Where Does Your State Stand on Shackling of Pregnant Incarcerated Women?

Pregnant incarcerated women have been identified as a particularly high-risk group and among the most vulnerable women in the United States. The use of shackling or restraints poses health risks to pregnant women and their fetuses. Currently, only 22 states have legislation prohibiting or limiting the shackling of pregnant women. Here we provide an overview of the potential negative health outcomes that can result from shackling pregnant women, especially during labor and birth, and suggest strategies for nurses who wish to promote optimal health care for incarcerated women and to advocate for anti-shackling legislation in their states.     

Depression in pregnancy: drug safety and nursing management

Women who are already predisposed to depression are at increased risks during pregnancy because of endocrine changes; untreated depression in pregnant women might lead to adverse effects for both mothers and infants. This article examines outcomes associated with the use of antidepressants during pregnancy and identifies how nurses can help depressed pregnant women. It is recommended that pregnant women who have mild depression be treated with nonpharmacologic therapy, such as counseling, cognitive-behavioral therapy, or interpersonal psychotherapy. Current appropriate treatment for pregnant women with moderate and severe depression is antidepressant medication, although there is no consensus on the best antidepressants for use in pregnancy. Thus, the psychotropic drug must be chosen carefully to minimize negative effects on infants and mothers, for some studies have demonstrated deleterious effects on infants. Nurses in multiple settings who interact with pregnant women should be aware of the necessity of screening for depression. Nurses in antenatal care settings can refer appropriately screened women to mental health specialists; psychiatric nurse practitioners can identify suitable interventions based on potential risks and benefits to maternal and infant health.     

Exercise and the Prevention of Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is associated with pregnancy complications and fetal complications, as well as long-term health consequences for women and their offspring. Pregnancy is a pseudodiabetogenic state of increasing insulin resistance and decreasing insulin sensitivity, which places a woman at increased risk for GDM. Exercise facilitates the uptake of blood glucose into cells to be used for energy, making exercise a potential strategy in preventing GDM. Extensive evidence has found an association between consistent moderate to vigorous exercise in pregnancy and the prevention of GDM. With close attention to risk factors, maternity care nurses and other health care providers can play an important role in educating pregnant women on exercise recommendations to help them achieve optimal health and wellness.     

Nutrition and health patterns in midlife women.

The middle years for women present many challenges and opportunities. The changes of life--physical, psychosocial, developmental, and environmental--can be rewarding, positive experiences. At the same time, as women enter the middle years, they may face a number of health problems. Preparation for health maintenance, illness prevention, and coping with problems as they occur can prevent many of the potential health alterations through life style changes. Even when these health problems are unpreventable, modification of behaviors and habits may ameliorate some of their consequences. The nurse is the logical person to educate and counsel women on how to lower their risks for midlife health problems. An overview of the health status of women at midlife is presented, including current life expectancy, mortality, and morbidity data. Risk factors and risk assessment specific to diseases prevalent in midlife and older women are reviewed, with emphasis on nutrition and obesity. Nursing strategies for reducing the risk factors (obesity, hypercholesterolemia, and sedentary life style) related to many of the health concerns of midlife women are presented.     

Prioritizing oral health in pregnancy

Pregnant women are particularly susceptible to gum and periodontal disease. The biochemical and hormonal changes of pregnancy enhance the risk. In addition, pregnant women may not experience symptoms until advanced disease stages and therefore unknowingly increase perinatal risk. Associated risks include: premature birth, low birth weight babies, pre-eclampsia, ulcerations of the gingival tissue, pregnancy granuloma, and tooth erosion. These risks increase in women who smoke, experience nutritional deficiencies, or have less frequent visits to the dentist. Many women fail to see the importance of oral care in pregnancy while others experience barriers to care. Health care providers should be educated to recognize the risks of oral health complications during pregnancy. This article provides a review of literature on the correlations between oral health and pregnancy. Implications for practice include: enhanced screening and referral services in preconception and pregnant populations, providing oral health education in clinics, and advocating affordable oral health for all pregnant women.     

How women who have experienced one or more miscarriages manage their feelings and emotions when they become pregnant again - a qualitative interview study

Scand J Caring Sci; 2012; 26; 262–270 How women who have experienced one or more miscarriages manage their feelings and emotions when they become pregnant again – a qualitative interview study Aim: The aim of this study was to investigate how women who have experienced one or more miscarriages manage their feelings when they become pregnant again. Method: Individual qualitative interviews were conducted with 16 women who were pregnant again after experiencing one or more miscarriages. The interviews were analysed using qualitative content analysis with an inductive approach. Results: The analysis of the material ended up in five categories: distancing herself from her pregnancy, focusing on her pregnancy symptoms, searching for confirming information, asking for ultrasound examination and asking for professional and social support. Because of their past experience with miscarriage, it could be painful to have another pregnancy terminate in disappointment. Therefore, the women manage their feelings by distancing themselves from their pregnancies. Simultaneously, they are managing their emotions by seeking affirmation that their current pregnancy is normal. Conclusion: Generally speaking, women manage their emotions by themselves. They feel isolated with their worries and concerns, and they are in need of the support provided from their intimate circle of friends and family as well as from the staff of the maternity health care ward. Unfortunately, the women do not feel that they get the support they need from the staff, instead they have to rely on their friends, family and partners to help them manage their emotions.     

乙肝病毒携带孕产妇心理状态的质性研究

目的了解乙肝病毒携带孕产妇的心理状态。方法采用深度访谈法收集12名产妇的资料,并用现象学分析法进行分析。结果乙肝病毒携带孕产妇因自身和家属疾病认知水平低下,影响着母亲角色的良好适应,母婴传播的风险又让她们充满困惑。结论对乙肝病毒携带孕产妇及其家属提供专业信息支持,呼吁社会共同关注,让乙肝病毒携带孕产妇走出困惑,促进母婴健康。     

Women's knowledge, concerns and psychological reactions before undergoing an invasive procedure for prenatal karyotyping.

OBJECTIVES: To evaluate women's reasons for having an invasive procedure, their knowledge, how information was obtained, their satisfaction with this information, their concerns about complications and psychological reactions and distress evoked by the procedure. METHODS: Ninety-four pregnant women undergoing early amniocentesis or chorionic villus sampling (CVS) at 10-13 weeks' gestation participated in a questionnaire study. The women could choose between early amniocentesis (n = 38) and CVS (n = 31), or to be randomized to either of them (n = 25). RESULTS: Apart from two items, no differences were found between the groups. Age was the main reason for testing, and anxiety was stated as a reason by 38.3%. The women knew more about methods for fetal karyotyping, what the tests can reveal and how they are performed, than about the risks and reliability of the tests. The main source of information had been doctors and midwives at the antenatal care center. For a majority of women (64.9%) the decision to have the test was made together with their partner. The women's concerns were focused on worry about fetal injury, miscarriage and waiting for the result. The test did not have a major psychological impact on the women in general, but a substantial minority reacted with anxiety and distress. CONCLUSIONS: Knowledge of factors important to women and their concerns is essential for professionals working with genetic counselling and performance of invasive procedures.     

Pregnancy and the struggle to quit smoking

The negative effects of smoking during pregnancy are well documented. Health care providers typically advise pregnant women who smoke usually to quit for their health as well as for the health of their fetus. Most women are familiar with the need to stop smoking while pregnant. Hospitals offer various smoking cessation services. However, the literatures reveals a low uptake of smoking cessation services among pregnant women. The purpose of this paper is to explore the smoking cessation experience and feelings amongst women during pregnancy and assess smoking cessation intervention in antenatal care. Findings may provide health care providers a better understanding of this issue and help women overcome related challenges.     

Radiation risk from medical imaging

This review provides a practical overview of the excess cancer risks related to radiation from medical imaging. Primary care physicians should have a basic understanding of these risks. Because of recent attention to this issue, patients are more likely to express concerns over radiation risk. In addition, physicians can play a role in reducing radiation risk to their patients by considering these risks when making imaging referrals. This review provides a brief overview of the evidence pertaining to low-level radiation and excess cancer risks and addresses the radiation doses and risks from common medical imaging studies. Specific subsets of patients may be at greater risk from radiation exposure, and radiation risk should be considered carefully in these patients. Recent technical innovations have contributed to lowering the radiation dose from computed tomography, and the referring physician should be aware of these innovations in making imaging referrals.     

Infection prevention and control for HIV and other infectious agents in obstetric, gynecologic and neonatal settings

Personnel working in obstetric and gynecologic settings have long recognized their increased risks for infection with the hepatitis B virus and many have been immunized with hepatitis B vaccine. Staphylococcus aureus cross-transmission among neonates in newborn nurseries in the 1950s was a major impetus for the development of hospital infection control programs. In recent years, however, it is concerns about infection with the human immunodeficiency virus (HIV) that have caused health care workers and hospitals to rethink traditional infection risk reduction strategies and change them. This article describes infection risks peculiar to obstetric, gynecologic, and neonatal settings and presents practical approaches for reducing these risks, both for patients and for health care workers.     

Travel Health Implications for Women Traveling Abroad

International travel is increasing each year, and many travelers are female. Travel-related health risks include diseases, accidents, and other safety concerns. Whether traveling for business or pleasure, women should practice appropriate measures that minimize the impact travel can have on their health and well-being. Female travelers can have unique health risks related to pregnancy, lactation, and infectious disease. A large part of pretravel health preparation is often performed by nurses and should include a comprehensive health risk assessment, education, and vaccinations, all of which can help mitigate potential health risks for travelers.     

Towards understanding the concept of risk for pregnant women: some nursing and midwifery implications

Aims and objectives. This paper aims to explore the concept of risk in pregnancy. Background. Notions of risk and ‘not knowing’ have always surrounded pregnant women, although in the last two decades trends of increased consumer confidence and midwifery activism have together promoted a greater appreciation of pregnancy as a normal life event. At the same time, advances in pregnancy‐related technologies have contributed new levels of concern related to an increasing ability to detect minor abnormalities by ultrasound. This, in turn, causes a concordant rise in the number of women referred to high‐risk pregnancy care to monitor suspect findings. Overall, it seems likely that this increasing emphasis on abnormality detection and risk may have serious implications for women. Design. Concept analysis. Method. In this paper, I undertake an exploration of the concept of risk as understood by health professionals and pregnant women. Then, using Deborah Lupton’s understanding of a ‘discourse of risk’, I discuss the ways pregnant women both contribute to and are enmeshed in, this discourse. In the final section, I consider how nurses act informally to shield vulnerable women. Conclusions. Health professionals and pregnant women understand risk differently. Women employ a subjective appraisal of risk, measuring it against their personal values and prior experience, while health professionals evaluate risk in an objective manner. Relevance to clinical practice. As increasing numbers of women are referred to ‘at risk’ care, it is important that health professionals understand and respond to maternal understandings of risk. Nurses and midwives particularly, have a role to play in assisting women to make sense of risk calculations. In this way, they can act to ameliorate the growing concept of risk for pregnant women.     

孕产妇分娩知识调查研究

目的 了解孕产妇及其丈夫对分娩知识的掌握情况,为有针对性地实施产前健康教育提供依据,使孕产妇能够合理选择分娩方式,顺利度过分娩期,降低目前高剖宫产率中社会因素的影响.方法 采用整群抽样的方法,抽取重庆市某区作为研究地区,2006年6～8月在某区的13所医院中住院分娩的孕产妇599例及丈夫242例,对其分娩知识、分娩方式的认识、知识来源、感兴趣的分娩知识进行了问卷调查.结果 在调查的孕产妇中有283例参加了孕妇学校的学习,316例未参加.丈夫中有107例陪妻子参加过各种形式的分娩教育项目,有127例从未陪妻子参加过任何形式的分娩教育项目.结论 应加强孕妇学校建设,加强对孕产妇及其家属分娩有关知识的宣传教育,提高其自我保健能力,降低剖宫产率.     

紧急剖宫产术后产妇心理健康问题的研究进展

紧急剖宫产术是保障急危重症孕产妇及胎儿生命安全的必要手段。近年来对经历紧急剖宫产术后产妇的心理健康问题引起关注。该文从紧急剖宫产术概述、行紧急剖宫产术后产妇的心理健康问题、相关影响因素及对策4个方面进行综述,旨在帮助临床工作者了解行紧急剖宫产术后产妇的心理健康状况,为制订预防及干预措施提供参考。     

African American women and breast cancer: notes from a study of narrative

Survival after breast cancer and after all cancers is significantly worse for African American women than for others. Although many reasons have been proposed, no studies have explored the reception of messages about breast cancer by African American survivors of this disease, and how public images and discourses about breast cancer affects both their perceived risk for this disease and their experiences of illness. Narrative accounts of their lived experiences with breast cancer were collected from 23 African American survivors of breast cancer. Three themes have emerged: (a) Breast cancer is perceived to be a white woman's disease; (b) cancer is caused by experiences of repeated traumatic heartbreak; and finally, (c) there is a perceived lack of social support and understanding for the unique life experiences of the African American survivor of breast cancer. Nurses are on the front line of patient care. In the context of the managed care environment, they spend more time with patients than other health care providers and are soundboards for many patient concerns. As such, they can use the information provided in this study to inform high-risk women, current patients, partners, and other individuals in the medical community of how African American women might inaccurately access their personal risks for breast cancer, despite the public emphasis on this disease. Through the use of culturally sensitive pamphlets, nurses and other medical practitioners can also open discussions with underserved and minority patients as a means of realistically addressing some of these women's fears about breast cancer. These fears are barriers to effective cancer prevention because these individuals may consciously or unconsciously link a diagnosis of breast cancer, or even behaviors related to cancer prevention, to a potential death sentence.     

An update on contraceptive therapy options

The introduction of new contraception formulations and different routes of administration offers women more options when choosing birth control methods. Despite new options, there are still risks to consider when prescribing contraception to women on an individual basis. In the past 5 years alone, there has been the introduction of extended and continuous cycle oral contraceptives, a new subdermal implant, and shorter hormone-free intervals in 28-day cycles. Cardiovascular risks including stroke, myocardial infarction, and venous thromboembolism are risks that must still be considered in certain populations. In 2005, the Food Drug and Administration issued a press release concerning the higher exposure to estrogen in the transdermal patch compared with 35-μg oral contraceptives. This statement led to concerns of serious adverse events. Women who have no contraindications for contraception continue to struggle with adherence to daily, weekly, and even monthly regimens. Patients must take responsibility for taking their contraception as scheduled or risk becoming pregnant. The relationship of weight and efficacy of combined hormonal contraception is a concern that many health care practitioners have, and unfortunately, the data available do not answer the question at this time. The most important aspect of prescribing contraception is communication with the patient. Taking complete histories and prescribing contraceptive methods on an individualized basis will offer the patient the optimal method available to the patient.     

Pregnancy,Fertility, and Contraception Risk in the Context of Chronic Disease

Chronic health conditions complicate everyday choices patients make regarding their health and reproductive options. The risks and possible complications of existing conditions should be clearly communicated to patients so they can make informed decisions regarding their care. This compilation of 4 articles presents the fertility, infertility, and contraceptive challenges faced by individuals living with 4 common chronic conditions: systemic lupus erythematosus, rheumatoid arthritis, scoliosis, and organ transplant history. The article centers on reproductive concerns and risks facing both men and women affected by these disorders. It is critical that clinicians be aware of the unique issues these patients face so that appropriate education and counseling can be provided. These articles provide a basic understanding of the issues and concerns for these 4 chronic conditions.     

One theoretical framework for cardiovascular disease prevention in women

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality for women in the United States. Vulnerable and underserved women are even less likely to participate in healthy lifestyle behaviors to prevent CVD than the general US population. Many women are not aware that they are at risk for CVD and do not modify unhealthy lifestyle behaviors to reduce their risks for CVD. Healthcare providers may not promote awareness of CVD or consistently counsel female patients concerning lifestyle behavior modifications to reduce their risks for CVD. "The Evidence-Based Guidelines for the Prevention of Cardiovascular Disease in Women 2011 Update: A Guideline From the American Heart Association" provides a guide for healthcare providers to help women lower their risk for heart disease. By using a theoretical approach, nurses can facilitate implementation of these evidence-based guidelines to help women reduce their risks for CVD. Commonly used intrapersonal, interpersonal, and organizational- and community-level health behavior change theories that can be used to effectively promote CVD risk reduction in women will be discussed. The theoretical basis for changing CVD risk behaviors in women can be applied by using the PRECEDE-PROCEED Model to guide planning, implementing, and evaluating health behavior programs. The purpose of this article was to help nurses improve healthcare delivery by using the PRECEDE-PROCEED Model as a theoretical framework to guide CVD risk reduction efforts for women.