Pandemics Past, Present, and Future: What History Can Teach Us.

One of the lessons of the current pandemic is that Americans have lost trust in the public health system in the United States (US) and in the health recommendations of the Federal government. History tells us that each pandemic brings new challenges and new lessons. Looking back at the history of pandemics, and at the present experience, nurses and midwives can craft responses to patient concerns and contribute to future planning that better addresses the needs of maternal-child health practices.

Pre-Exposure Prophylaxis for HIV Infection and the Role of the Women's Health Care Provider in HIV Prevention.

HIV infection is a major public health problem for women in the United States. Prevention of new HIV infections is essential to the goal of eliminating HIV in the United States. Pre-exposure prophylaxis (PrEP) is an effective and safe HIV prevention method recommended for women at increased risk for HIV infection, including during pregnancy and lactation. The recommended PrEP regimen is a fixed-dose combination of tenofovir disoproxil fumarate and emtricitabine administered as a single daily dose. The initial evaluation for individuals desiring PrEP for HIV prevention includes obtaining a history, laboratory evaluation, and evaluation of the accessibility and acceptability of PrEP. Individuals using PrEP medications are seen every 3 months for follow-up. These follow-up visits include evaluation for signs and symptoms of seroconversion, management of side effects and adverse reactions, and evaluation of adherence to PrEP. Follow-up visits also include testing for HIV, sexually transmitted infections, and renal function and a review of HIV prevention and risk reduction methods. Despite known safety and efficacy of PrEP among women, PrEP use in women in the United States remains low. Gaps exist in HIV prevention that can in part be addressed by women's health care providers through risk screening and provision of HIV prevention methods. All providers of comprehensive sexual health care can and should assess individuals for risk factors for HIV infection and offer HIV prevention methods, including PrEP, to individuals at risk for HIV.

Staphylococcus Infections in Pregnancy: Maternal and Neonatal Risks.

Staphylococcus aureus is carried by up to one third of the general population; about 2% are carriers for methicillin-resistant S. aureus (MRSA). Infections caused by the antibiotic-resistant form include skin and soft tissue infections, as well as pneumonia, sepsis, and wound infections. Although the risks of hospital-associated systemic infections have decreased with attention to infection control procedures, serious obstetric illness remains a concern. This article describes the range of MRSA infection in the setting of pregnancy and discusses risks to both mother and newborn associated with active MRSA infection during pregnancy and childbirth. Methicillin-resistant S. aureus remains a risk to mothers and newborns, requiring prompt identification and appropriate management.

Patient safety during induction of labor.

Rates of induction of labor have risen rapidly since 1990, from 9.6% in that year to a peak of 23.8% of the 2010 singleton births in the United States. Even as the definition of term pregnancy has been refined to reflect the continuing maturation needs of the fetus, and mothers have been encouraged to "go the full forty," management strategies for pregnancy conditions that increase risk have included early induction. Labor induction should only be undertaken when there are specific indications for interrupting the normal processes of pregnancy. These indications may relate to maternal, fetal, or placental conditions or simply reflect the understanding that in all pregnancies, the placenta will eventually lose its ability to adequately provide oxygen, nutrition, and waste removal for the fetus. Patient safety-for both the mother and the child-can be improved when clinicians practice within clinical guidelines that follow the best available evidence and women are able to make informed decisions regarding plans for labor.

Obesity in pregnancy: addressing risks to improve outcomes.

The rapidly increasing rates of obesity among women of childbearing age, not only in the United States but also across the globe, contribute to increased risks during pregnancy and childbirth. Overweight and obesity are quantified by body mass index (BMI) for clinical purposes. In 2010, 31.9% of U.S. women aged 20 to 39 years met the definition of obesity, a BMI of 30 kg/m or greater. Across the life span, obesity is associated with increased risks of hypertension, cardiovascular disease, diabetes, sleep apnea, and other diseases. During pregnancy, increasing levels of prepregnancy BMI are associated with increases in both maternal and fetal/neonatal risks. This article reviews current knowledge about obesity in pregnancy and health risks related to increased maternal BMI, addresses weight stigma as a barrier to care and interventions that have evidence of benefit, and discusses the development of policies and guidelines to improve care.

A successful model of collaborative practice in a university-based maternity care setting.

When building an integrated practice, the ability of each team member to work comfortably with other professionals is key. Midwives need to understand departmental expectations for participation in resident/student education, be willing to provide midwifery care in a high-acuity setting with limited opportunities for low-intervention care, and understand expectations for clinical leadership. Physicians need to build on the group expectation of mutual respect and best use of each group member. Confusion about midwifery and physician roles in maternity care still exists.

Obesity as a complication of pregnancy and labor.

Over the last 40 years, there have been significant increases in the rates of overweight and obesity in childbearing women. There has been a parallel increase in the rates of pregnancy complications including hypertension, diabetes, fetal macrosomia, and complications of delivery. Caregivers can focus on appropriate interventions during pregnancy and childbirth to improve outcomes and prevent harm.

Infectious diseases in pregnancy: issues of screening, prevention, and treatment.

Infectious disease recommendations that play a part in care during birth, or among hospitalized antepartum women, are updated with new information as evidence becomes available. At the time of hospitalization during pregnancy, attention to testing and treatment can prevent the transmission of infections to the newborn, can improve the management of the mother's health, and is an increasingly important aspect of patient safety initiatives. Obstetric and perinatal nurses who are aware of current recommendations play a critical role in disease prevention. This article discusses issues that are relevant for maternal child healthcare practitioners. Examples are used to illustrate concerns of particular importance during pregnancy, such as antibiotic-resistant infections, vaccine-preventable illness, and testing for infectious diseases.