Deborah S. Walker

Fetal alcohol spectrum disorders prevention: An exploratory study of women's use of, attitudes toward, and knowledge about alcohol

Purpose The incidence of fetal alcohol spectrum disorders (FASD) is increasing, even though it is 100% preventable. This study examined use of, knowledge about, and attitudes toward alcohol of women requesting emergency contraception (EC) and/or a pregnancy test, and evaluated whether a brief intervention would be effective in educating them about the risks of FASD. Data sources Fifty women from two outpatient clinics participated. Information was collected on demographic and personal health habits, alcohol use, and knowledge of and attitudes toward alcohol. As a brief intervention to increase knowledge about FASD, participants read a short pamphlet about the risks of alcohol exposure in pregnancy and then completed a post‐test questionnaire. Descriptive statistics, including means, standard deviations, and skewness, were calculated for all variables. Pearson correlations were computed to assess relationships between demographic/lifestyle variables and attitudes toward and knowledge about alcohol. Paired t‐tests were used to analyze the relationship between pretest and post‐test knowledge scores. Conclusions The majority of participants were single (76%), college educated (94%), and received EC at the clinic visit (60%). The average age was 24 years. Slightly over half (52%) reported drinking beer at least once a week, with one to six cans on occasion. Younger women expressed more tolerant attitudes toward alcohol use (p= .02) and drank significantly more beer on occasion (p= .015). Women who reported drinking alcohol when they last had sex were significantly (p= .017) less tolerant in their attitudes toward alcohol use. The intervention used in this study was effective in communicating knowledge about FASD to this population (p < .0001). Implications for practice These findings suggest that young women may be engaging in behaviors that could put potential offspring at risk for exposure to alcohol. Clinicians are advised to take a thorough history to determine alcohol use in all women of childbearing age and to provide information regarding FASD prevention.

EVALUATION OF A REDUCED-FREQUENCY PRENATAL VISIT SCHEDULE FOR LOW-RISK WOMEN AT A FREE-STANDING BIRTHING CENTER

OBJECTIVE to evaluate the effectiveness of a reduced-frequency prenatal visit schedule by comparing perinatal outcomes, anxiety and maternal satisfaction with prenatal care. METHODS pregnancy outcomes of infant and maternal morbidity and mortality, anxiety and satisfaction for 81 women receiving prenatal care at a free-standing birthing center according to either an alternative prenatal care visit schedule (APCVS) (n = 43) or the traditional prenatal care visit schedule (TPCVS) (n = 38) were examined in this prospective randomized study. Upon entry into prenatal care, all women were of low obstetrical risk status. RESULTS major findings revealed no significant differences in selected perinatal outcomes between the two study groups. Women in the APCVS group reported significantly higher levels of satisfaction than women in the TPCVS group on both the satisfaction with provider subscale (F = 5.74, P = .02) and the satisfaction with the prenatal care system subscale (F = 2.01, P = .04). There were no statistically significant differences found in anxiety scores between women in the two study groups. CONCLUSIONS low-risk women who followed the reduced-frequency visit schedule experienced no difference in perinatal outcomes or anxiety. Women in the reduced-frequency (APCVS) group reported an increased level of satisfaction with both provider and the prenatal care system.

Contemporary childbirth education models.

Since the 1960s, childbirth education advocates have attempted to persuade pregnant women that educational preparation for labor and birth is an essential component of the transition to motherhood. Initially, pregnant women who were seeking unmedicated births as a refuge from the inhumane childbirth treatments of the mid-20th century embraced this view. However, with the changing childbirth climate, including a growing preference for medicated birth, scheduled inductions, and cesarean sections, attendance has diminished and childbirth education finds itself at a crossroads. Commonly used childbirth education models/organizations and several new emerging models along with the available research literature and recommendations for clinical practice and research are presented.

Promoting Healthy Pregnancies Through Perinatal Groups: A Comparison of CenteringPregnancy® Group Prenatal Care and Childbirth Education Classes

CenteringPregnancy® group prenatal care is growing in popularity and has commonalities with childbirth education classes. In order for leaders of childbirth education classes to best serve their clients’ needs, it is important to be aware of new, emerging models of prenatal care such as CenteringPregnancy. This article provides an overview of CenteringPregnancy and similarities and differences between CenteringPregnancy and childbirth education classes. Providers of prenatal education, whether it is within CenteringPregnancy group prenatal care or in childbirth education classes, have a common important aim: promoting positive perinatal outcomes.

Evidence-based prenatal care visits: when less is more.

Traditionally, low-risk pregnant women in the United States who participate in prenatal care have been scheduled for approximately 14-16 prenatal visits, which is the schedule recommended by the American College of Obstetricians and Gynecologists. In 1989, an expert panel convened by the United States Department of Health and Human Services proposed a reduced frequency prenatal visit schedule for low-risk, healthy women based on the timing of specific tests or events that occur in pregnancy. Available evidence shows no adverse effect on maternal or neonatal outcomes for low-risk pregnant women who follow a reduced visit schedule, making it a highly important consideration for pregnant women and their health care providers. Other important aspects of prenatal care, especially related to adequacy and content, will be explored in-depth in a future segment of this series on evidence-based prenatal care.

Strategies for state statutory language changes granting fully independent nurse practitioner practice.

For nurse practitioners (NPs) to be considered as a critical component of health care reform, they must change their state statutes to permit independent practice. This can be accomplished by plenary prescriptive authority including controlled substances. This article provides a summary of NP scope of practice and prescriptive privileges to date, together with a discussion of the strong statutory language used by Alaska and New Mexico with regard to independent practice. Comparisons of model independent scope and prescriptive authority statutory language are discussed along with prevalent opposition arguments, appropriate practitioner titles, and an enumeration of strategies for effective lobbying.

Midwifery Data Collection: Options and Opportunities

Most midwives are aware of the need to collect clinical practice data and of its usefulness in supporting the care they provide, which contributes to healthy outcomes for mothers and babies. For the individual midwife, there is more than one easily accessible, standardized data collection instrument from which to choose. However, despite these choices, in an American College of Nurse-Midwives (ACNM) Division of Research (DOR) survey on midwifery clinical data collection (N = 263), the majority of member respondents (n = 135; 51%) reported using a self-designed data collection tool, and more than one-third did not know of the ACNM Nurse-Midwifery Clinical Data Sets (NMCDS). On a larger scale, the midwifery profession is also in need of an organized and consistent approach to data collection for the purpose of capturing midwifery practice and outcomes in order to provide data to support legislation, practice, and policy changes. However, the profession currently lacks a single common midwifery practice database. In order to facilitate data aggregation that captures a larger view of midwifery practice at the local, regional, and national levels, it is imperative that all midwives collect relevant data that are uniform and standardized, and that the midwifery professional organizations move forward with the development of a common electronic database. This article describes currently available data collection tools as well as their best uses, applications to practice, and future directions.

Improving the Quality of Life of African Americans Receiving Palliative Care

The purpose of this pilot study was to examine the effects of personal characteristics on quality of life (QOL) among African Americans receiving palliative care. Although an important goal of palliative care is to improve the client’s QOL, no studies were found examining the QOL of African Americans receiving palliative care. The study sample included African Americans receiving palliative care in inpatient settings or through enrollment in a hospice program. Data were collected using a structured interview guided by five questionnaires to measure QOL, physical performance, spirituality, social support, and family support/satisfaction. Data were analyzed using descriptive statistics, Pearson r correlation coefficients, and multiple regression analysis. The total sample (N = 16) was predominately single, female, and 50 to 59 years old. There was a significant relationship between QOL and religious and spiritual coping and between QOL and social support. Participant recruitment was a significant issue in this study.

Fetal alcohol spectrum disorders: Prevention, identification, and intervention

Fetal alcohol spectrum disorders (FASD) remain a common cause of intellectual disability in infants and children, with an estimated incidence of 9.1 out of every 1,000 U.S. live births. This article discusses methods for identifying and assisting women who consume alcohol prenatally and referring infants and children with FASD for intervention.