Journal of midwifery & women's health最新文献

Tuskegee, in Macon County, Alabama, has played an important role in Alabama's midwifery legacy and was home to 2 different midwifery education programs from the 1920s through the 1940s. In response to a 1918 state law requiring midwives to pass an examination to receive a practice permit in their county, stakeholders developed a four-week course for Black Alabamian midwives on the grounds of Tuskegee Institute at the John A. Andrew Memorial Hospital. In the 1940s, in the same location on the grounds of Tuskegee Institute, the Tuskegee School of Nurse-Midwifery educated Black nurse-midwives to improve Black maternal and neonatal outcomes in the South.

Midwifery, and by extension, midwifery research, exists within a complex social and political context. The ideation, construction, conduct, and presentation of midwifery scholarship are embedded in these structures, as well as the researchers and research participants who contribute, in varying ways, to the construction of the work. Positionality is understanding one's social identities and how these identities influence our interactions with others. Reflexivity can include examination of one's assumptions, biases, and blind spots.¹ Seeing things from multiple perspectives expands knowledge beyond the researcher's lived experience. Positionality and reflexivity are important in both qualitative and quantitative research.

Midwifery is built on the foundation of having the knowledge to address issues such as social determinants of health, racism, and other sources of inequity. Health care practitioners are increasingly aware of the societal structures that exist in our health care system and that influence health outcomes. Similarly, researchers need to be aware of the structures that exist within the research context to address health equity.

Our experiences shape who we are. Messages received since childhood shape our perception and understanding of the world. When generating knowledge to inform midwifery practice and education, it is important that we stay true to the realities of those we care for. The research findings should reflect their perceptions to inform how we understand the challenges and circumstances, and not be limited by our own perspectives.

Systems of power and oppression are built into the systems within which research is conducted. Underlying assumptions about value and importance that determine what is being studied (ie, what health conditions), who is being studied (what populations), and how it is studied (what methods) are determined by those who hold the most power (researchers, funders, authors, journals, and editors). These systems can be challenged only if we are aware and acknowledge that they exist. These include not just racism, but sexism, classism, and other forms of marginalization that can intersect within individuals. These oppressive structures are embedded so deep in our society that, as researchers, we may unknowingly become a part of these systemic issues and cause unintentional harm throughout the research process.

Qualitative research often involves direct contact between researchers and participants in dynamic data collection in the form of interviews. The researcher is the instrument of data collection when there is an interview. Similarly, the researcher is intricately part of the analysis and interpretation of findings. Interviews can be impacted by the lenses that interviewers and participants bring to the interaction from their social identities, past experiences with the topic of interest, and level of trust that the participant has in the research

A miscarriage is the early loss of a pregnancy. Miscarriage can happen any time between your last menstrual period and 20 weeks of pregnancy. After 20 weeks, a pregnancy loss is called a stillbirth. Most miscarriages happen before 14 weeks of pregnancy.

Miscarriage happens in about 15% to 20% of pregnancies. The true number is unknown because many happen before the person knows they are pregnant.

Usually there is no known cause. About half of all miscarriages are caused by genetic problems. Pregnancy loss is more common in older people and those who have had a miscarriage before. Medical problems like diabetes or thyroid disease, smoking, or alcohol use can increase the chance of miscarriage. A miscarriage can happen to anyone.

The most common signs of miscarriage are vaginal bleeding, cramping, or pain in your lower abdomen or back. These symptoms don't always mean a miscarriage will happen. Sometimes a miscarriage can occur without any warning.

A miscarriage is diagnosed by ultrasound. The ultrasound will show that the fetus does not have a heartbeat. Blood tests can also be done to check your levels of the pregnancy hormone (HCG). This can be helpful if your health care provider thinks you are having a miscarriage.

When someone is having a miscarriage before 20 weeks, nothing can be done to stop it. There are several options after you know you are miscarrying. The best option depends on how far along the pregnancy is, how healthy you are, and if other problems are happening. Your desires and your health care provider's advice are important too.

If your pregnancy is more than 16 weeks, your health care provider may admit you to the hospital to induce labor. This process can take some time and may involve the use of several medications. You will receive care during the process to support you and answer questions. You may be asked if you want to see the fetus.

When you become pregnant again, be sure to tell your health care provider that you have a history of pregnancy loss. They will check you out and tell you about your specific chance of having another miscarriage.

Flesch Kincaid score 7.1

Approved June 2024. This handout replaces “Miscarriage” published in Volume 58, Number 4, July/August 2013.

This page may be reproduced for noncommercial use by health care professionals to share with clients. Any other reproduction is subject to the Journal of Midwifery & Women's Health's approval. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, the Journal of Midwifery & Women's Health suggests that you consult your health care provider.

Most exercise is safe in a healthy pregnancy. Daily exercise can help you and your baby be healthier and decrease your chance of some problems during pregnancy. Exercise in pregnancy does not increase your chance of miscarriage, low birth weight, or early delivery. If you had a medical problem before you became pregnant or have had complications during your pregnancy, you should talk about the safety of exercise with your health care provider before you start any activity.

Exercise in pregnancy can help you in many ways. It can help you feel better and have less back pain, constipation, and tiredness. Exercise can also help you sleep better and improve your mood. Your body will be better prepared for labor. You may have a shorter labor with less chance of having a cesarean birth. You may gain less weight in pregnancy, which will help you get back to your pre-pregnancy weight more quickly after the baby comes. Exercise in pregnancy lowers your chance of gestational diabetes or high blood pressure during pregnancy. Your baby is more likely to be born with a healthy birth weight. Exercise can also lower the chance of having postpartum depression after the baby is born.

You should try to do moderate exercise for at least 150 minutes a week. Moderate exercise means you should start to sweat and your heart rate should increase, but you are still able to talk while you are exercising. You can divide your exercise into whatever amounts work best in your life. Some find 30 minutes a day at one time works. Others prefer 10–15 minutes a few times a day. If you exercised before pregnancy, you can probably continue the same physical activities and intensity of exercise. If you are not currently exercising, pregnancy is a good time to start. You want to start slow and gradually increase your exercise.

Walking or swimming are good exercises to start with. You will get moving and have less strain on your joints. Biking, yoga, Pilates, and low-impact aerobics are also good choices. Light weight training is okay, too. Being creative with your exercise will help you stay motivated. Hiking, dancing, and rowing can be fun activities to try. You do not need to pay money for an exercise class or activity. Walking up and down stairs or doing exercises at home are all good, free activities.

Be sure to stretch your muscles first and warm up and cool down each time you exercise. Drink water throughout your exercise so you can stay well hydrated. Make sure you don't get too hot, and don't overdo your exercise especially on a hot day. During pregnancy, your balance changes as the baby grows so it is important to move carefully and always make sure you are not in danger of falling. Pregnancy hormones cause your joints to be more relaxed. They can be injured easier especially with jerky, bouncy, or high-impact movements. You have more oxygen needs in pregnancy. This can make it harder to breath, especially with hard exercise or for people with obesit

Outpatient perinatal care providers (one certified nurse-midwife, one nurse practitioner, and one physician assistant) at a high-volume, suburban health system in southeastern Pennsylvania developed and implemented a care model to identify and care for patients at risk for perinatal and postpartum mental health conditions. The program, Women Adjusting to Various Emotional States (WAVES), was created to bring the most up-to-date, evidence-based treatment recommendations to patients while addressing the increased demand placed on the health care system by pregnant and postpartum patients in need of psychiatric services. WAVES is a specialized program offered for anyone who is pregnant or up to one year postpartum who is struggling with mental health symptoms or concerns. Perinatal mood and anxiety disorders have become one of the most prevalent pregnancy ailments, yet mental health is not always addressed during routine prenatal care visits. Common obstacles to patients obtaining mental health care during pregnancy include lack of access, clinician gaps in knowledge, and stigma surrounding diagnoses. WAVES offers a method to empower perinatal providers with the education and tools to address this need. The model outlines how to appropriately assess, diagnose, manage, or refer patients for mental health services. Patient feedback has been overwhelmingly positive, and this novel care model shows great promise for the future of perinatal care. The development of integrated programs like WAVES may be a valuable resource to help combat the perinatal mental health epidemic.