Megan W. Arbour

Postpartum fatigue and evidence-based interventions.

The aim of this article is to review postpartum fatigue, especially as it relates to the occurrence and pathophysiology of three common postpartum conditions known to contribute to fatigue: anemia, infection/inflammation, and thyroid dysfunction. Fatigue is an unrelenting condition that affects physical and mental health, and it has implications for everyday activities, motivation, and social interactions. Although individuals of all ages and both genders are at risk for developing fatigue, postpartum fatigue is particularly challenging, because the new mother has demanding life tasks to accomplish during this period of time. Postpartum fatigue may impact postpartum maternal role attainment and may place a woman at increased risk for postpartum depression. Although several treatable physiological conditions common during the postpartum period are known to increase fatigue, none of these conditions is a part of the usual assessment of healthy postpartum women. For many women, subtle fatigue may develop, linger or worsen, and even lead to depression, with both the woman and her care provider unaware.

Strategies to Promote Cultural Competence in Distance Education.

Cultural competence is a mainstay in health care and nursing education. With the expansion in the number of distance-based nursing programs across the country, innovative teaching methods for distance learning faculty are required to instill cultural competence in students. Faculty must be deliberate when planning distance-based learning activities that incorporate cultural experiences. This article describes several such strategies including the creative use of blogging, recorded lectures, the online synchronous classroom, social media, and cultural immersion projects. These methods capitalize on existing information technologies and offer distance-based students the opportunity to connect with one another, as well as develop the awareness, sensitivity, and respect that is required when providing culturally competent care. These teaching methods are modifiable to meet the teaching and learning needs of the faculty and the students, thereby allowing educators to support the integration of cultural competence into patient care for distance students.

Mammary Hypoplasia: Not Every Breast Can Produce Sufficient Milk

Breast milk is considered the optimal form of nutrition for newborn infants. Current recommendations are to breastfeed for 6 months. Not all women are able to breastfeed. Mammary hypoplasia is a primary cause of failed lactogenesis II, whereby the mother is unable to produce an adequate milk volume. Women with mammary hypoplasia often have normal hormone levels and innervation but lack sufficient glandular tissue to produce an adequate milk supply to sustain their infant. The etiology of this rare condition is unclear, although there are theories that refer to genetic predisposition and estrogenic environmental exposures in select agricultural environments. Women with mammary hypoplasia may not exhibit the typical breast changes associated with pregnancy and may fail to lactate postpartum. Breasts of women with mammary hypoplasia may be widely spaced (1.5 inches or greater), asymmetric, or tuberous in nature. Awareness of the history and clinical signs of mammary hypoplasia during the prenatal period and immediate postpartum increases the likelihood that women will receive the needed education and physical and emotional support and encouragement. Several medications and herbs demonstrate some efficacy in increasing breast milk production in women with mammary hypoplasia.

Racial differences in the health of childbearing-aged women.

The incidence of preterm birth in the United States varies by race/ethnicity and socioeconomic status. Given the unsatisfactory reduction in preterm birth with interventions directed at single risk factors, we examined the preconceptional health of childbearing-aged women of different racial/ethnic groups to understand the risk prior to pregnancy. PurposeTo evaluate the preconceptional health of childbearing-aged women by examining specific health factors implicated in preterm birth in light of racial/ethnic and socioeconomic factors. We tested the hypothesis that subgroups with historically high levels of preterm birth would have poorer preconceptional health compared to other groups and that the economic influence would be similar across groups. Study Design and MethodsWe performed a secondary analysis of cross-sectional population-based data from the National Health and Nutrition Examination Survey 2001–2002 and 2003–2004 data sets, including 1,497 of 2,108 eligible White, African American, and Mexican American women. We measured health using select indicators of cardiovascular and metabolic disorders, infectious disease, and sexual and substance-use behaviors associated with increased risk for preterm birth and conducted comparisons within and across racial groups. We used adjusted logistic regression by race. ResultsIn addition to increased rates of preterm birth shown in the literature, childbearing-aged African American women have poorer overall preconceptional health than the other groups. Measures of socioeconomic status affect preconceptional health differently for each racial/ethnic group. Clinical ImplicationsRacial/ethnic subgroups with higher rates of preterm birth experience poorer health preconceptionally. Clinicians should address preconceptional health risks for preterm birth in all childbearing-aged women, paying attention to racial/ethnic-specific risks identified here.

Identification of the Pregnant Woman Who Is Using Drugs: Implications for Perinatal and Neonatal Care

Neonatal abstinence syndrome (NAS) is a set of drug withdrawal symptoms that affect the central nervous, gastrointestinal, and respiratory systems in the newborn when separated from the placenta at birth. Maternal substance use of opioids, benzodiazepines, barbiturates, and alcohol can cause NAS. Universal drug screening via questioning pregnant women is recommended, but identification of drug use is incomplete with this method. This article provides resources for the identification and management of drug use during pregnancy for midwives who provide care not only during the prenatal period but also during the intrapartum and postpartum periods. The impact of drug use on newborns can be significant and may require pharmacologic assistance with the transition to extrauterine life. Challenges involved in caring for the woman who is using drugs during pregnancy include ordering toxicology screens on the newborn, alerting social services, and educating the woman about her newborns progress. Several measures to comfort a newborn with NAS may help to enable a mother to provide the best care for her newborn.

Preconception Care: Improving the Health of Women and Families

Approximately 50% of the pregnancies in the United States are unintended. Most pregnancies are not diagnosed until after the period of organogenesis. Environmental exposures, chronic and acute illnesses, and ingestion of teratogens that can negatively affect the fetus may occur during these early weeks of pregnancy. Some chronic disease effects and lifestyle behaviors that affect the fetus can be adjusted prior to conception. Because of this, the health of a woman and her partner prior to pregnancy are of utmost importance. The Centers for Disease Control and Prevention and the Preconception Health and Health Care Initiative have established goals and evidence-based guidelines for preconception care. Preconception health care can be threaded into every visit with all women of reproductive age who are not pregnant. The guidelines focus on 3 main areas: screening, health promotion, and interventions. Screening is accomplished with women and couples via a thorough history and assessment of risks including a reproductive life plan; assessment of tobacco, alcohol and drug use; sexually transmitted infection (STI) testing and education; and assessment of environmental or teratogenic risk factors. Health promotion includes making sure the woman is current with regard to recommended vaccines, taking appropriate levels of folic acid, and maintaining a healthy weight and level of physical activity. The health care provider can intervene when indicated with management of chronic and acute illnesses, as well as provide assistance with tobacco, alcohol, and drug cessation as necessary. When a woman and her partner are healthy prior to pregnancy, unintended or planned, the woman and her fetus have a better chance at a healthy gestation and beyond. This article, via the use of case presentations, reviews how preconception health can be integrated into an office visit.

Innovative Uses of Technology in Online Midwifery Education

Womens health care in the United States is at a critical juncture. There is increased demand for primary care providers, including womens health specialists such as certified nurse-midwives/certified midwives, womens health nurse practitioners, and obstetrician-gynecologists, yet shortages in numbers of these providers are expected. This deficit in the number of womens health care providers could have adverse consequences for women and their newborns when women have to travel long distances to access maternity health care. Online education using innovative technologies and evidence-based teaching and learning strategies have the potential to increase the number of health care providers in several disciplines, including midwifery. This article reviews 3 innovative uses of online platforms for midwifery education: virtual classrooms, unfolding case studies, and online return demonstrations of clinical skills. These examples of innovative teaching strategies can promote critical and creative thinking and enhance competence in skills. Their use in online education can help enhance the student experience. More students, including those who live in rural and underserved regions and who otherwise might be unable to attend a traditional onsite campus, are provided the opportunity to complete quality midwifery education through online programs, which in turn may help expand the womens health care provider workforce. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.

Douching Patterns in Women Related to Socioeconomic and Racial/Ethnic Characteristics

OBJECTIVE To examine whether socioeconomic and racial/ethnic characteristics contribute independently and in combination to influence douching behavior. DESIGN A cross-sectional design. SETTING United States. PARTICIPANTS Women between 14 and 49 years of age who were both interviewed and examined as part of the National Health and Nutrition Examination Survey data collection process. MAIN OUTCOME MEASURES Douching rates in women categorized on socioeconomic and racial and ethnic characteristics. RESULTS Based on data from 3,522 women, 21% reported recent douching. Separated by race, Black women douche at much higher percentage (47%) than non-Hispanic White (17%), Mexico-born Mexican American women (12.5%), or U.S.-born Mexican American women (19%). Although increasing age and low socioeconomic status are both associated with increased douching, the effects of socioeconomic status on douching vary by race/ethnicity. CONCLUSIONS Low income and minority racial status contribute both independently and together to influence douching behavior in women. These findings suggest cultural contributions to douching may be especially prevalent in the Black population while Mexican American women born in Mexico may be relatively immune to U.S. cultural influences.

Evidence-based nurse-driven interventions for the care of newborns with neonatal abstinence syndrome.

Neonatal abstinence syndrome (NAS) is a growing problem in the United States, related to increased maternal substance use and abuse, and a set of drug withdrawal symptoms that can affect the central nervous system and gastrointestinal and respiratory systems in the newborn when separated from the placenta at birth. Infants with NAS often require a significant length of stay in the neonatal intensive care unit (NICU). Pharmacologic treatments and physician-directed interventions are well researched, but nursing-specific interventions and recommendations are lacking. A thorough review and analysis of the literature and interviews with neonatal experts guided the development of a nursing clinical practice guideline for infants with NAS in a level IV NICU. Recommended nursing-specific interventions include methods for maternal drug-use identification, initiation and timing of the Finnegan Scoring System to monitor withdrawal symptoms, and bedside interventions to lessen the drug-withdrawal symptoms in the newborn with NAS.

Educational Strategies to Help Students Provide Respectful Sexual and Reproductive Health Care for Lesbian, Gay, Bisexual, and Transgender Persons

Graduate medical, nursing, and midwifery curricula often have limited amounts of time to focus on issues related to cultural competency in clinical practice, and respectful sexual and reproductive health care for all individuals in particular. Respectful health care that addresses sexual and reproductive concerns is a right for everyone, including those who self-identify as lesbian, gay, bisexual, or transgender (LGBT). LGBT persons have unique reproductive health care needs as well as increased risks for poor health outcomes. Both the World Health Organization and Healthy People 2020 identified the poor health of LGBT persons as an area for improvement. A lack of educational resources as well as few student clinical experiences with an LGBT population may be barriers to providing respectful sexual and reproductive health care to LGBT persons. This article offers didactic educational strategies for midwifery and graduate nursing education programs that may result in reducing barriers to the provision of respectful sexual and reproductive health care for LGBT clients. Specific ideas for implementation are discussed in detail. In addition to what is presented here, other educational strategies and clinical experiences may help to support students for caring for LGBT persons prior to entrance into clinical practice.