Moral Distress: A Labor and Delivery Nurse''s Experience

Moral distress occurs when nurses make moral decisions they cannot implement. This article contains a true account of such a case. A nurse was present at the delivery of a premature infant who was allowed to expire without intervention. A moral distress equation is used as a framework for describing the nurse's experience and its effects on her and her patient care.     

A Waste of Life: Fathers' Experience of Losing a Child Before Birth

Background: The prenatal loss of an expected child entails parental despair and grief. The grief after a stillborn child is sometimes described as a “forgotten form of grief” and the fathers as the “forgotten mourners.” Our aim was to describe how fathers experienced losing a child as a result of intrauterine death. Method: Eleven men were interviewed 5 to 27 months after the intrauterine death of their child during weeks 32 to 42 of pregnancy. The interviews were analyzed using a phenomenological methodology. Results: After being informed of the infant's death, most fathers first wanted their partners to have a cesarean section, but all later thought that it would be right for the child to be delivered vaginally. A strong feeling of frustration and helplessness came over them during and after the delivery. Several men found meaning and relief in their grief by supporting their partner. Tokens of remembrance from the child were invaluable, and fathers appreciated that the staff collected these items, even if the parents declined them. The perceived prerequisite for resuming their everyday lives consisted of the support they received from the hospital staff and precious memories of the child. The most important comfort in their grief was a good relationship with their partner. Some fathers missed having a man to talk to both at the time of the stillbirth and subsequently. Conclusion: The fathers' general trust in life and the natural order was suddenly and unexpectedly severely tested by the death of their child, which they perceived as a terrible waste of life. They sought understanding as grieving men and fathers from both the hospital personnel and their partners, as well as from relatives. Being able to protect their partner and to grieve in their own way was important to the fathers.     

A Study of Father and Nurse Support During Labor

ABSTRACT: Support behaviors directed to the woman during childbirth are documented, along with the identity of the providers in this study of 40 primiparous women. A time-sampling method was used during labor observations to record kinds and frequencies of support behaviors provided by different individuals. In addition, a postpartum interview with mother and father included maternal recall of the support behaviors and her evaluation of the helpfulness of these activities. The data show husbands were an important source of support. Of special interest was amount of touching. Fathers were 5 times as likely to touch their wives as were nurses to touch their patients. Mothers’postpartum reports centered on the husbands’behavior, indicating that the most helpful thing was the husbands’presence. Other postpartum maternal reports are discussed.     

Labor and Delivery 120 Years Ago

This is the second of two articles based on n hook by the author's great-great grandfather. The first, which appeared in the March/April issue, covered past ideas and practices in prenatal care It was accompanied by further information about the hook and the author of the present article     

Fathers' Coping Style,Antenatal Preparation,and Experiences of Labor and the Postpartum

Background: In recent years the trend for fathers in Western postindustrial countries to attend childbirth has increased. This study examined the interaction between fathers' information‐seeking coping predispositions and their level of attendance at antenatal classes with respect to their experiences of attending childbirth. Associations between fathers' childbirth experiences, their relationship with their baby, and level of depressive symptomatology at 6 weeks postpartum were also examined. Methods: A quantitative methodology was employed in which 78 fathers completed several questionnaires, some within 6 days of childbirth and others at 6 weeks postpartum. Results: Fathers who were characterized as high blunters (avoiders) of threat information, from antenatal classes reported that experiencing childbirth was less fulfilling than fathers with similar coping styles who did not attend classes. Fathers' reports of fulfillment and delight while attending childbirth were negatively related to their level of depressive symptomatology at 6 weeks postpartum. Levels of distress were associated with subsequent depressive symptoms, but their effect was removed when preexisting depressive symptoms were partialled out. Fathers whose children were born by cesarean delivery used significantly more negative adjectives to describe their baby at 6 weeks postpartum compared with those born by vaginal delivery. More married fathers attended antenatal classes and reported lower levels of depressive symptomatology than unmarried fathers. Conclusions: Although fathers' attendance at antenatal classes may have positive consequences for them and their partner, for some fathers, attendance at classes may be associated with less positive reports of experiencing childbirth. The way in which men experience childbirth may have some influence on their subsequent emotional well‐being.     

Twin Delivery After a Previous Caesarean: A Twelve-Year Experience

Objectives: To compare maternal and neonatal morbidities between trial of labour (TOL) and elective Caesarean section in women with twin pregnancies who have had a prior Caesarean.Methods: An observational study was conducted of women with a prior Caesarean who delivered twins at 28 weeks’ gestation or greater in Ste-Justine Hospital between 1988 and 2001. Maternal and neonatal outcomes were compared between women who had a TOL (group I) and those who had an elective Caesarean delivery (group 2).Results: Twenty-six women and 52 fetuses were included in group 1 and compared to the 71 women and 142 fetuses in group 2. Maternal age, gestational age, and birth weight were comparable in both groups. In group 1, 22 (85%) out of 26 women delivered twin A vaginally and 19 (73%) delivered both vaginally. There was no significant difference in the umbilical artery cord pH, Apgar score, ventilatory support, and admission to the neonatal intensive care unit between the 2 groups. There was also no significant difference in the rate of postpartum maternal fever or decrease of serum hemoglobin between the 2 groups, but the median hospital stay was higher in the group with elective Caesarean (5.0 vs. 3.0 days, p <0.001). There were no uterine ruptures or other major complications in either group.Conclusion: There were no significant differences in maternal and neonatal morbidity outcomes between births by trial of labour and by elective Caesarean, in twin pregnancies after a prior Caesarean section. A trial of labour is associated with a shorter hospital stay.     

Computer systems in Labor and Delivery Units

Although most hospitals use computer systems in other areas, many nurses have had limited hands-on experience with computers. The issues to address when a bedside computer system is selected and introduced into a labor and delivery unit are presented.     

Educating New Labor and Delivery Room Nurses

Nurses who are new to the labor and delivery area need a foundation in maternal-newborn theory before beginning clinical practice. A model for a two-week, theory course for nurses orienting to the labor and delivery area is presented.     

Women's Evaluations of Their Labor and Delivery Nurses

Objective: To document women's evaluations of their labor and delivery nurses.
Design: An exploratory, qualitative study using open-ended, intensive, tape-recorded interviews.
Setting: Postpartum unit of a 400-bed midwestern hospital, except for two interviews in the women's homes.
Participants: Sixty-one Lamaze-prepared, married, multigravidae, aged 21-37years.
Results: Ninety percent of the women evaluated their nurses favorably, 10% unfavorably. Nurses were evaluated favorably because of their positive participation (80%), acceptance (78%), information giving (75%), encouragement (65%), presence (53%), and competence (7%).
Conclusions: Although technical competence is important, manner, provision of supportive care, and acceptance of each woman as a unique human being may be a nurse's most important characteristics.     

Women''s Expectations of the Labor and Delivery Nurse

Sixty-one, Lamaze-prepared, married multigravidae identified their expectations of the labor and delivery nurse in semistructured interviews conducted at 36 to 38 weeks' gestation. Findings indicate variations in the amount of involvement women expected from the nurses during labor and delivery: limited (n = 17), moderate (n = 22), or extensive (n = 22). Women varied in the amount of time they wanted nurses present, who they expected to make caregiving decisions, and whether or not they wanted nurses to assist them in managing labor and delivery.     

产程中饮食对足月分娩孕妇产程及分娩结局的影响

【摘 要】 目的：观察产程中饮食对足月分娩孕妇产程及分娩结局的影响。方法：选取2015年11月-2016年6月于郑州大学第三附属医院住院待产的足月孕妇338例,根据饮食意愿不同分为流质饮食组162例（对照组）和自愿饮食组176例（观察组）,观察2组孕妇第一及第二产程持续时间、产程中呕吐、酮症的发生率及分娩结局。结果：①观察组第一产程和第二产程持续时间均长于对照组,差异均有统计学意义（P＜0.05）。②2组孕妇呕吐发生率比较,差异无统计学意义（P＞0.05）;观察组孕妇酮症的发生率低于对照组,差异有统计学意义（P＜0.05）。③2组孕妇产程中催产素使用情况、会阴侧切率及中转剖宫产率比较,差异均无统计学意义（P＞0.05）,2组孕妇分娩过程中均未使用器械助产。④2组新生儿1 min、5 min Apgar评分及新生儿转入新生儿重症监护病房（NICU）的入住率比较,差异均无统计学意义（P＞0.05）,2组新生儿均未出现窒息等严重并发症。结论：分娩过程中自愿饮食的孕妇虽相对增加第一、第二产程持续时间,但自愿饮食可降低孕妇酮症的发生率、不增加产程干预,且不影响母儿结局,也不增加孕妇呕吐的发生率。     

Quantitative Description of the Patient Population in a Labor and Delivery Unit

Realistic efforts should be made to quantitatively determine patient care given by labor and delivery nursing personnel. In an effort to accurately evaluate staffing requirements, the total patient population utilizing the labor and delivery room was analyzed. Of the 1,281 patients receiving treatment or evaluation, 453 were nondelivered patients (36%) who were not recorded in the average census. These nondelivered patients were analyzed according to their diagnoses. Suggestions are given on which more realistic nursing staffing can be based.