Brenda Baker

Parenting After Infertility: Issues for Families and Infants

This article reviews the research related to parenting after assisted reproduction and uses that research to discuss clinical implications for nurses who work to support these families and the development of their children. The worldwide diagnosis of infertility continues to rise and now hovers near 20%. The increased availability and success of assisted reproductive technologies (ARTs) provides a potential option for infertile families to conceive and begin a family, but as nurses know, infertility treatments are not easy to tolerate, are time-consuming, physically taxing, and expensive. In addition, a positive outcome is far from guaranteed. Even when infertile couples successfully give birth, they can continue to struggle with the psychological aspects of infertility and the ongoing care of a child who may be premature, low birth weight, or afflicted with another high-risk condition such as long-term developmental or behavioral problems. Unfortunately, the psychological needs of the couple and the family may not be addressed during ART treatment or after the birth of a child. Parenting is a challenging life task; parenting when the partners may have to work through the psychological aspects of infertility and the care of a high-risk child is even more complex and may have long-lasting effects on the partners as well as their children.

Competence and Responsiveness in Mothers of Late Preterm Infants Versus Term Infants

OBJECTIVE To compare maternal competence and responsiveness in mothers of late preterm infants (LPIs) with mothers of full-term infants. DESIGN A nonexperimental repeated-measures design was used to compare maternal competence and responsiveness in two groups of postpartum mothers and the relationship of the theoretical antecedents to these outcomes. SETTING Urban academic medical center. PARTICIPANTS Mothers of late preterm infants (34-36, 6/7-weeks gestation) and mothers of term infants (≥37-weeks gestation), including primiparas and multiparas. Data were collected after delivery during the postpartum hospital stay and again at 6-weeks postpartum. METHODS Descriptive and inferential analysis. RESULTS A total of 70 mothers completed both data collection periods: 49 term mothers and 21 LPI mothers. There were no differences between the two groups related to their perception of competence or responsiveness at delivery or 6-weeks postpartum. At 6-weeks postpartum, none of the assessed factors in the model was significantly related to competence or responsiveness. CONCLUSIONS The results, which may have been limited by small sample size, demonstrated no difference in the perceptions of LPI and term mothers related to competence or responsiveness. Maternal stress and support were significantly related to other factors in the model of maternal competence and responsiveness.

Maternal–Child Microbiome: Specimen Collection, Storage, and Implications for Research and Practice

Background The maternal microbiome is a key contributor to the development and outcomes of pregnancy and the health status of both mother and infant. Significant advances are occurring in the science of the maternal and child microbiome and hold promise in improving outcomes related to pregnancy complications, child development, and chronic health conditions of mother and child. Objectives The purpose of this study was to review site-specific considerations in the collection and storage of maternal and child microbiome samples and its implications for nursing research and practice. Approach Microbiome sampling protocols were reviewed and synthesized. Precautions across sampling protocols were also noted. Results Oral, vaginal, gut, placental, and breast milk are viable sources for sampling the maternal and/or child microbiome. Prior to sampling, special considerations need to be addressed related to various factors including current medications, health status, and hygiene practices. Proper storage of samples will avoid degradation of cellular and DNA structures vital for analysis. Discussion Changes in the microbiome throughout the perinatal, postpartum, and childhood periods are dramatic and significant to outcomes of the pregnancy and the long-term health of mother and child. Proper sampling techniques are required to produce reliable results from which evidence-based practice recommendations will be built. Ethical and practical issues surrounding study design and protocol development must also be considered when researching vulnerable groups such as pregnant women and infants. Nurses hold the responsibility to both perform the research and to translate findings from microbiome investigations for clinical use.

The Maternal Infant Microbiome: Considerations for Labor and Birth.

Abstract The human microbiome plays a role in maintaining health, but is also thought to attenuate and exacerbate risk factors for adverse maternal–child health outcomes. The development of the microbiome begins in utero; however, factors related to the labor and birth environment have been shown to influence the initial colonization process of the newborn microbiome. This “seeding” or transfer of microbes from the mother to newborn may serve as an early inoculation process with implications for the long-term health outcomes of newborns. Studies have shown that there are distinct differences in the microbiome profiles of newborns born vaginally compared with those born by cesarean. Antibiotic exposure has been shown to alter the microbial profiles of women and may influence the gut microbial profiles of their newborns. Considering that the first major microbial colonization occurs at birth, it is essential that labor and birth nurses be aware of factors that may alter the composition of the microbiome during the labor and birth process. The implications of various activities and factors unique to the labor and birth environment that may influence the microbiome of women and newborns during the labor and birth process (e.g., route of birth, antibiotic use, nursing procedures) are presented with a focus on the role of labor nurses and the potential influence of nursing activities on this process.

Patient Falls in Labor and Delivery

Poster Presentation Purpose for the Program At an urban academic medical center with approximately 2200 births per year, 10 falls occurred in labor and delivery (L&D) unit in a 12‐month period. None of the patients who fell was categorized, as high risk for falling, which led the nurses to ask if the current risk scale for falls was useful in the perinatal population. The hospital‐wide falls screening tool had little application in the perinatal population because the tool was validated in the geriatric population. A review of the literature revealed little evidence as most studies excluded perinatal patients from their validation work. The purpose of this project was to create an obstetric specific falls prevention program and screening tool to identify women at risk of falling and decrease the number of falls in the L&D unit. Proposed Change To create a population specific falls prevention program and screening tool to identify pregnant women at risk of falling and decrease the incidence of falls in the perinatal population. Implementation, Outcomes, and Evaluation A review of literature was conducted using CINAHL and PubMed. Search terms included falls and pregnancy. Nine publications related to falls in pregnancy met search the criteria. Findings from this review indicated history of previous fall, visual disturbances, sedentary life style, and edema in feet and ankles during pregnancy as most predictive of risk of falling. Along with the review of literature, an in‐depth analysis of each fall event was completed. This work lead to development of a clinical practice guideline, Falls Prevention in Labor & Delivery, and a population‐specific screening tool built in the Electronic Medical Record. Staff education and monthly chart audits were conducted to monitor adherence to the tool and to provide feedback related to use of the screening tool. In 2008, 10 falls were reported. After the implementation of the obstetric falls program, two falls were reported in 2013. Implications for Nursing Practice A continual decline in patient falls in L&D has occurred since implementation of multiple initiatives, including a population specific screening tool. Future plans include validation of the screening tool.Poster PresentationPurpose for the Program At an urban academic medical center with approximately 2200 births per year, 10 falls occurred in labor and delivery (L&D) unit in a 12-month period. None of the patients who fell was categorized, as high risk for falling, which led the nurses to ask if the current risk scale for falls was useful in the perinatal population. The hospital-wide falls screening tool had little application in the perinatal population because the tool was validated in the geriatric population. A review of the literature revealed little evidence as most studies excluded perinatal patients from their validation work. The purpose of this project was to create an obstetric specific falls prevention program and screening tool to identify women at risk of falling and decrease the number of falls in the L&D unit. Proposed Change To create a population specific falls prevention program and screening tool to identify pregnant women at risk of falling and decrease the incidence of falls in the perinatal population. Implementation, Outcomes, and Evaluation A review of literature was conducted using CINAHL and PubMed. Search terms included falls and pregnancy. Nine publications related to falls in pregnancy met search the criteria. Findings from this review indicated history of previous fall, visual disturbances, sedentary life style, and edema in feet and ankles during pregnancy as most predictive of risk of falling. Along with the review of literature, an in-depth analysis of each fall event was completed. This work lead to development of a clinical practice guideline, Falls Prevention in Labor & Delivery, and a population-specific screening tool built in the Electronic Medical Record. Staff education and monthly chart audits were conducted to monitor adherence to the tool and to provide feedback related to use of the screening tool. In 2008, 10 falls were reported. After the implementation of the obstetric falls program, two falls were reported in 2013. Implications for Nursing Practice A continual decline in patient falls in L&D has occurred since implementation of multiple initiatives, including a population specific screening tool. Future plans include validation of the screening tool.

Improving Outcomes for Late Preterm Infants and Their Mothers

Brenda Baker, PhD, RNC, CNS, is a perinatal clinical nurse specialist at Virginia Commonwealth University, Richmond, VA. I n 2005 the National Institutes of Health (NIH) convened a workshop of experts to address issues surrounding outcomes of near-term infants, and participants addressed definition and terminology, epidemiology, etiology, biology of maturation, clinical care, and public health issues (Raju, Higgins, Stark, & Leveno, 2006). The expert panel recommended discontinuation of the use of the term near-term infant and the adoption of the term late preterm infant (LPI) for infants born between 34 0/7 and 36 6/7 weeks gestation. The committee’s consensus indicated that near-term was misleading and conveyed an impression that these infants were “almost term,” which resulted in underestimation of risk to this rapidly growing population (Raju et al., 2006).

Nursing Sensitive Quality Indicators in the Perinatal Setting

Poster Presentation Objective To develop a nursing sensitive quality indicator in the perinatal setting. Design Evidence‐based quality improvement project. Sample Random sampling of patients from a labor and delivery (LD engagement of staff in data collection that is meaningful to practice; and data‐driven decision making. Data included in the L&D Quality Dashboard have been used to guide the purchase of new equipment for the unit, facilitate design of a new L&D Suite, develop interdisciplinary simulation training, and initiate a nursing research project related to falls in the perinatal population. Conclusion/Implications for Nursing Practice Perinatal areas have struggled to identify nursing sensitive indicators that are meaningful and representative of the care provided in this specialty. National indicators and benchmarks have primarily focused on topics common in the medical/surgical and critical care areas of nursing. In an effort to measure and improve the valuable care provided in L&D, the unit based Nursing Quality Committee at an urban teaching hospital developed an L&D Quality Dashboard of indicators that are specific to perinatal nursing care. The L&D Quality Dashboard is a dynamic tool that has improved communication between staff, leadership, and administration. It has empirically guided decision making and promoted accountability at the bedside and in the boardroom to transform practice in the perinatal setting.

Case StudiesSupporting Mothering Through Breastfeeding for Incarcerated Women

Newborn Care Poster Presentation Background More than 1 million women are under the control of the criminal justice system, representing the fastest growing group of prisoners. Women serving prison sentences most commonly have been convicted of drug‐related offenses followed by nonviolent crimes. It is estimated that 8% to 10% of women entering prison are pregnant. A disproportionally large number of women in prison have a history of physical or sexual abuse, substance abuse, and are mothers of minor children. Statistics indicate the average prison time for women is 12 months; therefore, on average, pregnant prisoners spend 6 to 12 months in prison after the birth of a child, a critical time period in the mothering experience. Breastfeeding offers immunological, developmental, and psychosocial benefits to mother and infant. Additionally, breastfeeding contributes to positive maternal self‐image and development of maternal–infant relationship. Currently, little is known about the experience of mothering while incarcerated or the benefits of breastfeeding in this population. Case A mother from a local jail delivered a term newborn at an urban medical center. Collaboratively the healthcare team, mother, father, and guards created a breastfeeding and pumping plan supporting the mothers desire to breastfeed. The newborn was discharged with the father who would pick up breast milk daily from the jail to feed the newborn. The jail agreed to allow the mother to pump in her cell and store milk in the medical unit refrigerator. At 10 days of age, the newborns nutritional needs were met with expressed breast milk. Conclusion For incarcerated women, pumping and storing breast milk is a simple and uncomplicated way to promote maternal–infant attachment and improve health for mother and infant. Nurses working with mothers who are incarcerated have the opportunity to change the mothering experience for incarcerated mothers and their newborns.

Supporting Mothering Through Breastfeeding for Incarcerated Women

Newborn Care Poster Presentation Background More than 1 million women are under the control of the criminal justice system, representing the fastest growing group of prisoners. Women serving prison sentences most commonly have been convicted of drug‐related offenses followed by nonviolent crimes. It is estimated that 8% to 10% of women entering prison are pregnant. A disproportionally large number of women in prison have a history of physical or sexual abuse, substance abuse, and are mothers of minor children. Statistics indicate the average prison time for women is 12 months; therefore, on average, pregnant prisoners spend 6 to 12 months in prison after the birth of a child, a critical time period in the mothering experience. Breastfeeding offers immunological, developmental, and psychosocial benefits to mother and infant. Additionally, breastfeeding contributes to positive maternal self‐image and development of maternal–infant relationship. Currently, little is known about the experience of mothering while incarcerated or the benefits of breastfeeding in this population. Case A mother from a local jail delivered a term newborn at an urban medical center. Collaboratively the healthcare team, mother, father, and guards created a breastfeeding and pumping plan supporting the mothers desire to breastfeed. The newborn was discharged with the father who would pick up breast milk daily from the jail to feed the newborn. The jail agreed to allow the mother to pump in her cell and store milk in the medical unit refrigerator. At 10 days of age, the newborns nutritional needs were met with expressed breast milk. Conclusion For incarcerated women, pumping and storing breast milk is a simple and uncomplicated way to promote maternal–infant attachment and improve health for mother and infant. Nurses working with mothers who are incarcerated have the opportunity to change the mothering experience for incarcerated mothers and their newborns.