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Miller ML, Dupree J, Monette MA, Lau EK, Peipert A. Health Equity and Perinatal Mental Health. Curr Psychiatry Rep 2024; 26:460-469. [PMID: 39008146 DOI: 10.1007/s11920-024-01521-4] [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] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE OF REVIEW Pregnancy and the postpartum period are vulnerable times to experience psychiatric symptoms. Our goal was to describe existing inequities in perinatal mental health, especially across populations, geography, and in the role of childbirth. RECENT FINDINGS People of color are at an increased risk for perinatal mental health difficulties and more likely to experience neglect, poor communication, and racial discrimination. LGBTQ + individuals encounter unique challenges, implicating the role of heteronormativity, cisnormativity, and gender dysphoria through pregnancy-related processes. Rural-dwelling women are significantly less likely to seek care, be screened for, or receive treatment for perinatal mental health conditions. Trauma-informed, comprehensive mental health support must be provided to all patients during pregnancy, childbirth, and the postpartum period, especially for racially and ethnically minoritized individuals that have often been omitted from care. Future research needs to prioritize inclusion of perinatal populations not well represented in the literature, including rural-dwelling individuals.
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Affiliation(s)
- Michelle L Miller
- Indiana University School of Medicine, Goodman Hall / IU Health Neuroscience Center, Suite 2800 355 W. 16 St. Indianapolis, IN, 46202, Indiana, United States.
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Marshall K. Exploring the Impacts of Heteronormative and Cisnormative Ideologies on Fertility Intentions and Family Planning Experiences Within the 2SLGBTQ Community: A Qualitative Case Study. J Holist Nurs 2024; 42:156-167. [PMID: 37545438 PMCID: PMC11131341 DOI: 10.1177/08980101231189653] [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] [Received: 05/14/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023]
Abstract
Objectives: Normative beliefs around gender and sexuality place individuals in the Two Spirit, lesbian, gay, bisexual, trans, and queer (2SLGBTQ) community at risk for poorer health outcomes within the health care system compared with their heterosexual and cisgender counterparts, particularly within gendered areas of care including family planning and fertility intentions. The purpose of this research was to explore the effect that the normative beliefs of heteronormativity and cisnormativity had on the experiences of 2SLGBTQ people engaged in family planning, and to begin to understand how health care providers can provide appropriate, safe, and holistic care. Methods: We conducted a qualitative study using case study methodology and completing semi-structured interviews with 11 participants with diverse genders and sexualities. Findings: For members of the 2SLGBTQ community, family planning is greatly affected by ideals of normal, intersections of identities, health care systems, and community. They may face additional emotional labor and intentional decision-making when related to family planning. Heteronormativity and cisnormativity greatly impact the health care that is received. Conclusions: The findings contribute information in the limited field of research related to the 2SLGBTQ community and may support health care providers in providing holistic care.
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Affiliation(s)
- Kerry Marshall
- University of Saskatchewan, Saskatoon, Canada
- University of British Columbia, Vancouver, Canada
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Murdock M. Providing Inclusive Midwifery Care for 2SLGBTQQIA+ People: Supporting Inclusion in Ontario's Midwifery Education Program. J Midwifery Womens Health 2024; 69:91-100. [PMID: 37708221 DOI: 10.1111/jmwh.13557] [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] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Research on how midwives in North America are trained to provide inclusive care to Two Spirited, Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex, or Asexual (2SLGBTQQIA+) clients is limited. The objective of this study was to define 2SLGBTQQIA+ inclusive midwifery care in the Canadian context and to explore the experiences of graduates of Ontario's Midwifery Education Program (MEP) to determine how midwives are trained to provide inclusive care. METHODS Ethics approval was obtained for this qualitative study to perform semistructured interviews with graduates from the MEP hosted by McMaster, Toronto Metropolitan, and Laurentian University. Eleven midwives were recruited and were required to be (1) graduates of Ontario's MEP, (2) registered midwives under the College of Midwives of Ontario or elsewhere, (3) currently practicing or on leave, and (4) self-identified advocates for 2SLGBTQQIA+ individuals. RESULTS When defining 2SLGBTQQIA+ inclusive care, midwives described the following principles: using inclusive language, changing the clinical environment, amending documents and websites, and tailoring care for each client. Participants recognized recent efforts by Ontario's MEP to provide 2SLGBTQQIA+ inclusive education while highlighting the need to expand 2SLGBTQQIA+ content across all courses, practicing inclusive care during placement, and ensuring an inclusive environment in the program. DISCUSSION Midwives in this study helped conceptualize inclusive midwifery care for 2SLGBTQQIA+ clients and underlined remaining gaps in Ontario's MEP toward providing student midwives with this competency by graduation. This study helped to fill a gap in the literature on how Canadian midwives are trained to provide 2SLGBTQQIA+ inclusive care and generated recommendations for Ontario's MEP to support prelicensure education that trains inclusive midwives. Having demonstrated gaps in how birth workers are trained to provide 2SLGBTQQIA+ inclusive care, this study points to the need for other prelicensure health professional programs to evaluate their training and to support 2SLGBTQQIA+ inclusive practice.
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Affiliation(s)
- Melanie Murdock
- Department of Gender Studies, Queen's University, Kingston, Ontario, Canada
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Permezel J, Arnold ASC, Thomas J, Maepioh AL, Brown R, Hafford-Letchfield T, Skouteris H, Hatzikiriakidis K, McNair RP. Experiences in the delivery of preconception and pregnancy care for LGBTIQA+ people: A systematic review and thematic synthesis of patient and healthcare provider perspectives. Midwifery 2023; 123:103712. [PMID: 37178659 DOI: 10.1016/j.midw.2023.103712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The widespread availability of reproductive technology and family planning services has led to an increase in the number of available pathways to parenthood for LGBTIQA+ people. However, emerging research indicates that significant healthcare inequities have been documented among LGBTIQA+ people and attributed to the pervasiveness of structural and systemic discrimination that extends to preconception and pregnancy care. AIM The aim of this systematic review was to synthesise qualitative research that has explored the experiences of LGBTIQA+ people in navigating preconception and pregnancy care services to inform healthcare quality improvement. METHOD Six databases were searched for relevant research published between 2012 and 2023. The findings of all included studies underwent a secondary thematic synthesis, and methodological quality was assessed using the Joanna Briggs Institute Checklist for Qualitative Research. FINDINGS A total of 37 studies were eligible for inclusion. Four major themes were constructed through thematic synthesis: (1) unavailability of information, services, and support; (2) clinical competencies of healthcare staff; (3) hetero- and cis-sexist care experiences; and (4) discrimination and traumatisation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The findings of this review indicate that LGBTIQA+ people experience significant challenges during the journey towards parenthood, marked predominantly by the pervasiveness of inequity, and defined by discriminatory healthcare processes. This review has led to several recommendations for future healthcare quality improvement through an investment in policies, procedures, and interactions that are sensitive to the needs of LGBTIQA+ people. Importantly, future research must be co-designed and led by LGBTIQA+ community input.
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Affiliation(s)
| | - Amelia St Clair Arnold
- Department of Social Work, Griffith University, Australia; Women's Health in the North (WHIN), Australia
| | - Jacob Thomas
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia
| | - Anita Lorelle Maepioh
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Australia
| | - Trish Hafford-Letchfield
- School of Social Work and Social Policy, Faculty of Humanities and Social Sciences, University of Strathclyde, United Kingdom
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia; Warwick Business School, Warwick University, United Kingdom
| | - Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia
| | - Ruth P McNair
- Department of General Practice, University of Melbourne, Australia.
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Soled KRS, Niles PM, Mantell E, Dansky M, Bockting W, George M. Childbearing at the margins: A systematic metasynthesis of sexual and gender diverse childbearing experiences. Birth 2023; 50:44-75. [PMID: 36198035 PMCID: PMC9991943 DOI: 10.1111/birt.12678] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/12/2022] [Accepted: 09/02/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The reproductive and perinatal health of sexual and gender-diverse (SGD) individuals is a research priority area for the National Institutes of Health. Over the past decade, this childbearing population has been the focus of several qualitative studies providing the opportunity to evaluate and synthesize the qualitative literature on SGD childbearing experiences in a metasynthesis. METHODS We conducted a literature search of four databases to identify original research published from January 2011 through June 2021. These results were augmented by forward and backward searching strategies. Two authors independently screened studies. All qualitative studies of the childbearing experience were eligible. Data were extracted and inductively coded using conventional content analysis, and studies underwent a quality appraisal by two authors. RESULTS From 2396 articles, 127 full-text articles were screened, and 25 were included in this synthesis. Three overarching themes were identified: (a) Systematic Invisibility; (b) Creating Personhood Through Parenthood; and (c) Resilient Narratives of Childbearing. CONCLUSIONS Relative to heterosexual and cisgender parents, SGD childbearing parents experience unique structural and interpersonal challenges and employ critically important resilience strategies and coping techniques to manage an overwhelming heterocisnormative experience. These findings provide an important target for health care organizations and professionals to improve SGD perinatal health. In addition, this metasynthesis identified persistent gaps in our understanding of this marginalized childbearing population, which have important implications for reducing health disparities that SGD parents experience.
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Affiliation(s)
- Kodiak Ray Sung Soled
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Columbia University School of Nursing, New York, New York, USA
| | - Paulomi Mimi Niles
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Elise Mantell
- Columbia University School of Nursing, New York, New York, USA
| | - Mars Dansky
- The Institute of Family Health, New York, New York, USA
| | - Walter Bockting
- New York State Psychiatric Institute/Columbia Psychiatry and the Columbia University School of Nursing, New York, New York, USA
| | - Maureen George
- Columbia University Medical Center, New York, New York, USA
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Hudon É, Hudon C, Chouinard MC, Lafontaine S, de Jordy LC, Ellefsen É. The Prenatal Primary Nursing Care Experience of Pregnant Women in Contexts of Vulnerability: A Systematic Review With Thematic Synthesis. ANS Adv Nurs Sci 2022; 45:274-290. [PMID: 35404308 PMCID: PMC9345523 DOI: 10.1097/ans.0000000000000419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The contexts of vulnerability are diversified and cover a wide range of situations where pregnant women are likely to experience threats or disparities. Nurses should consider the particular circumstances of women in contexts of vulnerability. We used a qualitative thematic synthesis to describe the experience of these women regarding their prenatal primary nursing care. We identified that the women's experience is shaped by the prenatal care. The fulfillment of their needs and expectations will guide their decision regarding the utilization of their prenatal care. We propose a theoretical model to guide nurses, promoting person-centered delivery of prenatal care.
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Affiliation(s)
- Émilie Hudon
- Département de médecine de famille et médecine d'urgence (Dr Hudon) and École des sciences infirmières (Drs Lafontaine and Ellefsen), Faculté de médecine et des sciences de la santé (Ms Hudon), Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (Dr Hudon); Faculté des sciences infirmières, Université de Montréal, Montreal, Quebec, Canada (Dr Chouinard); and Département des sciences infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Ms de Jordy)
| | - Catherine Hudon
- Département de médecine de famille et médecine d'urgence (Dr Hudon) and École des sciences infirmières (Drs Lafontaine and Ellefsen), Faculté de médecine et des sciences de la santé (Ms Hudon), Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (Dr Hudon); Faculté des sciences infirmières, Université de Montréal, Montreal, Quebec, Canada (Dr Chouinard); and Département des sciences infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Ms de Jordy)
| | - Maud-Christine Chouinard
- Département de médecine de famille et médecine d'urgence (Dr Hudon) and École des sciences infirmières (Drs Lafontaine and Ellefsen), Faculté de médecine et des sciences de la santé (Ms Hudon), Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (Dr Hudon); Faculté des sciences infirmières, Université de Montréal, Montreal, Quebec, Canada (Dr Chouinard); and Département des sciences infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Ms de Jordy)
| | - Sarah Lafontaine
- Département de médecine de famille et médecine d'urgence (Dr Hudon) and École des sciences infirmières (Drs Lafontaine and Ellefsen), Faculté de médecine et des sciences de la santé (Ms Hudon), Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (Dr Hudon); Faculté des sciences infirmières, Université de Montréal, Montreal, Quebec, Canada (Dr Chouinard); and Département des sciences infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Ms de Jordy)
| | - Louise Catherine de Jordy
- Département de médecine de famille et médecine d'urgence (Dr Hudon) and École des sciences infirmières (Drs Lafontaine and Ellefsen), Faculté de médecine et des sciences de la santé (Ms Hudon), Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (Dr Hudon); Faculté des sciences infirmières, Université de Montréal, Montreal, Quebec, Canada (Dr Chouinard); and Département des sciences infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Ms de Jordy)
| | - Édith Ellefsen
- Département de médecine de famille et médecine d'urgence (Dr Hudon) and École des sciences infirmières (Drs Lafontaine and Ellefsen), Faculté de médecine et des sciences de la santé (Ms Hudon), Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (Dr Hudon); Faculté des sciences infirmières, Université de Montréal, Montreal, Quebec, Canada (Dr Chouinard); and Département des sciences infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Ms de Jordy)
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7
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Kirubarajan A, Barker LC, Leung S, Ross LE, Zaheer J, Park B, Abramovich A, Yudin MH, Lam JSH. LGBTQ2S+ childbearing individuals and perinatal mental health: A systematic review. BJOG 2022; 129:1630-1643. [PMID: 35048502 DOI: 10.1111/1471-0528.17103] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND The perinatal period may uniquely impact the mental health and wellbeing of lesbian, gay, bisexual, transgender, queer, and Two-Spirit (LGBTQ2S+) childbearing individuals. OBJECTIVES To characterise and synthesise the experiences of LGBTQ2S+ childbearing individuals regarding perinatal mental health, including symptomatology, access to care and care-seeking. SEARCH STRATEGY We conducted and reported a systematic review following PRISMA guidelines of eight databases (EMBASE, MEDLINE-OVID, CINAHL, Scopus, Web of Science: Core Collection, Sociological Abstracts, Social Work Abstract, and PsycINFO) from inception to 1 March 2021. SELECTION CRITERIA Original, peer-reviewed research related to LGBTQ2S+ mental health was eligible for inclusion if the study was specific to the perinatal period (defined as pregnancy planning, conception, pregnancy, childbirth, and first year postpartum; includes miscarriages, fertility treatments and surrogacy). DATA COLLECTION AND ANALYSIS Findings were synthesised qualitatively via meta-aggregation using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI), and the ConQual approach. MAIN RESULTS Our systematic search included 26 eligible studies encompassing 1199 LGBTQ2S+ childbearing participants. Using the JBI SUMARI approach, we reported 65 results, which we synthesised as six key findings. The studies described unique considerations for LGBTQ2S+ individuals' perinatal mental health, including heteronormativity, cisnormativity, isolation, exclusion from traditional pregnancy care, stigma, and distressing situations from the gendered nature of pregnancy. Many participants described a lack of knowledge from healthcare providers related to care for LGBTQ2S+ individuals. In addition, LGBTQ2S+ individuals described barriers to accessing mental healthcare and gaps in health systems. Strategies to improve care include provider education, avoidance of gendered language, documentation of correct pronouns, trauma-informed practices, cultural humility training and tailored care for LGBTQ2S+ people. CONCLUSIONS Pregnancy, postpartum, and the perinatal period uniquely impacts the mental health and wellbeing of LGBTQ2S+individuals, largely due to systems-level inequities and exclusion from perinatal care. Healthcare providers should implement the identified strategies to improve perinatal care and address inequities.
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Affiliation(s)
- Abirami Kirubarajan
- University of Toronto Faculty of Medicine, Toronto, ON, Canada.,University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada
| | - Lucy C Barker
- University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada.,University of Toronto Department of Psychiatry, Toronto, ON, Canada.,Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada
| | - Shannon Leung
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Lori E Ross
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Juveria Zaheer
- University of Toronto Department of Psychiatry, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Bomi Park
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Alex Abramovich
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Mark H Yudin
- University of Toronto Department of Obstetrics and Gynaecology, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, Unity Health, St Michael's Hospital, Toronto, ON, Canada
| | - June Sing Hong Lam
- University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada.,University of Toronto Department of Psychiatry, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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Lane J. Using Queer Phenomenology to Disrupt Heteronormativity and Deconstruct Homosexuality. JOURNAL OF HOMOSEXUALITY 2021; 68:2169-2188. [PMID: 32141801 DOI: 10.1080/00918369.2020.1733353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Stigma is structurally embedded and preexists a person's involvement in-the-world. This is understood to create the conditions necessary for what is described here as a priori homophobia, which is defined as a projection of structurally embedded stigma that extends into the mind of 2SLGBTQ individuals and causes them to hide their identities out of fear. With this in mind and by way of queer phenomenology, heteronormativity will be disrupted and the inherently negative notion of "homosexuality" will be deconstructed to understand the role of stigma as a root cause of 2SLGBTQ mental health disparities. Implications for practice are offered so health service providers can understand heteronormativity as a source of everyday harm for 2SLGBTQ and be responsive to the ways in which stigma influences 2SLGBTQ mental health outcomes.
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Affiliation(s)
- Jennifer Lane
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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9
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Mosley EA, Lanning RK. Evidence and guidelines for trauma-informed doula care. Midwifery 2020; 83:102643. [PMID: 32014617 DOI: 10.1016/j.midw.2020.102643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/14/2020] [Accepted: 01/19/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Trauma and trauma-related health conditions are common during pregnancy, but there is little evidence and guidance on how doulas (trained lay birth assistants) can provide trauma-informed care. The purpose of this narrative review is to critique and synthesize the existing evidence for trauma-informed doula care and to offer guidelines for practice. DESIGN We conducted a narrative review of existing evidence in the peer-reviewed and gray literatures on trauma-informed care in maternity and perinatal settings including doula training curricula and community-based doula guidelines on trauma-informed doula care. Materials were analyzed for relevant data on trauma and pregnancy, evidence-based approaches for trauma-informed doula and perinatal care, and strengths/weaknesses of the evidence including research design, gaps in the evidence base, and populations included. SETTING This narrative review focuses on trauma-informed doula care in the United States, although the evidence and guidelines provided are likely applicable in other settings. KEY CONCLUSIONS To be trauma-informed, doulas must first realize the scope and impact of trauma on pregnancy including possible ways to recovery; then recognize signs and symptoms of trauma during pregnancy; be ready to respond by integrating evidence and sensitivity into all doula training and practices; and always resist re-traumatization. Trauma-informed doula care also centers on these 6 principles: safety; trustworthiness and transparency; peer support with other survivors; collaboration and mutuality; resilience, empowerment, voice, and choice; and social, cultural, and historical considerations. In practice, this includes universal trauma-informed doula care offered to all clients, trauma-targeted care that can be offered specifically to clients who are identified as trauma survivors, and connection to trauma specialist services.
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Affiliation(s)
- Elizabeth A Mosley
- Emory University Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Center for Reproductive Health Research in the Southeast (RISE) Postdoctoral Fellow, 250 E Ponce de Leon Ave. Suite 325, 30030, Decatur, GA, United States.
| | - Rhonda K Lanning
- University of North Carolina, Assistant Professor School of Nursing, United States
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10
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MacCormick H, George RB. Sexual and gender minorities educational content within obstetric anesthesia fellowship programs: a survey. Can J Anaesth 2020; 67:532-540. [PMID: 31898774 DOI: 10.1007/s12630-019-01562-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/20/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Improved patient-provider relationships can positively influence patient outcomes. Sexual and gender minorities (SGM) represent a wide variety of marginalized populations. There is an absence of studies examining the inclusion of SGM-related health education within postgraduate training in anesthesia. This study's objective was to perform an environmental scan of the educational content of North American obstetric anesthesia fellowship programs. METHODS An online survey was developed based on a review of the existing literature assessing the presence of SGM content within other healthcare-provider curricula. The survey instrument was distributed electronically to 50 program directors of North American obstetric anesthesia fellowship programs. Survey responses were summarized using descriptive statistics. RESULTS Survey responses were received from 30 of the 50 program directors (60%). Of these, 54% (14/26) felt their curriculum adequately prepares fellows to care for SGM patients, yet only 19% (5/26) of participants stated that SGM content was part of their curriculum and 31% (8/26) would like to see more incorporated in the future. Perceived lack of need was chosen as the biggest barrier to curricular inclusion of SGM education (46%; 12/26), followed by lack of available/interested faculty (19%; 5/26) and time (19%; 5/26). CONCLUSIONS Our results suggest that, although curriculum leaders appreciate that SGM patients are encountered within the practice of obstetric anesthesia, most fellowship programs do not explicitly include SGM curricular content. Nevertheless, there appears to be interest in developing SGM curricular content for obstetric anesthesia fellowship training. Future steps should include perspectives of trainees and patients to inform curricular content.
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Affiliation(s)
- Hilary MacCormick
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada. .,Department of Women's & Obstetric Anesthesia, IWK Health Centre, 5980, University Avenue, Halifax, NS, B3K 6R8, Canada.
| | - Ronald B George
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA
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Chamberlain C, Ralph N, Hokke S, Clark Y, Gee G, Stansfield C, Sutcliffe K, Brown SJ, Brennan S. Healing The Past By Nurturing The Future: A qualitative systematic review and meta-synthesis of pregnancy, birth and early postpartum experiences and views of parents with a history of childhood maltreatment. PLoS One 2019; 14:e0225441. [PMID: 31834894 PMCID: PMC6910698 DOI: 10.1371/journal.pone.0225441] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/05/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Child maltreatment can have serious effects on development and physical, social and emotional wellbeing. Any long-lasting relational effects can impede the capacity to nurture children, potentially leading to 'intergenerational trauma'. Conversely, the transition to parenthood during pregnancy, birth and the early postpartum period offers a unique life-course opportunity for healing. This systematic review aims to understand the pregnancy, birth and early postpartum experiences of parents who reported maltreatment in their own childhood. METHODS A protocol, based on the ENTREQ statement, was registered with PROSPERO. We searched Medline, PsycINFO, CINAHL, EMBASE, NHS Evidence and key Web of Science databases from date of inception to June 2018 to identify qualitative studies exploring perinatal experiences of parents who were maltreated in their own childhood. Two reviewers independently screened articles for inclusion and extracted data. Data were synthesised using grounded theory and thematic analysis approaches. FINDINGS The search yielded 18329 articles, 568 full text articles were reviewed, and 50 studies (60 articles) met inclusion criteria for this review. Due to the large number of studies across the whole perinatal period (pregnancy to two years postpartum), this paper reports findings for experiences during pregnancy, birth and early postpartum (27 studies). Parents described positive experiences and strategies to help them achieve their hopes and dreams of providing safe, loving and nurturing care for their children. However, many parents experienced serious challenges. Seven core analytic themes encapsulated these diverse and dynamic experiences: New beginnings; Changing roles and identities; Feeling connected; Compassionate care; Empowerment; Creating safety; and Reweaving a future. CONCLUSIONS Pregnancy birth and the early postpartum period is a unique life-course healing opportunity for parents with a history of maltreatment. Understanding parent's experiences and views of perinatal care and early parenting is critical for informing the development of acceptable and effective support strategies.
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Affiliation(s)
- Catherine Chamberlain
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Naomi Ralph
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Stacey Hokke
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Yvonne Clark
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Graham Gee
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Claire Stansfield
- Evidence for Policy and Practice Co-ordinating Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, United Kingdom
| | - Katy Sutcliffe
- Evidence for Policy and Practice Co-ordinating Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, United Kingdom
| | - Stephanie J. Brown
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Department of Paediatrics, Royal Children’s Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sue Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Abstract
Lesbian nurses have historically been silenced, but diversity initiatives within professional health programs suggest a need to initiate scholarly discussions that explore heteronormativity as increasing the risk of harm for nonheterosexual nurses as compared to their heterosexual counterparts. Nurses can reflect on relative privilege within the profession to better understand the ways in which normative health practices perpetuate adverse health outcomes among vulnerable patient populations. Nurses from diverse backgrounds, such as this lesbian author, offer insight into how the nursing profession might illuminate relational aspects of privilege. As such, the nursing profession could uncover solutions to systemic vulnerabilities which are inadvertently perpetuated within our profession, the health-care system, and society more broadly. The notion of compulsory heterosexuality is discussed in relation to nursing in this opinion piece with an aim to render structural harms visible that have been obscured by the institutionalization of heteronormativity in health care, to build awareness of the ways in which systemic vulnerabilities are unknowingly perpetuated despite health-care professionals being well-intended in their practice.
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13
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Queer Phenomenology, the Disruption of Heteronormativity, and Structurally Responsive Care. ANS Adv Nurs Sci 2019; 42:109-122. [PMID: 30839330 DOI: 10.1097/ans.0000000000000258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) health disparities persist and reflect larger structural inequities that negatively impact the health of historically marginalized communities. By way of using queer phenomenology, the author analyzes a personal experience that was harmful to her as a lesbian patient who required emergency medical attention. Also a registered nurse, the author draws on her lived experiences to reveal heteronormativity as a prevalent, but largely unacknowledged, source of structural harms for LGBTQ patients. This aims to bring about an appreciation among nurses and other health care professionals to locate themselves within systems of privilege and oppression and gain an awareness on how they might better respond to ongoing structural harms that are disproportionately experienced by vulnerable patient populations.
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Polmanteer RSR, Keefe RH, Brownstein-Evans C. Trauma-informed care with women diagnosed with postpartum depression: a conceptual framework. SOCIAL WORK IN HEALTH CARE 2019; 58:220-235. [PMID: 30346906 DOI: 10.1080/00981389.2018.1535464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/03/2018] [Accepted: 10/09/2018] [Indexed: 06/08/2023]
Abstract
Postpartum depression (PPD) is a mental health disorder that affects approximately 20% of all new mothers. PPD frequently co-occurs with and is exacerbated by trauma, particularly for women from vulnerable populations. Trauma-informed care (TIC) is a best practice that recognizes the importance of, and takes steps to promote recovery from, trauma while preventing retraumatization. Despite its potential utility, there is limited research published on TIC, including how TIC is operationalized across practice settings. Further, despite the prevalence and negative effects of untreated PPD, to date there have been limited articles published on TIC and PPD. The purpose of this article is to provide a TIC framework for service delivery for women diagnosed with PPD including explicit strategies for how TIC should be structured across roles, settings, and systems. Implications for health practice, policy, and future research are provided.
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Affiliation(s)
| | - Robert H Keefe
- b School of Social Work , University at Buffalo, SUNY , Buffalo , New York , USA
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15
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Burrow S, Goldberg L, Searle J, Aston M. Vulnerability, Harm, and Compromised Ethics Revealed by the Experiences of Queer Birthing Women in Rural Healthcare. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:511-524. [PMID: 30402734 DOI: 10.1007/s11673-018-9882-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
Phenomenological interviews with queer women in rural Nova Scotia reveal significant forms of trauma experienced during labour and birth. Situating the accounts of participants within both phenomenological and intersectional analyses reveals harms enabled by structurally embedded heteronormative and homophobic healthcare practices and policies. Our account illustrates the breadth and depth of harm experienced and outlines how these violate core ethical principles and values in healthcare.
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Affiliation(s)
- Sylvia Burrow
- Cape Breton University, 5300 Grand Lake Road, Sydney, NS.B1P 6L2, Canada.
| | - Lisa Goldberg
- Dalhousie University, 5869 University Avenue, Halifax, NS B3H 4R2, Canada
| | - Jennifer Searle
- Dalhousie University, 5869 University Avenue, Halifax, NS B3H 4R2, Canada
| | - Megan Aston
- Dalhousie University, 5869 University Avenue, Halifax, NS B3H 4R2, Canada
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16
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A critical review of human milk sharing using an intersectional feminist framework: Implications for practice. Midwifery 2018; 66:141-147. [PMID: 30172991 DOI: 10.1016/j.midw.2018.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 07/27/2018] [Accepted: 08/15/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Driven by a growing body of research demonstrating the health benefits of human milk over substitute feeding preparations, the demand for human milk donations in North America is rapidly increasing. In the context of an increasingly institutionalized and commercialized human milk market, informal peer-to-peer milk sharing networks are commonplace. Race, class, gender and sexual orientation are intersecting aspects of identity and power that influence participation in breastfeeding and the domain of milk exchange. Using an intersectional feminist framework, we critically review studies of participation in milk sharing to examine the identities and socio-political circumstances of milk sharing participants. DESIGN, SETTING AND PARTICIPANTS We use an intersectional feminist framework to conduct a critical review of the evidence pertaining to human milk sharing participants in North America. The search strategy included relevant databases (Pubmed, CINAHL) and hand-searches of key journals. We include research studies with participants in the United States and Canada and where participants milk shared as recipients or donors. FINDINGS Of those studies that examine socio-political identities such as race and class, participants are largely white and high-income. Many studies did not examine socio-political identities, and none examine sexual orientation. Themes we identify in this review include: (1) Socio-political identities; (2) Milk sharing supports parental health; (3) Socio-political influences; (4) Resistance against institutionalization. IMPLICATIONS FOR PRACTICE Maternity care providers can advocate for improved access to breastfeeding support and pasteurized human donor milk to address inequities. Maternity care providers can bring consciousness of intersecting socio-political identities to discussions with families about milk-sharing.
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