Introduction Although breastfeeding has been shown to improve health outcomes for infants, African American women initiate and continue breastfeeding at lower rates than women from other racial groups. This scoping review was conducted to assess the effect racism, bias, and discrimination have on breastfeeding care, support, and outcomes for African American women. Methods A scoping review was performed of the literature published between January 2010 through December 2019 using databases MEDLINE via PubMed, CINAHL, Cochrane Library, PsycINFO, and Sociological Abstracts. Studies that examined racism, bias, or discrimination with breastfeeding as an outcome were included. After a review of titles and abstracts of the articles using exclusion and inclusion criteria, 5 full‐text articles were included in the scoping review. Results The qualitative and quantitative studies reviewed provide the perspectives of pregnant and postpartum African American women as well as those of health care providers. African American women's experiences of racism adversely affected both breastfeeding initiation and duration. Health care providers’ biased assumption that African American women would not breastfeed affected the quality of breastfeeding support provided to them. Specifically, African American women received fewer referrals for lactation support and more limited assistance when problems developed. This scoping review provides evidence that African American women experience racism, bias, and discrimination affecting breastfeeding care, support, and outcomes. Discussion Racism, bias, and discrimination are modifiable barriers that adversely affect breastfeeding among African American women. Researchers and health care providers are encouraged to consider the effect of racism, bias, and discrimination on breastfeeding care, support, and outcomes.

Despite evidence of adverse fetal and maternal outcomes from the use of sustained Valsalva bearing down efforts, current second‐stage care practices are still characterized by uniform directions to “push” forcefully upon complete dilatation of the cervix while the woman is in a supine position. Directed pushing might slightly shorten the duration of second stage labor, but can also contribute to deoxygenation of the fetus; cause damage to urinary, pelvic, and perineal structures; and challenge a woman's confidence in her body. Research on the second stage of labor care is reviewed, with a focus on recent literature on maternal bearing down efforts, the “laboring down” approach to care, second‐stage duration, and maternal position. Clinicians can apply the scientific evidence regarding the detrimental effects of sustained Valsalva bearing down efforts and supine positioning by individualizing second stage labor care and supporting women's involuntary bearing down sensations that can serve to guide her behaviors.

The quality of the studies in this systematic review varied. Although clinical practice recommendations were limited by the strength of evidence, probiotic interventions were effective in treatment and prevention of urogenital infections as alternatives or co-treatments. More good quality research is needed to strengthen the body of evidence needed for application by clinicians.

BACKGROUND Reduced monocyte function is associated with adverse outcomes from critical illness. PRBC are thought to impair monocyte function but relationships between PRBC storage solution and monocyte suppression are unknown. This study was designed to test the hypothesis that immunosuppressive effects of PRBC on monocytes are related to both storage time and preservative solution. STUDY DESIGN AND METHODS Monocytes from healthy adult donors were co-cultured with PRBC that had been stored in AS-1, AS-3, or CPD-only for 7, 14, or 21 days. Cells were then stimulated with LPS and their supernatants assayed for TNFα and IL-10. Transwell experiments were performed to evaluate the role of cell-to-cell contact. Monocyte mRNA expression was quantified by RT-PCR. RESULTS LPS-induced TNFα production capacity was reduced compared to controls for all groups, but CPD-only PRBC suppressed monocyte function more than PRBC stored in AS-1 (p = 0.007) and AS-3 (p = 0.006). IL-10 production was preserved or augmented in all groups. Longer storage time was associated with reduced TNFα production capacity for AS-1 and AS-3 groups but not CPD. Preventing cell-to-cell contact did not eliminate the inhibitory effect of PRBC on monocyte responsiveness. PRBC exposure was associated with decreased LPS-induced TNFA mRNA expression (p < 0.05 for all groups). CONCLUSIONS CPD-only PRBC suppressed monocyte function more than PRBC stored with additive solutions. TNFα production was reduced even in the absence of cell-to-cell contact and was impaired at the mRNA level. Further work is needed to understand the role of preservative solutions in this process.

Prenatal probiotic therapy has the potential to reduce GBS colonization. The potential of the probiotic intervention appears to be linked to daily adherence. A controlled clinical trial with a larger, adequately powered sample is feasible and justified.