women with significant mental illness., Conclusion: Public health nurses require educational opportunities to explore expressions of psychological distress across cultures and their own personal attitudes to mental health, systems of clinical supervision, and support pathways., Impact: Generating new knowledge on the importance of incorporating an attitude component in perinatal mental health education for public health nurses., (© 2019 John Wiley & Sons Ltd.)

The growing opioid crisis in the United States affects childbearing women and their infants at an alarming rate. Substance use disorders in pregnancy have transitioned from a topic barely addressed to one that has become mainstream in the issue of pregnancy management. Opioid use can include appropriate use of a prescribed medication, the misuse of street drugs, and maintenance on an opioid agonist treatment such as methadone. Identifying this population of childbearing women is critical to be able to organize the appropriate resources and to provide a comprehensive multidisciplinary evidence-based plan of care. All clinicians need to be educated in identifying and caring for the growing population of women with substance use disorders. Each component of the continuum from prenatal care, labor and birth, and postpartum has challenges and issues that can have a positive or negative impact on the outcome of the pregnancy and the mother-infant relationship. Risk assessment, medication-assisted treatment, pain management, and fostering maternal-infant bonding are important considerations in the care of the woman with substance use disorder. Unbiased empathetic nurses are well positioned to strongly advocate and intervene on behalf of women with substance use disorder, which in turn will help to create positive outcomes for the mother and her baby.

Critical care nurses are faced with many challenges, and one that is particularly stressful is caring for obstetric patients. This care can become more complex when the obstetric patient requires extracorporeal membrane oxygenation. It is imperative that critical care nurses have knowledge about this unique population, the expected physical changes of pregnancy, and the management of extracorporeal membrane oxygenation. Obstetric patients present unique challenges, and care is focused on the woman and her family. The purpose of this paper is to provide information for critical care nurses regarding care of obstetric patients who receive extracorporeal membrane oxygenation., (©2019 American Association of Critical-Care Nurses.)

Background: The ability to adopt and implement health promotion behaviors is one of the most important determinants of health status. Various factors affect the successful changing of behaviors and choosing a healthy lifestyle. The present study aims at exploring the experiences of overweight pregnant women in terms of the factors influencing selection and adoption of health promoting behaviors during pregnancy., Methods: This qualitative study reports the findings of individual and group in-depth interviews with 32 overweight pregnant women using semi-structured questions which was conducted in Tabriz-Iran in 2017 and lasted for 6 months. The data collection continued until the saturation of the data. Participants were selected using purposive sampling and study inclusion criteria. Interviews were recorded and transcribed. Thereafter, content analysis was made using MAXQDA v. 10. Strength of data was verified by both participants and external control., Results: The reported effective factors led to identification of the two themes of two contextual perceived barriers and facilitators, which were classified into four main categories and nine subcategories: 1. Individual barriers (disabilities-additional needs in pregnancy and mental barriers) 2. Socio- environmental barriers (adverse effects of the environment, adverse effects of the relatives and financial pressures) 3. Individual facilitators (intrinsic incentives, abundance and individual skills) 4. Socio- environmental (social and family support, incentive environments, and raising awareness)., Conclusion: The adoption of health behaviors and healthy lifestyle is under the mutual influence of individual characteristics and socio-environmental factors. What should be considered in planning and designing interventions is focused on removing barriers and strengthening facilitators, in particular by moderating social factors and taking into account individual needs and personal expectations.

Objective: The study was conducted to determine the effects of prenatal education on quality of life and complaints during pregnancy., Methods: This study is a quasi-experimental research with a control group. Personal Information Form and Scale of Complaints during Pregnancy and their Effects on Quality of Life (SCPEQL) were used to collect the data. Thirty participants were included in both the control and the intervention groups (N = 60)., Results: The mean scores of SCPEQL of the intervention group was 46.2 ± 21.1 and the mean scores of SCPEQL of the control group was 99.8 ± 21.6 in 2nd trimester. In the 3rd trimester, the mean score of SCPEQL of the intervention group was 43.5 ± 16.4, and the mean score of SCPEQL of the control group was 108.0 ± 16.8. The difference between the groups was statistically significant in 2nd and 3rd trimesters (p < 0.05)., Conclusion: Findings of the study suggest that providing prenatal education reduces complaints and increases quality of life of pregnant women., Practice Implications: Assessing complaints during pregnancy by nurses is a part of the prenatal care. Therefore, nurses should evaluate pregnancy-related complaints. Quality of life should be increased by giving effective education about complaints during pregnancy., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Pulmonary edema is an acute pregnancy complication that, if uncorrected, can result in increased maternal and fetal morbidity and mortality. Although pulmonary edema is relatively rare in the general obstetrics population, pregnant patients are at increased risk for pulmonary edema because of the physiologic changes of pregnancy. The risk may be exacerbated by certain pregnancy-related diseases, such as preeclampsia. Prompt identification and appropriate clinical management of pulmonary complications is critical to prevent adverse outcomes in pregnant patients. This article reviews the collaborative treatment of pulmonary edema in pregnant women with complex critical illnesses., (©2018 American Association of Critical-Care Nurses.)

Obstetric emergencies often require intensive care intervention. Amniotic fluid embolism is a rare, unpredictable, and often catastrophic complication of pregnancy that is suspected in a woman who experiences cardiac arrest after a cesarean section. The condition occurs in approximately 1 in 40 000 births and has an average case-fatality rate of 16%. This complication may result from activation of an inflammatory response to fetal tissue in the maternal circulation. Risk factors may include maternal age over 35 years and conditions in which fluid can exchange between the maternal and fetal circulations. The presentation is abrupt, with profound cardiovascular and respiratory compromise, encephalopathy, fetal distress, and disseminated intravascular coagulopathy. Diagnosis is by exclusion and clinical presentation. Treatment is supportive, with a focus on reversal of hypoxia and hypotension, delivery of the fetus, and correction of coagulopathy. Staff debriefing and psychological support for the woman and family are vital., (©2018 American Association of Critical-Care Nurses.)

Introduction: Obesity is associated with increased risks for adverse health outcomes during and after pregnancy in both the woman with obesity and her infant. This study was designed to investigate midwifery management of pregnant women with obesity., Methods: Certified midwives and certified nurse-midwives who were members of the American College of Nurse-Midwives were sent a survey. The survey instrument was divided into 4 sections: demographic characteristics; practice guidelines and protocols; the role of the 2015 Levels of Maternal Care guidelines for referral, including transfer to a higher level of care; and factors that influence management of pregnant women with obesity. Descriptive statistics were used to analyze data., Results: In a sample of 546 midwives, 87% of respondents reported observing an increase in perinatal complications associated with obesity. Midwives reported increasing discomfort with the care of pregnant women with obesity as body mass index (BMI) increased. For pregnant women with extreme obesity, the respondents reported less frequent use of physiologic birth guidelines only and increased use of interventions, referral to physician care, and transfer to a higher level of care. Approximately half (270, 49.5%) reported having a guideline that addressed the care of women with obesity. Of these, 145 midwives (53.7%) reported that extreme obesity was the BMI threshold for identifying an increased or high risk for perinatal complications. Sixty percent (339) of midwives who participated requested guidance for management of laboring women who are obese., Discussion: This study provides a greater understanding of midwifery management practices when caring for women with obesity and opportunities to improve care. The results suggest that midwifery management alters with increased BMI, specifically in the care of women with extreme obesity. Suggestions for future study include research on management of pregnant women with obesity and extreme obesity with outcome data examining management strategies that provide safe, satisfying care., (© 2018 by the American College of Nurse-Midwives.)

Introduction: The objective of this study was to compare gestational weight gain (GWG) among women in group and traditional prenatal care., Methods: This is a retrospective cohort study of women who received prenatal care between 2011 and 2015 in a setting in which low-risk women had the option of group prenatal care. Women with height and initial and final weight were eligible. Women who chose group prenatal care were compared with women who chose traditional prenatal care and gave birth during the same study period. A propensity score analysis was used to create a matched control group from women who received traditional prenatal care. Bivariable comparisons of demographics, maternal characteristics, and GWG as a categorical variable (inadequate, adequate, or excessive per the 2009 Institute of Medicine guidelines) were performed with chi-square or Wilcoxon rank-sum tests. A logistic regression analysis was performed to estimate the association of group prenatal care with excessive GWG., Results: The final sample included 818 women who received either group or traditional prenatal care and were matched according to age, body mass index (BMI), nulliparity, and marital status. In the unadjusted analysis, women in group prenatal care had lower odds of excessive GWG (odds ratio [OR], 0.75; 95% CI, 0.57-0.99), but the statistical significance of this finding did not persist in the adjusted analysis (OR, 0.77; 95% CI, 0.45-1.30). When the analyses were limited to women who had at least 5 group or traditional prenatal care visits, there were no differences in excessive GWG in unadjusted (OR, 0.83; 95% CI, 0.59-1.16) or adjusted (OR, 0.97; 95% CI, 0.24-3.96) analyses., Discussion: In this propensity score matched cohort study of predominantly Hispanic women, there were no differences in excessive GWG between women in group compared with traditional prenatal care. Further study is indicated to determine the relationship between prenatal care model and GWG outcomes., (© 2018 by the American College of Nurse-Midwives.)

In this article, we describe an integrated care model in a perinatal psychiatry program to improve access to care for women who experience mood changes during the perinatal period. A nurse-practitioner trained in psychiatry and obstetrics is embedded in the obstetric clinic, and perinatal nurses, often the first professionals to recognize women who are experiencing mood changes, can easily refer women for follow-up. Barriers, lessons learned, and goals for implementation are described., (Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

The Substance Abuse and Mental Health Services Administration (2014) reported that 1.1% of pregnant women used nonprescription opiates (either heroin or prescription pills) in the last 30 days. Methadone and buprenorphine are the most common treatments for opiate addiction in pregnant women. Reasons for seeking opiate maintenance treatment (OMT) include keeping custody of one's children and the hope of developing a healthy parenting relationship. Yet, healthcare organizations and professionals have mixed opinions regarding health promotion within the maternal OMT population. Proper education regarding the growing and complex opiate epidemic continues to remain a void for many healthcare professionals. It is imperative that nurses who regularly interact with women in OMT show compassion and competence. It is important to highlight the universality of the challenges and needs of caring for the OMT population. This Perspectives column will explore and describe the context of maternal nonprescription opiate use and the care mothers in OMT should receive based on established nursing ethical standards.

Aims and Objectives: To determine the prevalence of domestic violence (physical, psychological or sexual) during pregnancy and to characterise these women., Background: Pregnant women are not immune to domestic violence and therefore may be subject to any form of physical, psychological or sexual violence by partners. Health professionals' knowledge and awareness are important in the identification and intervention of pregnant women who experience domestic violence., Methods: Quantitative, descriptive, correlational study, using a nonprobabilistic convenience sample consisting of a total of 852 postpartum women, of whom 370 were experiencing domestic violence according to the criteria adopted through the modified scale of prevalence, applied between February-June 2012 in two Portuguese public health institutions. Authorisation was given by the Ethics Committees/Administration Councils of both institutions involved and the National Committee of Data Protection., Results: The prevalence of DV during pregnancy was 43·4% (physical violence - 21·9%; psychological violence - 43·2%; and sexual violence - 19·6%). These women had the following profile: immigrant (OR = 5·70; IC95% 3·32-9·78), non-Caucasian (OR = 6·27; IC95% 3·76-10·46), single/divorced/widowed (OR = 2·28; IC95% 1·70-3·05), academic qualifications up to year 9 (OR = 4·94; IC95% 3·31-7·37); between 10-12 years of schooling (OR = 2·36; IC95% 1·70-3·29); unemployed (OR = 2·01; IC95% 1·50-2·69); and with a monthly income <1000 euros (OR = 1·90; IC95% 1·44-2·50). Through logistic regression, the following protective factors have been identified: nationality (Portuguese), race (Caucasian) and place of residence (city)., Conclusions: Almost half of the sample had experienced some form of domestic violence. This is associated with certain sociodemographic factors identified in the study. Psychological violence was the most prevalent during pregnancy., Relevance to Clinical Practice: Knowledge of the prevalence and characteristics of pregnant women who experience domestic violence is of paramount importance in planning appropriate strategies for their needs during pregnancy. Results indicate the need for nurses to intervene when warning signs of domestic violence against pregnant women are detected., (© 2017 John Wiley & Sons Ltd.)

Aims and Objectives: To describe the family health, functioning, social support and child maltreatment risk and associations between them in families expecting a baby., Background: Finland was one of the first countries in banning corporal punishment against children over 30 years ago. Despite of this, studies have shown that parents physically abuse their children. In addition, professionals struggle in intervention of this phenomenon. Abusive parents should be recognised and helped before actual violent behaviour., Design: A follow-up case-control study, with a supportive intervention in the case group (families with a heightened risk) in maternity and child welfare clinics. The baseline results of families are described here., Methods: Child maltreatment risk in families expecting a baby was measured by Child Abuse Potential Inventory. The health and functioning was measured by Family Health, Functioning and Social Support Scale. Data included 380 families., Results: A total of 78 families had increased risk for child maltreatment. Heightened risk was associated with partners' age, mothers' education, partners' father's mental health problems, mothers' worry about partners' drinking and mothers' difficulties in talking about the family's problems. Risk was associated with family functioning and health. Families with risk received a less support from maternity clinics. Families with child maltreatment risk and related factors were found., Conclusions: This knowledge can be applied for supporting families both during pregnancy and after the baby is born. Professionals working with families in maternity clinics need tools to recognise families with risk and aid a discussion with them about the family life situation. The Child Abuse Potential, as a part of evaluating the family life situation, seems to prove a useful tool in identifying families at risk., Relevance to Clinical Practice: The results offer a valid and useful tool for recognising families with risk and provide knowledge about high-risk family situations., (© 2016 John Wiley & Sons Ltd.)

Aims and Objectives: To examine the association between sociodemographic, pregnancy-related variables and psychological and verbal intimate partner abuse, as well as to determine which of these variables are predictors of psychological and verbal intimate partner abuse during pregnancy., Background: Intimate partner violence is a significant health issue, with severe implications to both mother and foetus. However, much of the research to date focuses on the outcomes of physical abuse. This article addresses the dearth in the literature by examining the association between sociodemographic, pregnancy-related variables and psychological and verbal intimate partner abuse during pregnancy., Design: A survey research design was used., Method: Three hundred postnatal women were recruited by convenience, nonproportional quota sampling technique. The WHO Violence Against Women Instrument was self-administered by participants. The association between categorical variables was assessed using Pearson's chi-square test, the strength of association using Cramer's V and the phi coefficient, and the identification of predictor variables for psychological and verbal abuse using logistic regression analysis., Results: Four predictors were identified for psychological abuse, namely low education level in women, an unplanned pregnancy, experiencing two or more pregnancy-related health problems and living with an unemployed partner. However, unemployment in women, an unplanned pregnancy, fear of partner and a low education level of partner were identified as the predictors of verbal abuse., Conclusion: This study identified a number of variables that strongly predict psychological and verbal intimate partner abuse during pregnancy; however, it extends the available literature by identifying a low standard of education in males, unemployment and fear of the intimate partner as the significant predictors of psychological and verbal intimate partner abuse., Relevance to Clinical Practice: Healthcare professionals should be aware of the predictors predisposing pregnant women to abuse. This would enable the identification of pregnant women who are susceptible to psychological and verbal intimate partner abuse, thus enabling the provision of adequate support. There is also a need to introduce routine screening for psychological and verbal intimate partner abuse during the antenatal period, following extensive training to all professionals concerned., (© 2016 John Wiley & Sons Ltd.)

Background: Psychological distress negatively impacts fetal development and may result in complications such as preterm delivery, low infant birth weight, and poor maternal-infant attachment during the postpartum period. Female adolescents may be experiencing environmental and psychosocial stressors during the pre- and postnatal periods that may predispose them to psychological distress. Health literacy has been used to assess the needs of individuals who have chronic illnesses. Mental health literacy however has not been assessed as extensively, particularly among pregnant adolescents., Purpose: Analysis of 2 health literacy frameworks for assessment of relevancy for use among adolescents experiencing psychological distress., Methods: Systematic analyses of health literacy frameworks by Anthony Jorm and that of Paasche-Orlow and Wolf are provided in this article., Results: Paasche-Orlow and Wolf's frameworks both provide useful approaches for assessing pregnant adolescent needs. A modified holistic health literacy conceptual model based on Paasche-Orlow and Wolf's and Jorm's framework is proposed., Implications for Practice: Assessing the mental health needs of pregnant adolescents requires a holistic approach. The modified conceptual model provides a basis for research and practice addressing health literacy and psychological distress among pregnant adolescents.

Aim: To report findings of a systematic review and meta-synthesis of qualitative studies exploring public health nurses' perceptions and experiences of identifying and managing women with perinatal mental health (PMH) problems., Background: Public health nurses play a key role in supporting women who experience PMH problems and several qualitative studies have explored their role., Design: Systematic review and meta-synthesis DATA SOURCES: A comprehensive search was developed and multiple databases were searched from 2000-2015., Review Methods: Studies that employed qualitative methods to explore experiences of public health nurses in identifying and managing women with PMH problems were included. Two reviewers independently assessed the methodological quality of studies. Themes, concepts and interpretations were extracted and synthesized using the process of thematic analysis., Results: Fifteen papers including 14 unique qualitative studies were included. Two overarching themes were identified: 'conceptualization and detection of PMH problems' and 'barriers and facilitators to management'. The former of these comprised several subthemes including the use of formal screening tools vs. clinical intuition and challenges encountered in detection. The latter theme, barriers to management included availability of referral pathways and time. In terms of facilitators, training, public health nursing interventions, support groups and referral pathways were identified as factors that optimize management., Conclusions: Public health nurses use a variety of methods to identify women with PMH problems. However, several support structures are needed to optimize management including access to appropriate referral pathways, support groups and relationship continuity., (© 2016 John Wiley & Sons Ltd.)

Objective: To examine access to perinatal nurse home visiting services for high-risk pregnant women who have diabetes or hypertension., Design: Secondary data analysis., Setting: Philadelphia, PA., Participants: Pregnant women who had a live birth during 2012 and those referred to a community-based agency for perinatal nurse home visiting because of their diagnosis of diabetes or hypertension., Methods: Access to services was measured by examining referral information (dosage, diagnosis, gestational age at time of referral, and insurance type) retrieved from administrative logs of the community-based organization that provides perinatal home visiting to high-risk pregnant women. The population-based prevalence rates of hypertension and diabetes were calculated from birth record data provided by the Philadelphia Department of Public Health., Results: During 2012, 595 pregnant women were referred for perinatal nurse home visiting services. The mean gestational age when referred for services was 24.9 weeks (standard deviation = 8.5) with a mean number of 8.8 authorized visits (standard deviation = 8). Associated with more authorized visits was having Medicaid as the insurance type and medical diagnoses that included hypertension (p < .01). Philadelphia prevalence rates for diabetes and hypertension varied by race and ethnicity (p < .001); Asian mothers had the greatest rates for diabetes and Black mothers the greatest rates for hypertension., Conclusion: Various models of home visiting programs exist to improve maternal and child health outcomes. Because maternal morbidity and mortality rates are rising in the United States, further research about perinatal nurse home visiting programs for pregnant women with diabetes and hypertension is warranted., (Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To examine iron metabolism during the second and third trimesters in African American women with high-risk pregnancies., Design: Longitudinal pilot study., Setting: Large, university-based, urban Midwestern U.S. medical center., Participants: Convenience sample of 32 African American women with high-risk pregnancies seeking care at an urban maternal-fetal medicine clinic., Methods: Nonfasting venous blood was collected in the second and third trimesters to assess iron status, hepcidin, and systemic inflammation. Anthropometric and survey data were obtained via self-report. Descriptive statistics were calculated from these data, and changes in the clinical parameters between the second and third trimesters were evaluated via paired t tests. Associations among demographic, reproductive, anthropometric, inflammatory, and iron-related parameters were also assessed in each trimester., Results: The mean age of participants was 28.3 (± 6.8) years, and mean prepregnancy body mass index was 31.9 (± 10.7) kg/m 2 . In the longitudinal analysis, significant (p < .05) declines in serum iron, ferritin, transferrin saturation, and C-reactive protein were observed between the second and third trimesters. There was no statistically significant change in hepcidin between trimesters. When using a ferritin level cut-point of less than 15 ng/ml and soluble transferrin receptor level of greater than 28.1 nmol/L, 48% of the participants (14 of 29) were classified with iron deficiency in the third trimester., Conclusion: In this pilot study, iron deficiency was prevalent among a small cohort of African American women with high-risk pregnancies. Hepcidin concentrations were greater than previously reported in healthy, pregnant, primarily White women, which suggests decreased iron bioavailability in this high-risk group., (Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Female genital mutilation (FGM) or female circumcision is a global health issue with increasing international migration of affected women and girls to countries unfamiliar with the practice. Western health care providers are unfamiliar with FGM, and managing obstetric care presents challenges to midwives who are in the forefront of care provision for the women. The participants in this Heideggerian qualitative interpretive study elucidated the strategies they used in overcoming the particular physical, emotional, and gynecological health issues with which mutilated women present. Ongoing emphases on women-centered, culturally competent maternity care are germane to optimal maternity care of circumcised women.

There are approximately 3.3 million people of the Muslim faith living in the United States. This article explores how Muslim women observe their religious beliefs during pregnancy and discusses implications for nursing care of pregnant Muslim women during Ramadan. Although pregnant Muslim women can be exempt from fasting, many still choose to fast during Ramadan. Factors that influence a woman's decision to fast include gravity and parity, maternal education, maternal age, body mass index, comprehension of Islamic Law, and gestational trimester. Nurses can tailor their care of pregnant Muslim women to include episodes of fasting and help them make informed decisions regarding fasting during Ramadan., (© 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.)

Midwives recognise that asthma in pregnancy is a common chronic condition that can lead to serious complications. Asthma has been defined as a complex polygenic disease which can result from genetic susceptibility and environmental exposure (Gunawardhana et al 2014), and is characterised by experiencing tightness in the chest, wheezing, production of thick sputum, cough and breathlessness (van der Wiel et al 2013). These symptoms occur in episodes, either daily, weekly, monthly or even only a few times a year, affecting approximately 8-9 per cent of pregnant women (Chan et al 2015; Gent et al 2015). When asthma occurs in pregnancy, the woman can experience poor pulmonary function, hypoxia that can lead to adverse health outcomes for the mother and fetus. This clinical update discusses the aetiology of asthma in pregnancy; how asthma affects the woman and fetus, and the role of the midwife caring for pregnant women with asthma.

Severe and persistent mental illness (SPMI) refers to complex mood disorders that include major depressive disorder with or without psychosis; severe anxiety disorders resistant to treatment; affective psychotic disorders including bipolar affective disorder, schizophrenia, and schizoaffective disorder; and other nonaffective subtypes of schizophrenia. SPMIs affect 1 in 17 people and are among the leading causes of disability and impaired health-related quality of life in the United States. Caring for childbearing women with preexisting SPMI can be challenging for maternal-child health clinicians. This article provides an overview of SPMI during pregnancy and challenges for clinicians, including early identification, accuracy of diagnoses, and appropriate management through care coordination among an interdisciplinary team that includes obstetric providers, psychiatrists, nurses, and others., (© 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.)

This is a reflective analysis on the lived experience of a medical mission in a third world country, where young women are abused and trafficked for sex. Practices of Scripture study, Lectio Divina, and contemplative prayer enabled me to deal with the spiritual darkness we encountered. Opening a dialogue with community members to view males and females in a different manner and battling alongside the local mission and ministers against sex trafficking, are not easy tasks. The perseverance found in the Bible gives us hope to be witnesses and healers in our broken world, and a small part in change that can take root with prayer.

Aims and Objectives: To report an analysis of the concept of maternal risk and explore implications for practice using Walker and Avant's eight step method analysis., Background: Although mortality during pregnancy is a relatively rare occurrence, serious maternal morbidities are increasingly present in today's pregnant population. Risk factors have been identified that increase the potential for morbidities and subsequent care modalities have been implemented to decrease this risk. However, despite the wide use of the term 'risk' in the medical and nursing literature, determining a common definition is difficult. Differences in the understanding of risk during pregnancy can hinder the ability to provide consistent and appropriate care., Design: Concept analysis., Methods: A search of the English literature was completed using the databases CINAHL, PubMed, Medline, and Google Scholar for years 2000-2014 using the keywords 'risk', 'maternal' and 'pregnancy'., Results: Three defining attributes of risk were identified: chance of injury/loss, cognitive recognition and the decision-making processes. The antecedent of risk is the ability to understand the situation and cognitive ability to think about the potential consequences and adverse outcomes. Consequences of risk include the actual action taken as a result of the decision-making process., Conclusion: This paper contributes to the understanding of risk allowing for the development of an individualised plan of care for each pregnant woman and empowering the nurse to advocate for appropriate care. Findings in this analysis assist nurses in bridging the gap in communication between the provider's and pregnant woman's interpretation of risk., Relevance to Clinical Practice: The analysis of risk resulted in the identification of differences in perceptions of risk that can potentially result in miscommunication between provider and pregnant woman and increase the risk of inadequate or incomplete care., (© 2016 John Wiley & Sons Ltd.)

The issue of women experiencing mental health problems during pregnancy which can progress and exacerbate into the transition of motherhood is one that midwives need to be alerted to.

Pregnancy is often a time when chronic pain is exacerbated, or when acute pain appears. Frequently the easiest intervention within reach, for both chronic and acute pain, is a prescription. However, medication cannot correct the cause of the pain; instead it alters the person's experiential perception of the pain. In addition, medication exposes both mother and fetus to risks. To provide simple, evidence-based, holistic/alternative remedies for women who experienced nonemergent pain during pregnancy. Holistic/alternative techniques for increasing comfort were taught to the participants and individualized during three sessions. Levels of pain and comfort were measured before and after the treatment, using the validated General Comfort Questionnaire and Pain Outcomes Profile. Pain scores decreased from an average of 5.8/10 to 3.5/10 (p = .00). Comfort scores increased from an average of 17.5 to 30 (p = .00)., (Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Objective: To describe responses issued by pregnant women, and the improvement of the gravidic discomforts after the use of the acupressure technique., Method: Qualitative and descriptive study conducted with 15 pregnant women between November 2013 and February 2014 in a Basic Health Unit in Natal, RN, Brazil. The data were collected through unstructured interviews and depositions that were then transcribed and treated according to Minayo's operative proposal, carefully read, compared and organized into two groups., Results: The categories that resulted were: Positive effects of acupressure, and the recommended use of acupressure. According to pregnant women, the discomforts of pregnancy cramps, fatigue in the legs, lower back pain and headaches decreased with the use of acupressure., Conclusions: Based on the results, acupressure should be introduced by the nurse in pre-natal care as a therapeutic resource for the pregnant woman's well-being.

Background: Herbal and homeopathic remedies have been used to assist with child bearing and pregnancy for centuries. Allopathic ('Western') medicine is traditionally avoided during pregnancy because of limited drug trials and the suspected teratogenic effects of these medications. This has led to an increase in the use of herbal and homeopathic remedies, asthey are viewed to have no teratogenic effect on the developing foetus. Health providers are faced with questions from their clients regarding the safety of these remedies, but much of the evidence about these herbal and homeopathic remedies is anecdotal and few remedies havebeen tested scientifically., Objectives: By conducting a systematic review, the primary objective was to evaluate maternal and neonatal outcomes of ingested herbal and homeopathic remedies during pregnancy., Method: A systematic review was conducted to synthesise all the evidence with the purpose of evaluating the safety of herbal and homeopathic remedies based on adverse maternal and neonatal outcomes. Only randomised and quasi-randomised controlled trials that met allinclusion criteria were included in the review., Results: The ingestion of ginger for nausea and vomiting during pregnancy was shown to have no harmful maternal or neonatal effects. Ingestion of castor oil for induction of labour showed a tendency towards an increase in the incidence of caesarean section and meconiumstained liquor, warranting further research into its safety issues., Conclusion: Larger randomised controlled trials need to be conducted, especially in South Africa, to establish the safety and efficacy of commonly-used remedies.

Guideline commentary takes its place alongside Cochrane corner and Research unwrapped as part of our evidence series. The aim of Guideline commentary is to support you to critique and utilise newly published guidelines, enabling translation of appropriate recommendations to practice. The objective is to scrutinise recent guidelines to encourage an understanding of the key issues, recommendations and midwifery practice implications. This month, Hannah Rogers looks at the new MBRRACE report and is struck by the addition of mental health disorders as a cause of death. She also considers the proportion of women who suffer morbidity.

Unlabelled: International guidelines recommend a collaborative approach to the care of pregnant women with asthma. Midwives, as the primary health care provider for childbearing women should be viewed as collaborative partners in the provision of antenatal asthma management. However, the role of the midwife in providing antenatal asthma management has not been widely reported., Method: Australian midwives' perceived role in antenatal asthma management was studied using a qualitative descriptive method. Semi-structured in-depth interviews were conducted with 13 midwives working in a regional tertiary hospital. Morse and Field's four-stage process was used to analyse the data., Findings: the perceived role of the midwife in antenatal asthma management varied among participants. Some midwives stated their role was to refer women on to other health professionals. Other midwives stated that they should provide education to the women regarding their asthma management during their pregnancy., Conclusion: participants were uncertain about their role and lacked confidence in antenatal asthma management. The midwifery context in which they worked and the resources available to them at this health care facility appeared to influence the perception of their role., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: detecting and treating depression early on in pregnancy can improve health outcomes for women and their children. UK guidelines recommend that Midwives screen for antenatal depression (AND) at the woman's first Midwife appointment using recommended depression case finding questions. This is the first qualitative study to explore Midwives' and women's views of using these questions in the context of antenatal care., Design: Semi-structured interviews with Midwives and pregnant women exploring their views and experiences of screening for AND, conducted alongside a validation study of the depression case finding questions., Setting: the initial appointment with the Midwife when the woman is 10-12 weeks pregnant. Interviewees were working or living in Bristol, England., Participants: maximum variation samples of 15 Midwives and 20 pregnant women., Measurements and Findings: Midwives and pregnant women viewed the depression case finding questions as a useful way of introducing mental health issues. Midwives often adapted the questions rather than using the phrasing specified in the UK guideline. Sometimes Midwives chose not to use the questions, for example if a partner was present. Both Midwives and women struggled to differentiate symptoms of early pregnancy from antenatal depression; yet thought that detecting depression early on in pregnancy was important. Women were unsure about the kind of help that was available; some women reported this as a reason for withholding their true feelings. There was a general lack of awareness among Midwives about the range of non-drug treatments potentially available to women and referral pathways to access them., Key Conclusion: both Midwives and women regard screening for AND as acceptable and important but reported shortcomings with the recommended depression case finding questions., Implications for Practice: providing training for Midwives on how to frame the questions and increase their knowledge and application of the referral pathways suggested by UK guidelines will help address some of the issues raised by Midwives and women in our study., (Copyright © 2016. Published by Elsevier Ltd.)