The United States has long been a leader in protecting human health through environmental regulation. Since 2025, however, environmental deregulation has reversed or eliminated many air, land, water, and climate protections. This shift in federal policy has, and will continue to have, serious consequences for the health of pregnant women, infants, and children. In this article, we examine environmental regulatory changes since January 2025 and evaluate their current and potential effects on maternal, infant, and child health outcomes. We use Bardach’s eight-fold path to review major federal actions, including the revocation of the greenhouse gas endangerment findings, the weakening of toxic air pollution standards and their enforcement, and the rollback of environmental justice programs that directly address the disproportionate burden of environmental pollution on women, infants, and children in at-risk communities. We conclude with policy and practice recommendations to strengthen environmental health protections and safeguard maternal and child health amid ongoing deregulation.The purpose of this series is to critically examine emerging federal and state health policy changes and their implications for the health and well-being of women, childbearing families, and young children and to provide evidence-based analyses that inform the nurses who care for these populations. The author solicitation and preparation of each article are overseen by series coordinators Mindy B. Tinkle, PhD, RN, WHNP-BC, CNE, FAAN, associate professor, and Nick Edwardson, PhD, MS, associate professor, College of Nursing, University of New Mexico, Albuquerque, NM.
The author describes a list or national databases and registries that could be useful in OBGYN related research and quality improvement initiatives.
With 2024 as the hottest year on record and 2025 also a scorcher, the effects of extreme heat are felt by all of us but particularly those at higher risk, including pregnant women. Evidence on the consequences of extreme heat on maternal health and birth outcomes and the disproportionate burden of heat on communities of color and low-resourced communities is building. In this column, I review the research on the health effects of extreme heat; the need for systems-level mitigation strategies and the implications for research, policy, and practice. I conclude with information from professional organizations and the need for specific and actionable recommendations that address extreme heat.
OBJECTIVE:To increase the percentage of women with severe-range blood pressure during the perinatal period who are treated within 30 min from 25% to at least 50% within 8 weeks. DESIGN:Plan-Do-Study-Act model comprising four 2-week cycles with data-driven tests of change every cycle. SETTING:A high-volume, community, academic obstetric triage. PATIENTS:We conducted interventions with women identified at risk for or diagnosed with hypertensive disorder of pregnancy (N = 182). In addition, we surveyed a convenience sample of women (n = 30) about their understanding of hypertension care and maternity care staff (n = 39) about their knowledge of treatment for hypertensive disorders of pregnancy. INTERVENTION/MEASUREMENTS:We implemented two interventions: standardized screening for hypertensive disorders of pregnancy using a modified preeclampsia early recognition tool and an algorithm-based checklist for effective treatment for hypertensive disorders of pregnancy. We measured use and outcomes through chart review and analyzed data with descriptive statistics. RESULTS:After the intervention, the percentage of women treated within 30 min increased to 97%. Mean medication administration times decreased from 41.4 to 11.2 min (p < .001), which demonstrated a significant improvement in care. CONCLUSION:Standardized screening and care improved time to treatment among women with hypertensive disorders of pregnancy. This advanced practice nurse-led initiative is adaptable for widespread implementation.
OBJECTIVE:To describe attitudes about trauma-informed care among nurse and physician leaders in birthing hospitals. DESIGN:Descriptive, cross-sectional survey study. SETTING:In-person meeting in Maryland. PARTICIPANTS:Nurses (n = 23) and physicians (n = 7) who worked in leadership roles in birthing hospitals. METHODS:We administered a survey that included the Attitudes Related to Trauma-Informed Care (ARTIC-45) scale. We used descriptive statistics and analysis of variance to analyze the data. RESULTS:The mean ARTIC-45 score for participants was 5.52 (SD = 0.47, range = 4.00-6.43). The Underlying Causes of Problem Behavior and Symptoms of Trauma subscale had the lowest mean score (M = 5.04, SD = 0.74), and the System-wide Support for TIC subscale had the greatest variation (SD = 1.15, range = 1.8-7.0). CONCLUSION:Overall, participants had favorable attitudes toward trauma-informed care. The greatest variation in responses was related to attitudes about systems-level support for the provision of trauma-informed care. Organizational support of trauma-informed care is foundational to its provision; therefore, it is essential that health care leaders who work in birth settings recognize the root causes of trauma among their patient populations and critically assess existing systems and policies to ensure that trauma-informed care is consistently provided.
Long-standing mandates in the United States require universal ophthalmic prophylaxis with erythromycin for all neonates, although recent evidence has led to reconsideration of this practice. This intervention was originally adopted to prevent blindness caused by Neisseria gonorrhoeae (gonococcal ophthalmia neonatorum, GON) and Chlamydia trachomatis (chlamydial ophthalmia neonatorum, CON). Today, however, prenatal screening and treatment have rendered such infections rare at birth. Current population data indicate that GON is exceedingly uncommon in the United States and that erythromycin is ineffective at preventing CON. Moreover, issues regarding antimicrobial resistance, medication shortages, and early microbiome disruption call into question the rationale for maintaining this policy raise concerns that question the continued rationale for this policy. In this analysis, we integrate contemporary epidemiologic and policy evidence to support the conclusion that continuing universal prophylaxis provides minimal clinical benefit, exposes newborns to unnecessary antibiotics, and conflicts with modern principles of antibiotic stewardship. Risk-based prevention models already adopted in many high-income countries offer a safer and more evidence-aligned alternative. Nurses are uniquely positioned to lead this transition through patient education, antibiotic stewardship, and advocacy for evidence-based neonatal care.
Climate change has resulted in increased extreme weather events, including prolonged heat waves, extended wildfire regions and seasons, and more frequent hurricanes and flooding. These events create problems with access to health services, shelter, potable water, diminished air quality, and increased incidence of vector-borne disease that affect the health of pregnant women and families. Nurses caring for pregnant women must have the knowledge to identify and respond to climate change-related health risks. Nursing care related to heat, wildfires and wildfire smoke, hurricanes, and flooding must include accurate assessments and discharge planning that addresses women's health conditions within the context of environmental risks. The purpose of this article is to raise awareness of the clinical nursing care of pregnant women related to heat, wildfires, hurricanes, and flooding in the era of climate change.
OBJECTIVE:To identify and categorize components of the work system that obstetric nurses address using workarounds. DESIGN:Convergent parallel mixed methods. SETTING:Online survey distribution from September 7, 2024, to October 11, 2024, and virtual interviews from September 13, 2024, to November 20, 2024. PARTICIPANTS:Registered nurses (N = 168) who worked in antepartum, intrapartum, and postpartum settings who completed an online survey and a subset (n = 30) who participated in semistructured interviews. METHODS:We collected data for the quantitative arm using the Nursing Workarounds Instrument and categorized the results according to the Systems Engineering Initiative for Patient Safety (SEIPS) model using descriptive statistics. For the qualitative arm, we used semistructured interviews to obtain a more in-depth understanding of the use of workarounds. We securely recorded, transcribed, checked for accuracy, and coded interviews using content analysis and the SEIPS components as a deductive framework. We used Dedoose software for data analysis and developed a joint display to facilitate data integration and interpretation. RESULTS:Workarounds were most frequently related to the technology and tools component of the SEIPS model, and most participants (n = 133, 79.2%) reported that problems with technology interfered with their work. Participants described the need to "override" emergency medication systems through workarounds in the electronic medical record and at medication dispensing cabinets. However, nearly all participants reported a preference for following procedures when possible (n = 163, 97.0%). CONCLUSION:Participants innovated and implemented workarounds as adaptive responses to operational failures. Quality improvement efforts to improve the work system could reduce the need for workarounds during patient care.
OBJECTIVE:To identify risk factors associated with inadequate and excessive gestational weight gain (GWG) among nurses in Korea. DESIGN:Secondary analysis of data from the Korea Nurses' Health Study, a nationwide prospective cohort study. SETTING:Online surveys distributed from 2014 to 2023 in Korea. PARTICIPANTS:Nurses (N = 296) who gave birth in the past year. METHODS:We categorized GWG using guidelines from the Institute of Medicine and conducted bivariate and logistic regression analyses to identify factors associated with inadequate and excessive GWG. RESULTS:Among participants, 40.2% had inadequate GWG, 36.1% had adequate GWG, and 23.7% had excessive GWG. We found significant differences in GWG based on pre-pregnancy body mass index (BMI) and weekly overtime hours worked. As age increased, the odds of excessive GWG decreased (odds ratio (OR) = 0.89, 95% confidence interval (CI) [0.79, 0.99]), whereas higher levels of fatigue were associated with increased odds (OR = 1.08, 95% CI [1.01, 1.15]) of excessive GWC. CONCLUSION:Our study suggests that health care providers should consider ethnicity, pre-pregnancy BMI, overtime work hours, age, and fatigue levels when educating and caring for pregnant nurses. Although the findings reflect a specific maternal population of Korean nurses, they may inform care for similar working women. We recommend that information about GWG be incorporated into prenatal education, visits, checklists, and counseling for women who are pregnant or planning to become pregnant.
OBJECTIVE:To estimate the frequency of racial/ethnic and gender discrimination and lack of a regular source of care in the postpartum period and to examine how these factors were related to health and stress in the postpartum period. DESIGN:Cross-sectional survey study. SETTING:Online research panels in the United States. PARTICIPANTS:Survey respondents (N = 427: 424 women, 1 transgender man, 1 non-binary individual, and 1 individual for whom gender was missing). METHODS:Equity items included racial/ethnic discrimination, gender discrimination, and lack of a regular care source. Health outcomes included a global measure of physical and mental health, perceived stress, and postpartum-specific stress. We analyzed the data using correlational and hierarchical regression analyses adjusted for covariates. RESULTS:Racial/ethnic discrimination was reported by 15.2% of respondents, gender discrimination was reported by 45.9% of respondents, and lack of a regular source of care was reported by 13.8% of respondents. After adjusting for covariates, equity factors accounted for 1.8% of the variance in physical health (p < .05), 3.4% in mental health (p = .001), 5.0% in perceived stress (p < .001), and 7.8% in postpartum-specific stress (p < .001). The only significant equity factor significantly associated with physical and mental outcomes was gender discrimination. CONCLUSION:Nearly half of respondents reported that they experienced gender discrimination. Gender discrimination was significantly related to worse health and higher stress. Nurses can aid women in dealing with gender discrimination by providing information about rights and resources.
In this report, we describe the case of a newborn with a rare neonatal infection caused by Citrobacter koseri, which followed a fulminant course. Unfortunately, despite prompt initiation of the sepsis treatment protocol by the health care team, the newborn developed significant complications that affected the central nervous system. As a result, palliative care was instituted, and brain death was declared on the 12th day of life, 6 days after the onset of the first symptoms of the infection. We discuss the epidemiology of C. koseri infection; the therapeutic management of sepsis, including the role of the nurse; and the ethical considerations involved in clinical decision-making. We present this case to encourage reflection on strategies to detect subtle signs of infection and respond early in a critical effort to prevent severe complications.
Exposure to wildfire smoke is a critical environmental health concern, and the potential negative health effects of exposure on vulnerable populations such as pregnant women, infants, and children urgently requires attention. Climate change is leading to increased wildfire frequency and intensity and a prolonged and less predictable wildfire season, resulting in negative effects on air quality and health. It is critical that nurses understand the relationship between the environment and health and are equipped with the training and resources necessary to address it. Because environmental health topics are not commonly incorporated into standard nursing curricula, the aim of this article is to address this knowledge gap, provide evidence-based information, and offer practical tools and guidance that can be shared with patients and families.
OBJECTIVE:To examine the effect of experiencing a TeamBirth huddle during labor on patient trust and autonomy in decision-making during childbirth in Oklahoma. DESIGN:A cross-sectional survey with a two-group comparison. SETTING:Hospitals in Oklahoma at which patients gave birth between March 2022 and June 2024. PARTICIPANTS:Patients who were 15 years and older and had live births (N = 6,528). METHODS:We surveyed participants who gave birth at participating hospitals on their demographic and clinical characteristics, experience with TeamBirth huddles, and responses to the Health Care Relationship Trust Scale-Revised (HCRTS-R) and the My Autonomy in Decision-Making (MADM) scale. We used descriptive analyses to compare participant characteristics by receipt of a TeamBirth huddle during labor and robust multivariable linear regression models to assess the association between TeamBirth exposure and HCRTS-R and MADM scores. We performed subgroup analyses to explore variations in scores among racial and ethnic groups. RESULTS:Participants who were exposed to TeamBirth huddles during labor exhibited significantly higher mean HCRTS-R (b = 1.81, p < .001) and MADM scale (b = 2.59, p < .001) scores than those who were not exposed. Across all racial and ethnic groups, participants who experienced TeamBirth huddles during labor had elevated trust and autonomy scores, and exposure to huddles reduced variations in scores across groups. CONCLUSION:Experiencing a TeamBirth huddle during labor was associated with increased patient trust and autonomy scores in our study, which suggests its potential to improve equity, patient outcomes, and childbirth experiences.
Numerous drugs used to treat cancer and other conditions, such as lupus and rheumatoid arthritis, are teratogenic and can cause fertility impairment and reproductive toxicity; therefore, they are considered hazardous. Researchers have found that health care workers (HCWs) who are exposed to hazardous drugs on the job are at increased risk for adverse reproductive outcomes, and breastfeeding infants can be exposed to hazardous drugs through breast milk. As more of these drugs are administered, and as their use expands beyond oncology settings to long-term care facilities and the home, increased awareness of the risks they pose to HCWs is needed. In this critical commentary, we review what is known about adverse reproductive outcomes of occupational exposure to hazardous drugs, describe sources of exposure, and suggest strategies to minimize exposure.
OBJECTIVE:To explore the effect of work-related stress on women who experienced miscarriage during the COVID-19 pandemic. DESIGN:Secondary qualitative analysis using a qualitative descriptive approach. SETTING:Participants completed interviews virtually or face to face in North Carolina in 2022. PARTICIPANTS:Thirteen women who experienced miscarriage from March 30, 2020, to February 24, 2021, during recommended and mandated stay-at-home orders, and discussed work-related stress. METHODS:We used qualitative data from a primary study. We analyzed semistructured interviews using inductive content analysis with first- and second-cycle coding. After finalizing the themes, we applied the theory of transactional stress and coping deductively as an interpretive lens to contextualize the findings. RESULTS:Four themes emerged: Difficulties Maintaining Work-Life Balance, Inadequate Workplace Accommodations, Varying Levels of Workplace Social Support, and Compounded Pressures of Miscarriage and Pandemic-Related Stress. Struggles with work-life balance, inadequate work accommodations, and limited workplace social support led to additional emotional distress and impaired work performance, and they prompted changes in employment status. CONCLUSION:Our findings underscore the need for comprehensive workplace policies and interventions that support women's unique needs after miscarriage, particularly during crises. Practical recommendations include flexible work schedules, paid leave, and mental health resources.
OBJECTIVE:To examine associations between prenatal wildfire smoke exposure and neonatal outcomes. DESIGN:Population-based retrospective analysis. SETTING:Washington State. PARTICIPANTS:Data from 526,649 live births between 2010 and 2018. METHODS:We used pooled cross-sectional birth records data with computed number of wildfire smoke days to examine effects of prenatal exposure on gestational age at birth, birth weight, Apgar scores, and NICU admissions using regression analysis. RESULTS:We found small increases in gestational age with wildfire smoke exposure in trimester 1 (B = 0.003, 95% CI [.003, .004], p < .001), trimester 3 (B = 0.011, 95% CI [.011, .012], p < .001), and across pregnancy (B = 0.003, 95% CI [.003, .004], p < .001), and a small decrease in trimester 2 (B = -0.002, 95% CI [-.002, .002], p < .001). We observed small increases in birth weight with exposure in trimester 2 (B = 0.303, 95% CI [.201, .405], p < .001) and across pregnancy (B = 0.148, 95% CI = [.086, .210], p < .001). No differences were found for Apgar scores. Finally, we found a 0.003% increase in NICU admissions with exposure in trimesters 1 and 2 (OR = 1.00, 95% CI [1.002, 1.004], [1.001,1.004], respectively) and a 0.002% increase with exposure across pregnancy (OR = 1.002, 95% CI [1.001, 1.003]). CONCLUSION:Prenatal exposure to wildfire smoke had limited effects on neonatal outcomes. Although associations with gestational age and birth weight aligned with prior studies, our findings were not clinically meaningful.
OBJECTIVE:To examine the relationships among years of experience and attitudes about birth among labor and delivery nurses and their individual cesarean rates for women with low-risk pregnancies. DESIGN:Non-experimental correlational study. SETTING:One large academic medical center in the northeastern United States. PARTICIPANTS:Labor and delivery nurses (N = 68). METHODS:We collected data through a one-time online survey that included a demographic questionnaire and the Nurse Attitudes and Beliefs Questionnaire-Revised. We measured years of overall registered nursing experience, labor and delivery experience, and experience on the unit and calculated cesarean rates using data from retrospective chart reviews of women with low-risk pregnancies (nulliparous, term, singleton, vertex; NTSV) whose births were attended by participants. We used descriptive statistics and chi-square tests with calculated odds ratios and confidence intervals for the analyses and compared rates above and below the median threshold. RESULTS:Nurse cesarean rates for women with NTSV pregnancies ranged from 2% to 46%. Nurses with more years of work experience as registered nurses, in labor and delivery, and on their current units had greater odds of lower cesarean rates (≤24%) than those with less work experience. In addition, participants who worked the day shift, served as charge nurses, or held part-time or per-diem positions had greater odds of lower cesarean rates (≤24%) than those who worked the night shift, were not in charge nurse roles, or worked full-time. We found no significant correlation between attitudes about birth and nurse cesarean rates. CONCLUSION:Our results suggest that increased years of nursing experience could be correlated with lower cesarean rates for women with low-risk pregnancies. Further research with larger samples is warranted to better understand the effect of nursing experience and to explore additional contributing factors.
OBJECTIVES:To quantify maternal sleep during the 24 hours before hospital discharge after childbirth and to identify and describe the antecedents and contexts of waking. DESIGN:Secondary analysis of data from an observational video study. SETTING:Academic medical center in the southeastern United States. PARTICIPANTS:Fourteen women who gave birth. METHODS:We conducted a secondary analysis of video and audio recordings of inpatient postpartum care from a mixed-methods study conducted in 2020 by the Postnatal Patient Safety Learning Lab. We used a behavioral taxonomy to code 316.5 hours of sleep in 5-minute increments and waking context in the 24 hours before hospital discharge after childbirth. We developed case descriptions and visual case summaries to identify and describe the antecedents and contexts of waking. RESULTS:We found a median of 2.8 hours of total sleep (range, 50 minutes to 5.6 hours) per participant during the 24-hour observation period. Antecedents to waking included sounds from the newborn, companion, health care team member(s), or environment. Difficulty getting to sleep due to physical and emotional discomfort was common in the case studies. CONCLUSION:Total sleep and the antecedents and contexts of waking varied among participants. The low amount and fragmented nature of maternal sleep before hospital discharge highlights multiple opportunities to protect and promote sleep during inpatient care after childbirth. The hours leading up to hospital discharge are important for newborn feeding, recovery, and education about health warning signs.
In 2007, the Maternal-Fetal Medicine Units Network published a clinical calculator with a race-based correction factor that systematically lowered the predictive probability of a Black or Hispanic woman having a successful vaginal birth after cesarean (VBAC). The ensuing pushback that race is a social construct and not a biological factor led to the removal of race and ethnicity in the updated Maternal-Fetal Medicine Units Network VBAC calculator in 2021. In this column, I provide a brief overview of the inclusion of race in clinical algorithms and the development of VBAC calculators, evaluations of the calculators on VBACs by race and ethnicity, and the implications for research, practice, and policy. I conclude with information from professional organizations and the need for updating clinical guidelines to recommend health care systems and clinicians to adopt the revised VBAC calculator.
