A randomized controlled trial of an oral probiotic to reduce antepartum group B Streptococcus colonization and gastrointestinal symptoms

BACKGROUND

Probiotics have been suggested as a strategy to reduce antenatal group B Streptococcus colonization. Although probiotics are known to improve gastrointestinal symptoms, this has not been studied during pregnancy.

OBJECTIVE

This study aimed to evaluate the efficacy of a probiotic to reduce: (1) standard-of-care antenatal group B Streptococcus colonization and colony counts and (2) gastrointestinal symptoms of pregnancy.

STUDY DESIGN

In a double-blind fashion, 109 healthy adult pregnant people were randomized to Florajen3 probiotic or placebo capsules once daily from 28 weeks' gestation until labor onset. Baseline vaginal and rectal study swabs for group B Streptococcus colony-forming units and microbiome analysis were collected at 28 and 36 weeks' gestation. Standard-of-care vaginal to rectal group B Streptococcus swabs were collected from all participants at 36 weeks' gestation and determined the need for intrapartum antibiotic prophylaxis. Data collection included solicitation of adverse events, demographic information, Antepartum Gastrointestinal Symptom Assessment score, yogurt ingestion, sexual activity, and vaginal cleaning practices.

RESULTS

A total of 83 participants completed the study to 36 weeks' gestation with no adverse events. Standard-of-care group B Streptococcus colonization was 20.4% in the control group and 15.4% in probiotic group participants (-5%; P=.73). The relative risk for positive standard-of-care vaginal-rectal group B Streptococcus colonization was 1.33 (95% confidence interval, 0.5-3.40) times higher in the control group than in the probiotic group (P=.55). There were no differences in median vaginal (P=.16) or rectal (P=.20) group B streptococcus colony-forming units at baseline or at 36 weeks (vaginal P>.999; rectal P=.56). Antepartum Gastrointestinal Symptom Assessment scores were similar at baseline (P=.19), but significantly decreased in probiotic group participants at 36 weeks (P=.02). No covariates significantly altered group B Streptococcus colonization. Significantly more Florajen3 bacteria components were recovered from the vaginal-rectal samples of probiotic group participants (32%; P=.04) compared with controls.

CONCLUSION

The findings of this study provided insufficient evidence for the clinical application of the Florajen3 probiotic intervention to reduce standard-of-care vaginal-rectal group B Streptococcus colonization. The prevalence of group B Streptococcus was lower than expected in the study population, and intervention adherence was poor. Probiotic bacteria colonization of the genitourinary tract occurred more in intervention group participants than in controls and significantly reduced gastrointestinal symptoms of pregnancy.

Probiotic interventions to reduce antepartum Group B streptococcus colonization: A systematic review and meta-analysis

OBJECTIVE

To systematically review and meta-analyse studies of the efficacy of probiotics to reduce antenatal Group B Streptococcus (GBS) colonisation.

PARTICIPANTS

Antenatal participants with known positive GBS colonisation or unknown GBS status.

INTERVENTION

Probiotic interventions containing species of Lactobacillus or Streptococcus.

DESIGN

Systematic review and meta-analysis.

MEASUREMENTS AND FINDINGS

The systematic review included 10 studies. Five articles contained in vitro studies of probiotic interventions to determine antagonistic activity against GBS. Six clinical trials of probiotics to reduce antenatal GBS were systematically reviewed and meta-analysed. The meta-analysis revealed that the use of an antenatal probiotic increased the probability of a negative GBS result by 79% (OR = 0.56, 95% CI = 8.7%, 194.1%, p = 0.02) (n = 709). However, only one clinical trial of 6 had a low risk of bias.

KEY CONCLUSIONS

The probiotic interventions subjected to in vitro testing showed antagonistic activity against GBS through the mechanisms of acidification, immune modulation, and adhesion. The findings of the meta-analysis of the clinical trials revealed that probiotics are a moderately effective intervention to reduce antenatal GBS colonisation. More well-controlled trials with diverse participants and with better elucidation of variables influencing GBS colonisation rates are needed.

IMPLICATIONS FOR PRACTICE

Probiotic interventions appear to be a safe and effective primary prevention strategy for antenatal GBS colonisation. Application of this low-risk intervention needs more study but may reduce the need for intrapartum antibiotic prophylaxis in countries or regions where antenatal GBS screening is used. Midwives can be instrumental in conducting and supporting larger well-controlled clinical trials.

U.S.-Born Mexican-Origin Women's Descriptions About Their Eating Patterns

INTRODUCTION

Mexican origin (MO) women comprise the largest Hispanic subgroup of Latinas in the United States. This subgroup has high incidences of obesity and associated chronic diseases. Modifiable risk factors for these include unhealthy diets and eating patterns. Efforts to understand eating patterns of Hispanics have focused on primarily first-generation Hispanics. The purpose of this study was to explore U.S.-born MO women's descriptions about eating patterns.

METHOD

A qualitative exploratory-descriptive study, using a thematic analysis approach, was employed. Fifteen MO women were interviewed. The participants were second to fourth generation and reported higher educational attainment, middle-income socioeconomic brackets, and English proficiency compared with previous groups studied.

RESULTS

Five themes were identified: (a) personal agency, (b) relationships with people about food, (c) cultural and familial influences, (d) environments, and (e) time and money. Themes comprised multiple factors to classify the varied aspects of the women's eating patterns.

CONCLUSION

This study provides insights about descriptions of eating patterns from a subgroup, generational, and gender-specific perspective that extended beyond acculturative and homogeneous group viewpoints to a broader structural view. The structural layers that affected the women's eating patterns were multifaceted and complex.

Diverse students collaborating to address social determinants of health using listening sessions

In this article, a Nursing Workforce Diversity grant-funded project examined the social determinants of health (SDH) including diverse high school and baccalaureate nursing students. All involved students were from educationally and/or economically disadvantaged backgrounds and/or underrepresented minority groups. The purpose of this article is to report the project outcome data and analysis gathered from students' experiences of SDH, using the collaborative method, listening sessions. The project staff and student nurses discussed SDH with high school students, who then identified and prioritized key SDH in their neighborhoods during a series of facilitated listening sessions in their schools. Initial analysis included reviewing, with the students, the notes taken during the sessions, resulting in a list of SDH to address. As a secondary analysis, the listening session tapes were transcribed and independently coded and examined by project staff. Six themes evolved that illustrate the depth of understanding of the complex challenges of SDH experienced by students in their local communities. Based on student-determined priorities, the project staff developed programs to meet the identified SDH needs at both high schools. Nursing and other health professionals are in ideal positions to collaborate with schools to create programming interventions for addressing SDH effectively into the future.

Validity and Reliability of the Antepartum Gastrointestinal Symptom Assessment Instrument

OBJECTIVE

To examine the psychometric properties of the nine-item Antepartum Gastrointestinal Symptom Assessment (AP-GI-SA) instrument.

DESIGN

Single-group prospective design.

SETTING

Urban prenatal clinic serving a diverse population.

PARTICIPANTS

Convenience sample of 45 pregnant women.

METHODS

Participants completed the AP-GI-SA before a scheduled prenatal care appointment. We used Bayesian structural equation modeling to evaluate the construct validity of the scale and assessed known-groups validity. We assessed reliability through maximal reliability coefficient estimate and measured internal consistency with Cronbach's alpha coefficient.

RESULTS

Participants completed the instrument in 2 minutes or less. Construct validity was supported by confirmatory factor analysis (posterior predictive p value = 0.49, gamma-hat = 0.970, and root mean square error of approximation = 0.065), which indicated that the single-factor model is a plausible data-generative model for GI symptoms. The maximal reliability coefficient of 0.75 and Cronbach's alpha coefficient of 0.67 supported reliability. Average AP-GI-SA scores were the highest for women in the third trimester. Of all nine GI symptoms, heartburn in the third trimester received the highest score.

CONCLUSION

Our findings provide preliminary support for the validity and reliability of the AP-GI-SA. The instrument may be used as a measure in intervention studies where GI symptoms of pregnancy are an outcome. The AP-GI-SA could also be useful in clinical settings to quickly evaluate GI symptoms.

Registered Nurses' Experiences of Passing the NCLEX-RN After More Than One Attempt

BACKGROUND

In the past decade, little research has been conducted regarding individuals' stories about not initially being successful on the National Council Licensure Examination for Registered Nurses. An unsuccessful licensure examination attempt may affect the individual personally and profoundly in ways that could influence their future success.

METHOD

Individual in-depth interviews were conducted once with 15 RNs who were initially unsuccessful on the licensure examination and subsequently passed. Data analyses were conducted using both manual and electronic coding through thematic identification. Rigor was ensured by meeting quality criteria for qualitative research.

RESULTS

Four themes were identified: (a) Pressures all Around, (b) the Stigma of Being Unsuccessful, (c) Correcting the Problems, and (d) Ultimate Triumph in Discovery.

CONCLUSION

Following their initial unsuccessful National Council Licen-sure Examination for Registered Nurses results, participants were deeply affected, but after accepting help from family, friends, nursing instructors, and managers, they were able to move forward, change their approaches, and become RNs. [J Nurs Educ. 2018;57(10):590-597.].

Reactions of Low-Income African American Women to Breastfeeding Peer Counselors

OBJECTIVE

To examine the influence of breastfeeding peer counseling on the breastfeeding experiences of African American mothers who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

DESIGN

Qualitative study using focus groups.

SETTING

Two WIC clinics in Southeast Wisconsin were used for recruitment and data collection.

PARTICIPANTS

A convenience sample of nine African American mothers participated in one of two focus groups.

METHODS

The women responded to a series of open-ended questions about their breastfeeding experiences and the effect of breastfeeding peer counselors (BPCs). Content and thematic analyses were used to analyze patterns related to the influence of BPCs on breastfeeding.

RESULTS

Four themes were categorized: Educating With Truth, Validating for Confidence, Countering Others' Negativity, and Supporting With Solutions. Mothers in this study expressed positive reactions to educational, emotional, and social support from BPCs. The mothers noted that the contact they had with BPCs had a direct positive influence on their breastfeeding experiences. However, the contact from BPCs varied between the two WIC clinics.

CONCLUSION

The findings demonstrate the positive effects of BPCs on breastfeeding experiences among African American WIC participants. Findings from this study can guide future explorations using BPCs. Interventions are needed to develop standardized guidelines to bring about homogeneity of, better access to, and greater use of BPCs.

Continuity and change in mothers' narratives of perinatal hospice

OBJECTIVES

(1) To broadly explore the experiences of women who chose to continue pregnancies affected by lethal fetal diagnoses and (2) to develop knowledge useful to nurses and other healthcare professionals who provide perinatal hospice (PH) care.

DESIGN

Qualitative descriptive study using narrative analysis.

PARTICIPANTS

Fifteen women who learned during their pregnancies of a lethal fetal diagnosis and chose to continue the affected pregnancies.

METHOD

Participants' stories of their PH experiences were recorded in face-to-face interviews. A qualitative approach using narrative analysis was used to identify themes and develop suggestions for care.

RESULTS

The element of time was prevalent in mothers' stories. Some aspects of mothers' experiences continued, particularly feelings of love and connection to their babies. Mothers also reported evolving changes in their thoughts and feelings. Personal changes such as increased compassion, faith, and strength were frequently mentioned. Mothers described transient phases of highs and lows. Drawing personal meanings or life lessons was the main way mothers connected their experiences to their present lives.

CONCLUSIONS

Mothers' descriptions of their experiences can enhance nurses' understanding of perinatal loss. Established care practices, such as birth planning and creating mementoes, were supported. Nurses can help mothers experiencing loss by elucidating and reflecting their personal meanings.

Impact of self-hypnosis in women on select physiologic and psychological parameters

OBJECTIVE

To examine physiologic and psychologic effects of hypnosis in healthy women.

DESIGN

Quasi-experimental, within-subject, repeated measures.

SETTING

Private laboratory setting in an urban Midwestern College of Nursing.

PARTICIPANTS

Convenience sample of 30 healthy, female volunteers who were nonpregnant, predominantly White, college students.

METHOD

Participants listened to a 30-minute recording of relaxing, affirming hypnotic suggestions while sitting comfortably in a recliner. Hypnotizability and trait anxiety were measured at baseline. Tension-anxiety was measured at baseline and following the hypnotic induction. Heart rate, respiratory rate, and heart rate variability were collected before, during, and following the hypnotic experience.

RESULTS

Paired t tests revealed significantly reduced heart rate (p<.001), respiratory rate (p<.001), low-to-high frequency heart rate variability ratio (p<.001), and tension-anxiety (p<.001), whereas high frequency heart rate variability was increased (p<.001) after the 30-minute hypnotic session.

CONCLUSIONS

Hypnosis is an innovative, low-technology, self-modulated approach that may contribute to stress reduction and health promotion. Parameters demonstrated increased parasympathetic nervous system activity associated with relaxation during and immediately after the hypnosis experience. Findings from this study suggest that nurses can include hypnosis information when advising healthy women about available stress reduction approaches, as well as tailor their nursing care for women who present using this alternative approach.

A critical appraisal of guidelines for antenatal care: components of care and priorities in prenatal education

There are a variety of published prenatal care (PNC) guidelines that claim a scientific basis for the information included. Four sets of PNC guidelines published between 2005 and 2009 were examined and critiqued. The recommendations for assessment procedures, laboratory testing, and education/counseling topics were analyzed within and between these guidelines. The PNC components were synthesized to provide an organized, comprehensive appendix that can guide providers of antepartum care. The appendix may be used to locate which guidelines addressed which topics to assist practitioners to identify evidence sources. The suggested timing for introducing and reinforcing specific topics is also presented in the appendix. Although education is often assumed to be a vital component of PNC, it was inconsistently included in the guidelines that were reviewed. Even when education was included, important detail was lacking. Addressing each woman's needs as the first priority was suggested historically and remains relevant in current practice to systematically provide care while maintaining the woman as the central player. More attention to gaps in current research is important for the development of comprehensive prenatal guidelines that contribute effectively to the long-term health and well-being of women, families, and their communities.

Exploration of African-American women's infant feeding choices

It is well documented in the literature that breastfeeding is more beneficial for infants and mothers than is formula feeding. Yet, African-American women are least likely to initiate and continue breastfeeding compared to other ethnic groups. Few studies have examined African-American women's infant feeding choices from the women's perspectives. Therefore, the purpose of this exploratory study was to examine African-American women's infant feeding choices with individual narrative interviews at 3 weeks postpartum. Five African-American women participated. After coding and analyzing the narrative interviews, three major themes with sub-themes emerged that identified influencing factors on participants' choices and their opinions about other women who chose formula. The women willingly shared their rationales for their infant feeding methods. In an effort to develop and implement culturally appropriate interventions and to increase breastfeeding rates in this population, further exploration of infant feeding choices from the women's perspectives is needed.

Simulation-based learning for midwives: background and pilot implementation

Simulation-based learning is an emerging learning modality with promising potential for certified nurse-midwife (CNM) and certified midwife (CM) education. Unlike standard didactic methods, simulation-based learning affords opportunities to address multiple domains of learning and performance. Unlike standard clinical education, simulation-based learning provides learners exposure to events that are rare in the clinical setting, and allows learners to assume leadership roles in emergencies. Simulation-based learning is consistent with constructivist learning principles, which promote retention, understanding, and active use of skills. A simulation-based shoulder dystocia learning module was implemented on a pilot basis in a class of four student nurse-midwives. Student nurse-midwives self-assessed their preparedness to manage a shoulder dystocia in the cognitive, psychomotor, and affective domains before and after the simulation-based learning exercise. Feedback from student evaluations was promising. Although the small sample precluded statistical analysis, student self-assessment scores appeared to be higher after the simulation-based learning exercise. Open-ended student feedback was unanimous that simulation-based learning should be incorporated into the curriculum. Further implementation and evaluation of simulation-based learning in CNM and CM education is warranted.

Rh negative status and isoimmunization update: a case-based approach to care

Prior to the 1970s and the advent of Rho (D) immune globulin (RIG) for Rh negative women, hemolytic disease of the newborn led to morbidity, long-term disabilities, and mortality. Antepartum RIG administration has been a standard of practice since 1983. Yet, Rh isoimmunization (sensitization) and its sequelae have not been completely eradicated. Rh-related issues remain clinical challenges facing perinatal and neonatal nurses. Evidence for the administration of RIG prenatally and during the postpartum period is presented including controversies and challenges. Current information about fetal and neonatal care of erythroblastosis fetalis and immune hydrops is also presented.

Use of over-the-counter medications during pregnancy

The use of over-the-counter medications by pregnant women is common. Over-the-counter medications are widely assumed to be harmless because they may be purchased without prescription. Some consumers do not consider them to be drugs. Women may not realize that over-the-counter medications have the potential to harm them or their fetuses. This article reviews selected over-the-counter medications commonly used by pregnant women, including pharmacology, risks, Food and Drug Administration risk classifications, and strategies for counseling clients.

Self-hypnosis: alternative anesthesia for childbirth

The purpose of this article is to inform nurses about the use of self-hypnosis in childbirth. Hypnosis is a focused form of concentration. Self-hypnosis is one form of hypnosis in which a certified practitioner or therapist teaches an individual to induce his or her own state of altered consciousness. When used for childbirth pain, the primary aim of self-hypnosis is to help the woman maintain control by managing anxiety and discomfort though inducing a focused state of relaxation. Before the widespread use of pharmaceuticals for pain, hypnosis was one of the few pain relief methods available for labor. However, as new technologies for pain relief emerged, hypnosis received less attention. Most nurses have little experience with hypnosis, and there is limited information available in the literature. However, because nurses are at laboring women's bedsides, it is important that nurses learn about self-hypnosis to be able to inform pregnant women fully about all pain control options and to maximize the benefits for the woman choosing hypnosis.

The theater of birth: scenes from women's scripts

An analogy between theater and birth is drawn from analyses of women's birth stories to describe birth from a fresh perspective. Birth and theater are compared using the theatrical production elements: setting, casting, props, set, behind the scenes, script, and roles. Selected examples from women's birth stories highlight each element. Nurses' roles are significant during labor and birth, but nurses' abilities to fulfill these roles are threatened. This analogy promotes rethinking of nursing actions in the theater of birth. Implications for clinical practice are provided, including altering the birth environment, offering choices, and maintaining the woman's role as star.

Evaluation of online course discussions. Faculty facilitation of active student learning

Graduate nursing faculty evaluated their initial experiences with online course discussions after making the transition from traditional use of weekly face-to-face classroom discussions to primarily computer-based interactions with students at distant sites. The online discussion data were analyzed qualitatively. The ways the faculty member communicated to facilitate active student involvement in the online discussions were coded. Six categories were identified that describe the ways the faculty member communicated to facilitate active student involvement in online discussions: assist with navigation, explain expectations, clarify faculty role, stimulate critical thinking, share expertise, and provide encouragement. Examples of each were provided to demonstrate ways faculty promoted student learning in online discussions.

The essential forces of labor revisited: 13 Ps reported in womens' stories

PURPOSE

The purpose of this study was to analyze women's birth stories. Women's perspectives were used to expand the current model of the essential forces of labor (the three Ps: powers, passenger, and passageway).

DESIGN

This was a qualitative descriptive study analyzing women's birth narratives.

METHODS

Narratives consisted of women's spontaneous responses to the request to tell their birth stories in any way they wished. Fifteen Midwestern women (eight primiparas and seven multiparas) were interviewed, resulting in a total of 33 birth stories. Content and thematic analyses of verbatim transcripts of the birth narratives were done to elicit women's personal meanings of control during labor.

RESULTS

Women identified many essential forces of labor that exerted control or direction over their labors. Some of the forces were internal to the women, such as maternal psyche and position, as well as the classic three Ps (powers, passenger, and passageway). Others were external forces such as professional providers and procedures. An expanded model is proposed to demonstrate the complexity of labor and the multiple interacting forces.

CLINICAL IMPLICATIONS

The educational model, consisting of three essential forces that currently appears in textbooks, is inadequate. Maternity nursing practice can be improved by including a broader array of the essential forces of labor, thus attending more adequately to the complexity of caring holistically and contextually for laboring women. Women indicated that nurses have a profound impact during labor. Nurses are in a position to make positive change by working with women to share control.

Sculpting a nurse-midwifery philosophy. Ernestine Wiedenbach's influence

An educational project used in a professional-issues course for student nurse-midwives is described. The class project involved nurse-midwives portraying (in clay), and subsequently discussing, their individual practice philosophies. Background information on the importance of philosophy statements is provided. Included is the historic influence of a certified nurse-midwife foremother, Ernestine Wiedenbach, on the professional importance of articulating a guiding philosophy.