Nitrous Oxide Use for Pain in Labor, Conversion to Neuraxial Analgesia, and Birth Outcome.

Introduction: A variety of labor pain management options is essential to patients and their care providers. Inhaled, patient controlled nitrous oxide (NO) is a valuable addition to these options. The purpose of this study was to examine laboring patient, newborn, and provider characteristics associated with NO use for pain relief in labor and to examine the association between NO, conversion to neuraxial analgesia, and cesarean birth.

Anesthetic Management and Neuromonitoring in a Patient with Very Long-Chain Acyl-Coenzyme A Dehydrogenase Deficiency Undergoing Scoliosis Surgery: A Case Report and Review of Literature.

Patients with very long-chain acyl-CoA dehydrogenase deficiency (VLCADD) are prone to hypoglycemia and clinical decompensation when metabolic demands of the body are not met. We present a pediatric patient with VLCADD who underwent a posterior spinal fusion for scoliosis requiring intraoperative neurophysiology monitoring. Challenges included minimization of perioperative metabolic stressors and careful selection of anesthetic agents since propofol-based total intravenous anesthesia (TIVA) was contraindicated due to its high fatty acid content.

Concerns of Women Choosing Community Birth During the COVID-19 Pandemic: A Qualitative Study.

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, midwives have reported increased demand for community birth services. The purpose of this qualitative study was to understand childbearing persons' decision-making during the pandemic and to illuminate their experiences giving birth in community settings.

Methods: The study was framed by the interpretive phenomenological approach.

Malaria in Pregnancy: Considerations for Health Care Providers in Nonendemic Countries.

Malaria is a common infection world-wide, which carries significant risk of morbidity and mortality. Health care providers in the United States may lack experience in recognizing and treating this disease. The pathophysiology of malaria differs during pregnancy, resulting in increased risk for serious morbidity and mortality for the woman and her fetus.

A Public Health Ethics Analysis of the Criminalization of Direct Entry Midwifery.

Multiple types of midwives practice in the United States, but regulation of midwifery practice varies by state. In some states, direct entry midwifery practice is unregulated or criminalized. Because regulations are the most burdensome of the public health interventions, they require the most stringent ethical critique.

Estimating the Financial Impact of Reducing Primary Cesareans.

Introduction: Preventing a primary cesarean birth in nulliparous women with term, singleton, vertex pregnancies (NTSV) is recognized as an important strategy to reduce maternal morbidities and risks to the newborn. Multiple professional organizations are supporting approaches to safely reduce NTSV cesarean rates, including the American College of Obstetricians and Gynecologists; the Society for Maternal-Fetal Medicine; and the Association of Women's Health, Obstetric and Neonatal Nurses. The American College of Nurse-Midwives (ACNM) is leading one such effort as part of its Healthy Birth Initiative: the Reducing Primary Cesareans (RPC) Learning Collaborative.

Expanded Practice in Midwifery: Designing, Implementing, and Maintaining Programs.

Advances in health care science and delivery, coupled with patient need for access to care, have driven expanded practice in midwifery for decades. The process for development and implementation of expanded practices for midwives and midwifery practices is described. Important components include assessment of need, identifying stakeholders and supporters, development of a program proposal, obtaining privileges, developing training programs, and conducting ongoing quality management and program evaluation.

Innovations in Midwifery Education: The Academic Medical Center Model.

Workforce analyses project a need for women's health care providers, especially in maternity care. With a stagnant number of certified nurse-midwife/certified midwife (CNM/CM) education programs, the present production of new CNMs/CMs is not robust enough to meet the growing demand. This article describes an existing but underutilized model for CNM/CM education programs, based in an academic medical center with an existing academic affiliation.

A Qualitative Study of the Maternity Care Experiences of Women with Obesity: "More than Just a Number on the Scale".

Introduction: The prevalence of obesity among pregnant women in the United States is high. Obesity can have long-term health consequences for both women and their offspring, so high-quality perinatal care for women with obesity is essential. However, stigmatizing encounters with health care professionals can decrease quality and promote avoidance of care.

The Evolving Role of Midwives as Laborists.

This article examines the history and present state of the midwife as laborist. The role of the midwife and obstetrician laborist/hospitalist is rapidly evolving due to the need to improve patient safety and provide direct care due to reduced resident work hours, as well as practice demands experienced by community providers and other factors. Models under development are customized to meet the needs of different communities and hospitals.

Obesity stigma as a determinant of poor birth outcomes in women with high BMI: a conceptual framework.

Obesity stigma has been linked to poor health outcomes on an individual and population basis. However, little research has been conducted on the role of chronic or recent obesity stigma in the health disparities experienced by pregnant women with high body mass index. The purpose of this article is to discuss poor birth outcomes in this population from an integrated perinatal health framework perspective, incorporating obesity stigma as a social determinant.

Validation of a certified nurse-midwifery database for use in quality monitoring and outcomes research.

Introduction: Certified nurse-midwives (CNMs) and certified midwives (CMs) attend 11% of US vaginal births, and CNM/CM databases include a rich source of information on the birth outcomes of women not generally available through obstetric electronic health records (oEHRs). Although CNM databases are in wide use, studies on their validity are sparse. We examined the validity of a practice-specific CNM birth database compared with an oEHR in a large tertiary-care facility.

Pilot Test of a Preconception and Midwifery Care Promotion Program for College Women.

Introduction: College campuses remain an underused setting for implementing the 10 strategies for promoting preconception health proposed by the US Centers for Disease Control and Prevention. This setting can also be used to educate young women about their options for care in future pregnancies, including midwifery care. To address these needs, the author and 2 peer educators developed and pilot-tested a multiweek health education program for college women.

Paternal involvement and fetal morbidity outcomes in HIV/AIDS: a population-based study.

Prior research indicates that infants with absent fathers are vulnerable to unfavorable fetal birth outcomes. HIV is a recognized risk factor for adverse birth outcomes. However, the influence of paternal involvement on fetal morbidity outcomes in women with HIV remains poorly understood.

HIV infection and its impact on fetal outcomes among women of advanced maternal age: a propensity score weighted matching approach.

Advanced maternal age (AMA) and HIV status have been investigated separately for their influence on infant outcomes. Both are associated with adverse fetal growth outcomes, including low birth weight (LBW) and preterm birth (PTB). However, the impact of the cooccurrence of these factors in relation to birth outcomes remains relatively understudied.

Maternal and newborn outcomes following uterine rupture among women without versus those with a prior cesarean.

Objective: To compare outcomes from uterine ruptures (UR) among women without versus with a prior cesarean.

Method: This case-control study matched on gestational age +/- 1 week and birth year +/- 2 years using a variable numbers of controls (maximum = 4) for each case. All URs in Massachusetts between 1990 and 1998 were identified using ICD-9 codes from linked hospital discharge and birth/fetal death certificate files and confirmed by medical record review.

Making it work: successful collaborative practice.

There are three major examples of collaborative programs between certified nurse-midwives (CNMs) and obstetrician-gynecologists at Baystate Medical Center in Springfield, Massachusetts, within the Department of Obstetrics and Gynecology. One program is a midwifery practice that serves a diverse population in a hospital-based office, four neighborhood health centers, and a correctional facility. Another program provides a triage function for patients who present to the hospital with obstetric or gynecologic problems.

Control of mammary tumor differentiation by SKI-606 (bosutinib).

C-Src is infrequently mutated in human cancers but it mediates oncogenic signals of many activated growth factor receptors and thus remains a key target for cancer therapy. However, the broad function of Src in many cell types and processes requires evaluation of Src-targeted therapeutics within a normal developmental and immune-competent environment. In an effort to understand the appropriate clinical use of Src inhibitors, we tested an Src inhibitor, SKI-606 (bosutinib), in the MMTV-PyVmT transgenic mouse model of breast cancer.

"Midwives are nice, but . . .": perceptions of midwifery and childbirth in an undergraduate class.

Introduction: The purpose of this study was to explore college students' beliefs about childbirth and midwifery.

Methods: A critical qualitative analysis was used to identify common themes that occurred in an online class discussion about midwifery.

Results: This population of 459 college students drew on the larger social discourse of the medical model of childbirth to frame their discussion of childbirth and midwives.

Design and synthesis of novel diaminoquinazolines with in vivo efficacy for beta-catenin/T-cell transcriptional factor 4 pathway inhibition.

We are introducing a novel series of 2,4-diaminoquinazolines as beta-catenin/Tcf4 inhibitors which were identified by ligand-based design. Here we elucidate the SAR of this series and explain how we were able to improve key molecular properties such as solubility and cLogP leading to compound 9. Analogue 9 exhibited better biological activity and improved physical and pharmacological properties relative to the HTS hit 49.

New equipment and techniques for airway management in trauma.

A patent, unobstructed airway is fundamental in the care of the trauma patient, and is most often obtained by placing a cuffed tube in the trachea. The presence of shock, respiratory distress, a full stomach, maxillofacial trauma, neck hematoma, laryngeal disruption, cervical spine instability, and head injury all combine to increase tracheal intubation difficulty in the trauma patient. Complications resulting from intubation difficulties include brain injury, aspiration, trauma to the airway, and death.

Maternal body mass index, delivery route, and induction of labor in a midwifery caseload.

The purpose of this study was to identify the association between prepregnancy body mass index (BMI), weight gain in pregnancy, and newborn birth weight on route of delivery and induction of labor in patients receiving nurse-midwifery care. This retrospective cohort study examined the outcomes of 1500 consecutively delivered women who were cared for by two midwifery practices and delivered between January 1, 1998, and December 31, 2000. Cesarean delivery was significantly associated with the obese BMI (P < .

Abstinence-only education: how we got here and where we're going.

This paper examines the history of abstinence education in the United States and the empirical evidence of its effectiveness in preventing teenage pregnancy. It concludes that abstinence education has not yet been proven effective, and therefore recommends that federal policy and funding should be directed towards teen pregnancy prevention programs that have demonstrated success.

The shifting sands for applicants to maternal and child health training programs.

Objective: Anecdotal evidence suggests that fewer students today than in decades past are applying to maternal and child health (MCH) graduate training programs with previous clinical degrees. The purpose of this study was to determine the extent to which applicants accepted to an MCH training program demonstrated a shift away from the tradition of having a prior health professional degree and discuss options needed to provide responsive training.

Methods: Twenty years of demographic face sheet data (1983 through 2002) for admitted applicants to the MCH training program at the University of South Florida College of Public Health were examined.