OBJECTIVE:Cervical cancer remains a significant U.S. health concern, with more than 13,000 new cases expected in 2025. Suboptimal screening rates remain a concern, especially among underserved patients often missing appointments. This quality improvement project piloted a cervical health facilitator (c-HF) role to address barriers to follow-up after abnormal cervical cancer screening results. DESIGN:A posttest design to evaluate the impact of a dedicated c-HF on patient participation in recommended follow-up care. SETTING/LOCAL PROBLEM:The pilot took place at a high-volume women's health clinic contending with long clinic wait times and patients who often face barriers to care. PARTICIPANTS:Seventy-five new and established patients, ages 21 to 65 years, with a cervix and a recent abnormal cervical cancer screening result. INTERVENTION/MEASUREMENTS:From October 2025 to January 2026, the c-HF conducted electronic medical record queries, standardized outreach, and offered follow-up visits each week. Data from the electronic medical record, visit logs, and outreach records were analyzed, measuring time to outreach, time to scheduled visit, visit completion, and visit duration by clinician. RESULTS:Patients with existing diagnoses experienced slower outreach, inefficiency in scheduling, and lower completion rates. Ninety-eight percent of patients with low-grade findings were reached, and 29% completed visits on time compared to 100% and 41% with high-grade findings, respectively. Clinic wait times were 67% shorter with c-HF support. Overall, 45.3% of patients completed follow-up, 33% within 45 days. CONCLUSION:The c-HF model improves outreach, scheduling efficiency, and timely follow-up while reducing visit duration. Simple to implement, the role enhances patient engagement and clinician support, as well as patient-centered cervical cancer prevention.
OBJECTIVE:To explore pregnant women's and obstetricians' experiences with a nurse-led digital newsletter and its perceived value as a complement to routine prenatal care. DESIGN:Descriptive qualitative study. SETTING:Department of obstetrics and gynecology of a tertiary hospital in the Madrid region of Spain. PARTICIPANTS:Seventeen pregnant women enrolled in the digital newsletter program, with nine obstetricians providing prenatal care at the participating hospital. METHODS:Semi-structured in-depth interviews were conducted using criterion-based purposive sampling. Data were analyzed using inductive thematic analysis following Braun and Clarke. RESULTS:Three main themes emerged: Accessing trustworthy and timely information, Preparing for routine prenatal visits and shared understanding, and Perceived continuity ofsupport and added value to the prenatal care experience. Women described the week-by-week evidence-based information as helping them feel better informed and less uncertain throughout pregnancy. Obstetricians perceived that the newsletter helped address predictable informational needs and supported women in attending routine prenatal visits better prepared and with more focused questions. CONCLUSION:A nurse-led digital prenatal newsletter was perceived as a valuable complement to routine prenatal care, supporting women's sense of preparation and continuity throughout pregnancy. These findings suggest that nurse-led digital education may support women's experience of care, although they do not establish clinical effectiveness or organizational impact.
Objective To explore the implementation of a birth preferences worksheet to facilitate shared decision-making during prenatal and intrapartum care. Design Cross-sectional, descriptive study. Setting University-affiliated hospital in an urban setting. Participants Postpartum people, physicians, certified nurse-midwives, and nurses. Methods This is a cross-sectional study of implementation of a birth preferences worksheet. Both patients and providers are included. Postpartum patients were recruited on the inpatient unit and completed a survey before hospital discharge. Clinicians included nurses, midwives, and physicians on the birthing unit. A separate survey was developed for clinicians. Results There were 81 participants in the study sample: 36 patients and 45 clinicians. Fifty percent of patient participants (n = 18) completed the birth preferences worksheet during prenatal care, and 36% (n = 13) completed it in the hospital. Ninety-two percent of patient participants (n = 33) stated that the health care team in the hospital reviewed their birth preferences with them, and all agreed that the worksheet provided clear information. Sixty-eight percent of clinician respondents (19 of 28) agreed that they understood why the birth preferences worksheet was introduced. Forty-seven percent of clinicians (18 of 38) reported integrating the worksheet into their practice, and 40% (8 of 20) stated they use it with all their prenatal encounters. Barriers to implementation included time constraints, difficulty accessing the worksheet, trouble remembering that it was available, and the inability to edit the worksheet after patient encounters. Conclusion Birth preferences worksheets are a promising intervention that should be considered part of routine perinatal care. For new practices, repeated implementation strategies are necessary for successful uptake by patients and providers. By identifying barriers and facilitators to implementation, this study contributes to a deeper understanding of how to approach implementation and strengthen shared decision-making in maternity care settings.
The pharmacologic management of spontaneous abortion with misoprostol is a clinically essential, evidence-based intervention. However, the conflation of "spontaneous abortion" and "medically induced abortion" in political discourse, lay media, and emerging legislation threatens access to this medication for persons experiencing pregnancy loss. Failure to correct this conflation risks regulatory and prescribing barriers that could result in serious maternal harm, including retained products of conception leading to hemorrhage and sepsis. Nurses, positioned at the front line of reproductive and perinatal health, are professionally obligated to lead clear, evidence-based communication that distinguishes these two unique clinical indications. Abortion bans may increase pregnancy-associated deaths and second-trimester sepsis rates among patients experiencing pregnancy loss. Nurses must engage in clinical advocacy, patient education, and policy dialogue to safeguard pharmaceutical access and protect maternal health outcomes.
A nurse reflects on the doula-like support they provided to a colleague during advanced cardiac life support recertification.
OBJECTIVE:To investigate early postpartum (6-hr) lactate levels for both vaginal and cesarean births. Secondarily, to correlate the length of both stages of labor, active and second stage, with postpartum lactate levels for people with a vaginal birth. DESIGN:Prospective observational cohort study. SETTING:Urban, level 3, nonacademic medical center with more than 5,000 births per year. PARTICIPANTS:Convenience sample of 50 healthy, uninfected full-term peripartum individuals who had no pregnancy complications. METHODS:Two cohorts were observed at two time periods. Participants in Cohort A were scheduled for an induction of labor and Cohort B for cesarean birth. Venous lactate levels were collected on admission (baseline) and at 6 hr postpartum. RESULTS:The mean early postpartum (6-hr) lactate level for all participants was 1.3 mmol/L (SD = 0.38 mmol/L). Forty-four of 48 retained individuals (92%) had mean lactate levels of 2 mmol/L or less at 6 hr postpartum. Four outliers (false positives) were observed, two in each cohort. For Cohort A, the length of active labor accounted for only 4% of the variance in postpartum lactate levels, and the length of the second stage of labor accounted for 22% of the variance. CONCLUSION:Lactate level in early postpartum is often elevated above prelabor reference ranges. Clinicians could benefit from knowing when postpartum lactate is minimally influenced by childbirth. This evidence supports that the physiologic effects of labor are minimal at 6 hr postpartum, thus clinically useful. Current obstetric sepsis guidelines encourage early postpartum lactate levels to be collected on patients who screen positive for a serious infection and to reevaluate every 3 to 4 hr until vital signs and lactate level are normal. Lactate can be used to measure the severity of infection/sepsis and to trend the success of treatment measures.
The U.S. Department of Education has excluded graduate nursing programs from the professional designation, thereby restricting access to federal loan funding.
A nurse's commitment to prioritizing compassionate, patient-centered care during traumatic medical events fosters an environment where patients feel seen, supported, and respected.
OBJECTIVE:To examine the effects of preeclampsia on birth perception and postpartum depression (PPD) among women with infants admitted into a NICU. DESIGN:A cross-sectional, descriptive study. SETTING:An online platform recruited participants across the United States. PARTICIPANTS:Of 877 participants, 367 reported preeclampsia with current/past infants in the NICU. METHODS:Participants took part via an online researcher-developed website. They rated their perception of birth and completed the Edinburgh Postnatal Depression Scale. Descriptive statistics revealed characteristics of the sample. Linear regression examined relationships between the variables and the predictive ability of preeclampsia and mental health. RESULTS:A high number of women reported preeclampsia and past or current depression. Significant relationships between preeclampsia, birth perception, gestational age, and birth mode were found. Regression analysis revealed preeclampsia to have significant but little effect (1.7% variance) on birth perception and a nonsignificant effect on PPD. Additional analysis showed that gestational age, birth mode, and PPD together explained 18.9% of the variance for birth perception, and birth perception explained 4.8% of the variance for PPD. CONCLUSION:Little noted variance implies that many other factors impact birth perception and PPD other than preeclampsia, thus additional research is suggested. However, noted relationships can help guide necessary assessments, inquiries, and education. For high-risk women, a more positive birth perception and the best mental and physical health outcomes can be promoted via an interdisciplinary team of maternal-child health, mental health, and medical providers for immediate and follow-up assessments and monitoring.
Prenatal genetic testing provides families with critical information regarding fetal genetic disorders and structural anomalies. As testing options expand, nurses must navigate a range of complex clinical, ethical, and systemic considerations that shape how tests are selected, conducted, and applied to treatment planning. This article discusses prenatal genetic screening and diagnostic modalities and their implications for nursing practice. It is critically important to offer comprehensive pretest and posttest counseling and to address uncertainty surrounding prenatal genetic testing. Provider shortages, time constraints in clinical settings, and evolving policies create barriers to equitable access to genetics care. Nurses play a pivotal role in supporting informed decision-making, promoting health literacy, and addressing equity in prenatal genetic care.
Maternal sepsis accounts for 5% of obstetric intensive care unit admissions and 23% of in-hospital maternal deaths in the United States, 63% of which are preventable. Individuals who undergo unscheduled cesarean birth face elevated postoperative infection risk, yet partners and support persons are rarely included in discharge sepsis education. During recovery, the birthing person simultaneously manages surgical pain, sedation effects, and neonatal care demands, all of which can delay early sepsis recognition. This article presents an evidence-based framework for nurses to deliver partner-focused sepsis education following unscheduled cesarean birth, addressing timing, content, communication strategies, clinical tools, and documentation. Incorporating partners into routine postoperative nursing care is a practical, high-impact intervention that supports earlier recognition, reduces care-seeking delays, and may prevent maternal deaths.
OBJECTIVE:To explore the lived experiences of sub-Saharan Black African migrant women (SBAMW) in accessing and receiving equitable maternal-newborn health care in Ontario, Canada, and to examine how intersecting identities and structural determinants shape these experiences. DESIGN:Interpretive descriptive qualitative design, guided by intersectionality and structural determinants of health frameworks. SETTING/LOCAL PROBLEM:Ontario, Canada, where persistent inequities in maternal-newborn care are reported for SBAMW, particularly related to temporary immigration status, navigation barriers, and experiences of discrimination and lack of culturally safe care. PARTICIPANTS:Ten SBAMW residing in Ontario who had accessed maternal-newborn care within the past 5 years; most held temporary visas, including student and work permit holders. METHODS:Semistructured interviews were conducted with field notes and audio-recorded for transcription. Data were analyzed using an iterative, inductive thematic analysis approach to generate codes, categories, and themes. RESULTS:Three major practice-oriented insights emerged: (a) This (Canadian health care system) is not a health-care-for-all system. Women described discrimination tied to temporary visa status, barriers in navigating the system, poorly coordinated referrals and follow-ups, and limited postpartum support. (b) We are relying on Google: lack of information and compassionate care. Participants frequently reported rushed appointments, inadequate communication, insufficient information, and feeling unheard. (c) Felt less of a person: racialization, stereotypes, and cultural unsafety. Participants noted experiences of stereotyping, dismissal of pain, covert racism, lack of culturally safe care, and distrust in provider relationships. CONCLUSION:Findings highlight how intersecting identities (e.g., race, sex, and immigration status) produce overlapping disadvantages that exacerbate inequitable maternal-newborn care. Key strategies to mitigate these inequities include inclusive health insurance policies, enhanced provider communication, cultural safety training, and antiracism initiatives across health care organizations. Addressing these systemic barriers is critical to rebuilding trust, reducing disparities, and ensuring high-quality care.
Mild uterine prolapse during pregnancy can complicate counseling regarding mode of birth and challenge women's confidence in pelvic floor safety. This case report describes the care of a multiparous woman with first-degree uterine prolapse and persistent urinary hesitancy following a postpartum urinary retention episode. She was followed within a midwifery continuity of care model and a coordinated multidisciplinary pathway, including obstetric, urogynecologic, and pelvic floor physiotherapy support. Although the woman initially requested an elective cesarean, iterative counseling within a trusted care relationship supported shared decision-making and attempted vaginal birth. She experienced a spontaneous vaginal birth at term with stable postpartum pelvic floor findings without persistent urinary dysfunction. A postpartum interview illustrated how continuity of midwifery care facilitated trust, reframed perceived risk, and supported confidence in future maternity. This case highlights the potential role of midwifery continuity in supporting shared decision-making when clinical risk is low but experiential vulnerability is high.
OBJECTIVE:To review and evaluate the literature for upstream, structural interventions that seek to improve maternal mortality rates among Black birthing people in the United States. DATA SOURCES:Searches were conducted in PubMed, Embase, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. STUDY SELECTION:Of the 883 articles returned, 623 abstracts were screened, and 7 articles met the criteria for inclusion. Articles were eligible for inclusion if they assessed the impact of structural interventions on maternal mortality, including among Black birthing people. DATA EXTRACTION:Data were extracted on study designs, intervention type, outcomes, and health equity implications using a standardized template. DATA SYNTHESIS:Findings were synthesized thematically according to intervention type and included Access to reproductive health care and Social investment as effective maternal health policy. The findings revealed that maternal mortality is largely preventable and responsive to structural interventions. Interventions that addressed upstream determinants such as racism and social conditions demonstrated the greatest impact in reducing maternal mortality and improving equity. CONCLUSION:Targeted policy and programmatic interventions that address social and structural determinants of maternal health are essential to mitigating the maternal mortality crisis. Efforts that extend health care access, invest in public health infrastructure, and promote reproductive justice are particularly effective in improving outcomes for Black birthing people.
OBJECTIVE:To determine the optimal wording for development of an instrument to screen for complicated grief after reproductive loss (Reproductive Grief Screen [RGS]). DESIGN:This study used a cross-sectional survey design. SETTING:Participants were recruited throughout the United States to complete an online REDCap (Research Electronic Data Capture) or Qualtrics survey. PARTICIPANTS:Survey respondents included 844 women who had one or more previous spontaneous or induced losses (regardless of gestational age) after January 1, 2017. METHODS:Survey participants assessed three possible ways of rewording three items in an online survey. In addition to completing a permutation of the RGS, respondents ranked the wording of each of the RGS items and completed the Arousal Adjective Checklist and the Reactions to Research Participation Questionnaire (RRPQ) to assess possible negative effects of the version of the RGS they received. RESULTS:There were no significant differences among the three possible ways to word two of the items using women's rating of the wording or the Arousal Adjective Checklist or the RRPQ. However, linear regression did demonstrate that across all permutations of the RGS, women who received the third version of one item reported greater negative symptoms using the RRPQ. The third iteration of one item in the RGS is suboptimal, suggesting that either the original wording or the second formulation is preferred by the target population. Participants were grateful to be asked about their reproductive losses and overwhelmingly rated all items as acceptable. CONCLUSION:When combined with other data previously published by this research team that suggested preferred wording for other items, a single preferred form of the RGS is now defined.
OBJECTIVE:To assess the interaction and relationship-building skills of nurses caring for an individual experiencing fetal demise, evaluate the effectiveness of simulation to reflect on these skills, and provide recommendations for revision, improvement, and future offerings of simulation experiences. DESIGN:Guided by the National League for Nursing Jeffries Simulation Theory, this evidence-based practice project provided labor and delivery nurses with an opportunity to participate in a fetal demise simulation scenario with a standardized patient (SP) and receive real-time, constructive feedback about their communication skills. SETTING:The project was conducted in a large academic medical center in northern New Jersey that cares for approximately 50 to 60 individuals/families experiencing fetal demises annually. PARTICIPANTS:A convenience sample of 23 nurses participated in the experience. INTERVENTIONS/MEASUREMENTS:A fetal demise simulation was created, implemented, and evaluated. Using the Patient-Professional Interaction Questionnaire and the Provider-Patient Relationship Questionnaire, each participant and the SP evaluated communication skills during the encounter, discussing their interaction and soliciting and receiving feedback. After the patient encounter, participants completed a survey to determine the value of the simulation as an educational experience. RESULTS:Nurses with more practice experience demonstrated stronger communication skills, but respondents' self-assessment scores, including several from experienced nurses, were higher than those provided by the SP. Regardless of years of experience, nurses valued the simulation experience, appreciated the SP feedback, and reported that the experience would improve their nursing practice. CONCLUSION:Simulation, especially using SPs and providing structured and open-ended feedback, may improve nursing communication with individuals and families experiencing fetal demise and stillbirth. Future offerings of this and similar scenarios may provide clinicians with opportunities to practice and improve their communication skills, thereby improving the care they provide.
OBJECTIVE:To examine the efficacy of virtual reality (VR) glasses on anxiety, physiologic parameters, and satisfaction among high-risk pregnant women undergoing nonstress tests. DESIGN:A quasi-experimental pretest-posttest nonequivalent control group design was adopted. SETTING:This study was conducted at the nonstress test rooms of the Obstetric and Gynecologic Speciality Center at Mansoura University Hospitals. PARTICIPANTS:A convenience sample of 106 pregnant women was recruited. METHODS:A structured interviewing questionnaire schedule, the State-Trait Anxiety Inventory-State subscale, and a maternal satisfaction questionnaire were used to collect data. VR glasses refers to a smartphone-based passive optical viewer that presents calming 360° nature scenes with ambient audio, requiring no interactive input or active sensors and enabling low-cost use at the point of care. RESULTS:The VR glasses group demonstrated significantly lower mean anxiety scores compared to the control group (M = 38.2, SD = 11.9 vs. M = 56.1, SD = 13.9; p < .001). Significant improvements were also observed in maternal physiologic parameters, including systolic and diastolic blood pressure and maternal heart rate compared to the control group (all p < .001). Furthermore, maternal satisfaction scores were significantly higher in the VR glasses group (M = 34.7, SD = 1.4) than in the control group (M = 23.4, SD = 1.8; p < .001). CONCLUSION:Pregnant women who used VR glasses during their nonstress test showed significantly lower anxiety scores, improved maternal physiologic parameters, and higher satisfaction scores compared to nonusers. VR glasses can be integrated into routine antenatal care as a supportive, low-cost intervention to improve maternal experience and potentially optimize nonstress test interpretation. Incorporating VR glasses into antenatal education programs can increase awareness of their benefits during nonstress tests among pregnant women.
OBJECTIVE:To explore the experiences and factors associated with exclusive breastfeeding among women with postpartum depression (PPD). DATA SOURCES:Following Arksey and O'Malley's methodological framework for scoping studies, searches were conducted in the PubMed, ScienceDirect, Scopus, EBSCO, Virtual Health Library, and Taylor & Francis databases. STUDY SELECTION:Full-text articles published in English, Spanish, and Portuguese between 2015 and 2024 on breastfeeding experiences among women up to 6-months postpartum with PPD. In total, 14 articles met the inclusion criteria. DATA EXTRACTION:Data were charted using a spreadsheet matrix, which included the following information: authors, year of publication, country, study population, objectives, methods, and main findings. DATA SYNTHESIS:Extracted data were collated and analyzed using thematic synthesis to group recurring patterns into conceptual themes. Consequently, a variety of experiences with exclusive breastfeeding were identified among women with PPD and classified into three main categories: (a) rewarding, characterized by emotional bonding and a sense of accomplishment; (b) frustrating, often involving latching difficulties, low supply, or feelings of inadequacy; or (c) supportive, highlighting the critical role of health care provider encouragement and perseverance. These experiences were influenced by sociocultural, physical, psycho-emotional, and health care-related factors. CONCLUSION:The experiences of women with PPD who exclusively breastfeed are shaped by multiple interrelated factors that affect the breastfeeding process. Health care systems and public policies must integrate emotional and physical support strategies to strengthen breastfeeding, especially among women experiencing PPD.
This longitudinal case report describes a mother-infant dyad, focusing on how early pacifier use, scheduled feeding, and postpartum alcohol resumption affected breastfeeding behavior and infant growth. Pacifier use and scheduled feeding decreased breast stimulation and suckling frequency. Alcohol resumption at 3 weeks, initiation of pumping at 7 weeks, and increased consumption, coinciding with menses, likely accelerated an existing decline in milk supply and suboptimal infant weight gain. These challenges required formula supplementation and metoclopramide. Alcohol use paused at 17 weeks during a transition to mixed feeding but resumed at 24 weeks. This case illustrates how reduced suckling and alcohol-induced inhibition of the milk ejection reflex contributed to low milk supply. Nurses play a critical role in providing proactive education on these factors.
OBJECTIVE:To examine the frequency of unfair treatment based on gender in various contexts, descriptive experiences of it, and its association with postpartum health. DESIGN:Cross-sectional survey with closed- and open-ended responses. SETTING:Online research panel in the United States. PARTICIPANTS:Participants included 86 survey respondents who were 6 to 30 months postpartum. Respondents' mean age was 32.6 years (SD = 5.5 years); 98.8% identified as women; and 69% were White and 31% were Black, Hispanic, or other racial/ethnic identities. METHODS:Survey items included demographic characteristics, the frequency of unfair treatment, contexts in which such treatment occurred (e.g., workplace, health care, relationships), ratings of physical and mental health, and respondents' open-ended descriptions of unfair treatment experiences. Analyses included descriptive and inferential statistics and content analysis. RESULTS:The highest ranked context of unfair treatment based on gender or having young children was the workplace, for example, being denied work opportunities and being judged as less competent based on gender. Although some partners held rigid gendered attitudes, it was unfair treatment in the context of the family (e.g., sexist treatment) or health care visits (e.g., dismissal of symptoms) that were associated with poorer health ratings (p < .01). Friendships was a context where respondents reported exclusion because of having young children. CONCLUSION:Unfair treatment occurred in a wide range of postpartum contexts, and in some contexts, such as health care visits, it was associated with poorer mental and physical health. The findings support the importance of fostering a culture of respectful postpartum care and of linking those who face support challenges to additional resources.
