- Email: [email protected]
The Use of Automobile Safety Restraint Systems during Pregnancy
clinical studies The U s e of Automobile Safety Restraint Systems during Pregnancy TERRY L. HAMMOND, MAJOR, NC, USAF, BRENDA .E MICKENS-POWERS, MAJOR, NC, USAF, KAREN STRICKLAND, RNC, MSN, AND GARY D. V. HANKINS, LTCOL, MD, USAF The American Medical Association's Committee on Medical Aspects of Automobile Safety recommends that pregnant women use seat belts. Currently, all military installations, 39 states, and the District of Columbia mandate varying degrees of seat belt usage. A survey was conducted to evaluate seat belt usage in the antepartum population at the Wilford Hall United States Air Force Medical Center. Eighty-eight percent of the respondents used automobile safety restraints 100% of the time when driving, and 90% of the respondents used automobile safety restraints 100% of the time when riding as a passenger. Twenty-three percent, however, were uninformed or misinformed about seat belt safety procedures and practices during pregnancy. Increased education regarding seat belt safety would be beneficial to this population.
Thirty-nine states, the District of Columbia, and all military installations have enacted laws with various requirements for the mandatory use of automobile safety restraints (Table 1). According to studies done by t h e National Highway Traffic Safety Administration, use of automobile safety restraints would reduce fatalities and injuries by 50-65%,' which could translate into 12,000-15,000 lives saved annually in the United States alone. Nonetheless, research indicates that only approxThe opinions expressed in this manuscript are those of the authors and not necessarily those of the United States Air Force or the Department of Defense. Accepted: July 1989
19:4 July/August 1990 JOCNN
imately 43.4% of Americans currently use automobile safety restraints.' LITERATURE REVIEW
In December 1983, the American College of Obstetricians and Gynecologists (ACOG) issued a technical bulletin on the use of automobile passenger safety restraints for children and pregnant women. ACOG reported that, although women a r e more likely t o use safety belts than men, during pregnancy those same women decrease seat belt use because of concern that the belt may result in increased fetal injuries or deaths3 In another study, Crosby and Costiloe found that, of 441 pregnant women involved in automobile ac-
cidents, only 14%were using their safety belts at the time of the accident~.~ Crosby and Costiloe also found that, among unbelted pregnant women involved in severe collisions, the maternal death rate was 33% for those who were ejected from the car and 5%for those who were not e j e ~ t e dThe . ~ fetal death rate was 47% when the pregnant women were ejected and 1 1 % when they were not e j e ~ t e d . ~ Therefore, the mother and fetus are at less risk when the mother is wearing a seat belt. Nonetheless, injury may occur when seat belts a r e worn. The leading cause of maternal and fetal morbidity and mortality from severe collisions when pregnant women are wearing seat belts are abruptio placen339
Table 1. Seat Belt Usage Laws by Coverage and State (Total of 39 States plus the District of Columbia)
All Occupants
California Montana Nevada Washington Wisconsin
Front Seat, Rear Seat Passengers under 2 Years Old Colorado Connecticut District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Louisiana Maryland Michigan Missouri New Jersey North Carolina Ohio Oklahoma Pennsylvania South Carolina Tennessee Texas Utah Virginia Wyoming
Front Seat, Rear Seat Passengers under 10 Years Old Kansas Minnesota New Mexico New York
Children to 16 Years of Age Maine Mississippi New Hampshire Oregon Rhode Island West Virginia
Correct use of automobile safety restraints could save 12,000-1 4,000 lives annually in the United States alone. METHODOLOGY
Source: Texas Coalition for Safety Belts, Austin, Texas, February 1990.
tae, maternal shock, and direct PURPOSE fetal skull injury. These injuries occur secondarily t o the jackknifelike body flexion and abdomiOn Christmas Eve in 1986, one of our antepartal patients was innal compression caused by the volved in a motor vehicle acci“second collision” effect and perdent. Because she was not wearing haps are exacerbated by the use of the lap belt alone. The use of a a seat belt, she was thrown from her vehicle and expired in transit three-point safety restraint system to the hospital from internal injumay minimize such injuries. Notries with hemorrhage. Touched by withstanding, researchers generthis tragedy, we undertook t h e ally agree that the leading cause of survey presented here to deterfetal death in an automobile accimine the need for education on dent is the death of the mother seat belt usage in pregnancy so and that fetal injury is closely related to the extent of maternal in- that similar tragedies might be averted in the future. The survey jury. Since pregnant women wearwas designed to assess the impact ing seat belts suffer fewer injuries of pregnancy, previous auto acciand deaths than those not wearing dents, ongoing public awareness seat belts, health-care providers campaigns, mandatory Departshould emphatically recommend seat belt usage during p r e g n a n ~ y . ~ ment of Defense (DOD) require~
340
ments, and the recently instituted Texas seat belt law on the pregnant population at the Wilford Hall United States Air Force (USAF) Medical Center, Lackland Air Force Base, in San Antonio, Texas. After the available data were assessed, the need for prenatal education and counseling could be determined, as well as the willingness of the sample pregnant population to use automobile safety restraint systems.
~
~
~
From February through April 1987, a two-page questionnaire was placed in the obstetric records of all women receiving prenatal c a r e a t t h e Wilford Hall USAF Medical Center. T h e res p o n d e n t s completed and returned the forms to the obstetric check-in desk as they were waiting to be seen for their scheduled appointments. The questionnaire, which took two to five minutes to complete, consisted of 12 questions that required simple “yes,” “no,” o r numerical responses. T h e study was closed after 12 weeks, when all patients in the system would have had a minimum of three scheduled appointments and been afforded ample opportunity t o complete their questionnaires. Approximately 1,200 survey sheets were distributed, and 725 patients completed the survey. RESULTS
The demographics of the pregnant women surveyed on automo-
19:4 July/August 1990 JOGNN
bile safety restraint usage during pregnancy a r e summarized in Table 2. The distribution of maternal age and pregnancy trimester are similar to those of the overall pregnant population of the United States. Survey results indicated that 88% of the respondents used automobile safety restraints 100% of the time when they were driving and 90% of the respondents used automobile safety restraints 100% of the time when they were passengers (Table 3). Furthermore, 92%of the respondents requested passengers in their cars t o use safety belts.
I
Eighty-eight percent of the 725 rewondents used seat 1 belts when driving. Various factors influencing the use of automobile safety restraints were analyzed. DOD's law instituting mandatory use of automobile safety restraints on all military installations was a positive factor for 432 respondents (60%). Next in order of influence on seat belt usage was t h e newly instituted Texas seat belt law, which positively influenced 384 respondents (53%). The fact that respondents
Table 2. Demographics of Pregnant Women Surveyed on Automobile Safety Restraint Usage during Pregnancy
Age (years)
15-19 20-24 25-29 30-34 235
80 283 21 1 120 31
11.0 39.0 29.1 16.6 4.3
128 270 271 56
17.7 37.2 37.4 7.7 -
Trimester
1 2 3 No response N = 725.
19:4 July/August 1990 JOGNN
Table 3.
Automobile Safety Restraint Usage during Pregnancy As Driver
Percentage of Time
n
100 75 50 25 0
638 29 7 3 9 39
No response N
=
As Passenger O/O
88.0 4.0 1 .o 0.4 1.2 5.4
n
YO
655 34 19 6 5 6
90.4 4.7 2.6 0.8 0.7 0.8
725.
were pregnant positively influenced safety restraint usage in only 220 respondents (31%) and actually exerted a negative influence on nine respondents (1.2%). Two hundred fifty-five of the respondents had been involved previously in automobile accidents; 50 were pregnant at the time, and 43 of those 50 (86%) were wearing seat belts. Fifty-six percent (142) of the group of respondents that had previously had accidents stated that the accidents had played positive roles in their subsequent decisions to wear seat belts.
I
Twenty-two percent of the respondents wore their seat I belts incorrectly. Only 42% (305) of the respondents had been counseled by any obstetric health-care provider as to the advisability and proper technique for wearing a seat belt while pregnant. Of the respondents who used seat belts, 22% wore them incorrectly, with the lap belt positioned either across the midabdomen or high over the top of the uterus (Table 4). Of particular interest is that a significant number of women did not answer questions dealing with the potential effect of the safety restraint on the fetus (20%) or the proper po-
sitioning of the belt around the pregnant abdomen (18%). Possibly, the respondents were confused about t h e questions o r lacked knowledge of the topics. The majority of the respondents (91%) believed that seat belts would provide protection for the mother. Similarly, 481 (83%) of the 579 women who responded to the question about the impact of wearing a seat belt on the fetus believed that the fetus would be less likely to be injured. Noteworthy is that 83 (14%) of the women who responded to the question believed that the use of seat belts would increase the risk of injury to the fetus (Table 5).
DISCUSSION The results of this survey indicate a high degree of compliance in the use of automobile safety restraints by pregnant women. Furthermore, the study indicates that several areas exist in which the heal t h-care provi de r -w he t her
Table 4. Positioning of Lap Belt Portion of Safety Restraints during Pregnancy Position of Lap Belt
n
Over abdomen (high) Across abdomen (umbilicus) Under abdomen (low)
37 96 462
N
=
O/O
6.3 16.1 77.6
595.
34 1
Table 5.
Perceived Impact of Seat Belt Usage during Accident
To Pregnant Woman n
YO
To Fetus n
YO
Less likely injured More likely injured No impact
530 43 11
7.3 1.9 -
481 83 15 -
83.1 14.3 2.6 -
Total response
584
100
579
100
a nurse practitioner, nurse-midwife, or physician-can have a positive impact on the use of safety restraints. Only 42% (305) of the respondents had been counseled on either the advisability or the correct use of seat belts during pregnancy. One hundred thirty-three (22%) of the respondents who were using safety restraints were wearing them incorrectly. An additional five to nine respondents (1%) were not using seat belts at all. Therefore, a total of 138-142 respondents (23%) (those women who either were not using their seat belts at all or were using them incorrectly) were susceptible t o injury to themselves or their fetuses. Furthermore, more than 14% (83) of the respondents mistakenly believed that the use of safety restraints would predispose the fetus to injury should a n accident occur, while another 2.6% (15) believed that safety restraints would have no effect at all on the fetus.
90.8
Pregnant women need to be educated on the proper use of seat belts. high compliance in the use of automobile safety restraints: of the respondents to the questionnaire, 88%wore seat belts regularly during pregnancy. This level of compliance is primarily a result of strictly enforced driver and passenger seat belt usage on all military facilities, together with the fact that one would be unlikely to remove these safety devices after driving off base. Additionally, the state of Texas adopted a mandatory seat belt law for both drivers and passengers, which became effective in 1986. Nonetheless, while base regulations and Texas state law had the greatest influence on respondents, 31% of the sample were positively influenced to wear seat belts in an effort to protect themselves and their fetuses.
seat belt use (Figure 1) and explaining the potential benefits and risks of using seat belts. 2. Posters like Figure 1 should be displayed prominently in obstetric waiting areas. 3. Health-care providers should be encouraged to counsel their pregnant patients at least once on the use of automobile safety restraints and to note such counseling on the obstetric records. The major impact of this study is in helping improve the nursing and medical professions’ awareness of the many misconceptions that obstetric patients have concerning t h e use of automobile safety restraints. The study indicated that a significant number of pregnant patients were not wearing seat belts or were not wearing them correctly. Through patient education, nurses can correct patients’ misconceptions concerning the use of seat belts, help improve seat belt use in the pregnant popu-
I
I
WHMC MATERNITY
PROTECT YOURSELF A N D YOUR BABY ALNAYS B U C k L E UP’
NURSING IMPLICATIONS
Mandated seat belt use on all military installations had the greatest influence on the compliance rate of the respondents.
I
The ACOC technical bulletin published in December 1983 states that only 14% of pregnant women were using passenger restraint devices in 1971.3 By contrast, the current study has found
342
Based on t h e findings of the survey, recommendations are as follows: 1. When conducting prenatal orientation classes, nurses should instruct the pregnant women in the advisability, as well as t h e correct use, of automobile safety restraint systems. Nurses can easily accomplish this within two minutes or less, using diagrams showing proper
Figure 1. Proper seat belt usage for pregnant women. From the Department of the Air Force, Headquarters Joint Military Medical Command-San Antonio (ATC), Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas. Used with permission.
19:4 July/August 1990 JOCNN
burg, Pennsylvania: Keystone Auto Club. 3. American College of Obstetricians and Gynecologists (ACOG). 1983. Automobile Passenger Restraints for Children and Pregnant Women. Technical Bulletin 74. Washington, D.C.: ACOC. 4. Crosby, W.M., and J.P. Costiloe. 1971. Safety of lap-belt restraint for pregnant victims of automobile I Med. 284532collisions. N Engl . 36. 5. American College of Obstetricians and Gynecologists (ACOG). 1983. Seat Belt Use during Pregnancy. Washington, D.C.: ACOG.
lation, and, potentially, help save maternal and fetal lives. CONCLUSIONS
Seat belt usage is imperative for both the pregnant and the nonpregnant patient. However, if a seat belt is worn incorrectly, the belt may produce injury. As nurses, we are in excellent positions to educate pregnant women and their significant others on the proper use of seat belts. REFERENCES
Address for correspondence: Terry L. Hammond, Major, NC, USAF, Department of Obstetrics and Gynecology, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, TX 78236-5300.
1. National Safety Council. 1985. Accident Facts, p 53. Chicago: National Safety Council. 2. Keystone Safety Belt Network. 1988. Say Yes to Seat Belts. Harris-
Critical Concepts in I Fetal Heart Rate Monitoring: I Presented by Bonnie Flood Chez, RNC,
MSN; Carol J. Harvey, RNC, MS; and Michelle L. Murray, RNC, MSN Now you can get Critical Concepts - the follow-up videotape series to the acclaimed Essentials of Electronic Fetal Monitoring. Critical Concepts consists of five videotapes, each about 20 minutes long, and an accompanying manual that provides guidelines for policies and procedures, plus sample forms for practical record-keeping. To find out more, order the Preview tape for just $25.00! The charge for the Preview tape will be deducted from the purchase price of the series or any individual tapes that you order.
Terry L. Hammond is an obstetric and gynecologic nurse practitioner and a consultant to the Air Force Surgeon General assigned to Wilford Half USAF Medical Center in San Antonio, Texas. Major Hammond is a member of NAACOG and Sigma Xi. Brenda F. Mickens-Powers is an obstetric and gynecologic nurse practitioner assigned to lncirlik Air Base in Turkey. Major MickensPowers is a member of NAACOG. Karen Strickland is an instructor of maternalchild and medical-surgical nursing at the Baptist Memorial Hospital School of Professional Nursing in San Antonio, Texas. Ms. Strickland is a member of NAACOG and Sigma Theta Tau. Gary D.V. Hankins is chairman and program director of the Department of Obstetrics and Gynecology at Wilford Hall USAF Medical Center in San Antonio, Texas. Lt. Colonel Hankins is a member of the American College of Obstetricians and Gynecologists.
Essentials series (17258-1) $25.00 0I’d like to order Critical Concepts in Fetal Heart Rate Monitoring now. Please send me: __ Full Set:Includes 5 videotapes and the resource manual (17256-5) $675.00 Tape 1: Antepartum Fetal Surveillance (17251-4) $160.00 -Tape 2: The Fetal Response (17252-2) $160.00 Tape 3: Systematic Analysis (17253-0) $160.00 -Tape 4: Advanced Clinical Applications (17254-9) $160.00 Tape 5: Fetal Blood Sampling (17255-7) $160.00 -Manual: Resources, Guidelines, and Documentation (17257-3) $19.95 O T d like to order the full Essentials of Electronic Fetal Monitoring set (17281-6) $575.00
I I I I I I I I I I I I I I I
I I I 1 I I I I Includes 3 VHS tapes (about 20 minutes each):Principles of Instrumentation, Pattern Interpretation, I and Nursing Intervention and Documentation; textbook; workbook; and laminated card. I Textbook and card are also sold separately. Discounts on bulk orders and to NAACOG I members available. Call Williams & Wilkins for details. Indicate your preferred payment option. Payment must be made in full before orders are processed. I AII sales are final. I 0 Checkenclosed 0 MasterCard 0 VISA 0 AmericanExpress I Card# Exp. Date I I I I Signatureor P.O. # I I Name I I
CALL FREE FOR FASTEST SERVICE! From anywhere in the US and Canada call 1-800-527-5597. From elsewhere- call . .. . 301-528-4223 between 830 and 4:30 EST.
#98465-0A when calling.
-
I
Address City My Daytime Phone #
Providing your phone number will help us serve you better.
C A and MD residents, please add state sales tax. Prices quoted-nd must be paid-in higher outside the US and Canada, and subject to change without notice. in.US JOGNNAD -Printed ---_ --------------------
19:4 July/August 1990 JOG”
ZP
State
US dollars. Prices slightly #984650A
90
343
Thirty-nine states, the District of Columbia, and all military installations have enacted laws with various requirements for the mandatory use of automobile safety restraints (Table 1). According to studies done by t h e National Highway Traffic Safety Administration, use of automobile safety restraints would reduce fatalities and injuries by 50-65%,' which could translate into 12,000-15,000 lives saved annually in the United States alone. Nonetheless, research indicates that only approxThe opinions expressed in this manuscript are those of the authors and not necessarily those of the United States Air Force or the Department of Defense. Accepted: July 1989
19:4 July/August 1990 JOCNN
imately 43.4% of Americans currently use automobile safety restraints.' LITERATURE REVIEW
In December 1983, the American College of Obstetricians and Gynecologists (ACOG) issued a technical bulletin on the use of automobile passenger safety restraints for children and pregnant women. ACOG reported that, although women a r e more likely t o use safety belts than men, during pregnancy those same women decrease seat belt use because of concern that the belt may result in increased fetal injuries or deaths3 In another study, Crosby and Costiloe found that, of 441 pregnant women involved in automobile ac-
cidents, only 14%were using their safety belts at the time of the accident~.~ Crosby and Costiloe also found that, among unbelted pregnant women involved in severe collisions, the maternal death rate was 33% for those who were ejected from the car and 5%for those who were not e j e ~ t e dThe . ~ fetal death rate was 47% when the pregnant women were ejected and 1 1 % when they were not e j e ~ t e d . ~ Therefore, the mother and fetus are at less risk when the mother is wearing a seat belt. Nonetheless, injury may occur when seat belts a r e worn. The leading cause of maternal and fetal morbidity and mortality from severe collisions when pregnant women are wearing seat belts are abruptio placen339
Table 1. Seat Belt Usage Laws by Coverage and State (Total of 39 States plus the District of Columbia)
All Occupants
California Montana Nevada Washington Wisconsin
Front Seat, Rear Seat Passengers under 2 Years Old Colorado Connecticut District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Louisiana Maryland Michigan Missouri New Jersey North Carolina Ohio Oklahoma Pennsylvania South Carolina Tennessee Texas Utah Virginia Wyoming
Front Seat, Rear Seat Passengers under 10 Years Old Kansas Minnesota New Mexico New York
Children to 16 Years of Age Maine Mississippi New Hampshire Oregon Rhode Island West Virginia
Correct use of automobile safety restraints could save 12,000-1 4,000 lives annually in the United States alone. METHODOLOGY
Source: Texas Coalition for Safety Belts, Austin, Texas, February 1990.
tae, maternal shock, and direct PURPOSE fetal skull injury. These injuries occur secondarily t o the jackknifelike body flexion and abdomiOn Christmas Eve in 1986, one of our antepartal patients was innal compression caused by the volved in a motor vehicle acci“second collision” effect and perdent. Because she was not wearing haps are exacerbated by the use of the lap belt alone. The use of a a seat belt, she was thrown from her vehicle and expired in transit three-point safety restraint system to the hospital from internal injumay minimize such injuries. Notries with hemorrhage. Touched by withstanding, researchers generthis tragedy, we undertook t h e ally agree that the leading cause of survey presented here to deterfetal death in an automobile accimine the need for education on dent is the death of the mother seat belt usage in pregnancy so and that fetal injury is closely related to the extent of maternal in- that similar tragedies might be averted in the future. The survey jury. Since pregnant women wearwas designed to assess the impact ing seat belts suffer fewer injuries of pregnancy, previous auto acciand deaths than those not wearing dents, ongoing public awareness seat belts, health-care providers campaigns, mandatory Departshould emphatically recommend seat belt usage during p r e g n a n ~ y . ~ ment of Defense (DOD) require~
340
ments, and the recently instituted Texas seat belt law on the pregnant population at the Wilford Hall United States Air Force (USAF) Medical Center, Lackland Air Force Base, in San Antonio, Texas. After the available data were assessed, the need for prenatal education and counseling could be determined, as well as the willingness of the sample pregnant population to use automobile safety restraint systems.
~
~
~
From February through April 1987, a two-page questionnaire was placed in the obstetric records of all women receiving prenatal c a r e a t t h e Wilford Hall USAF Medical Center. T h e res p o n d e n t s completed and returned the forms to the obstetric check-in desk as they were waiting to be seen for their scheduled appointments. The questionnaire, which took two to five minutes to complete, consisted of 12 questions that required simple “yes,” “no,” o r numerical responses. T h e study was closed after 12 weeks, when all patients in the system would have had a minimum of three scheduled appointments and been afforded ample opportunity t o complete their questionnaires. Approximately 1,200 survey sheets were distributed, and 725 patients completed the survey. RESULTS
The demographics of the pregnant women surveyed on automo-
19:4 July/August 1990 JOGNN
bile safety restraint usage during pregnancy a r e summarized in Table 2. The distribution of maternal age and pregnancy trimester are similar to those of the overall pregnant population of the United States. Survey results indicated that 88% of the respondents used automobile safety restraints 100% of the time when they were driving and 90% of the respondents used automobile safety restraints 100% of the time when they were passengers (Table 3). Furthermore, 92%of the respondents requested passengers in their cars t o use safety belts.
I
Eighty-eight percent of the 725 rewondents used seat 1 belts when driving. Various factors influencing the use of automobile safety restraints were analyzed. DOD's law instituting mandatory use of automobile safety restraints on all military installations was a positive factor for 432 respondents (60%). Next in order of influence on seat belt usage was t h e newly instituted Texas seat belt law, which positively influenced 384 respondents (53%). The fact that respondents
Table 2. Demographics of Pregnant Women Surveyed on Automobile Safety Restraint Usage during Pregnancy
Age (years)
15-19 20-24 25-29 30-34 235
80 283 21 1 120 31
11.0 39.0 29.1 16.6 4.3
128 270 271 56
17.7 37.2 37.4 7.7 -
Trimester
1 2 3 No response N = 725.
19:4 July/August 1990 JOGNN
Table 3.
Automobile Safety Restraint Usage during Pregnancy As Driver
Percentage of Time
n
100 75 50 25 0
638 29 7 3 9 39
No response N
=
As Passenger O/O
88.0 4.0 1 .o 0.4 1.2 5.4
n
YO
655 34 19 6 5 6
90.4 4.7 2.6 0.8 0.7 0.8
725.
were pregnant positively influenced safety restraint usage in only 220 respondents (31%) and actually exerted a negative influence on nine respondents (1.2%). Two hundred fifty-five of the respondents had been involved previously in automobile accidents; 50 were pregnant at the time, and 43 of those 50 (86%) were wearing seat belts. Fifty-six percent (142) of the group of respondents that had previously had accidents stated that the accidents had played positive roles in their subsequent decisions to wear seat belts.
I
Twenty-two percent of the respondents wore their seat I belts incorrectly. Only 42% (305) of the respondents had been counseled by any obstetric health-care provider as to the advisability and proper technique for wearing a seat belt while pregnant. Of the respondents who used seat belts, 22% wore them incorrectly, with the lap belt positioned either across the midabdomen or high over the top of the uterus (Table 4). Of particular interest is that a significant number of women did not answer questions dealing with the potential effect of the safety restraint on the fetus (20%) or the proper po-
sitioning of the belt around the pregnant abdomen (18%). Possibly, the respondents were confused about t h e questions o r lacked knowledge of the topics. The majority of the respondents (91%) believed that seat belts would provide protection for the mother. Similarly, 481 (83%) of the 579 women who responded to the question about the impact of wearing a seat belt on the fetus believed that the fetus would be less likely to be injured. Noteworthy is that 83 (14%) of the women who responded to the question believed that the use of seat belts would increase the risk of injury to the fetus (Table 5).
DISCUSSION The results of this survey indicate a high degree of compliance in the use of automobile safety restraints by pregnant women. Furthermore, the study indicates that several areas exist in which the heal t h-care provi de r -w he t her
Table 4. Positioning of Lap Belt Portion of Safety Restraints during Pregnancy Position of Lap Belt
n
Over abdomen (high) Across abdomen (umbilicus) Under abdomen (low)
37 96 462
N
=
O/O
6.3 16.1 77.6
595.
34 1
Table 5.
Perceived Impact of Seat Belt Usage during Accident
To Pregnant Woman n
YO
To Fetus n
YO
Less likely injured More likely injured No impact
530 43 11
7.3 1.9 -
481 83 15 -
83.1 14.3 2.6 -
Total response
584
100
579
100
a nurse practitioner, nurse-midwife, or physician-can have a positive impact on the use of safety restraints. Only 42% (305) of the respondents had been counseled on either the advisability or the correct use of seat belts during pregnancy. One hundred thirty-three (22%) of the respondents who were using safety restraints were wearing them incorrectly. An additional five to nine respondents (1%) were not using seat belts at all. Therefore, a total of 138-142 respondents (23%) (those women who either were not using their seat belts at all or were using them incorrectly) were susceptible t o injury to themselves or their fetuses. Furthermore, more than 14% (83) of the respondents mistakenly believed that the use of safety restraints would predispose the fetus to injury should a n accident occur, while another 2.6% (15) believed that safety restraints would have no effect at all on the fetus.
90.8
Pregnant women need to be educated on the proper use of seat belts. high compliance in the use of automobile safety restraints: of the respondents to the questionnaire, 88%wore seat belts regularly during pregnancy. This level of compliance is primarily a result of strictly enforced driver and passenger seat belt usage on all military facilities, together with the fact that one would be unlikely to remove these safety devices after driving off base. Additionally, the state of Texas adopted a mandatory seat belt law for both drivers and passengers, which became effective in 1986. Nonetheless, while base regulations and Texas state law had the greatest influence on respondents, 31% of the sample were positively influenced to wear seat belts in an effort to protect themselves and their fetuses.
seat belt use (Figure 1) and explaining the potential benefits and risks of using seat belts. 2. Posters like Figure 1 should be displayed prominently in obstetric waiting areas. 3. Health-care providers should be encouraged to counsel their pregnant patients at least once on the use of automobile safety restraints and to note such counseling on the obstetric records. The major impact of this study is in helping improve the nursing and medical professions’ awareness of the many misconceptions that obstetric patients have concerning t h e use of automobile safety restraints. The study indicated that a significant number of pregnant patients were not wearing seat belts or were not wearing them correctly. Through patient education, nurses can correct patients’ misconceptions concerning the use of seat belts, help improve seat belt use in the pregnant popu-
I
I
WHMC MATERNITY
PROTECT YOURSELF A N D YOUR BABY ALNAYS B U C k L E UP’
NURSING IMPLICATIONS
Mandated seat belt use on all military installations had the greatest influence on the compliance rate of the respondents.
I
The ACOC technical bulletin published in December 1983 states that only 14% of pregnant women were using passenger restraint devices in 1971.3 By contrast, the current study has found
342
Based on t h e findings of the survey, recommendations are as follows: 1. When conducting prenatal orientation classes, nurses should instruct the pregnant women in the advisability, as well as t h e correct use, of automobile safety restraint systems. Nurses can easily accomplish this within two minutes or less, using diagrams showing proper
Figure 1. Proper seat belt usage for pregnant women. From the Department of the Air Force, Headquarters Joint Military Medical Command-San Antonio (ATC), Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas. Used with permission.
19:4 July/August 1990 JOCNN
burg, Pennsylvania: Keystone Auto Club. 3. American College of Obstetricians and Gynecologists (ACOG). 1983. Automobile Passenger Restraints for Children and Pregnant Women. Technical Bulletin 74. Washington, D.C.: ACOC. 4. Crosby, W.M., and J.P. Costiloe. 1971. Safety of lap-belt restraint for pregnant victims of automobile I Med. 284532collisions. N Engl . 36. 5. American College of Obstetricians and Gynecologists (ACOG). 1983. Seat Belt Use during Pregnancy. Washington, D.C.: ACOG.
lation, and, potentially, help save maternal and fetal lives. CONCLUSIONS
Seat belt usage is imperative for both the pregnant and the nonpregnant patient. However, if a seat belt is worn incorrectly, the belt may produce injury. As nurses, we are in excellent positions to educate pregnant women and their significant others on the proper use of seat belts. REFERENCES
Address for correspondence: Terry L. Hammond, Major, NC, USAF, Department of Obstetrics and Gynecology, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, TX 78236-5300.
1. National Safety Council. 1985. Accident Facts, p 53. Chicago: National Safety Council. 2. Keystone Safety Belt Network. 1988. Say Yes to Seat Belts. Harris-
Critical Concepts in I Fetal Heart Rate Monitoring: I Presented by Bonnie Flood Chez, RNC,
MSN; Carol J. Harvey, RNC, MS; and Michelle L. Murray, RNC, MSN Now you can get Critical Concepts - the follow-up videotape series to the acclaimed Essentials of Electronic Fetal Monitoring. Critical Concepts consists of five videotapes, each about 20 minutes long, and an accompanying manual that provides guidelines for policies and procedures, plus sample forms for practical record-keeping. To find out more, order the Preview tape for just $25.00! The charge for the Preview tape will be deducted from the purchase price of the series or any individual tapes that you order.
Terry L. Hammond is an obstetric and gynecologic nurse practitioner and a consultant to the Air Force Surgeon General assigned to Wilford Half USAF Medical Center in San Antonio, Texas. Major Hammond is a member of NAACOG and Sigma Xi. Brenda F. Mickens-Powers is an obstetric and gynecologic nurse practitioner assigned to lncirlik Air Base in Turkey. Major MickensPowers is a member of NAACOG. Karen Strickland is an instructor of maternalchild and medical-surgical nursing at the Baptist Memorial Hospital School of Professional Nursing in San Antonio, Texas. Ms. Strickland is a member of NAACOG and Sigma Theta Tau. Gary D.V. Hankins is chairman and program director of the Department of Obstetrics and Gynecology at Wilford Hall USAF Medical Center in San Antonio, Texas. Lt. Colonel Hankins is a member of the American College of Obstetricians and Gynecologists.
Essentials series (17258-1) $25.00 0I’d like to order Critical Concepts in Fetal Heart Rate Monitoring now. Please send me: __ Full Set:Includes 5 videotapes and the resource manual (17256-5) $675.00 Tape 1: Antepartum Fetal Surveillance (17251-4) $160.00 -Tape 2: The Fetal Response (17252-2) $160.00 Tape 3: Systematic Analysis (17253-0) $160.00 -Tape 4: Advanced Clinical Applications (17254-9) $160.00 Tape 5: Fetal Blood Sampling (17255-7) $160.00 -Manual: Resources, Guidelines, and Documentation (17257-3) $19.95 O T d like to order the full Essentials of Electronic Fetal Monitoring set (17281-6) $575.00
I I I I I I I I I I I I I I I
I I I 1 I I I I Includes 3 VHS tapes (about 20 minutes each):Principles of Instrumentation, Pattern Interpretation, I and Nursing Intervention and Documentation; textbook; workbook; and laminated card. I Textbook and card are also sold separately. Discounts on bulk orders and to NAACOG I members available. Call Williams & Wilkins for details. Indicate your preferred payment option. Payment must be made in full before orders are processed. I AII sales are final. I 0 Checkenclosed 0 MasterCard 0 VISA 0 AmericanExpress I Card# Exp. Date I I I I Signatureor P.O. # I I Name I I
CALL FREE FOR FASTEST SERVICE! From anywhere in the US and Canada call 1-800-527-5597. From elsewhere- call . .. . 301-528-4223 between 830 and 4:30 EST.
#98465-0A when calling.
-
I
Address City My Daytime Phone #
Providing your phone number will help us serve you better.
C A and MD residents, please add state sales tax. Prices quoted-nd must be paid-in higher outside the US and Canada, and subject to change without notice. in.US JOGNNAD -Printed ---_ --------------------
19:4 July/August 1990 JOG”
ZP
State
US dollars. Prices slightly #984650A
90
343