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.
