Mary C. Brucker

Management of the third stage of labor: an evidence-based approach

The third stage of labor usually is eclipsed by the excitement of the birth of a baby. Evidence shows that management of this stage can directly influence important maternal outcomes such as blood loss, need for manual removal of the placenta, and postpartum hemorrhage. Most of the large trials have compared active management of the third stage to expectant management. Active management includes routine use of cord traction and uterotonins, whereas expectant management can be characterized as one of watchful waiting. The use of herbal therapies and homeopathic remedies lack study; additional factors such as site of birth and hydrotherapy also remain to be explored. However, on the basis of current evidence, if a decrease in postpartum bleeding or avoidance of manual removal is desired, an active approach to third stage is the one that should be adopted until and unless contradictory findings are published.

Drugs Uterine Motility

Nurses who care for pregnant and laboring women are faced with an increasingly frequent use of pharmaceutical agents that facilitate initiation of labor (uterotropins), augment labor (uterotonics), or potentially stop labor (tocolytics). The choice of the drug, administration, side effects, and complications varies. Knowledge about uterine physiology helps the clinician understand the action of these agents. Knowledge of the differences and similarities among oxytoxics, ergots, prostaglandins, and the various drugs used as tocolytics is essential for safe and effective care of women and their fetuses who may be exposed to these agents.

The 2015 US Food and Drug Administration Pregnancy and Lactation Labeling Rule.

&NA; As of 2015, the US Food and Drug Administration (FDA) discontinued the pregnancy risk categories (ABCDX) that had been used to denote the putative safety of drugs for use among pregnant women. The ABCDX system has been replaced by the FDA Pregnancy and Lactation Labeling Rule (PLLR) that requires narrative text to describe risk information, clinical considerations, and background data for the drug. The new rule includes 3 overarching categories: 1) pregnancy, which includes labor and birth; 2) lactation; and 3) females and males of reproductive potential. This article reviews the key components of the PLLR and clinical implications, and provides resources for clinicians who prescribe drugs for women of reproductive age.

Mothering the world: improving global maternal health.

This editorial focuses on improving maternal health globally and the United Nations Millennium Development Goals specifically MDG 5 - maternal health. It provides the strategies for MDG 5 - management of preeclampsia postpartum hemorrhage and infection as well as training of traditional birth attendants and midwives. It concludes that maternal health is an integral component of a nations health and combined with child health comprises the most important health issues of a developing country.

Midwifery education today

Today, there are more than 7000 CNMs and CMs in the United States, who attend approximately 9% of American births annually in hospitals, birth centers, and homes. Midwives work in a variety of practice models, including group practices with physicians, HMOs, private practices, rural and urban community health centers, and large managed care organizations. CNMs and CMs also serve as administrators, policy makers, and consultants in international maternal and child health. Midwifery education has come a long way since 1931, when the first education program started. The dedication of CNMs to our clients and the midwifery model of care, as well as these midwifery educational innovations, will continue to support the professions goals of offering humane, holistic, and safe health care to women and their families.

Nurse-midwifery: yesterday, today, and tomorrow.

This article chronicles the dramatic changes in nurse-midwifery over the last 25 years. Presently, multiple models of midwifery education leading to certification exist, all within a competency-based framework. Accreditation of education programs and the certification process within nurse-midwifery remain examples to others. The consumer demand for certified nurse-midwives continues to rise, spurring the preparation for more professionals. However, the average woman in the United States still does not have access to a certified nurse-midwife/certified midwife for care. Several of the barriers to practice have been dismantled during the last quarter century; however, adequate reimbursement, relationships with various groups, and managed care are among the issues that will challenge midwifery in the new century.

Chorionic villus sampling: counseling your patient.

Chorionic villus sampling is a technique for prenatal genetic screening that has been widely publicized by the print and television media. Although not yet commonly available, women may seek additional information about the procedure from nurse practitioners. This article discusses the women for whom this procedure is most appropriate, the procedures accuracy, sampling techniques, safety records and the procedures accessibility and cost. The NPs role in counseling and anticipatory guidance is also discussed.

NEWS & OPINIONSLifelong Learning

Most Northwest Campus special interest courses are led by adjunct instructors. Adjuncts add great diversity to Northwest Campuss list of course offerings. Our adjuncts have taught courses on a wide range of topics, including ceramics, photography, watercolor, Microsoft Excel and Word, emergency medical services, first aid, snowmachine maintenance and repair, welding, edible and medicinal plants, and various languages.

Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk, 6th edition, Gerald G. Briggs, Roger K. Freeman, Sumner J. Yaffe. Lippincott Williams & Wilkins (2002), 1595 pages.

When patients are asking important questions about the effects of drugs on the foetus and newborn, this resource provides the practitioner with a reliable database and the answers to these critical questions. Since the publication of the first edition in 1983, this book has provided a quick, definitive reference to all the risks and benefits of medications used during pregnancy and lactation. This classic reference is available in an edition that is fully revised and easy-to-use. The authors have carefully evaluated the available research for you, focusing on human rather than animal data to establish risk factors for over 500 drugs, including information on drugs such as marijuana, Cocaine, Valproic acid, amphetamines, cardiac drugs, anthelmics and much more. Easy and accessible format; each drug is concisely described and divided into sections which list its generic name and pharmacological class.

110.00, hardcover

ABUSE AND VIOLENCE .......................................... 2 DELAWARE’S 24 HOUR DOMESTIC VIOLENCE HOTLINES ............................................. 2 ADVOCACY & SUPPORT......................................... 2 ADOLESCENTS & YOUNG ADULTS ................... 3 ADOLESCENTS & YOUNG ADULTS-SEXUAL BEHAVIOR PROBLEMS ........................................... 4 ADULT CHILDREN OF DYSFUNCTIONAL FAMILIES (TREATMENT) ...................................... 4 AGING (HEALTHY AGING)................................... 7 CASE MANAGEMENT/SOCIAL WORK ............. 7 CERTIFICATION BOARDS .................................... 8 COMPASSION FATIGUE ......................................... 9 CO-OCCURRING MENTAL HEALTH AND SUBSTANCE USE CONDITIONS ....................... 10 COUNSELING ............................................................ 11 CRISIS INTERVENTION ...................................... 12 DSM-IV ......................................................................... 12 ENGAGING CONSUMERS .................................... 13 ETHICS ......................................................................... 13 ETHICS-SELF DISCLOSURE ............................... 14 FINANCIAL MANAGEMENT ................................ 14 GAMBLING .................................................................. 15 HOPE .............................................................................. 15 MENTAL FITNESS RESOURCES ........................ 16 MENTAL HEALTH RESOURCES: GENERAL . 17 MOTIVATIONAL INTERVIEWING MOTIVATIONAL ENHANCEMENT .................... 17 OBSESSIVE COMPULSIVE DISODER ............ 17 PEER SUPPORT SPECIALISTS.......................... 18 PERSONALITY DISORDERS............................... 19 PHARMACOLOGY: DEPENDENCY .................... 19 POST TRAUMATIC STRESS DISORDER ....... 20 PRIVATE PRACTICE ............................................... 20 PSYCHIATRIC REHABILITATION MODEL .. 20 RECOVERY .................................................................. 21 RELAPSE PREVENTION ........................................ 21 RESILIENCY ............................................................... 21 SUBSTANCE USE CONDITIONS ....................... 22 SUICIDE PREVENTION ........................................ 23 SYSTEMS OF CARE ................................................. 23 THERAPUETIC RELATIONSHIPS .................... 24 TRAUMA ....................................................................... 24 TRAUMATIZATION (VICARIOUS).................. 32 TREATMENT PLANNING ...................................... 33 WELLNESS RECOVERY ACTION PLAN ......... 33 Legal Disclaimer: The information and publications contained in the Resource List does not necessarily reflect the views or opinions of the Division of Mental Health and Substance Abuse or the Department of Health and Social Services, and should not be construed as such. Further, the Resource List is a compilation of information and is guided by the faculty of the Summer Institute. This Resource List, which is based upon input from this-year’s faculty, should not be considered to be comprehensive or all-inclusive.