PRIMARY CARE FOR WOMEN: An Overview of the Role of the Nurse-Midwife

The nurse-midwife's past, present, and future roles in the primary care of women are explored using a recent Institute of Medicine report on primary care as a framework for discussion. Primary care, the scope of services, and the role of the primary care clinician are described, and specific strategies for a primary care emphasis in basic nurse-midwifery education are addressed. The nurse-midwife's future roles in collaborative practice for the primary care of women and the need for continuing education opportunities in primary care are also discussed.     

An overview of the role of the nurse-midwife

The nurse-midwife's past, present, and future roles in the primary care of women are explored using a recent Institute of Medicine report on primary care as a framework for discussion. Primary care, the scope of services, and the role of the primary care clinician are described, and specific strategies for a primary care emphasis in basic nurse-midwifery education are addressed. The nurse-midwife's future roles in collaborative practice for the primary care of women and the need for continuing education opportunities in primary care are also discussed.     

Toward a Gender‐Responsive Restorative Correctional Health Care Model

Infectious and chronic diseases are disproportionately greater among detained women than among women in the population at large. The overall punitive, male‐based, one‐size‐fits‐all approach to health care and the variant overall health care standards across correctional systems call for a new model of correctional health care. The assumptions, constructs, strategies, and future research implications of the restorative health care model are described.     

Part 2. Antepartum and Intrapartum Care

The spread of human immunodeficiency virus (HIV) disease among childbearing women presents a unique nursing challenge in the delivery of specialized antepartum and intrapartum care. The nurse must be competent in the delivery of psychosocial and physical care to these women, as well as assume a pivotal role as a member of the multidisciplinary health-care team. Aspects of care, from the diagnosis of pregnancy through delivery of the neonate, that are unique to women with HIV disease are described.     

Comanagement of the patient on subcutaneous terbutaline pump therapy

The subcutaneous terbutaline pump is a new modality available for pharmacologic treatment of preterm labor. Because nurse-midwives may be involved in the care of women on this therapy, an overview of terbutaline pharmacology, pump development, and advantages versus disadvantages of this therapy is provided. Initiation of therapy in the appropriate patient is described. Outpatient therapy is the goal for these women, and the nurse-midwife may appropriately comanage this aspect of care. Guidelines are presented for physical and psychosocial care.     

Childbearing among the Igbos of Nigeria

Traditional Obstetric care among women of the Igbo tribe in Nigeria is described. The role of traditional birth attendants, antenatal care, management of delivery complications, postnatal care and traditional community practices surrounding birth are discussed.     

Assessment of Women for Partner Abuse

Nearly 4 million women in the United States were physically hurt by their husbands or boyfriends in 1994. The health and well-being of these women and their children, as well as the women who are overlooked in these statistics, are jeopardized by past and current experiences with abuse within intimate relationships. Strategies for nurses in women's health care settings to screen women for current or past abuse within their intimate personal relationships, guidelines for effective responses to disclosure of abuse, and supportive interventions are described.     

Understanding Women With Dual Diagnoses

The most common types of psychiatric diagnoses linked with substance abuse or dependence in women are defined and discussed. A framework is described to facilitate the nurse provider's understanding of the various relationships psychiatric symptoms can have to substance-using patterns. Guidelines are provided to assist the nurse in identifying problems of dual diagnoses and providing care to women with dual diagnoses in general care settings.     

Third Stage of Labour Care for Women at Low Risk of Postpartum Haemorrhage

In normal birth there should be a valid reason to interfere with normal processes. Yet, active management of third stage labor is being imposed on women who have no known risks of postpartum hemorrhage. This article examines the evidence from existing randomised trials comparing active and physiological third stage care for its relevance and validity to the effectiveness of physiological third stage care for women who are at low risk of postpartum hemorrhage. Consideration is given to midwifery and medical perspectives of the following definitions: ‘postpartum hemorrhage’; ‘low‐risk status’; ‘active’; ‘expectant’ and ‘physiological’ third stage care. A systematic search of the research literature regarding the third stage of labour is described. Four randomised trials and a meta‐analysis by Cochrane were considered. These studies are examined in terms of their potential generalisability to women who are at low risk of postpartum hemorrhage. All trials included women who were at high risk of postpartum hemorrhage. The existing research does not provide relevant and valid evidence about the effectiveness of physiological third stage care, as defined by midwives, for women who are at low risk of postpartum hemorrhage.     

Cultural competence in primary care services

The assessment of cultural competence in providing primary care services for women is addressed. Emphasis is placed on the ways in which cultural competency attainment can ensure the availability of key primary care components to all women, especially those from certain vulnerable populations and those who have specific primary health care needs. A cultural competence continuum is described that will assist providers in an assessment of their own cultural competency levels, as well as those of the service settings in which they practice. Six scenarios are provided, describing experiences at each level of the continuum that may hinder the development and delivery of effective primary care service interventions. Examples of ways in which nurse-midwives can provide leadership in the area of cultural competence in women's primary care are also included.     

Peri-operative care

This is the third 'midwifery basics' series aimed at student midwives, and focuses on midwifery care during labour. This article provides a summary of peri-operative care for women who experience caesarean birth. Students are encouraged to seek further information through a series of activities, and to link theory with practice by considering the issues relating to the care of the woman described in the short vignette.     

Anaesthesia for obstetricians

Anaesthesia and the anaesthetist have an important contribution to make to the provision of safe and effective maternity care. This is particularly relevant for current obstetric practice which is providing care to an older obstetric population with an increasing incidence of co-morbidities. In this review, the role of the anaesthetist in maternity care is described and the issues for providing anaesthesia and analgesia to pregnant women are discussed.     

Midwives and maternal and child health: building resource capacity

With dramatic changes in health, social services, and welfare systems and escalating pressure to increase clinical productivity, midwives need to enhance their capacity to work with federal, regional, and state partners to promote and protect comprehensive, culturally competent, and community-based quality health care for pregnant women and their families. Information about maternal and child health (MCH) regional and state resources is provided, and strategies for obtaining additional MCH resources are suggested, so that midwives and other women's health care providers can more effectively improve health care programs and systems that benefit women and their families. In addition, ways to work with MCH programs at the regional and state levels are described.     

She can lip-read, she''ll be all right: improving maternity care for the deaf and hearing-impaired

In the UK a midwife is unlikely to meet many deaf women during her working life. Therefore very few midwives have a wealth of experience in providing care for these women. Postnatal discussion with one woman showed us that despite our good intentions the care we had given her was inadequate for her individual needs. We recognised that other deaf women were possibly receiving inadequate care. We set out to investigate this, and when we discovered that our suspicions were correct, devised a method that we hoped would improve the care we provided. The process of investigating the needs of deaf women is described in this paper together with the development of a teaching package for student and qualified midwives.     

Survivors of childhood sexual abuse: implications for perinatal nursing care

Childhood sexual abuse has a lifelong impact on its survivors and may affect the childbearing experience in a variety of ways. Nurses caring for women during the perinatal period can benefit from understanding the phenomenon of child sexual abuse, its prevalence, and the sequelae experienced by childbearing women. Signs, symptoms, and correlates of prior sexual abuse manifested during the perinatal period are described, and nursing care responses are suggested. Nurses may be able to use this information to recognize survivors and facilitate both a positive childbirth experience and the healing process, by helping the survivor learn to trust, respect, and care for her body.     

Approaches to improve the quality of maternal and newborn health care: an overview of the evidence

Despite progress in recent years, an estimated 273,500 women died as a result of maternal causes in 2010. The burden of these deaths is disproportionately bourne by women who reside in low income countries or belong to the poorest sectors of the population of middle or high income ones, and it is particularly acute in regions where access to and utilization of facility-based services for childbirth and newborn care is lowest. Evidence has shown that poor quality of facility-based care for these women and newborns is one of the major contributing factors for their elevated rates of morbidity and mortality. In addition, women who perceive the quality of facilty-based care to be poor,may choose to avoid facility-based deliveries, where life-saving interventions could be availble. In this context, understanding the underlying factors that impact the quality of facility-based services and assessing the effectiveness of interventions to improve the quality of care represent critical inputs for the improvement of maternal and newborn health. This series of five papers assesses and summarizes information from relevant systematic reviews on the impact of various approaches to improve the quality of care for women and newborns. The first paper outlines the conceptual framework that guided this study and the methodology used for selecting the reviews and for the analysis. The results are described in the following three papers, which highlight the evidence of interventions to improve the quality of maternal and newborn care at the community, district, and facility level. In the fifth and final paper of the series, the overall findings of the review are discussed, research gaps are identified, and recommendations proposed to impove the quality of maternal and newborn health care in resource-poor settings.     

The Importance of Interdepartmental Collaboration and Safe Triage for Pregnant Women in the Emergency Department

Pregnant women who present to the emergency department can present challenges that range from the diagnoses of unsuspected pregnancies to the determination of where evaluations should occur. In this review we identify literature associated with the triage of pregnant women in the emergency department and propose a model for triage and evaluation of pregnant women in the emergency department. Strategies are described to facilitate interdepartmental communication to optimize safe maternal/fetal care.     

Testing women for human immunodeficiency virus infection: who, when, and how?

Obstetrician-gynecologists provide comprehensive primary and preventive care for women and are ideally suited to provide human immunodeficiency virus (HIV) screening for their patients. This paper provides a summary and rationale for the current recommendations for HIV testing among women in the United States, emphasizing recommendations from the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists [corrected] Who should receive HIV testing, when and how often testing should be conducted, and how testing should be offered are discussed. These recommendations are described separately for general populations (including nonpregnant women) and for pregnant women and their infants.     

A Guide for Preceptors of Advance Practice Nursing Students Caring for Women and Infants

Women's health care in the United States has been described as unsatisfactory and falling behind the Healthy People 2010 objectives. Inadequate health care due to a shortage of providers is especially problematic for women who are poor with lower socioeconomic status. Advanced practice nurses are well suited to address this need. In this article, preceptor and academic partnerships are discussed as strategies to make more qualified women's health and infant providers available.