research topics for labor and delivery nursing

Introduction to Labor and Delivery Nursing Research Topics

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Labor and delivery nursing is a specialized field that focuses on providing care for women during childbirth and the immediate postpartum period. Research in this area is essential to improving patient outcomes, enhancing nursing practice, and advancing the overall quality of care. As a nursing student, exploring labor and delivery research topics can deepen your understanding, strengthen your skills, and help you contribute to this vital field. This article will delve into various labor and delivery nursing research topics to spark your curiosity and inspire your academic journey.

Pain Management during Labor and Delivery

Pain management during labor and delivery is a critical aspect of patient care. Research in this area can lead to the development of new techniques and interventions that promote comfort and minimize distress during childbirth. Some research topics to consider include:

• Efficacy of non-pharmacological pain relief methods, such as hydrotherapy, massage, and acupuncture
• Comparison of epidural analgesia versus other pain management techniques
• The role of patient education and prenatal preparation in pain management during labor
• The impact of pain management strategies on maternal satisfaction and birth outcomes
• Cultural influences on pain perception and management during labor
• The efficacy of epidural anesthesia versus intravenous opioids
• Non-pharmacological approaches to pain relief during labor
• The psychological impact of pain management choices on maternal mental health
• The influence of birthing environment on perceived pain and discomfort
• Patient education and its role in pain management expectations
• Comparing the effectiveness of different non-pharmacological pain management techniques during labor
• Evaluating the safety and efficacy of epidural analgesia in labor and delivery
• The role of hydrotherapy in managing pain during labor
• Assessing the use of transcutaneous electrical nerve stimulation (TENS) for pain relief in labor
• Exploring the impact of patient-controlled analgesia during labor and delivery

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Fetal Monitoring and Assessment

Fetal monitoring and assessment during labor and delivery are essential for identifying potential complications and ensuring the safety of both mother and baby. Research topics in this area might include:

• Evaluating the effectiveness of various fetal monitoring techniques, such as continuous electronic fetal monitoring and intermittent auscultation
• The role of fetal heart rate variability in predicting neonatal outcomes
• Investigating the impact of maternal position on fetal monitoring accuracy and outcomes
• Assessing the effectiveness of fetal scalp stimulation in identifying fetal distress
• Exploring the potential benefits and risks of umbilical cord blood gas analysis
• Investigating the effectiveness of intermittent versus continuous fetal monitoring during labor
• Advancements in non-invasive fetal monitoring techniques
• The accuracy of ultrasound in predicting fetal distress
• Correlation between maternal vital signs and fetal health
• Continuous vs. intermittent fetal heart rate monitoring: Risks and benefits
• The role of Doppler imaging in assessing fetal blood flow and well-being
• Assessing the role of fetal scalp sampling in predicting neonatal outcomes
• Evaluating the benefits and risks of using Doppler ultrasound for fetal monitoring
• Exploring the impact of wireless fetal monitoring on patient comfort and outcomes
• Examining the effectiveness of non-invasive fetal ECG monitoring

High-Risk Pregnancies and Complications

High-risk pregnancies and complications during labor and delivery present unique challenges for nursing care. Research in this area can help improve outcomes for mothers and babies in these situations. Some research topics to explore include:

• The impact of maternal age, obesity, and other risk factors on labor and delivery outcomes
• Strategies for managing preterm labor and preventing preterm birth
• The role of nursing interventions in managing gestational diabetes and preeclampsia
• Assessing the effectiveness of interventions for managing shoulder dystocia and other delivery complications
• The impact of maternal age on pregnancy outcomes
• Management strategies for gestational diabetes
• The implications of preeclampsia on maternal and fetal health
• The influence of multiple pregnancies on labor and delivery outcomes
• Risk factors and preventive measures for preterm labor
• Exploring the impact of high-risk pregnancy care models on maternal and neonatal outcomes
• Investigating the impact of nursing interventions on managing gestational diabetes
• Assessing the role of labor and delivery nurses in managing preeclampsia and eclampsia
• Evaluating the effectiveness of nursing care for women with multiple gestations
• Exploring the impact of nurse-led management of preterm labor and birth
• Examining the role of nursing interventions in preventing and managing postpartum hemorrhage

Neonatal Care and Resuscitation

Neonatal care and resuscitation are essential aspects of labor and delivery nursing practice. Research in this area can help improve outcomes for newborns who require immediate medical attention. Some research topics to consider include:

• Assessing the efficacy of various neonatal resuscitation techniques and equipment
• The role of nursing interventions in preventing and managing neonatal hypothermia
• Evaluating the effectiveness of early skin-to-skin contact and delayed cord clamping on neonatal outcomes
• Investigating the impact of neonatal resuscitation training and simulation on nursing competence and confidence
• Exploring the role of parental involvement and education in neonatal care and resuscitation
• Latest advancements in neonatal resuscitation techniques
• The role of temperature regulation in neonatal survival
• Implications of delayed cord clamping on neonatal health
• Neonatal adaptation to extrauterine life: Challenges and interventions
• Training and competency among healthcare providers in neonatal resuscitation
• Investigating the effectiveness of skin-to-skin contact immediately after birth for neonatal outcomes
• Assessing the role of labor and delivery nurses in neonatal resuscitation and stabilization
• Evaluating the use of therapeutic hypothermia for neonatal encephalopathy
• Exploring the impact of early versus delayed cord clamping on neonatal outcomes
• Examining the role of nurse-led family-centered care in the neonatal intensive care unit (NICU)

Postpartum Care and Support

Postpartum care and support are crucial for promoting the health and well-being of both mother and baby after delivery. Research in this area can help identify best practices and strategies for providing optimal care during this critical period. Some research topics to consider include:

• The impact of early postpartum support and follow-up on maternal and neonatal outcomes
• Assessing the effectiveness of breastfeeding education and support in promoting successful lactation
• Investigating the role of nursing interventions in preventing and managing postpartum hemorrhage
• Exploring the impact of postpartum depression screening and intervention on maternal mental health
• Evaluating the effectiveness of discharge planning and postpartum care coordination on readmission rates and patient satisfaction
• The impact of immediate skin-to-skin contact on maternal-infant bonding
• Assessment and management of postpartum hemorrhage
• Role of lactation consultants in supporting breastfeeding mothers
• Postpartum depression: Risk factors, assessment, and interventions
• Physical rehabilitation and recovery strategies post-delivery
• Investigating the effectiveness of nurse-led breastfeeding support and education
• Assessing the impact of postpartum depression screening and intervention on maternal mental health
• Evaluating the role of nursing interventions in preventing and managing postpartum infections
• Exploring the impact of early postpartum discharge on maternal and infant outcomes
• Examining the effectiveness of nurse-led postpartum weight management interventions

Cultural Considerations and Disparities in Labor and Delivery Nursing

Cultural considerations and labor and delivery nursing disparities are important factors influencing patient outcomes and satisfaction. Research in this area can help identify ways to provide culturally sensitive care and address maternal and neonatal health disparities. Some research topics to explore include:

• Investigating the impact of cultural competence training on nursing practice and patient satisfaction
• Assessing the effectiveness of culturally tailored prenatal education and interventions
• Exploring the role of cultural beliefs and practices in labor and delivery nursing care
• Identifying strategies for reducing racial and ethnic disparities in maternal and neonatal outcomes
• Examining the impact of language barriers and interpreter services on labor and delivery nursing care
• The influence of cultural beliefs on birthing practices and choices
• Addressing language barriers in labor and delivery settings
• Understanding and respecting traditional birthing rituals in diverse populations
• Socioeconomic disparities and their impact on maternal and neonatal outcomes
• Cultural competence training for labor and delivery nurses
• Investigating the impact of language-concordant care on patient satisfaction and outcomes
• Assessing the role of cultural competency training in improving labor and delivery nursing care
• Evaluating the effectiveness of community-based interventions to improve access to prenatal care for underserved populations
• Exploring the impact of cultural beliefs on pain management preferences during labor and delivery
• Examining the role of culturally tailored childbirth education in enhancing patient satisfaction and birth outcomes

Advancements in Labor and Delivery Nursing Practice

Labor and delivery nursing practice advancements can lead to improved patient care and outcomes. Research in this area can help identify new techniques, technologies, and approaches to enhance nursing practice. Some research topics to consider include:

• Evaluating the impact of simulation training on labor and delivery nursing competence and confidence
• Investigating the effectiveness of telehealth and remote monitoring in prenatal and postpartum care
• Assessing the potential benefits and challenges of robotic assistance in labor and delivery nursing
• Exploring the role of electronic health records and decision support tools in improving labor and delivery nursing practice
• The rise of telemedicine in prenatal and postpartum care
• Innovations in simulation training for labor and delivery nurses
• The role of artificial intelligence in predicting and managing labor complications
• Emerging technologies in fetal monitoring and assessment
• Interdisciplinary collaboration in labor and delivery care
• Examining the impact of interprofessional collaboration and communication on patient outcomes and satisfaction
• Investigating the impact of simulation-based training on labor and delivery nursing competence
• Assessing the effectiveness of interprofessional education in improving teamwork and communication in the labor and delivery setting
• Evaluating the use of electronic health records for enhancing labor and delivery nursing care
• Exploring the role of virtual and augmented reality technologies in labor and delivery nursing education and practice
• Examining the impact of innovative nursing care models on maternal and neonatal outcomes

Advancing Labor and Delivery Nursing Research

Labor and delivery nursing research is vital for improving patient care, enhancing nursing practice, and advancing the field. By exploring diverse research topics, nursing students can deepen their knowledge, strengthen their skills, and contribute to the ongoing development of evidence-based practice. As you embark on your research journey, consider the topics presented in this article as potential starting points, and remember that your work can have a lasting impact on the lives of mothers, babies, and families.

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• Published: 13 July 2022

Maternal childbirth experience and time in labor: a population-based cohort study

• Sara Carlhäll 1 , 2 ,
• Marie Nelson 1 , 2 ,
• Maria Svenvik 2 , 3 ,
• Daniel Axelsson 2 , 4 &
• Marie Blomberg 1 , 2  

Scientific Reports volume  12 , Article number:  11930 ( 2022 ) Cite this article

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• Epidemiology
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• Reproductive signs and symptoms
• Risk factors

A negative childbirth experience may have long term negative effects on maternal health. New international guidelines allow a slower progress of labor in the early active phase. However, a longer time in labor may influence the childbirth experience. In this population-based cohort study including 26,429 women, who gave birth from January 2016 to March 2020, the association between duration of different phases of active labor and childbirth experience was studied. The women assessed their childbirth experience by visual analogue scale (VAS) score. Data was obtained from electronic medical records. The prevalence of negative childbirth experience (VAS 1–3) was 4.9%. A significant association between longer duration of all labor phases and a negative childbirth experience was found for primi- and multipara. The adjusted odds ratio (aOR (95%CI)) of negative childbirth experience and longer time in active labor (above the 90th percentile) in primipara was 2.39 (1.98–2.90) and in multipara 2.23 (1.78–2.79). In primi-and multipara with duration of labor ≥ 12 h or ≥ 6 h the aOR (95%CI) of negative childbirth experience were 2.22 (1.91–2.58) and 1.91 (1.59–2.26) respectively. It is of great importance to identify and optimize the clinical care of women with longer time in labor to reduce the risk of negative childbirth experience and associated adverse long-term effects.

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Introduction.

The woman’s experience of care during childbirth is as important as an optimal clinical care to achieve desired outcomes of childbirth and labor according to the World Health Organization (WHO) 1 . Despite this, a negative childbirth experience has been reported in 5–10% of laboring women 2 , 3 , 4 , 5 which may have long-term effects on maternal health 6 . Posttraumatic stress disorder, postpartum depression and dysfunctional bonding with the newborn have been related to a traumatic childbirth experience 7 , 8 . Furthermore, a negative childbirth experience may lead to secondary fear of childbirth, longer interval to subsequent deliveries and increased risk of future cesarean section (CS) 9 , 10 , 11 , 12 .

Maternal childbirth experience is affected by several factors including maternal age, mode of delivery, postpartum hemorrhage, low Apgar score, induction of labor and obstetric anal sphincter injury 2 , 3 , 6 , 13 . Emergency CS has been described as a significant risk factor for a negative childbirth experience 2 , 4 , 6 , 14 , 15 . The CS rate increases worldwide 16 . To reduce the incidence of emergency CS due to failure to progress, new guidelines on normal labor progression have been published by the WHO 1 and the American College of Obstetricians and Gynecologists (ACOG) 17 , allowing a slower progress in the beginning of the active phase of labor compared with the traditional guidelines by Friedman 18 . However, a long time in labor may increase the risk of a negative childbirth experience, which in turn may lead to a future demand of CS in the following pregnancy 19 , 20 . When a study compared childbirth experience in women randomized to follow either the traditional partograph or new guidelines allowing longer time in labor, women following new guidelines scored lower on positive memories and feeling of control 21 .

The knowledge about maternal childbirth experience in relation to time in active labor is sparce and studies show conflicting results. A few studies have analyzed duration of the active labor in primiparous women, most without taking possible confounders into account, and concluded that prolonged labor was a risk factor for a negative childbirth experience 14 , 19 , 22 . Another study could not confirm that duration of the first stage of labor affected the childbirth experience but found that a longer pushing phase contributed to a negative childbirth experience 23 . Further, in a Swedish single center study the maternal childbirth satisfaction was not affected by the duration of neither the latent nor the active phase of labor 24 .

There are not only conflicting results concerning the impact of time in labor on maternal childbirth experience in the previous literature, but there is also inconsistent data on relevant adjustments related to time in labor as the exposure. Most of these studies are based on single center cohorts, increasing the risk of selection bias.

Thus, this study aimed to evaluate whether the duration of active labor was associated with the women’s self-reported childbirth experience. We hypothesized that longer time in active labor increased the risk of a negative childbirth experience.

Study-design and population

This retrospective population-based cohort study was conducted between January 2016 and March 2020 at all the seven delivery units in the southeast health care region of Sweden. All women giving birth to a singleton infant at or above 37 gestational weeks were included. The women with elective CS, non-cephalic presentation and stillbirth were excluded as well as the women with missing data on childbirth experience and missing labor time estimates before the final analyses.

After delivery, the women were asked by the midwife at the postnatal ward to assess their overall experience of the active phase of childbirth by using a visual analog scale (VAS) ranging from 1 to 10, where 1 is a very negative experience and 10 is a very positive experience. This assessment of satisfaction of childbirth by VAS is a well-established routine in the postnatal care at all participating delivery units included in this study. The VAS scoring is usually completed within 2 days after delivery, before discharge from the postnatal ward and is documented in the women’s electronic medical record. The overall assessment of satisfaction of childbirth by VAS has been validated and is comparable with the Wijma Delivery Experience Questionnaire (W-DEQ) and the Childbirth Experience Questionnaire (CEQ) 24 , 25 , 26 .

Data collection and definitions

Data in this study was obtained from the women’s electronic medical records. The maternal variables that were extracted included the self-reported childbirth experience VAS score, maternal age at time of delivery, early pregnancy body mass index (BMI), parity and gestational age at delivery. Labor and neonatal variables assessed were onset of labor (spontaneous or induction), usage of epidural anesthesia, oxytocin augmentation, mode of birth (non-instrumental vaginal delivery, instrumental vaginal delivery, or emergency CS), obstetric anal sphincter injury, postpartum hemorrhage, Apgar score at five minutes and birth weight. Further, the time estimates for start of active labor, start of pushing contractions, and time of birth were extracted from the electronic medical records.

Maternal BMI was categorized according to the World Health Organization (WHO) classification: < 18.5 kg/m 2 (underweight), 18.5–24.9 kg/m 2 (normal weight), 25.0–29.9 kg/m 2 (overweight), 30–34.9 kg/m 2 (class I obesity), 35.0–39.9 kg/m 2 (class II obesity) and ≥ 40 kg/m 2 (class III obesity).

Primiparous women and multiparous women were analyzed separately. Women with induced labor and a spontaneous onset of labor were included in the analyses as well as women with emergency CS.

The main exposure was duration of labor. The different labor time variables that were analyzed were the duration of the total active labor (from start of the active labor until the time of birth), the active phase in the first stage of labor (from start of the active labor until start of the pushing efforts) and the pushing phase. Start of active labor was defined according to the Swedish nationally recommended definition, which states that at least two out of three of the following criteria must be fulfilled: spontaneous rupture of the membranes, regular painful contractions (2–3/10 min), and the cervix dilated four centimetres or effaced and dilated more than one centimetre. In addition to these criteria, the labor should progress within the following 2 h 27 . The midwife at the delivery ward prospectively documented the time when the active phase and the pushing efforts started and the time of birth. The distribution of total labor duration is presented in a descriptive approach as crude observed data of the 10th, 25th, 50th, 75th and 90th percentiles of time in active labor. For the purpose of this study, prolonged labor was defined based on the Swedish definition of dystocia (cervical dilatation less than 1 cm/hour during the active phase and > 3 h from cervix fully dilated to delivery for primiparous women) 28 and previous similar research, defining prolonged labor ≥ 12 h for primiparous women 14 , 19 and clinically relevant cut offs. The total active labor was defined prolonged if duration was ≥ 12 h in primiparous women and ≥ 6 h in multiparous women. The active phase of the first stage of labor was defined prolonged if duration was ≥ 10 h in primiparous women and ≥ 5 h in multiparous women. The pushing phase was defined prolonged if the duration was ≥ 60 min in primiparous women and ≥ 30 min in multiparous women. These cut offs were similar to the 75th quartiles of time in labor for the present study population; for primiparous women the 75th percentile was 13.0 h and for multiparous women the 75th percentile was 6.2 h (Table S2 ). Incorrect values of the labor time estimates were excluded. The time estimates were regarded incorrect, if they were < 11 min and ≥ 52 h for the total labor, < 10 min or ≥ 48 h for the active phase of first stage of labor and < 1 min and ≥ 4 h for the pushing phase, based the graphical distribution of time in labor excluding the outliers and based on clinical experience. Information on start of the pushing phase was not available for all women.

The main outcome was maternal childbirth experience by VAS score. The VAS score was dichotomized into negative birth experience (VAS 1–3) and not being dissatisfied with childbirth (VAS 4–10). The definition of negative childbirth experience was based on the clinical recommendation at the participating study sites to offer extra psychologic support to the women scoring VAS 1–3 2 . The VAS score was further coded into three groups for descriptive analyses: negative birth experience (VAS 1–3), intermediate birth experience (VAS 4–7) and positive birth experience (VAS 8–10). The classification of positive birth experience as VAS 8–10 was based on the definition used in the national Swedish pregnancy register 29 .

Continuous data is presented as mean and one standard deviation (SD), or median and inter quartile range [IQR] if not normally distributed. Categorical data is presented as number and per cent. Differences in the categorical labor time variables between the VAS groups were analyzed with Chi-square test. The labor time variables were not normally distributed. Kruskal–Wallis test was used to compare median durations of the total active labor, the active phase in first stage of labor and the pushing phase among the three VAS groups. Multivariable logistic regression analyses were used to study the association between time in labor, in percentiles and categorical labor time variables, and binary outcomes; negative birth experience (VAS 1–3) and not being dissatisfied with childbirth (VAS 4–10), presented as crude and adjusted odds ratios (ORs and aORs). In the multivariable analyses, adjustments were made for maternal age, BMI, and fetal birthweight. The reference category for the analyses of the labor time estimates in primiparous and multiparous women was set as 10th–90th percentiles for duration of total active labor. In primiparous women the reference categories were set as < 12 h in total active labor, < 10 h in the active phase in first stage of labor, and < 60 min in the pushing phase. For multiparous women the reference categories were chosen as < 6 h in total active labor, < 5 h in the active phase in first stage of labor, and < 30 min in the pushing phase. The statistical analyses were performed using IBM SPSS version 26 (IMB inc, Armok, NY). A p-value < 0.05 was considered statistically significant.

Sensitivity analyses

Sensitivity analyses were performed to examine the robustness of our findings.

First, we compared the prevalence of maternal characteristics and obstetric outcomes in the women that were excluded from the final study-population due to missing VAS score as well missing information on start of active labor, with the women included in the final study-population (Table S1 ).

Further we performed extended analyses on time in total active labor. Time in active labor was classified in < 25th percentile, 25th–75th percentile and > 75th percentile and sensitivity analyses examined whether the crude ORs for a negative childbirth experience differed compared to the main analyses (Table S2 ).

Sensitivity analyses of time in total active labor, classified in < 10th percentile, 10th–90th percentile and > 90th percentile and crude ORs for a negative childbirth experience in primiparous and multiparous women categorized according to type of onset of labor and mode of birth were done (Table S3 , S4 ).

Ethical approval

The Regional Ethical Review Board in Linköping, Sweden approved this study on October 26th, 2018 (Dnr 2018/337-31) and on January 1st, 2020 (Dnr 2019-04529). All methods were performed in accordance with the relevant guidelines and regulations.

A total number of 26,429 women, with a singleton term pregnancy, who had assessed their childbirth experience by VAS score and with known start of active labor constituted the final study population. Of all 43,953 eligible women, 9.5% (n = 4168) were excluded due to elective cesarean section, non-cephalic presentation and/or stillbirth. Of all 39,785 included women 33.6% (n = 13,356) were excluded due to missing information on VAS and/or start of active labor (Fig.  1 ).

Flow chart of the study population.

In the final study population, 82.7% had a documented VAS score. Overall, 69.7% ( n  = 18,428) of the women had a positive birth experience (VAS 8–10), whereas 4.9% ( n  = 1298) reported a negative birth experience (VAS 1–3).

The maternal characteristics, obstetric interventions, and outcomes in the study-population, categorized according to a positive, intermediate, or negative childbirth experience, are presented in Table 1 . The women who had a negative childbirth experience were statistically significantly older, primiparous, at gestational age ≥ 41 weeks, had induced labor, an infant with Apgar score < 7 at 5 min or with a birthweight of ≥ 4.5 kg, compared with the women in the total study population. Further, the frequencies of epidural anesthesia, oxytocin augmentation, operative vaginal birth or emergency CS, occurrence of obstetric anal sphincter injury and postpartum hemorrhage ≥ 1000 ml were statistically significantly higher among women with a negative childbirth experience (Table 1 , p < 0.05 for all variables, not shown in Table 1 ).

The distribution of labor duration in primiparous and multiparous women according to a positive, intermediate, or negative childbirth experience, is presented by percentiles in Table 2 . When analyzing the distribution of total labor duration in primiparous and multiparous women, according to the different labor duration percentiles, the same pattern emerges regardless of parity. The associations between the labor time categories defining prolonged labor and childbirth experience in primiparous and multiparous women are shown in Table 2 . The proportion of primiparous and multiparous women with prolonged labor phases increased with decreasing VAS scores, indicating a negative childbirth experience (p for homogeneity < 0.001). Almost half of the primiparous women with a negative childbirth experience had a prolonged total active labor (48%) and in multiparous women with a negative childbirth experience 40% had a prolonged total active labor (Table 2 ).

Tables 3 and 4 demonstrate a significant association between duration of labor and risk of negative childbirth experience in primiparous and multiparous women, in all labor time categories that were analyzed. The analyses were adjusted for maternal age, BMI and fetal birthweight (Model 1 in Tables 3 , 4 ). For primiparous women with duration of total active labor above the 90th percentile the risk of a negative birth experience was more than doubled (aOR 2.39 (1.98–2.90), Model 1, Table 3 ). If, on the other hand, duration of total active labor was below the 10th percentile, primiparous women had a significantly reduced risk of a negative childbirth experience (aOR 0.46, 95% CI (0.32–0.69) (Table 3 , Model 1).

In primiparous women with a defined prolonged total labor (≥ 12 h) the risk of a negative childbirth experience was more than twice as high, compared with women with normal duration of labor; aOR 2.11, 95% CI (1.81–2.46). Primiparous women with prolonged active phase (≥ 10 h) had an increased risk for a negative childbirth experience; aOR1.89, 95% CI (1.59–2.24). The risk of negative childbirth experience was also increased (aOR 1.49, 95% CI (1.22–1.83)), if the pushing phase was ≥ 60 min (Table 3 , Model 1).

For multiparous women with duration of total active labor above the 90th percentile, the risk of a negative childbirth experience was more than twice as high (aOR 2.23 (1.78–2.79), Model 1, Table 4 ). Further with a defined prolonged total active labor (≥ 6 h) and prolonged active phase (≥ 5 h) the risk of a negative childbirth experience was increased in multiparous women compared with women with normal duration of labor; aOR 1.91, 95% CI (1.59–2.28) and aOR1.55, 95%CI (1.28–1.88) respectively. A prolonged pushing phase in multiparous women doubled the risk of a negative birth experience aOR 2.05, 95%CI (1.62–2.60) (Table 4 , Model 1).

When the multivariable logistic regression analyses on the association between time in labor and childbirth experience also included adjustments for onset of labor and mode of delivery, the aORs were still statistically significant and only changed marginally (Tables 3 , 4 , Model 2).

The sensitivity analyses comparing the prevalence of maternal characteristics and obstetric outcomes in women with available or missing VAS score as well as women with available or missing start of active labor demonstrated statistically significant differences. More women with gestational age ≥ 42 weeks, induction of labor and cesarean delivery had missing information on start of active labor compared to women with known start of active labor (Table S1 ). A larger proportion of women with missing VAS (7.9%) was also delivered by CS compared to women with known VAS (4.6%).

A dose–response relation between time in active labor and risk of a negative childbirth experience was seen, with statistically significant higher crude ORs for a negative childbirth experience when prolonged time in active labor was defined above the 90th percentile for both primiparous (OR 2.54 95% CI (2.10–3.07)) and multiparous women (OR 2.27 95% CI (1.81–2.83)) compared to the analyses when the 75th percentile of total labor duration was analyzed for primiparous (OR 2.00 95% CI (1.70–2.35) and multiparous women (OR 1.80 95% CI (1.49–2.81) (Table S2 ).

In Tables S3 and S4 the crude OR for negative birth experience for women, categorized according to type of start of labor and mode of delivery in percentiles of labor duration, are presented. Primiparous women with induced labor and labor duration above the 90th percentile, had higher crude OR for negative birth experience; OR 3.60 95% CI (2.42–5.35) compared to women with spontaneous onset of labor and labor duration above the 90th percentile; OR 2.34 95% CI (1.88–2.91) (Table S3 ). When comparing primiparous women with induction and spontaneous onset in labor time categories, the women with prolonged total labor (≥ 12 h) and induced labor had higher crude OR for a negative birth experience; OR 2.70 95% CI (1.88–3.88), than the women with spontaneous start and same categorization of prolonged labor; OR 1.87 95% CI (1.55–2.25) (OR not shown in Table S3 ). No difference was seen between the non-instrumental and instrumental vaginal delivery groups (Table S3 ). For multiparous women no significant differences were seen between women with induced labor and spontaneous start of labor or between women with instrumental and non-instrumental vaginal delivery (Table S4 ). For primi- and multiparous women delivered with CS, no statistically significant differences were seen (Tables S3 , S4 ).

In this large multi-center population-based cohort study, we found a significant association between longer duration of active labor and low VAS score, indicating a negative childbirth experience in both primiparous and multiparous women and the most pronounced risk of a negative childbirth experience was seen for those with induced labor. All different labor phases that were studied were significantly related to the women’s childbirth satisfaction score. The longer duration of total labor, active phase and pushing phase, respectively, the lower both primiparous women and multiparous women rated their childbirth satisfaction score by VAS. The dose–response relation between time in active labor and risk of negative childbirth experience, with statistically significant higher crude ORs for a negative childbirth experience when prolonged labor was defined at or above the 90th percentile compared to the 75th percentile, strengthens the result that there is an association between long time in labor and an overall negative childbirth experience by VAS.

In line with previous research, the women in our cohort with negative childbirth experience were more likely to be primiparous, have induced labor, an infant with Apgar score < 7 at 5 min, oxytocin augmentation, operative vaginal birth or emergency CS, obstetric anal sphincter injury or postpartum hemorrhage 2 , 3 , 13 .

There are some studies that have investigated the relationship between prolonged labor and birth experience, although the definition of prolonged labor was not specified in all studies 30 , 31 . A Swedish study found that nulliparous women with negative birth experience reported longer labors measured in hours than women with positive birth experience 30 . An Iranian study stated that labor dystocia was a strong predictor of low birth satisfaction 31 . Our results are consistent with previous studies concluding that prolonged labor, defined as > 12 h, increased the risk of negative childbirth experience 14 , 19 . However, these studies were conducted at a single center, included smaller study populations, were restricted to primiparous women, and did not study the active phase of first stage of labor and the pushing phase separately 14 , 19 . In contrast to these studies, Fenaroli et al. found that the duration of first stage of labor did not affect the woman’s birthing experience among 111 Italian primiparous women who completed the Wijma Delivery Experience Questionnaire (W-DEQ), however a longer pushing phase contributed to a negative childbirth experience 23 . An association between prolonged second stage of labor and a negative childbirth experience, evaluated more than a decade after delivery was also found in primi- and multiparous American women who delivered by CS but not for those who delivered vaginally 6 . In another single center study including 70 primiparous women, Turkmen et al. showed that the childbirth satisfaction score by Childbirth Experience Questionnaire was not affected by the duration of neither the latent phase nor the active phase of labor 24 . An aspect when studying time in labor and women’s childbirth experiences is that women´s perceptions of start of active labor, the labor phases and time in labor might differ from the established medical definitions 32 , 33 . However, in a Swedish study, women with negative childbirth experiences both reported longer labors measured in hours and experienced longer labors and viewed the length as prolonged compared to women with a positive birth experience 34 .

A major strength of this study is the multicenter population-based design with prospectively recorded data in standardized medical records, which reduces the risk of selection bias and recall bias. There were some statistically significant differences between the women with missing or known start of active labor or VAS. We cannot exclude the possibility that the missing data may have had some influence on the adjusted estimates. To exclude a group of women that differ from the included women will influence the generalizability. There was a higher prevalence of women with gestational age ≥ 42 weeks and induction in the group with unknown start of active labor compared to women with known start of active labor. This might be explained by the fact that a gestational week ≥ 42 is an indication for induction of labor and some women with induction of labor never reach start of active labor before they are delivered by cesarean section due to failure to induce labor. This may also explain why more women with missing start of active labor (11.4%) were delivered by cesarean section than women with available start of active labor (3.6%). However, it is also possible that among the women that were excluded due to unknown start of active labor there were women with emergency CS due to slow progress of labor. Among the women in the final study population the percentage of women with labor duration above the 90th percentile was higher among women with CS compared with women with non-instrumental vaginal delivery. Hence, most likely, if these excluded women would answer similar to the women in the final study population, the estimates would be even more significant if more women with longer labor duration would have been included, following the hypothesis that women with prolonged labor are more likely to have negative birth experience. This strengthens the results.

To our knowledge, this study has the largest cohort of women with detailed information on maternal characteristics, known time in active labor and assessed childbirth experience, which gave sufficient power to evaluate the association between duration of the different labor phases and childbirth experience and in addition, enabled adjustments for possible confounding factors. If adjustments for all possible known confounders had been done, this might have resulted in different results. However, our purpose with this study was to evaluate the overall effect of time in labor and childbirth-experience focusing on the main groups primiparous and multiparous women, not necessarily to imply causality between the exposure and the outcome. Our approach could be looked upon as both a strength and a limitation.

In contrast to Kempe et al. who only analyzed the mean VAS score in relation to time in labor 14 , we categorized the VAS scores. To categorize the VAS scale into negative and positive childbirth experience and to present the distribution of exposure, time in labor, in percentiles gives a wider dimension of the childbirth experience compared with the mean value. Further, the high response rate of VAS (82.7%), increases the likelihood of representative study samples. The prevalence of negative childbirth experience of 4.9% is similar to the reported prevalence in previous studies 2 , 13 which also strengthens the generalizability of the study results.

The evaluation of the overall childbirth experience by VAS score is an accessible, easy, and valid method that correlates with other birthing experience instruments such as the W-DEQ and the Childbirth Experience Questionnaire 24 , 25 , 26 . The VAS method is used nationwide in Sweden to assess women’s birth experiences a few days after childbirth and the VAS scores are registered in the national Swedish Pregnancy Register 2 , 3 , 14 , 35 . Another advantage of the VAS method is that it is part of the clinical routine and reaches the majority of all parturients and therefore is a good method to study a larger cohort.

On the other hand, the VAS method is a limitation due to its simplified and non-specific measure on childbirth experience overall that does not give a deeper understanding of the multifaceted childbirth experience. Some risk factors for a negative childbirth experience, such as personal experience of pain or support during labor 5 , 19 , 36 , was not documented in the women’s electronic medical records and can thus not be adjusted for in the analyses. This may decrease the validity of the present study. Further, there is no established definition of negative childbirth experience by VAS and another definition might have given different results. However, our definition of an overall negative childbirth experience by a low VAS score (1–3) was based on the current clinical guidelines at the participating study sites to offer extra psychosomatic support to women scoring below 4 and thereby including the women who were the most dissatisfied with their childbirth experience. Another limitation is that the childbirth experience was evaluated within the first 72 h after childbirth, since women’s rating of childbirth might be influenced by the initial positive feelings shortly after birth 37 . A certain amount of time estimates for the different phases of labor were missing, however there is no reason to suspect an association between missing time estimates and VAS that could have biased the results.

The definition of normal labor progression is currently under international debate. The WHO and ACOG has changed their definitions and allow a slower progress in the beginning of the active phase of labor 1 , 17 . The reason for this change has mainly been to reduce the incidence of emergency CS and avoid unnecessary emergency CS due to failure to progress. However, since long time in labor increases the risk of a negative birthing experience, as demonstrated in this study, it may also increase future demands on CS in the following pregnancy due to fear of childbirth 9 , 10 . Since a negative birth experience also may have every day and life-long consequences affecting the bonding with the newborn and the women’s mental health and result in avoidance of a future pregnancy as a result from fear of childbirth, care givers must pay attention to the women with long time in active labor 34 , 38 , 39 . The childbirth experience is multidimensional. Some contributing factors for a negative childbirth experience, like unexpected events such as instrumental delivery, emergency CS, and postpartum hemorrhage, are difficult to prevent, while other factors might be noticed and thus improve the care of women in labor. It is described that women who experienced more pain than expected, did not receive the support by the care givers that they needed, had insufficient continuous information and did not feel included in decisions made during labor were at risk of a negative childbirth experience 5 , 19 , 36 . Reducing the risk of these known factors might compensate for the effect of a longer time in labor. Hence, it might be of extra importance to make sure that women with longer time in labor have enough pain relief and to be aware of a possible need for extra support and guidance during labor. A cesarean delivery due to failure of labor progress might contribute to a negative childbirth experience 2 , 4 , 6 , 14 , 15 . It is therefore important not to terminate labor with CS due to failure of progress before the women have been offered continuous support and the expectations from the women have been ascertained . A Swedish study including 10 women with prolonged labor concluded that emotional support and encouragement by caregivers helped to accept the prolonged labor 40 . Clear information on labor interventions like induction procedure or instrumental delivery may also reduce the risk of negative birth experience 41 .

In conclusion, our data show that a longer time in active labor significantly increases the risk of an overall negative childbirth experience for both primiparous and multiparous women. The most pronounced risk of a negative childbirth experience was seen for those with induced labor. This risk also applies to the active phase of first stage of labor and the pushing phase separately. It is of great importance to identify and optimize the clinical care of women with long time in labor to reduce the risk of negative childbirth experience and associated adverse long-term effects.

Data availability

The data that support the findings of this study are available on request from the corresponding author.

Abbreviations

World Health Organization

Cesarean section

American College of Obstetricians and Gynecologists

Visual analog scale

Body mass index

Adjusted odds ratio

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Acknowledgements

We express our gratitude to all participants and staff involved in this study.

Open access funding provided by Linköping University. Financial support was received from the County Council of Östergötland and Linköping University, Sweden (ALF grants, Region Östergötland) and the Medical Research Council of Southeast Sweden (FORSS; grant number FORSS-909171).

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S.C. and M.B. contributed to the study concept and design. M.N., S.C. and M.B. contributed to the data acquisition. S.C. and M.B. performed the statistical analyses and S.C., M.B., D.A. and MS interpreted the data. S.C. wrote the manuscript. M.B., D.A. and M.S. critically revised the manuscript. All authors gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy. All authors gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.

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Carlhäll, S., Nelson, M., Svenvik, M. et al. Maternal childbirth experience and time in labor: a population-based cohort study. Sci Rep 12 , 11930 (2022). https://doi.org/10.1038/s41598-022-14711-y

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A nursing research paper is a work of academic writing composed by a nurse or nursing student. The paper may present information on a specific topic or answer a question.

During LPN/LVN and RN programs, most papers you write focus on learning to use research databases, evaluate appropriate resources, and format your writing with APA style. You'll then synthesize your research information to answer a question or analyze a topic.

BSN , MSN , Ph.D., and DNP programs also write nursing research papers. Students in these programs may also participate in conducting original research studies.

Writing papers during your academic program improves and develops many skills, including the ability to:

• Select nursing topics for research
• Conduct effective research
• Analyze published academic literature
• Format and cite sources
• Synthesize data
• Organize and articulate findings

About Nursing Research Papers

When do nursing students write research papers.

You may need to write a research paper for any of the nursing courses you take. Research papers help develop critical thinking and communication skills. They allow you to learn how to conduct research and critically review publications.

That said, not every class will require in-depth, 10-20-page papers. The more advanced your degree path, the more you can expect to write and conduct research. If you're in an associate or bachelor's program, you'll probably write a few papers each semester or term.

Do Nursing Students Conduct Original Research?

Most of the time, you won't be designing, conducting, and evaluating new research. Instead, your projects will focus on learning the research process and the scientific method. You'll achieve these objectives by evaluating existing nursing literature and sources and defending a thesis.

However, many nursing faculty members do conduct original research. So, you may get opportunities to participate in, and publish, research articles.

Example Research Project Scenario:

In your maternal child nursing class, the professor assigns the class a research paper regarding developmentally appropriate nursing interventions for the pediatric population. While that may sound specific, you have almost endless opportunities to narrow down the focus of your writing. 

You could choose pain intervention measures in toddlers. Conversely, you can research the effects of prolonged hospitalization on adolescents' social-emotional development.

What Does a Nursing Research Paper Include?

Your professor should provide a thorough guideline of the scope of the paper. In general, an undergraduate nursing research paper will consist of:

Introduction : A brief overview of the research question/thesis statement your paper will discuss. You can include why the topic is relevant.

Body : This section presents your research findings and allows you to synthesize the information and data you collected. You'll have a chance to articulate your evaluation and answer your research question. The length of this section depends on your assignment.

Conclusion : A brief review of the information and analysis you presented throughout the body of the paper. This section is a recap of your paper and another chance to reassert your thesis.

The best advice is to follow your instructor's rubric and guidelines. Remember to ask for help whenever needed, and avoid overcomplicating the assignment!

How to Choose a Nursing Research Topic

The sheer volume of prospective nursing research topics can become overwhelming for students. Additionally, you may get the misconception that all the 'good' research ideas are exhausted. However, a personal approach may help you narrow down a research topic and find a unique angle.

Writing your research paper about a topic you value or connect with makes the task easier. Additionally, you should consider the material's breadth. Topics with plenty of existing literature will make developing a research question and thesis smoother.

Finally, feel free to shift gears if necessary, especially if you're still early in the research process. If you start down one path and have trouble finding published information, ask your professor if you can choose another topic.

The Best Research Topics for Nursing Students

You have endless subject choices for nursing research papers. This non-exhaustive list just scratches the surface of some of the best nursing research topics.

1. Clinical Nursing Research Topics

• Analyze the use of telehealth/virtual nursing to reduce inpatient nurse duties.
• Discuss the impact of evidence-based respiratory interventions on patient outcomes in critical care settings.
• Explore the effectiveness of pain management protocols in pediatric patients.

2. Community Health Nursing Research Topics

• Assess the impact of nurse-led diabetes education in Type II Diabetics.
• Analyze the relationship between socioeconomic status and access to healthcare services.

3. Nurse Education Research Topics

• Review the effectiveness of simulation-based learning to improve nursing students' clinical skills.
• Identify methods that best prepare pre-licensure students for clinical practice.
• Investigate factors that influence nurses to pursue advanced degrees.
• Evaluate education methods that enhance cultural competence among nurses.
• Describe the role of mindfulness interventions in reducing stress and burnout among nurses.

4. Mental Health Nursing Research Topics

• Explore patient outcomes related to nurse staffing levels in acute behavioral health settings.
• Assess the effectiveness of mental health education among emergency room nurses .
• Explore de-escalation techniques that result in improved patient outcomes.
• Review the effectiveness of therapeutic communication in improving patient outcomes.

5. Pediatric Nursing Research Topics

• Assess the impact of parental involvement in pediatric asthma treatment adherence.
• Explore challenges related to chronic illness management in pediatric patients.
• Review the role of play therapy and other therapeutic interventions that alleviate anxiety among hospitalized children.

6. The Nursing Profession Research Topics

• Analyze the effects of short staffing on nurse burnout .
• Evaluate factors that facilitate resiliency among nursing professionals.
• Examine predictors of nurse dissatisfaction and burnout.
• Posit how nursing theories influence modern nursing practice.

Tips for Writing a Nursing Research Paper

The best nursing research advice we can provide is to follow your professor's rubric and instructions. However, here are a few study tips for nursing students to make paper writing less painful:

Avoid procrastination: Everyone says it, but few follow this advice. You can significantly lower your stress levels if you avoid procrastinating and start working on your project immediately.

Plan Ahead: Break down the writing process into smaller sections, especially if it seems overwhelming. Give yourself time for each step in the process.

Research: Use your resources and ask for help from the librarian or instructor. The rest should come together quickly once you find high-quality studies to analyze.

Outline: Create an outline to help you organize your thoughts. Then, you can plug in information throughout the research process. 

Clear Language: Use plain language as much as possible to get your point across. Jargon is inevitable when writing academic nursing papers, but keep it to a minimum.

Cite Properly: Accurately cite all sources using the appropriate citation style. Nursing research papers will almost always implement APA style. Check out the resources below for some excellent reference management options.

Revise and Edit: Once you finish your first draft, put it away for one to two hours or, preferably, a whole day. Once you've placed some space between you and your paper, read through and edit for clarity, coherence, and grammatical errors. Reading your essay out loud is an excellent way to check for the 'flow' of the paper.

Helpful Nursing Research Writing Resources:

Purdue OWL (Online writing lab) has a robust APA guide covering everything you need about APA style and rules.

Grammarly helps you edit grammar, spelling, and punctuation. Upgrading to a paid plan will get you plagiarism detection, formatting, and engagement suggestions. This tool is excellent to help you simplify complicated sentences.

Mendeley is a free reference management software. It stores, organizes, and cites references. It has a Microsoft plug-in that inserts and correctly formats APA citations.

Don't let nursing research papers scare you away from starting nursing school or furthering your education. Their purpose is to develop skills you'll need to be an effective nurse: critical thinking, communication, and the ability to review published information critically.

Choose a great topic and follow your teacher's instructions; you'll finish that paper in no time.

Joleen Sams is a certified Family Nurse Practitioner based in the Kansas City metro area. During her 10-year RN career, Joleen worked in NICU, inpatient pediatrics, and regulatory compliance. Since graduating with her MSN-FNP in 2019, she has worked in urgent care and nursing administration. Connect with Joleen on LinkedIn or see more of her writing on her website.

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Obstetric and Gynecological Nursing Research Paper Topics

The diverse array of obstetric and gynecological nursing research paper topics underscores the critical importance of this specialized field of nursing. Obstetric and gynecological nursing encompasses a wide range of topics that address the health and wellness of women from adolescence through menopause and beyond. This includes the management of pregnancy and childbirth, preventive care, and the diagnosis and treatment of diseases and disorders specific to women. As the healthcare needs of women continue to evolve, so does the need for ongoing research and development of evidence-based practices in obstetric and gynecological nursing. This article provides a comprehensive list of research paper topics that will be of interest to students and professionals seeking to expand their knowledge and contribute to the body of knowledge in this vital area of healthcare.

100 Obstetric and Gynecological Nursing Research Paper Topics

Obstetric and gynecological nursing is a specialized field of nursing that focuses on the health and well-being of women throughout their lifespan. It encompasses a wide range of topics including pregnancy and prenatal care, labor and delivery, postpartum care, gynecological disorders, reproductive health, maternal and newborn health, high-risk pregnancy, women’s health across the lifespan, menopausal health, and ethical and legal issues in obstetric and gynecological nursing. The significance of this field cannot be overstated as it plays a crucial role in ensuring the health and well-being of both women and newborns. This article provides a comprehensive list of obstetric and gynecological nursing research paper topics, divided into 10 categories, each containing 10 topics.

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Pregnancy and Prenatal Care:

• The role of prenatal vitamins in preventing birth defects.
• The effects of maternal stress on fetal development.
• The impact of prenatal exercise on maternal and fetal health.
• The role of routine ultrasound examinations in prenatal care.
• The effectiveness of non-pharmacological interventions for nausea and vomiting during pregnancy.
• The impact of maternal obesity on pregnancy outcomes.
• The role of folic acid supplementation in the prevention of neural tube defects.
• The effectiveness of smoking cessation interventions during pregnancy.
• The impact of maternal alcohol consumption on fetal development.
• The role of prenatal education in preparing expectant mothers for childbirth.

Labor and Delivery:

• The effectiveness of epidural analgesia in managing labor pain.
• The impact of birthing positions on labor outcomes.
• The role of continuous support during labor and delivery.
• The effectiveness of non-pharmacological pain relief methods during labor.
• The impact of induced labor on maternal and neonatal outcomes.
• The role of midwives in managing labor and delivery.
• The effectiveness of water birth in reducing labor pain.
• The impact of cesarean section on maternal and neonatal outcomes.
• The role of intrapartum fetal monitoring in preventing adverse outcomes.
• The effectiveness of active management of the third stage of labor in preventing postpartum hemorrhage.

Postpartum Care:

• The role of breastfeeding support in promoting successful breastfeeding.
• The impact of postpartum depression on mother-infant bonding.
• The effectiveness of skin-to-skin contact in promoting neonatal thermoregulation.
• The role of postpartum exercise in promoting maternal physical and mental health.
• The impact of early postpartum discharge on maternal and neonatal outcomes.
• The effectiveness of postpartum contraceptive counseling in preventing unplanned pregnancies.
• The role of routine newborn screening in the early detection of congenital disorders.
• The impact of maternal-infant rooming-in on breastfeeding success.
• The effectiveness of postpartum home visits in promoting maternal and newborn health.
• The role of pelvic floor exercises in preventing postpartum urinary incontinence.

Gynecological Disorders:

• The effectiveness of hormonal therapy in managing polycystic ovary syndrome.
• The impact of lifestyle modifications on the management of endometriosis.
• The role of screening in the early detection of cervical cancer.
• The effectiveness of non-surgical interventions for uterine fibroids.
• The impact of human papillomavirus vaccination on the incidence of cervical cancer.
• The role of hormonal replacement therapy in managing menopausal symptoms.
• The effectiveness of conservative management for ovarian cysts.
• The impact of early detection and treatment on the prognosis of ovarian cancer.
• The role of lifestyle modifications in the prevention of gynecological cancers.
• The effectiveness of surgical interventions for pelvic organ prolapse.

Reproductive Health:

• The role of contraceptive counseling in preventing unplanned pregnancies.
• The impact of long-acting reversible contraceptives on reducing the rate of unintended pregnancies.
• The effectiveness of fertility awareness-based methods in preventing pregnancy.
• The role of preconception care in promoting healthy pregnancies.
• The impact of sexually transmitted infections on reproductive health.
• The effectiveness of barrier methods in preventing sexually transmitted infections.
• The role of hormonal contraceptives in managing menstrual disorders.
• The impact of infertility on mental health.
• The effectiveness of assisted reproductive technologies in managing infertility.
• The role of male involvement in promoting reproductive health.

Maternal and Newborn Health:

• The impact of gestational diabetes on maternal and neonatal outcomes.
• The effectiveness of kangaroo mother care in promoting neonatal health.
• The role of antenatal corticosteroids in preventing neonatal respiratory distress syndrome.
• The impact of maternal anemia on neonatal outcomes.
• The effectiveness of newborn resuscitation in preventing neonatal mortality.
• The role of immunization in promoting maternal and newborn health.
• The impact of maternal mental health on neonatal outcomes.
• The effectiveness of neonatal intensive care in improving the survival of preterm infants.
• The role of early intervention services in promoting the development of high-risk infants.
• The impact of maternal-infant bonding on neonatal outcomes.

High-Risk Pregnancy:

• The role of antenatal care in managing high-risk pregnancies.
• The impact of multiple pregnancies on maternal and neonatal outcomes.
• The effectiveness of nutritional interventions in managing gestational diabetes.
• The role of bed rest in managing preterm labor.
• The impact of advanced maternal age on pregnancy outcomes.
• The effectiveness of antihypertensive medications in managing preeclampsia.
• The role of fetal surveillance in managing intrauterine growth restriction.
• The impact of preconception care on the outcomes of high-risk pregnancies.
• The effectiveness of interventions for preventing recurrent preterm birth.
• The role of specialist care in managing high-risk pregnancies.

Women’s Health Across the Lifespan:

• The impact of lifestyle modifications on the prevention of cardiovascular diseases in women.
• The effectiveness of breast cancer screening in early detection and treatment.
• The role of hormone replacement therapy in managing menopausal symptoms.
• The impact of osteoporosis on women’s health.
• The effectiveness of interventions for preventing urinary incontinence in women.
• The role of regular exercise in promoting mental health in women.
• The impact of domestic violence on women’s health.
• The effectiveness of interventions for promoting healthy eating in women.
• The role of stress management in preventing chronic diseases in women.
• The impact of depression on women’s health.

Menopausal Health:

• The impact of menopause on cardiovascular health.
• The effectiveness of hormonal replacement therapy in managing menopausal symptoms.
• The role of lifestyle modifications in managing menopausal weight gain.
• The impact of menopause on mental health.
• The effectiveness of non-hormonal interventions for managing hot flashes.
• The role of regular exercise in preventing osteoporosis in postmenopausal women.
• The impact of menopause on sexual health.
• The effectiveness of dietary interventions in managing menopausal symptoms.
• The role of stress management in promoting menopausal health.
• The impact of menopause on the risk of developing gynecological cancers.

Ethical and Legal Issues in Obstetric and Gynecological Nursing:

• The role of informed consent in obstetric and gynecological procedures.
• The impact of religious and cultural beliefs on women’s health decisions.
• The effectiveness of mandatory reporting of domestic violence in promoting women’s safety.
• The role of confidentiality in obstetric and gynecological care.
• The impact of legal restrictions on abortion services.
• The effectiveness of legal interventions in preventing female genital mutilation.
• The role of ethical considerations in assisted reproductive technologies.
• The impact of legal and ethical issues on the practice of obstetric and gynecological nursing.
• The effectiveness of legal interventions in promoting maternal and newborn health.
• The role of ethical considerations in the management of high-risk pregnancies.

The importance of research in obstetric and gynecological nursing cannot be overstated as it plays a crucial role in ensuring the health and well-being of both women and newborns. The diverse range of topics listed above provides a comprehensive overview of the various aspects of obstetric and gynecological nursing. It is our hope that this list will serve as a valuable resource for students and professionals seeking to expand their knowledge and contribute to the body of knowledge in this vital area of healthcare.

The Range of Obstetric and Gynecological Nursing Research Paper Topics

Obstetric and gynecological nursing is an essential branch of healthcare that focuses on the well-being of women during pregnancy, childbirth, and the postpartum period, as well as the diagnosis and treatment of diseases of the female reproductive system. The significance of this field is immense, as it plays a crucial role in ensuring the health and safety of both mothers and newborns, and in managing and preventing gynecological disorders. The scope of obstetric and gynecological nursing research paper topics is vast, encompassing a wide range of issues from pregnancy and prenatal care, labor and delivery, postpartum care, gynecological disorders, and much more.

Pregnancy and Prenatal Care

Proper care during pregnancy is essential for the health and well-being of both the mother and the baby. Prenatal care involves a series of regular check-ups and screenings to monitor the health of the mother and the developing fetus. Obstetric nurses play a crucial role in providing this care, educating expectant mothers about proper nutrition, exercise, and lifestyle habits, monitoring the progress of the pregnancy, and identifying and managing any potential complications. Some obstetric and gynecological nursing research paper topics in this area could include the effectiveness of different prenatal screening tests, the impact of maternal lifestyle habits on fetal development, or the role of prenatal education in preparing expectant mothers for childbirth.

Labor and Delivery

The process of labor and delivery is a critical period that requires skilled care and management to ensure the safety of both the mother and the baby. Obstetric nurses are involved in every stage of this process, from monitoring the progress of labor, providing pain relief, assisting with the delivery, and caring for the mother and newborn immediately after birth. Research topics in this area could include the effectiveness of different pain relief methods during labor, the impact of birthing positions on labor outcomes, or the role of continuous support during labor and delivery.

Postpartum Care

The postpartum period, or the time after childbirth, is a crucial time for both the mother and the newborn. Obstetric nurses provide care to the mother as she recovers from childbirth, monitor the newborn’s health and development, provide breastfeeding support, and educate the new parents on infant care. Some potential obstetric and gynecological nursing research paper topics in this area could include the impact of postpartum depression on mother-infant bonding, the effectiveness of skin-to-skin contact in promoting neonatal thermoregulation, or the role of postpartum exercise in promoting maternal physical and mental health.

Gynecological Disorders

Gynecological nursing involves the diagnosis and treatment of diseases of the female reproductive system. Gynecological nurses provide care to women with a variety of gynecological disorders such as polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, cervical cancer, and more. Research topics in this area could include the effectiveness of hormonal therapy in managing PCOS, the impact of lifestyle modifications on the management of endometriosis, or the role of screening in the early detection of cervical cancer.

The diverse range of obstetric and gynecological nursing research paper topics provides an opportunity for researchers to explore a variety of issues that affect women’s health. By conducting research in this field, nurses can contribute to the body of knowledge that informs clinical practice and helps improve outcomes for women and newborns.

In conclusion, obstetric and gynecological nursing is a vital field that plays a crucial role in ensuring the health and well-being of women and newborns. From pregnancy and prenatal care, labor and delivery, postpartum care, and the management of gynecological disorders, the scope of this field is vast. The wide range of obstetric and gynecological nursing research paper topics provides an opportunity for researchers to explore various aspects of this field and contribute to the improvement of women’s health.

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Your Success Starts Here!

Every nursing student understands the importance of submitting high-quality research papers. Not only do they contribute significantly to your final grade, but they also reflect your understanding and knowledge of the subject matter. Obstetric and gynecological nursing is a crucial area of study that demands thorough research and a comprehensive understanding of various topics. As a student, you may sometimes find yourself overwhelmed with multiple assignments, leaving you with limited time to complete your research paper. This is where iResearchNet comes in. We are here to support you in your academic journey by providing custom obstetric and gynecological nursing research papers that will not only earn you top grades but also enhance your understanding of the subject matter.

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Evidence-based labor and delivery management

Affiliation.

• 1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
• PMID: 18984077
• DOI: 10.1016/j.ajog.2008.06.093

Our objective was to provide evidence-based guidance for management decisions during labor and delivery. We performed MEDLINE, PubMed, and COCHRANE searches with the terms labor, delivery, pregnancy, randomized trials, plus each management aspect of labor and delivery (eg, early admission). Each management step of labor and delivery was reviewed separately. Evidence-based good quality data favor hospital births, delayed admission, support by doula, training birth assistants in developing countries, and upright position in the second stage. Home-like births, enema, shaving, routine vaginal irrigation, early amniotomy, "hands-on" method, fundal pressure, and episiotomy can be associated with complications without sufficient benefits and should probably be avoided. We conclude that labor and delivery interventions supported by good quality data as just described should be routinely performed. All aspects with lower data quality should be researched with adequately powered and designed trials.

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• Synthesize evidence and they will change? Thorp J. Thorp J. Am J Obstet Gynecol. 2008 Nov;199(5):441-2. doi: 10.1016/j.ajog.2008.06.095. Am J Obstet Gynecol. 2008. PMID: 18984075 No abstract available.
• Chlorhexidine and evidence-based labor management. Elkington KW. Elkington KW. Am J Obstet Gynecol. 2009 Aug;201(2):e16-7; author reply e17. doi: 10.1016/j.ajog.2009.02.008. Epub 2009 Apr 26. Am J Obstet Gynecol. 2009. PMID: 19394586 No abstract available.
• Berghella et al's review of evidence-based labor and delivery management. Rooks JP, Norsigian J. Rooks JP, et al. Am J Obstet Gynecol. 2009 Sep;201(3):e10-1; author reply e11. doi: 10.1016/j.ajog.2009.04.014. Epub 2009 May 21. Am J Obstet Gynecol. 2009. PMID: 19463984 No abstract available.
• On evidence and labor practices. Greenfield M. Greenfield M. Am J Obstet Gynecol. 2009 Sep;201(3):e7-8; author reply e8. doi: 10.1016/j.ajog.2009.03.026. Epub 2009 May 30. Am J Obstet Gynecol. 2009. PMID: 19481724 No abstract available.

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• Evidence-based surgery for cesarean delivery. Berghella V, Baxter JK, Chauhan SP. Berghella V, et al. Am J Obstet Gynecol. 2005 Nov;193(5):1607-17. doi: 10.1016/j.ajog.2005.03.063. Am J Obstet Gynecol. 2005. PMID: 16260200 Review.
• Evidence-based intrapartum care. Hofmeyr GJ. Hofmeyr GJ. Best Pract Res Clin Obstet Gynaecol. 2005 Feb;19(1):103-15. doi: 10.1016/j.bpobgyn.2004.10.009. Epub 2004 Dec 13. Best Pract Res Clin Obstet Gynaecol. 2005. PMID: 15749069 Review.
• A critical review of labor and birth care. Obstetrical Interest Group of the North American Primary Care Research Group. Smith MA, Acheson LS, Byrd JE, Curtis P, Day TW, Frank SH, Franks P, Graham AV, LeFevre M, Resnick J, et al. Smith MA, et al. J Fam Pract. 1991 Sep;33(3):281-92. J Fam Pract. 1991. PMID: 1880487 Review.
• Enema prior to labor: a controversial routine in Taiwan. Tzeng YL, Shih YJ, Teng YK, Chiu CY, Huang MY. Tzeng YL, et al. J Nurs Res. 2005 Dec;13(4):263-70. J Nurs Res. 2005. PMID: 16372237 Clinical Trial.
• Comparison of maternal outcomes in caring by Doula, trained lay companion and routine midwifery care. Shahbazi Sighaldeh S, Azadpour A, Vakilian K, Rahimi Foroushani A, Vasegh Rahimparvar SF, Hantoushzadeh S. Shahbazi Sighaldeh S, et al. BMC Pregnancy Childbirth. 2023 Oct 31;23(1):765. doi: 10.1186/s12884-023-05987-7. BMC Pregnancy Childbirth. 2023. PMID: 37907873 Free PMC article.
• Planned hospital birth compared with planned home birth for pregnant women at low risk of complications. Olsen O, Clausen JA. Olsen O, et al. Cochrane Database Syst Rev. 2023 Mar 8;3(3):CD000352. doi: 10.1002/14651858.CD000352.pub3. Cochrane Database Syst Rev. 2023. PMID: 36884026 Free PMC article. Review.
• Decision-making during obstetric emergencies: A narrative approach. Raoust GM, Bergström J, Bolin M, Hansson SR. Raoust GM, et al. PLoS One. 2022 Jan 26;17(1):e0260277. doi: 10.1371/journal.pone.0260277. eCollection 2022. PLoS One. 2022. PMID: 35081113 Free PMC article.
• Effects of Obstetric Interventions During Labor on Birth Process and Newborn Health. Akyıldız D, Çoban A, Gör Uslu F, Taşpınar A. Akyıldız D, et al. Florence Nightingale J Nurs. 2021 Feb 1;29(1):9-21. doi: 10.5152/FNJN.2021.19093. eCollection 2021 Feb. Florence Nightingale J Nurs. 2021. PMID: 34263219 Free PMC article.
• Brazilian women's use of evidence-based practices in childbirth after participating in the Senses of Birth intervention: A mixed-methods study. da Matta Machado Fernandes L, Lansky S, Reis Passos H, T Bozlak C, A Shaw B. da Matta Machado Fernandes L, et al. PLoS One. 2021 Apr 16;16(4):e0248740. doi: 10.1371/journal.pone.0248740. eCollection 2021. PLoS One. 2021. PMID: 33861756 Free PMC article.

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• J Perinat Educ
• v.10(1); Winter 2001

Maternal-Newborn Nursing: Thirteen Challenges That Influence Excellence in Practice

The purpose of this paper is to review the research and discuss 13 challenges that currently influence excellence in maternal-newborn nursing practice. Nurses working in the maternal-newborn arena are encouraged to evaluate their own practices in relation to the identified areas. The 13 identified challenges are the following: integration and expansion of midwifery and family-centered models of care, reduction in the use of unnecessary or questionable-benefit technology, patient and family teaching, the questionable need for a normal newborn nursery, integration of research into practice, further development of genetic technology and counseling, computer technology as an adjunct to prenatal care and birth, the need for comprehensive breastfeeding education and support, prenatal care on a continuum beginning as women's health promotion, health promotion beyond the postpartum period, culturally competent care, health insurance coverage for all women and children, and an undereducated work environment.

Introduction

During a review of the literature, 13 challenge areas were identified as important to achieving excellence in maternal-newborn nursing practice. These challenges point out priority areas on which to focus improvement efforts to achieve the highest level of patient care in maternity settings. Many of the identified challenges overlap and, thus, affect one another. Acknowledging the significance of these issues can be useful for clinicians and administrators in evaluating their own practices and facilities. Improvement in any or all of these issues of care would increase the quality of patient care for mothers and their newborns. As the literature on each of the 13 issues is presented below, a discussion of the implications for maternal-newborn care is integrated into the presentation.

Challenges Related to Models of Maternity Care

1. integration and expansion of midwifery and family-centered models of care.

Gagnon and Waghorn (1999) conducted a secondary analysis to compare the benefits of one-to-one nurse labor support with usual intrapartum nursing care in women stimulated with oxytocin. One hundred nulliparous women with a singleton gestation participated in the study. All fetuses were vertex and women had a cervical dilation of less than 5 centimeters at the time of entry into the study. The authors describe one-to-one nursing care as the presence of a nurse during labor and birth who attends to the physical and emotional needs of the laboring woman and her family. Such a nurse also provides instruction on relaxation and coping techniques. Usual care in this study consisted of one nurse caring for 2 to 3 laboring patients, with supportive interventions varying according to nurse preference. Results of the secondary analysis indicate a beneficial trend to having one-to-one nursing care. In this sample, a 56% reduction in the risk of total cesarean deliveries existed in the group receiving one-to-one nursing care. The results of this study warrant careful consideration by nurses and nurse managers of labor and delivery units to ensure excellence in maternal newborn care.

In this sample, a 56% reduction in the risk of total cesarean deliveries existed in the group receiving one-to-one nursing care.

Certified Nurse Midwives are an essential part of delivering family-centered care. The expansion and integration of nurse-midwives into all areas of maternity practice are essential to improving maternity care throughout the world. Nurse-midwifery care has been documented in repeated studies to be equal to or better than care provided by physicians. Nurse-midwives tend to focus on health promotion and patient teaching, which further assist the patient to have favorable birth outcomes. Nurse-midwives traditionally are less invasive than their physician colleagues, which can lower costs, increase patient satisfaction, and contribute to improved outcomes by avoiding unnecessary interventions.

2. Reduction in the Use of Unnecessary or Questionable-Benefit Technology

The following is a review of evidence related to overuse of technology in childbirth. Curtin and Mathews (2000) provide an in-depth discussion of current obstetric procedures for 1998. They note that electronic fetal monitoring, ultrasound, and stimulation and induction of labor continued to rise in 1998. Both the total numbers of cesarean sections and primary cesarean sections increased. The rate of vaginal births following cesarean delivery (VBAC) declined for the second year in a row. While the number of births assisted by vacuum extraction has continued to rise, a slight decrease was reported for 1997-1998 ( Ventura, Martin, Curtin, & Mathews, 2000 ) .

Sleutel and Golden (1999) conducted an in-depth review of the literature regarding food and fluid restrictions during labor. They reviewed MEDLINE, CINAHL, and historical texts. The authors concluded that research does not support the restriction of food or oral fluids during routine labor for the prevention of gastric aspiration. They also note that restricted oral intake can have adverse effects.

Another controversial practice in maternal-newborn nursing is the use of routine continuous electronic fetal monitoring. Haggerty (1999) notes that several professional organizations have endorsed the use of intermittent auscultation for low-risk pregnant women, yet the majority of U.S. women continue to receive continuous electronic fetal monitoring during labor. Routine electronic fetal monitoring was quickly implemented into practice without appropriate research to test the effectiveness, reliability, or efficiency of its use. Haggerty notes that, while a reassuring fetal heart rate pattern is a good predictor of fetal well-being, a nonreassuring fetal heart rate pattern is not a good predictor of fetal problems or demise.

Lundquist, Olsson, Nissen, and Norman (2000) conducted a study to determine if any differences existed in the healing or discomfort associated with vaginal lacerations that were or were not sutured following childbirth. Eighty women with first- or second-degree tears were randomized to either group. The perineum was examined and the women were questioned about their experiences at 2 to 3 days, 8 weeks, and 6 months after delivery. No differences were found in healing or amount of pain. However, women in the sutured group reported more visits to their health care provider for care related to the sutures. Sixteen percent of the women in the sutured group also reported that the sutures had a negative impact on breastfeeding.

Sixteen percent of the women in the sutured group also reported that the sutures had a negative impact on breastfeeding.

Creedy, Shochet, and Horsfall (2000) conducted a study to determine the incidence of acute trauma symptoms in women that resulted from their labor and delivery experiences. In this prospective study, women were recruited during their last trimester of pregnancy. Telephone interviews were conducted with 499 women 4 to 6 weeks after delivery. In this sample of urban Australian women, 33% (or 1 in 3 women) reported a traumatic birthing event and at least three symptoms they believed were related to the experience. Slightly more than 5% of women met DSM-IV criteria for acute post-traumatic stress disorder. A high level of intervention and the perception of inadequate intrapartum care were associated with the development of symptoms in this group of women. Prenatal variables did not contribute to the development of symptoms in this sample. When high levels of support are available, this high level of trauma should not occur.

3. Patient and Family Teaching

Chapman (2000) conducted a qualitative study to describe expectant fathers' labor and delivery experiences when their partners received epidural anesthesia. Fathers identified two main concepts: “losing her” and “she's back.” The theme “losing her” referred to women turning inward as a way to cope with labor prior to epidural administration. “She's back” referred to the transition women went through after they received an epidural and their pain was controlled. Expectant fathers who are aware of what to expect during labor and delivery and from the use of epidural anesthesia will be better able to support their partners and have a positive birthing experience. Nurses and childbirth educators are in a key role to educate the father (and significant others) regarding labor and delivery.

Ruchala (2000) conducted a study to identify what nurses and postpartum women believed to be the most important areas for postpartum teaching. Nurses were invited to participate via mailed surveys and new mothers were interviewed in the hospital within 24 hours of delivery. Statistically significant differences were found between the mothers' and nurses' prioritizations. New mothers identified issues related to their own care as most important, while nurses rated newborn care issues as most important. This information has implications for nurses who work with postpartum mothers. New mothers may need to learn how to appropriately care for themselves before being able to care for another. Birth is an intimate process and women have significant fears related to their healing and adaptation. If their energy is focused here, they may not be able to learn effectively about newborn care. The nurse must first assess what the learner knows and what the learner believes she needs to know before teaching occurs. Focusing first on what a mother needs to know will allow her to absorb that information and then move on to what the nurse believes to be important. Facilitating learning in such a manner will provide the best opportunity for the new mother to learn as much as possible before being discharged. It is likely that facilitated teaching would reduce the risk of unnecessary rehospitalizations and complications.

Karl (1999) described the use of an interactive newborn bath as a method both for teaching the family about the newborn and as a way to help parents learn to interact with the newborn. During the bath, the nurse is able to point out infant reflexes, states of alertness, and newborn skills such as eye contact and listening. The nurse can also encourage the parents to touch and hold their newborns and help the parents to interpret the newborn's responses. This type of interaction accomplishes several goals: It cleans the newborn; the parents learn how to give a bath, interpret behavior, and understand newborn emotions and reflexes; and it allows the nurse to assess family cohesion, readiness to learn, and previous experience.

Sampsell, Seng, Yeo, Killion, and Oakley (1999) conducted a study to describe patterns of postpartum physical activity and to identify any specific risks or benefits from such activity. The authors interviewed 1,003 women at their 6-week postpartum checkup. Almost 35% of these women reported participating in vigorous exercise. In this sample, women who were more active retained less pregnancy weight, scored better on measures of postpartum adaptation, and participated in more social activities and hobbies. These initial exploratory results warrant discussion of the benefits of exercise with new mothers before hospital discharge.

4. The Questionable Need for a Normal Newborn Nursery

Those who are truly devoted to excellence in maternal-newborn nursing and family-centered care have to question the necessity of the normal newborn nursery, which has disappeared in some progressive hospitals. Many mothers desire to have their infants in the nursery so that they have a chance to rest. However, mothers and infants tend to rest more completely if they room-in together ( Keefe, 1987 ). Other mothers state they want to shower. Sending a newborn back to the nursery is generally not necessary, as the new mother will likely have to shower at home too. Staying in or near the bathroom with the mother during her shower will not harm the newborn. Nursing staff may challenge that they prefer to have the newborn in the nursery for procedures. Routine procedures such as vital signs and drawing blood can be effectively accomplished in the mother's room. Less disruption to the mother's routine occurs and the procedures offer the nurse an opportunity to observe family interaction and to teach the mother about her new infant. Additionally, the nurse's presence in the room may generate questions from the mother. One must also acknowledge that assisting personnel, not the nurse, may perform such skills. These are still good opportunities for interaction with the mother. Simply having another individual in the mother's room can be helpful; nursing assistants can report a problem to the nurse or may, themselves, be able to answer a simple question, such as when dinner is served.

Challenges Related to Keeping Maternity Practice Current

5. integration of research into practice.

The following are examples of practice-ready research of which clinicians should be aware. Mayberry, Gennaro, Strange, Williams, and De (1999) found that the reduction in maternal fatigue related to second stage labor needs to be addressed. Fatigue can be minimized by shortened periods of strong pushing or bearing down and by open-glottis breathing. Women who have received epidural anesthesia may be particularly at-risk for fatigue. Excessive fatigue may interfere with the woman's ability to manage care activities following discharge ( Tulman, Fawcett, Groblewski, & Silverman, 1990 ). Lee and Zaffke (1999) found that fatigue during the postpartum period was related more to the new mother's receiving adequate amounts of uninterrupted sleep and adequate nutrition (especially in terms of iron, folic acid, and ferritin) than to the number of other children, amount of household responsibilities, and whether or not the mother was employed outside the home. Nurses who work with pregnant and postpartum women need to implement these types of research findings into their current practice; new mothers need to be made aware of the likelihood of fatigue during the first postpartum months and how best to resolve such fatigue. Lee and Zaffke (1999) also found that younger women were more likely to experience fatigue than their older counterparts, even after controlling for parity.

D'Apolito (1999) conducted a repeated-measures experimental design to determine if the use of a mechanical rocking bed with maternal intrauterine sounds would decrease symptoms of withdrawal and promote neurobehavioral adaptation in drug-exposed infants. She found that infants who experienced the intervention had a significantly greater incidence of symptoms and sleep withdrawal. The author concluded that the infants who received the intervention might have been overstimulated. Therefore, it is imperative that nurses integrate such findings into their own practice, to ensure that these delicate newborns are not overstimulated but calmed and helped to recover from addiction.

Dowling (1999) conducted a study to describe and compare short-term physiologic responses of preterm infants during breastfeeding and bottle-feeding with an orthodontic nipple. She found statistically significant differences in physiologic parameters between feeding methods. In this research project, infants served as their own controls. Infants were able to breathe better and experienced fewer oxygen desaturations during breastfeeding when compared to bottle-feeding. This research has implications for nurses who work in neonatal intensive care units in terms of the safety and appropriateness of breastfeeding for preterm newborns.

Pridham et al. (1999) conducted a study to determine if caloric and protein intake and weight change of fully nipple-fed infants differed by feeding regimen (scheduled vs. ad-lib) and the caloric density of the formula (20 or 24 kcalories per ounce). Seventy-eight infants were randomized by feeding method and calorie groups. In this group of infants, the ad-lib feeding regime had a negative impact on the amount of formula the infants consumed and the overall total caloric intake. Caloric intake, not feeding regime or the caloric density of the assigned formula, influenced infant weight gain.

Ludington-Hoe et al. (1999) conducted a study to assess preterm neonates' (34-36 weeks) physiological and behavioral responses during “Kangaroo Care” * for the first 6 hours after birth. Data were collected in Columbia, South America. Six neonates with 5-minute Apgar scores of 6 or more were enrolled in the study. Heart rate, respirations, oxygen saturation, temperature, and behavioral state were recorded every minute. Heart rate, respiratory rate, temperature, and oxygen saturation remained stable. All babies were fully breastfed and able to be discharged within 48 hours, suggesting that Kangaroo Care is an environment that assists the infant to recover from birth-related fatigue and adapt to his or her extrauterine environment.

There are implications for nurses who work neonatal intensive care units and delivery suites. Labor and delivery nurses can facilitate a preterm neonate's adaptation to extrauterine life by beginning Kangaroo Care immediately after birth for infants who are not in severe distress. Neonatal intensive care nurses can assist by remaining patient and keeping the infant with his or her mother, rather than rushing an infant to the neonatal intensive care unit or to a nearby warmer.

Nick (1999) conducted a study to identify the presence of residual blood and organic matter on “clean” infant stethoscopes in maternal-newborn units. This study was a retrospective, nonexperimental study in which 97 stethoscopes were collected from 11 acute care hospitals. A special lens was used to assess for visual evidence of buildup, and a phenolphtalein test was used to detect residual blood. Eighty percent of stethoscopes from labor and delivery units and 72% of stethoscopes from nurseries had organic buildup present. Seventy-six percent of stethoscopes from labor and delivery and 46% of nursery stethoscopes tested positive for blood. Nurses need to examine stethoscopes in their own units and carefully monitor their cleanliness. Consultation with the hospital biomedical or housekeeping services may be a first step to rectify the problem.

6. Further Development of Genetic Technology and Counseling

With the recent advances in genetic technology and the mapping of the human genome, nurses will have an instrumental role in the future care of families affected by this new genetic technology. While some initial successes have occurred, nurses will need to continually monitor new advances in genetic technology to ensure excellence in maternal-newborn nursing practice. For example, many advances can be anticipated in providing information regarding genetic testing for expectant parents and couples considering pregnancy. It will be crucial that families' rights are protected. The discovery of genetic information must be protected and used to the benefit of the patient and family, not to their disadvantage, as might be threatened by some insurance companies who are struggling for financial gain. Nurses must advocate for patients and families to ensure that they receive appropriate follow-up care and counseling for new genetic therapies. Genetic decision-making can be some of the most difficult decisions a person may face in a lifetime. Nurses are in a key role to ensure that families are supported.

7. Computer Technology as an Adjunct to Prenatal Care and Birth

The Internet is an enormous source of information that can assist nurses in providing safe, effective care. Huyhn et al. (2000) describe the development of an Internet web site to promote healthy behaviors among teens. The authors note that the teen years are a time when healthy behaviors are learned and when teens often have difficulty seeking out such information from parents and other adults. A survey recently conducted in Seattle, WA, found that students wanted to know information that was not being presented in their current health classes. The authors report that personnel were positive about the use and development of the Internet site described in the article.

The discovery of genetic information must be protected and used to the benefit of the patient and family, not to their disadvantage …

While the project discussed by these authors did not specifically address prenatal care, some reproductive information likely was included in such a web site or will be included in the near future. Additionally, the authors present a solid foundation to further build on their ideas and experiences. The information provided can be used as a stepping stone for the further development of Internet technology that can be used during the perinatal period.

Corrarino, Walsh, and Anselmo (1999) describe the use of a slide program to be viewed by the mother and her nurse during a home visit. The topic of the presentation is hepatitis B. The slide presentation is used as an adjunct to one-on-one teaching. It is easy to see how such an intervention could be adopted to a variety of topics to improve perinatal nursing care.

Challenges Related to Competency and Scope of Maternity Care

8. the need for comprehensive breastfeeding education and support.

A number of authors have documented the problems that arise when breastfeeding education and support for mothers is inconsistent or is not comprehensive. For example, Mozingo, Davis, Droppleman, and Merideth (2000) conducted a phenomenological study of the experience of women who initiate breastfeeding but wean within the first 2 weeks postpartum. The women who participated in this study (n = 9) described incongruence between their expectations and the reality of the first weeks of breastfeeding. The incongruence these women felt slowly led to the cessation of breastfeeding. The women also described guilt, a sense of failure, shame, and self-doubt about discontinuing breastfeeding. While this study was exploratory in nature and attempted to understand the experience in-depth with a few participants, the results should be examined carefully. Women who wish to breastfeed benefit from having realistic expectations about the first weeks of breastfeeding. Further, once they are fully informed regarding their options, women need to be supported in whatever decision they choose, whether it is to wean or to continue breastfeeding. In order to increase their readily available sources of support and, hence, their ability to prevent or resolve problems, women can be assisted to identify supportive family members, contacts, and informational resources prenatally for the postpartum period. Additionally, women can be referred to support groups and professional lactation consultants for further assistance.

In another recent example, Riordan, Gross, Angeron, Krumwiede, and Melin (2000) conducted a study to examine the relationship of labor pain relief medications with neonatal suckling and breastfeeding duration. One hundred twenty-nine mothers who delivered vaginally participated in the study. The authors controlled for infant gestational age, birth weight, and gender, and found that infants born to unmedicated mothers had greater sucking abilities. Breastfeeding duration did not differ between unmedicated and medicated groups (measured up to 6 weeks postpartum); however, infants with a lower suckling score tended to wean earlier than cohorts with higher suckling scores. The results of this study provide important considerations for clinicians working with breastfeeding mothers. This recent study supports previous assertions that unmedicated births and/or early assessment and correction of neonatal suckling abilities can be instrumental in breastfeeding success. Additionally, the above information needs to be communicated to mothers during the prenatal period so that they can make informed choices about preparation, support, and pain relief options during labor. Mothers aware of such information can be assisted to exert the effort to ensure that breastfeeding efforts are more successful even when the level of medication used during labor is not ideal. In summary, comprehensive breastfeeding support is broader than assisting the mother with the techniques of breastfeeding. Her ongoing support system and preparation for labor are examples of items to be included in comprehensive support.

… unmedicated births and/or early assessment and correction of neonatal suckling abilities can be instrumental in breastfeeding success.

9. Prenatal Care on a Continuum Beginning as Women's Health Promotion

A number of health behaviors of preconceptual women will influence their childbearing experiences. Thus, providers of preconceptual health care or health education have the opportunity to link general health behavior to prenatal health behavior. In a preconceptual example, Leffler (2000) conducted a study to evaluate the knowledge and attitudes of U.S. high school girls regarding infant feeding. One hundred teenagers from two suburban high schools participated in the study. The author reported that 79% of girls expected to have children, and 52% of them planned to breastfeed. Girls who were breastfed or had exposure to breastfeeding were more likely to report that they would breastfeed their own children. The author concludes that teens may be receptive to health promotion activities that relate to breastfeeding. Breastfeeding health promotion is an excellent place for preconception health promotion activities to begin. Many adolescent girls have thought about childbirth and becoming a mother; however, many of them have not had breastfeeding experiences. Introducing them to the health benefits for both mothers and infants would help to provide a solid foundation for preconceptual health promotion.

In a prenatal example, Bungum, Peaslee, Jackson, and Perez (2000) conducted a nonexperimental retrospective study to assess for an association between participation in aerobic exercise during the first two trimesters of pregnancy and delivery type in nulliparous women. One hundred thirty-seven women participated in the study. The authors found that sedentary women (n = 93) were 2 times more likely to deliver via cesarean section. When mother's prepregnancy exercise program, age, use of epidural anesthesia, change in prepregnancy to delivery body mass index, labor length, whether labor was induced, and the hospital of birth were controlled, the risk of cesarean delivery increased for sedentary women to greater than 4 times. This presents another prime area for health promotion. The cesarean delivery rate in the U.S. is rather high, and a simple nursing intervention such as teaching women about prenatal exercise may prove useful in helping women to avoid an unnecessary cesarean delivery.

… a simple nursing intervention such as teaching women about prenatal exercise may prove useful in helping women to avoid an unnecessary cesarean delivery.

Nutrition promotion is an example of health behavior with both preconceptual and prenatal implications for pregnancy. Reifsnider and Gill (2000) conducted an in-depth review of the literature to provide state-of-the-science recommendations for preconceptual and pregnancy nutrition. They concluded that maternal nutrition directly relates to neonatal health, size, and growth, both during pregnancy and lactation. Prenatal weight gain may also contribute to a woman's future risk of obesity. Therefore, nutritional teaching and monitoring are an essential part of the continuum of prenatal care from preconception through postpartum and lactation. A more specific nutritional example pertains to folic acid. Montgomery and Mayne (2000) describe a program to increase awareness of the need for folic acid during the preconception period and during pregnancy. Folic acid awareness is a crucial component of prenatal care that must be emphasized across the perinatal continuum to adequately protect against birth defects. An example is the need to advise women to obtain adequate amounts of folic acid to prevent spina bifida.

10. Health Promotion beyond the Postpartum Period

Walker and Wilging (2000) note that most mothers have physical, mental, and social concerns that continue beyond 6 weeks postpartum. The authors advocate for increased services for women beyond the initial 6 weeks postpartum. They identify that key areas for health promotion include lifestyle changes in exercise, nutrition, and smoking, and services that address psychosocial well-being, including mood and body image. The authors describe a dichotomy that includes maternal-child health (MCH) and women's health. MCH traditionally has dealt with reproductive health issues, while women's health has dealt more with health issues not related to reproductive function. However, beyond 6 weeks postpartum (or the cessation of reproductive function) little effort has been devoted to health promotion activities for mothers. Walker and Wilging (2000) advocate for redefining “postpartum” to include the first year following delivery. They note that this is consistent with published research that confirms women do not return to normal activities of daily living, lose weight, or regain their previous level of energy until one year or more after delivery.

Parks, Lenz, Milligan, and Han (1999) conducted a secondary analysis to understand the consequences of mothers experiencing fatigue throughout the first 18 months following delivery. Their sample included 229 women, half of whom reported that they were persistently fatigued. Mothers identified that their fatigue contributed to more physical and mental problems. There were no differences in infant health. However, infant performance development (e.g., eye-hand coordination) was lower for infants whose mothers had either persistent mental or physical fatigue.

Bottorff, Johnson, Irwin, and Ratner (2000) found that, while many women stop smoking during pregnancy, many resume during the postpartum period. The authors interviewed women about their experiences with smoking relapse and found that five general story lines could be identified: controlling one's smoking, being vulnerable to smoking, nostalgia for one's former self, smoking for relief, and never really having quit smoking. Findings from this exploratory study provide some initial evidence that smoking resumption among postpartum women may have unique characteristics and, therefore, require different interventions than other populations who experience smoking relapse. This is an important area in which health promotion can begin.

11. Culturally Competent Care

Sinclair (2000) quotes the 1990 U.S. Census Bureau in that 1 in 4 persons who responded to the census was of color, and the numbers are expected to increase with the collection of data for Census 2000. Sinclair also notes that the increasing diversity of America's culture demands that health care providers become more culturally aware. Gichia (2000) conducted an ethnographic study to describe motherhood, maternal role requirements, and family life as perceived by poor, urban, African-American women. She interviewed 15 new mothers between the ages of 14 and 44. In addition to interviewing the mothers, Gichia collected information through home and community observation and conducted interviews with significant others. Initial interviews with the new mothers occurred within 24 hours of the birth of a normal, full-term infant. Participants described motherhood as a significant event in their lives, with both positive and negative aspects. In this sample, maternal role attainment behaviors were learned from extended family and seemed to follow a sequential pattern. Nurses caring for African-American mothers during the postpartum period must consider family and cultural influences if they are to provide the best care to new mothers and their infants.

Mattson (2000) notes that culturally competent care is especially essential in perinatal care, because individuals who immigrate tend to be young and often initially enter the health care system for maternity care. According to Heilemann, Lee, Stinson, Koshar, and Goss (2000) , health outcomes for urban women who are of Mexican descent are related to acculturation. The authors compared perinatal outcomes for 773 women who gave birth in three counties in California. They measured acculturation by place of birth and language spoken, and by combining the two factors to form an acculturation index (AI). They found that the language spoken by the Mexican women who participated in this study had less of an impact on acculturation associated with perinatal outcomes when compared to either place of birth or the AI measure.

Challenges Related to the General Health Care System

12. health insurance coverage for all women and children.

Another essential component of providing excellent nursing care to mothers and newborns is advocating for health insurance for all women and children. Low-income families and probably many middle-income families are not able to receive routine health maintenance visits without health insurance. Health promotion checkups are directly related to overall health and well-being and are a crucial component of global health for all persons. Routine visits often include immunizations, which benefit every individual worldwide by preventing the spread of devastating, preventable diseases. Health promotion visits are often used for routine screening such as cholesterol, cancer risk, and other lifestyle factors. Potential problems that are identified and managed early are much less likely to become serious problems, and are much more likely to be able to be treated affordably.

Health insurance coverage during the preconception and prenatal period helps to ensure that women receive early and regular prenatal care. Early and regular prenatal care has been associated with improved outcomes and healthier general lifestyles for mothers and babies. Similar to general health promotion, care during the prenatal period can help to identify problems early to prevent further complications or dysfunction.

13. An Undereducated Work Environment

Anderson (2000) notes that nurses, when compared to other health care professionals, are severely undereducated. She quotes the 1997 U.S. Department of Health and Human Services figures that indicate only 31% of RNs in the workforce hold a college degree. Without a higher level of education, many nurses will find it difficult to effectively participate in discussions regarding appropriate patient care and health care at interdisciplinary or policy levels. If most nurses are unable to participate in these types of discussions, nursing cannot hope to advance. It is crucial that nurses be able to participate in such discussions so that they can help guide practice and health care policy for the benefit of the profession and patient care. Taking positive action will allow nurses to have a say in what happens to them, rather than letting someone else decide.

Excellence in the delivery of health care services to new mothers and their infants is a realistic goal that can be achieved in nursing today. This paper identifies some specific challenges toward achieving this goal. Nurses who are concerned about achieving excellence in maternal-newborn practice can examine their beliefs and attitudes and act not only as individuals but also as a group to take responsibility for ensuring quality nursing care in maternal newborn nursing.

Get Up and Go!

You can't build a reputation on what you're going to do.

—Henry Ford

It is in vain to say human beings ought to be satisfied with tranquility; they must have action; and they will make it if they cannot find it.

—Charlotte Bronte ( Jane Eyre , 1847)

* “Kangaroo Care” involves placing the infant on the mother's chest, skin to skin.

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Oxford Population Health: NPEU

Research Projects Topic: Labour and delivery

Birthplace follow-on analysis to enhance policy and service delivery decision-making for planned place of birth.

Lead: Jennifer Hollowell (NPEU (Former member)) Topics: Labour and delivery , Organisation and delivery of maternity and neonatal care

Birthplace in England Research Programme

Lead: Peter Brocklehurst (NPEU) Topics: Labour and delivery , Organisation and delivery of maternity and neonatal care

CORONIS (International study of caesarean section surgical techniques : the follow-up study)

Lead: Peter Brocklehurst (NPEU) Topics: Infertility , Labour and delivery

CORONIS Trial - a fractional factorial unmasked randomised controlled trial of caesarean section surgical techniques in developing countries

Lead: Peter Brocklehurst (NPEU) Topics: Labour and delivery

Enhancing the Safety of Midwifery-Led Births Enquiry (ESMiE): A confidential enquiry of term, intrapartum-related perinatal deaths in births planned in midwifery-led settings in England & WAles

Lead: Jennifer Hollowell (NPEU (Former member)) Topics: Labour and delivery

Ethnic differences in women's worries about labour and birth

Lead: Maggie Redshaw (NPEU (Former member)) Topics: Labour and delivery , Socioeconomic and ethnic inequalities , Women's experience of maternity care

EUPHRATES trial - trial of blood collector bag in third stage of labour

Lead: Sophie Alexander (Universite Libre de Bruxelles, Brussels) Topics: Labour and delivery

EUROCAT - European Surveillance of Congenital Anomalies - Survey of prenatal diagnosis screening methods across Europe Perinatal screening for birth defects in Europe - a EUROCAT study of the impact of different national policies

Leads: Helen Dolk (University of Ulster) and Patricia Boyd (NPEU (Former member)) Topics: Labour and delivery

Evidence to improve the quality and safety of midwifery-led intrapartum care

Lead: Rachel Rowe (NPEU) Topics: Labour and delivery , Organisation and delivery of maternity and neonatal care , Stillbirth and infant death

Immersion in water for pain relief and the risk of intrapartum transfer among low risk nulliparous women: secondary analysis of the Birthplace national prospective cohort study

Impact of maternal age on intrapartum interventions and outcomes: secondary analysis of the birthplace in england national prospective cohort study, impact of maternal bmi on intrapartum outcomes: secondary analysis of the birthplace national prospective cohort study.

Lead: Jennifer Hollowell (NPEU (Former member)) Topics: Labour and delivery , Obesity

Informing policy on childbirth choices: the Birthplace Choices project

Leads: Oliver Rivero-Arias (NPEU) and Rachel Rowe (NPEU) Topics: Labour and delivery

Maternal health and wellbeing in the perinatal period

Lead: Maggie Redshaw (NPEU (Former member)) Topics: Antenatal care , Labour and delivery , Mental health and wellbeing , Women's experience of maternity care

National Maternity Survey 2010: women's experience of maternity care

Lead: Maggie Redshaw (NPEU (Former member)) Topics: Antenatal care , Labour and delivery , Women's experience of maternity care

National survey of women's views and experience of maternity care 2006

Outcome of planned vaginal birth after caesarean (vbac) at home, pre-eclampsia in hospital: early induction or expectant management (phoenix)..

Leads: Lucy Chappell (King's College, London) and Andy Shennan (King's College, London) Topics: Antenatal care , Care of the compromised term infant , Care of the preterm or low birthweight infant , Child health and development , Labour and delivery , Preterm birth , Severe maternal morbidity and mortality , Stillbirth and infant death

Surveillance of fetomaternal alloimmune thrombocytopenia

Lead: Marian Knight (NPEU) Topics: Antenatal care , Care of the compromised term infant , Labour and delivery , Severe maternal morbidity and mortality , Stillbirth and infant death

The Oxford Worries about Labour Scale: maternal concerns about labour and birth

Lead: Maggie Redshaw (NPEU (Former member)) Topics: Labour and delivery , Mental health and wellbeing , Women's experience of maternity care

Transfer from midwifery unit to obstetric unit during labour: rates, process, outcomes and women's experience

Lead: Rachel Rowe (NPEU) Topics: Labour and delivery , Women's experience of maternity care

UK Midwifery Study System (UKMidSS)

Lead: Rachel Rowe (NPEU) Topics: Labour and delivery , Obesity , Severe maternal morbidity and mortality , Stillbirth and infant death

UKMidSS Severe Obesity Study

Lead: Rachel Rowe (NPEU) Topics: Labour and delivery , Obesity

Women's experience of caesarean section: a qualitative study

Lead: Maggie Redshaw (NPEU (Former member)) Topics: Labour and delivery , Women's experience of maternity care

Women's experience of induction of labour

Lead: Maggie Redshaw (NPEU (Former member)) Topics: Labour and delivery

Research Topics

• Alcohol in pregnancy
• Antenatal care
• Breastfeeding
• Care of the compromised term infant
• Care of the preterm or low birthweight infant
• Child health and development
• Congenital anomalies
• Health economics
• Infertility
• Labour and delivery
• Mental health and wellbeing
• Methodology
• Multiple births
• Organisation and delivery of maternity and neonatal care
• Paediatric surgery
• Preterm birth
• Severe maternal morbidity and mortality
• Smoking or vaping in pregnancy
• Socioeconomic and ethnic inequalities
• Stillbirth and infant death
• Women's experience of maternity care
• Randomised Trials

Suggest a Topic

If you'd like to suggest a new topic for us to consider, please email [email protected]

Current students

News + events, get involved, search metrostate.edu, nurs 399 topics in nursing.

Effective August 24, 2024 to December 15, 2024

Learning outcomes

• Demonstrate critical reflection of research literature on a topic of interest
• Develop and articulate clear project outcomes and time-frame
• Apply self-directed communication activities