Journal of midwifery & women's health
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J Midwifery Womens Health · Jan 2001
Hidden from view: violent deaths among pregnant women in the District of Columbia, 1988-1996.
Maternal mortality is underreported in the United States in part because traumatic deaths are not included in nationally reported maternal mortality ratios. The overall study goal was to compare women whose deaths had been reported to and investigated by a medical examiner and who had evidence of pregnancy to women without evidence of pregnancy in terms of socio-demographic information, toxicology results, and manner and cause of death. A secondary goal was to compare the pregnancy status and gestational age of women with evidence of pregnancy at the time of death in relation to the manner of death, with particular focus on women who died as a result of violent death. ⋯ Medical examiner autopsy records identify violent pregnancy-associated deaths, many of which occur early in pregnancy and are missed by other enhanced case-finding techniques that require a record of a birth or fetal death. These deaths are usually excluded from reported maternal mortality ratios. Few studies have evaluated the prevalence of homicide in women of childbearing age, yet understanding the extent of less commonly associated causes of death during pregnancy such as homicide, may lead to improved identification of preventable problems that contribute to maternal morbidity and mortality. This study, which sheds new light on the identifying and reporting of maternal mortality, and specifically on homicide as a form of violence toward pregnant women, should be of particular interest for all women's health providers, as well as public health professionals, researchers, and advocates who are interested in the design, development, and evaluation of prevention programs, especially those directed toward preventable problems such as domestic violence.
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"Scope of practice" has a variety of meanings amongst midwives, other health professionals, health organizations, and consumers of midwifery care. For some, it refers to the Standards for the Practice of Midwifery; for others, it encompasses the legal base of practice; still others equate it with the components of the clinical parameters of practice. ⋯ This article provides a comprehensive discussion of the concept "scope of practice." Clinical scenarios are provided as case exemplars. The aim of this paper is to provide both new and experienced midwives with a substantive definition of the concept "scope of practice."
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J Midwifery Womens Health · May 2000
ReviewNipple pain in breastfeeding women: causes, treatment, and prevention strategies.
This article identifies problems and conditions that contribute to nipple pain during lactation and that may lead to early cessation or noninitiation of breastfeeding. Signs and symptoms of poor latch-on and positioning, oral anomalies, and suckling disorders are reviewed. ⋯ Comfort measures for sore nipples and current treatment recommendations for nipple wound healing are discussed. Suggestions are made for incorporating in-depth breastfeeding content into midwifery education programs.