Margaret W. Beal

Women’s use of complementary and alternative therapies in reproductive health care

Numerous studies have documented that health care consumers all over the world are spending money out of pocket for alternative therapies and that billions of dollars are spent in the United States alone. In this article, the use of complementary and alternative therapies by women health care consumers is discussed, particularly as this phenomenon relates to womens reproductive health in the United States. Women use conventional health care services more frequently than men; thus, it is not surprising that women account for approximately two thirds of health care appointments for complementary and alternative therapies. The traditional conceptual frameworks of herbal medicine, homeopathy, acupuncture, and acupressure are presented, and common clinical applications to womens reproductive care are discussed.

Implanon: a review of the literature with recommendations for clinical management.

Implanon is a new implantable, progestin-only contraceptive which was approved in the United States in July 2006. Implanon is comprised of a single ethylene vinylacetate copolymer rod that is 4 cm long and 2 mm in diameter. It is inserted subdermally in the groove between the biceps and triceps of the nondominant arm. A literature review was conducted and side effects are discussed. Implanon offers promise as a high-efficacy, long-term contraceptive and can enhance the contraceptive options offered by the womens health care providers. Clinical trial data indicate that the device is both safe and effective.

Acupuncture and related treatment modalities: Part II: Applications to antepartal and intrapartal care

The application of acupuncture, moxibustion, acupressure, and shiatsu to antepartal and intrapartal care are discussed. Information on therapeutic interventions as described in textbooks is presented and compared with specific treatments evaluated in research studies. Specific clinical indications addressed include nausea during pregnancy, repositioning of the fetus in breech position, stimulation of contractions and true labor, and pain relief in labor. Qualifications for practitioners and recommendations for certified nurse-midwives caring for clients seeking referral for these services are discussed.

The Role of Exercise in the Prevention and Treatment of Wasting in Acquired Immune Deficiency Syndrome

Involuntary weight loss with lean tissue depletion is a serious and AIDS-defining complication of HIV infection. This article explores definitions of AIDS wasting syndrome (AWS), its etiology, methods of assessing body composition, and pharmacological treatments. Recent research literature on the role of exercise in the prevention and treatment of AWS is reviewed. Included are studies of the safety of exercise, the effects of exercise on the immune system, and the effects of exercise on weight gain and body composition as well as studies of exercise in combination with medications and other interventions. Implications for clinical practice are discussed.

NURSE-MIDWIFERY INTRAPARTUM MANAGEMENT

A retrospective chart review was done to identify differences between nurse-midwifery (CNM) and medical intrapartum management. Eighty-five subjects were admitted to the hospital in labor at term with no history of medical or obstetrical complications. The clinic call schedule provided nonpurposeful assignment of such patients to either CNM or medical management. Age, gravidity, parity, and admission, and admission hematocrit values were similar in both groups. Major differences in management were less routine use of electronic monitoring and intravenous fluids and smaller doses of pain medication in the CNM group. The incidence of amniotomy and pitocin augmentation of labor was similar in the two groups, although amniotomies were performed later in labor by the CNMs. CNM management included a higher frequency of spontaneous vaginal delivery performed under local or no anesthesia, and a lower incidence of instrument-assisted vaginal delivery, epidural anesthesia, episiotomy, and lacerations. Except for a shorter mean second stage in the CNM group, length of labor and length of hospitalization during labor were similar in two groups, as were infant Apgar scores. Implications for parturients, cost-effectiveness, and health care planning are discussed.

Acupuncture and related treatment modalities. Part I: Theoretical background.

The application of acupuncture, moxibustion, acupressure, and shiatsu to antepartal and intrapartal care are discussed. Information on therapeutic interventions as described in textbooks is presented and compared with specific treatments evaluated in research studies. Specific clinical indications addressed include nausea during pregnancy, repositioning of the fetus in breech position, stimulation of contractions and true labor, and pain relief in labor. Qualifications for practitioners and recommendations for certified nurse-midwives caring for clients seeking referral for these services are discussed.

CLINICAL USES OF MIFEPRISTONE: AN UPDATE FOR WOMEN'S HEALTH PRACTITIONERS

In September 2000, the U.S. Food and Drug Administration (FDA) approved the use of mifepristone for the provision of medical abortion. Although mifepristone was developed and marketed because of its potential to effect early first-trimester medical abortion, it has additional applications to health care, including the treatment of gynecologic conditions, cancer, and Cushings disease. The controversial nature of abortion has dominated the publicity about mifepristone. The evidence for the safety and efficacy of mifepristone in medical abortion has been overshadowed, and many clinicians are unaware of the other potential uses of the drug. This article provides a discussion of background information on the pharmacology, development of, and research on mifepristone and an update on current and potential uses in health care today. Information on the FDA-approved regimen and alternative protocols for management of mifepristone in its use in abortion care are presented.

Homeopathy and Women's Health Care

A 1997 survey revealed that 40% of Americans use some type of complementary therapy or medicine and that many use such therapies in conjunction with treatments prescribed to them by conventional medical practitioners. One alternative modality that is growing in popularity is homeopathy. Although use of this modality is growing, many health care providers know very little about it. This article provides an introduction to homeopathy, including its historical origins and theoretical principles. Also included is a review of two meta-analyses that examined the efficacy of homeopathy in clinical trials. The homeopathic approach to prolonged pregnancy is presented as an example of a potential application to womens health. Information on education and certification in homeopathy is provided, along with resources on homeopathy available to womens health care providers. Implications for nursing practice are discussed.

Preventing Perinatal Transmission of HIV: An Evidence-Based Update For Midwives

This article presents an update on human immunodeficiency virus care in the United States, with an emphasis on care during pregnancy and strategies to prevent perinatal transmission. Common drug regimens are reviewed. Obstetric factors related to transmission, such as mode of delivery, also are discussed. Guidelines for collaboration between midwives and human immunodeficiency virus specialists are outlined.

Understanding Cervical Cytology

Nurse practitioners and nurse midwives perform Pap smears routinely as a part of well-woman health care. However, the clinician may not understand the terminology used to express the results of the test or the rationale for strict adherence to correct technique. Information on basic histology and cytology is presented with the goal of helping the clinician understand what the cytologist is looking for and what the results from a Pap smear mean. Two sets of nomenclature for results are presented. Risk factors for development of cancerous and precancerous conditions of the cervix and the controversy regarding frequency of Pap smear sampling are discussed, as are guidelines for treatment and referral of women with class II Pap smears.