It is a new year, 2011, and with this new year begins JOGNN's 40th year of publication. A careful look at the cover will tell you that this is Volume 40, Issue 1. JOGNN is middle aged! Two years ago, the members of JOGNN's Editorial Advisory Board (EAB), the editorial staff, and JOGNN's publisher began planning for this significant milestone in the journal's history. Throughout the year, you will see the following:
- •In each issue of Volume 40 at least one article labeled “Then and Now” will follow the opening editorial. Each of these papers will be a contemporary look at a topic that appeared in a JOGNN article in 1972. The editors and the EAB reviewed the entire first volume and chose articles whose topics were relevant for a reprise. Various past and current members of the EAB have written these manuscripts and I hope you enjoy their efforts.
- •We will publish a 40th anniversary virtual (online only) issue in June. This issue is planned as a compilation of classic JOGNN articles chosen by individuals who have served on JOGNN's EAB. The articles will represent the best of the journal over the years and articles that have made enduring contributions to the literature. Although this issue will not be printed, it will be specially packaged on the JOGNN website and announced to all subscribers.
- •A birthday party is planned for the 2011 AWHONN convention so that all who attend can gather to celebrate the past and the future of JOGNN and its role in leading nursing scholarship for the care of women, infants, and childbearing families. We hope to see many of you there.
Journals have life because of the researchers and clinicians who contribute their manuscripts; the individuals who serve the journal on the EAB, as reviewers, and as editors and staff; the publisher who shepherds the journal's production and promotion; and the readers who use the information to inform and improve the care of women, infants, and childbearing families. We all share in JOGNN's success, and I encourage you also to enjoy our celebration.
To help us appreciate the health care world into which JOGNN was born 40 years ago, I have taken a look back at maternity care in 1972 as I experienced and remember it. I was there as a staff nurse in my third year of labor and delivery nursing. I remember seeing this new journal at the hospital and being drawn to its pages. Let me tell you a bit about maternity care in 1972.
I worked evenings (3–11) in labor and delivery at a relatively young hospital in the far western suburbs of Chicago: Central DuPage Hospital (CDH) in Winfield, Illinois. Although it is now a major medical center serving several of Chicago's western suburbs, in 1972 CDH was a small community hospital with a busy maternity unit. We had three small private labor rooms, two hall labor beds with surrounding curtains for overflow that were frequently needed, and two delivery rooms. The hospital's operating rooms for Cesarean deliveries and postpartum tubal ligations were through a connecting door in the back hallway. We also had a small nurses' station with an attached storage room, a utility room where we washed and wrapped instruments, and two small locker rooms for the nurses (all female) and the physicians (all male). The nurses wore white scrub dresses with white hose and shoes, and the physicians white scrub suits. Our patient volume was in excess of 150 births per month and constantly on the rise. We had an electronic fetal monitor or two in a closet, new mechanical infusion pumps to regulate intravenous (IV) flow, glass thermometers, and manual sphygmomanometers. We charted on a labor and delivery flow sheet with about seven columns if my memory serves me correctly: time, fetal heart rate, contraction frequency, contraction duration, contraction strength, and notes. We charted blood pressure, temperature, pulse, and respiration on a separate vital signs graphic record. Any interventions, such as giving medications or starting an IV were recorded in the notes column. We only started IVs if the woman needed oxytocin, was being prepared for surgery, or had a history of postpartum hemorrhage.
Although we were still shaving a woman's labia and perineum in preparation for delivery on admission, we were not giving admission enemas, which were common in many hospitals. We were also ahead of the curve in allowing women with ruptured membranes to be out of bed if the fetal head was well applied to the cervix. Vaginal birth after Cesarean was unheard of, but we regularly did frank breech vaginal births and vaginal deliveries of multiples. I remember one evening when a tall nulliparous woman pregnant with triplets and in labor walked in. Her babies were born later on our shift, and each weighed more than 5.5 pounds. I also remember those “surprise” twins that would occasionally occur and the experience of helping the mother and father understand that we were not kidding when we told them there was another one!
Although we sometimes used meperidine with phenergan or vistaril for analgesia during labor, women most commonly received a paracervical block if needed during labor and pudendal block for birth. Unfortunately, episiotomy (usually a midline) was the norm. We also used IV alcohol for suppression of preterm labor, an approach that left women with incredible hangovers. Perinatal regionalization had occurred in Illinois so we sometimes transferred women with preterm labor and some other high-risk complications into Chicago prior to birth, although more commonly, the baby was transferred after birth. There were tragic outcomes such as stillbirths due to the mother's type I diabetes or Rh isoimmunization and resulting hydrops fetalis in the fetus. Fetal chromosomal and developmental anomalies most often were identified at birth.
Our staff nurses and physicians (obstetricians and family practice) were a fairly agreeable, flexible group. We had been welcoming fathers or another support person into the delivery room for several years and actively supported breastfeeding as best we knew how including putting the baby to breast in the delivery room, although this practice was very nurse dependent. We had many patients who had taken community-based Lamaze classes usually taught in the home of an independent Lamaze instructor. Although the fathers were able to hold their newborns in the delivery room, once mother and baby moved around the corner to postpartum and the newborn nursery, the fathers were unable to be present when the babies were in the mothers' rooms. This was an unfortunate inconsistency in our care, and I remember working hard to implement family-centered care and rooming-in on postpartum, an effort that was not totally successful. Mothers and babies were usually hospitalized for 3 days after a vaginal birth and 5 to 7 days after Cesarean delivery. The criterion for maternal discharge was that she had produced a bowel movement!
On the evening shift we had two registered nurses for labor and delivery with no unit secretary or housekeeping support. We cleaned our own rooms including labor rooms and delivery rooms and washed and wrapped our instruments before sending them to central supply for autoclaving. I remember one evening quite vividly when we had nine births in 8 hours with no multiples! I recall it as exhausting but truly fun. When we were busy in the two delivery rooms, we opened the doors and told the laboring families to either come get us or yell loudly if they needed us. Our house nurse supervisor pitched in as best she could, someone brought us food from the cafeteria, a nursing assistant from another unit came to clean rooms, physicians checked on patients who were not their own, and one of our physicians mopped floors. At the end of the evening, our utility room was so full of stacked instrument basins and bags of trash that you could barely get in it. I truly believe that despite the chaos, each family felt well cared for and that their baby's birth had been celebrated. It seems fairly simple and straightforward when I look back.
Newborn care was different too. Baby boys were circumcised in the delivery room, and babies were weighed in the newborn nursery. Although we kept mother and baby together in the delivery room and transferred them with the baby in the mother's arms, they were separated when we reached the nursery. After the baby's admission to the nursery, he or she was usually returned to the nursery after each feeding. Sterile water only feedings for the first 12 hours after birth were common, and water or formula supplements after breastfeeding the norm. Mothers rarely changed their babies' diapers in the hospital or had their babies in their rooms throughout the night. The babies were confined to the nursery during visiting hours, were bathed daily and went home by car in their mothers' arms.
There was no continuous electronic fetal monitoring or routine IVs, no Group B beta-hemolytic streptococcus screening or newborn Hepatitis vaccine, no epidurals or Cesarean delivery on request, no newborn security systems or visitor identity checks, no self-glucose monitoring or routine ultrasound, no in vitro fertilization or fetal anomaly screening, no pulse oximetry or surfactant therapy, no managed care or payer controlled lengths of stays, no obstetric anesthesiologists or lactation consultants, no HIPPA or electronic medical records, and the list could go on. It was a different world.
One thing has not changed: the mothers and the babies were the main point. Our goal was to do whatever we could, to the best of our knowledge and skills at the time, to protect and promote the health and well-being of mothers and babies, one mother and baby at a time. This it still the case, and I predict that in yet another 40 years, the same will be true despite whatever social, medical, or technological changes occur. My hope is that JOGNN will still be helping to lead the way by providing the clinical research and scholarship to inform and support nursing care of women, infants, and childbearing families.