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Stacey E. Iobst, Phd, RN [email protected]

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Stacey E. Iobst, Phd, RN Siobst@Gmail.Com Factors Influencing the Use of Labor Management Interventions and Their Effect on Cesarean Birth Item Type dissertation Authors Iobst, Stacey Elaine Publication Date 2018 Abstract Background: The cesarean birth (CB) rate of 31.9% in the US is concerning because the procedure is associated with increased maternal mortality as well as increased maternal and neonatal morbidity. Women considered low-risk for CB are defined as null... Keywords cervical dilation; intrapartum interventions; low-risk pregnancy; NTSV; Cesarean Section; Labor, Obstetric Download date 30/09/2021 10:30:19 Link to Item http://hdl.handle.net/10713/7939 Stacey E. Iobst, PhD, RN [email protected] EDUCATION Doctor of Philosophy 5/18 University of Maryland, Baltimore Baltimore, Maryland Teaching Certificate, Nursing and Health Professions 12/17 University of Maryland School of Nursing Baltimore, Maryland Bachelor of Science, Nursing, Magna Cum Laude 5/07 University of Maryland School of Nursing Rockville, Maryland Bachelor of Arts, Biology 5/00 St. Mary’s College of Maryland St. Mary’s City, Maryland LICENSURE Licensed Registered Nurse, Maryland Board of Nursing, R181555 Exp. 1/20 CERTIFICATIONS National Certification Corporation, ID104361835 Inpatient Obstetrics (RNC-OB) Exp. 6/19 Electronic Fetal Monitoring (C-EFM) Exp. 9/20 American Heart Association, Basic Life Support Exp. 2/19 American Academy of Pediatrics, Neonatal Resuscitation Exp. 7/18 WORK EXPERIENCE Clinical Nurse Holy Cross Hospital, Silver Spring, Maryland Labor and Delivery Unit 7/10 to date Women’s Surgical Unit 4/08-7/10 Clinical Nurse Georgetown University Hospital, Washington, D.C. Medical Intensive Care Unit 8/07-4/08 Guided Study Session Tutor University of Maryland School of Nursing, Rockville, Maryland Center for Academic Success 8/06-12/06 Research Associate III The Institute for Genomic Research (TIGR), Rockville, Maryland 1/01-12/05 HONORS AND AWARDS Research Institute Trainee Award-2017 Annual Meeting 10/16 Patient-Centered Outcomes Research Institute Washington, D.C. Star of the Quarter 6/09 Holy Cross Hospital, Silver Spring, MD Alumni Association Award for Leadership 5/07 University of Maryland School of Nursing, Baltimore, MD ORGANIZATIONAL MEMBERSHIPS Graduate Nursing Student Academy (GNSA) Washington, D.C. Liaison to AACN Task Force-Defining Scholarship in Academic Nursing 2/17-8/17 Leadership Council Member 8/15-8/17 Doctoral Student Organization, University of Maryland School of Nursing Baltimore, Maryland PhD Curriculum Committee Representative 8/17 to date First Year PhD Program Representative 8/15-5/16 Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) Member ID36761720 6/13 to date Maryland Section Social Media Editor 11/16 to date Montgomery County, Maryland Chapter Co-Coordinator 11/16 to date Holy Cross Hospital Nursing Practice and Education Council Silver Spring, Maryland Co-Chair, Nursing Division 5/10-1/11 Secretary, Nursing Division 12/09-5/10 Chair, Women’s Surgical Unit 1/08-7/10 Sigma Theta Tau International Nursing Honor Society Pi Chapter Induction, Member ID 0521112 5/07 University of Maryland School of Nursing Student Government Association Universities of Shady Grove Campus, Rockville, Maryland Vice President 8/05-5/07 PRESENTATIONS Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) Oral Presentation: “Shared Decision Making for Elective Induction of Labor” 10/17 Maryland Section Conference, Baltimore, Maryland Poster: “Shared Decision Making for Induction of Labor” 6/17 National Conference, New Orleans, Louisiana University of Maryland School of Nursing Baltimore, Maryland Three-Minute Thesis Competition (3MT) 11/16, 02/18 FUNDING Future of Nursing Scholar 8/15-5/18 Robert Wood Johnson Foundation at Johnson and Johnson, Inc., $75,000 University of Maryland School of Nursing, $50,000 matching funds Doctoral Student Grant Award 7/17-6/18 Sigma Theta Tau International, Pi Chapter, $1,500 Donor Scholarships Frank and Robin Newhouse Scholarship, $1,035 10/17 Dean Janet D. Allan Scholarship, $1,000 11/17 PUBLICATIONS (*Indicates data-based) Published Manuscripts: *Iobst, S. (2017). Shared decision making for induction of labor. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 46(3), S47. *Jakubovics, N., Gill, S., Iobst, S., Vickerman, M., Kolenbrander, P. (2008). Regulation of gene expression in a mixed-genus community: stabilized arginine biosynthesis in Streptococcus gordonii by coaggregation with Actinomyces naeslundii. Journal of Bacteriology, 190(10), 3646-3657. *Vickerman, M., Iobst, S., Jesionowski, A., Gill, S.R. (2007). Genome-Wide Transcriptional Changes in Streptococcus gordonii in Response to Competence Signaling Peptide. Journal of Bacteriology, 189(21), 7799-7807. *Rensink, W., Iobst, S., Hart, A., Stegalkina, S., Liu, J., Buell, C. (2005). Gene expression profiling of potato responses to cold, heat, and salt stress. Functional Integrative Genomics, 5(4), 201-207. *Rensink, W., Lee, Y., Liu, J., Iobst, S., Ouyang, S., Buell, C. (2005). Comparative analyses of six solanaceous transcriptomes reveal a high degree of sequence conservation and species-specific transcripts. BMC Genomics, 6(1),124. *The International Rice Genome Sequencing Project. (2005). The map-based sequence of the rice genome. Nature, 436, 793-800. *The Rice Chromosome 10 Sequencing Consortium. (2003). In-depth view of structure, activity, and evolution of rice chromosome 10. Science, 300(5625),1566-1569. Abstract Dissertation Title: Factors Influencing the Use of Labor Management Interventions and Their Effect on Cesarean Birth Stacey E. Iobst, Doctor of Philosophy, 2018 Dissertation Directed by: Meg Johantgen, PhD, RN Associate Professor Associate Dean of the PhD Program University of Maryland School of Nursing Background: The cesarean birth (CB) rate of 31.9% in the US is concerning because the procedure is associated with increased maternal mortality as well as increased maternal and neonatal morbidity. Women considered low-risk for CB are defined as nulliparous and pregnant with a term, singleton gestation in the vertex position (NTSV). Even among NTSV women, cesarean rates range from 2.4% to 36.5% across hospitals, suggesting that CB may be influenced by differences in practice patterns, including admission triage, the use of labor management interventions (e.g., amniotomy, epidural analgesia, and oxytocin augmentation), and availability of a laborist. Purpose: The following were examined in three manuscripts: (1) influence of cervical dilation at admission on labor management and CB, (2) influence of provider and hospital characteristics on labor management and CB, (3) influence of combinations of labor management interventions on likelihood of CB. Methods: All three manuscripts were cross-sectional, observational studies of NTSV women with spontaneous onset of labor whose births occurred from 2002-2007 at hospitals included in the National Institutes of Health Consortium on Safe Labor. Samples sizes varied due to missing data but ranged from 17,443 to 26,259. Generalized linear mixed modeling was used to account for the effects of hospital and provider clusters. Results: Greater dilation at admission (>6 cm) was associated with a lower likelihood of receiving all three interventions (RR 0.40, CI95 0.35-0.46) and a lower likelihood of CB (4-5 cm: RR 0.44, CI95 0.40-0.49; >6 cm: RR 0.20, CI95 0.17-0.24). Midwives were more likely to use no interventions compared to obstetrician/gynecologists (RR 1.81, CI95 1.50-2.19). Women delivering at hospitals with an as-needed laborist available had a greater likelihood of receiving no interventions (RR 4.27, CI95 1.43-12.70) compared to those at hospitals with a 24/7 laborist. Compared to no interventions, use of all three interventions was associated with an increased likelihood of CB (RR 1.84, CI95 1.53- 2.21). Conclusion: Admitting women at more advanced cervical dilation may reduce the use of labor management interventions and CB. The combined use of labor management interventions should be considered carefully given the association with an increased likelihood of CB. Factors Influencing the Use of Labor Management Interventions and Their Effect on Cesarean Birth by Stacey E. Iobst Dissertation submitted to the Faculty of the Graduate School of the University of Maryland, Baltimore in partial fulfillment of the requirements for the degree of Doctor of Philosophy 2018 © Copyright 2018 by Stacey E. Iobst All rights Reserved This dissertation is dedicated to the many inspirational women who have motivated me to persist in fighting the good fight. iii Acknowledgements I would like to acknowledge the Robert Wood Johnson Foundation (RWJF) and Johnson and Johnson, Inc., for providing the support necessary to complete my PhD in three years. I was committed to the RWJF Future of Nursing Program the moment I learned of their goal to increase the number of PhD-prepared nurses in order to bring transformational change to healthcare in the United States. I am grateful especially to Dr. Sue Hassmiller, Dr. Julie Fairman, and Heather Kelley-Thompson, for their unwavering support and mentorship throughout my PhD program. I am grateful to the members of my dissertation committee for supporting me along this journey. Many thanks to my dissertation chair, Dr. Meg Johantgen, for obtaining support from the RWJF and for spending countless hours working with me to develop and defend my dissertation. Dr. Johantgen, I strive to someday be an educator and researcher of your caliber. Your patience and dedication
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