1. Simpson, Kathleen Rice PhD, RNC, CNS-BC, FAAN

Article Content

In this special topics issue of MCN, the focus is on inpatient maternity care. Over 98% of births in the United States occur in the hospital, with very small, but increasing numbers, occurring in birth centers and at home. Although overall the quality of care for women giving birth in the United States is excellent, not everyone equally benefits or has easy access. There is significant disparity in maternal and infant outcomes between White women and Black women, among others, based on long-standing racism, bias, and structural inequities in the current healthcare system. We must do better at treating women with respect, listening to their concerns, partnering with them in their care, and intervening only when necessary. The priority should be what is best for the mother and baby rather than cost and convenience; however, this is not always reality in every setting and for every patient (Simpson, 2020).


Six articles cover various important aspects of care for mothers and babies during childbirth hospitalization. Three experts offer their thoughts on current threats to patient safety in the inpatient maternity setting (O'Neill, Miller, & Rohan, 2020). Common themes among their concerns include knowledge and execution of basic aspects of nursing care required for the specialty, promoting teamwork and quality communication, addressing racism and bias, and a healthy wariness of new trends, practices, and "one-size-fits-all approaches" that have not been rigorously tested. O'Brien-Abel (2020) presents an overview of the physiologic basis of fetal heart rate monitoring to assist clinicians with interpretation and appropriate intervention. The increase in cesarean births from 4.5% in 1965 to 31.9% in 2018 has been directly linked to an increase in maternal morbidity and mortality, mostly associated with hemorrhage and placental abnormalities in subsequent pregnancies. Burke and Allen (2020) review complications of cesarean birth and evidence-based strategies for prevention and management. Women having cesarean birth can experience perioperative hypothermia, leading to avoidable complications. Dendis and Hooven (2020) review the evidence on preventive interventions including recommendations from professional associations. There are many efforts to promote exclusive breastfeeding. One strategy that showed early promise was delaying the first newborn bath. Retrospective pre- and postintervention studies have since produced mixed results. Long, Rondinelli, Yim, Cariou, and Valdez (2020) used this design in a study of over 1,300 mother-baby couplets to evaluate potential impact of delaying the first newborn bath at least 12 hours on exclusive breastfeeding in the hospital. They were successful in changing practice, but found no differences in breastfeeding rates. Randomized controlled trials are needed to rigorously test this intervention. Sudden unexpected postnatal collapse of the newborn appears to be on the rise. Addison and Ludington-Hoe (2020) surveyed nurse participants on an Association of Women's Health, Obstetric, and Neonatal Nurses-hosted listserv and found many were lacking in knowledge on this topic and on safe newborn positioning. They present an overview of this important issue and how nurses can help mothers with safe newborn positioning in the hospital and after discharge. We hope you enjoy reading the articles.




Addison C., Ludington-Hoe S. (2020). Maternity nurses' knowledge about sudden unexpected postnatal collapse and safe newborn positioning. MCN. The American Journal of Maternal Child Nursing, 45(2), 116-121. DOI:10.1097/NMC.0000000000000597 [Context Link]


Burke C., Allen R. (2020). Complications of Cesarean birth: Clinical recommendations for prevention and management. MCN. The American Journal of Maternal Child Nursing, 45(2), 92-99. DOI:10.1097/NMC.0000000000000598 [Context Link]


Dendis M., Hooven K. (2020). Preventing hypothermia during Cesarean birth: An integrative review. MCN. The American Journal of Maternal Child Nursing, 45(2), 102-108. DOI:10.1097/NMC.0000000000000599 [Context Link]


Long K., Rondinelli J., Yim A., Cariou C., Valdez R. (2020). Delaying the first newborn bath and exclusive breastfeeding. MCN. The American Journal of Maternal Child Nursing, 45(2), 110-115. DOI:10.1097/NMC.0000000000000606 [Context Link]


O'Brien-Abel N. (2020). Clinical implications of fetal heart rate interpretation based on underlying physiology. MCN. The American Journal of Maternal Child Nursing, 45(2), 82-91. DOI:10.1097/NMC.0000000000000596 [Context Link]


O'Neill L., Miller L. A., Rohan A. J. (2020). Threats to patient safety in the inpatient maternity setting. MCN. The American Journal of Maternal Child Nursing, 45(2), 74-81. DOI:10.1097/NMC.0000000000000603 [Context Link]


Simpson K. R. (2020). Perinatal patient safety and quality. In K. R. Simpson, P. A. Creehan, N. O'Brien-Abel, C. Roth, & A. Rohan (Eds.), AWHONN's perinatal nursing (5th ed., pp. 1-17). Philadelphia, PA: Wolters Kluwer. [Context Link]