The increase in severe maternal morbidity and mortality in the United States correlates with a significant rise in U.S. cesarean birth rates from 5.5% in 1970 to a rate of 31.9% of all births in 2018, far beyond the World Health Organization goal of 10% to 15%. Three key contributors to maternal morbidity and mortality related to cesarean birth include complications of hemorrhage, surgical site infection, and venous thromboembolism. All women should be screened for risk factors associated with these major complications during the antepartum, intrapartum, and postpartum period to assure the availability of immediate resources based on the assessment. Implementing evidence-based maternity care safety bundles, toolkits, and protocols to manage these complications can reduce adverse outcomes.

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Galactosemia is an inborn error of galactose metabolism that results from a deficiency in one of three enzymes, uridine diphosphate galactose 4'epimerase, galactokinase, or galactose-1-phosphate uridyltransferase (GALT). This article focuses on classical, clinical variant, and biochemical variant (Duarte) galactosemias caused by GALT enzyme deficiency. A brief overview of galactosemia and newborn screening is presented, followed by detailed information about each of the conditions. Confirmatory testing, acute and long-term management, and outcome for these galactosemia types are discussed as well as the importance of genetic counseling and testing for the infant and family to refine reproductive risk.

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Oral feeding readiness is a complex concept. More evidence is needed on how to approach beginning oral feedings in premature hospitalized infants. This article provides a review of literature related to oral feeding readiness in the premature infant and strategies for promoting safe and efficient progression to full oral intake. Oral feeding readiness assessment tools, clinical pathways, and feeding advancement protocols have been developed to assist with oral feeding initiation and progression. Recognition and support of oral feeding readiness may decrease length of hospital stay and have a positive impact on reducing healthcare costs. Supporting effective cue-based oral feeding through use of rigorous assessment or evidence-based care guidelines can also optimize the hospital experience for infants and caregivers, which, in turn, can promote attachment and parent satisfaction.

The administration of injections is a fundamental nursing skill; however, it is not without risk. Children receive numerous vaccines, and pediatric nurses administer the majority of these vaccines via the intramuscular route, and thus must be knowledgeable about safe and evidence-based immunization programs. Nurses may not be aware of the potential consequences associated with poor injection practices, and historically have relied on their basic nursing training or the advice of colleagues as a substitute for newer evidence about how to administer injections today. Evidence-based nursing practice requires pediatric nurses to review current literature to establish best practices and thus improved patient outcomes.

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Falls in the perinatal setting have received minimal attention and have not been well documented. Women are at risk for falling following vaginal or cesarean birth, especially during initial attempts at ambulation. Recently, a women's hospital that averages over 500 births per month recorded a postpartum fall rate that exceeded the national mean for adult surgical patient falls. A fall prevention team (FPT) of five nurses was formed with a goal to decrease the incidence of postpartum patient falls to zero within the following 7 months. A patient-centered fall prevention strategy was developed. The results of this project have laid the foundation for additional research of a program that will consider not only prevention of falls in a healthy population but also the development of a risk assessment tool specific to women in the immediate postpartum period.

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This article synthesizes research that has examined the impact of abuse on women, fetuses, and developing children. Intimate partner violence affects the lives of millions of women, sometimes in ways we have yet to understand. Despite the research in this area, the full impact of abuse on the long-term physical and psychosocial well-being of women and their families is not fully understood. There are data, however, that suggest that lifelong health changes may be linked to patterns of abuse. Intimate partner violence during pregnancy has an impact on not only the woman but the developing fetus and the extended family. It is essential that all women be screened for intimate partner violence, and that nurses understand interventions that have been shown to be effective for this group of patients.