Ms. Ashley V Gruber

Epidural analgesia is one of the most common forms of pain relief during labor and delivery. However, despite its benefits, it is not without risk. Two notable complications of epidural use are postdural puncture headache and maternal hypotension, both of which can affect maternal health and overall experience. Maternal hypotension following epidural administrations has been linked to reduced uteroplacental blood flow, increasing the risk of fetal complications (Anim-Somuah et al., 2018). Meanwhile, post dural puncture headache has been associated with more long-term maternal complications, such as chronic headache, back pain, and auditory disturbances (Lacombe et al., 2022). Understanding how often these complications occur, and under what conditions, is critical to improving maternal safety and enhancing clinical decision-making. Due to the frequency of epidural use, examining these risks contributes to optimizing maternal care and outcomes.

Nurse-to-patient staffing ratios are crucial for ensuring quality patient care and nurse well-being. When nurses care for too many patients, stress, burnout, and turnover increase. States like California with mandated staffing ratios, report higher nurse satisfaction, better mental health, and improved retention. Understanding this relationship supports evidence-based staffing policies that enhance both nurse and patient outcomes.

Respiratory distress syndrome (RDS) is the most common complication among preterm infants due to their underdeveloped lungs. These infants not only face RDS but are also at risk for related issues such as apnea, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). Current Consensus Guidelines recommend early rescue surfactant therapy within the first two hours after birth, but only if respiratory distress is evident (Cucerea et al., 2023). Investigating whether prophylactic administration offers better outcomes is vital, as it may prevent the onset of RDS altogether and improve recovery in this vulnerable population. Infants born before 32 weeks gestation are at significant risk due to incomplete development of vital organs, including the lungs. At this stage, insufficient surfactant production impairs lung function by allowing alveoli to collapse, making breathing difficult and increasing the risk of RDS. Surfactant serves to reduce surface tension and maintain alveolar stability during exhalation. Without adequate levels, gas exchange is compromised, leading to respiratory failure. This topic is especially important to nursing practice, as it impacts survival rates, reduces the need for invasive interventions such as intubation or mechanical ventilation, and supports earlier discharge from the NICU. A review by the European Society for Pediatric and Neonatal Intensive Care (ESPNIC) found that among eight clinical trials, surfactant replacement in neonates with ARDS improved oxygenation in seven and reduced mortality in one (De Luca et al., 2021). Understanding whether surfactant therapy is more beneficial when given prophylactically versus as a rescue treatment directly informs clinical decision making. Ultimately, this knowledge enhances neonatal outcomes and supports nurses in delivering evidence based, family centered care that facilitates bonding and developmental progress in premature infants.

In previous years, newborns were bathed within the first few hours of life. This was done to remove the fluids and bodily matter that stick to their bodies after birth. In the last decade most hospitals and medical settings prefer to delay the newborns bath for at least 24 hours. This topic was chosen in order ro find out what the effects of delayed bathing are on breastfeeding and thermoregulation. This review was done on the effects of bathing on breastfeeding and thermoregulation.

Maternal position during the second stage of labor (from full dilation to birth) is an influential and modifiable factor that affects maternal and neonatal outcomes. Factors that are affected include length of second stage laboring, mode of delivery (increased use of assistive devices such as forceps, vacuums or cesarean), perineal trauma, blood loss/hemorrhaging, fetal heart rate changes, and maternal birth experience. Several recent reviews found that upright and lateral positions often improved outcomes (i.e. shorter second stage, fewer episiotomies) while horizontal positions such as lithotomy/supine (conventional) were associated with worse outcomes (i.e. longer second stage, more abnormal fetal heart rate patterns and greater risk of severe perineal trauma) in some studies. These differences make positioning a practical, non-pharmacologic intervention that nurses and midwives can use to improve safety and patient experience during labor and postpartum.