Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing最新文献

In July 2023, the U.S. Food and Drug Administration approved Opill (norgestrel 0.075 mg), a progestin-only tablet to prevent pregnancy to be used without a prescription. Although progestin-only birth control pills were approved in 1973, it has taken 50 years for the first oral contraceptive pills to be sold over the counter. In this column, I review the evidence on the barriers to access oral contraceptive pills, the efficacy, preferences and support of a nonprescription progestin-only pill, the cost, and policy implications for health insurance coverage. I conclude with recommendations from professional organizations on over-the-counter access to hormonal contraception.

Objective

To explore women’s experiences of mechanical labor induction using a balloon catheter with self-traction.

Design

Descriptive qualitative.

Setting

Birth unit of an urban hospital in Quebec, Canada.

Participants

Fourteen women who experienced labor induction with a balloon catheter using self-traction.

Methods

We conducted individual structured interviews between May 2022 and January 2023 to collect data that we subsequently analyzed using the manifest content analysis approach of Graneheim et al. We adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results

We identified five categories: Expectations, Pain or Comfort Experienced, Emotions Felt, Support From Nursing Staff, and Appreciation of the Procedure. The participants anticipated rapid, effective induction, expressed concerns about potential discomfort, and appreciated control of their experiences. We found a generally positive trend in terms of appreciation for all categories.

Conclusion

The positive experiences of participants underline the promising potential of the balloon catheter method of labor induction with self-traction. Given the continuing growth in labor induction rates, it becomes necessary to continue efforts to offer services specifically geared to women’s needs. Offering an additional option such as self-traction is a step in this direction.

Objective

To explore the experiences of women in the postpartum period who received the Association of Women’s Health, Obstetric and Neonatal Nurses’ “POST-BIRTH Warning Signs Save Your Life” (PBWS-SYL) educational handout at discharge.

Design

Qualitative content analysis.

Setting

Virtual or in-person interviews in Connecticut, New York, and Florida.

Participants

Women (N = 41) who gave birth in the previous 12 months.

Methods

In individual audio-recorded interviews, we asked participants to describe their experiences of receiving the PBWS-SYL educational handout. We used Krippendorff’s method for qualitative content analysis to cluster units within the data to identify emergent themes.

Results

Participants who received the handout emphasized that they recognized potential warning signs during the postpartum period. Conversely, participants who reported that the PBWS-SYL educational handout was not adequately reviewed with them during discharge expressed heightened levels of distress and doubt when they encountered concerns. Analysis of transcripts revealed six overarching themes: The Invisible Pain of the Postpartum Period, Stronger Together, The Art of Active Listening, Lost in the Pile, Postbirth Revelations, and Optimal Discharge Education.

Conclusion

Our findings suggest that the consistent and thorough application of the PBWS-SYL handout education process is a pivotal factor in safeguarding women’s health after childbirth. This education is essential to equip women with the knowledge and confidence needed to detect and address any warning signs that may emerge after birth. Nurses and health care providers can empower women to recognize and address warning signs during the postpartum period, which can lead to improved health outcomes for women.

Objective

To measure change in financial toxicity from pregnancy to the postpartum period and to identify factors associated with this change.

Design

Longitudinal survey.

Setting

Obstetric clinics at an academic medical center in Massachusetts between May 2020 and May 2022.

Participants

Obstetric patients who were 18 years of age or older (N = 242).

Methods

Respondents completed surveys that included the COmprehensive Score for financial Toxicity tool during pregnancy and in the postpartum period. We collected additional medical record data, including gestational age, birth weight, and cesarean birth. We used paired t tests to assess changes in financial toxicity before and after childbirth and one-way analysis of variance to compare average change in financial toxicity by demographic and medical variables.

Results

The mean current financial toxicity score was significantly lower after childbirth (M = 19.0, SD = 4.6) than during pregnancy (M = 21.8, SD = 5.4), t(241) = 13.31, p < .001. Concern for future financial toxicity was not significantly different after childbirth (M = 8.5, SD = 2.9) compared to during pregnancy (M = 8.2, SD = 3.0), t(241) = –1.80, p = .07. Individual-level sociodemographic variables (e.g., racial/ethnic category, insurance, employment) and medical factors (e.g., cesarean birth, preterm birth) were not associated with change in financial toxicity.

Conclusion

Among respondents, financial toxicity worsened after childbirth, and patients are at risk regardless of their individual socioeconomic and medical conditions.

Objective

To identify clusters of women based on anxiety, depression, fear of birth, and childbirth self-efficacy and factors associated with the clusters.

Design

Cross-sectional survey.

Setting

Online in Sweden.

Participants

Pregnant women (N = 1,419).

Methods

We collected data through online questionnaires. We included scales to measure anxiety, depression, worries about and fear of birth, and self-efficacy in a kappa-means cluster analysis. We calculated odds ratios with 95% confidence intervals between clusters and background variables.

Results

We identified 4 clusters based on severity: Resourceful–Robust, Resourceful–Fearful, Vulnerable–Fearful, and Fragile–Fearful. Participants in the Resourceful–Fearful and Vulnerable–Fearful clusters were more likely to report mental health problems than those in the Resourceful–Robust cluster. Participants in the Vulnerable–Fearful and Fragile–Fearful clusters were more likely to report mental health problems than those in the Resourceful–Robust cluster. Participants in the Fragile–Fearful cluster were more likely to be multiparous, report that their pregnancy was not normal, and prefer cesarean birth than those in the Resourceful–Robust cluster.

Conclusions

Women with childbirth fear may be vulnerable to anxiety and depression during the perinatal period, although the severity might vary. Self-efficacy might be a mediator against mental health problems. Findings demonstrated levels of severity, and the one-size-fits-all approach in Swedish health care may benefit from a more targeted approach for women with fear of childbirth.

Objective

To explore parents’ shared experiences of separation from their newborns after birth in Denmark.

Design

Phenomenological hermeneutic design.

Setting

A NICU in the Capital Region of Denmark.

Participants

Four sets of parents (N = 8) with prematurely born neonates who were admitted to the NICU.

Methods

We used dyadic interviews for data collection. We applied a phenomenological hermeneutic approach inspired by Ricoeur’s theory of interpretation to analyze the data.

Results

Two overarching themes emerged that reflected two distinct temporal phases of separation. Initial separation caused an experience of becoming parents at different paces. Separation based on care needs (i.e., the NICU vs. maternity unit) left parents at the juncture between separation and closeness.

Conclusion

Separation from their newborns complicated parents’ transitions into parenthood. Their sense of unity was undermined when different units assumed responsibility for the mother and newborn. This challenged family-centered care. Our findings indicate the need to minimize separation through initiatives such as zero separation and couplet care.

Objective

To investigate mode of birth in relation to onset of labor and Bishop score.

Design

Retrospective observational cohort design.

Setting

A 434-bed Magnet redesignated community hospital.

Participants

Nulliparous women, 18 years of age or older, who gave birth at 37 to 41 weeks gestation to live, singleton fetuses in the vertex presentation (N = 701).

Methods

We conducted a retrospective chart review and used chi-square analysis to measure the associations among mode of birth, onset of labor, and Bishop score. We used logistic regression to test the probability of cesarean birth for women undergoing elective induction of labor.

Results

Most participants (n = 531, 75.7%) gave birth vaginally. Significant findings included the following relationships: spontaneous onset of labor and vaginal birth (χ² = 22.2, Ø = 0.18, p < .001) and Bishop score of greater than or equal to 8 and vaginal birth (χ² = 4.9, Ø = .14, p = .028). Induction of labor was a significant predictor in cesarean birth when controlling for age and body mass index (OR = 2.1, 95% confidence interval [1.5, 3.1], p < .001).

Conclusion

Reducing elective induction of labor in women with low-risk pregnancies may help lower the risk of cesarean birth. Clinically, Bishop score and mode of birth have a weak association, particularly when induction includes cervical ripening.