Journal of midwifery & women's health
-
J Midwifery Womens Health · Nov 2005
ReviewLiability in triage: management of EMTALA regulations and common obstetric risks.
The Emergency Medical Treatment and Active Labor Act (EMTALA) affects all clinicians who provide triage care for pregnant women. EMTALA has specific regulations for hospitals relative to women in active labor. ⋯ It is critical for clinicians performing obstetric triage to understand the duties and obligations of this law. This article discusses EMTALA and reviews common liability risks in obstetric triage as well as strategies to modify those risks.
-
Nuchal cord, or cord around the neck of an infant at birth, is a common finding that has implications for labor, management at birth, and subsequent neonatal status. A nuchal cord occurs in 20% to 30% of births. All obstetric providers need to learn management techniques to handle the birth of an infant with a nuchal cord. ⋯ Evidence for specific management techniques is lacking. Cutting the umbilical cord before birth is an intervention that has been associated with hypovolemia, anemia, shock, hypoxic-ischemic encephalopathy, and cerebral palsy. This article proposes use of the somersault maneuver followed by delayed cord clamping for management of nuchal cord at birth and presents a new rationale based on the available current evidence.
-
This article reviews clinical and program issues in the prevention of mother to child transmission (PMTCT) of HIV in sub-Saharan Africa. Topics include prevention of infection, voluntary counseling and testing, prenatal care, labor and birth, postpartum, family planning, infant feeding, and the role of traditional birth attendants. Programs providing short-course antiretroviral therapy to prevent infant infection are contrasted with comprehensive programs offering antiretroviral therapy and medical care to mothers, children, and families. ⋯ They are the backbone of the new PMTCT programs and will be the largest group of health workers available to diagnose and treat opportunistic infections and dispense antiretroviral therapy. But they have received little training and support to provide AIDS care and treatment and are rarely consulted when plans are made about workforce issues and capacity development in the health sector. Clinical training, leadership skills, salary support, expansion of the nursing workforce, and development of expanded roles for nurses and midwives in AIDS care are needed to help them turn the tide of the epidemic.
-
J Midwifery Womens Health · Jan 2005
ReviewA literature review of the effectiveness of ginger in alleviating mild-to-moderate nausea and vomiting of pregnancy.
Mild-to-moderate nausea and vomiting of pregnancy affects up to 80% of all pregnancies. Concern about antiemetic use and the time-limited nature of symptoms has restrained the development of effective treatment approaches, yet supportive, dietary, and lifestyle changes may be ineffective. This article reviews 4 recent well-controlled, double-blind, randomized clinical studies that provide convincing evidence for the effectiveness of ginger in treating nausea and vomiting of pregnancy. It also provides a dosage update for the various forms of ginger.
-
This article is a review of analgesics and anesthetics offered to laboring women, including intravenous drugs, epidural and spinal agents, and inhalational anesthetics. An overview of the uses, risks, and benefits is provided for each anesthetic alternative. To provide the most effective care to women in labor, clinicians have a responsibility to have current knowledge of the best evidence for safety and efficacy of these pharmacologic agents and techniques and be able to effectively communicate this information to clients.