The Journal of Perinatal & Neonatal Nursing - Current Issue

From the Editors No abstract available

Placentophagy, Lotus Birth, and Other Placenta Practices: What Does the Evidence Tell Us? No abstract available

Disparate Care in the NICU: An Opportunity for Improvement No abstract available

When Signals Become Crossed: Maternal-Fetal Signal Ambiguity No abstract available

The Ethics of Perinatal Care for Black Women: Dismantling the Structural Racism in “Mother Blame” Narratives Perinatal and neonatal nurses have a critical role to play in effectively addressing the disproportionate prevalence of adverse pregnancy outcomes experienced by black childbearing families. Upstream inequities in maternal health must be better understood and addressed to achieve this goal. The importance of maternal health before, during, and after pregnancy is illustrated with the growing and inequitable prevalence of 2 common illnesses, pregestational diabetes and chronic hypertension, and 2 common conditions during and after pregnancy, gestational diabetes and preterm birth. New care models are needed and must be structured on appropriate ethical principles for serving black families in partnership with nurses. The overarching purpose of this article is to describe the ethics of perinatal care for black women; to discuss how social determinants of health, health disparities, and health inequities affecting women contribute to poor outcomes among their children; and to provide tools to dismantle structural racism specific to “mother blame” narratives.” Finally, strategies are presented to enhance the provision of ethical perinatal care for black women by nurses.

An Alternative to Mother and Infants Behind Bars: How One Prison Nursery Program Impacted Attachment and Nurturing for Mothers Who Gave Birth While Incarcerated The number of women in United States prisons has increased, with the most rapid growth among women of childbearing age. Detrimental effects on maternal-infant attachment have been shown to exist when mothers and infants are separated at birth. The purpose of this exploratory study was to examine the impact of an out-of-prison nursery program, Baby and Mother Bonding Initiative (BAMBI), on maternal-infant attachment and nurturing competencies among women who gave birth while incarcerated. A sample of 41 participants was recruited through a “Closed” BAMBI Alumni Facebook page and nonprobability snowball sampling. Participants were surveyed, and responses were submitted online or via mail. Data were analyzed using descriptive statistics, correlation coefficients, multiple regression, and logistic regression. Results indicated that the number of children living in the mother's household was a significant predictor of positive maternal nurturance. Inversely, the high number of children in the household was the most significant predictor of increased risk for infants to have insecure attachment to mothers. As the number of women giving birth in prisons continues to trend upward, the need for more programs to promote best outcomes for both mother and infants is crucial.

Obesity and Socioeconomic Disparities: Rethinking Causes and Perinatal Care Obesity affects more than 35% of women aged 20 to 39 years in the United States. This article summarizes recent research that reconceptualizes obesity as adipose disease associated with smoking; socio-economic disparities in employment, education, healthcare access, food quality, and availability; and environmental toxins, ultimately altering microbiomes and epigenetics. Individual prenatal care of women with obesity includes early testing for diabetes, counseling on epigenetic diets, advice supporting weight gain within national guidelines, and vigilance for signs of hypertensive disorders of pregnancy. Intrapartum care includes mechanical cervical ripening measures, patience with prolonged labor, and uterotonic medication readiness in the event of postpartum hemorrhage. Postpartum care includes thrombus risk amelioration through early ambulation, use of compression stockings, and anticoagulation. Delays in lactogenesis II can be offset by measures to support early breastfeeding. Sociopolitical action by nurses at national, state, and community levels to reduce population disparities in racism, education, and employment; reduce pollution from obesogenic chemicals; and improve food quality and distribution policies is likely to have the broadest impact in future obesity reductions and prevention.

Obesity and Socioeconomic Disparities: Rethinking Causes and Perinatal Care No abstract available

Continued Disparities in Postpartum Follow-Up and Screening Among Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Systematic Review The postpartum period represents a critical window to initiate targeted interventions to improve cardiometabolic health following pregnancies complicated by gestational diabetes mellitus and/or a hypertensive disorder of pregnancy. The purpose of this systematic review was to examine studies published since 2011 that report rates of postpartum follow-up and risk screening for women who had gestational diabetes and/or a hypertensive disorder of pregnancy and to identify disparities in care. Nine observational studies in which postpartum follow-up visits and/or screening rates were measured among US women following pregnancies complicated by gestational diabetes and/or a hypertensive disorder of pregnancy were reviewed. Rates of postpartum follow-up ranged from 5.7% to 95.4% with disparities linked to black race and Hispanic ethnicity, low level of education, and coexisting morbidities such as mental health disorders. Follow-up rates were increased if the provider was an obstetrician/endocrinologist versus primary care. Payer source was not associated with follow-up rates. The screening rate for diabetes in women who had gestational diabetes did not exceed 58% by 4 months across the studies analyzed, suggesting little improvement in the last 10 years. While women who had a hypertensive disorder appear to have had a postpartum blood pressure measured, it is unclear whether follow-up intervention occurred. Overall, postpartum screening rates for at-risk women remain suboptimal and vary substantially. Further research is warranted including reliable population-level data to inform equitable progress to meeting the evidence-informed guidelines.

Maternal Stress and Mental Health Prior to Their Technology-Dependent Infant's Discharge Home From the NICU Mothers of infants in the neonatal intensive care unit (NICU) face stressors including turbulent emotions from their pregnancy/unexpected preterm delivery and their infant's unpredictable health status. The study purpose was to examine the psychological state of mothers prior to the discharge of their technology-dependent infants (eg, feeding tubes, supplemental oxygen) from the NICU to home. The study sample consisted of mothers (N = 19) of infants dependent on medical technology being discharged from a large Midwest NICU. A descriptive, correlational design using convenience sampling was employed to recruit mothers to examine associations of infant and maternal factors, resourcefulness, and stress with psychological state (depressive symptoms, posttraumatic stress symptoms). Forty-two percent of mothers were at high risk for clinical depression, with 37% in the clinical range for posttraumatic stress disorder. Increased maternal depressive symptoms were significantly associated with the increased frequency and perceived difficulty of their stress and posttraumatic stress symptoms. Increased posttraumatic stress symptoms were significantly associated solely with elevated depressive symptoms. This study identified factors associated with the mothers' increased psychological distress, providing beginning evidence for future interventions to employ prior to their technology-dependent infant's NICU discharge.