Journal of midwifery & women's health最新文献_第2页

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-11-15 DOI: 10.1111/jmwh.70046

Muchos tipos de bacterias viven en la vagina y la mantienen sana. La vaginosis bacteriana (VB) resulta cuando hay más bacterias dañinas que saludables en la vagina. La VB es la infección vaginal más común en mujeres de 15 a 44 años.

Muchas mujeres con VB no presentan síntomas. Es posible que tengas más flujo vaginal de lo habitual. Este flujo puede ser gris o blanco y tener olor a pescado. Este olor suele empeorar justo después de tener relaciones sexuales vaginales con un hombre. También puede haber ardor o picazón en la vagina o ardor al orinar.

No se sabe con certeza porque las mujeres contraen VB. Cualquier mujer puede contraer VB, pero suele presentarse en mujeres que han tenido relaciones sexuales con otra persona. Algunas mujeres tienen mayor probabilidad de contraer VB que otras. Las mujeres que tienen nuevas parejas sexuales, más de una pareja sexual o parejas sexuales femeninas tienen mayor probabilidad de contraer VB. Las mujeres con herpes genital tienen mayor probabilidad de contraer VB. Las duchas vaginales también aumentan la probabilidad de contraer VB.

La VB se trata con antibióticos. Puedes tomar pastillas o usar un medicamento vaginal. Toma todos tus medicamentos incluso si los síntomas desaparecen. Evita tener relaciones sexuales vaginales hasta que termines el medicamento. Los medicamentos vaginales pueden perforar los condones de látex y los diafragmas lo cual facilita el embarazo o el contagio de una infección de transmisión sexual (ITS) si tienes relaciones sexuales.

Las mujeres con VB tienen mayor probabilidad de tener bebés prematuros, de tener un bebé que pese menos de 2,5 kg al nacer y de contraer una infección uterina. Si presenta síntomas de VB durante el embarazo, se recomienda tratamiento. Los antibióticos son seguros para usted y su bebé durante el embarazo.

Debe comunicarse con su proveedor de atención médica si cree que podría tener una infección vaginal. Su profesional analizará su flujo vaginal para determinar si tiene VB, otra infección vaginal o una ITS. Todas estas infecciones pueden presentar síntomas similares, pero el tratamiento para cada una es diferente.

Approved October 2025.

Replaces “La Vaginosis Bacteriana” published in Volume 58, Issue 5, September/October 2013.

This handout may be reproduced for noncommercial use by health care professionals to share with patients, but modifications to the handout are not permitted. The information and recommendations in this handout are not a substitute for health care. Consult your health care provider for information specific to you and your health.

La información y las recomendaciones en este documento no sustituyen la atención médica. Consulte con su proveedor de atención médica para obtener información específica para usted y su salud.

许多种类的细菌生活在阴道内并保持阴道健康。细菌性阴道病（BV）是由阴道中有害细菌多于健康细菌引起的。乙肝是15至44岁妇女最常见的阴道感染。许多感染乙肝病毒的妇女没有症状。你可能有比平时更多的阴道流量。这种水流可能是灰色或白色的，有鱼腥味。这种气味通常在与男性发生阴道性交后立即恶化。阴道也可能有灼烧感或瘙痒感，或排尿时灼烧感。目前还不清楚为什么女性会感染乙肝病毒。任何妇女都可能感染乙肝病毒，但通常发生在与他人发生性关系的妇女身上。有些妇女比其他人更容易感染乙肝病毒。有新的性伴侣、不止一个性伴侣或女性性伴侣的女性更有可能感染乙型肝炎。患有生殖器疱疹的女性更容易感染乙肝病毒。阴道淋浴也会增加感染乙肝病毒的机会。乙型肝炎用抗生素治疗。你可以吃药或使用阴道药物。即使症状消失，也要服用所有的药物。在服药结束前避免阴道性交。阴道药物会刺穿乳胶避孕套和横膈膜，如果你发生性交，就更容易怀孕或感染性病。患有乙肝病毒的妇女更有可能早产，婴儿出生时体重不足2.5公斤，并感染子宫感染。如果你在怀孕期间出现乙肝症状，建议进行治疗。在怀孕期间，抗生素对你和你的宝宝都是安全的。如果你认为你可能有阴道感染，你应该联系你的卫生保健提供者。你的医生会检查你的阴道流，以确定你是否有乙肝，其他阴道感染或性传播感染。所有这些感染都可能表现出相似的症状，但对每种感染的治疗方法不同。2025年10月批准。替代“La Vaginosis Bacteriana”，发表于2013年9月/ 10月第58卷第5期。本手册可由医疗保健专业人员复制作非商业用途，与患者分享，但不允许对手册进行修改。本手册中的信息和建议不能取代医疗保健。在你的医疗保健提供者那里了解你和你的健康的具体信息。本文件中的信息和建议不能替代医疗保健。向你的医疗服务提供者咨询针对你和你的健康的信息。

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引用次数: 0

Masaje Perineal En El Embarazo 孕期会阴按摩

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-11-07 DOI: 10.1111/jmwh.70047

<p>El perineo es la zona entre la abertura vaginal y el recto. Esta zona se estira al dar a luz y, en ocasiones, el perineo o la vagina se desgarran durante el nacimiento del bebé. Si su proveedor médico realiza una episiotomía durante el parto, es esta zona la que corta. Es posible que necesite puntos de sutura después del nacimiento del bebé si tiene un desgarro o si se le realiza una episiotomía.</p><p>Aproximadamente entre 4 y 8 de cada 10 mujeres que dan a luz por vía vaginal presentan algún desgarro en el perineo. Aproximadamente dos tercios de estas mujeres necesitarán puntos de sutura.</p><p>La mayoría de las mujeres no necesitan una episiotomía. Aunque eran comunes antes de la década de 1990, hoy en día rara vez se realizan. Sin embargo, en ocasiones, el profesional de la salud puede recomendar una episiotomía justo cuando nace el bebé. Por ejemplo, una episiotomía puede ser útil si es necesario que un bebé nazca pronto. Puede pedirle a su proveedor de atención médica que hable con usted sobre la episiotomía durante una visita prenatal.</p><p>Se han realizado numerosas investigaciones acerca la prevención del desgarro perineal durante el parto. Diversos estudios de investigación han demostrado que el masaje perineal durante las últimas semanas del embarazo puede reducir la probabilidad de un desgarro en las mujeres primerizas. Este masaje, en el que se utilizan dos dedos para estirar los tejidos perineales, se realiza por la mujer o su pareja en casa una o dos veces por semana durante las últimas 4 a 6 semanas del embarazo. En la siguiente página se explica cómo realizarlo. Por cada 15 mujeres que se realizan un masaje perineal, una evitará una episiotomía y un desgarro perineal que requiera puntos de sutura. Mientras se masajea, puede practicar la relajación de los músculos del perineo. Esto puede ayudarla a prepararse para la sensación de estiramiento y ardor que podría sentir cuando nazca la cabeza de su bebé. Relajar esta zona durante el parto puede ayudar a prevenir el desgarro.</p><p>El masaje parece funcionar mejor en algunas mujeres que en otras. Las mujeres primerizas, las mayores de 30 años y las que se han sometido a episiotomías presentan menos desgarros y desgarros menos graves cuando se realiza el masaje perineal durante las últimas semanas del embarazo.</p><p>¡Sí! A muchas mujeres les resulta más fácil que sus parejas les realicen este masaje. Consulte las instrucciones para el masaje perineal a continuación para obtener más información.</p><p>No que sepamos. Es gratis. No duele. Es fácil de hacer. Y a la mayoría de las mujeres no les molesta hacerlo. No se debe estirar el perineo hasta el punto de que duela ni masajearlo con demasiada frecuencia ya que puede lastimar la piel de esa zona. No se realice el masaje perineal más de una o dos veces por semana. Las mujeres que lo realizan con más frecuencia no tienen un menor riesgo de desgarro perineal. Consulte con su médico antes de comenzar el masaje perineal. Y si cree que

围产期是阴道开口和直肠之间的区域。这个区域在分娩时被拉伸，有时围产期或阴道在婴儿出生时被撕裂。如果你的医生在分娩时做了会阴切开术，这个区域就会被切除。出生后，如果你有撕裂或外阴切开术，你可能需要缝针。大约每10名通过阴道分娩的妇女中就有4到8人在围产期出现撕裂。这些妇女中大约有三分之二需要缝针。大多数女性不需要外阴切开术。虽然在20世纪90年代之前，它们很常见，但今天很少实施。然而，有时卫生保健专业人员可能会建议在婴儿出生时进行会阴切除术。例如，如果婴儿需要早产，外阴切开术可能是有用的。你可以让你的卫生保健提供者在产前检查期间与你讨论会阴切开术。关于预防分娩期间的围产期撕裂，已经进行了许多研究。几项研究表明，在怀孕的最后几周进行会阴按摩可以降低早期妇女撕裂的可能性。在怀孕的最后4 - 6周，女性或她的伴侣每周在家里进行一到两次这种按摩，用两根手指拉伸会阴组织。下一页解释了如何做到这一点。每15名接受会阴按摩的女性中，就有1人可以避免会阴切开术和需要缝合的会阴撕裂。在按摩的同时，你可以练习放松会阴肌肉。这可以帮助你为宝宝出生时可能感受到的拉伸和灼烧感做好准备。在分娩过程中放松这个区域可以帮助防止撕裂。按摩似乎对某些女性比其他女性更有效。在怀孕的最后几周进行会阴按摩时，30岁以上的首次女性和接受过会阴切开术的女性会出现较少的撕裂和不那么严重的撕裂。许多女性发现她们的伴侣做这种按摩更容易。更多信息请参阅下面的会阴按摩说明。不是我们所知道的。是免费的。这不会伤害。这很容易做到。大多数女性并不介意这样做。不要把会阴拉伸到疼痛的程度，也不要太频繁地按摩会阴，因为这会伤害该区域的皮肤。会阴按摩每周不要超过一到两次。经常这样做的女性并没有降低会阴撕裂的风险。在开始会阴按摩之前，请咨询你的医生。如果你认为你失去了羊水（水袋），在把任何东西插入阴道之前咨询你的医生。2025年10月批准。本手册可由医疗保健专业人员复制作非商业用途，与患者分享，但不允许对手册进行修改。本手册中的信息和建议不能取代医疗保健。在你的医疗保健提供者那里了解你和你的健康的具体信息。本文件中的信息和建议不能替代医疗保健。向您的医疗服务提供者咨询针对您和您的健康的具体信息

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引用次数: 0

Journal Award Winners Ad 2025 杂志获奖广告2025

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-10-16 DOI: 10.1111/jmwh.70045

引用次数: 0

Plan de Parto

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-10-04 DOI: 10.1111/jmwh.70003

Un plan de parto es una declaración escrita de sus metas y de lo que es importante para usted durante su trabajo de parto y cuando esté dando a luz. Un plan de parto describe la experiencia que espera tener y cómo desea recibir apoyo de quienes le atienden.

Durante una de las consultas de seguimiento prenatal puede compartir y revisar su plan de parto con su partera u otro proveedor de atención prenatal. Cuando el plan esté completo, es posible que su proveedor querrá colocar una copia en su expediente prenatal. Usted también debería conservar una copia para compartirla con los proveedores que la cuiden cuando esté en trabajo de parto.

Ventajas: Desarrollar un plan de parto le permite aprender acerca de sus opciones antes de estar en trabajo de parto y comunicar con sus proveedores y familia sus objetivos e ideas acerca de estas opciones. El revisar con su partera/proveedor de atención medica el plan de parto durante una visita prenatal le brinda la oportunidad de informarse acerca de los procedimientos de rutina en el lugar donde dará a luz antes del parto, lo cual le permite estar mejor preparada.

Desventajas: Puede sentirse decepcionada si las cosas que enumera en su plan de parto no suceden. No hay certeza que su plan se llevará a cabo en todos los aspectos porque muchas cosas inesperadas pueden suceder durante el trabajo de parto y el nacimiento. Si su trabajo de parto se complica, puede necesitar intervenciones que quizás esperaba evitar.

Asistir a clases de preparación al parto, hablar con familiares o amigos que hayan dado a luz en el lugar donde usted dará a luz, hablar con una doula (persona de apoyo durante el embarazo y el parto), leer libros y buscar información en sitios web sobre el embarazo son algunas de las maneras de informarse acerca de las opciones disponibles para usted. También puede platicar con su proveedor y con amigos o familiares que tengan valores similares a los suyos mientras considera sus opciones. Puede visitar el hospital o centro de parto donde planea dar a luz para que le puedan explicar los procedimientos de rutina que puede anticipar.

Approved July 2025.

This handout may be reproduced for noncommercial use by health care professionals to share with patients, but modifications to the handoutare not permitted. The information and recommendations in this handout are not a substitute for health care. Consult your health careprovider for information specific to you and your health.

La información y las recomendaciones en este documento no sustituyen la atención médica. Consulte con su proveedor de atención médicapara obtener información específica para usted y su salud.

分娩计划是一份书面声明，说明你的目标，以及在分娩和分娩过程中对你重要的事情。一份分娩计划描述了你期望的经历，以及你希望如何从护理人员那里得到支持。在一次产前随访中，你可以与助产士或其他产前保健提供者分享和审查你的分娩计划。当你的计划完成后，你的医疗服务提供者可能想要在你的产前档案中放置一份副本。你也应该保留一份副本，以便在分娩时与照顾你的提供者分享。好处：制定一个分娩计划可以让你在分娩前了解你的选择，并与你的提供者和家人沟通你的目标和关于这些选择的想法。在产前检查期间与助产士/卫生保健提供者一起检查分娩计划，可以让你有机会了解分娩地点的常规程序，从而更好地做好准备。缺点：如果你的分娩计划中列出的事情没有发生，你可能会感到失望。你的计划是否能全面实施还不确定，因为在分娩和分娩过程中可能会发生很多意想不到的事情。如果你的分娩变得复杂，你可能需要你希望避免的干预。分娩参加预备课程,跟家人或朋友中有人在你的地方,她怀孕了,跟一个douala妊娠和分娩期间支助(人),阅读书籍和网站上搜集关于怀孕都是如何找出的一些关于你可用选项。你也可以和你的提供者以及价值观相似的朋友或家人讨论你的选择。你可以去你计划分娩的医院或分娩中心，这样他们就可以解释你可能预料到的常规程序。2025年7月批准。本手册可由医疗保健专业人员复制作非商业用途，与患者分享，但不允许对手册进行修改。本手册中的信息和建议不能取代医疗保健。与你的医疗保健提供者讨论你和你的健康的具体信息。本文件中的信息和建议不能替代医疗保健。向你的医疗服务提供者咨询针对你和你的健康的信息。

{"title":"Plan de Parto","authors":"","doi":"10.1111/jmwh.70003","DOIUrl":"https://doi.org/10.1111/jmwh.70003","url":null,"abstract":"<p>Un plan de parto es una declaración escrita de sus metas y de lo que es importante para usted durante su trabajo de parto y cuando esté dando a luz. Un plan de parto describe la experiencia que espera tener y cómo desea recibir apoyo de quienes le atienden.</p><p>Durante una de las consultas de seguimiento prenatal puede compartir y revisar su plan de parto con su partera u otro proveedor de atención prenatal. Cuando el plan esté completo, es posible que su proveedor querrá colocar una copia en su expediente prenatal. Usted también debería conservar una copia para compartirla con los proveedores que la cuiden cuando esté en trabajo de parto.</p><p><i>Ventajas</i>: Desarrollar un plan de parto le permite aprender acerca de sus opciones antes de estar en trabajo de parto y comunicar con sus proveedores y familia sus objetivos e ideas acerca de estas opciones. El revisar con su partera/proveedor de atención medica el plan de parto durante una visita prenatal le brinda la oportunidad de informarse acerca de los procedimientos de rutina en el lugar donde dará a luz antes del parto, lo cual le permite estar mejor preparada.</p><p><i>Desventajas</i>: Puede sentirse decepcionada si las cosas que enumera en su plan de parto no suceden. No hay certeza que su plan se llevará a cabo en todos los aspectos porque muchas cosas inesperadas pueden suceder durante el trabajo de parto y el nacimiento. Si su trabajo de parto se complica, puede necesitar intervenciones que quizás esperaba evitar.</p><p>Asistir a clases de preparación al parto, hablar con familiares o amigos que hayan dado a luz en el lugar donde usted dará a luz, hablar con una doula (persona de apoyo durante el embarazo y el parto), leer libros y buscar información en sitios web sobre el embarazo son algunas de las maneras de informarse acerca de las opciones disponibles para usted. También puede platicar con su proveedor y con amigos o familiares que tengan valores similares a los suyos mientras considera sus opciones. Puede visitar el hospital o centro de parto donde planea dar a luz para que le puedan explicar los procedimientos de rutina que puede anticipar.</p><p>Approved July 2025.</p><p>This handout may be reproduced for noncommercial use by health care professionals to share with patients, but modifications to the handoutare not permitted. The information and recommendations in this handout are not a substitute for health care. Consult your health careprovider for information specific to you and your health.</p><p>La información y las recomendaciones en este documento no sustituyen la atención médica. Consulte con su proveedor de atención médicapara obtener información específica para usted y su salud.</p>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 5","pages":"833-834"},"PeriodicalIF":2.3,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145297108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Development, Implementation, and Evaluation of Implicit Bias Skill Building Sessions for Maternal Health Care Professionals 孕产妇保健专业人员内隐偏见技能建设课程的发展、实施和评估。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-09-27 DOI: 10.1111/jmwh.70027

Nicole Warren CNM, PhD, MPH, Briana E. Kramer CNM, MS, MPH, Cheri Wilson MA, MHS, CPHQ, Nikki Akparewa MSN, MPH, RN, Kelly M. Bower PhD, MSN, MPH

Introduction

Maternal mortality and morbidity in the United States are marked by gross disparities linked to individual bias and systems-level factors. Implicit bias training is one strategy to address these disparities, and several states now require such education. Although evidence-based strategies to mitigate bias exist, these are not commonly integrated into training opportunities in clinical settings or evaluated for their impact on learners. We designed and evaluated an implicit bias skill building training program to address this gap.

Methods

We used a quasiexperimental, multimethod evaluation to assess the outcomes of our program: reach, participant satisfaction, knowledge and acknowledgment of bias and its impacts, as well as behaviors to mitigate one's own and others’ biases. Survey and qualitative data from internal hospital facilitators provided added details about program satisfaction.

Results

People who participated in didactic implicit bias training reported being more aware of their own and others’ biases and reported using more mitigation strategies than those who did not participate in any such training. Participants in the didactic training and at least one implicit bias skill building session reported using more mitigation strategies than people who completed the didactic training alone. Participants agreed that the training was relevant and motivated them to change their behavior.

Discussion

Our results suggest there is potential value in adding skill building activities to maximize the impact of implicit bias training efforts.

在美国，孕产妇死亡率和发病率的显著差异与个人偏见和系统层面的因素有关。内隐偏见培训是解决这些差异的一种策略，现在有几个州要求进行此类教育。尽管存在以证据为基础的减轻偏见的策略，但这些策略通常没有纳入临床环境中的培训机会，也没有评估它们对学习者的影响。我们设计并评估了一个内隐偏见技能培养培训项目来解决这一差距。方法：我们使用准实验、多方法评估来评估我们项目的结果：覆盖面、参与者满意度、对偏见及其影响的认识和承认，以及减轻自己和他人偏见的行为。来自医院内部辅导员的调查和定性数据提供了更多关于项目满意度的细节。结果：参加说教式内隐偏见培训的人报告说，与没有参加任何此类培训的人相比，他们更了解自己和他人的偏见，并报告说使用了更多的缓解策略。与单独完成说教式培训的人相比，参加说教式培训和至少一次内隐偏见技能建设课程的参与者报告使用了更多的缓解策略。参与者一致认为培训是相关的，并激励他们改变自己的行为。讨论：我们的研究结果表明，增加技能建设活动，以最大限度地提高内隐偏见培训工作的影响，是有潜在价值的。

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引用次数: 0

Midwifery's Moment: Medicaid Partnerships Open Doors for Expansion and Integration 助产的时刻：医疗补助伙伴关系为扩张和整合打开了大门。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-09-25 DOI: 10.1111/jmwh.70034

Melissa D. Avery CNM, PhD, Amy M. Kohl

<p>The Centers for Medicare & Medicaid Services (CMS) has officially launched new funding to assist a group of state Medicaid agencies in improving maternal and newborn health for individuals enrolled in Medicaid and the Children's Health Insurance Program (CHIP). Announced in December 2023, proposals were submitted in Fall 2024. The Transforming Maternal Health (TMaH) Model has opportunities for midwives and freestanding birth centers right at the top of the list.<span><sup>1</sup></span></p><p>The 15 states selected to receive funding were announced in January 2025. Those selected are Alabama, Arkansas, California, District of Columbia, Illinois, Kansas, Louisiana, Maine, Minnesota, Mississippi, New Jersey, Oklahoma, South Carolina, West Virginia, and Wisconsin. The 10-year, $17,000,000 funding provided to each of these states and the District of Columbia includes a 3-year preimplementation period for states to develop their model followed by 7 years of implementation.<span><sup>1</sup></span></p><p>The overall goal of the TMaH project is to help states improve perinatal outcomes while supporting health equity to reduce maternal and newborn health disparities within the Medicaid program. The project also aims to improve access, quality, and the experience for patients while reducing costs. It is well known that the United States spends more on perinatal and newborn health care than any other developed country and yet ranks at the bottom on health outcomes. It is also well known that countries with a well-integrated and robust midwifery workforce as part of their care system demonstrate better outcomes than the United States. Experts have commented that it will take much more funding plus coordination nationally and among states to make the strides needed for meeting the full TMaH objectives.<span><sup>2</sup></span> Others have offered a formal <i>Playbook</i> to support state Medicaid agencies in working toward the TMaH goals and implementing proposed solutions.<span><sup>3</sup></span></p><p>Why should midwives be excited about this project? The TMaH program is centered around 3 pillars: (1) access, infrastructure, workforce; (2) quality improvement and safety; and (3) whole-person care delivery. The proposed solution to the lack of access to all care providers identified in pillar 1 is to increase access to midwives and freestanding birth centers. The pillars provide many opportunities for midwives in the 15 states to engage the project teams in their state Medicaid offices and take actions to remove barriers to midwifery practice and birth centers.<span><sup>1</sup></span></p><p>Midwives, birth centers, and midwifery-led care models are central to the success of the TMaH program. Midwives must promote midwifery-led care into the broader, whole-person approach to pregnancy and postpartum care. Related to pillar 1, reimbursement for all licensed midwives at the same rate as physicians for the same type of care is essential. Paying freesta

医疗保险和医疗补助服务中心（CMS）正式启动了新的资金，以帮助一组州医疗补助机构改善参加医疗补助和儿童健康保险计划（CHIP）的个人的孕产妇和新生儿健康。提案于2023年12月公布，并于2024年秋季提交。产妇保健转型（TMaH）模式为助产士和独立分娩中心提供了机会。被选中接受资助的15个州于2025年1月宣布。被选中的是阿拉巴马州、阿肯色州、加利福尼亚州、哥伦比亚特区、伊利诺伊州、堪萨斯州、路易斯安那州、缅因州、明尼苏达州、密西西比州、新泽西州、俄克拉荷马州、南卡罗来纳州、西弗吉尼亚州和威斯康星州。向这些州和哥伦比亚特区提供的10年1700万美元的资金包括3年的预实施期，供各州开发他们的模式，然后是7年的实施期。TMaH项目的总体目标是帮助各州改善围产期结果，同时支持医疗公平，以减少医疗补助计划内孕产妇和新生儿的健康差距。该项目还旨在改善患者的可及性、质量和体验，同时降低成本。众所周知，美国在围产期和新生儿保健方面的花费比任何其他发达国家都要多，但在健康结果方面却排名垫底。众所周知，在医疗体系中拥有完善和强大的助产人员队伍的国家比美国表现出更好的结果。专家们评论说，需要更多的资金以及国家间和国家间的协调，才能取得实现tma全部目标所需的进展其他人则提供了一个正式的剧本，以支持州医疗补助机构朝着TMaH的目标努力，并实施拟议的解决方案。为什么助产士应该对这个项目感到兴奋？TMaH计划围绕三个支柱展开：(1)访问、基础设施、劳动力；(2)质量改进和安全；(3)全人护理服务。针对支柱1中确定的无法获得所有护理提供者服务的问题，建议的解决办法是增加助产士和独立分娩中心的服务。这些支柱为15个州的助产士提供了许多机会，让他们在州医疗补助办公室参与项目团队，并采取行动消除助产士执业和生育中心的障碍。助产士、分娩中心和助产士主导的护理模式是TMaH项目成功的关键。助产士必须促进助产士主导的护理进入更广泛的，全人的方法，以怀孕和产后护理。与第一支柱相关的是，所有有执照的助产士必须按照与医生相同的费率报销相同类型的护理。以与医院相同的报销费率支付独立生育中心的妊娠、分娩和新生儿费用，并涵盖生育中心护理的所有方面，包括医院转院，这对于生育中心的可持续性是必要的。激励卫生系统增加助产服务是支柱2的一个重要方面，也是获得分娩友好称号的一个组成部分，这是TMaH为所有参与者制定的目标。质量指标应包括对助产士敏感的措施，如助产士接生的比例和获得24/7助产服务的机会。最后，支柱3是探索创新护理模式的保护伞，促进有助产士、护士和助产师的护理模式，如产后家庭护理服务和激励措施，以增加获得团体产前护理的机会。个性化将有助于确保为每个妇女计划和量身定制的服务和护理得以实现。最近的研究提供了与州医疗补助官员分享的证据，以支持TMaH的工作。由CMS资助的“母亲和新生儿强势起步计划”（Strong Start for Mothers and新生儿Initiative），在2013年至2017年期间，研究了3种旨在改善医疗补助和CHIP保险个人结果的护理模式。与在产科医院或团体产前护理中接受医疗补助的参保者相比，参加“强启动”增强分娩中心护理模式的参保者的早产和低出生体重率较低，剖宫产率较低，剖宫产后阴道分娩率较高。3 .婴儿出生后第一年的围产期护理费用每名母婴死亡少花费2000美元CMS发布了一份两页的研究背景和结果摘要，便于与同事和政策制定者分享。5A Strong Start对参与研究的45个生育中心接受护理的人的记录进行了二次数据分析，比较了(1)接受强化Strong Start生育中心护理的医疗补助接受者，(2)接受常规助产士领导的生育中心护理的医疗补助接受者，以及(3)接受常规生育中心护理的私人保险个人。在接受“强势起步”模式的医疗补助接受者和接受私人保险护理的人之间，孕产妇和新生儿的结局没有区别。参加医疗补助计划的孕妇接受普通分娩中心护理的结果也与参加私人保险的孕妇相似。影响生育中心发展和可持续性的障碍最近在新泽西州进行了检查。为医疗补助计划下的投保人报销的生育中心设施费用是扩大生育中心护理机会以及启动和运营成本的主要直接障碍此外，将分娩中心完全整合到围产期护理系统中的障碍包括对护理模式的不熟悉、网络整合问题、许可和医疗补助过程中的困难以及与地理位置有关的问题。助产士独立执照的好处是众所周知的。在实行自主监管的州，助产士的数量是实行限制性监管的州的两倍多，包括没有助产士的县更少更高测量的州一级助产一体化与更高的助产密度和更好的分娩结果相关。这些结果包括更高的自然阴道分娩率和母乳喂养率，以及更低的早产率、低出生体重和新生儿死亡率虽然各州的独立实践立法很重要，但州和卫生系统层面的其他政策举措似乎更直接地增加了获得助产实践的机会，更多的政策特征导致更多的助产机会。这些特征包括独立的助产士处方，助产士医院特权，以及对助产士的公平医疗补助报销。这些研究的关键证据可以帮助州医疗补助机构为他们的个人TMaH计划采取策略。助产士应与世界卫生组织（世卫组织）最近敦促采用助产护理模式的立场文件一起分享简短、简明的研究摘要世卫组织的声明提供了助产保健原则，敦促全球采纳，以提高孕产妇和新生儿保健的质量和成本效益。重要的是，TMaH州的助产士直接与州医疗补助机构接触，教育员工，帮助塑造该州的项目，使其包括助产士和助产护理理念。无论助产士是否居住在指定的TMaH状态，参与关于将所有持牌助产士纳入整个连续体的护理模式的价值和益处的重要对话至关重要。此外，在州一级与政策制定者和围产期利益攸关方就提供持证助产士的执照和监管进行对话，对于增加助产人员队伍和扩大获得孕产妇保健的机会至关重要。根据TMaH倡议，所有有兴趣扩大所有国家认证助产士（例如，CMs和认证的专业助产士）的州都可以从CMs获得技术援助，帮助他们更好地将这些提供者整合到护理团队中。在美国，助产士的利用率仍然严重不足。虽然孕产妇死亡和发病的原因是复杂和多因素的，越来越多的证据表明，助产士可以帮助显著降低孕产妇和新生儿死亡率，降低不必要的干预率，提高患者满意度，并解决卫生保健提供者短缺困扰整个美国社区。扩大能够提供全面护理的强大助产人员队伍，可以显著缓解提供者短缺问题，并解决孕产妇死亡率和发病率问题。联邦政府将在未来10年投资2.5亿美元，通过TMaH改善孕产妇和新生儿护理。助产士、助产护理和独立分娩中心的整合是拟议解决方案的关键部分。尽管解决美国围产期护理问题需要更多资金和国家协调，但15个TMaH州助产士的大力参与至关重要。与盟友、临床医生同事、政策制定者、医院管理者、消费者团体和其他对孕产妇健康有既得利益的人建立现有关系，对于扩大助产服务的足迹至关重要。15个TMaH州以外的助产士也可以使用这些策略在其所在州促进助产。通过协调一致的行动和深入的参与，助产士可以共同影响TMaH项目，并进一步消除助产实践的障碍，同时继续在美国促进以人为本、公平和具有成本效益的围产期护理。让我们创造属于我们的时刻！

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引用次数: 0

Designing a Statewide Hospital Equity Initiative: A Qualitative Formative Evaluation 设计一个全国性的医院公平倡议：定性的形成性评价。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-09-19 DOI: 10.1111/jmwh.70026

Kelly M. Bower PhD, MSN, MPH, RN, Briana E. Kramer CNM, MPH, MS, RN, Nicole Warren CNM, PhD, MPH, RN

Introduction

Implicit bias training for health professionals is widely recommended as a strategy to mitigate maternal health inequities; however, evidence to support its efficacy is limited. Furthermore, experts recommend that bias training be embedded in a program of systems-level equity interventions. Although frameworks and broad recommendations for hospitals exist, there is limited actionable guidance for operationalizing effective maternal health equity programs in hospitals. This study aimed to gather data to inform the design and implementation of a statewide offering of implicit bias training and systems-level maternal health equity-focused interventions responsive to hospital needs and preferences, and expert input.

Methods

This qualitative formative evaluation consisted of in-depth interviews with maternal health leaders from Maryland birth hospitals and experts in maternal health equity to understand current maternal health equity work, recommended strategies, barriers, and facilitators of hospital-based implicit bias training and systems-level maternal health equity initiatives.

Results

Seventeen interviews were conducted with birth hospital representatives and experts in maternal health equity. Hospital representatives reported limited prior work providing implicit bias training or implementing systems-level interventions. Participants recommended equity-focused interventions that align with existing health care improvement and maternal health equity recommendations. They also suggested implementation approaches aimed at leveraging facilitators and overcoming barriers of hospital-based settings.

Discussion

Formative work in the design of maternal health equity initiatives can offer an expanded understanding of the actual barriers and needed support for hospitals and could improve effectiveness of these interventions.

导言：广泛建议对卫生专业人员进行内隐偏见培训，作为减轻孕产妇保健不公平现象的一项战略；然而，支持其有效性的证据有限。此外，专家建议将偏见培训纳入系统级公平干预计划。虽然存在针对医院的框架和广泛建议，但在医院实施有效的孕产妇保健公平方案方面的可操作指导有限。本研究旨在收集数据，为全州范围内提供内隐偏见培训和系统级孕产妇健康公平干预措施的设计和实施提供信息，以响应医院的需求和偏好，以及专家的意见。方法：本定性形成性评估包括对马里兰州妇产医院的孕产妇健康负责人和孕产妇健康公平专家进行深入访谈，以了解当前孕产妇健康公平工作、推荐策略、障碍和基于医院的隐性偏见培训和系统级孕产妇健康公平倡议的促进因素。结果：对生育医院代表和孕产妇保健公平专家进行了17次访谈。医院代表报告了提供内隐偏见培训或实施系统级干预的有限先前工作。与会者建议采取注重公平的干预措施，与现有的改善保健和孕产妇保健公平建议保持一致。他们还提出了旨在利用促进者和克服医院环境障碍的实施办法。讨论：设计孕产妇保健公平倡议的形成性工作可以使人们更深入地了解医院的实际障碍和所需的支持，并可以提高这些干预措施的有效性。

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引用次数: 0

Raynaud's Phenomenon of the Nipple: A Case Report of Postpartum Recurrence and Treatment 乳头雷诺现象：产后复发1例及治疗。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-09-16 DOI: 10.1111/jmwh.70012

Jennifer Trebbin CNM, Tara A. Singh MD

Raynaud phenomenon is a well-known condition that is characterized by episodic vasoconstriction of the extremities leading to pain and discoloration. It is more common among women than men and often results from exposure to cold or stress. Raynaud phenomenon can also affect the nipple during breastfeeding, causing severe pain and distress for the lactating individual and newborn, leading to premature cessation of breastfeeding. Raynaud phenomenon of the nipple is often confused with other breastfeeding pain causes, which can result in treatment oversights. The etiology of Raynaud phenomenon of the nipple is complex and thought to be caused by an interplay of hormones and stress in the peripartum period. Literature on this condition is limited, mostly consisting of case reports, and there are very little data about its recurrence in subsequent peripartum periods. Treatment options are similar to those for Raynaud phenomenon and, if initiated in a timely fashion, can allow breastfeeding to continue uninterrupted. This clinical rounds article presents a case report of Raynaud phenomenon of the nipple after a first birth and a reoccurrence during a subsequent (second) postpartum period. Discussion of the pathophysiology, clinical presentation, diagnostic tips, and appropriate treatment options are included.

雷诺现象是一种众所周知的疾病，其特征是四肢间歇性血管收缩，导致疼痛和变色。它在女性中比男性更常见，通常是由于暴露在寒冷或压力下造成的。雷诺现象也会影响母乳喂养期间的乳头，对哺乳期个体和新生儿造成严重的疼痛和痛苦，导致过早停止母乳喂养。乳头雷诺现象经常与其他哺乳疼痛原因混淆，这可能导致治疗疏忽。乳头雷诺现象的病因是复杂的，被认为是由围生期激素和压力的相互作用引起的。关于这种情况的文献是有限的，主要由病例报告组成，并且很少有关于其在随后的围产期复发的数据。治疗方案与雷诺现象类似，如果及时开始，可以使母乳喂养继续不受干扰。这篇临床查房文章提出了一个病例报告雷诺现象的乳头后，第一次生产和在随后的（第二次）产后期间复发。讨论病理生理学，临床表现，诊断提示，并适当的治疗方案包括。

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引用次数: 0

Omega-3 Fatty Acids During Pregnancy 怀孕期间的Omega-3脂肪酸

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-09-15 DOI: 10.1111/jmwh.70030

<p>During pregnancy, your baby gets most of their food from the foods you eat and vitamins you take. Omega-3 fatty acids (omega 3s) are an important family of building blocks needed during pregnancy and breastfeeding. The two most important omega-3s are DHA and EPA. Our bodies cannot make these fatty acids so we have to get them from food.</p><p>Omega-3s are important to health. They can lower blood pressure and reduce heart diseases and other health problems. Omega-3s improve your baby's eye and brain growth and early development. Taking in enough omega-3s can lower your baby's chances of being born to soon, or getting asthma and other allergic conditions. They also may lower your risk of depression after you have your baby (postpartum depression).</p><p>Only a few foods contain omega-3s. Fatty fish like salmon, sardines, and trout are the best sources. Omega-3s are also now added to certain foods (fortified) like some brands of eggs, milk, juice, and yogurt. Walnuts, flaxseed, chia seeds, seaweed and grass-fed beef all have DHA, just in lower amounts.</p><p>Because of mercury contamination of our oceans, rivers and lakes, almost all fish contain some mercury. Some fish contain too much mercury. Some fish may also have PCBs (polychlorinated biphenyls) and dioxin from industrial pollution. High amounts of mercury and PCBs in your body can cause problems with your baby's brain growth, so fish with high levels of these toxins should not be eaten during pregnancy. Check local advisories on the safety of fish from local waters. Fish advisories are available from your local health department and online from state agencies. The health benefits of eating low mercury fish during pregnancy outweigh the risks, so <b>DO</b> eat safe fish during pregnancy and while you are breastfeeding your baby.</p><p>Choose fish low in mercury. Remove skin and fat before cooking. Baking, broiling, steaming, or grilling fish lets the fat drain away and reduces PCBs in fish. Do not eat raw fish or shellfish.</p><p>Pregnant women and women who are breastfeeding should get about 200–300 mg of omega-3s per day. Since omega-3s stay in the body for a few days, eating 2 to 3 servings of fatty fish per week can give you the 200–300 mg per day needed. One serving is a 4 ounce portion of cooked fish. If you do not eat fish, or do not want to eat it every week, you can get fish oil as a pill or liquid you can swallow. Purified fish oil in pills or liquid form have all PCBs and dioxin removed. Read the label carefully to make sure there are at least 200 mg of omega-3s. Fish oil pills generally do not have side effects. Some women do say they have a fishy aftertaste with burping. There are other foods that contain DHA. If you prefer get your DHA through these sources, you will need to eat more of them or buy food that has been fortified to get the amount of DHA you need. Eating less fried and processed foods in your diet will help your body's ability to use the omega-3s you are taking

在怀孕期间，你的宝宝从你吃的食物和你服用的维生素中获得大部分食物。欧米伽-3脂肪酸（欧米伽-3）是孕期和哺乳期所需的重要组成部分。两种最重要的-3脂肪酸是DHA和EPA。我们的身体不能制造这些脂肪酸，所以我们必须从食物中获取。-3脂肪酸对健康很重要。它们可以降低血压，减少心脏病和其他健康问题。欧米茄-3可以促进宝宝的眼睛和大脑的生长和早期发育。摄入足够的omega-3脂肪酸可以降低宝宝早产的几率，或者降低患哮喘和其他过敏性疾病的几率。它们还可以降低你生完孩子后患抑郁症的风险（产后抑郁症）。只有少数食物含有ω -3脂肪酸。鲑鱼、沙丁鱼和鳟鱼等富含脂肪的鱼类是最好的来源。omega -3现在也被添加到某些食品（强化食品）中，比如一些品牌的鸡蛋、牛奶、果汁和酸奶。核桃、亚麻籽、奇亚籽、海藻和草饲牛肉都含有DHA，只是含量较低。由于我们的海洋、河流和湖泊受到汞污染，几乎所有的鱼类都含有汞。有些鱼含有过多的汞。有些鱼也可能含有工业污染的多氯联苯和二恶英。你体内大量的汞和多氯联苯会对宝宝的大脑发育造成问题，所以怀孕期间不应该吃这些毒素含量高的鱼。查阅有关本港水域鱼类安全的警告。有关鱼类的建议可以从当地的卫生部门获得，也可以从州机构的网上获得。在怀孕期间吃低汞鱼的健康益处大于风险，所以在怀孕期间和哺乳期间一定要吃安全的鱼。选择汞含量低的鱼。烹调前去皮去脂。烘烤、烤、蒸或烤鱼可以让脂肪流失，减少鱼中的多氯联苯。不要吃生的鱼或贝类。孕妇和哺乳期妇女每天应该摄入200-300毫克的ω -3脂肪酸。由于欧米茄-3脂肪酸会在体内停留几天，每周吃2到3次富含脂肪的鱼可以为你提供每天所需的200-300毫克欧米茄-3脂肪酸。一份是4盎司的熟鱼。如果你不吃鱼，或者不想每周都吃鱼，你可以把鱼油制成药丸或液体，可以吞咽。以丸剂或液体形式纯化的鱼油已去除所有多氯联苯和二恶英。仔细阅读标签，确保至少含有200毫克的ω -3脂肪酸。鱼油丸一般没有副作用。有些女性确实说她们打嗝时有一股腥味。还有其他含有DHA的食物。如果你更喜欢通过这些来源获得DHA，你就需要多吃这些食物，或者购买强化食品来获得你所需的DHA。在你的饮食中少吃油炸和加工食品将有助于你的身体利用你摄入的omega-3脂肪酸。像鱼肝油这样的鱼肝油在怀孕期间应该避免食用，因为它们会导致你体内维生素A的水平达到危险水平。FDA网站8-25-2025审核；adviceabouteatingfish - mainpdf - 2021 - 10 - 26 - 1025。pdf阅读水平7.7 2025年8月批准。这份讲义取代了2010年11月/ 12月第55卷第6期发表的“孕期ω -3脂肪酸”

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引用次数: 0

Precepting Through Perinatal Emergencies: A Simulation-Based Training for Midwifery Educators 围产期紧急情况的指导：助产教育工作者的模拟培训。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-09-13 DOI: 10.1111/jmwh.70024

Susanna R. Cohen CNM, DNP, Kimberly Calkins MA, Jennifer E. Kaiser MD, MA, MSCI, Heidi Breeze Harris MA, Elizabeth Auricchio CNM, DNP, Julie Blumenfeld CNM, DNP

The growth of the midwifery model of care depends on the preparation of new midwives, which necessitates skilled midwifery clinical preceptors. The University of Utah, Rutgers University, and PRONTO International supported by the New Jersey Department of Health, created the Precepting Through Perinatal Emergencies Workshop. We developed this sustainable in-person and virtual preceptor educational content through iterative feedback and pilot testing with active New Jersey midwifery preceptors. The preceptor training centered around introducing preceptors to evidence-based educational tools like the Educational Time Out, a teaching strategy using guided discovery learning concepts, goal setting, peer coaching strategies, and adult learning theories to enhance communication and debriefing skills. The in-person, highly interactive workshops included didactic lessons, role-plays, and 2 high-fidelity person-centered simulation scenarios and debriefs using the model developed by PRONTO International. The initial workshop's success led us to create a facilitation workshop for preceptors to learn how to train others and 3 online asynchronous modules to augment the learning. Midwifery preceptors who completed the facilitator training were equipped with the requisite skills, knowledge, and supplies needed to repeat the training in their home facilities.

助产护理模式的发展取决于新助产士的培养，这就需要熟练的助产临床导师。犹他大学、罗格斯大学和PRONTO国际在新泽西州卫生部的支持下，创建了围产期紧急情况训诫讲习班。我们开发了这种可持续的面对面和虚拟教师教育内容通过迭代反馈和试点测试与活跃的新泽西助产教师。教师培训的重点是向教师介绍基于证据的教育工具，如教育时间，这是一种使用引导发现学习概念、目标设定、同伴辅导策略和成人学习理论的教学策略，以提高沟通和汇报技能。面对面的、高度互动的研讨会包括教学课程、角色扮演和2个高保真的以人为中心的模拟场景，并使用PRONTO国际开发的模型进行汇报。最初的研讨会的成功使我们创建了一个促进研讨会，让导师学习如何培训他人，并创建了3个在线异步模块来增强学习。完成促进者培训的助产教师具备了在其家庭设施中重复培训所需的必要技能、知识和用品。

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引用次数: 0