A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice.

To document the use of herbal preparations for cervical ripening, induction, and augmentation of labor by certified nurse-midwives (CNMs) and nurse-midwifery education programs, a national survey of 500 members of the American College of Nurse-Midwives was conducted. Forty eight nurse-midwifery education programs were also surveyed to determine whether they were formally or informally educating students in the use of herbal preparations for cervical ripening, induction, or augmentation of labor. The results of this study, a review of the literature, professional issues, and recommendations for clinical practice are presented in this article. Of 500 questionnaires mailed to ACNM members, 90 were returned from CNMs who used herbal preparations to stimulate labor and 82 were returned from CNMs who did not use herbal preparations to stimulate labor. Three questionnaires were excluded due to incomplete data or blank questionnaires. No significant differences were noted in relations to geographical region, midwifery education, or highest level of education between the CNM respondents who did and those who did not use alternative methods to stimulate labor. Of the CNMs who used herbal preparations to stimulate labor, 64% used blue cohosh, 45% used black cohosh, 63% used red raspberry leaf, 93% used castor oil, and 60% used evening primrose oil. CNMs who used herbal preparations to stimulate labor were younger (43 versus 45 years, P < .01) and more likely to deliver at home or in an in-hospital or out-of-hospital birthing center (P < .0006), than CNMs who never used herbal preparations to stimulate labor. The most cited reason for using herbal preparations to stimulate labor was that they are "natural," whereas the most common reason for not using herbal preparations was the lack of research or experience with the safety of these substances. Sixty-nine percent of CNMs who used herbal preparations to stimulate labor learned about using them from other CNMs, 4% from formal research publications, and none from their formal education programs. Although 78% of the CNMs who used herbal preparations to stimulate labor directly prescribed them and 70% indirectly suggested them to clients, only 22% had included them within their written practice protocols. Seventy-five percent of the CNMs who used herbal preparations to stimulate labor used them first or instead of pitocin. Twenty-one percent reported complications including precipitous labor, tetanic uterine contractions, nausea, and vomiting. Sixty-four percent of the nurse-midwifery education programs included instruction in the use of herbal preparations to stimulate labor in their formal curricula, and 92% included informal discussions on the use of herbal preparations. Evening primrose oil was the most common herbal preparation discussed in nurse-midwifery education programs. Castor oil was the most commonly used herbal preparation used by nurse-midwives in clinical practice.

A reliability study of measurement techniques to determine static scapular position.

Current shoulder rehabilitation programs encourage scapular stabilization components although, to date, no scientific studies have evaluated changes in scapular position following such rehabilitation. Four different measurement methods of scapular position have been reported in the literature. The purpose of this study was to examine the intratester and intertester reliability of these four methods and to also examine if significant differences exist in scapular position between dominant and nondominant extremities. Thirty-two subjects volunteered for this study. Intraclass correlation coefficients (ICC) revealed acceptable intratester reliability (ICC = 0.81-0.95) for all measurement methods. However, while one method also proved to be acceptable (ICC = 0.91-.92) for intertester measurements, the other three methods were unacceptable (ICC = 0.18-0.69). One tester reported significant differences in scapular position of the dominant and nondominant extremities when using the most reliable method. The second tester found no significant differences with either method. Future research is recommended to reexamine reliability of these methods and measure subjects with shoulder pathology.

The prenatal human submandibular gland: a histological, histochemical and ultrastructural study.

The submandibular glands of 6 human fetuses, 13.5-16 weeks old, were studied using light and electron microscopic techniques. The developing gland at this stage consisted of a bush-like network of terminal buds (primitive acini) and primary ducts surrounded by a loose mesenchyme. Both components had a lumen which was surrounded by 1 or 2 layers of epithelial cells. Those cells adjacent to the lumen were attached by desmosomes but lacked well developed terminal bars. The cells were separated by an intercellular space, into which projected numerous microvilli. The cytoplasm of the epithelial cells contained the usual organelles with some cells containing large accumulations of glycogen granules. Serous granules and the luminal contents were both strongly PAS and AB positive. The function of this secretory material, at this stage of human development, is unknown. No mucus-like granules were observed. The terminal buds and primary ducts were surrounded by a well developed basal lamina and contained a few elongated cells which appeared morphologically as developing myoepithelial cells. Morphologically the development of the human submandibular gland, at 13.5-16 weeks of age, is roughly equivalent ot the developmental stage of the gland seen in the newborn rat or mouse. By birth, the human submandibular gland would likely reach a mature state, because there would be ample time remaining, in a normal gestation, for the maturation process to be completed.

Popliteal entrapment syndrome.

A probable cause of popliteal artery entrapment is proposed. The medial head of the gastrocnemius muscle during its embryological development crosses the popliteal fossa from lateral to medial. It is proposed that the migrating medial head carries the popliteal artery and vein across the fossa and entraps them against the medial condyle of the femur. Dissection of 86 anatomical specimens revealed two cases of unilateral and one case of bilateral entrapment of both popliteal vessels. Two surgical cases of popliteal entrapment are presented. This entrapment syndrome is a remedial cause of claudication and when considered, it is readily diagnosed and surgical correction is effective. Because of distal embolisation and occlusions, early recognition and treatment is desirable. Forty-seven cases from the literature are reviewed as to the entrapment type and the age and sex of the patients.