EDITORIAL & UPDATES
research & practice briefs
T
he World Health Organization
(WHO) has released WHO
Recommendations: Intrapartum
Care for a Positive Childbirth
Experience, which includes 56
evidence-based recommendations
for childbirth care for women and
newborns. Although a majority of the
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Pregnancy, Motherhood, and Surgical Training
nwhjournal.org
estimated 140 million births that
take place every year occur without
complications, trends over the last
20 years indicate increased use
of interventions such as oxytocin
administration or cesarean birth,
which were previously used only to
avoid risks or treat complications.
Multiple challenges facing
pregnant surgical residents
may negatively influence ca-
reer satisfaction, according
to a study published in JAMA
Surgery. Researchers set out
to directly assess the resi-
dent experience of childbear-
ing during training and learn
more about the perception
and experience of pregnant
general surgery residents.
To better characterize their
experiences and target
interventions, investigators
© 2018 AWHONN; doi: 10.1016/j.nwh.2018.04.002
Global Care
Standards
for Pregnant
Women
Summer Hunt
These recommendations establish
global care standards for healthy
pregnant women and aim to
reduce any unnecessary medical
interventions. Find the document here:
www.who.int/reproductivehealth/
publications/intrapartum-care-
guidelines/en.
conducted a national survey of
347 general surgery residents
who had at least one pregnancy
during residency. Results from
their research show significant
cultural challenges and infra-
structure shortcomings that led
39% of respondents to seriously
consider leaving residency and
30% to report that they would
advise a female medical student
against pursuing a career in
surgery. Find the study here:
https://doi.org/10.1001/jama
surg.2018.0153.
203
Research & Practice Briefs
Summer Hunt is assistant managing editor
at AWHONN in Washington, DC.
Biologics in
Pregnancy
Biologic therapies for wom-
en with autoimmune dis-
eases do not increase risk
of preterm birth or having
a small-for-gestational-age
infant, according to a study
in Annals of the Rheumatic
Diseases. Researchers stud-
ied 6,218 women with 8,607
pregnancies who had an au-
toimmune disease diagnosis;
of those, 109 women with 120
pregnancies received a bio-
logic medication during preg-
nancy or 3 months before be-
coming pregnant. They found
no significant difference from
the risk for preterm birth
when compared with women
with autoimmune diseases
who did not receive biolog-
ics. Likewise, they found no
significant difference in the
risk of small-for-gestation-
al-age infants among the two
groups. Find the study here:
https://doi.org/10.1136
/annrheumdis-2018-213023.
204 Volume 22 Issue 3
Sleep Apnea in Pregnancy
Snoring, older age, and obesity may probability of sleep apnea in early
increase a pregnant woman’s risk for and mid-pregnancy. This tool may
sleep apnea, according to a study in be used by obstetric providers to iden-
the American Journal of Obstetrics and tify women at risk for the condition.
Gynecology. Participants responded Find the study here: https://doi
to questionnaires about sleep habits, .org/10.1016/j.ajog.2018.01.031.
snoring, and daytime sleepiness in
early pregnancy (6–15 weeks) and
mid-pregnancy (22–29 weeks). The
women also underwent sleep apnea
testing with the use of an at-home
monitoring device. The researchers
found that 3.6% of 3,264 women in
early pregnancy and 8.3% of 2,512
women in mid-pregnancy had sleep
apnea. Risk factors included frequent
snoring (3 or more nights per week),
older maternal age, and being over-
weight or obese. The authors devel-
oped a calculator using maternal age,
body mass index, and frequency of
snoring to arrive at a woman’s
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Diabetes Report Card
The Centers for Disease Control The Diabetes Report Card also
and Prevention’s Division of Di- recognizes ongoing challenges
abetes Translation has released among members of some racial
its 2017 Diabetes Report Card, and ethnic minority groups that
which provides the most current are more likely to have diag-
information and data available nosed diabetes than non-His-
about diabetes and prediabe- panic Whites. Find the report
tes, along with diabetes-related here: www.cdc.gov/diabetes
preventive care practices, health /library/reports/reportcard
outcomes, risk factors, and .html.
national and state trends. Key
findings include the following:
• The rate of new cases of dia-
betes among U.S. adults has
decreased.
• Overall rates of diagnosed
diabetes seem to be stabi-
lizing (although not in all
populations).
• The number of organizations
that deliver the National
Diabetes Prevention Program
and the number of adults
participating in the program
have increased.
doi: 10.1016/j.nwh.2018.04.002

Fetal Alcohol Spectrum Disorders
A significant number of U.S. chil-
dren have fetal alcohol spectrum
disorders (FASDs), with conserva-
tive rates ranging from 1% to 5%
in community samples, according
to a study published in JAMA.
The study was conducted by the
Collaboration on Fetal Alcohol
Spectrum Disorders Prevalence
(CoFASP) consortium, which
studies the prevalence of FASD
among U.S. schoolchildren. Be-
fore the study began, consortium
members established standardized
classification criteria for FASD
based on facial features, growth,
and neurodevelopmental perfor-
mance. Researchers collected data
from 2010 through 2016 on 6,639
children in four U.S. communities.
At each site, first graders in public
and private schools were recruit-
ed across 2 academic years and
evaluated based on the FASD crite-
ria. Prenatal alcohol exposure was
assessed by interviewing mothers
or other close relatives. Using a
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Crowdsourcing to Understand Pregnancy
The National Institutes of
Health has launched Preg-
Source, a research project
that aims to improve
knowledge of pregnancy
by collecting information
directly from pregnant
women. Women who sign
up for PregSource use on-
line surveys to share what
they are experiencing, and
they can compare these
experiences with those of
other participants. Over
the course of their preg-
nancies, women can chart changes
to their weight, sleep, mood, morning
sickness, and physical activity. In
addition, they can access information-
al resources developed by experts on
pregnancy, childbirth, and child
June 2018
weighted prevalence approach
that assumed that the rate of FASD
in children who were evaluated
would be the same in all eligible
first grade children in each com-
munity, the researchers estimat-
ed that prevalence of FASD was
higher than conservative estimates
of 1% to 5%—ranging from 3.1%
to 9.8% among the study sites. Of
the 222 children diagnosed with
FASD in the study, only two had
been previously diagnosed with
FASD, although many parents
and guardians were aware of the
children’s learning and behavioral
challenges. These latest findings
represent more accurate preva-
lence estimates of FASD among
general U.S. communities than
prior research studies, which were
based on smaller study popula-
tions and did not reflect the over-
all U.S. population. Find the study
here: https://doi.org/10.1001/
jama.2017.21896.
development. PregSource also en-
ables women to track their experienc-
es after childbirth to help determine if
any outcomes, such as heart dis-
ease, can be linked to events during
pregnancy. Find the website here:
https://pregsource.nih.gov.
Hunt
Diet and
Endometriosis
A higher intake of fruits, espe-
cially citrus, is associated with
a lower risk of endometriosis,
according to a study in Human
Reproduction. Women who
consumed at least one serving
of citrus daily had a 22% lower
risk of developing endometrio-
sis compared with women who
ate less than one serving per
week. The researchers say that
beta-cryptoxanthin in these
foods may partially explain the
association. Conversely, study
authors found that consumption
of cruciferous vegetables—such
as cabbage, cauliflower, brocco-
li, and Brussels sprouts—may
in fact increase the risk for
endometriosis. Compared with
women who consumed less
than one serving of cruciferous
vegetables per week, women
consuming one or more serv-
ings weekly had a 13% greater
risk of developing endometrio-
sis. Although it remains unclear
as to what exactly in these
foods might contribute to the
connection, researchers suggest
that this link between vegeta-
bles and increased risk may in-
dicate a role of gastrointestinal
symptoms in the presentation
and exacerbation of endometri-
osis-related pain. Find the study
here: https://doi.org/10
.1093/humrep/dey014.
Nursing for Women’s Health 205
Research & Practice Briefs
Optimal Blood
Pressure for
Infant, Child CPR
Infants and children who
suffer cardiac arrest while in
the hospital have a greater
chance of survival if their
blood pressure is maintained
above certain threshold levels
throughout cardiopulmonary
resuscitation (CPR), according
to a study in Circulation. The
multisite, National Institutes
of Health–funded study is
the first to address target
blood pressure levels during
CPR for infants and children.
Researchers analyzed hospital
monitors and charts of 164
children during CPR treat-
ments at 11 U.S. hospitals
from 2013 through 2016. They
found that for infants, the
optimal diastolic blood pres-
sure should be maintained at
greater than 25 mm Hg during
CPR. In children ages 1 year
and older, the optimal diastol-
ic blood pressure should be
greater than 30 mm Hg. When
these blood pressure rates
were maintained throughout
the course of CPR, infants and
children had a 70% greater
likelihood of surviving and
being discharged from the
hospital and a 60% greater
likelihood of surviving with
favorable neurological out-
comes. When the diastolic
blood pressure values were
lower than these levels, surviv-
al rates dropped markedly.
Find the study here: https://
doi.org/10.1161/CIRCULA
TIONAHA.117.032270.
206 Volume 22 Issue 3
Mother-to-Child
Transmission of
Hepatitis B
Tenofovir disoproxil fumarate (TDF),
an antiviral drug commonly prescribed
to treat hepatitis B infection, does
not significantly reduce mother-to-
child transmission of hepatitis B virus
when taken during pregnancy and
after birth, according to results from
a Phase III clinical trial in Thailand
published in the New England Journal
of Medicine. Researchers tested TDF
therapy in addition to the standard
preventive regimen—administration
of hepatitis B vaccine and protective
antibodies at birth—to explore the
drug’s potential effects on mother-to-
child transmission rates. More than
2,500 women were screened for eligi-
bility, and 331 pregnant women with
hepatitis B were enrolled. The women
received placebo (n = 163) or TDF (n
= 168) at intervals from 28 weeks of
pregnancy to 2 months after birth. All
infants received standard hepatitis B
preventives given in Thailand, which
include hepatitis B immunoglobulin at
birth and five doses of the hepatitis
B vaccine by age 6 months (which dif-
fers from the three doses given in the
United States). A total of 294 infants
(147 in each group) were followed
Adolescents Riding With Impaired Drivers
Roughly one third of recent high
school graduates have ridden in
a motor vehicle with a substance-
through age 6 months. Three infants
in the placebo group had hepatitis B
infection at age 6 months, compared
with zero infants in the TDF treat-
ment group. Given the unexpectedly
low transmission rate in the placebo
group, the researchers concluded
that the addition of TDF to current
recommendations did not significantly
reduce mother-to-child transmission
of the virus. Although the reasons are
unknown, the researchers speculate
that the lower transmission rate seen
in the study may relate to the number
of doses of hepatitis B vaccine given
to infants in Thailand, lower rates of
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amniocentesis and cesarean births in
this study, or the lower prevalence of
mutated viruses that result in higher
vaccine efficacy in Thailand compared
with other countries. Find the study
here: https://doi.org/10.1056/NEJ
Moa1708131.
impaired driver, according to a study
published in the Journal of Studies on
Alcohol and Drugs. Researchers found
that during the first 2 years after
high school graduation, 23% of young
adults had ridden with a marijuana-
impaired driver at least once, 20%
had ridden with an alcohol-impaired
driver, and 6% had ridden with a driver
impaired by glue or solvents or harder,
illicit drugs, such as amphetamines,
opioids, or cocaine. Find the study
here: https://doi.org/10.15288/
jsad.2018.79.277.
doi: 10.1016/j.nwh.2018.04.002
 Hunt

Opioid Overdoses Behavioral

The U.S. opioid overdose epidemic
continues to worsen, according to
a Vital Signs report by the Centers
for Disease Control and Prevention
(CDC). Researchers examined the
timeliest data available to the CDC
on emergency department (ED)
visits for opioid overdoses across
multiple states. Overall, ED visits
(reported by 52 jurisdictions in
45 states) for suspected opioid
overdoses increased 30% in the
United States from July 2016
through September 2017. Opioid
Diuretic Therapy in
Preterm Infants
Diuretic therapy, which is com-
monly given to extremely preterm
infants to help them overcome
respiratory problems, appears to
offer no benefit for this purpose,
according to a study published in
The Journal of Pediatrics. Sur-
prisingly, infants in the study who
received diuretic therapy were
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overdoses increased for men and
women, all age groups, and all
regions but varied by state, with ru-
ral/urban differences. The findings
highlight the need for enhanced
prevention and treatment efforts
in EDs and for greater access to
evidence-based treatments for opi-
oid use disorder, including medica-
tion-assisted treatment and harm
reduction services. Find the report
here: www.cdc.gov/vitalsigns/
opioid-overdoses.
more likely to require respiratory
support, compared with extreme-
ly preterm infants with similar
respiratory problems who did not
receive the therapy. Researchers
analyzed data collected as part
of the Prematurity and Respira-
tory Outcomes Program study, an
effort to understand respiratory
difficulties in extremely premature
infants during the first year of life.
The study included 835 infants
born between 23 and 28 weeks
Counseling to
Prevent Skin
Cancer
The U.S. Preventive Services
Task Force (USPSTF) recom-
mends behavioral counseling
to help reduce the risk of skin
cancer from ultraviolet radia-
tion in persons ages 6 months
to 24 years with fair skin
types. The USPSTF routine-
ly makes recommendations
about the effectiveness of
preventive care services. This
recommendation statement
updates a 2012 recommen-
dation on behavioral coun-
seling to prevent skin cancer
and a 2009 recommendation
on screening for skin cancer
with self-examinations. Skin
cancer is the most common
type of cancer in the United
States. There were an esti-
mated 3.3 million new cases
of nonmelanoma skin cancer
in 2012 and approximately
90,000 new cases of melano-
ma skin cancer in 2018. Find
the final recommendation

at 13 U.S. NICUs. An infant is

statement published in JAMA
considered full term at 39 weeks.
here: https://doi.org/10.1001/
Researchers analyzed the infants’
jama.2018.1623.
daily medication and respira-
tory support records from birth
through 34 weeks. They found
that 90% of the infants on diuret-
ics needed supplemental oxygen
compared with 59% of infants who
did not receive the therapy. On the
day before the first diuretic treat-
ment (14 days of life), 56% of the
diuretic group were sicker and on
ventilator support, compared with
11% of the nondiuretic group. The
authors called for more research
to better understand diuretic
treatments. Find the study here:
https://doi.org/10.1016/j
.jpeds.2018.01.066.

June 2018 Nursing for Women’s Health 207

Research & Practice Briefs

Neonatal Abstinence
Sleep-Related Syndrome Among
Infant Deaths Medicaid
There are about 3,500
sleep-related deaths among Participants
U.S. infants each year,
Among infants covered by Medicaid,
including sudden infant
neonatal abstinence syndrome (NAS)
death syndrome, acciden-
incidence increased more than fivefold
tal suffocation, and deaths
from 2004 to 2014 (from 2.8 per
from unknown causes,
1,000), according to a study pub-
according to a new Vital
lished in Pediatrics. Medicaid-covered
Signs report. In the 1990s,
infants with NAS were significantly
there were sharp declines
more likely to be males from poor, ru-
in sleep-related deaths
ral counties; be transferred to another
after the national “Back to
hospital; and have a longer length
Sleep” safe sleep campaign.
of stay when compared with Medic-
However, declines have
aid-covered infants without NAS and nosis of NAS. The authors concluded
slowed since the late 1990s,
infants with NAS who were covered by that the continued growing incidence
and data from this report
private insurance. This study is the of NAS presents an opportunity to im-
show that the risk persists.
first to quantify the incidence differ- plement policies that improve opioid
Researchers analyzed
ence between Medicaid and privately use disorder treatment for women
Pregnancy Risk Assessment
insured infants over time. Research- before, during, and after pregnancy.
Monitoring System (PRAMS)
ers looked at 2004 through 2014 Additionally, they state that Medicaid
data from 2015 reported by
hospital birth data from the National programs could promote standard-
mothers about unsafe sleep
Inpatient Sample, a nationally repre- ization of clinical protocols to reduce
positioning, any bed shar-
sentative sample of hospital discharg- hospital costs and improve outcomes
ing, and use of soft bedding
es in the United States. The sample for infants with NAS. Find the study
from states with available
included 9.1 million hospital birth here: https://doi.org/10.1542/
data. Key findings include
records; 35,629 infants had a diag- peds.2017-3520.
the following:
• Approximately 21.6% of
mothers reported plac-
ing infants to sleep on Pediatric Medication Safety in the

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their side or stomach—
this was more common Emergency Department
among mothers who were
non-Hispanic Black or The American Academy of Pediatrics, Physicians, and the Emergency Nurs-
younger than 25 years the American College of Emergency es Association collaborated on the
or who had 12 or fewer policy statement “Pediatric Medica-
years of education. tion Safety in the Emergency Depart-
• More than half of moth- ment,” published in Pediatrics and the
ers (61.4%) reported Annals of Emergency Medicine. The
any bed sharing with policy describes 18 recommendations
their infants. to improve medication safety in the
• Approximately 2 in 5 emergency department, including
mothers (38.5%) reported distraction-free safety zones for medi-
using any soft bedding in cation preparation, pharmacists in the
the infants’ sleep area. emergency department, and adding a
dedicated pediatric medication safety
Find the report here: curriculum to training programs. Find
www.cdc.gov/vitalsigns/ the statement here: https://doi
safesleep/index.html. .org/10.1542/peds.2017-4066.

208 Volume 22 Issue 3 doi: 10.1016/j.nwh.2018.04.002


Prenatal Tobacco Smoke Exposure
A study published in the journal
CHEST highlights the burden of ob-
structive lung disease in U.S. chil-
dren and implicates tobacco smoke
exposure (TSE) through maternal
smoking during pregnancy as more
strongly associated with worse lung
function than current, ongoing TSE
in school-aged children with asth-
ma. Investigators analyzed the rela-
tionship between lung function and
the type of secondhand smoke ex-
posure in a representative sample
of school-aged children ages 6 to
11 years. The sample consisted of
2,070 children who participated in
the 2007 to 2012 National Health
and Nutrition Examination Survey.
Detailed information about ongoing
secondhand smoke exposure and
parental self-reported exposure
before birth were obtained. During
the study period, lung function was
measured using spirometry, and
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Importance of Hand Hygiene
June 2018
exposure to smoking was assessed
through levels of cotinine in the
blood, a marker of the extent of
current secondhand smoke expo-
sure. Thus, investigators were able
to distinguish clearly between expo-
sure in pregnancy and ongoing sec-
ondhand smoke exposure. Nearly
10% of children with and without
asthma in the sample had reduced
lung function. Investigators found
that current tobacco smoke expo-
sure was independently associated
with airflow obstruction in school-
aged children, although the extent
of the association was small.
However, prenatal tobacco smoke
exposure was associated with a
2.5-times increase in the odds of
having airflow obstruction in chil-
dren with asthma. Find the study
here: https://doi.org/10.1016/j
.chest.2017.10.003.
Infection prevention practices
centered on hand hygiene pro-
tocols can save lives across all
health care facilities, not just
hospital settings, according to
results published in the American
Journal of Infection Control . Re-
searchers studying hand hygiene
in nursing homes found that in-
corporating consistent measures
that prompt staff, residents, and
visitors to wash hands can lower
mortality and antibiotic pre-
scription rates and can increase
overall hand cleaner use. This
study is among the first to assess
hand hygiene practices outside
of the hospital setting through a
randomized controlled trial.
Find the study here: https://doi
.org/10.1016/j.ajic.2017.08.030.
Hunt
Self-Harm Behavior
and Suicide Risk
Youth treated for deliberate but nonsui-
cidal self-harm, such as cutting, were
more than 25 times as likely as demo-
graphically matched peers to die from
suicide within the following year, accord-
ing to a study in Pediatrics. Researchers
followed 32,395 youth between ages
12 and 24 years who were enrolled in
Medicaid between 2001 and 2007. The
risk of suicide within a year of self-
harm varied considerably by age, race,
and other factors. It was more than
four times greater for males (338.8
per 100,000) than for females (80.2
per 100,000). In addition, the risk was
markedly higher for American Indians/
Alaskan Natives than for non-Hispanic
White youth and for youth who used
more violent methods of self-harm, es-
pecially firearms. The study also showed
differences among adolescents and
young adults who were treated for the
initial self-harm. Although depression
and anxiety diagnoses were common in
both age groups, for example, adoles-
cents with self-harm were far more likely
to have been recently diagnosed with
attention-deficit/hyperactivity disorder
and other disruptive behaviors, where-
as young adults more commonly had
substance use and personality disorder
diagnoses. Authors of the study said
that their findings underscore the impor-
tance of follow-up care for youth treated
for self-harm to help ensure their safety.
Find the study here: https://doi
.org/10.1542/peds.2017-3517.
Nursing for Women’s Health 209
Research & Practice Briefs

Binge Drinking Among U.S. Adults

Adults in the United States
consumed more than 17 billion
binge drinks in 2015, or about
470 binge drinks per binge
drinker, according to a first-of-
its-kind study released by the
Centers for Disease Control and
Prevention (CDC) and published
in the American Journal of Pre-
ventive Medicine. Researchers
found that 1 in 6, or 37 million,
adults binge drink about once
a week, consuming an average
of seven drinks per binge. They
analyzed data on self-reported
binge drinking during the past
30 days from the CDC’s 2015
Behavioral Risk Factor Surveil-
lance System (BRFSS) and found • About 4 in 5 total binge • Binge drinkers consumed the
that binge drinking varied by drinks were consumed most alcohol in Arkansas,
age, sex, and social factors. Key by men. Mississippi, Kentucky, and
findings include the following: • Drinkers from lower-income Hawaii and the least in Wash-
• Binge drinking was more households (<$25,000 per ington, DC; New Jersey; New
common among young adults year) and lower education York; and Washington State.
ages 18–34 years, but more levels (less than high school) Find the study here: https://
than half of total yearly binge consumed more drinks per doi.org/10.1016/j.amepre
drinks consumed were by year than those with higher .2017.12.021.
adults ages 35 years and older. incomes and education levels.

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Managing Postmenopausal
Vulvovaginal Symptoms
Many postmenopausal women
have bothersome vulvovaginal
symptoms, including vaginal
dryness, itching, and pain with
sex. Researchers publishing in
JAMA Internal Medicine suggest
that a better understanding of the
underlying mechanism of post-
menopausal vulvovaginal symp-
toms is needed to guide efforts
to improve treatment options. In
their study, researchers conduct-
ed a 12-week randomized clini-
cal trial of 302 postmenopausal
women with moderate to severe
symptoms. They found that nei-
ther a prescribed vaginal estradi-
ol tablet nor an over-the-counter
vaginal moisturizer provided
more benefit than a placebo vagi-
nal tablet and gel to reduce post-
menopausal vulvovaginal symp-
toms in women. Find the study
here: https://doi.org/10.1001/
jamainternmed.2018.0116.

210 Volume 22 Issue 3 doi: 10.1016/j.nwh.2018.04.002


Health
Biomarkers and
Noisy Jobs
High blood pressure and high
cholesterol are more common
among workers exposed to loud
noise at work, according to a
study published in the American
Journal of Industrial Medicine.
Researchers also found that
a quarter of U.S. workers—an
estimated 41 million people—
reported a history of noise
exposure at work. Researchers
from the National Institute for
Occupational Safety and Health
analyzed data from the 2014
National Health Interview Survey
to estimate the prevalence of
occupational noise exposure,
hearing difficulty, and heart
conditions within U.S. industries
and occupations; they also
looked at the association be-
tween workplace noise exposure
and heart disease. They found
that 25% of current workers had
a history of work-related noise
exposure. Additionally, 12% of
current workers had hearing dif-
ficulty, 24% had high blood pres-
sure, and 28% had high choles-
terol. Of these cases 58%, 14%,
and 9%, respectively, can be
attributed to occupational noise
exposure. Find the study here:
https://doi.org/10.1002/
Photo © SIphotography / iStock Collection / thinkstockphotos.com
ajim.22833.
June 2018
NEW RESOURCES
AAP: Diversity and Inclusion Statement
AAP and ACOG: Guidelines for
Perinatal Care, 8th edition
CDC: 2017 Diabetes Report Card
ANA: Care Coordination:
Blueprint for Action for RNs
ACOG Practice Bulletin 193:
“Tubal Ectopic Pregnancy”
ACOG Practice Bulletin 192:
“Management of Alloimmunization
During Pregnancy”
ACOG Practice Bulletin 190:
“Gestational Diabetes Mellitus”
ACOG Committee Opinion 731:
“Group Prenatal Care”
ACOG Committee Opinion 730:
“Fatigue and Patient Safety”
ACOG Practice Advisory:
Hepatitis B Prevention
AWHONN Position Statement:
“Nursing Care of Incarcerated
Women During Pregnancy and
the Postpartum Period”
AWHONN Practice Brief
Number 6: “Use of Nitrous
Oxide in Maternity Care”
NICHD infographic: Don’t
Ignore Your Pelvic Floor
NIH: PregSource
Office of Disease Prevention
and Health Promotion Webinar:
Preventing Adverse Drug Events
Relias White Paper: “Promoting
Vaginal Birth: A Guide to Understand
and Lower the Cesarean Birth Rate”
U.S. Preventive Services
Task Force Recommendation
Statement: “Behavioral Counseling
to Prevent Skin Cancer”
WHO Recommendations:
Intrapartum Care for a Positive
Childbirth Experience
Hunt
https://doi.org/10.1542/peds.2018-0193
http://shop.aap.org/guidelines-for-perinatal-
care-8th-edition-paperback
www.cdc.gov/diabetes/library/reports/
reportcard.html
www.nursingworld.org/nurses-books/care-
coordination-blueprint-for-action-for-rns
www.acog.org/Clinical-Guidance-and-
Publications/Practice-Bulletins/Committee-on-
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