Journal of nurse-midwifery
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Modern obstetrics relies on a collection of drugs that affect the motility of the uterus either to stimulate or to suppress uterine contractions. Although a comprehensive, detailed understanding of how these drugs work does not yet exist, many, such as oxytocin, appear to work by altering cytosolic calcium levels in uterine smooth muscle cells. ⋯ This report is intended to summarize the current state of knowledge regarding how these drugs affect the motility of the uterus. The delineation of the molecular mechanisms of action of these drugs is important because it provides the basis for their rational therapeutic use as well as for the design of new and better uterotrophic drugs.
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A woman's experience of unrelenting back pain with a fetus in an occipitoposterior position and the escalating interventions culminating in a cesarean birth is every midwife's nightmare. Intrathecal analgesia is a relatively simple and rapid method to provide maternal relaxation and relief from severe back labor. This article describes the use of intrathecal opioid analgesia in labor complicated by failure to progress in first-stage labor due to persistent occipitoposterior position of the fetus. ⋯ It does not cause motor blockade, so it allows the mother to be mobile and feel the urge to push. Consequently, there is no associated risk of an increased need for forceps or vacuum-assisted delivery. The authors note a decreased incidence of operative delivery for fetal occipitoposterior position with the use of intrathecal narcotics.
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Severe hemorrhage occurs in less than 1% of all pregnancies; however, it remains one of the important causes of maternal morbidity and mortality. Although the importance of hemorrhage has been recognized in obstetric circles for years, in the last decade or so, research has been conducted that has disproven long-held beliefs. Nurse-midwives must be knowledgeable about the etiology, management, and treatment of postpartum hemorrhage. ⋯ The mechanisms of action of ergots, oxytocin, and prostaglandins are described, and criteria for selecting a medication are presented. Herbal remedies for hemorrhage are discussed briefly. Also discussed are the optimal time for drawing the hematocrit and what this laboratory value can tell the nurse-midwife.
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Comparative Study
Cesarean section rates in low-risk private patients managed by certified nurse-midwives and obstetricians.
This study was designed to assess the impact of selected medical interventions during labor upon cesarean section rates by comparing the maternal and neonatal outcomes of obstetrician- and nurse-midwife-managed low-risk private patients. All patients who delivered at Prentice Women's Hospital in Chicago, Illinois, from January 1, 1987 through December 31, 1990 were evaluated for low-risk criteria to be included in the study. During that time, the nurse-midwives delivered 573 patients and the obstetricians delivered 12,077 patients. ⋯ Both interventions were associated with an increased rate of cesarean section. Fetal outcomes in the two groups were not statistically different. Women cared for by nurse-midwives had a lower cesarean section rate, fewer interventions, and equally good maternal and infant outcomes when compared with those cared for by physicians.
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Political participation, which is promoted by nurse-midwifery leaders, is a widely studied topic in this country. Yet, there is little data that describes political participation among health care providers such as nurse-midwives. The descriptive findings presented here are from a national survey of a random sample of members of the American College of Nurse-Midwives. ⋯ As in the general population of the country, the electoral act of voting is the predominant political activity. Nurse-midwives are more apt to demonstrate nonelectoral political behaviors in regard to women's issues. Overall, there is a general assumption that the representatives of the ACNM membership maintain the responsibility for political action.