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Grünebaum A, Chervenak FA. Why do women choose home births. J Perinat Med 2024; 0:jpm-2024-0175. [PMID: 38753538 DOI: 10.1515/jpm-2024-0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024]
Abstract
In recent years, the US has seen a significant rise in the rate of planned home births, with a 60 % increase from 2016 to 2023, reaching a total of 46,918. This trend positions the US as the leading developed country in terms of home birth prevalence. The American College of Obstetricians and Gynecologists (ACOG) suggests stringent criteria for selecting candidates for home births, but these guidelines have not been adopted by home birth midwives leading to poor outcomes including increased rates of neonatal morbidity and mortality. This paper explores the motivations behind choosing home births in the US despite the known risks. Studies highlight factors such as the desire for a more natural birth experience, previous negative hospital experiences, and the influence of the COVID-19 pandemic on perceptions of hospital safety. We provide new insights into why women choose home births by incorporating insights from Nobel laureate Daniel Kahneman's theories on decision-making, suggesting that cognitive biases may significantly influence these decisions. Kahneman's work provides a framework for understanding how biases and heuristics can lead to the underestimation of risks and overemphasis on personal birth experiences. We also provide recommendations ("nudges according to Richard Thaler") to help ensure women have access to clear, balanced information about home births. The development of this publication was assisted by OpenAI's ChatGPT-4, which facilitated the synthesis of literature, interpretation of data, and manuscript drafting. This collaboration underscores the potential of integrating advanced computational tools in academic research, enhancing the efficiency and depth of our analyses.
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Affiliation(s)
- Amos Grünebaum
- Department of Obstetrics and Gynecology, Zucker School of Medicine, 5945 Lenox Hill Hospital , New York, NY, USA
| | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Zucker School of Medicine, 5945 Lenox Hill Hospital , New York, NY, USA
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2
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Athanasopoulou SG, Cicero M, Sanseau E, Kou M, Auerbach M. Use of a SimBox, a Video-Augmented, Newborn Resuscitation Simulation for Prehospital Providers to Measure Clinical Performance and Educational Experience. Cureus 2024; 16:e57925. [PMID: 38725757 PMCID: PMC11081711 DOI: 10.7759/cureus.57925] [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: 01/02/2024] [Accepted: 04/06/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES Few studies have described the current clinical practices, adherence to guidelines, and outcomes of newborn resuscitations attended by emergency medical services (EMS). SimBox, a novel, video-augmented simulation, was used to describe the adherence of prehospital providers to Neonatal Resuscitation Program guidelines, to measure satisfaction with the simulation intervention, and to describe the self-reported improvement in knowledge, skills, and attitudes after the simulation. METHODS A prospective observational cohort study of EMS providers was designed and conducted using SimBox, an open-access simulation platform, and facilitated by EMS educators. Clinical performance measures were collected using a five-item checklist. Simulation satisfaction measures were collected through net promoter scores. Learners' demographics, and self-reported knowledge, skills, and attitudes were measured using a retrospective survey of 25 questions. RESULTS In total, 33 facilitator and 55 learner surveys were collected across Connecticut, Colorado, and Alaska between July 2021 and September 2022. At least one deviation from clinical guidelines occurred in 22/30 (73.3%) of the sessions, with 10/30 (33.3%) teams inappropriately performing chest compressions, 5/31 (16.1%) teams not warming, drying, stimulating, and suctioning the newborn, and 7/31 (22.6%) teams not performing positive pressure ventilation correctly. Lastly, 10/30 (33.3%) teams administered an incorrect dose of dextrose-containing fluids. Very high levels of satisfaction were reported with net promoter scores of 97 and 82 out of 100 for the facilitator and learner surveys, respectively. Finally, all 55/55 (100%) of the learners strongly or somewhat agreed that the simulation improved their knowledge, teamwork, communication, and psychomotor skills. CONCLUSIONS In this cohort of prehospital providers, clinical management decisions during a newborn resuscitation simulation often deviated from the gold-standard, newborn resuscitation guidelines. Free, online, open-access simulation resources like SimBox can be used to identify and measure practice deviations from standardized resuscitation protocols in the prehospital setting.
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Affiliation(s)
| | - Mark Cicero
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, USA
| | - Elizabeth Sanseau
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Maybelle Kou
- Department of Emergency Medicine, University of Virginia School of Medicine, Inova Fairfax Medical Campus, Falls Church, USA
| | - Marc Auerbach
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, USA
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3
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Grünebaum A, Chervenak FA. Enduring safety concerns for out-of-hospital births in the United States. Am J Obstet Gynecol 2024:S0002-9378(24)00453-8. [PMID: 38537792 DOI: 10.1016/j.ajog.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Amos Grünebaum
- Northwell, New Hyde Park, NY, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine, Northwell, 2000 Marcus Ave., Suite 300, New Hyde Park, 11042-1069, NY.
| | - Frank A Chervenak
- Northwell, New Hyde Park, NY, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine, Northwell, 2000 Marcus Ave., Suite 300, New Hyde Park, 11042-1069, NY
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4
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Grünebaum A, Mcleod-Sordjan R, Bornstein E, De Four Jones M, Lewis D, Chervenak FA. Trends in racial and ethnic distribution of United States birthplaces 2016-2022. Am J Obstet Gynecol 2024; 230:e12-e13. [PMID: 38001016 DOI: 10.1016/j.ajog.2023.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Amos Grünebaum
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY.
| | | | - Eran Bornstein
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | | | - Dawnette Lewis
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Frank A Chervenak
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
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5
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Da Silva AM, De Lavôr JR, Freitas VS, Vieira AR. Risk of orofacial clefts in relation to maternal body mass index, diabetes and hypertension. J Neonatal Perinatal Med 2024; 17:41-48. [PMID: 38277306 DOI: 10.3233/npm-230118] [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: 01/28/2024]
Abstract
BACKGROUND To investigate if maternal body mass index, diabetes and hypertension are associated with orofacial clefts. METHODS Case-control study. Information from 53,188 live births with and without orofacial cleft registered at USA Vital Statistics Natality Birth Data between 2017 and 2021. Case group consisted of all affected live births diagnosed with orofacial clefts (13,297 cases). Comparison group consisted of 39,891 live births without clefts or any other congenital malformation. Information about orofacial cleft cases were compared with the comparison group. The unadjusted and adjusted Odds Ratios were estimated to evaluate the strength of association between mother's pre-pregnancy body mass index, maternal diabetes and hypertension and orofacial cleft occurrence, assuming a p value < 0.05 and 95% confidence intervals (95% C.I.) for statistically significant differences. RESULTS Mother's pre-pregnancy body mass index, maternal diabetes and maternal hypertension are conditions associated with an increased risk of orofacial cleft development in the child (OR = 1.08, p = 0.004, 95% C.I. = 1.024-1.149; OR = 1.32, 95%, p = 0.000, 95% C.I. = 1.202-1.444; and OR = 1.35, p = 0.000, 95% C.I. = 1.239-1.484; respectively). Maternal ethnicity, sex of infant, and cigarette smoking pregnancy remained as covariates after adjustments in all logistic regression models. CONCLUSION Due to the increased prevalence of obesity, diabetes, and hypertension, and also to their association with congenital malformations, such as clefts, it is recommended that mothers planning to become pregnant to follow healthy habits, maintain healthy weight, and be screened for possible diabetes or hypertension prior to conception and early in pregnancy.
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Affiliation(s)
- A M Da Silva
- Public Health PhD Graduate Program, State University of Feira de Santana, Feira de Santana, BA, Brazil
- Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - J R De Lavôr
- Pediatric Dentistry PhD Graduate Program, State University of Pernambuco, Recife, PE, Brazil
- Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - V S Freitas
- Department of Health, State University of Feira de Santana, Feira de Santana, BA, Brazil
| | - A R Vieira
- Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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6
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Quispe-Vicuña C, Fernandez-Guzman D, Caira-Chuquineyra B, Failoc-Rojas VE, Bendezu-Quispe G, Urrunaga-Pastor D. Association between receiving information on obstetric complications and institutional delivery: An analysis of the demographic and health survey of Peru, 2019. Heliyon 2023; 9:e21146. [PMID: 38027831 PMCID: PMC10665671 DOI: 10.1016/j.heliyon.2023.e21146] [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: 02/05/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To evaluate the association between receiving information on obstetric complications and institutional delivery in Peruvian women in 2019. Methods We conducted a secondary analysis of the 2019 Peruvian Demographic and Family Health Survey (ENDES) database. The dependent variable was the type of delivery (institutional or non-institutional). The exposure variable was self-reporting of having received information on obstetric complications during prenatal care. The association of interest was evaluated using binary logistic regression models, obtaining crude odds ratios (cOR) and adjusted odds ratios (aOR) with their respective 95 % confidence intervals (95%CI). Values of p < 0.05 were considered statistically significant. Results We included a total of 14,835 women in the analysis. Of the total, 14,088 (94.1 %) reported having received information on pregnancy complications. Also, 13,883 (92.5 %) had an institutional delivery in their last pregnancy. The adjusted model showed that women who reported knowing the complications that can occur in pregnancy had a higher probability of presenting an institutional delivery (aOR = 1.47; 95%CI: 1.04-2.08). Conclusions Receiving information about pregnancy complications was found to be associated with a higher probability of institutional delivery. Ensuring the provision of information to the pregnant woman about pregnancy complications can be a useful strategy to increase institutional delivery.
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Affiliation(s)
- Carlos Quispe-Vicuña
- Sociedad Científica San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
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Johansson M, Jansson O, Lilja F, Ekéus C, Volgsten H. Freebirth, the only option for women who do not fit into common practice- A Swedish national interview study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100866. [PMID: 37295181 DOI: 10.1016/j.srhc.2023.100866] [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: 02/15/2023] [Revised: 05/20/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore women's experience of freebirth, as giving birth without the presence of a skilled healthcare professional such as a midwife. METHODS Online semi-structured interviews with nine multiparous women in Sweden. A qualitative experiential approach, as described by Burnard, was followed for data analysis. RESULTS The five main categories explored were: (i) previous negative experiences of hospital care as a reason for freebirth; (ii) receiving support for the decision of freebirth was crucial; (iii) longing for individual midwifery-assisted home-birthing support; (iv) to give birth in peace and in self-control, in the safe home environment; and (v) helpful support during labor and birth was appreciated. CONCLUSIONS The women in the study had a powerful and positive experience of freebirth, but individual midwifery birthing support was also requested. Easily available and respectful midwifery support should be offered to all childbearing women.
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Affiliation(s)
- Margareta Johansson
- Uppsala University, Department of Women's and Children's Health, Akademiska University Hospital, SE-751 85 Uppsala, Sweden.
| | - Olivia Jansson
- Akademiska University Hospital, Department of Obstetrics and Gynaecology, SE-751 85 Uppsala, Sweden.
| | - Fanny Lilja
- BB Stockholm Family Kungsholmen, Sankt Eriksgatan 44, SE-112 34 Stockholm, Sweden.
| | - Cecilia Ekéus
- Uppsala University, Department of Women's and Children's Health, SE-751 85 Uppsala, Sweden.
| | - Helena Volgsten
- Uppsala University, Department of Public Health and Caring Sciences, SE-75122 Uppsala University, Uppsala, Sweden.
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8
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Akinyemi OA, Fasokun ME, Weldeslase TA, Makanjuola D, Makanjuola OE, Omokhodion OV. Determinants of Neonatal Mortality in the United States. Cureus 2023; 15:e43019. [PMID: 37674952 PMCID: PMC10478149 DOI: 10.7759/cureus.43019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Despite a notable reduction in infant mortality over recent decades, the United States, with a rate of 5.8 deaths per 1,000 live births, still ranks unfavorably compared to other developed countries. This improvement appears inadequate when contrasted with the country's healthcare spending, the highest among developed nations. A significant proportion of this infant mortality rate can be attributed to neonatal fatalities. Objective The present study aimed to determine the risk factors associated with neonatal deaths in the United States. Method Using the United States Vital Statistics records, we conducted a retrospective study on childbirths between 2015 and 2019 to identify risk factors for neonatal mortality. Our final multivariate analysis included maternal parameters like age, insurance type, education level, cesarean section rate, pregnancy inductions and augmentations, weight gain during pregnancy, birth weight, number of prenatal visits, pre-existing conditions like chronic hypertension and prediabetes, and pregnancy complications like gestational diabetes mellitus (GDM). These variables were incorporated to enhance our model's sensitivity and specificity. Result There were 51,174 neonatal mortalities. Mothers with augmentation of labor had a 25% reduction in neonatal mortalities (NM) (OR=0.75; 95% CI 0.72-0.79), while labor induction was associated with a 31% reduction in NM (OR=0.69; 95% CI 0.66-0.72). Women above 40 years had a 29% increase in NM rate (OR=1.29;95% CI 1.15-1.44). Women without prenatal care have a 22% increase in the risk of NM (OR=1.22; 95% CI 1.14-1.30). The present model has a 60.7% sensitivity and a 99.9% specificity. Conclusion In the present study, significant interventions such as labor induction, augmentation, and prenatal care were associated with improved neonatal outcomes. These findings could serve as an algorithm for improving neonatal outcomes in the United States.
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Affiliation(s)
- Oluwasegun A Akinyemi
- Health Policy and Management, University of Maryland School of Public Health, College Park, USA
- Surgery, Howard University, Washington D.C., USA
| | - Mojisola E Fasokun
- Epidemiology and Public Health, The University of Alabama at Birmingham, Birmingham, USA
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Whittington JR, Ghahremani T, Whitham M, Phillips AM, Spracher BN, Magann EF. Alternate Birth Strategies. Int J Womens Health 2023; 15:1151-1159. [PMID: 37496517 PMCID: PMC10368118 DOI: 10.2147/ijwh.s405533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023] Open
Abstract
Community birth is defined as birth that occurs outside the hospital setting. Birthing in a birth center can be safe for certain patient populations. Home birth can also be safe in well-selected patient with a well-established transfer infrastructure should an emergency occur. Unfortunately, many areas of the United States and the world do not have this infrastructure, limiting access to safe community birth. Immersion during labor has been associated with decreased need for epidural and pain medication. Delivery should not occur in water due to concerns for infection and cord avulsion. Umbilical cord non-severance (also called lotus birth) and placentophagy should be counseled against due to well-documented risks without clear benefit. Birth plans and options should be regularly discussed during pregnancy visits.
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Affiliation(s)
- Julie R Whittington
- Department of Obstetrics and Gynecology, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA, USA
| | - Taylor Ghahremani
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Megan Whitham
- Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Amy M Phillips
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bethany N Spracher
- Department of Obstetrics and Gynecology, Edward via College of Osteopathic Medicine, Blacksburg, VA, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Knox‐Kazimierczuk F, Trinh S, Odems D, Shockley‐Smith M. Challenges and lessons learned birthing during the COVID-19 pandemic: A scoping review. Health Sci Rep 2023; 6:e1387. [PMID: 37484060 PMCID: PMC10359605 DOI: 10.1002/hsr2.1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Background and Aims The impact of the COVID-19 pandemic on the healthcare system facilitated a change in policies to redress the consequences of increased demand and fear of disease transmission. Restrictive measures throughout the healthcare system limiting access to accompanying partners of birthing people in addition to fears of contracting COVID-19, an increasing number of birthing people chose to have an out-of-hospital birth. Out-of-hospital births are not prevalent in the United States. However, in recent years the percentage of out-of-hospital births has been steadily increasing. COVID-19 was a novel virus imposing a unique birthing situation for millions of women, complicated by lack of integration and varied policies in the U.S. Methods To better understand the challenges of birthing people during the pandemic a scoping review was conducted to explore the literature during the first wave of the pandemic related to out-of-hospital births. The approach for this review made use of the methodology manual published by the Joanna Briggs Institute for scoping reviews. All manner of publications (i.e. peer-reviewed published articles, grey articles, conference proceedings, webinars, editorials, and textbook chapters) were included in the review. Results Articles retrieved from the database search yielded sixty-three articles, after duplicate removal forty-six records were available for screening. Articles were further excluded using the PRISMA process, yielding thirty-one remaining records. From the thirty-one records twelve themes emerged, which were collapsed into four meta-themes. Conclusion These meta-themes focused on (a) advocacy, (b) homebirth infrastructure, (c) support networks, and (d) uncertainty during the pandemic. COVID-19 has accelerated this movement to birthing at home and thought must be given to how the healthcare system is going to support and integrate this mode of birthing.
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Affiliation(s)
| | - Shannon Trinh
- Department of Rehabilitation, Exercise, & Nutrition ScienceUniversity of CincinnatiCincinnatiOhioUSA
| | - Dorian Odems
- Department of Population HealthCollege of Health & Human Services, The University of ToledoToledoOhioUSA
| | - Meredith Shockley‐Smith
- Cradle Cincinnati, Queens Village InitiativeCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsCollege of Medicine, University of CincinnatiCincinnatiOhioUSA
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Grünebaum A, Chervenak J, Pollet SL, Katz A, Chervenak FA. The exciting potential for ChatGPT in obstetrics and gynecology. Am J Obstet Gynecol 2023; 228:696-705. [PMID: 36924907 DOI: 10.1016/j.ajog.2023.03.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023]
Abstract
Natural language processing-the branch of artificial intelligence concerned with the interaction between computers and human language-has advanced markedly in recent years with the introduction of sophisticated deep-learning models. Improved performance in natural language processing tasks, such as text and speech processing, have fueled impressive demonstrations of these models' capabilities. Perhaps no demonstration has been more impactful to date than the introduction of the publicly available online chatbot ChatGPT in November 2022 by OpenAI, which is based on a natural language processing model known as a Generative Pretrained Transformer. Through a series of questions posed by the authors about obstetrics and gynecology to ChatGPT as prompts, we evaluated the model's ability to handle clinical-related queries. Its answers demonstrated that in its current form, ChatGPT can be valuable for users who want preliminary information about virtually any topic in the field. Because its educational role is still being defined, we must recognize its limitations. Although answers were generally eloquent, informed, and lacked a significant degree of mistakes or misinformation, we also observed evidence of its weaknesses. A significant drawback is that the data on which the model has been trained are apparently not readily updated. The specific model that was assessed here, seems to not reliably (if at all) source data from after 2021. Users of ChatGPT who expect data to be more up to date need to be aware of this drawback. An inability to cite sources or to truly understand what the user is asking suggests that it has the capability to mislead. Responsible use of models like ChatGPT will be important for ensuring that they work to help but not harm users seeking information on obstetrics and gynecology.
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Affiliation(s)
- Amos Grünebaum
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY.
| | - Joseph Chervenak
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY
| | - Susan L Pollet
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Adi Katz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
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12
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Grünebaum A, Bornstein E, McLeod-Sordjan R, Lewis T, Wasden S, Combs A, Katz A, Klein R, Warman A, Black A, Chervenak FA. The impact of birth settings on pregnancy outcomes in the United States. Am J Obstet Gynecol 2023; 228:S965-S976. [PMID: 37164501 DOI: 10.1016/j.ajog.2022.08.011] [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: 07/09/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 05/12/2023]
Abstract
In the United States, 98.3% of patients give birth in hospitals, 1.1% give birth at home, and 0.5% give birth in freestanding birth centers. This review investigated the impact of birth settings on birth outcomes in the United States. Presently, there are insufficient data to evaluate levels of maternal mortality and severe morbidity according to place of birth. Out-of-hospital births are associated with fewer interventions such as episiotomies, epidural anesthesia, operative deliveries, and cesarean deliveries. When compared with hospital births, there are increased rates of avoidable adverse perinatal outcomes in out-of-hospital births in the United States, both for those with and without risk factors. In one recent study, the neonatal mortality rates were significantly elevated for all planned home births: 13.66 per 10,000 live births (242/177,156; odds ratio, 4.19; 95% confidence interval, 3.62-4.84; P<.0001) vs 3.27 per 10,000 live births for in-hospital Certified Nurse-Midwife-attended births (745/2,280,044; odds ratio, 1). These differences increased further when patients were stratified by recognized risk factors such as breech presentation, multiple gestations, nulliparity, advanced maternal age, and postterm pregnancy. Causes of the increased perinatal morbidity and mortality include deliveries of patients with increased risks, absence of standardized criteria to exclude high-risk deliveries, and that most midwives attending out-of-hospital births in the United States do not meet the gold standard for midwifery regulation, the International Confederation of Midwives' Global Standards for Midwifery Education. As part of the informed consent process, pregnant patients interested in out-of-hospital births should be informed of its increased perinatal risks. Hospital births should be supported for all patients, especially those with increased risks.
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Affiliation(s)
- Amos Grünebaum
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY.
| | - Eran Bornstein
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Renee McLeod-Sordjan
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra Northwell School of Nursing and Physician Assistant Studies, Northwell Health, New York, NY
| | - Tricia Lewis
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, South Shore University Hospital, Bay Shore, NY
| | - Shane Wasden
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Adriann Combs
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY
| | - Adi Katz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Risa Klein
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Ashley Warman
- Division of Medical Ethics, Department of Medicine, Lenox Hill Hospital, New York, NY
| | - Alex Black
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
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Paul KJ, Murosko D, Smith VC, Montoya-Williams D, Parga-Belinkie J. Defining Gender in Infant Care. Neoreviews 2023; 24:e199-e205. [PMID: 36854845 DOI: 10.1542/neo.24-3-e199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Kathryn J Paul
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Daria Murosko
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Vincent C Smith
- Division of Newborn Medicine, Boston Medical Center, Boston, MA
| | - Diana Montoya-Williams
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA
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Perinatal outcomes for rural obstetric patients and neonates in rural-located and metropolitan-located hospitals. J Perinatol 2022; 42:1600-1606. [PMID: 35963889 DOI: 10.1038/s41372-022-01490-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To compare rural obstetric patient and neonate characteristics and outcomes by birth location. METHODS Retrospective observational cohort study of rural residents' hospital births from California, Pennsylvania, and South Carolina. Hospitals in rural counties were rural-located, those in metropolitan counties with ≥10% of obstetric patients from rural communities were rural-serving, metropolitan-located, others were non-rural-serving, metropolitan-located. Any adverse obstetric patient or neonatal outcomes were assessed with logistic regression accounting for patient characteristics, state, year, and hospital. RESULTS Of 466,896 rural patient births, 64.3% occurred in rural-located, 22.5% in rural-serving, metropolitan-located, and 13.1% in non-rural-serving, metropolitan-located hospitals. The odds of any adverse outcome increased in rural-serving (aOR 1.27, 95% CI 1.10-1.46) and non-rural-serving (aOR 1.35, 95% CI 1.18-1.55) metropolitan-located hospitals. CONCLUSION One-third of rural obstetric patients received care in metropolitan-located hospitals. These patients have higher comorbidity rates and higher odds of adverse outcomes likely reflecting referral for higher baseline illness severity.
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Cheung KW, Seto MTY, Wang W, Ng CT, To WWK, Ng EHY. Trend and causes of maternal death, stillbirth and neonatal death over seven decades in Hong Kong. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 26:100523. [PMID: 35833208 PMCID: PMC9272372 DOI: 10.1016/j.lanwpc.2022.100523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Reducing maternal and perinatal mortality is a global objective. Hong Kong is a city with low maternal and perinatal mortality but little is known about the trend and causes of these deaths in this high-income city. We analyzed the maternal death, stillbirth and neonatal death since 1946 in Hong Kong. METHODS Data were extracted from vital statistics, based on the number of registered deaths and births, provided by the Department of Health, the Government of the HKSAR. The annual change rate of mortality was evaluated by regression analysis. Contextual factors were collected to assess the association with mortality. FINDINGS Between 1946 and 2017, the stillbirth rate (per 1,000 total births) reduced from 21·5 to 2·4; early and late neonatal deaths (per 1,000 live births) reduced from 14·1 and 18·1 to 0·7 and 0·4 in 2017, respectively. The maternal mortality ratio (per 100,000 live births) declined from 125 to 1·8.The causes of maternal and perinatal deaths were available since 1981 and 1980 respectively. The leading causes of death were thromboembolism (37·0%) and obstetric haemorrhage (30·4%) for maternal death; congenital problem (30·1%) and prematurity (29·0%) for neonatal death. No data on causes of stillbirth were available. No specific shift of pattern was observed in the causes of maternal and neonatal death with time. There were no cases of maternal death due to sepsis and only 2 cases (2·2%) of maternal deaths due to indirect cause. INTERPRETATION The maternal and perinatal death have reduced significantly in Hong Kong and maintained at the lowest level globally. Indirect maternal death and sepsis were unusual causes of maternal deaths. Use of ICD-PM stillbirth classification, setting up a maternal death confidential enquiry and adding pregnancy checkbox could be the next step to identify and categorize hidden burden. FUNDING Nil.
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Affiliation(s)
- Ka Wang Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Mimi Tin Yan Seto
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Weilan Wang
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Chi Tao Ng
- Clinical Trials Centre, The University of Hong Kong, Hong Kong SAR, China
| | - William Wing Kee To
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong SAR, China
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
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16
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Grünebaum A, McCullough LB, Bornstein E, Lenchner E, Katz A, Spiryda LB, Klein R, Chervenak FA. Neonatal outcomes of births in freestanding birth centers and hospitals in the United States, 2016-2019. Am J Obstet Gynecol 2022; 226:116.e1-116.e7. [PMID: 34217722 DOI: 10.1016/j.ajog.2021.06.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Births in freestanding birth centers have more than doubled between 2007 and 2019. Although birthing centers, which are defined by the American College of Obstetricians and Gynecologists as ". . . freestanding facilities that are not hospitals," are being promoted as offering women fewer interventions than hospitals, there are limited recent data available on neonatal outcomes in these settings. OBJECTIVE To compare several important measures of neonatal safety between 2 United States birth settings and birth attendants: deliveries in freestanding birth centers and hospital deliveries by midwives and physicians. STUDY DESIGN This is a retrospective cohort study using the United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, and Division of Vital Statistics natality online database for the years 2016 to 2019. All term, singleton, low-risk births were eligible for inclusion. The study outcomes were several neonatal outcomes including neonatal death, neonatal seizures, 5-minute Apgar scores of <4 and <7, and neonatal death in nulliparous and in multiparous women. Outcomes were compared between the following 3 groups: births in freestanding birth centers, in-hospital births by a physician, and in-hospital births by a midwife. The prevalence of each neonatal outcome among the different groups was compared using Pearson chi-squared test, with the in-hospital midwife births being the reference group. Multivariate logistic regression models were performed to account for several potential confounding factors such as maternal prepregnancy body mass index, maternal weight gain, parity, gestational weeks, and neonatal birthweight and calculated as adjusted odds ratio. RESULTS The study population consisted of 9,894,978 births; 8,689,467 births (87.82%) were in-hospital births by MDs and DOs, 1,131,398 (11.43%) were in-hospital births by midwives, and 74,113 (0.75%) were births in freestanding birth centers. Freestanding birth center deliveries were less likely to be to non-Hispanic Black or Hispanic, less likely to women with public insurance, less likely to be women with their first pregnancy, and more likely to be women with advanced education and to have pregnancies at ≥40 weeks' gestation. Births in freestanding birth center had a 4-fold increase in neonatal deaths (3.64 vs 0.95 per 10,000 births: adjusted odds ratio, 4.00; 95% confidence interval, 2.62-6.1), a more than 7-fold increase in neonatal deaths for nulliparous patients (6.8 vs 0.92 per 10,000 births: adjusted odds ratio, 7.7; 95% confidence interval, 4.42-13.76), a more than 2-fold increase in neonatal seizures (3.91 vs 1.94 per 10,000 births: adjusted odds ratio, 2.19; 95% confidence interval, 1.48-3.22), and a more than 7-fold increase of a 5-minute Apgar score of <4 (194.84 vs 28.5 per 10,000 births: adjusted odds ratio, 7.46; 95% confidence interval, 7-7.95). Compared with hospital midwife deliveries, hospital physician deliveries had significantly higher adverse neonatal outcomes (P<0.001). CONCLUSION Births in United States freestanding birth centers are associated with an increased risk of adverse neonatal outcomes such as neonatal deaths, seizures, and low 5-minute Apgar scores. Therefore, when counseling women about the location of birth, it should be conveyed that births in freestanding birth centers are not among the safest birth settings for neonates compared with hospital births attended by either midwives or physicians.
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Grünebaum A, Bornstein E, Katz A, Chervenak FA. An immutable truth: planned home births in the United States result in avoidable adverse neonatal outcomes. Am J Obstet Gynecol 2022; 226:138-140. [PMID: 34861989 DOI: 10.1016/j.ajog.2021.11.1347] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/01/2022]
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18
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Grünebaum A, Bornstein E, Katz A, Chervenak FA. Worsening risk profiles of out-of-hospital births during the COVID-19 pandemic. Am J Obstet Gynecol 2022; 226:137-138. [PMID: 34895908 PMCID: PMC8660066 DOI: 10.1016/j.ajog.2021.11.1346] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
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Utilization and Comparative Effectiveness of Uterine Artery Embolization vs. Hysterectomy for Severe Postpartum Hemorrhage: A National Inpatient Sample Study. J Vasc Interv Radiol 2021; 33:427-435.e4. [PMID: 34915166 DOI: 10.1016/j.jvir.2021.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess if uterine artery embolization conferred a lower risk of mortality or prolonged hospital stay compared to hysterectomy in severe post-partum hemorrhage (PPH) and to analyze if geographical or clinical determinants affected which therapy was received. MATERIALS AND METHODS This National Inpatient Sample study from 2005-2017 included all patients with live-birth deliveries. Severe PPH was defined as those requiring transfusion, hysterectomy, or uterine artery embolization (UAE). Propensity score weighting adjusted demographic, maternal, and delivery risk factors were used to assess mortality and prolonged hospital stay. RESULTS Of 9.8 million identified live births, PPH occurred in 31.0 per 1,000. The most common intervention for PPH was transfusion (116.4 per 1,000 cases of PPH). Hysterectomy was used more frequently than UAE (20.4 vs 12.9 per 1,000). The following factors predicted hysterectomy would be used more commonly than UAE: previous cesarean delivery, breech fetal position, placenta previa, transient hypertension of pregnancy without pre-eclampsia, pre-existing hypertension without pre-eclampsia, pre-existing hypertension with pre-eclampsia, unspecified maternal hypertension, and gestational diabetes (all p<0.001). Delivery risk factors associated with greater utilization of hysterectomy over UAE included post-dates pregnancy, premature rupture of membranes, cervical laceration, forceps vaginal delivery, and shock (all p<0.001). There was no difference in mortality between hysterectomy and UAE. After balancing demographic, maternal, and delivery risk factors, the odds of prolonged hospital stay were 0.38 times lower with UAE than hysterectomy (p<0.001). CONCLUSION Despite similar mortality and shorter hospital stays, UAE is used far less than hysterectomy in the management of severe PPH.
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20
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Fiorentino R, Jefferson K, Lichtman R. Let complete numbers speak for themselves. Birth 2021; 48:453-457. [PMID: 34609009 DOI: 10.1111/birt.12595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022]
Abstract
The authors describe the challenges they encountered, having attempted to retrospectively complete a home birth outcome data set for New York State. In addition, they provide a compelling argument for a midwifery data collective that would bring together health record data for all midwife-attended births nationwide, regardless of setting.
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Affiliation(s)
- Renée Fiorentino
- SUNY Downstate Health Sciences University (alumna), Brooklyn, USA
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21
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Hamadi HY, Xu J, Tafili AA, Smith FS, Spaulding AC. Hospital Geographic Location and Unexpected Complications in term Newborns in Florida. Matern Child Health J 2021; 26:358-366. [PMID: 34613554 DOI: 10.1007/s10995-021-03240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Birth trauma rates in term of neonates is a quality measure used by the Joint Commission. In the United States birth trauma rates occurs at a rate of 37 per 1000 live births and are on the decline. However, this decline has been significantly lower among term neonates born in rural facilities. There is a critical lack of evidence toward the influence geographical risk factors has on birth trauma rates for neonatal patients. We sought to measure rural community and hospital characteristics associated with birth trauma. METHODS A retrospective longitudinal study design was used to examine inpatient medical discharge data across 103 hospitals of neonates at birth from 2013 to 2018. Discharge data was linked to the American Hospital Association annual survey. We used a multi-level mixed effect model to investigate the relationship between individual and hospital-level attributes associated with increased risk of birth trauma among neonatal patients. RESULTS We found that rural hospitals were 3.99 times (p < 0.001) more likely to experience higher birth trauma than urban hospitals. Medium sized hospitals were 2.11 times (p < 0.001) more likely to experience higher birth trauma. Hospitals who indicate having a safety culture were more likely (p < 0.05) to have high rates of birth trauma. DISCUSSION Neonates born at rural hospitals, were more likely to experience a birth-related injury. Policy strategies focusing on improving health care quality in rural areas are critical to mitigating this increased risk of birth trauma. Further research is required to assess how physician characteristics may impact birth trauma rates.
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Affiliation(s)
- Hanadi Y Hamadi
- Health Administration Program, Department of Health Administration, University of North Florida, 1 UNF Drive, Building 39 Room 4033, Jacksonville, FL, 32224, USA.
| | - Jing Xu
- Health Administration Program, Department of Health Administration, University of North Florida, 1 UNF Drive, Building 39 Room 4033, Jacksonville, FL, 32224, USA
| | - Aurora A Tafili
- Department of Health Services Administration, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL, 35294, USA
| | - Farouk S Smith
- Health Administration Program, Department of Health Administration, University of North Florida, 1 UNF Drive, Building 39 Room 4033, Jacksonville, FL, 32224, USA
| | - Aaron C Spaulding
- Division of Health Care Policy and Research, Department of Health Sciences Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 4500 San Pablo Drive, Jacksonville, FL, 32224, USA
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Chervenak FA, McCullough LB, Grünebaum A, Bornstein E, Sen C, Stanojevic M, Degtyareva M, Kurjak A. Professionally responsible advocacy for women and children first during the COVID-19 pandemic: guidance from World Association of Perinatal Medicine and International Academy of Perinatal Medicine. J Perinat Med 2020; 48:867-873. [PMID: 32769228 DOI: 10.1515/jpm-2020-0329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 01/21/2023]
Abstract
The goal of perinatal medicine is to provide professionally responsible clinical management of the conditions and diagnoses of pregnant, fetal, and neonatal patients. The New York Declaration of the International Academy of Perinatal Medicine, "Women and children First - or Last?" was directed toward the ethical challenges of perinatal medicine in middle-income and low-income countries. The global COVID-19 pandemic presents common ethical challenges in all countries, independent of their national wealth. In this paper the World Association of Perinatal Medicine provides ethics-based guidance for professionally responsible advocacy for women and children first during the COVID-19 pandemic. We first present an ethical framework that explains ethical reasoning, clinically relevant ethical principles and professional virtues, and decision making with pregnant patients and parents. We then apply this ethical framework to evidence-based treatment and its improvement, planned home birth, ring-fencing obstetric services, attendance of spouse or partner at birth, and the responsible management of organizational resources. Perinatal physicians should focus on the mission of perinatal medicine to put women and children first and frame-shifting when necessary to put the lives and health of the population of patients served by a hospital first.
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Affiliation(s)
- Frank A Chervenak
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Laurence B McCullough
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Amos Grünebaum
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Eran Bornstein
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Cihat Sen
- Department of Perinatology, Cerrahpaşa Medical School, University of Istanbul, Istanbul, Turkey
| | - Milan Stanojevic
- Department of Neonatology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Marina Degtyareva
- Department of Neonatology, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Asim Kurjak
- Department of Obstetrics and Gynecology, University of Zagreb, Zagreb, Croatia
- University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Grünebaum A, McCullough L, Klein R, Chervenak FA. US midwife-attended hospital births are increasing while physician-attended hospital births are decreasing: 2003-2018. Am J Obstet Gynecol 2020; 223:460-461. [PMID: 32247837 DOI: 10.1016/j.ajog.2020.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/26/2020] [Indexed: 11/25/2022]
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Premkumar A, Cassimatis I, Berhie SH, Jao J, Cohn SE, Sutton SH, Condron B, Levesque J, Garcia PM, Miller ES, Yee LM. Home Birth in the Era of COVID-19: Counseling and Preparation for Pregnant Persons Living with HIV. Am J Perinatol 2020; 37:1038-1043. [PMID: 32498092 PMCID: PMC7416217 DOI: 10.1055/s-0040-1712513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022]
Abstract
With the coronavirus disease 2019 (COVID-19) pandemic in the United States, a majority of states have instituted "shelter-in-place" policies effectively quarantining individuals-including pregnant persons-in their homes. Given the concern for COVID-19 acquisition in health care settings, pregnant persons with high-risk pregnancies-such as persons living with HIV (PLHIV)-are increasingly investigating the option of a home birth. Although we strongly recommend hospital birth for PLHIV, we discuss our experience and recommendations for counseling and preparation of pregnant PLHIV who may be considering home birth or at risk for unintentional home birth due to the pandemic. We also discuss issues associated with implementing a risk mitigation strategy involving high-risk births occurring at home during a pandemic. KEY POINTS: · Coronavirus disease 2019 pandemic has increased interest in home birth.. · Women living with HIV are pursuing home birth.. · Safe planning is paramount for women living with HIV desiring home birth, despite recommending against the practice..
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Affiliation(s)
- Ashish Premkumar
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Irina Cassimatis
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Saba H. Berhie
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jennifer Jao
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Susan E. Cohn
- Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sarah H. Sutton
- Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brianne Condron
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jordan Levesque
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Patricia M. Garcia
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily S. Miller
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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