ABSTRACT
The optimal time for umbilical cord clamping after birth remains a critical unknown fact that has implications for the infant, the mother, and science. A national survey was conducted using a randomized sample (n = 303) of the active membership of the ACNM to determine cord clamping practices and beliefs of American nurse-midwives. The response rate was 56%. The respondents fell into three cord clamping categories: early (EC) or before 1 minute (26%); intermediate (IC) or 1 to 3 minutes (35%); and late (LC) or after pulsations cease (33%). The EC group believes that early clamping facilitates management of the newborn. The IC group believes that a moderate delay of clamping allows for a gradual transition to extrauterine circulation, although many think that the timing of cord clamping is not significant. The LC group have strongly held beliefs that late clamping supports physiologic birth processes. The majority of CNMs (87%) place the baby on the mother's abdomen immediately after birth and 96% avoid clamping a nuchal cord whenever possible. Although Varney's Midwifery was cited most frequently as a reference, 78% of the respondents listed no references reflecting, in part, the absence of evidence-based recommendations for cord clamping practices.
Subject(s)
Delivery, Obstetric/methods , Nurse Midwives , Umbilical Cord , Adult , Aged , Constriction , Evidence-Based Medicine , Health Knowledge, Attitudes, Practice , Humans , Infant, Newborn , Middle Aged , Societies , Surveys and Questionnaires , United StatesABSTRACT
This case report involves an adolescent primigravida at term who was admitted with urinary complaints to the labor and delivery unit of a medical center. Within an hour, she suddenly began screaming and complaining of severe pain running from her anterior pelvis through her vagina and up her spine. Three days of very challenging co-management of the patient, with several recurrences of acute pain, followed. Differential diagnoses that could explain this patient's symptoms are reviewed and discussed. Difficult management issues, including the stress of clinical management in the face of unidentified disease processes, are addressed. Lacking a certain diagnosis even retrospectively, the authors request comments from readers.
Subject(s)
Dystocia/complications , Pain/etiology , Abdomen, Acute/complications , Abdomen, Acute/diagnosis , Abruptio Placentae/complications , Abruptio Placentae/diagnosis , Adolescent , Diagnosis, Differential , Dystocia/diagnosis , Dystocia/etiology , Female , Humans , Pregnancy , Pubic Symphysis , Rupture/complications , Rupture/diagnosis , Somatoform Disorders/complications , Somatoform Disorders/diagnosisABSTRACT
Quantitative evaluation of amniotic fluid volume is now widely used to evaluate fetal status during pregnancy. A finding of decreased fluid volume raises management issues and requires that nurse-midwives arrange collaborative care. This article reviews the literature relevant to amniotic fluid volume and oligohydramnios. The significance to nurse-midwifery is discussed. Conservative management of oligohydramnios is described. A case involving oligohydramnios diagnosed prior to term is presented and discussed.
