The Intimate Partner Violence in New Jersey
Directions: Perform a literature search/review for intimate partner violence. List annotated references for 3 articles you have reviewed that are related to your selected problem for the case study (will attach the case study). Select 1 quantitative research study article that addresses your selected problem (intimate partner violence) and summarize the article in a literature review table with one of the templates provided. Then in narrative paragraph(s) discuss strengths and limitations of the study, what additional research is needed, and how this study relates to the problem you are addressing in your case study.Then based on your review of the literature propose two research questions and state PICO elements to address your problem. (3-5 pages not including title page and reference page).
NOTE: for this assignment avoid copying word for word what is stated in the research article. Try your best to restate information in your own words. If you are unable to do this use quotation marks.Be succinct and stay to page limit.
Perform a literature search/review for your selected problem in the case study (intimate partner violence). List references for 3 articles you have reviewed that are related to your selected problem for the case study. Annotate with 1-2 sentences with information about study.
Review of the Literature Table
1 research article – Address the following questions and present answers to questions in a Review of the Literature table with one of the provided templates (horizontal or vertical) to summarize the following components of the research study. (See also attached examples of a ROL table).
What is the research question, and include hypothesis or purpose/aims. State PICO elements for research question.
Quantitative studies PICO: P-Population I-Intervention C-Comparison group O-Outcome(s)
What is the study design? Why is this quantitative?
What is the research level for this study and why? [Cite source of levels of evidence you are using. You can do this once in a footnote to table.]
What are the results?
For QUANTITATIVE studies these should include both a numerical statement of the results (actual value, odds ratio, relative risk, etc.) and a statement of the statistical significance of the result (p-value or confidence interval).
Are the results statistically significant (p-values)? Why?
What is the conclusion? Do the results support the hypothesis?
First column of table: Include the full article citation in the first column before answering the questions. Provide active link to article or attach article to Canvas.
Paragraph of discussion of article reviewed
Grammar and APA format for all references, 3-5 pages not including title page and references
Group C Case Study
CC: Chantee presents today to find someone to manage her bipolar disorder and medication and help her come up with a plan for housing. She does not have health insurance.
HPI: Chantee is a 60-year-old white woman who is homeless, currently in transitional housing. History of bipolar disorder since 20 years of age, and history of depression, and heroin and opioid addiction. She needs someone to manage her bipolar disorder and medication. She was discharged from a rehab facility with a two month supply of medication and instructed to find a psychiatrist to manage her bipolar disorder. She still takes the lithium but stopped taking the antidepressant because she doesn’t feel depressed. Previous to being at rehab facility she was admitted to hospital for complications of her Hepatitis C and then discharged to a rehab facility. Minimal family support: she was victim of IPV and husband left her when she was 43 years old. Estranged from children who recently resumed contact with her while she was in rehab facility.
Medical History: Back injury from being knocked down stairs intimate partner violence (IPV)->dependence on opioids. Heroin use. Hepatitis C.
Hospitalizations: For childbirth. Recently hospitalized for Hepatitis C complications and then sent to rehab facility.
OB History: G3 P3, postpartum depression after each pregnancy. IPV with pregnancies.
Emotional/physical/sexual abuse: IPV: Emotional abuse first pregnancy, physical abuse second pregnancy and third pregnancy (knocked down stairs and had back injury).
Psychiatric History: Postpartum depression, depression, attempted suicide after second child. Bipolar disorder since 20 years old and avoided treatment. characterized by manic episodes where she paints for days, often steeling art supplies, followed by periods of deep depression. While in rehab her bipolar disorder was treated with lithium and an antidepressant and she was discharged with a two month supply and instructed to find a psychiatrist to manage her bipolar disorder. She still takes the lithium but stopped taking the antidepressant because she doesn’t feel depressed.
Substance use/abuse: History of opioid dependence and heroin use. Has been drug free for 2 months upon release from rehab facility. Smoker since 17 years old and smokes ½ ppd.
Living situation: Homeless. Lived on street and in and out of shelters. Currently in transitional housing. She is expected to leave the transition home in 1 month and is trying to come up with a plan for housing and work upon her release.
Family and Marital status: Chantee grew up in a middle-class household. Married at age 23. History of IPV. Husband left her after 20 years marriage when she was 43 years old. Was estranged from children. Her children came to visit her in the rehab facility and she saw pictures of her grandchildren. Has remained in touch with her children while in transitional housing.
Education: Completed college and pursued her passion for painting with a degree in fine arts from her state university.
Occupation: On and off jobs as art teacher.
Recreation/hobbies: Painting passionately as emotional outlet.
Review of Literature Evidence Table: [Topic inserted here]
Research Question or hypothesis; include PICO (Quant) /PICo (Qual)
State if Qualitative or Quantitative; Study Design; Level Evidence. Cite source for Level Evidence
Results (include statistics and p values here OR qualitative results)
Source for Level of Evidence:
NOTE: This is example of template which may include quantitative or qualitative studies. For assignment you will only do Article 1 which will be quantitative.
Levels of Evidence:
Schuiling. K.D. & Likis, F.E. (2022). Women’s Gynecologic Health (4th Ed.). Burlington, MA: Jones & Bartlett, pp. 59-61.
Polit, D.F. & Beck, C.T. (2021). Nursing Research (11th Ed.). Philadelphia: Wolters Kluwer. pp. 28-30.
Riegelman, R.K. & Nelson, B.A. (2021). Studying a study & testing a test. (7th Ed.) Wolters Kluwer, pp. 335-336.
Also: Melynk, B.M. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare (3rd Ed,). Wolters Kluwer, pp. 11, 80, 92.
Journal of Midwifery &Women’s Health www.jmwh.org
CEUBreastfeeding Outcomes After Oxytocin Use During
Childbirth: An Integrative Review Elise N. Erickson, CNM, MS, Cathy L. Emeis, CNM, PhD
Introduction:Despite widespread use of exogenous synthetic oxytocin during the birth process, few studies have examined the effect of this drug
on breastfeeding. Based on neuroscience research, endogenous oxytocin may be altered or manipulated by exogenous administration or by block-
ing normal function of the hormone or receptor. Women commonly cite insufficient milk production as their reason for early supplementation,
jeopardizing breastfeeding goals. Researchers need to consider the role of birth-related medications and interventions on the production of milk.
This article examines the literature on the role of exogenous oxytocin on breastfeeding in humans.
Methods: Using the method described by Whittemore and Knafl, this integrative review of literature included broad search criteria within the
PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, and Scopus databases. Studies published in English
associating a breastfeeding outcome in relation to oxytocin use during the birth process were included. Twenty-six studies from 1978 to 2015 met
Results: Studies were analyzed according to the purpose of the research, measures and methods used, results, and confounding variables. The
26 studies reported 34 measures of breastfeeding. Outcomes included initiation and duration of breastfeeding, infant behavior, and physiologic
markers of lactation. Timing of administration of oxytocin varied. Some studies reported on low-risk birth, while others included higher-risk ex-
periences. Fifty percent of the results (17 of 34measures) demonstrated an association between exogenous oxytocin and less optimal breastfeeding
outcomes, while 8 of 34 measures (23%) reported no association. The remaining 9 measures (26%) had mixed findings. Breastfeeding intentions,
parity, birth setting, obstetric risk, and indications for oxytocin use were inconsistently controlled among the studies.
Discussion: Research on breastfeeding and lactation following exogenous oxytocin exposure is limited by few studies and heterogeneousmethods.
Despite the limitations, researchers and clinicians may benefit from awareness of this body of literature. Continued investigation is recommended
given the prevalence of oxytocin use in clinical practice.
J Midwifery Womens Health 2017;62:397–417 c© 2017 by the American College of Nurse-Midwives.
Keywords: active management third-stage labor, breastfeeding, drug effects, lactation, labor (induced), labor (obstetric), labor stage (third),
While increasing numbers of women are breastfeeding their newborns at birth, the ability to maintain breastfeeding may be affected by factors contributing to maternal milk pro- duction. This is reflected by the Centers for Disease Con- trol and Prevention (CDC) 2016 Breastfeeding Report Card, which shows that while 81.1% of women initiate breastfeed- ing after birth, only 44.4% of women are still exclusively breastfeeding at 3 months, falling to 22.3% of infants by the 6-month target.1 Common reasons for early cessation of ex- clusive or any breastfeeding is the perception of insufficient milk supply2,3 and the early introduction of formula.4,5 There- fore, factors that may influence physiologic milk production are compelling targets for translational research.
Understanding possible causes of suboptimal breastfeed- ing may have implications for improving maternal and in- fant health. Infants receiving formula or solid foods before 6 months of age are at increased risk for acute and chronic illnesses, as well as sudden infant death syndrome.6 The number of infant deaths potentially preventable by meeting breastfeeding goals are estimated upwards of 700 annually.7,8
Furthermore, a growing body of literature is examining the
Address correspondence to Elise N. Erickson, CNM, MS, Oregon Health & Science University, School of Nursing, 3455 SE US Veterans Hospital Rd, Portland, OR 97239-2941. E-mail: [email protected]
long-term effect of breastfeeding on maternal health. Women who have no breastfeeding history have poorer indices of car- diovascular health in later life.9 Another study used a simula- tionmodel to estimate the impact of suboptimal breastfeeding on many maternal health outcomes, reporting a potential an- nual excessmortality of 3340 deaths andmore than $14 billion in costs in the United States due to premature death.7
Milk production and successful breastfeeding require oxytocin-driven neuroendocrine pathways that are primed by pregnancy and the process of childbirth.10 Endogenous oxytocin function is essential for onset of lactation and milk ejection in mammals.11 Manipulation of oxytocin in experi- mental animal models can lead to deficits in lactation, ma- ternal behavior, and abnormal behavioral development of offspring.12,13 Oxytocin is commonly administered inmodern maternity care for labor augmentation, induction of labor,14
and to minimize or treat uterine bleeding in the third stage of labor.15 There is evidence that exogenous oxytocin can pass through the placenta and into fetal circulation.16 Therefore, depending on the timing of administration, this synthetic hor- mone and neurotransmitter could affect neonates as well as women.
The significance of these questions relate to the extensive use of oxytocin in practice. Estimates of induction of labor, typically involving exogenous oxytocin, range from 23% to 29% of births17,18 but may be in the range of 31% to 42% in
1526-9523/09/$36.00 doi:10.1111/jmwh.12601 c© 2017 by the American College of Nurse-Midwives 397
✦ Oxytocin administration during childbirth is widespread; few studies have investigated the effects of this on breastfeeding, and most of these have not directly studied the relationship.
✦ The effect of exogenous oxytocin on breastfeeding has been measured through infant breastfeeding behavior, physiologic lactation, maternal initiation, and duration or exclusivity of breastfeeding.
✦ While oxytocin administration has an important role in modern maternity care, potential effects on lactation should be explored more, as the research on breastfeeding outcomes is incomplete.
some settings, based onUSdata.19,20 Amongwomenwho start labor spontaneously, augmentation of labor with oxytocin due to slow progress is also frequent,20 though exact national rates are not published. Epidural analgesia is also associated with induced and augmented labor, with more than 75% of women using epidural analgesia undergoing induction or augmenta- tion, according to 2008 CDC data.21 During cesarean birth, accounting for 32.7% of births,18 oxytocin is administered af- ter extracting the placenta to slow bleeding.15 Finally, to help minimize bleeding, the World Health Organization (WHO) promotes prophylactic administration of oxytocin as the stan- dard of care following vaginal birth.15 It is also a mainstay treatment for postpartum hemorrhage.
Despite widespread use of oxytocin and the importance of the physiology of oxytocin for successful lactation, clinical studies have rarely explored long-term effects on women and infants, such as breastfeeding outcomes.22,23 The purpose of this integrative review is to understand 1) what breastfeeding outcomes (maternal or infant) have been reported following any clinical oxytocin administration and 2) any patterns in the published results to better inform future research.
An integrative approach described by Whittemore and Knafl informed the procedure for this review, as a preliminary litera- ture search revealed significant heterogeneity in methods and outcomes among relevant studies.24 We were unable to iden- tify articles synthesizing the body of literature regarding oxy- tocin administration in humans and breastfeeding outcomes. The complexity of this question is owed to both the various indications and timing of oxytocin use during the birth pro- cess and the multifactorial nature of breastfeeding and lacta- tion research outcomes. In an effort to capture all possible oxy- tocin administration during the birth process, our review in- cluded intrapartum oxytocin and/or third-stage labor admin- istration. Breastfeeding outcomes were defined as any mater- nal and infant breastfeeding-related measure.
Due to the exploratory nature of this investigation, the ap- proach included broad search terms and no limits on pub- lication date. We performed a Boolean search (as shown in Table 1) of PubMed Medical Subject Heading (MeSH) terms including: 1) “oxytocin,” “labor (induced),” “labor (obstet- ric),” “labor stage (third),” or “epidural analgesia”; and 2) “breastfeeding,” “feeding behavior,” “lactation,” or “lactation
(disorder),” yielding 1847 results after limiting to human studies. A duplicate search in the Cumulative Index to Nurs- ing and Allied Health Literature (CINAHL) yielded 268 cita- tions (“infant behavior” substituted for “feeding behavior”). A total of 2115 abstracts (including duplicates) were scanned for inclusion by 1) data-based studies published in English and 2) noting oxytocin administration and a breastfeeding outcome (maternal or infant). If a potential match did not mention oxytocin administration in the abstract, the full text was reviewed in detail. Induction of labor studies not evaluat- ing oxytocin specifically were excluded, as well as studies as- sessing infant bottle feeding. The resulting group consisted of 26 studies published between 1978 and 2015.
Significant heterogeneity in the study objectives, design, and outcomes complicated the evaluation of this body of litera- ture. Themajority of the studies were descriptive or secondary analysis reports (either prospective or retrospective); how- ever, one randomized controlled trial, 2 quasi-experimental studies, and 2 case-control studies also made up the sample.
While studies in this review considered oxytocin exposure during birth with at least one breastfeedingmeasure, most did not set out to study this relationship. Many noted the associ- ation between oxytocin and breastfeeding as a subanalysis of the primary aim or as a covariate or control for another objec- tive. We identified 3 groups of research objectives within the sample studies. Only 9 studies examined the effect of oxytocin use on breastfeeding. Four studies examined factors (general health and obstetric) associated with delayed lactogenesis and poor breastfeeding generally. In these reports, use of oxytocin was among many variables considered. The largest group of studies, however, sought to understand broad outcomes of specific obstetric interventions: epidural analgesia (n = 4), medication use (n = 3), active management of third-stage la- bor (AMTSL) (n = 1), or as part of an induction of labor (n = 5). These studies included a breastfeeding measure among other outcomes.
Time point of oxytocin administration varied among the studies, illustrated in Figure 1. The majority considered intra- partum oxytocin administration only. Four of these assessed the postpartum dose of oxytocin as well.25–28 Another 3 stud- ies mention that oxytocin was routinely given postpartum but was not included in the analysis in terms of exposure.29–31
Three other studies addressed the third-stage issue generally by reporting “increased need for postpartum uterotonics”
398 Volume 62, No. 4, July/August 2017
Table 1. Search Strategy for Oxytocin Use During Birth and Breastfeeding
Database Search Terms (MeSH and Keyword) Results
PubMed Oxytocin, labor (induced), labor (obstetric), labor stage (third),
epidural analgesia AND breastfeeding, feeding behavior, lactation,
Lactogenesis (keyword) 131 3
Labor (induced) AND oxytocin 1118 4
CINAHL Oxytocin, labor (induced), obstetric care, labor stage (third), epidural
analgesia AND breastfeeding, infant behavior, lactation, lactation
Lactogenesis 54 1
Labor (induced) AND oxytocin 125 0
Cochrane Induced labor AND breastfeeding 13 0
Active management (third stage) labor 1 1
Hand check of reference
Abbreviation: CINAHL, Cumulative Index to Nursing and Allied Health Literature.
Figure 1. Number of Studies by Time Point of Oxytocin Exposure
and Type of BreastfeedingMeasures Reported
MaternalMeasures of Breastfeeding (Initiation orDuration
of Breastfeeding, Physiology of Lactation).
Infant Measures of Breastfeeding (Infant Feeding
Both Maternal and Infant Measures.
Abbreviations: AOL, augmentation of labor; IOL, induction of labor; PP, postpartum prophylaxis.
(ie, oxytocin and other medications),32–34 or commenting on the relationship of postpartum hemorrhage and breastfeeding outcomes.35
Breastfeeding outcomes included maternal behaviors like initiation, duration of breastfeeding, measures of physio- logic milk production (eg, hormones, lactogenesis), and in- fant breastfeeding behavior. A total of 34 measures in the 26 studies were examined in relationship to oxytocin use as il- lustrated in Figure 2. Some studies reported more than one outcome in the findings. Due to the variety of study objec- tives, methods, and outcomes used in the sample, rigor of the studies was not evaluated by a standardized rubric or score. Instead, we addressed quality of the studies by assess- ing and synthesizing themes that may introduce bias or limit generalizability.
No primary study outcome associated oxytocin use with a more favorable breastfeeding outcome. Data were arranged into 3 categories: 1) use of oxytocin (intrapartum and/or post- partum) and a less optimal breastfeeding outcome, 2) no association, or 3) having mixed findings. Results were la- beled mixed if they were the subanalyses of the primary aim of the study or significance was seen in certain subgroups of the sample (ie, primiparas). Of the 34 measures reported in the studies, 50% found oxytocin use was associated with a less optimal breastfeeding outcome (n = 17). Mixed or qual- ified support of less optimal outcomes was reported by 26% (n = 9), and 23% showed no differences in breastfeeding out- comes with oxytocin use or not (n = 8). Table 2 lists the mea- sures, statistical data, and information about the study design and limitations.
Initiation of Breastfeeding
Eleven studies examined associations between breastfeeding initiation and oxytocin administration; 7 studies reported on initiation only.28,32,33,36–39 Initiation of breastfeeding was de- fined by various time points ranging from 10 minutes after birth through 7 days postpartum. An additional 4 studies re- ported duration measures as well as initiation measures of breastfeeding.30,40–42
Four of these 11 studies were generated from large data sets and controlled for multiple covariates in their analyses.28,32,33,36 Two noted delay in initiation of breastfeed- ing following induction of labor and elective induction of la- bor in Latin American countries.32,33 Another reported lower breastfeeding rates at hospital discharge following AMTSL in
Journal of Midwifery &Women’s Health � www.jmwh.org 399
Figure 2. Number ofMeasures by Direction of Findings Reporting Relationship Between Oxytocin Use and BreastfeedingOutcomes
Measures Showing Less Optimal Breastfeeding Outcome With Oxytocin Use.
Measures Reporting Mixed Findings: Less Optimal Outcome With Oxytocin Use in Subgroup Analysis.
Measures Reporting No Association Between Oxytocin and Breastfeeding.
theUnited Kingdom.28 In this study, after controlling formul- tiple intrapartum factors and examining a subgroup ofwomen with low-risk, physiologic labors, AMTSL was still associated with an approximate 7% reduction in breastfeeding at 2 days postpartum.
However, the study by Prendiville,39 the only random- ized controlled trial in the sample, did not find an as- sociation between AMTSL and breastfeeding at hospital discharge. This study is limited by a lack of fidelity to the ran- domization; only 403 of 849 participants allocated to physio- logic management had it performed. In addition, the physio- logic group was also more likely to put the newborn to breast 10 minutes after birth per midwives’ recommendation.
Brown and Jordan42 also did not find thatAMTSL affected rates of breastfeeding initiation in a self-report study of breast- feeding and administration of postpartum oxytocin.42 How- ever, they did report a reduction in duration of breastfeeding at both 2 and 6 weeks postpartum among participants who had AMTSL. The most often reported reasons for cessation were pain, difficulty, and embarrassment compared towomen who had physiologic management. This study did not control for prenatal intentions to breastfeed.
Altogether, the definition of initiation of breastfeeding was variable but appeared to reflect the first several postpar- tum days. Five papers associated delayed initiation of breast- feeding with induction or augmentation of labor compared to spontaneous labor or no augmentation (postpartum use not reported)30,32,33,37 or postpartum administration of oxytocin compared to expectant management.28 Mixed findings were reported in 3 studies.36,40,41
Duration of Breastfeeding
Eight studies examined duration of breastfeeding. This was defined as the time of breastfeeding cessation,25 report of ex- clusive breastfeeding at 3 months after birth,30,31 at 6 weeks postpartum,42,43 or breastfeeding at 8 weeks.26,40,41 Shorter duration or exclusivity of breastfeeding was associated with intrapartum oxytocin use by 4 studies compared to sponta- neous labor25,26,30,31 and with postpartum use in the study by Brown and Jordan.42 Two reports hadmixed findings ondura- tion of breastfeeding.40,43 One paper reported no difference.41
The total dosage of oxytocinwas examined in terms of du- ration of breastfeeding by 2 authors. Both Gu et al26 andOlza- Fernandez31 noted that higher levels of exposure to oxytocin during the birth process were associated with reduced exclu- sive breastfeeding at 2 and 3months postpartum, respectively. Additionally, the participants in the study by Dozier et al25
most likely to cease breastfeeding by one month postpartum were those with both epidural analgesia and oxytocin expo- sure during labor (HR, 1.34; 95% confidence interval [CI], 1.00-1.79).25 Women with epidural analgesia in this study were more likely to have oxytocin administered during labor (58.8% vs 38.3%, P � .01). Breastfeeding was not analyzed by total dosage specifically in this study, but this may imply that women with epidural analgesia had more need for oxytocin administration, possibly representing higher total dosage.
Physiology of Lactation
Eight studies examined breastfeeding as a measure of phys- iologic milk production. Six of these examined lactogenesis
400 Volume 62, No. 4, July/August 2017
Table 2. Studies Reporting an Association Between Synthetic Oxytocin Use and a BreastfeedingOutcome
Author, Year, Location Design Measures Results Limitations
Gu et al,26
Oxytocin Time Point
Intrapartum and postpartum
Mixed parity sample
Self-report: Exclusivity of
breastfeeding at 2 months
Plasma oxytocin levels at 2
N = 386
92% of women received oxytocin
Exclusively breastfeeding mothers at 2 months
postpartum had received significantly less oxytocin
during labor (33 units) when compared to formula
(44 units) or mixed feeding mothers (43 units)
(after controlling for education level) (P � .0001)
Physiology of Lactation
Circulating oxytocin at 2 months postpartum was
positively correlated to dosage given during birth
(Pearson, 0.16, P � .01)
Did not specify the rates of analgesia,
mode of birth, indication for
oxytocin use, or neonatal problems
Breastfeeding intention not reported
Did not control for parity or other
neonatal or obstetric issues in
Brimdyr et al,49
Oxytocin Time Point
Mixed parity sample
Widström’s 9 instinctive
stages of neonatal
N = 63
84% of women having oxytocin with or without
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