Journal of midwifery & women's health (J Midwifery Wom Health)

Publications in this journal

• Article: Development and Pilot Outcome Data of a Midlife Women's Health Assessment Clinic: A Comprehensive and Multidisciplinary Approach to Health Care.

  Angela Deneris, Catherine Wheeler, Shanna Salmon
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  ABSTRACT: INTRODUCTION: As women enter midlife, health issues and chronic health problems can emerge. The University of Utah Health Science Center's Midlife Women's Health Assessment Clinic was developed to provide a personalized approach to healthy aging by individual assessment, group education, motivational interviewing, and wellness coaching to women. This article describes the model of care and an initial evaluation of this model. METHODS: Four pilot clinics were conducted to determine if the model would be successful. Data analyzed included patient history questionnaires, laboratory and diagnostic test results, new diagnoses, and follow-up recommendations; telephone surveys of patients 2 to 4 weeks after clinic visits; and verbal queries of clinicians about their experiences and recommendations for improving the clinics. RESULTS: Among the 62 women attending the clinics, the most frequent concern was healthy aging. Two-thirds of the women had new diagnoses during the clinics. Both the women and clinicians participating positively evaluated the pilot clinics. DISCUSSION: This model of care could be replicated to provide comprehensive and efficient health care to aging women in a variety of settings.
  Journal of midwifery & women's health 05/2013;
• Article: NURSE PRACTITIONERS, CERTIFIED NURSE-MIDWIVES, AND PHYSICIAN ASSISTANTS CAN SAFELY PERFORM FIRST-TRIMESTER ASPIRATION ABORTIONS.

  Nancy A Niemczyk
  Journal of midwifery & women's health 05/2013;
• Article: Multidisciplinary Collaborative Development of a Plain-Language Prenatal Education Book.

  Julie Mottl-Santiago, Carolyn Shepard Fox, Christine Chang Pecci, Ronald Iverson
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  ABSTRACT: During pregnancy, women actively seek out health information that promotes the well-being of themselves and their fetuses. For those with health literacy challenges, access to understandable health information can be difficult. Written information, in particular, needs to be readable and usable by the women served. Plain language is an essential component of effective health education material. In an effort to create standardized prenatal education materials for a diverse population of childbearing women, Boston Medical Center's midwifery service led a multidisciplinary initiative to develop a comprehensive plain-language prenatal education book. Midwives, obstetricians, family physicians, nurses, and community doulas contributed to the content of the book; art students provided graphic design skills; and a literacy consultant assisted in the wording and layout. The Hey Mama! book provides women with woman-centered, readable, comprehensive information about pregnancy, labor, postpartum, and newborn care.
  Journal of midwifery & women's health 05/2013;
• Article: Prevention of Obesity and Diabetes in Childbearing Women.

  Kimberly K Trout, Kathryn K Ellis, Alexandra Bratschie
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  ABSTRACT: Obesity and diabetes have become pandemic in the United States, with more than one-third of the US population obese and 8.3% of the population affected by diabetes. Efforts to prevent type 2 diabetes focus primarily on healthy eating and physical activity. In particular, women from at-risk racial and ethnic groups and those who have experienced gestational diabetes are at high risk for developing type 2 diabetes. Achieving a healthy weight prior to conception, staying within weight gain guidelines during pregnancy, and losing accumulated pregnancy weight postpartum are key prevention factors. Maintaining a healthy weight in the long-term is a challenge. Behavioral psychology and coaching techniques are presented in this article that can be useful in sustaining behaviors that promote a healthy weight.
  Journal of midwifery & women's health 05/2013;
• Article: Screening for Substance Abuse in Women's Health: A Public Health Imperative.

  Daisy J Goodman, Kristina B Wolff
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  ABSTRACT: Alcohol and drug use is a significant public health problem with particular implications for the health and safety of women. Women who abuse these substances are more likely to have untreated depression and anxiety and are at higher risk for intimate partner violence, homelessness, incarceration, infectious disease, and unplanned pregnancy. Substance abuse during pregnancy places both mother and fetus at risk for adverse perinatal outcomes. Data regarding the prevalence of substance abuse in women are conflicting and difficult to interpret. On the clinical level, strong arguments exist against routine urine drug testing and in favor of the use of validated instruments to screen women for drug and alcohol use both in primary women's health care and during pregnancy. A number of sex-specific screening tools are available for clinicians, some of which have also been validated for use during pregnancy. Given the risks associated with untreated substance abuse and dependence in women, the integration of drug and alcohol screening into daily clinical practice is imperative. This article reviews screening tools available to providers in both the prenatal and primary women's health care settings and addresses some of the challenges raised when women screen positive for drug and alcohol abuse.
  Journal of midwifery & women's health 04/2013;
• Article: Interconception Care for Women With Prior Gestational Diabetes Mellitus.

  Ruth T Mielke, Deborah Kaiser, Rhonda Centuolo
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  ABSTRACT: The diagnosis of gestational diabetes mellitus (GDM) signals greater pregnancy risk but also increased lifelong risk of developing diabetes and cardiovascular disease. In women with GDM, insulin resistance exceeds that observed in normal pregnancy and to varying degrees may persist or worsen after birth. Therefore, during postpartum and interconception periods, women with a history of GDM must be monitored for manifestations of increasing insulin resistance, hyperglycemia, dyslipidemia, hypertension, and increased adiposity. Care of women with prior GDM in the postpartum and interconception periods affords clinicians a unique opportunity for targeted screening and health promotion. The objective of this review was to synthesize evidence related to interconception care for women following a pregnancy complicated by GDM and to suggest principles of care: 1) case finding and multiple patient/clinician reminders for women with prior GDM are necessary so that screening occurs in the postpartum through interconception periods; 2) monitoring of metabolic (glucose) and cardiovascular risk (lipids, blood pressure, adiposity) should occur at regular intervals and more often in women with additional risk factors such as insulin use during pregnancy, early diagnosis of GDM, obesity, prediabetes, and dyslipidemia; 3) breastfeeding and use of long-term contraception should be encouraged; and 4) lifestyle modifications that are effective in preventing and delaying disease should be encouraged.
  Journal of midwifery & women's health 04/2013;
• Article: Health Literacy and the Readability of Written Information for Hormone Therapies.

  Deborah H Charbonneau
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  ABSTRACT: INTRODUCTION: Health education and counseling are important elements of the care provided by clinicians. Counseling efforts may involve helping women to understand their options for symptom management related to various reproductive life transitions. In light of this, the need for information during the menopausal transition is critical for assisting women with their health care decisions. Yet the Institute of Medicine estimates that approximately half the adult population in the United States has difficulty understanding and using health information. The US Food and Drug Administration (FDA) mandates the distribution of written information for estrogen-containing products; however, the readability of information for these pharmaceutical products has not been widely studied. To address this gap, this study examined the readability of written information for FDA-approved prescription menopausal hormone therapies (N = 31). METHODS: Readability of the written information about hormone therapies from 31 hormone therapy products was assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level formulas. RESULTS: The reading level ranged from 6.70 to 12.30, with an average grade level of 9.33 (ninth-grade reading level). All but one of the hormone therapy products evaluated in this study exceeded the recommended sixth-grade reading level for written health information. In addition, only 48% of the written information instructions in the study sample (n = 15) included illustrations. DISCUSSION: Assessment of written information about menopausal hormone therapies showed that the majority of the materials are written at a high reading level. These findings have implications for health literacy and counseling efforts when helping women to understand their options for menopausal symptom management. Midwives, nurses, and other health care providers may need to supplement written information with additional consumer-friendly written information, utilize illustrations, and use verbal instructions more frequently to help support women in evaluating their treatment options.
  Journal of midwifery & women's health 04/2013;
• Article: Health Literacy and Women's Health: Challenges and Opportunities.

  Jane E Corrarino
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  ABSTRACT: INTRODUCTION: This article describes the impact of health literacy on women's health and provides strategies for addressing this public health issue. METHODS: A comprehensive literature review was conducted of peer-reviewed journals. Multiple electronic databases were used, including CINAHL, MEDLINE, PubMed, and Google Scholar. Key words were used to identify articles and were combined to include health literacy, health behavior, women's health, patient education, and professional role. Additional articles were identified as a result of reviewing reference lists found during the electronic search. RESULTS: Health literacy is a complex issue that affects many women and can adversely affect women's knowledge, ability to adhere to clinical plans of care, and health outcomes for women and their children. It is estimated that 36% of adults in the United States possess limited health literacy skills. Effective strategies can be used by health care providers to address this serious problem, including clear and effective communication, development of health education materials, professional education, and development of community partnerships. DISCUSSION: Health literacy is a serious problem. Effective approaches can be employed to blunt the adverse effect on women's health. Health care providers are well positioned to demonstrate leadership within the health care system regarding health literacy.
  Journal of midwifery & women's health 04/2013;
• Article: Why Kangaroo Mother Care Should Be Standard for All Newborns.

  Caroline Rodgers
  Journal of midwifery & women's health 04/2013;
• Article: Improving Satisfaction with Care and Reducing Length of Stay in an Obstetric Triage Unit Using a Nurse-Midwife-Managed Model of Care.

  Julie Paul, Robin Jordan, Susan Duty, Janet L Engstrom
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  ABSTRACT: Introduction: A quality improvement project was initiated at a tertiary-care center in a suburban area of the northeastern United States to determine whether length of stay and patient satisfaction in an obstetric triage unit could be improved by using a certified nurse-midwife (CNM) to manage and organize care in the triage unit. Methods: Patient satisfaction was measured using a previously validated instrument that consisted of 6 items using a 6-point Likert-type scale. The items measured patient satisfaction with: wait time for provider, information given, amount of time spent with provider, length of visit, overall care received, and overall triage experience. Patient satisfaction was measured before (n = 37) and after implementing CNM-managed care (n = 66) in an obstetrical triage unit. Length of stay in the triage unit was measured during standard care (n = 121) and after the implementation of CNM-managed care (n = 151) by recording the number of minutes women spent in the triage unit. Results: Participants in the CNM-managed care group reported increased patient satisfaction with care in 5 of the 6 aspects of satisfaction that were measured, including wait time for provider (P= .01), time spent with provider (P= .01), length of visit (P= .04), overall care received (P= .04), and overall triage experience (P= .01). The length of stay was significantly shorter for the women in the CNM-managed group (mean = 94.7 minutes; standard deviation [SD] 50.1) than for the women in the standard care model (mean = 122 minutes; SD = 66.8; P < .01). Discussion: The findings from this project suggest that a CNM-managed obstetric triage unit can improve satisfaction with care during the triage experience and reduce length of stay in the triage unit.
  Journal of midwifery & women's health 03/2013;
• Article: Female Fertility: A Conceptual and Dimensional Analysis.

  Dana Rodriguez
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  ABSTRACT: Introduction: Female fertility is commonly described as the biological nature of women, yet different meanings emerge when one takes a holistic approach to fertility while considering varying contexts and perspectives. An improved understanding of female fertility will enhance health care professionals' understanding of female fertility and improve communication with women and other health care professionals. This article presents a conceptual and dimensional analysis of female fertility. Methods: A search of the literature included the databases CINAHL, PsycINFO, Philosopher's Index, and Web of Science. Concept and dimensional analyses were performed using the Rogers' methodology and the Caron and Bowers' framework to define female fertility and explore the concept. Articles were examined to identify definitions, dimensions, perspectives, antecedents, and consequences of female fertility. Results: Biological self, psychosexual self, power, and paradox are the attributes of female fertility. The contexts of menarche, menstruation, menopause, infertility, fertility goals, society and culture, and health care were explored. Perspectives included those of women across many different fertility stages as well as perspectives of various clinicians. Necessary antecedents were sexual decision making and influences of culture and society. Consequences were realized fertility, stress, and an understanding of self. A definition of fertility was proposed: Female fertility is a paradoxical phenomenon of power between the biological and psychosexual self. Discussion: Antecedents, attributes, and consequences derived from the fertility literature can be used by health care providers for patient education and therapeutic interventions. This concept analysis may assist in facilitation of a greater understanding of biological and psychosexual self, as they relate to fertility across the lifespan.
  Journal of midwifery & women's health 03/2013;
• Article: Body Image and Gestational Weight Gain: A Prospective Study.

  Briony Hill, Helen Skouteris, Marita McCabe, Matthew Fuller-Tyszkiewicz
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  ABSTRACT: Introduction: Approximately 50% of Australian adult women of childbearing age are overweight or obese, and, when pregnant, the majority gain excessive weight; this is also the case in the United States and other developed nations. High gestational weight gain (GWG) is the strongest predictor of maternal overweight/obesity postbirth and is also associated with an increased risk of childhood obesity. Understanding factors that contribute to excessive GWG is vital in combating obesity. The aim of the current study was to examine whether body image attitudes (eg, feeling fat, attractive, or strong and fit, and salience of weight and shape) predict GWG. Methods: Pregnant women, recruited through advertisements on pregnancy online forums and parenting magazines, completed questionnaires assessing body image, demographic variables, and GWG. The Body Attitudes Questionnaire assessed body image in early-to-middle, middle, and late pregnancy (mean of 16.8, 24.7, and 33.0 weeks' gestation, respectively). Total GWG was calculated by subtracting self-reported pre pregnancy weight from self-reported weight at 36.8 weeks' gestation. Results: A total of 150 pregnant women responded to the study's advertisements, and 72% (n= 108) took part. After controlling for pre pregnancy body mass index (BMI), lower attractiveness in early-to-middle pregnancy was associated with higher GWG. In late pregnancy, women who had the lowest feelings of fatness had greater GWG. Body image attitudes earlier in pregnancy did not predict whether GWG recommendations were exceeded. Women of higher BMI were more likely to gain excessive weight. Discussion: The findings suggest that the type and timing of pregnancy, body attitudes, and the time of pregnancy when they are noted, predict GWG. However, more research in the area is needed, including assessment of the relationship between body image concerns, GWG, and other psychosocial factors. We recommend that midwives monitor body image concerns in pregnancy to help address factors affecting GWG in at-risk women.
  Journal of midwifery & women's health 03/2013;
• Article: Low-income, Pregnant, African American Women's Views on Physical Activity and Diet.

  Susan W Groth, Dianne Morrison-Beedy
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  ABSTRACT: Introduction: This research was conducted to gain insight into how low-income, pregnant, African American women viewed physical activity and approached nutrition during pregnancy. Methods: Three focus groups with a total of 26 women were conducted utilizing open-ended questions related to physical activity and diet during pregnancy. Content analysis was used to analyze the verbatim transcripts. Groups were compared and contrasted at the within-group and between-group levels to identify themes. Results: Two themes that related to physical activity during pregnancy were identified: 1) fatigue and low energy dictate activity and 2) motivation to exercise is not there. Three themes were identified that related to diet: 1) despite best intentions, appetite, taste, and cravings drive eating behavior; 2) I'll decide for myself what to eat; and 3) eating out is a way of life. Discussion: Women reported that being physically active and improving their diets was not easy. Women indicated that their levels of physical activity had decreased since becoming pregnant. Attempts at improving their diets were undermined by frequenting fast food restaurants and cravings for highly dense, palatable foods. Women ceded to the physical aspects of pregnancy, often choosing to ignore the advice of others. A combination of low levels of physical activity and calorie-dense diets increased the risk of excessive gestational weight gain in this sample of women, consequently increasing the risk for weight retention after pregnancy. Health care providers can promote healthy eating and physical activity by building on women's being "in tune with and listening to" their bodies. They can query women about their beliefs regarding physical activity and diet and offer information to ensure understanding of what contributes to healthy pregnancy outcomes. Intervention can focus on factors such as cravings and what tastes good, suggesting ways to manage pregnancy effects within a healthy diet.
  Journal of midwifery & women's health 03/2013;
• Article: Expanded Care for Women and Families after Preterm Birth.

  Ira Kantrowitz-Gordon
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  ABSTRACT: Prematurity is a complication of pregnancy for 1 in 8 families in the United States. The focus of care after preterm birth shifts to the fragile newborn, while the needs of the woman and her family may be overlooked. There are many challenges for parents, including impaired parent-newborn attachment, difficulties with breastfeeding, postpartum mental health, and family disruption. Premature birth may even risk the developing relationship between parents and their child. Comprehensive care is recommended for parents who have experienced a preterm birth, including support of effective lactation, promotion of skin-to-skin care, reflection on the birth experience, support and evaluation of postpartum mental health, and provision of family-centered care. Preconception care after preterm birth needs to include guidance about the recurrence risk for preterm birth as well as recommendations for risk reduction.
  Journal of midwifery & women's health 03/2013; 58(2):158-166.
• Article: The Case Against Early-Term Elective Induction: A Call to Action.

  Caroline C Rodgers, Kim J Cox
  Journal of midwifery & women's health 03/2013; 58(2):126-129.
• Article: CATEGORIZING SENTINEL EVENTS ON LABOR AND DELIVERY UNITS HELPS DETER NEAR MISSES.

  Sharon Bond
  Journal of midwifery & women's health 03/2013; 58(2):228-229.
• Article: The Pharmacology of Prostaglandins for Induction of Labor.

  Susan M Yount, Nicole Lassiter
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  ABSTRACT: Prostaglandin medications are frequently used in the process of induction of labor. Understanding the history and research that supports prostaglandin use for induction of labor is crucial for safe practice. Dinoprostone has been the standard of care for cervical ripening in term pregnancies. Misoprostol administration via various routes has been shown to be efficacious. Oral misoprostol in particular is effective and associated with reassuring maternal and fetal outcomes. In addition, cost has become a variable in decision making regarding best practice. More research is necessary to determine the safest medication, route, dose, and interval of administration. This article reviews cervical physiology and endogenous prostaglandin activity in relation to labor, and the pharmacologic profiles of synthetic prostaglandins currently used for induction of labor.
  Journal of midwifery & women's health 03/2013; 58(2):133-144.
• Article: New-Onset Graves' Disease in the Postpartum Period.

  Ami L Goldstein
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  ABSTRACT: During routine evaluation for lactation failure, hyperthyroidism was discovered in a postpartum woman. Although postpartum thyroiditis and Hashimoto's disease are relatively more common than Graves' disease during the postnatal period, this young woman was found to have new-onset Graves' disease. Distinguishing between normal postpartum symptoms and thyroid disorders can be challenging. Utilizing history, physical examination, and laboratory testing, the provider can identify the etiology of hyperthyroidism during the postpartum period. Treatment options differ depending on the cause of the thyroiditis and include antithyroid medications and beta-blockers for relief of symptoms.
  Journal of midwifery & women's health 03/2013; 58(2):211-214.
• Article: NO-COST CONTRACEPTION REDUCES UNINTENDED PREGNANCIES AND ABORTION RATES AT A POPULATION LEVEL.

  Sharon Bond
  Journal of midwifery & women's health 03/2013; 58(2):226-227.
• Article: The Words We Choose.

  Frances E Likis
  Journal of midwifery & women's health 03/2013; 58(2):123.