Women's Perspectives of Needs Surrounding Adverse Birth Outcomes: A Qualitative Assessment of the Neighborhood Impact of Adverse Birth Outcomes

Protective Places: the Relationship between Neighborhood Quality and Preterm Births to Black Women in Oakland, California (2007-2011)

Black women have the highest incidence of preterm birth (PTB). Upstream factors, including neighborhood context, may be key drivers of this increased risk. This study assessed the relationship between neighborhood quality, defined by the Healthy Places Index, and PTB among Black women who lived in Oakland, California, and gave birth between 2007 and 2011 (N = 5418 women, N = 107 census tracts). We found that, compared with those living in lower quality neighborhoods, women living in higher quality neighborhoods had 20-38% lower risk of PTB, independent of confounders. Findings have implications for place-based research and interventions to address racial inequities in PTB.

Radiation exposure in pregnancy: outcomes, perceptions and teratological counseling in Turkish women

BACKGROUND

Fetal effects of radiation are associated with the gestational week of exposure, dose, and duration of exposure, but the perception of risk of radiation in expecting mothers is greater than the actual risk of physical effects.

OBJECTIVES

Evaluate the overestimation of the teratogenic risk in women exposed to radiation and the role of teratological counseling in minimizing preconceptions.

DESIGN

Analytical, cross-sectional.

SETTING

Tertiary care center, genetic diseases diagnosis center.

PATIENTS AND METHODS

Out of 10 784 people who applied for teratological consultation between 2009 and 2018, pregnant women meeting inclusion criteria and exposed to radiation were selected as the study group; pregnant women without radiation exposure were selected as the control group. Two subgroups of the study group based on the week and dose of exposure were also analyzed.

MAIN OUTCOME MEASURES

Abortion rate, termination recommendation rates before and after teratological counseling.

SAMPLE SIZE

461 pregnant exposed to radiation; 213 pregnant women without radiation exposure.

RESULTS

Preterm birth and termination rates differed significantly between cases and controls (P=.038, P=.019, respectively). Termination recommendation at the first examination was more frequent for both the week of exposure overall and dose subgroups comparing cases and controls (P<.001). In the comparison of subgroups by week of exposure, only the miscarriage rate was statistically significant (P=.007). After teratological counseling termination decision rates were significantly decreased (P<.001).

CONCLUSION

Subjective perceptions about the risks of radiation may lead to the termination of an otherwise wanted pregnancy. Teratological counseling is crucial for the prevention of termination of pregnancy, clarifying misinformation, and minimizing anxiety.

LIMITATIONS

With the exception of measurable values as calculated doses of radiation, the conclusions are mostly derived from medical records and subjective responses of pregnant women. The termination rates in our study probably do not reflect the whole population.

CONFLICT OF INTEREST

None.

Addressing bias and disparities in periviable counseling and care

Addressing bias and disparities in counseling and care requires that we contend with dehumanizing attitudes, stereotypes, and beliefs that our society and profession holds towards people of color, broadly, and Black birthing people in particular. It also necessitates an accounting of the historically informed, racist ideologies that shape present-day implicit biases. These biases operate in a distinctly complex and damaging manner in the context of end-of-life care, which centers around questions related to human pain, suffering, and value. Therefore, this paper aims to trace biases and disparities that operate in periviable care, where end-of-life decisions are made at the very beginning of life. We start from a historical context to situate racist ideologies into present day stereotypes and tropes that dehumanize and disadvantage Black birthing people and Black neonates in perinatal care. Here, we review the literature, address historical incidents and consider their impact on our ability to deliver patient-centered periviable care.

A new perspective on the maternal mortality disparity

The disparity in maternal mortality rates between ethnicities in the United States is alarming, with Black women at far higher risk of dying than women of other ethnicities. Factors typically thought of as protective in health disparity research are not necessarily protective with maternal mortality. Building upon a social justice framework by utilizing a strength-based focus is needed when addressing this issue to build upon strengths and empower Black women as a part of the solution.

Medicaid, motherhood, and the challenges of having a healthy pregnancy amidst changing social networks

BACKGROUND

African American women with low income face various challenges to having a healthy pregnancy. Unplanned pregnancies often amplify those challenges and negatively impact women's ability to get the care that she needs. Research has shown that social networks can improve pregnancy outcomes by helping women cope with and address the problems that they face. However, there is little research on how unintended pregnancy impacts the medical and social support that African American women receive.

AIM

This research explored how unintended pregnancies impact women's social networks and the type of support that they need throughout the pregnancy.

DESIGN AND SAMPLE

This ethnographic study included 20 African American women who used pregnancy services at a health department in the United States. Fourteen women were enrolled in the study during their first or second trimester and were interviewed upon enrollment, in their third trimester, and within one month of giving birth. An additional six women were enrolled and interviewed within one month of giving birth.

RESULTS

African American women's needs and social support networks change throughout their pregnancy. When medical providers primarily offer pregnancy information and referrals to social service agencies during the first trimester, problems that women have later in the pregnancy are not properly addressed.

CONCLUSION

Social support needs to be accessed at multiple times during the pregnancy. Pregnancy resources should be provided throughout the pregnancy, recognizing that social support and personal struggles evolve during the pregnancy.