Feasibility Study to Compare Oxytocin Function Between Body Mass Index Groups at Term Labor Induction.

OBJECTIVE: To determine the feasibility of a protocol to examine the association between oxytocin system function and birth outcomes in women with and without obesity before induction of labor. DESIGN: Prospective descriptive. SETTING: Academic medical center in the U.S. Midwest. PARTICIPANTS: Pregnant women scheduled for induction of labor at 40 weeks of gestation or greater (n = 15 normal weight; n = 15 obese). METHODS: We collected blood samples and abstracted data by chart review. We used percentages to examine adherence to protocol. We used t tests and chi-square tests to describe differences in sample characteristics, oxytocin system function variables, and birth outcomes between the body mass index groups. RESULTS: The recruitment rate was 85.7%, protocol adherence was 97.1%, and questionnaire completion was 80.0%. Mean plasma oxytocin concentration was higher in the obese group (M = 2774.4 pg/ml, SD = 797.4) than in the normal weight group (M = 2193.5 pg/ml, SD = 469.8). Oxytocin receptor DNA percentage methylation (CpG -934) was higher in the obese group than in the normal weight group. CONCLUSION: Our protocol was feasible and can serve as a foundation for estimating sample sizes in forthcoming studies investigating the diversity in oxytocin system measurements and childbirth outcomes among pregnant women in different body mass index categories.

Uncovering the Experience: Return to Work of Nurses After Parental Leave.

INTRODUCTION: To understand the experiences of emergency nurses who have returned to work after parental leave, specifically relating to the return to work transition, work-life balance, work engagement, and opportunities to continue human milk expression. METHODS: Nurses (N = 19) were recruited from 5 emergency departments within 1 hospital system in the United States Midwest. Nurses (n = 11) were eligible to participate in a one-on-one interview if they had returned from parental leave within 6 months of the interview date. Nurses (n = 8) were eligible to participate in a focus group if they had returned from parental leave within 2 years of the interview date. Interviews were structured and data collection concluded when researchers believed data saturation was reached. Interviews were audio recorded and transcribed verbatim. Data were analyzed using Braun and Clarke's qualitative thematic analysis 6-phase framework. RESULTS: Three major themes from the data were identified: (1) work engagement, (2) lactation, and (3) childcare. Work engagement was broken down into the subthemes: lack of communication, perceived engagement expectations, and actual engagement. Lactation was broken down into the subthemes: the act of pumping, lactation breaks, and lactation rooms. The coronavirus disease 2019 pandemic impact on return-to-work is described under each major theme. DISCUSSION: Our findings provide insight into the unique challenges and experiences of nurses navigating parental leave and return-to-work in the emergency department. Strategies such as provision of managerial check-ins, return to work reorientation, lactation break coverage, enhanced supplementary lactation support, and leadership-provided accommodation may lighten the burden of these challenges and improve the returning nurse's job satisfaction.

Initiative to Increase Skin-to-Skin Contact in the Operating Room After Cesarean.

OBJECTIVE: To measure the increase in rates of skin-to-skin contact (SSC) for at least 15 minutes within the first hour of life in the operating room (OR) after cesarean birth after implementation of an SSC initiative. Our goal was to improve the rate of SSC from 20.3% to 50% for eligible newborns. DESIGN: Quality improvement initiative with a pre-post-practice implementation design using surveys. SETTING/LOCAL PROBLEM: A tertiary academic hospital in the U.S. Midwest with more than 12,500 births annually. PARTICIPANTS: Nursing staff on a labor and delivery unit (N = 40). INTERVENTIONS/MEASUREMENTS: We implemented nurse education, included SSC as part of the interdisciplinary team time-out (TTO) before procedures, and developed a new practice guideline to initiate SSC for at least 15 minutes within the first hour of life in the OR after cesarean birth. We measured nurses' knowledge and self-reported SSC practices with preimplementation and postimplementation surveys. We measured nurses' inclusion of SSC in the TTO and actual SSC practices in the OR with an audit tool. RESULTS: We analyzed a total of 394 audit tool forms from the initiative. Nurses reported more use of SSC after implementation of the SSC initiative. Skin-to-skin contact was verbalized in 75.3% (70/93) of the TTOs after implementation, and SSC for 15 minutes in the OR was completed in 20.3% (16/79) of preimplementation and 24.7% (23/93) of postimplementation phases. Total SSC for any length of time within the first hour in the OR increased from 30.4% (24/79) to 61.3% (57/93) in eligible women and newborns after implementation of the initiative. CONCLUSION: SSC in the OR increased after a 4-month initiative to increase SSC through nurse education, inclusion of SSC in the TTO, and a new guideline to initiate SSC in the OR at least 15 minutes within the first hour of life.

Maternal and system characteristics, oxytocin administration practices, and cesarean birth rate.

BACKGROUND: The cesarean birth rate in the United States is 32%, and there is discussion about the cause of high surgical birth rates. Our purpose was to determine whether mode of birth is influenced by maternal, nurse, and system factors. METHODS: Secondary analysis of a data set of 163 women having postdates labor induction with oxytocin. Kaplan-Meier survival curves were calculated to compare the time for patients to reach an infusion rate of 6 mU/min, consistent with endogenous oxytocin levels in active labor. We used the log-rank test to evaluate survival curve differences. Multiple logistic regression and Cox proportional hazards models were conducted and included covariates that had statistically significant bivariate relationships with the time variable, or were clinically meaningful. RESULTS: The mean time to reach 6 mU/min was longer for women who birthed by cesarean (172.5 minutes) than for women who had vaginal birth (125.0 minutes, P = .024). The mean time to reach 6 mU/min was also longer for women admitted on night shift (147.0 minutes) than day shift (110.2 minutes, P = .018). No maternal characteristics were significantly related to the time to reach a rate of 6 mU/min. CONCLUSIONS: Even during the initial hours of labor induction, it is important that the oxytocin infusion is titrated appropriately to aid women in achieving timely vaginal birth. Intrapartum nurses should receive education about the pharmacokinetics of intravenous oxytocin to understand proper administration of this high-alert medication.

Safer Muslim motherhood: Social conditions and maternal mortality in the Muslim world.

The greatest variation in maternal mortality is among poor countries and wealthy countries that rely on emergency obstetric technology to save a woman's life during childbirth. However, substantial variation in maternal mortality ratios (MMRs) exists within and among poor countries with uneven access to advanced obstetric services. This article examines MMRs across the Muslim world and compares the impact of national wealth, female education, and skilled birth attendants on maternal mortality. Understanding how poor countries have lowered MMRs without access to expensive obstetric technologies suggests that certain social variables may act protectively to reduce the maternal risk for life-threatening obstetric complications that would require emergency obstetric care.

Titration of Intravenous Oxytocin Infusion for Postdates Induction of Labor Across Body Mass Index Groups.

OBJECTIVE: To evaluate whether oxytocin titration for postdates labor induction differs among women who are normal weight, overweight, and obese and whether length of labor and birth method differ by oxytocin titration and body mass index (BMI). DESIGN: Retrospective cohort study. SETTING: U.S. university-affiliated hospital. PARTICIPANTS: Of 280 eligible women, 21 were normal weight, 134 were overweight, and 125 were obese at labor admission. METHODS: Data on women who received oxytocin for postdates induction between January 1, 2013 and June 30, 2013 were extracted from medical records. Oxytocin administration and labor outcomes were compared across BMI groups, controlling for potential confounders. Data were analyzed using χ2, analysis of variance, analysis of covariance, and multiple linear and logistic regression models. RESULTS: Women who were obese received more oxytocin than women who were overweight in the unadjusted analysis of variance (7.50 units compared with 5.92 units, p = .031). Women who were overweight had more minutes between rate changes from initiation to maximum than women who were obese (98.19 minutes compared with 83.39 minutes, p = .038). Length of labor increased with BMI (p = .018), with a mean length of labor for the normal weight group of 13.96 hours (standard deviation = 8.10); for the overweight group, 16.00 hours (standard deviation = 7.54); and for the obese group, 18.30 hours (standard deviation = 8.65). Cesarean rate increased with BMI (p = .001), with 4.8% of normal weight, 33.6% of overweight, and 42.4% of obese women having cesarean births. CONCLUSION: Women who were obese and experienced postdates labor induction received more oxytocin than women who were non-obese and had longer length of labor and greater cesarean rates.