While Fetal Alcohol Syndrome Disorder is a recognized problem with alcohol ingestion during the formation of facial features, Fetal Alcohol Spectrum Disorders are not as widely recognized. These disorders result from exposure to alcohol throughout pregnancy when the brain and nervous system are developing. The resulting disorders include attention deficit disorders, social disorders, inappropriate behaviors, learning disorders, and intellectual disability. The incidence of children with alcohol-related disorders is increasing as evidenced by children needing special services in the educational systems. It is unknown how much alcohol ingestion is safe during pregnancy or how genetic factors are involved in the development of these disorders. Women often get conflicting information from the media and other resources about safe levels of alcohol consumption during pregnancy. Abstinence of alcohol ingestion is the only known prevention of such intellectual disorders. It is hypothesized that women of childbearing age may not be knowledgeable of the relationship between drinking and the implications of alcohol exposure on fetal development. The purpose of this research is to determine what women of childbearing age know about alcohol consumption during pregnancy and if there is a knowledge deficit that exists among women of a certain age or women that use specific resources for health information. The researcher surveyed 40 female students at East Tennessee State University by using true or false questions concerning alcohol consumption related to fetal development in order to determine if a knowledge deficit exists. Based on the findings, it may be determined if women of childbearing age need educational materials from a reliable source.

The objectives of this study were to determine whether there was an association between clinical nursing knowledge of four birthing positions and current evidence-based research of those same positions and also to identify possible areas where nursing knowledge of those birthing positions was inadequate. This pilot study used convenience sampling to survey registered nurses (RNs) and licensed practical nurses (LPNs) on labor and delivery units. The survey was distributed to three hospitals in the southeastern United States, and twenty-four RNs and LPNs participated. Participants’ knowledge did not reflect current clinical evidence in two key areas, (1) the best position to minimize blood loss and (2) the best position to decrease the likelihood anal sphincter tears. Respectively, only 13% and 27.3% of participants selected the correct position. Continuing education for maternity nurses regarding current evidence-based practice concerning various birthing positions remains a need, and incorporating this could include more frequent opportunities for education classes and unit inservices. Results from this study should not be generalized, and more research is needed in this area to validate these findings.

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Background: Tennessee Initiative for Perinatal Quality Care (TIPQC) is a statewide quality improvement collaborative that elected to design and develop a project to address Tennessee's low breastfeeding rates. Purpose: To improve the health of Tennessee infants and mothers by increasing initiation and duration of breastfeeding through systematic implementation of processes with high reliability (> 90%) that promote and support breastfeeding in the delivery setting. Methods: A toolkit was created using the evidence-based practices of the Ten Steps to Successful Breastfeeding and the USBC Toolkit, “Implementing the Joint Commission Perinatal Care Core Measure on Exclusive Breast Milk Feeding.” Eleven hospitals across the state of Tennessee are currently participating in the project since the state-wide kick-off in July 2012. Participating hospitals established improvement teams of stakeholders, and began collecting exclusive breastfeeding rates at hospital discharge, according to the Joint Commission Perinatal Core Measure 5 guidelines. After baseline data collection, the centers are implementing one or more of the 10 Steps to Successful Breastfeeding by using rapid Plan-Do-Study-Act (PDSA) cycles. Reliability of implementation is monitored by process measure audits. Web-based data-entry through REDCap provides on-demand run-charts to each individual center. Monthly webinars facilitate sharing of best practices between geographically distant centers, as well as sharing of the state-wide data in aggregate. Each participating center creates a Leadership Report highlighting its recent data on exclusive breastfeeding as well as selected PDSA cycles. Centers also share lessons learned and query participating centers on specific challenges. Additionally centers are invited to attend a face-to-face annual state-wide meeting with nationally recognized experts, as well as two regional workshops per year to share challenges and successes, and to learn quality improvement strategies from the TIPQC Quality Improvement team. Results: Baseline exclusive breastfeeding at discharge according to the Joint Commission criteria was 35% in aggregate. Initial data demonstrate that centers have noted some success in implementing changes in all of the Ten Steps to Successful Breastfeeding. Skin-to-skin care has been markedly increased in several centers, with some centers specifically targeting skin-to-skin care after C-Sections. Centers have also seen increases in rooming-in, staff training, and adoption of a breastfeeding policy. Upstream opportunities have been identified for prenatal education with providers of prenatal care (Step 3). Downstream opportunities have been identified for community support at discharge from the center (Step 10). Baseline data in the first 5 months of the project from over 7000 maternal-infant dyads (approximately 25% of Tennessee births) highlight improvement opportunities on all of the Ten Steps. Conclusions: This project serves as a model for how quality improvement methodologies may be combined with use of distance-learning and web-based data entry and reporting to facilitate implementation of evidenced based practices to increase breastfeeding rates.