Journal of midwifery & women's health
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J Midwifery Womens Health · Sep 2011
Maternal temperature elevation and occiput posterior position at birth among low-risk women receiving epidural analgesia.
To evaluate the relationship between maternal temperature elevation and occiput posterior position at birth as well as the association of fetal head position and temperature elevation on method of birth among women receiving epidural analgesia. ⋯ Intrapartum temperature elevation among women receiving epidural analgesia, even if only to 99.6°F (37.6°C), is associated with approximately a 2-fold increase in the occurrence of occiput posterior fetal head position at birth. Additionally, although this observational study cannot establish causal links, our findings suggest that the relationship between epidural-related intrapartum temperature elevation and occiput posterior position at birth could contribute to an increased cesarean birth rate among women receiving epidural analgesia for pain relief in labor.
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J Midwifery Womens Health · Jul 2011
Integration of routine rapid HIV screening in an urban family planning clinic.
Family planning centers can play an important role in HIV screening, education, and risk-reduction counseling for women who are sexually active. This article describes how 1 urban Title X-funded family planning clinic transitioned from using a designated HIV counselor for targeted testing to a model that uses clinic staff to provide integrated, routine, nontargeted, rapid HIV testing as standard of care. ⋯ Integrating routine HIV screening into a family planning clinic can be critical to identifying new HIV infections in women. This initiative demonstrated that routine, nontargeted, rapid HIV screening can be offered successfully as a standard of care in a high-volume, urban, reproductive health care setting. This description and evaluation of the process of changing the model of HIV testing in a clinic setting is useful for clinicians who are interested in expanding routine HIV testing in their clinics.
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J Midwifery Womens Health · Jul 2011
Postpartum care: evaluation and experience among care providers and care receivers.
There have been substantial alterations in the structure of postpartum care over the last several decades. Our aim was to investigate the perceived quality of, and satisfaction with, postpartum care among caregivers and care receivers in the maternity ward of a community hospital in Norway with about 2600 births per year. ⋯ By exploring both the caregivers' and care receivers' evaluations and expectations of the actual services in the maternity ward, areas for enhancement of the quality of the ward and its services can be detected and carried out. The present study revealed 2 areas needing further focus: assistance with child care during the night and teaching of child-care skills during the stay. We believe that investigations that collect data from both caregivers and care receivers, by using adapted and validated questionnaires to gather information on quality and satisfaction with the maternity ward, are mandatory for improvement and continuous adaptation of health services.
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J Midwifery Womens Health · May 2011
ReviewClinicians' guide to the use of oxytocin for labor induction and augmentation.
Oxytocin is commonly used in obstetrics for labor induction and augmentation. Careful assessment of the individual clinical situation based on indications and contraindications is essential to enhancing safe and effective use. Counseling the woman and her partner regarding potential risks and benefits before use is necessary to promote informed consent. ⋯ Although treatment of excessive uterine activity related to oxytocin has not been studied prospectively, several interventions such as maternal repositioning, an intravenous fluid bolus, and discontinuation of the oxytocin infusion are beneficial in returning uterine activity to normal, based on retrospective review of oxytocin-induced tachysystole. Perinatal quality measures from the National Quality Forum and the Joint Commission can be useful in monitoring care related to induction of labor. These include elective births before 39 weeks of pregnancy and cesarean births for low-risk, first-birth mothers.
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J Midwifery Womens Health · May 2011
ReviewHormonal management of the female-to-male transgender patient.
This article focuses on initiating and monitoring testosterone therapy for the female-to-male transgender person. For providers unfamiliar with the evaluation and treatment of the female-to-male transgender patient, this article offers an introduction to the diagnostic criteria for gender identity disorder as well as the eligibility and readiness criteria for hormonal treatment. Also included is information regarding screenings to be done before the initiation of testosterone therapy and during follow-up visits, common side effects of testosterone, and basic testosterone regimens available.