Mcn-The American Journal of Maternal-Child Nursing最新文献

Introduction: Lactation support services can improve exclusive breastfeeding rates among infants in the neonatal intensive care unit (NICU). There are limited data on how many NICUs offer these services.

Objective: To assess prevalence and type of lactation services provided in level III Canadian NICUs.

Methods: A nationwide comprehensive point-prevalence study was undertaken via a telephone survey of level III NICUs in Canada. Availability of lactation consultants, type of services offered, infrastructure such as centralized milk labs, private space for expressing milk, and refrigerators to store breast milk, and follow-up support programs were assessed.

Results: There are 31 level III NICUs in Canada. Nineteen of the 31 NICUs participated in the survey, representing a 61% response rate. Of these, 79% (n = 15) offered lactation consultant services. Most (n = 13, 68%) noted they had International Board-Certified Lactation Consultants (IBCLCs). The types of lactation services offered were either a reactive care model, a proactive care model, or a combination of both. Seven (37%) units, both with and without LCs, offered alternate lactation assistance, such as helping mothers at the bedside with breastfeeds. Several units had available infrastructure (n = 10, 53%) and offered follow-up lactation support (n = 10, 53%).

Conclusion: Most of the surveyed level III NICUs in Canada provided lactation support services; however, there was variation in type. More research is needed to identify barriers that NICUs face in offering lactation services for mothers of NICU babies.

Abstract: Caring for persons with mental health diagnoses can be daunting, especially when the conditions are rare, and there is little evidence to guide nursing practice. There is minimal information about caring for persons with dissociative disorders beyond the behavioral health literature, much less as in obstetric context. Women are more likely to experience dissociative disorders and post-traumatic stress disorders than men. Severe maternal morbidity is significantly more common in women with a history of stress and trauma-related conditions, highlighting the importance of providing guidance for clinicians caring for them. It is imperative that nurses caring for women who may dissociate understand the complexities of the disorders and advocate for early, interdisciplinary care. Dissociative disorders, including dissociative identity disorder, post-traumatic stress disorder with dissociation, dissociative amnesia, depersonalization-derealization disorder, other specified dissociative disorders, and the care of pregnant persons with these conditions are presented.

Purpose: Use administrative discharge data from 2018 to 2020 to determine if there are differences in the prevalence of hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) by race and ethnicity in Illinois.

Study design and methods: This retrospective cross-sectional study used administrative discharge records from all patients who had live births in Illinois over a 3-year period; 2018, 2019, 2020. Multivariate analyses were performed to control for covariates and determine if associations vary by race and ethnicity for HDP and GDM.

Results: A total of 287,250 discharge records were included. Multivariate analyses showed that after adjusting for covariates, non-Hispanic Black women had 1.60 increased odds of HDP compared to non-Hispanic White women (OR, 1.60; 95% CI, 1.55-1.65). Hispanic women (OR, 1.45; 95% CI, 1.40-1.50), Asian/Pacific Islander women (OR, 2.07; 95% CI, 1.97-2.17), and American Indian/Alaska Native women (OR, 1.43; 95% CI, 1.17-1.74) had an increased odds of GDM compared to non-Hispanic White women.

Clinical implications: Women of color were at increased odds for HDP and GDM in Illinois. To eliminate poor maternal outcomes in women of color at risk for HDP and GDM, more culturally congruent health equity practices, policies, and comprehensive care interventions must be adopted.

Background: Maternal morbidity and mortality in the United States are higher than peer countries. These adverse events disproportionally affect Black women.

Local problem: Rates of maternal morbidity and mortality among Black childbearing women in West Louisville, Kentucky are higher than rates in Kentucky and the United States.

Methods: We conducted a quality improvement project to evaluate the effectiveness of adding doulas to the health care teams at the Norton downtown hospital to address health disparities and other challenges identified by Black childbearing women related to communication and health care system barriers.

Intervention: Three culturally congruent doulas were hired and integrated into the health care teams in one large health care organization.

Results: Participants in the doula program had lower no-show rates for postpartum visits compared with non-participants. No-show rates for prenatal visits were the same for both groups. Rates of diagnosed preeclampsia, hypertension, and chronic hypertension were similar among doula program participants and those who did not participate. Narrative data indicated that program participants and health professionals were generally pleased with the doula program and there was positive feedback from the community.

Conclusions: Integrating culturally congruent doulas into the health care system maximized their impact to address health and other challenges experienced by Black childbearing women.