PURPOSE: To explore parents' holistic needs in the year after a perinatal loss experience. STUDY DESIGN AND METHOD: We used Wagner's Chronic Disease Model viewed through a holistic lens as a theoretical framework for thi...PURPOSE: To explore parents' holistic needs in the year after a perinatal loss experience. STUDY DESIGN AND METHOD: We used Wagner's Chronic Disease Model viewed through a holistic lens as a theoretical framework for this qualitative descriptive study. Wagner's five domains of chronic care (evidence-based practice, empowerment, collaboration, connection, assessment) and the five aspects of holistic care (physical, psychological, social, spiritual, cultural) were used as a priori categories and subcategories throughout data analysis. Holistic themes were organized into the domains of the chronic care model to identify participants' supportive needs throughout the progression of the year. RESULTS: Ten women who experienced perinatal loss from miscarriage, stillbirth, termination, and congenital anomalies were interviewed. Participant needs were primarily physical (bleeding, lactation) in the days following perinatal loss and transitioned into psychosocial and spiritual needs (navigating relationships, understanding grief, subsequent pregnancy) as time progressed. Participants overwhelmingly expressed a desire for continued professional support following their loss experience. Wagner's Model provides a framework to inform evidence-based recommendations for assessing and addressing parents' holistic needs with a collaborative approach to foster connection. IMPLICATIONS FOR PRACTICE: Despite the ongoing needs of many grieving parents after perinatal loss, follow-up care is not standard practice. Adverse biopsychosocial outcomes associated with perinatal loss are well documented. The prevention of chronic biopsychosocial health conditions following perinatal loss requires a strategic, multiprofessional approach. Study findings may provide a framework for implementing follow-up care in the year after perinatal loss.
McElfish PA, Ayala A, Greenfield W
… +11 more, McHardy H, Moore S, Sorrell S, Thornton N, Manning N, Callaghan-Koru J, Strong A, Tritt J, Fletcher N, Ayers BL, Langston K
PURPOSE: The purpose of this study was to gather information that can be used to help inform doula integration into the clinical care setting. STUDY DESIGN AND METHODS: We conducted a convergent (parallel) mixed-methods...PURPOSE: The purpose of this study was to gather information that can be used to help inform doula integration into the clinical care setting. STUDY DESIGN AND METHODS: We conducted a convergent (parallel) mixed-methods online survey study to understand maternity care team members' perceptions of doulas and their integration into the clinical setting. RESULTS: One hundred and ten maternity care team members responded to the survey with both open-ended questions. The majority (90.0%) of respondents were nurses, female (94.5%), and White (90.0%). Three quarters (75.5%) reported prior experience working with a doula. Four primary themes related to barriers and facilitators were identified through thematic content analysis: Doula Support and Its Benefits; Uncertainty about Doulas' Qualifications; Interference with the Maternity Care Team Member; and Integration into the Health Care System. Respondents discussed the benefits of doulas and the valuable support that doulas offered to patients, including: 1a) emotional, physical, and educational support and 1b) advocacy and communication. They expressed concerns about the potential interference with the maternity team, including: 3a) role confusion and influence on clinical decision-making and 3b) disrupting the patient-maternity care team member relationship. Recommendations for successful integration of doulas into the health care system included 4a) clear roles and boundaries, 4b) building relationships of trust and respect, 4c) collaborative communication, and 4d) education of maternity care team members. CLINICAL IMPLICATIONS: The study will be used to develop a doula integration tool kit. Doulas and maternity care team members should work together to create clear guidelines about the role of doulas within the hospital. Collaborative development of doula-supportive hospital policies and formalized hospital-doula partnership agreements can help reduce role ambiguity and create a more supportive hospital environment.
BACKGROUND: Gender-based violence (GBV) encompasses physical, emotional, verbal, coercive, and discriminatory forms of violence. Previous experiences of GBV have been shown to influence the childbirth experience negative...BACKGROUND: Gender-based violence (GBV) encompasses physical, emotional, verbal, coercive, and discriminatory forms of violence. Previous experiences of GBV have been shown to influence the childbirth experience negatively. PURPOSE: Examine subjective childbirth experiences of women with a history of GBV. INCLUSION CRITERIA: (1) Studies including qualitative content that discusses GBV; (2) participants identified as women; (3) aged 18 years or older; (4) focused on women's subjective childbirth experiences; (5) written in English; and (6) available as full-text sources. STUDY DESIGN AND METHODS: The qualitative scoping review followed the Joanna Briggs Institute (JBI) methodology. Databases searched included CINAHL (EBSCO), MEDLINE (Ovid), ProQuest Nursing and Allied Health, Scopus, OVID Emcare, ProQuest Dissertations and Theses, PsycINFO, and grey literature. No publication date restrictions were applied. Two reviewers independently screened titles and abstracts, with full texts retrieved for eligible sources. Discrepancies were resolved through consensus discussion or adjudicated by a third reviewer. Data were extracted using a standardized data extraction tool. RESULTS: Thirty-one articles were extracted. Six major themes were identified: (1) maintaining control; (2) triggers, flashbacks, and dissociations; (3) impact of support; (4) physical vulnerability; (5) desire to disclose; and (6) childbirth as healing. CLINICAL IMPLICATIONS: This review revealed novel findings regarding childbirth as a healing experience after GBV and emphasized women's desire to disclose GBV histories during the birthing process. Further research is needed to explore the childbirth experiences of individuals with diverse forms of GBV.
PURPOSE: To determine factors that increase the risk of newborn falls or drops during the birth hospitalization. STUDY DESIGN AND METHODS: Using evidence from a review of the literature and newborn falls and drops at our...PURPOSE: To determine factors that increase the risk of newborn falls or drops during the birth hospitalization. STUDY DESIGN AND METHODS: Using evidence from a review of the literature and newborn falls and drops at our hospital, a data collection instrument was developed and a retrospective, cross-sectional, exploratory review of a convenience sample from hospitals that had experienced at least one newborn fall was conducted. Data were collected from September 2016-June 2025. RESULTS: Information on 88 newborn falls or drops was collected from 15 hospitals. Eleven potential risk factors were identified: nighttime, cesarean birth, second and third night after birth, maternal anemia/excessive blood loss, use of prescribed opioids within 4 hours of fall, comorbidities, maternal attachments, high-risk fall behaviors, breastfeeding, in-hospital use of prescribed sedating medications, and history of illegal substance use within the last 2 years. CLINICAL IMPLICATIONS: All newborns are at risk of falling or being dropped by a parent or support person, and some are at higher risk than others. Knowing the risk factors can help nurses and other members of the maternity care team to identify those at greater risk of falling or being dropped and implement preventative measures.
PURPOSE: To identify the prevalence and patterns of perinatal missed nursing care, potential factors contributing to perinatal missed care, and understand the impact of perinatal missed nursing care on patient outcomes....PURPOSE: To identify the prevalence and patterns of perinatal missed nursing care, potential factors contributing to perinatal missed care, and understand the impact of perinatal missed nursing care on patient outcomes. STUDY DESIGN METHODS: Integrative review following the methodology of Whittemore and Knafl. Data were sourced from PubMed, CINAHL, EMBASE, Web of Science, and Scopus and appraised using the Mixed Methods Appraisal Tool. Data were extracted and iteratively compared to identify patterns, themes, and relationships. RESULTS: Seventeen studies from eight countries met inclusion criteria. Use of different adapted instruments covering diverse aspects of perinatal care made comparison across studies challenging. The prevalence of perinatal missed nursing care was 21.9% to 78.9% depending on the aspect of care assessed and measure used. Inadequate staffing, competing demands, and lack of material resources were commonly reported antecedents to perinatal missed nursing care. Limited maternal and neonatal outcomes have been explored; however, missed nursing care during labor and birth was significantly associated with lower hospital-level rates of initiation and exclusivity of breast milk feeding. CLINICAL IMPLICATIONS: Missed nursing care is a recognized indicator of quality of care across hospital settings. The prevalence of missed perinatal nursing care was driven by inadequate staffing and other structural factors which may also contribute to nurse burnout and job dissatisfaction. National standards for registered nurse staffing in perinatal units should be budgeted for and followed to ensure safe, high-quality perinatal care. A universal measure for the perinatal context could advance understanding of perinatal missed care.
BACKGROUND: Breastfeeding provides significant short- and long-term health benefits for mothers and infants. Despite national efforts, breastfeeding rates in the United States remain below target levels, particularly amo...BACKGROUND: Breastfeeding provides significant short- and long-term health benefits for mothers and infants. Despite national efforts, breastfeeding rates in the United States remain below target levels, particularly among underserved populations. OBJECTIVE: We used a scoping review to examine the influence of the Baby-Friendly Hospital Initiative (BFHI) on breastfeeding rates (initiation, exclusivity, duration) across five Centers for Disease Control and Prevention categories: age, race and ethnicity, education, income, and geographic location, and interpreted findings using the Kaiser Family Foundation framework to provide social context. Due to the limited evidence available, the review encompassed all BFHI-related articles published from 1996 onward. RESULTS: Twenty articles were included in the review. BFHI practices improve breastfeeding rates overall. However, the impact is not consistent across all social determinants of health. Evidence suggests BFHI may positively influence rates for mothers of varying income levels and racial/ethnic backgrounds, though findings are mixed. The influence of BFHI on maternal education and age was less conclusive. CONCLUSIONS: Although BFHI is associated with improved breastfeeding rates, its ability to reduce disparities linked to social determinants of health remains unclear. Further research is needed to explore how BFHI interacts with intersecting social and structural factors to promote equitable breastfeeding rates.
PURPOSE: To evaluate the incidence of uterine tachysystole and determine if nurses' management of tachysystole using an artificial intelligence-enabled clinical decision support (cEFM-aiCDS) alert system alone and in com...PURPOSE: To evaluate the incidence of uterine tachysystole and determine if nurses' management of tachysystole using an artificial intelligence-enabled clinical decision support (cEFM-aiCDS) alert system alone and in combination with an education module about tachysystole could be improved. STUDY DESIGN METHODS: Phase I involved a pre-post study design comparing the incidence and management of tachysystole in patients having labor induction after implementation of the cEFM-aiCDS alert system. Phase II involved a one-group pre-post quasi-experimental design to evaluate the effect of offering a comprehensive educational module about tachysystole to nurses using the alert system. Outcomes measured included nurses' knowledge, management, and incidence of tachysystole, and duration of the alerts. Data collection used system reporting and medical record reviews that occurred between January 2020 and August 2024. RESULTS: Phase I found no significant difference in the number of tachysystole events ( p = .626) or management of tachysystole with the decrease or discontinuance of oxytocin after implementation ( p = .603). In phase II, of the 210 labor nurses, 66 participants, representing 31.4% of the potential sample completed the educational module on tachysystole. Phase II found no change in the incidence of tachysystole among all births ( p = .945) and in those patients who experienced a Category II/III fetal heart rate pattern after implementing an educational intervention ( p = .070). The number of prolonged alerts also did not change ( p = .377). Phase II found a significant improvement in the timely management of tachysystole with evidence-based intervention in the presence of Category II/III fetal heart rate pattern ( p < .001). However, Phase II found no change in the incidence of tachysystole among all births ( p = .945) and in those patients who experienced a Category II/III fetal heart rate pattern after implementing an educational intervention ( p = .070). The number of prolonged alerts also did not change ( p = .377). CLINICAL IMPLICATIONS: Offering a comprehensive educational module about tachysystole combined with a cEFM-aiCDS alert system was associated with an improvement in nurses' management of tachysystole; however, these results should be interpreted with caution as only about one-third of the labor nurses participated in the education module.
BACKGROUND: In response to increasing maternal morbidity and mortality, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) developed an Obstetrical Care Cons...BACKGROUND: In response to increasing maternal morbidity and mortality, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) developed an Obstetrical Care Consensus on Levels of Maternal Care (LOMC) outlining four levels of care. This standardization reduces preventable morbidity and mortality by establishing hospital capabilities to ensure the provision of risk-appropriate care. LOCAL PROBLEM: In 2020, Florida's Maternal Mortality Review Committee found that 68% of pregnancy-related deaths were preventable, with 22% attributed to system- and facility-level factors. Subsequent recommendations emphasized the need to strengthen adherence to ACOG guidelines and other protocols and care coordination. INTERVENTIONS: The Florida Perinatal Quality Collaborative (FPQC) worked with ACOG District XII and The Joint Commission (TJC) to administer their Maternal Levels of Care Verification Program. The program involves an FPQC funding application, TJC application, TJC site visit, and FPQC evaluation. METHODS: FPQC provided support to applying hospitals through office hours, mentorship, technical assistance, the Florida LOMC Playbook, and a marketing toolkit for verified hospitals. RESULTS: At the time of this publication, 41 Florida hospitals completed verification, with additional hospitals in progress. These hospitals account for 55% of Florida births. Through FPQC consultation, several hospitals learned they could verify at a different level than planned and adjusted their applications. CONCLUSIONS: Florida's LOMC program demonstrates the utility of external review and objective verification standards to improve hospital readiness to provide optimal care. The comprehensive FPQC support process facilitates hospital preparation for a successful verification review.
BACKGROUND: Postpartum depression (PPD) affects 10% to 20% of mothers, with higher rates among marginalized communities. Mental health issues contribute to 22.7% of pregnancy-related deaths. Doulas provide continuous emo...BACKGROUND: Postpartum depression (PPD) affects 10% to 20% of mothers, with higher rates among marginalized communities. Mental health issues contribute to 22.7% of pregnancy-related deaths. Doulas provide continuous emotional, physical, and informational support throughout the perinatal continuum. METHODS: This narrative review synthesized data from articles published from 2020-2025 that examined the impact doula support had on PPD. PubMed, CINAHL, and Google Scholar were searched in February 2025. Search terms included "Depression, Postpartum," "Social Support," "Maternal Health Services," "Doula," "Birth Support," and "Perinatal Mental Health." RESULTS: Nine articles met inclusion criteria and were included in the review. Qualitative, quantitative, and review articles were represented in this narrative review. Women receiving doula support had lower odds of developing PPD or postpartum anxiety. Outcomes for women who had doula participation during and after pregnancy include enhanced social support, reduced stress, improved birth experiences, and increased maternal self-efficacy. CLINICAL IMPLICATIONS: Doulas show promise for PPD prevention. Barriers exist for marginalized and underresourced populations of patients in accessing doula care, yet these are the populations who report maternal mental health disorders disproportionately compared with nonmarginalized women. We recommend focusing on the protective value of doulas in preventing PPD, overcoming barriers for patient access to doulas, and standardized mental health education for doulas. Integrating doula support into maternity care requires alignment with the health care team to ensure continuity and effectiveness. Nurses are critical in this partnership through assessment and collaborative care coordination.
PURPOSE: To examine whether complications during childbirth moderates the relationship between exposure to a TeamBirth huddle during labor and patient trust and autonomy. STUDY DESIGN AND METHODS: Secondary analysis of p...PURPOSE: To examine whether complications during childbirth moderates the relationship between exposure to a TeamBirth huddle during labor and patient trust and autonomy. STUDY DESIGN AND METHODS: Secondary analysis of patient experience surveys from 31 birthing hospitals in Oklahoma implementing TeamBirth between March 2022 and June 2024. Sample included 6,528 patients ≥15 years, of whom 774 reported childbirth complications. Patients were asked about demographic and clinical characteristics, experience with TeamBirth huddles, and responses to the Health Care Relationship Trust Scale (HCRTS-R) and My Autonomy in Decision-Making (MADM) scale. We used multivariable regression with interaction terms, adjusting for key demographic and clinical factors, to explore the role of complications in the relationship between TeamBirth exposure and patient trust and autonomy levels. RESULTS: Reported childbirth complications significantly strengthened the positive association between TeamBirth exposure and patient trust and autonomy (HCRTS-R: b = 2.86, p < .001; MADM: b = 3.77, p < .001). CLINICAL IMPLICATIONS: Experiencing a TeamBirth huddle during labor is positively associated with improved patient-reported trust and autonomy across groups, with the strongest effects observed among patients with childbirth complications. Nurses play a key role in implementing the TeamBirth model to enhance patient-centered care and mitigate the potential negative effects of complications on childbirth experiences.