Objective: To evaluate the effect of a nurse-initiated protocol on the times to order and implement prenatal care, nurses' intentions to change practice based on an educational session, and nurses' perceived barriers to initiation of the protocol in a carceral facility.
Design: Quality improvement project.
Setting/local problem: Southeastern United States carceral facility.
Participants: A total of 44 nurses employed by a state women's carceral facility.
Intervention/measurements: Participants attended a 30-min educational session on a nurse-initiated intake protocol, including use of the Clinical Opiate Withdrawal Scale. The session was offered multiple times during shifts to maximize attendance. Participants then completed an adapted Continuing Professional Development-Reaction Questionnaire. We abstracted de-identified data from the charts of adult incarcerated women in the pre-implementation (n = 26) and post-implementation (n = 24) phases. We compared time to order (interval from admission to entry of order for a laboratory test, medication, or intervention) and time to implementation (interval from entry of order to initiation of the laboratory test, medication, or intervention) before and after implementation of the protocol. We assessed barriers to implementing the protocol 3 months after implementation.
Results: The time to order a prenatal diet and schedule a first obstetric appointment decreased significantly (p < .001), whereas the time to order prenatal labs increased significantly (p = .03) after implementation of the protocol. We identified the following themes as barriers to implementing the protocol: Lack of Integration of the Protocol Into the Electronic Health Record, Interruptions in the Flow of Care, and Limited Resources.
Conclusions: Use of a nurse-initiated protocol standardized and improved the timeliness of the delivery of prenatal care in a carceral facility and has the potential to enhance health care quality and maternal-fetal outcomes in this high-risk population.
Objective: To explore variations in maternal and infant outcomes among clusters of mother-infant dyads in the NICU characterized by intersecting social identity characteristics.
Design: Secondary exploratory analysis of data from a cluster randomized controlled trial conducted between December 2015 and July 2018.
Setting: Ten Level II NICUs in six cities across Alberta, Canada.
Participants: A total of 400 mothers and their preterm infants at 320⁄7 to 346⁄7 weeks gestation.
Methods: We used two-step cluster analysis to identify clusters based on maternal ethnicity, education, age, and annual family income. We employed multiple regression models to examine whether cluster membership was associated with infant length of stay, maternal psychosocial distress, and parenting self-efficacy at discharge, controlling for relevant infant and maternal characteristics and hospital setting (urban vs. regional).
Results: We identified four mother-infant dyad clusters: (1) younger, lower-education, lower-income White mothers; (2) older, higher-education, higher-income BIPOC (Black, Indigenous, or people of color) mothers; (3) diploma-educated, highest-income White mothers; and (4) university-educated, highest-income White mothers. Although cluster membership was not associated with maternal outcomes, infants of mothers in Cluster 1 had shorter lengths of stay compared with those in Cluster 4. Hospital setting was a predictor of length of stay and parenting self-efficacy.
Conclusion: Findings highlight the relevance of social identity and hospital setting in shaping NICU outcomes and support the need for equity-informed neonatal care.
Objective: To identify consequences of falls in women during the perinatal period.
Data sources: Academic Search Complete (EBSCO), CINAHL Ultimate (EBSCO), MEDLINE Ultimate (EBSCO), Cochrane Central Register of Controlled Trials (EBSCO), Cochrane Clinical Answers (EBSCO), Cochrane Database of Systematic Reviews (EBSCO), Cochrane Methodology Register (EBSCO), MedicLatina (EBSCO), Repositórios Científicos de Acesso Aberto de Portugal (RCAAP), SciELO, Scopus, and Web of Science.
Study selection: We included quantitative or qualitative primary studies, literature reviews, systematic reviews, expert opinion papers, organizational guidelines, and conference abstracts regarding consequences of falls in women during the perinatal period, in any context of care, that were published until November 11, 2024, in English, French, Portuguese, and Spanish.
Data extraction: We extracted the following data from the included reports: author(s), year, country, aim, study design, type of report, sample size, setting, types and consequences of falls, prevalence, and risk factors for falls.
Data synthesis: From a total of 33 articles, 27 were related to the consequences of falls during pregnancy, 3 were related to consequences of falls during both pregnancy and the postpartum period, 2 were related to consequences of falls during the perinatal period in which one does not identify the specific stage, and 1 was related to the postpartum period. We did not identify any reports of falls during childbirth. Injuries were common consequences of falls among women during the perinatal period, and the severity of falls varied from minor to severe. Obstetric injuries were severe and unique to pregnant women.
Conclusion: Pregnant women sustain varied injuries after falls and often need health care. Further research is warranted regarding the consequences of falls during childbirth and the postpartum period.
Objective: To assess the health outcomes of women on community supervision during the perinatal period and to analyze the associations between length of community supervision and perinatal health outcomes.
Design: A cross-sectional survey study.
Setting: Individual telephone interviews in San Antonio, Texas.
Participants: Women aged 18 to 50 years (N = 60) on community supervision.
Methods: We developed survey questions to measure participants' perinatal health outcomes during pregnancy, childbirth, and the postpartum period. We used logistic regression to assess the associations between the length of community supervision and perinatal health outcomes.
Results: Most participants had an average of 4 arrests (SD = 7) and 5 years of community supervision (SD = 3), gave birth before 38 weeks gestation (n = 43; 71%), and reported feelings of depression (n = 40; 67%) and anxiety (n = 31; 52%) during their most recent pregnancies. Most participants had inadequate social support during childbirth (n = 55; 92%). More than a third of the participants experienced partner violence while on community supervision (n = 21; 35%), and a quarter experienced violence during their most recent pregnancies (n = 15; 25%). For each additional year on community supervision before birth, the odds of experiencing a pregnancy complication were 1.63 (95% confidence interval = [1.08, 2.82]) times higher.
Conclusion: The criminal legal system, although not designed to provide health care, should dedicate resources to address the perinatal health care needs of women while on community supervision.
Objective: To increase the percentage of women with severe-range blood pressure during the perinatal period who are treated within 30 min from 25% to at least 50% within 8 weeks.
Design: Plan-Do-Study-Act model comprising four 2-week cycles with data-driven tests of change every cycle.
Setting: A high-volume, community, academic obstetric triage.
Patients: We conducted interventions with women identified at risk for or diagnosed with hypertensive disorder of pregnancy (N = 182). In addition, we surveyed a convenience sample of women (n = 30) about their understanding of hypertension care and maternity care staff (n = 39) about their knowledge of treatment for hypertensive disorders of pregnancy.
Intervention/measurements: We implemented two interventions: standardized screening for hypertensive disorders of pregnancy using a modified preeclampsia early recognition tool and an algorithm-based checklist for effective treatment for hypertensive disorders of pregnancy. We measured use and outcomes through chart review and analyzed data with descriptive statistics.
Results: After the intervention, the percentage of women treated within 30 min increased to 97%. Mean medication administration times decreased from 41.4 to 11.2 min (p < .001), which demonstrated a significant improvement in care.
Conclusion: Standardized screening and care improved time to treatment among women with hypertensive disorders of pregnancy. This advanced practice nurse-led initiative is adaptable for widespread implementation.

