Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Lois Howland, DrPH, RN; Jeffrey B. Gould, MD, MPH


maternal care, maternal outcomes, morbidity, nursing, Postpartum, risk factors, women


Although maternal deaths are the most tragic of obstetric events it continues to be a rare event. Maternal morbidity, on the other hand, is increasing and poses a greater impact on the economic, psychological, and physical health of the woman and her family, yet it has not been the focus of measurement or research since there is no systematic collection of data available. As complications increase, the likelihood of adverse maternal outcomes such as longer postpartum stays due to the need for more extensive care will also increase. Nurses are being challenged to use their knowledge and skills to identify potential factors that may cause injury or harm to the patient. The earlier these factors are recognized the better the nurse can initiate the decision making process to mitigate the risk. In order to adequately address the topic of risk-appropriate maternal care, three aims were developed and met through literature review, concept analysis, and data collection. This entire body of work aimed to describe the evolution of regionalization and its effect on maternal risk-appropriate care, clarify the meaning of risk and explore implications for practice, and identify the relationship between selected risk factors and an extended length of stay. The work is presented as three manuscripts. The first manuscript "Perinatal Regionalization: Changing Trends in Maternity Care" describes the evolution of regionalization, discusses the trends and practice changes that influenced the present day perinatal arena, and provides recommendations for an improved system of care. The second manuscript "Understanding the Concept of Maternal Risk during Pregnancy" provides an analysis of the concept of risk, clarifies the meaning of risk, and explores implications for practice as well as future research of this concept. The third manuscript "Mothers at Risk: Factors Effecting Maternal Length of Stay" describes the maternal risk factors identifiable during pregnancy, delivery, or postpartum that have the greatest odds of increasing postpartum length of stay in order to support the development of maternal risk-appropriate care. As previous studies indicate, many of the high-risk factors prompting adverse maternal outcomes are identifiable prior to delivery. An understanding of these risks can help identify measures to be taken to minimize their effect. The study findings provide needed evidence to develop policies on early identification and appropriate care to decrease risk.

Document Type

Dissertation: Open Access



Included in

Nursing Commons