Journal of nurse-midwifery最新文献

Obstetric triage services are rapidly advancing, and the concept is becoming a popular practice pattern. As more pregnant women are evaluated in ambulatory settings, especially in high volume obstetric tertiary centers, it is now realized more and more that labor and other complaints cannot be addressed solely in labor and delivery units, nor are most of these complaints solely labor related. This article presents the results of a national survey designed to discover what contributions nurse-midwives are making to obstetric triage services. In addition, the results provide initial benchmark data on obstetric triage components against which other midwifery services can address practice issues.

"Evidence-based medicine" has been hailed as the "new paradigm" for health care. This paper defines evidence-based practice, describes its development and growing importance, explains why randomized controlled trials are the "gold standard" for evidence about the effectiveness of specific therapeutic methods, warns about reaching conclusions based on any single study, and points the reader towards good sources of information on how to assess the relevance of findings from published studies and systematic reviews of the most reliable evidence regarding particular components of the care of pregnant women. As a result of those reviews, specific elements of perinatal care have been classified into categories based on their usefulness or harmfulness when applied to low-risk women. The paper goes on to summarize the evidence regarding three intrapartum practices that are demonstrably safe and useful and "should be encouraged" and four intrapartum practices that have trade-offs between beneficial and adverse effects and are "frequently used inappropriately." Some of the most beneficial elements of intrapartum care are not available to most women who give birth in American hospitals, and some practices that are useful but have adverse effects are being provided to an ever-expanding proportion of women.

The midwifery and medical models for the care of pregnant women are based on particular perspectives on pregnancy and birth. The approaches resulting from these perspectives are complementary and, as a result of midwives and physicians working together, there has been significant merging of the models. Instead of two mutually exclusive ways of managing birth, there is wide variation. Nevertheless, there are important differences between the two models, including differences in philosophy and focus, in the relationship between the care provider and the pregnant woman, in the main focus of prenatal care, in use of obstetric interventions and other aspects of care during labor, and in the goals and objectives of care. The midwifery model has advantages for many women because it avoids unnecessary interventions during labor, thus helping the process remain normal, and because it addresses needs that are often not adequately met by the medical management model.

This Clinical Practice Exchange focuses on alternative healing in nurse-midwifery practice. It features interviews with six certified nurse-midwives (CNMs) who practice complementary therapies (CTs). The healing modalities they use include homeopathy, Healing Touch, hypnosis, herbal healing, mindfulness meditation, and water healing. The CNMs discuss their training to practice CTs, how they use alternative healing with clients, and how they integrate this with midwifery practice. The interviews are followed by an Alternative Healing Directory composed of 37 CNMs who responded to a Call, which appeared several times in Quickening and JNM. Each midwife's listing includes contact information, CTs practices, and special interests in networking with other CNMs about alternative healing. The JNM hopes that this Directory will be a catalyst for networking and communication that will move forward the discussion, practice, and research of alternative healing within the midwifery community.