Management of the third stage of labor: an evidence-based approach.

The third stage of labor usually is eclipsed by the excitement of the birth of a baby. Evidence shows that management of this stage can directly influence important maternal outcomes such as blood loss, need for manual removal of the placenta, and postpartum hemorrhage. Most of the large trials have compared active management of the third stage to expectant management. Active management includes routine use of cord traction and uterotonins, whereas expectant management can be characterized as one of watchful waiting. The use of herbal therapies and homeopathic remedies lack study; additional factors such as site of birth and hydrotherapy also remain to be explored. However, on the basis of current evidence, if a decrease in postpartum bleeding or avoidance of manual removal is desired, an active approach to third stage is the one that should be adopted until and unless contradictory findings are published.

Nurse-midwifery: yesterday, today, and tomorrow.

This article chronicles the dramatic changes in nurse-midwifery over the last 25 years. Presently, multiple models of midwifery education leading to certification exist, all within a competency-based framework. Accreditation of education programs and the certification process within nurse-midwifery remain examples to others. The consumer demand for certified nurse-midwives continues to rise, spurring the preparation for more professionals. However, the average woman in the United States still does not have access to a certified nurse-midwife/certified midwife for care. Several of the barriers to practice have been dismantled during the last quarter century; however, adequate reimbursement, relationships with various groups, and managed care are among the issues that will challenge midwifery in the new century.

Intrapartum pain: pharmacologic management.

Even with the tremendous therapeutic benefit of nonpharmaceutical pain relief measures for laboring women, pharmaceutical therapies often are needed. Nurses and other health care providers need to be familiar with the differing pharmaceutical properties of commonly prescribed pain-relieving drugs. The pharmaceutical properties of sedatives and hypnotics, opioids, and local anesthetic agents used to relieve pain during labor and delivery are reviewed. Individualization of drug therapy and maximal therapeutic effects result when the health care provider is informed about the pharmaceutical properties of analgesic and anesthetic agents so that a wise choice can be made.

Drugs and uterine motility.

Nurses who care for pregnant and laboring women are faced with an increasingly frequent use of pharmaceutical agents that facilitate initiation of labor (uterotropins), augment labor (uterotonics), or potentially stop labor (tocolytics). The choice of the drug, administration, side effects, and complications varies. Knowledge about uterine physiology helps the clinician understand the action of these agents. Knowledge of the differences and similarities among oxytoxics, ergots, prostaglandins, and the various drugs used as tocolytics is essential for safe and effective care of women and their fetuses who may be exposed to these agents.

Pharmacologic management of common gastrointestinal health problems in women.

A wide variety of drugs are available for the treatment of common gastrointestinal health problems in women, including minor or serious as well as acute or chronic conditions. The midwife needs to be current in the pharmacology of over-the-counter as well as prescriptive agents for both pregnant and nonpregnant women. The drug classifications reviewed in this article include antacids, H2 receptor antagonists, antimicrobials, proton pumps, antiemetics, emetics, cholinergics, laxatives, prokinetics, and antidiarrheals. In addition, the physiologic principles are reviewed to enhance the understanding of how these drugs work.

Adolescents as victims: an overview of the special impact of sexual abuse.

Although under-reported, sexual abuse is an increasingly critical problem facing adolescents and their care providers. All care providers must consider the possibility of abuse in their clinical practice. This paper will address the significance of the problem and offer suggestions for immediate nursing intervention.

Breast disease. The role of the nurse-midwife.

Certified nurse-midwives provide primary care for women. An essential part of a physical examination is a complete assessment of the breasts. Normal breasts and their variations and deviations are discussed, with particular attention paid to breast pain, masses, and nipple discharge, and the clinical implications of each. In addition, the demographics, risk factors, staging criteria, and treatment modalities of breast cancer are presented.

The perimenopausal period. Implications for nurse-midwifery practice.

As more women move into their 40s, it can be anticipated that nurse-midwives will be sought to continue to provide care and anticipatory guidance in the perimenopausal period. This article reviews definitions, demographics, physiology, and clinical manifestations of the perimenopausal period. In addition, management strategies other than hormone replacement therapy for the common discomforts of menopause are identified and discussed.

A study of mothers' postpartum teaching priorities.

This descriptive study investigated the teaching priorities of mothers during the early puerperium. Subjects (N = 117) were English-speaking women who had normal vaginal deliveries and healthy newborns. A questionnaire consisting of 16 maternal and 23 infant care teaching topics was administered during the 3-day postpartum hospital stay. Respondents rated each topic's teaching priority on a 4-point, Very Important to Not Very Important, scale. Results were analyzed with percentages in relation to all mothers, maternal age groups (teens, twenties, thirties), and parity groups (primiparas, multiparas). The maternal care topic of highest priority for all age and parity groups was "Postpartum Complications." The infant care topic of highest priority for all age and parity groups was "Infant Illnesses." The results suggest that these teaching topics are of most concern to mothers during the early postpartum period. The mothers' priorities assigned to other teaching topics varied by age and parity groups.

Neonatal jaundice in the home: assessment with a noninvasive device.

Hyperbilirubinemia continues to be the major reason for hospital readmissions of neonates. This is particularly true for neonates who are discharged before the 72-hour physiological jaundice occurs. A small descriptive study reveals that use of a noninvasive bilirubinometer can be of assistance in screening for elevated bilirubin levels of newborns visited at home.

Chorionic villus sampling: counseling your patient.

Chorionic villus sampling is a technique for prenatal genetic screening that has been widely publicized by the print and television media. Although not yet commonly available, women may seek additional information about the procedure from nurse practitioners. This article discusses the women for whom this procedure is most appropriate, the procedure's accuracy, sampling techniques, safety records and the procedure's accessibility and cost. The NP's role in counseling and anticipatory guidance is also discussed.