1
|
Sorice V, Mortimore G, Faghy M, Sorice R, Tegally D. The Perpetual Cycle of Racial Bias in Healthcare and Healthcare Education: A Systematic Review. J Racial Ethn Health Disparities 2025:10.1007/s40615-025-02417-6. [PMID: 40240747 DOI: 10.1007/s40615-025-02417-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 03/28/2025] [Accepted: 03/31/2025] [Indexed: 04/18/2025]
Abstract
OBJECTIVES This systematic review aimed to identify and categorise racial bias in healthcare and education; evaluate their impact on healthcare practitioners, students, and patients; and explore strategies to reduce these biases and improve health equity. METHOD A systematic review was conducted following PRISMA guidelines to investigate racial bias in healthcare and healthcare education. Databases searched included PubMed, Cochrane, EMBASE, and CINAHL. Identification of additional papers was completed by employing backward and forward snowballing techniques. Rigorous interprofessional multi-reviewer screening and data extraction processes were performed. Thematic analysis was conducted inductively and collaboratively refined, with disagreements resolved through discussion and a third reviewer confirming resolutions as an additional quality assurance measure. RESULTS From an initial pool of 1634 records, 45 studies were included in the final review. The studies employed various designs, primarily cross-sectional, with most conducted in the United States of America. Five themes emerged: disparities in healthcare access and/or provision, perceived discrimination and/or medical mistrust, provider bias and/or stereotyping, disparities in education and training, and healthcare literature disparities. CONCLUSIONS The findings suggest significant racial disparities across multiple medical specialties, including maternal and infant healthcare, chronic disease management, and emergency care. The review also highlights the underrepresentation of racial minorities in medical imagery and educational materials, contributing to implicit bias and inadequate training for healthcare providers. Overall, the five identified themes appear interconnected, forming a self-reinforcing cycle of racial bias in healthcare and education.
Collapse
Affiliation(s)
- Vittoria Sorice
- College of Health, Psychology and Social Care, University of Derby, Derby, UK.
- Emergency and Acute Medicine, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK.
| | - Gerri Mortimore
- College of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - Mark Faghy
- College of Science and Engineering, University of Derby, Derby, UK
| | | | - Davinder Tegally
- Medicines and Healthcare Products Regulatory Agency, London, UK
- Care Quality Commission, Sheffield, UK
| |
Collapse
|
2
|
Butler MS, Young SL, Keenan-Devlin L. Applying authoritative knowledge to better understand preparation for breastfeeding. Front Glob Womens Health 2025; 6:1540376. [PMID: 40230579 PMCID: PMC11994699 DOI: 10.3389/fgwh.2025.1540376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Accepted: 03/18/2025] [Indexed: 04/16/2025] Open
Abstract
Introduction In this qualitative study, we employ the construct of authoritative knowledge to better understand how birthing people prepare for breastfeeding experiences postpartum. This construct has seldom been applied to the postpartum period, despite its application by reproductive anthropologists to pregnancy and childbirth experiences cross-culturally. Consistent with these applications, we define authoritative knowledge domains by the purveyors. We aimed to characterize the acquisition and valuation of information sources participants used to prepare for breastfeeding. Methods Twenty-five participants were recruited from a hospital-based pregnancy study in Chicagoland, Illinois, USA to complete interviews between November 2020 and March 2021. Audio recorded interviews were coded using a priori themes and iterative code development. Codes were used to characterize information sources and the designation of three domains of authoritative knowledge: biomedical, social network, and lived experience. Results All participants received information about breastfeeding from both biomedical and social network domains, with those with prior child rearing experiences also using the personal experience domain. Use of online resources like pregnancy tracking apps and social media platforms resulted in the domains of authoritative knowledge overlapping. Participants valued information from health care providers the most but found social network information was more accessible and fulfilled their desire for experiential information. Discussion In this first application of authoritative knowledge within the context of infant feeding, participants consistently cited biomedical sources as the most accurate and important. However, they cited barriers to gaining this information such as the short duration of prenatal appointments and the challenge of completing prenatal education courses. Many participants sought evidence-based information about breastfeeding on apps, social media, and websites, however content and quality across platforms varies significantly. This may be an avenue to improve access to reliable and helpful breastfeeding information.
Collapse
Affiliation(s)
- Margaret S. Butler
- Department of Anthropology, Northwestern University, Evanston, IL, United States
- Center of Excellence in Maternal and Child Health, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Sera L. Young
- Department of Anthropology, Northwestern University, Evanston, IL, United States
- Institute for Policy Research, Northwestern University, Evanston, IL, United States
| | - Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, Endeavor Health, Evanston, IL, United States
- Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| |
Collapse
|
3
|
Cayama MR, Vamos CA, Harris NL, Logan RG, Howard A, Daley EM. Respectful Maternity Care in the United States: A Scoping Review of the Research and Birthing People's Experiences. J Midwifery Womens Health 2025; 70:212-222. [PMID: 39812176 DOI: 10.1111/jmwh.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/21/2024] [Indexed: 01/16/2025]
Abstract
INTRODUCTION Birthing people around the world experience mistreatment during labor and birth, contributing to adverse maternal health outcomes. The adoption of respectful maternity care (RMC) has been recommended to address this mistreatment and improve care quality. Most RMC and mistreatment research has been conducted internationally. The purpose of this scoping review was to (1) explore the extent of RMC research and (2) describe labor and birth experiences in the United States. METHODS Embase, Scopus, and CINAHL databases were searched for concepts relating to RMC and mistreatment. A total of 66 studies met review inclusion criteria. Two reviewers screened titles, abstracts, and full-text articles. Data were extracted and categorized using the Bohren et al typology of mistreatment. Summary statistics and narrative summaries were used to describe study characteristics and birthing people's experiences. RESULTS Most studies represented national or urban samples and Western or Northeastern US regions. Few were from the South, and only one represented rural participants specifically. Few studies represented the unique experiences of justice-involved birthing people, and none represented sexual and gender minorities or Indigenous people. Qualitative methods were predominant. The most common forms of mistreatment included (1) poor rapport between women and health care providers (88% of studies), (2) stigma and discrimination (79%), and (3) a failure to meet professional standards of care (73%). DISCUSSION The extent of mistreatment in the United States highlights the need for robust programs and policies targeting provision of RMC. Additional research is needed to better understand the experiences of additional minority communities and those living rural areas and in the Southern United States.
Collapse
Affiliation(s)
| | - Cheryl A Vamos
- College of Public Health, University of South Florida, Tampa, Florida
- The Chiles Center, Tampa, Florida
| | - Nicole L Harris
- College of Public Health, University of South Florida, Tampa, Florida
| | | | - Allison Howard
- College of Public Health, University of South Florida, Tampa, Florida
- USF Health Libraries, University of South Florida, Tampa, Florida
| | - Ellen M Daley
- College of Public Health, University of South Florida, Tampa, Florida
- The Chiles Center, Tampa, Florida
| |
Collapse
|
4
|
Tilden EL, Jungbauer R, Hart EL, Cantor AG. One Hundred Years of Seeking Respectful Maternity Care: History and Evolution. Birth 2025; 52:129-137. [PMID: 39412007 DOI: 10.1111/birt.12876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/21/2024] [Accepted: 08/29/2024] [Indexed: 02/16/2025]
Abstract
Growing awareness of poor maternal health outcomes and maternal health disparities in the United States has heightened urgency around the need to promote Respectful Maternity Care (RMC) as a fundamental tenet of obstetric/midwifery care and standardize efforts to improve safety, eliminate obstetric violence and racism, and optimize health outcomes for all birthing people. The historical context of prior and contemporary perspectives around childbirth influences our understanding of RMC and are shaped by varying scholarly, clinical, and community standards (e.g., religion, human rights, government, public health, midwifery, ethics, activism, and the law), which have changed significantly since the mid-19th century. In this commentary, we share results of a contextual question scoped as part of a larger systematic review of RMC to help inform consensus around a shared definition and development of a metric to standardize delivery and evaluation of RMC. Synthesis of this literature identified landmark historical influences on RMC over the past 100 years, highlighting the multidisciplinary scholarship and historical context influencing the progress toward RMC. Further understanding of this history may also inform policies and guidance for ongoing efforts to center respect and accountability in all aspects of maternity care, with particular attention to populations who are disproportionally impacted by disrespectful care.
Collapse
Affiliation(s)
- Ellen L Tilden
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
- The Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Rebecca Jungbauer
- Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Erica L Hart
- Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Amy G Cantor
- The Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, Oregon, USA
- The Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
5
|
Faria APV, Silva TPRD, Abreu MNS, Canastra MA, Fernandes AC, Martins EF, Ferreira FM, Matozinhos FP. Obstetric outcomes in breastfeeding women in the first hour of delivery before and during the COVID-19 pandemic. BMC Pregnancy Childbirth 2025; 25:24. [PMID: 39799310 PMCID: PMC11724605 DOI: 10.1186/s12884-024-06975-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 11/11/2024] [Indexed: 01/15/2025] Open
Abstract
INTRODUCTION Breastfeeding provides several benefits to the health of women and newborns and constituting a protective factor against infant morbidity and mortality in the short and long term. OBJECTIVES/RESEARCH QUESTIONS The study aims to compare obstetric outcomes in women who did and did not breastfeed after birth. METHOD Cross-sectional epidemiological study, nested in a cohort, carried out with secondary data from the survey "Birth and breastfeeding in children of mothers infected with SARS-CoV-2", carried out in 2020, in Brazil. The results obtained were compared with those of the study "Birth in Belo Horizonte: survey on childbirth and birth", carried out in 2011-2012. RESULTS 1082 women were included in the sample of the survey carried out in the pandemic period and 382 in the pre-pandemic period. A total of 1,082 women were included in the sample of the research carried out during the pandemic period and 382 during the pre-pandemic period. A higher proportion of women who breastfed within the first hour after delivery and: did not have an indication for cesarean section in the pre-pandemic period and women without obstetric complications in the pre-pandemic period were observed when compared to the pandemic period. Regarding the comparison between infected/suspected and non-infected women, we observed: higher proportions of women who had a vaginal delivery and breastfed after delivery in non-infected women and higher proportions of non-infected women, with no indication for cesarean section at the time of admission and who breastfed within the first hour after delivery - when compared to infected/suspected women. Finally, regarding the multivariate analysis of the pre-pandemic period, we observed that women who had fewer than 7 prenatal consultations reduced, on average, 0.36 times the chance of breastfeeding after delivery (p = 0.007). Regarding the pandemic period, we observed that women who underwent cesarean section reduced, on average, 0.61 times the chance of breastfeeding after delivery (p = 0.027), women who had a newborn weighing less than 2500 g reduced, on average, 0.29 times the chance of breastfeeding after delivery (p = 0.031) and women who had a newborn with complications after delivery reduced, on average, 0.05 times the chance of breastfeeding after delivery (p < 0.001). CONCLUSIONS These findings highlight the importance of prenatal monitoring and childbirth assistance, especially in times of crisis, to promote breastfeeding. Furthermore, these findings may provide important contributions to improving health and care related to labor, delivery, birth and the postpartum period.
Collapse
Affiliation(s)
- Ana Paula Vieira Faria
- School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Thales Philipe Rodrigues da Silva
- School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Women's Health Nursing Department, Paulista School of Nursing, Federal University of São Paulo (Unifesp), Rua Napoleão de Barros, 754, Vila Clementino, São Paulo, 04023-062, Brazil
| | - Mery Natali Silva Abreu
- Department School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Ana Clara Fernandes
- Medical School Student at The Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Eunice Francisca Martins
- Department School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Fernanda Penido Matozinhos
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| |
Collapse
|
6
|
Shaw-Churchill S, Phillips KP. Experiences of Canadian perinatal care during the COVID-19 pandemic: Analysis of open-ended survey responses. WOMEN'S HEALTH (LONDON, ENGLAND) 2025; 21:17455057251331696. [PMID: 40238839 PMCID: PMC12035171 DOI: 10.1177/17455057251331696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 02/07/2025] [Accepted: 03/11/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND The COVID-19 pandemic caused significant socioeconomic and healthcare disruptions in Canada. COVID-19 healthcare policies and local infection rates varied considerably across Canada's geographically diverse, multijurisdictional healthcare system. Emergence of highly transmissible COVID-19 variants and widespread COVID-19 vaccination mandates in Fall 2021 further impacted life in Canada. The experiences of pregnant people, in particular, were challenged by COVID-19 outbreaks, Canadian hospital policies, and local public health restrictions. OBJECTIVE This study explored experiences of Canadian perinatal care in the context of the COVID-19 pandemic. DESIGN Online, cross-sectional survey with qualitative analysis. METHODS Individuals pregnant after January 1, 2020 who received perinatal care in Canada participated in our Pandemic Pregnancy Experiences eSurvey, September 1, 2021 to February 1, 2022. Open-ended survey responses were qualitatively evaluated by thematic and content analysis. Codes were identified both deductively and inductively, categorized using principles of woman-centered care, and developed into major and minor themes. RESULTS Prenatal care and COVID-19 vaccination experiences were evaluated from 362 participants, with 234 participants also elaborating on their labor and delivery (L&D) care. Major themes organized by woman-centered care category as follows: Choice of Healthcare Provider (good quality healthcare provider, barriers to provider of choice), Autonomy-Healthcare (autonomy empowered, autonomy impacted), Choice of Delivery Place (wanted hospital birth, got hospital birth), Choice of Support Companion(s) (no support companion for prenatal appointments, hospital restrictions L&D support companion(s)), and, Autonomy-COVID-19 Vaccination (vaccinated while pregnant/breastfeeding). CONCLUSIONS Pregnancy and birth experiences were generally positive; however, both COVID-19 and existing constraints of provincial/territorial healthcare systems impacted Canadian perinatal experiences. Limited choice of healthcare provider type and access to prenatal and L&D support companion(s) affected perinatal care satisfaction.
Collapse
Affiliation(s)
- Sigourney Shaw-Churchill
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Karen P. Phillips
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
7
|
Endres KH, Maurer GM. REVIVE Is an Evidence-Based Approach for Nurses to Universally Apply Trauma-Informed Care in Maternity Settings. Nurs Womens Health 2024; 28:485-491. [PMID: 39395813 DOI: 10.1016/j.nwh.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/24/2024] [Accepted: 09/11/2024] [Indexed: 10/14/2024]
Abstract
The principles of trauma-informed care-safety, compassion, collaboration, communication, autonomy, and empowerment-are also the domains most vulnerable to implicit bias and most cited in adverse outcomes in maternal health. Perinatal nurses can practice trauma-informed care universally and thereby foster and advance person-centered care for all individuals with respect to race, ethnicity, religion, or lived experiences. In this article, we present evidence-based nursing interventions, collectively called REVIVE, that are known to promote principles of trauma-informed care. Taken together, the REVIVE interventions may improve health outcomes and reduce disparities in maternal health outcomes because they are proactive nursing interventions independent of implicit bias. REVIVE is described here and intended for use by individual nurses or health care teams to implement and evaluate in different maternity settings.
Collapse
|
8
|
Neergheen VL, Chaer LE, Plough A, Curtis E, Paterson VJ, Short T, Bright A, Lipsitz S, Murphy A, Miller K, Subramanian L, Radichel E, Ervin J, Castleman L, Brown E, Yeboah T, Simas TM, Terk D, Vedam S, Shah N, Weiseth A. Assessing patient autonomy in the context of TeamBirth, a quality improvement intervention to improve shared decision-making during labor and birth. Birth 2024; 51:855-866. [PMID: 39140579 DOI: 10.1111/birt.12857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 06/10/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Respectful maternity care includes shared decision-making (SDM). However, research on SDM is lacking from the intrapartum period and instruments to measure it have only recently been developed. TeamBirth is a quality improvement initiative that uses team huddles to improve SDM during labor and birth. Team huddles are structured meetings including the patient and full care team when the patient's preferences, care plans, and expectations for when the next huddle will occur are reviewed. METHODS We used patient survey data (n = 1253) from a prospective observational study at four U.S. hospitals to examine the relationship between TeamBirth huddles and SDM. We measured SDM using the Mother's Autonomy in Decision-Making (MADM) scale. Linear regression models were used to assess the association between any exposure to huddles and the MADM score and between the number of huddles and the MADM score. RESULTS In our multivariable model, experiencing a huddle was significantly associated with a 3.13-point higher MADM score. When compared with receiving one huddle, experiencing 6+ huddles yielded a 3.64-point higher MADM score. DISCUSSION Patients reporting at least one TeamBirth huddle experienced significantly higher SDM, as measured by the MADM scale. Our findings align with prior research that found actively involving the patient in their care by creating structured opportunities to discuss preferences and choices enables SDM. We also demonstrated that MADM is sensitive to hospital-based quality improvement, suggesting that future labor and birth interventions might adopt MADM as a patient-reported experience measure.
Collapse
Affiliation(s)
- Vanessa L Neergheen
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lynn El Chaer
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Avery Plough
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth Curtis
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Victoria J Paterson
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Trisha Short
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amani Bright
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Stuart Lipsitz
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Aizpea Murphy
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kate Miller
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Laura Subramanian
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Evelyn Radichel
- Hillcrest Medical Center, Peggy V. Helmerich Women's Health Center, Tulsa, Oklahoma, USA
| | - John Ervin
- Hillcrest Medical Center, Peggy V. Helmerich Women's Health Center, Tulsa, Oklahoma, USA
| | - Lindsay Castleman
- Department of Obstetrics and Gynecology, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Erin Brown
- Department of Obstetrics and Gynecology, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Tracy Yeboah
- Department of Obstetrics and Gynecology, Chan Medical School, University of Massachusetts, Worcester, Massachusetts, USA
- Department of Obstetrics and Gynecology, UMass Memorial Health-UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Tiffany Moore Simas
- Department of Obstetrics and Gynecology, Chan Medical School, University of Massachusetts, Worcester, Massachusetts, USA
- Department of Obstetrics and Gynecology, UMass Memorial Health-UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Daniel Terk
- Department of Obstetrics and Gynecology, UMass Memorial Health-HealthAlliance-Clinton Hospital, Clinton, Massachusetts, USA
| | - Saraswathi Vedam
- Birth Place Lab, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neel Shah
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amber Weiseth
- Ariadne Labs, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
9
|
Sheffield EC, Fritz AH, Interrante JD, Kozhimannil KB. The Availability of Midwifery Care in Rural United States Communities. J Midwifery Womens Health 2024; 69:929-936. [PMID: 39044450 PMCID: PMC11622357 DOI: 10.1111/jmwh.13676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Access to pregnancy-related and childbirth-related health care for rural residents is limited by health workforce shortages in the United States. Although midwives are key pregnancy and childbirth care providers, the current landscape of the rural midwifery workforce is not well understood. The goal of this analysis was to describe the availability of local midwifery care in rural US communities. METHODS We developed and conducted a national survey of rural US hospitals with current or recently closed childbirth services. Maternity unit managers or administrators at 292 rural hospitals were surveyed from March to August 2021, with 133 hospitals responding (response rate 46%; 93 currently offering childbirth services, 40 recently closed childbirth services). This cross-sectional analysis describes whether rural hospitals with current or prior childbirth services had midwifery care with certified nurse-midwives available locally and whether rural communities with and without midwifery care differed by hospital-level and county-level characteristics. RESULTS Among hospitals surveyed, 55% of those with current and 75% of those with prior childbirth services reported no locally available midwifery care. Of the 93 rural communities with current hospital-based childbirth services, those without midwifery care were more likely to have lower populations (37% vs 33%); majority populations that were Black, Indigenous, and people of color (24% vs 10%); and hospitals where at least 50% of births were Medicaid funded (77% vs 64%), compared with communities with midwifery care. Conversely, communities with midwifery care more often had greater than 30% of patients traveling more than 30 miles for hospital-based childbirth services (38% vs 28%). DISCUSSION More than half of rural hospitals surveyed reported no locally available midwifery care, and availability differed by hospital-level and county-level characteristics. Efforts to ensure pregnancy and childbirth care access for rural birthing people should include attention to the availability of local midwifery care.
Collapse
Affiliation(s)
- Emily C. Sheffield
- University of Minnesota Rural Health Research CenterUniversity of Minnesota School of Public HealthMinneapolisMinnesota
- Division of Health Policy and ManagementUniversity of Minnesota School of Public HealthMinneapolisMinnesota
| | - Alyssa H. Fritz
- University of Minnesota Rural Health Research CenterUniversity of Minnesota School of Public HealthMinneapolisMinnesota
- Division of Health Policy and ManagementUniversity of Minnesota School of Public HealthMinneapolisMinnesota
| | - Julia D. Interrante
- University of Minnesota Rural Health Research CenterUniversity of Minnesota School of Public HealthMinneapolisMinnesota
- Division of Health Policy and ManagementUniversity of Minnesota School of Public HealthMinneapolisMinnesota
| | - Katy Backes Kozhimannil
- University of Minnesota Rural Health Research CenterUniversity of Minnesota School of Public HealthMinneapolisMinnesota
- Division of Health Policy and ManagementUniversity of Minnesota School of Public HealthMinneapolisMinnesota
| |
Collapse
|
10
|
LoGiudice JA. Meta-synthesis of the experiences of midwives providing care during the COVID-19 pandemic. Midwifery 2024; 138:104142. [PMID: 39142237 DOI: 10.1016/j.midw.2024.104142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/12/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024]
Abstract
PROBLEM During the COVID-19 pandemic, midwives faced emotional and physical risks while on the frontlines providing care. BACKGROUND To maintain a healthy midwifery workforce, it is necessary to understand midwives' pandemic challenges and successes, including how they personally and professionally faced changes to care provision. AIM The aim of this meta-synthesis was to understand the experiences of midwives working during the COVID-19 pandemic. METHODS Noblit and Hare's (1988) approach to synthesising qualitative research studies was followed. Fifteen qualitative research reports were identified using PRISMA guidelines, producing a sample of 588 midwives from 12 countries. FINDINGS The synthesis revealed three overarching themes: (1) Turmoil and confusion: a spectrum of emotions due to ever-changing protocols, (2) COVID-19 stripped the "being with" out of midwifery care, and (3) Finding our way: midwifery resilience and growth. Analysed together, these three themes contribute to understanding the experiences of midwives working during the COVID-19 pandemic. DISCUSSION Midwives experienced fear, stress, and anxiety. They felt they couldn't physically be with women during the pandemic. They were frustrated by being left out of institutional decision-making regarding COVID-19 protocols that impacted the women they served. Professional growth as a midwife, and personal resilience were ultimately realised. CONCLUSIONS The COVID-19 pandemic disrupted the routine ways in which midwives provide care in all settings. Understanding the complete experience of midwives during the pandemic allows for midwifery organizations to be aware of their members' needs, as well as for institutions to ensure supports are in place for midwives in the event of future pandemics.
Collapse
Affiliation(s)
- Jenna A LoGiudice
- Fairfield University, Egan School of Nursing and Health Studies, 1073 North Benson Rd, Fairfield, CT 06824, USA.
| |
Collapse
|
11
|
Basile-Ibrahim B, Combellick J, Mead TL, Sorensen A, Batten J, Schafer R. The Social Context of Pregnancy, Respectful Maternity Care, Biomarkers of Weathering, and Postpartum Mental Health Inequities: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:480. [PMID: 38673391 PMCID: PMC11049830 DOI: 10.3390/ijerph21040480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Background: Mental health disorders are the number one cause of maternal mortality and a significant maternal morbidity. This scoping review sought to understand the associations between social context and experiences during pregnancy and birth, biological indicators of stress and weathering, and perinatal mood and anxiety disorders (PMADs). Methods: A scoping review was performed using PRISMA-ScR guidance and JBI scoping review methodology. The search was conducted in OVID Medline and Embase. Results: This review identified 74 eligible English-language peer-reviewed original research articles. A majority of studies reported significant associations between social context, negative and stressful experiences in the prenatal period, and a higher incidence of diagnosis and symptoms of PMADs. Included studies reported significant associations between postpartum depression and prenatal stressors (n = 17), socioeconomic disadvantage (n = 14), negative birth experiences (n = 9), obstetric violence (n = 3), and mistreatment by maternity care providers (n = 3). Birth-related post-traumatic stress disorder (PTSD) was positively associated with negative birth experiences (n = 11), obstetric violence (n = 1), mistreatment by the maternity care team (n = 1), socioeconomic disadvantage (n = 2), and prenatal stress (n = 1); and inverse association with supportiveness of the maternity care team (n = 5) and presence of a birth companion or doula (n = 4). Postpartum anxiety was significantly associated with negative birth experiences (n = 2) and prenatal stress (n = 3). Findings related to associations between biomarkers of stress and weathering, perinatal exposures, and PMADs (n = 14) had mixed significance. Conclusions: Postpartum mental health outcomes are linked with the prenatal social context and interactions with the maternity care team during pregnancy and birth. Respectful maternity care has the potential to reduce adverse postpartum mental health outcomes, especially for persons affected by systemic oppression.
Collapse
Affiliation(s)
| | - Joan Combellick
- School of Nursing, Yale University, Orange, CT 06477, USA; (J.C.)
| | - Thomas L. Mead
- Biomedical Libraries, Dartmouth College, Hanover, NH 03755, USA;
| | - Alee Sorensen
- School of Nursing, Yale University, Orange, CT 06477, USA; (J.C.)
| | - Janene Batten
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT 06510, USA;
| | - Robyn Schafer
- Division of Advanced Nursing Practice, School of Nursing, Rutgers University, Newark, NJ 07107, USA;
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA
| |
Collapse
|
12
|
Ibrahim BB, Cheyney M, Vedam S, Kennedy HP. "I was able to take it back": Seeking VBAC after experiencing dehumanizing maternity care in a primary cesarean. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 4:100339. [PMID: 38239391 PMCID: PMC10795544 DOI: 10.1016/j.ssmqr.2023.100339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
In this article, we present findings from a qualitative narrative analysis that examined the pregnancy, primary cesarean, and subsequent birth experiences of women in the United States. Using a maximal variation sampling strategy, we recruited participants via social media and networking to participate in semistructured interviews. Twenty-five women from diverse backgrounds and geographic locations across the U.S. participated, eight self-identified as racialized and seventeen as non-Hispanic, White. Data were analyzed iteratively using Clandinin and Connelly's approach to Narrative Inquiry. Across their narratives, participants described their experiences of maternity care that were either generally negative (dehumanizing care) or positive (humanized care). They further described how their experiences of dehumanizing or humanized care impacted their decision-making for subsequent births, mental health, relationships with the healthcare system, early parenting birth satisfaction, and family planning. Findings suggest that regardless of ultimate mode of birth, what was most important to women was how they are treated by their maternity care team. We suggest practice changes that may improve the experience of maternity care for primary cesarean and subsequent births, especially among those made marginal by systems of oppression.
Collapse
Affiliation(s)
- Bridget Basile Ibrahim
- Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, United States
| | - Melissa Cheyney
- Oregon State University, Waldo Hall 224, 2250 SW Jefferson Way, Corvallis, OR, 97331, United States
| | - Saraswathi Vedam
- University of British Columbia, Birth Place Lab, UBC Midwifery, BC Women’s Hospital, Shaughnessy Building E416 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Holly Powell Kennedy
- Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, United States
| |
Collapse
|
13
|
Riggan KA, Weaver AL, Ashby G, Huang L, Long ME, Torbenson VE, Wick MJ, Allyse MA, Rivera-Chiauzzi EY. Influence of the COVID-19 pandemic on prenatal and postpartum patient experiences and well-being. Birth 2023; 50:1034-1044. [PMID: 37555375 PMCID: PMC10843728 DOI: 10.1111/birt.12760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/08/2022] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND It has yet to be fully elucidated how differing populations of obstetric patients adapted to the disruptions in perinatal care and postpartum support from the COVID-19 pandemic. We surveyed an enriched sample of socioeconomically advantaged patients to understand the influence of COVID-19 on their perinatal care experience, well-being, and coping. METHODS We surveyed pregnant and postpartum patients (n = 6140) at a large academic medical center in the Midwest of the United States using the Coronavirus and Perinatal Experiences instrument in Spring 2021. RESULTS The survey was sent to 6141 pregnant and postpartum patients; 1180 (17.8%) respondents completed the survey, including 256 who were pregnant and 834 postpartum. Most pregnant patients experienced no changes in their prenatal care with 16.5% indicating somewhat worsened care. In the postpartum cohort, 37.5% stated their care had somewhat worsened. In describing influences on stress and mental health, 58.1% of postpartum respondents stated it was moderately, and 17.4% significantly, worse. The pandemic had a somewhat or moderately negative influence for 72.7% of respondents, with 11.0% stating these effects were extremely negative. Both cohorts characterized a range of coping strategies, most commonly, talking with friends and family (76.3%). CONCLUSION(S) Even among this sample of socioeconomically advantaged patients, respondents indicated that the pandemic disrupted many facets of their medical care and daily life, especially social activities and postpartum support. Our findings suggest that counseling on coping and adaptation strategies for stressors and increased health systems support be part of perinatal care during public health emergencies for all demographic groups.
Collapse
Affiliation(s)
| | - Amy L. Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | | | - Lily Huang
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Margaret E. Long
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
| | | | - Myra J. Wick
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
| | - Megan A. Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
14
|
Butler MS, Smart BP, Watson EJ, Narla SS, Keenan-Devlin L. U.S. Breastfeeding Outcomes at the Intersection: Differences in Duration Among Racial and Ethnic Groups With Varying Educational Attainment in a Nationally Representative Sample. J Hum Lact 2023; 39:722-732. [PMID: 37522342 DOI: 10.1177/08903344231186786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND As breastfeeding rates in the United States increase, barriers persist for Black, Latine, and low-socioeconomic status household dyads when compared to White and high-socioeconomic status household dyads. Previous breastfeeding disparities research has almost exclusively considered the influence of race, ethnicity, and socioeconomic status separately, although these attributes are not randomly distributed across the population. RESEARCH AIM To identify breastfeeding duration patterns by race/ethnicity and educational attainment in a nationally representative U.S. National Immunization Survey sample. METHOD We conducted a cross-sectional, secondary analysis of the U.S. Centers for Disease Control and Prevention's 2020 National Immunization Survey-Child public-use data. To examine breastfeeding and exclusive breastfeeding durations at the intersection of race/ethnicity and educational attainment, we created a 12-item, cross-classified variable using three educational attainment groups and four race/ethnicity groups. We used linear regressions to test these associations. RESULTS In all, 83% of the sample breastfed. Mean durations of breastfeeding were 7.5 (SE = 1.95) months and exclusive breastfeeding duration was 4.9 (SE = 0.87) months. In adjusted models, multi-race/other high-educational attainment participants had the longest breastfeeding duration by almost 3 weeks (β: 19.53, 95% CI [5.27, 33.79]), and Black low-educational attainment participants exclusively breastfed for 1 month less than White high-educational attainment participants (β:-30.23, 95% CI [-40.87, -19.58]). CONCLUSIONS Examining race/ethnicity and educational attainment together provides an intersectional understanding of breastfeeding outcomes and can inform targeted, culturally appropriate interventions.
Collapse
Affiliation(s)
- Margaret S Butler
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Britney P Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Elijah J Watson
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Shreya S Narla
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
| | - Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| |
Collapse
|
15
|
Bose-Brill S, D’Amico R, Bartley A, Ashmead R, Flores-Beamon P, Jallaq S, Li K, Mao S, Gillespie S, Fareed N, Venkatesh KK, Crossnohere NL, Davis J, Bunger AC, Lorenz A. Establishing a clinical informatics umbilical cord: lessons learned in launching infrastructure to support dyadic mother/infant primary care. JAMIA Open 2023; 6:ooad065. [PMID: 37600075 PMCID: PMC10438959 DOI: 10.1093/jamiaopen/ooad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/23/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023] Open
Abstract
The Multimodal Maternal Infant Perinatal Outpatient Delivery System (MOMI PODS) was developed to facilitate the pregnancy to postpartum primary care transition, particularly for individuals at risk for severe maternal morbidity, via a unique multidisciplinary model of mother/infant dyadic primary care. Specialized clinical informatics platforms are critical to ensuring the feasibility and scalability of MOMI PODS and a smooth perinatal transition into longitudinal postpartum primary care. In this manuscript, we describe the MOMI PODS transition and management clinical informatics platforms developed to facilitate MOMI PODS referrals, scheduling, evidence-based multidisciplinary care, and program evaluation. We discuss opportunities and lessons learned associated with our applied methods, as advances in clinical informatics have considerable potential to enhance the quality and evaluation of innovative maternal health programs like MOMI PODS.
Collapse
Affiliation(s)
- Seuli Bose-Brill
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Rachel D’Amico
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Adam Bartley
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus, Ohio, USA
| | - Robert Ashmead
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus, Ohio, USA
| | - Paola Flores-Beamon
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Shadia Jallaq
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus, Ohio, USA
| | - Kevin Li
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Shengyi Mao
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - Naleef Fareed
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Kartik K Venkatesh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Norah L Crossnohere
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jody Davis
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Alicia C Bunger
- College of Social Work, The Ohio State University, Columbus, Ohio, USA
| | - Allison Lorenz
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
16
|
Saleh L, Canclini S, Mathison C, Combs S, Dickerson B. "This is not what I imagined motherhood would look like": pregnancy, postpartum, and parenting during COVID-19 - a qualitative analysis of the first year since birth. BMC Pregnancy Childbirth 2023; 23:578. [PMID: 37568087 PMCID: PMC10422746 DOI: 10.1186/s12884-023-05872-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Childbearing is one of the most emotional and transformative events in a woman's life. This study aims to explore the impact COVID-19 had on childbirth, postpartum, and the first year since giving birth. METHODS This was a qualitative study using data previously collected for a larger study of women who had given birth during the COVID-19 pandemic in the United States. The findings presented here are from an analysis of a subset of open-ended questions. Sixty-six participants completed questions about how COVID-19 affected childbearing and postpartum experiences. Data was analyzed using inductive thematic analysis. RESULTS Thematic analysis of the data identified five major themes and several subthemes, including: (1) amplification of new mother typical emotions (positive emotions and negative emotions), (2) financial impact on mothers and their families, (3) persistent impact of COVID-19, (4) new mom paradigm crash (first time mothers and experienced mothers faced different issues such as lack of education and support, adding a layer to the day-to-day, and negotiating time with others) and (5) validating the importance of maternal health. On the whole, participants were overwhelmed, isolated, and did not have enough physical and emotional support. There was a lack of supportive maternal healthcare both in the short-term and long-term, with an emphasis on poor postpartum support. CONCLUSIONS This study supports previous findings that women who gave birth and entered motherhood during the COVID-19 pandemic were impacted in many ways. These findings contribute to the understanding of women's experiences not just in the immediate postpartum period, but in their daily lives one year after childbirth. The results highlight that our nation's traditional maternal healthcare model may be insufficient, especially when facing a national crisis. Strain placed on the healthcare system by COVID-19 impacted both the physical and mental health of mothers who were often left with inadequate care, education, and support. Our findings point to the need for more supportive maternal health both during childbirth and postpartum.
Collapse
Affiliation(s)
| | | | | | - Shanna Combs
- Anne Marion Burnett School of Medicine at Texas Christian University, Fort Worth, USA
| | | |
Collapse
|
17
|
Ahlers-Schmidt CR, Hervey AM. COVID-19 Impact on Group Prenatal Education: A Comparison of Virtual and In-Person Formats. J Perinat Educ 2023; 32:133-140. [PMID: 37520789 PMCID: PMC10386784 DOI: 10.1891/jpe-2022-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
This retrospective study compared knowledge, intention, and satisfaction outcomes between pregnant women who attended prenatal education in person (n = 202; 55%) prior to the COVID-19 pandemic or virtually (n = 166; 45%) during the pandemic. Results identified increases in knowledge and intention for a healthy pregnancy and safe infant care for both groups. Virtual participants were less likely to endorse developing a birth plan (p = 0.035), knowledge of breastfeeding resources (p = 0.006), confidence in the ability to breastfeed (p = 0.033), and plans to use only a safe infant sleep location (p = 0.045). Important education was provided by continuing Baby Talk during the pandemic. However, topics with activities/demonstrations during in-person learning that were discontinued for virtual learning had significantly lower increases for virtual participants. Virtual education should incorporate more demonstrations/activities.
Collapse
|
18
|
Combellick J, Ibrahim BB, Scharer K, Brickley T, Julien T, Kennedy HP. Applying Lessons Learned from the COVID-19 Pandemic to Future Threats to the Perinatal Care System. J Midwifery Womens Health 2023; 68:333-339. [PMID: 36905175 DOI: 10.1111/jmwh.13481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION Health care systems will continue to face unpredictable challenges related to climate change. The COVID-19 pandemic tested the ability of perinatal care systems to respond to extreme disruption. Many childbearing people in the United States opted out of the mainstream choice of hospital birth during the pandemic, leading to a 19.5% increase in community birth between 2019 and 2020. The aim of the study was to understand the experiences and priorities of childbearing people as they sought to preserve a safe and satisfying birth during the time of extreme health care disruption caused by the pandemic. METHODS This exploratory qualitative study recruited participants from a sample of respondents to a national-scope web-based survey that explored experiences of pregnancy and birth during the COVID-19 pandemic. Maximal variation sampling was used to invite survey respondents who had considered a variety of birth setting, perinatal care provider, and care model options to participate in individual interviews. A conventional content analysis approach was used with coding categories derived directly from the transcribed interviews. RESULTS Interviews were conducted with 18 individuals. Results were reported around 4 domains: (1) respect and autonomy in decision-making, (2) high-quality care, (3) safety, and (4) risk assessment and informed choice. Respect and autonomy varied by birth setting and perinatal care provider type. Quality of care and safety were described in relational and physical terms. Childbearing people prioritized alignment with their personal philosophies toward birth as they weighed safety. Although levels of stress and fear were elevated, many felt empowered by the sudden opportunity to consider new options. DISCUSSION Disaster preparedness and health system strengthening should address the importance childbearing people place on the relational aspects of care, need for options in decision-making, timely and accurate information sharing, and opportunity for a range of safe and supported birth settings. Mechanisms are needed to build system-level changes that respond to the self-expressed needs and priorities of childbearing people.
Collapse
Affiliation(s)
| | | | | | - Tess Brickley
- Yale University School of Nursing, Orange, Connecticut
| | - Tamika Julien
- Yale University School of Nursing, Orange, Connecticut
| | | |
Collapse
|
19
|
Combellick JL, Telfer ML, Ibrahim BB, Novick G, Morelli EM, James-Conterelli S, Kennedy HP. Midwifery care during labor and birth in the United States. Am J Obstet Gynecol 2023; 228:S983-S993. [PMID: 37164503 DOI: 10.1016/j.ajog.2022.09.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 05/12/2023]
Abstract
The intrapartum period is a crucial time in the continuum of pregnancy and parenting. Events during this time are shaped by individuals' unique sociocultural and health characteristics and by their healthcare providers, practice protocols, and the physical environment in which care is delivered. Childbearing people in the United States have less opportunity for midwifery care than in other high-income countries. In the United States, there are 4 midwives for every 1000 live births, whereas, in most other high-income countries, there are between 30 and 70 midwives. Furthermore, these countries have lower maternal and neonatal mortality rates and have consistently lower costs of care. National and international evidences consistently report that births attended by midwives have fewer interventions, cesarean deliveries, preterm births, inductions of labor, and more vaginal births after cesarean delivery. In addition, midwifery care is consistently associated with respectful care and high patient satisfaction. Midwife-physician collaboration exists along a continuum, including births attended independently by midwives, births managed in consultation with a physician, and births attended primarily by a physician with a midwife acting as consultant on the normal aspects of care. This expert review defined midwifery care and provided an overview of midwifery in the United States with an emphasis on the intrapartum setting. Health outcomes associated with midwifery care, specific models of intrapartum care, and workforce issues have been presented within national and international contexts. Recommendations that align with the integration of midwifery have been suggested to improve national outcomes and reduce pregnancy-related disparities.
Collapse
Affiliation(s)
| | | | | | - Gina Novick
- Yale University School of Nursing, Orange, CT
| | | | | | | |
Collapse
|
20
|
Lalor JG, Sheaf G, Mulligan A, Ohaja M, Clive A, Murphy-Tighe S, Ng ED, Shorey S. Parental experiences with changes in maternity care during the Covid-19 pandemic: A mixed-studies systematic review. Women Birth 2023; 36:e203-e212. [PMID: 35973917 PMCID: PMC9364727 DOI: 10.1016/j.wombi.2022.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, pregnant women were identified as a high-risk and vulnerable group. To reduce risk of transmission, maternity healthcare services were modified to limit exposure but maintain services for pregnant women. However, the change in hospital practice may have compromised quality maternal care standards. Therefore, this review aims to explore parental experiences and views with maternity care received from healthcare institutions during the COVID-19 pandemic. METHODS A mixed studies systematic review was conducted. Six electronic databases (Medline, CINAHL, Embase, PsycInfo, Web of Science, and Maternity and Infant Care) were searched for qualitative, observational, and mixed method studies from the year 2019 to February 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Quantitative findings were converted to narrative findings. Data was synthesised thematically using a convergent synthesis design. RESULTS Fifty-eight articles were included. Four themes were generated: (1) Distress associated with COVID-19 regulations (perception of hospital restrictions, confusion with ever changing policies), (2) adaptability with maternity services (prenatal: changes in birth plans, prenatal: altered antenatal appointments, education, and care, intrapartum: medicalization of birth, postpartum: varied views on care received and Breastfeeding woes, postpartum: skin-to-skin contact and mother infant bonding) (3) importance of support persons, and (4) future direction for maternity services. CONCLUSIONS Parental experiences highlighted how maternity care during the COVID-19 pandemic did not adhere to WHO standards of quality maternity care. This calls for healthcare institutions to continuously appraise the implementation of restrictive practices that deviate from evidence-based frameworks underpinning quality care.
Collapse
Affiliation(s)
- Joan Gabrielle Lalor
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier St, Dublin 2, Ireland
| | - Greg Sheaf
- The Library of Trinity College Dublin, Dublin 2, Ireland
| | - Andrea Mulligan
- School of Law, Trinity College Dublin, House 39, New Square, Dublin 2, Ireland
| | - Magdalena Ohaja
- School of Nursing and Midwifery, National University of Ireland Galway, Ireland
| | - Ashamole Clive
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier St, Dublin 2, Ireland
| | | | - Esperanza Debby Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11,10 Medical Drive, 117597, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11,10 Medical Drive, 117597, Singapore.
| |
Collapse
|
21
|
Influence of the COVID-19 pandemic on labor and childbirth care practices in Brazil: a cross-sectional study. BMC Pregnancy Childbirth 2023; 23:91. [PMID: 36732728 PMCID: PMC9894737 DOI: 10.1186/s12884-023-05358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND It has been hypothesized that the coronavirus disease 2019 (COVID-19) pandemic may have changed the conduct of obstetric practices at the time of labor, delivery, and birth. In Brazil, many practices lacking scientific evidence are implemented in this care, which is charcaterized by excessive use of unnecessary interventions. This scenario may have been worsened by the pandemic. Thus, we analyzed the effects of the pandemic on care during prenatal care and delivery by comparing the results of two surveys (one was administered before the pandemic and the other during the pandemic) in public hospitals in Belo Horizonte - Minas Gerais (MG), Brazil. METHODS This cross-sectional and comparative study analyzed preliminary data from the study "Childbirth and breastfeeding in children of mothers infected with SARS-CoV-2", which was conducted in three referral maternity hospitals in Belo Horizonte - MG during the pandemic in the first half of 2020 in Brazil. The final sample consisted of 1532 eligible women. These results were compared with data from 390 puerperae who gave birth in the three public hospitals in the study "Birth in Belo Horizonte: labor and birth survey", conducted before the pandemic to investigate the changes in practices of labor and delivery care for the mother and her newborn, with or without COVID-19 infection, before and during the pandemic. In this research, "Birth in Belo Horizonte: labor and birth survey", data collection was performed between November 2011 and March 2013 by previously trained nurses. Between study comparisons were performed using Pearson's chi-square test, with a confidence level of 95%, and using Stata statistical program. RESULTS We found a significant increase in practices recommended by the World Health Organization during the pandemic including the following: diet offering (48.90 to 98.65%), non-pharmacological pain relief (43.84 to 67.57%), and breastfeeding in the newborn´s first hour of life (60.31 to 77.98%) (p < 0.001). We found a significant reduction of non-recommended interventions, such as routine use of episiotomy (15.73 to 2.09%), the Kristeller maneuver (16.55 to 0.94%), oxytocin infusion misused (45.55 to 28.07%), amniotomy (30.81 to 15.08%), and lithotomy position during labor (71.23 to 6.54%) (p < 0.001). CONCLUSION Our study revealed a statistically significant increase in the proportion of use of recommended practices and a reduction in non-recommended practices during labor and delivery. However, despite advances in the establishment of World Health Organization recommended practices in labor, delivery, and birth, the predominance of interventionist and medicalized practices persists, which is worsened by events, such as the pandemic.
Collapse
|
22
|
Kasaven LS, Raynaud I, Jalmbrant M, Joash K, Jones BP. The impact of the COVID-19 pandemic on perinatal services and maternal mental health in the UK. BJPsych Open 2023; 9:e13. [PMID: 36636816 PMCID: PMC9874036 DOI: 10.1192/bjo.2022.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND COVID-19 has created many challenges for women in the perinatal phase. This stems from prolonged periods of lockdowns, restricted support networks and media panic, alongside altered healthcare provision. AIMS We aimed to review the evidence regarding the psychological impact on new and expecting mothers following changes to antenatal and postnatal service provision within the UK throughout the pandemic. METHOD We conducted a narrative literature search of major databases (PubMed, Medline, Google Scholar). The literature was critically reviewed by experts within the field of antenatal and perinatal mental health. RESULTS Changes to service provision, including the introduction of telemedicine services, attendance of antenatal appointments without partners or loved ones, and lack of support during the intrapartum period, are associated with increased stress, depression and anxiety. Encouraging women and their partners to engage with aspects of positive psychology through newly introduced digital platforms and virtual service provision has the potential to improve access to holistic care and increase mental well-being. An online course, designed by Imperial College Healthcare NHS Trust in response to changes to service provision, focuses on postnatal recovery inspiration and support for motherhood (PRISM) through a 5-week programme. So far, the course has received positive feedback. CONCLUSIONS The pandemic has contributed to increased rates of mental illness among pregnant and new mothers in the UK. Although the long-term implications are largely unpredictable, it is important to anticipate increased prevalence and complexity of symptoms, which could be hugely detrimental to an already overburdened National Health Service.
Collapse
Affiliation(s)
- Lorraine S Kasaven
- Department of Surgery and Cancer, Imperial College London, UK; Cutrale Perioperative and Ageing Group, Imperial College London, UK; and Department of Obstetrics and Gynaecology, Queen Charlottes and Chelsea Hospital, Imperial College NHS Trust, UK
| | - Isabel Raynaud
- West Middlesex University Hospital, Chelsea and Westminster Hospitals NHS Trust, UK
| | | | - Karen Joash
- Department of Obstetrics and Gynaecology, Queen Charlottes and Chelsea Hospital, Imperial College NHS Trust, UK
| | - Benjamin P Jones
- Department of Surgery and Cancer, Imperial College London, UK; and Department of Obstetrics and Gynaecology, Queen Charlottes and Chelsea Hospital, Imperial College NHS Trust, UK
| |
Collapse
|
23
|
Basile Ibrahim B, Kozhimannil KB. Racial Disparities in Respectful Maternity Care During Pregnancy and Birth After Cesarean in Rural United States. J Obstet Gynecol Neonatal Nurs 2023; 52:36-49. [PMID: 36400125 PMCID: PMC9839498 DOI: 10.1016/j.jogn.2022.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the experiences of pregnancy and birth after cesarean of women who live in rural areas of the United States, including access to vaginal birth after cesarean (VBAC), type of maternity care provider, travel times, autonomy in decision making, and respectful maternity care. DESIGN Retrospective observational study. SETTING Online questionnaire of women who gave birth in the United States. PARTICIPANTS Women (N = 1,711) with histories of cesarean and subsequent births within 5 years of participating. METHODS We calculated descriptive and bivariate statistics by identified areas of residence and stratified measures of autonomy and respectful maternity care by self-identification as a member of a racialized group. We applied qualitative descriptive analysis to responses to an open-ended survey question. RESULTS A total of 299 (17.5%) participants identified their areas of residence as rural. Similar percentages of rural and metropolitan participants were able to plan VBAC (p = .88). More rural participants than metropolitan participants reported travel times of more than 60 minutes to give birth (p < .001), and fewer had obstetricians (p = .002) or doulas (p = .03). Rural participants from racialized groups experienced significantly less respectful maternity care than White, non-Hispanic rural participants and all metropolitan participants (p = .04). Qualitative data illustrating the main findings are included. CONCLUSIONS Our findings highlight challenges faced by rural residents accessing VBAC and help explain why rates of VBAC in rural areas remain low. We suggest a range of clinical and policy strategies to improve access to VBAC in rural areas and to improve the quality of maternity care for racialized women who live in rural areas.
Collapse
|
24
|
Pregnant Through the COVID-19 Chaos: Insights on How Women Use Information in the Perinatal Period During a Pandemic. CLIN NURSE SPEC 2022; 36:298-308. [PMID: 36279491 PMCID: PMC9560905 DOI: 10.1097/nur.0000000000000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To gain insights in how women use technology to address health information needs during the prenatal and postpartum time frame.
Collapse
|
25
|
Woeber K, Vanderlaan J, Long MH, Steinbach S, Dunn JL, Bouchard ME. Midwifery Autonomy and Employment Changes During the Early COVID-19 Pandemic. J Midwifery Womens Health 2022; 67:608-617. [PMID: 36098518 DOI: 10.1111/jmwh.13400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 06/07/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The COVID-19 pandemic presented the midwifery workforce with challenges for maintaining access to high-quality care and safety for patients and perinatal care providers. This study analyzed associations between different types of professional autonomy and changes in midwives' employment and compensation during the early months of the pandemic. METHODS An online survey distributed to midwifery practices in fall 2020 compared midwives' employment and compensation in February 2020 and September 2020. Chi-square analysis determined associations between those data and measures of midwives' autonomy: state practice environment, midwifery practice ownership, intrapartum practice setting, and midwifery participation in practice decision-making. RESULTS Participants included lead midwives from 727 practices, representing 50 states and the District of Columbia. Full-time equivalent (FTE) positions and number of full-time midwives were stable for 77% of practices, part-time employment for 83%, and salaries for 72%. Of the remaining practices, more practices lost FTE positions, full-time positions, part-time positions, and salary (18%, 15%, 9%, and 18%, respectively) than gained (11%, 8%, 8%, and 9%, respectively). Early retirements and furloughs were experienced by 9% of practices, and 18% lost benefits. However, midwifery practice ownership was significantly associated with increased salaries (20.3% vs 7.1%; P < .001) and decreased loss of benefits (7.8% vs 19.9%; P = .002) and furloughs (3.8 vs 10.1%; P = .04). Community-based practice was significantly associated with increased FTE positions (19.0% vs 8.8%; P = .005), part-time positions (17.4% vs 5.1%; P < .001), and salary (19.7% vs 7.0%; P < .001), as well as decreased loss of benefits (11.5% vs 21.1%; P = .02) and early retirement (1.4% vs 6.6%; P = .03). State practice environment and participation in practice decision-making were not directly associated with employment and compensation changes. DISCUSSION Policies should facilitate midwifery practice ownership and the expansion and integration of community birth settings for greater perinatal care workforce stability, greater flexibility to respond to disasters, and improved patient access to care and health outcomes.
Collapse
Affiliation(s)
- Kate Woeber
- Frontier Nursing University, Versailles, Kentucky
| | | | | | | | - Jessica L Dunn
- Tennessee Technological University, Cookeville, Tennessee
| | | |
Collapse
|
26
|
Wright KQ. "It changed the atmosphere surrounding the baby I did have": Making sense of reproduction during the COVID-19 pandemic. JOURNAL OF MARRIAGE AND THE FAMILY 2022; 84:1105-1128. [PMID: 35935914 PMCID: PMC9347647 DOI: 10.1111/jomf.12851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 04/13/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
Objective This study examines the schemas that women employed during the COVID-19 pandemic to make sense of their reproductive desires. Background Existing research on reproduction during epidemics suggests that there are variable population responses to periods of long-term social uncertainty. However, less is known about how individuals make sense of maintaining or adapting their reproductive desires during periods of social upheaval. Method Twenty-nine women aged 25-35 from a mid-sized Midwestern county in the United States were recruited and interviewed about their experiences during the first 8 months of the COVID-19 pandemic. They were asked about their daily lived experiences and their reproductive desires during in-depth interviews. These interviews were transcribed and analyzed using thematic coding. Results Participants used three normative schemas to describe their reproductive desires during the COVID-19 pandemic. Heteronormative schemas were used by many participants to articulate their commitment to a heteronormative aged-staged timeline of life events. Schemas of social support around being pregnant and giving birth were used by participants, primarily those who were currently or recently pregnant, to express grief and loss over the relational experience of having a new baby. Medicalized schemas were expressed by most participants to describe feelings of fear and risk at real or imagined encounters with medical institutions. Conclusion The schemas that participants used to make sense of their reproductive desires demonstrate how sense-making during a profound event that affects everyday realities allows participants to (re)articulate commitments to existing narratives that reinforce heterosexual, social, and medicalized hierarchies in reproduction.
Collapse
Affiliation(s)
- Kelsey Q. Wright
- Department of Sociology, Center for Demography and EcologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| |
Collapse
|
27
|
Deherder E, Delbaere I, Macedo A, Nieuwenhuijze MJ, Van Laere S, Beeckman K. Women's view on shared decision making and autonomy in childbirth: cohort study of Belgian women. BMC Pregnancy Childbirth 2022; 22:551. [PMID: 35804308 PMCID: PMC9264300 DOI: 10.1186/s12884-022-04890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Health care providers have an important role to share evidence based information and empower patients to make informed choices. Previous studies indicate that shared decision making in pregnancy and childbirth may have an important impact on a woman’s birth experience. In Flemish social media, a large number of women expressed their concern about their birth experience, where they felt loss of control and limited possibilities to make their own choices. The aim of this study is to explore autonomy and shared decision making in the Flemish population. Methods This is a cross-sectional, non-interventional study to explore the birth experience of Flemish women. A self-assembled questionnaire was used to collect data, including the Pregnancy and Childbirth Questionnaire (PCQ), the Labor Agentry Scale (LAS), the Mothers Autonomy Decision Making Scale (MADM), the 9-item Shared Decision Making Questionnaire (SDM–Q9) and four questions on preparation for childbirth. Women who gave birth two to 12 months ago were recruited by means of social media in the Flemish area (Northern part of Belgium). Linear mixed-effect modelling with backwards variable selection was applied to examine relations with autonomy in decision making. Results In total, 1029 mothers participated in this study of which 617 filled out the survey completely. In general, mothers experienced moderate autonomy in decision-making, both with an obstetrician and with a midwife with an average on the MADM score of respectively 18.5 (± 7.2) and 29.4 (±10.4) out of 42. The linear mixed-effects model showed a relationship between autonomy in decision-making (MADM) for the type of healthcare provider (p < 0.001), the level of self-control during labour and birth (LAS) (p = 0.003), the level of perceived quality of care (PCQ) (p < 0.001), having epidural analgesia during childbirth (p = 0.026) and feeling to have received sufficient information about the normal course of childbirth (p < 0.001). Conclusions Childbearing women in Flanders experience moderate levels of autonomy in decision- making with their health care providers, where lower autonomy was observed for obstetricians compared to midwives. Future research should focus more on why differences occur between obstetrics and midwives in terms of autonomy and shared decision-making as perceived by the mother.
Collapse
Affiliation(s)
- Elke Deherder
- VIVES University of Applied Sciences, Doorniksesteenweg 145, 8500, Kortrijk, Belgium.
| | - Ilse Delbaere
- VIVES University of Applied Sciences, Doorniksesteenweg 145, 8500, Kortrijk, Belgium
| | - Adriana Macedo
- Student master management and policy of health care, department of Public Health and Nursing and Midwifery Unit, Vrije Universiteit Brussel, UZ Brussel, Brussels, Belgium
| | - Marianne J Nieuwenhuijze
- Research Centre for Midwifery Science Maastricht, Zuyd University / CAPHRI, Maastricht University, Universiteitssingel 60, 6229 ER, Maastricht, the Netherlands
| | - Sven Van Laere
- Vrije Universiteit Brussel, Interfaculty Center Data processing & Statistics, Laarbeeklaan, 103, Brussels, Belgium
| | - Katrien Beeckman
- Vrije Universiteit Brussel, Universitair ziekenhuis Brussel (UZ Brussel), Faculty of Medicine and Pharmacy, Public Health, Nursing and Midwifery Research Unit, Laarbeeklaan 101, 1090, Brussels, Belgium.,Verpleeg- en vroedkunde, Centre for Research and Innovation in Care, Midwifery Research Education and Policymaking (MIDREP), Universiteit Antwerpen, Antwerpen, Belgium
| |
Collapse
|
28
|
Combellick JL, Basile Ibrahim B, Julien T, Scharer K, Jackson K, Powell Kennedy H. Birth during the Covid-19 pandemic: What childbearing people in the United States needed to achieve a positive birth experience. Birth 2022; 49:341-351. [PMID: 35218067 PMCID: PMC9111370 DOI: 10.1111/birt.12616] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/09/2021] [Accepted: 01/26/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The COVID pandemic exposed many inadequacies in the maternity care system in the United States. Maternity care protocols put in place during this crisis often did not include input from childbearing people or follow prepandemic guidelines for high-quality care. Departure from standard maternity care practices led to unfavorable and traumatic experiences for childbearing people. This study aimed to identify what childbearing people needed to achieve a positive birth experience during the pandemic. METHODS This mixed-methods, cross-sectional study was conducted among individuals who gave birth during the COVID pandemic from 3/1/2020 to 11/1/2020. Participants were sampled via a Web-based questionnaire that was distributed nationally. Descriptive and bivariate statistics were analyzed. Thematic and content analyses of qualitative data were based on narrative information provided by participants. Qualitative and convergent quantitative data were reported. RESULTS Participants (n = 707) from 46 states and the District of Columbia completed the questionnaire with 394 contributing qualitative data about their experiences. Qualitative findings reflected women's priorities for (a) the option of community birth, (b) access to midwives, (c) the right to an advocate at birth, and (d) the need for transparent and affirming communication. Quantitative data reinforced these findings. Participants with a midwife provider felt significantly better informed. Those who gave birth in a community setting (at home or in a freestanding birth center) also reported significantly higher satisfaction and felt better informed. Participants of color (BIPOC) were significantly less satisfied and more stressed while pregnant and giving birth during the pandemic. CONCLUSIONS High-quality maternity care places childbearing people at the center of care. Prioritizing the needs of childbearing people, in COVID times or otherwise, is critical for improving their experiences and delivering efficacious and safe care.
Collapse
Affiliation(s)
| | | | - Tamika Julien
- School of NursingYale UniversityOrangeConnecticutUSA
| | | | | | | |
Collapse
|
29
|
Goldstein JT, Eden AR, Taylor MK, Dotson A, Barreto T. Impact of COVID-19 on perinatal care: Perceptions of family physicians in the United States. Birth 2022; 49:719-727. [PMID: 35396870 PMCID: PMC9111605 DOI: 10.1111/birt.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient-centered care is the best practice in the care of pregnant and postpartum patients. The COVID-19 pandemic prompted changes in perinatal care policies, which were often reactive, resulting in unintended consequences, many of which made the delivery of patient-centered care more difficult. This study aimed to understand the impact of the COVID-19 pandemic on perinatal health care delivery from the perspective of family physicians in the United States. METHODS From October 5 to November 4, 2020, we surveyed mid- to late-career family physicians who provide perinatal care. We conducted descriptive analyses to measure the impact of COVID-19 on prenatal care, labor and delivery, postpartum care, patient experience, and patient volume. An immersion-crystallization approach was used to analyze qualitative data provided as open-text comments. RESULTS Of the 1518 survey respondents, 1062 (69.8%) stated that they currently attend births; 595 of those elaborated about the impact of COVID-19 on perinatal care in free-text comments. Eight themes emerged related to the impact of COVID-19 on perinatal care: visitation, patient decisions, testing, personal protective equipment, care continuity, changes in care delivery, reassignment, and volume. The greatest perceived impact of COVID-19 was on patient experience. CONCLUSIONS Family physicians who provided perinatal care during the COVID-19 pandemic noted a considerable impact on patient experience, which particularly affected the ability to deliver patient-centered and family-centered care. Continued research is needed to understand the long-term impact of policies affecting the delivery of patient-centered perinatal care and to inform more evidence-based, proactive policies to be implemented in future pandemic or disaster situations.
Collapse
Affiliation(s)
| | - Aimee R. Eden
- American Board of Family MedicineLexingtonKentuckyUSA
| | | | - Andrea Dotson
- Department of Family Medicine and Community HealthDuke University School of MedicineNorth Carolina
| | | |
Collapse
|