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Pandya SP. Women with disabilities, body image, and wellbeing: Assessing the effectiveness of dance sessions. J Bodyw Mov Ther 2024; 39:142-155. [PMID: 38876619 DOI: 10.1016/j.jbmt.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 12/04/2023] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION There is growing research evidence on bodily discourses and body image issues of women with disabilities. Within the art-based intervention repertoire for persons with disabilities, dance and movement-based therapies and interventions are gaining prominence. The aim of this study was to examine the impact of dance sessions (delivered online) on body image, body satisfaction/dissatisfaction, and wellbeing of women with disabilities. METHOD A quasi-experimental waitlist control design study was conducted with data collected at two time points: baseline or pre-test and five-months later or post-test. Outcomes were measured using the Body Image Scale and the WHO-5-Wellbeing Index. RESULTS The dance sessions were effective (Hedges' g = -0.56 -0.88; p < 0.01) and post-test body dissatisfaction scores were lower and wellbeing scores were higher for participants with a college degree or postgraduate degree, self-employed or students, and whose intervention compliance was above threshold (>50% dance sessions attended and corresponding homework sessions completed). Tobit regression models indicated that it was possible to estimate post-test outcomes due to dance sessions alone, controlling for significant socio-demographics. DISCUSSION The domain knowledge of non-pharmacological art-based interventions for persons with disabilities, particularly women, is supported. CONCLUSIONS Findings commend dance sessions as effective psychotherapeutic mechanisms to mitigate body dissatisfaction, improve body image and wellbeing of women with disabilities. Future research may focus on large-scale cross-sectional trials, variations in the repertoire for women with different disability types and histories, and qualitative narratives.
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Affiliation(s)
- Samta P Pandya
- Tata Institute of Social Sciences, Sion-Trombay Road, Deonar, Mumbai, 400088, Maharashtra, India.
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Acar Z, Oskay Ü, Kula G. Challenges Faced by Mothers With Visual Impairment From the Preconception Period Through the Postpartum Period. J Midwifery Womens Health 2024; 69:577-585. [PMID: 38351852 DOI: 10.1111/jmwh.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/15/2024] [Indexed: 08/03/2024]
Abstract
INTRODUCTION There is a misperception in society that individuals with visual impairment are asexual and cannot marry, have children, or take care of children. In addition, individuals with visual impairment face difficulties in many aspects of life due to accessibility issues. Although it is expected that visually impaired individuals experience difficulties when having children, very few studies have focused on understanding the challenges women with visual impairment face in the process of having children. The aim of this study was to identify the challenges faced by mothers with visual impairment from preconception through the postpartum period in Turkey. METHODS Semistructured interviews were conducted with a purposive sample of 17 mothers with visual impairment. Participants were from 28 to 38 years of age, and their youngest children were 2 years old or younger. Participants were asked about their experiences with the decision to have children, pregnancy, birth, and postpartum. Content analysis was used to analyze and present the data. RESULTS Participants had 1 to 3 children and a mean age of 32.4 years. Eleven themes were identified within 4 periods: preconception, pregnancy, birth, and postpartum. Themes related to the experience of the preconceptional period included concern about the decision to have a child and the social pressure on the decision to have a child. Themes related to the experience of pregnancy included inaccessible pregnancy tests, emotional reactions to pregnancy, dissatisfaction with health care providers, and unmet expectations. Themes related to labor and birth included mixed feelings about labor dissatisfaction with health care providers and unmet expectations. Themes related to the postpartum period included personal care, infant care, reaction of the social network, and unmet expectations. DISCUSSION The mothers with visual impairment faced many challenges in the process of becoming a parent. Mothers expressed the need for accessible health services from institutions and health professionals.
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Affiliation(s)
- Zehra Acar
- Hamidiye Faculty of Nursing, Birth and Women Diseases Nursing Department, University of Health Sciences Turkey, Istanbul, Turkey
| | - Ümran Oskay
- Department of Women's Health and Diseases Nursing, Florence Nightingale Faculty of Nursing, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Gülcan Kula
- Tekirdağ Dr İsmail Fehmi Cumalıoğlu City Hospital, Tekirdağ, Turkey
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Asim M, Hameed W, Sohail MM, Saleem S, Hayward M, Turan JM. Barriers and facilitators to perinatal care of women with disabilities in lower- and middle-income countries: a study protocol for scoping review of qualitative studies. BMJ Open 2024; 14:e079605. [PMID: 38926146 PMCID: PMC11216051 DOI: 10.1136/bmjopen-2023-079605] [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] [Received: 09/06/2023] [Accepted: 06/02/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The Sustainable Development Goals have put emphasis on equitable healthcare access for marginalised groups and communities. The number of women with disabilities (WWD) to marry and have children is rapidly increasing in low- and middle-income countries (LMICs). However, these women experience multifaceted challenges to seeking perinatal care in LMICs. The objective of this scoping review is to document key facilitators and barriers to seeking perinatal care by WWD. We also will propose strategies for inclusive perinatal healthcare services for women with disabilities in LMICs. METHODS We will conduct a scoping review of peer-reviewed and grey literature (published reports) of qualitative and mixed-methods studies on facilitators and barriers to seeking perinatal care for women with functional disabilities from 2010 to 2023 in LMICs. An electronic search will be conducted on Medline/PubMed, Scopus and Google Scholar databases. Two researchers will independently assess whether studies meet the eligibility criteria for inclusion based on the title, abstract and a full-text review. ETHICS AND DISSEMINATION This scoping review is based on published literature and does not require ethics approval. Findings will be published in peer-reviewed journals and presented at conferences related to reproductive health, disability and inclusive health forums.
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Affiliation(s)
- Muhammad Asim
- Population Research Center, The University of Texas at Austin, Austin, Texas, USA
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Malik Muhammad Sohail
- Center for Religion, Science and Social Wellbeing, Department of Sociology, University of Chakwal, Chakwal, Punjab, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Mark Hayward
- Population Research Center, The University of Texas at Austin, Austin, Texas, USA
- Department of Sociology, The University of Texas at Austin, Austin, Texas, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Benyamini Y, Delicate A, Ayers S, Dikmen-Yildiz P, Gouni O, Jonsdottir SS, Karlsdottir SI, Kömürcü Akik B, Leinweber J, Murphy-Tighe S, Pajalic Z, Riklikiene O, Limmer CM. Key dimensions of women's and their partners' experiences of childbirth: A systematic review of reviews of qualitative studies. PLoS One 2024; 19:e0299151. [PMID: 38551936 PMCID: PMC10980232 DOI: 10.1371/journal.pone.0299151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/06/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND The World Health Organization 2018 intrapartum guideline for a positive birth experience emphasized the importance of maternal emotional and psychological well-being during pregnancy and the need for safe childbirth. Today, in many countries birth is safe, yet many women report negative and traumatic birth experiences, with adverse effects on their and their families' well-being. Many reviews have attempted to understand the complexity of women's and their partners' birth experience; however, it remains unclear what the key dimensions of the birth experience are. OBJECTIVE To synthesize the information from reviews of qualitative studies on the experience of childbirth in order to identify key dimensions of women's and their partners' childbirth experience. METHODS Systematic database searches yielded 40 reviews, focusing either on general samples or on specific modes of birth or populations, altogether covering primary studies from over 35,000 women (and >1000 partners) in 81 countries. We appraised the reviews' quality, extracted data and analysed it using thematic analysis. FINDINGS Four key dimensions of women's and partners' birth experience (covering ten subthemes), were identified: 1) Perceptions, including attitudes and beliefs; 2) Physical aspects, including birth environment and pain; 3) Emotional challenges; and 4) Relationships, with birth companions and interactions with healthcare professionals. In contrast with the comprehensive picture that arises from our synthesis, most reviews attended to only one or two of these dimensions. CONCLUSIONS The identified key dimensions bring to light the complexity and multidimensionality of the birth experience. Within each dimension, pathways leading towards negative and traumatic birth experiences as well as pathways leading to positive experiences become tangible. Identifying key dimensions of the birth experience may help inform education and research in the field of birth experiences and gives guidance to practitioners and policy makers on how to promote positive birth experiences for women and their partners.
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Affiliation(s)
- Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Amy Delicate
- Centre for Maternal and Child Health Research, City, University of London, London United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City, University of London, London United Kingdom
| | - Pelin Dikmen-Yildiz
- Department of Psychology, Fen—Edebiyat Fakültesi, Cumhuriyet Mahallesi, Kirklareli University, Kırklareli, Turkey
| | - Olga Gouni
- Cosmoanelixis, Prenatal & Life Sciences Educational Organization, Nea Ionia, Athens, Greece
| | | | | | - Burcu Kömürcü Akik
- Department of Psychology, Faculty of Languages and History-Geography, Ankara University, Ankara, Turkey
| | - Julia Leinweber
- Institute of Midwifery, Charité University of Medicine, Berlin, Germany
| | - Sylvia Murphy-Tighe
- Department of Nursing & Midwifery, Health Sciences Building, University of Limerick, Ireland
| | | | - Olga Riklikiene
- Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Claudia Maria Limmer
- Department of Nursing and Management, Faculty of Business and Social Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
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Mheta D, Sibiya MN, Nkosi PB. Experiences of Women with Disabilities in Accessing Maternal Healthcare Services: A South African Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6966. [PMID: 37947524 PMCID: PMC10647398 DOI: 10.3390/ijerph20216966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
Access to maternal healthcare services is a challenge in most low- and middle-income countries. South Africa is one of the countries striving to improve the accessibility of maternal healthcare services. Although South Africa has put some interventions in place to improve the accessibility of maternal healthcare services, vulnerable women including women with disabilities are still facing numerous challenges when trying to access these services. The aim of this study was to explore the experiences of women with disabilities in the province of KwaZulu-Natal in South Africa in accessing public maternal healthcare services. The objectives of this study were to describe the experiences of women with disabilities in accessing maternal healthcare services during pregnancy, childbirth and post-partum care; explore the inhibitors of access to maternal healthcare services for women with disabilities; and explore the facilitators of access to maternal healthcare services for women with disabilities. Twelve women with disabilities (four with physical impairments, four with hearing impairments and four with visual impairments) were interviewed for this study. Data were transcribed verbatim and analysed utilising the Framework of Assessing Access to Maternal Healthcare Services by Peters et al., 2008. Our study found that narrow passages and information in inaccessible formats were a challenge for women with visual impairments. Women with hearing impairments faced communication difficulties due to the lack of sign language interpreters in most facilities. Moreover, healthcare professionals displayed unfavourable attitudes toward women with hearing impairments, and these women were often overlooked when seeking help. The women with physical impairments encountered inaccessible buildings, narrow passages, small consultation rooms and equipment that is not adjustable, such as beds and scales.
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Affiliation(s)
- Doreen Mheta
- Faculty of Health Sciences, Durban University of Technology, Durban 4000, South Africa;
| | - Maureen Nokuthula Sibiya
- Division of Research, Innovation and Engagement, Mangosuthu University of Technology, Durban 4031, South Africa;
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Barcelona V, Horton RL, Rivlin K, Harkins S, Green C, Robinson K, Aubey JJ, Holman A, Goffman D, Haley S, Topaz M. The Power of Language in Hospital Care for Pregnant and Birthing People: A Vision for Change. Obstet Gynecol 2023; 142:795-803. [PMID: 37678895 PMCID: PMC10510792 DOI: 10.1097/aog.0000000000005333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 09/09/2023]
Abstract
Language is commonly defined as the principal method of human communication made up of words and conveyed by writing, speech, or nonverbal expression. In the context of clinical care, language has power and meaning and reflects priorities, beliefs, values, and culture. Stigmatizing language can communicate unintended meanings that perpetuate socially constructed power dynamics and result in bias. This bias may harm pregnant and birthing people by centering positions of power and privilege and by reflecting cultural priorities in the United States, including judgments of demographic and reproductive health characteristics. This commentary builds on relationship-centered care and reproductive justice frameworks to analyze the role and use of language in pregnancy and birth care in the United States, particularly regarding people with marginalized identities. We describe the use of language in written documentation, verbal communication, and behaviors associated with caring for pregnant people. We also present recommendations for change, including alternative language at the individual, clinician, hospital, health systems, and policy levels. We define birth as the emergence of a new individual from the body of its parent, no matter what intervention or pathology may be involved. Thus, we propose a cultural shift in hospital-based care for birthing people that centers the birthing person and reconceptualizes all births as physiologic events, approached with a spirit of care, partnership, and support.
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Tarasoff LA, Lunsky Y, Welsh K, Proulx L, Havercamp SM, Parish SL, Brown HK. Unmet needs, limited access: A qualitative study of postpartum health care experiences of people with disabilities. J Adv Nurs 2023; 79:3324-3336. [PMID: 36932042 PMCID: PMC10440283 DOI: 10.1111/jan.15642] [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: 11/24/2022] [Revised: 02/16/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
AIM To understand the postpartum care received by birthing people with disabilities and their newborns, from their own perspectives. DESIGN A qualitative study with semi-structured interviews. METHODS Between July 2019 and February 2020, in-person and virtual interviews were conducted with 31 people with physical, sensory, and intellectual/developmental disabilities in Ontario, Canada, about the formal inpatient and outpatient services and supports they used in the first few months after they gave birth. Thematic analysis was used identify common themes. RESULTS We identified three overall themes concerning participants' postpartum care experiences and the different types of formal services received in and out of hospital: (1) lack of adequate care, (2) lack of provider awareness of disability and disability accommodations, and (3) fear of judgement, discrimination, and intrusive surveillance. The identified themes were applicable across disability groups. However, most comments on disability accommodations came from participants with physical or sensory disabilities, while participants with intellectual/developmental disabilities most commonly reported concerns about lack of adequate care and fear of judgement, discrimination, and intrusive surveillance. CONCLUSION Findings indicate that postpartum care often fails people with disabilities. This could contribute to negative health consequences for them and their newborns. IMPACT Birthing people with disabilities need multidisciplinary, proactive, and strengths-based postpartum care to mitigate risk for health complications. Further, disability-related training and guidelines for health and social service providers is required. REPORTING METHOD Consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION Our research team included two peer researchers with physical disabilities who served as co-interviewers and participated in data analysis, contributing their lived experience of disability and interactions with the health care system. All stages of the study were also informed by feedback from the study's Advisory Committee, which comprised women with disabilities (many of whom are parents), disability organization staff, clinicians, and policy representatives.
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Affiliation(s)
- Lesley A Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kate Welsh
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Laurie Proulx
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Canadian Arthritis Patient Alliance, Ottawa, Ontario, Canada
| | | | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Tarasoff LA, Saeed G, Lunsky Y, Welsh K, Proulx L, Havercamp SM, Parish SL, Brown HK. Prenatal Care Experiences of Childbearing People With Disabilities in Ontario, Canada. J Obstet Gynecol Neonatal Nurs 2023; 52:235-247. [PMID: 36940781 DOI: 10.1016/j.jogn.2023.02.001] [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: 12/01/2022] [Revised: 02/16/2023] [Accepted: 02/25/2023] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVE To explore the care experiences of childbearing people with physical, sensory, and/or intellectual/developmental disabilities during pregnancy. DESIGN Descriptive qualitative. SETTING Ontario, Canada, where physician and midwifery care during pregnancy are provided at no direct cost to residents. PARTICIPANTS Thirty-one people with physical, sensory, and/or intellectual/developmental disabilities (who self-identified as cisgender women [n = 29] and trans or nonbinary persons [n = 2]) who gave birth in the last 5 years. METHODS We recruited childbearing people with disabilities through disability and parenting organizations, social media, and our team's networks. Using a semistructured guide, we conducted in-person and virtual (e.g., telephone or Zoom) interviews with childbearing people with disabilities in 2019 to 2020. We asked participants about the services they accessed during pregnancy and if services met their needs. We used a reflexive thematic analysis approach to analyze interview data. RESULTS Across disability groups, we identified four common themes: Unmet Accommodation Needs, Lack of Coordinated Care, Ableism, and Advocacy as a Critical Resource. We found that these experiences manifested in unique ways based on disability type. CONCLUSION Our findings suggest the need for accessible, coordinated, and respectful prenatal care for people with disabilities, with the requirements of such care depending on the needs of the individual person with a disability. Nurses can play a key role in identifying the needs and supporting people with disabilities during pregnancy. Education and training for nurses, midwives, obstetricians, and other prenatal care providers should focus on disability-related knowledge and respectful prenatal care.
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Andrews EE, Ayers KB, Stramondo JA, Powell RM. Rethinking systemic ableism: A response to Zagouras, Ellick, and Aulisio. CLINICAL ETHICS 2023; 18:7-12. [PMID: 37283273 PMCID: PMC10202495 DOI: 10.1177/14777509221094472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Introduction This article is a response to Zagouras, Ellick, and Aulisio who presented a case study justifying the questioning of the capacity and autonomy of a young woman with a physical disability who was pregnant and facing coercive pressure to terminate. Case description Julia is described as a 26-year-old woman with a neurological disability that requires her to receive assistance with activities of daily living. She was described as living with her parents who provided her with personal care assistance. Julia became pregnant and her parents wished her to terminate because they did not want to care for her child in addition to her. In fact, Julia's parents threatened her with institutionalization if she did not elect to terminate the pregnancy. Her health care team questioned her decision-making capacity based on her alleged "mental age" and experiences of being sheltered and excluded. The health care team used directive tactics to convince Julia to terminate the pregnancy, which describe as both an ethical and feminist intervention. Discussion The current authors take issue with the case analysis provided by and argue that they neglected to account for numerous instances of systemic ableism that adversely affected Julia, demonstrated prejudicial and judgmental attitudes toward pregnancy and disability, inappropriately questioned her decision-making capacity by infantilizing her, misconstrued the feminist concept of relational autonomy, and colluded with coercive interference from family members. This is a classic example of discriminatory and culturally incompetent reproductive health care for a disabled woman.
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Affiliation(s)
- Erin E Andrews
- VA Texas Valley Coastal Bend Health Care System, Harlingen, TX, USA
- University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Kara B Ayers
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Cincinnati Children's Hospital Medical Center Division of Developmental and Behavioral Pediatrics, Cincinnati, OH, USA
| | - Joseph A Stramondo
- San Diego State University, Department of Philosophy and Institute for Ethics and Public Affairs, San Diego, CA, USA
| | - Robyn M Powell
- Stetson University College of Law, Gulfport, FL, USA
- Lurie Institute for Disability Policy, Brandeis University, Waltham, MA, USA
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Rosman AN, van der Vliet-Torij HWH, Hilberink SR. Trends in perinatal outcomes of women with chronic medical conditions: A 10-year population-based study in the Netherlands. Midwifery 2023; 118:103572. [PMID: 36587471 DOI: 10.1016/j.midw.2022.103572] [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: 06/22/2022] [Revised: 11/14/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To gain insight into perinatal outcomes in women with chronic medical conditions, in order to contribute to the optimization of personalized perinatal care. We hypothesize that women with a chronic medical condition have poorer perinatal outcomes than women without a known chronic medical condition. DESIGN Population-based study using data of the Netherlands Perinatal Registry between 2010-2019. SETTING Nationwide study in the Netherlands. PARTICIPANTS Pregnancies of women who were diagnosed with chronic medical conditions by a medical specialist before pregnancy (n=36,835), divided into seven sub-groups and a reference group of pregnancies of women without known chronic medical conditions (n=1,084,623). MEASUREMENTS AND FINDINGS The primary outcome measure was mode of birth. Secondary outcomes measures were onset of labour, preterm birth, asphyxia, Neonatal Intensive Care Unit (NICU) admission, and perinatal mortality. Spontaneous birth ranged from 45.0% (orthopaedic conditions) to 71.3% (neurological conditions) to 82.6% in the reference group. Assisted vaginal birth, planned caesarean birth, and emergency caesarean birth occurred significantly more in all groups compared to the reference group (p<0.001). Preterm birth was significantly more likely in the studied groups as well as perinatal asphyxia and NICU admission (all p<0.001). Adjusting for mode of birth, parity, age and ethnicity did not change the outcomes for the group of women with chronic medical conditions. Perinatal mortality was seen in all groups but in none of the separate groups significantly more than in the reference group. Descriptive statistics, univariate and multivariable logistic regression analyses were applied. KEY CONCLUSIONS Women with chronic medical conditions are more likely to experience preterm birth, caesarean births and NICU admission of the new-born. IMPLICATIONS FOR PRACTICE Knowledge about perinatal outcomes of women with chronic medical conditions is a first step for obstetrics care providers in order to optimize personalized care.
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Affiliation(s)
- Ageeth N Rosman
- Rotterdam University of Applied Sciences, Research Center of Innovations in Care, P.O. Box 25035, 30001 HA Rotterdam, The Netherlands; Perined, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands.
| | | | - Sander R Hilberink
- Rotterdam University of Applied Sciences, Research Center of Innovations in Care, P.O. Box 25035, 30001 HA Rotterdam, The Netherlands
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Collins B, Hall J, Hundley V, Ireland J. Effective communication: Core to promoting respectful maternity care for disabled women. Midwifery 2023; 116:103525. [PMID: 36401905 DOI: 10.1016/j.midw.2022.103525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 09/26/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous research highlights that disabled women have less choice, control and respect of their dignity during pregnancy, childbirth and parenting. The experience of dignity and respect during pregnancy and childbirth for those with physical and sensory disability in the UK and Ireland is explored. DESIGN, SETTING AND PARTICIPANTS Narrative, semi-structured telephone and Skype interviews were conducted with ten disabled women in the UK and Ireland. Interviews were audio-recorded and transcribed verbatim. Intra- and inter-thematic analysis was undertaken, beginning with a process of open coding. As themes developed, a process of constant comparison was used. FINDINGS The key finding is that effective communication with women was perceived to best respect the women's dignity in childbirth. This meant enabling women to feel heard, enabling women to make informed decisions about their care and providing individualized care. The single most important factor that enabled this communication was continuity of carer. KEY CONCLUSIONS The factor that most promoted maternity care that was perceived to be respectful was effective communication. This is not so different in other parts of the world, or for non-disabled women, however care providers should be particularly careful to enable good communication with disabled women.
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Affiliation(s)
- Bethan Collins
- Head of Occupational Therapy, School of Health and Society, University of Salford C401 Allerton Building, Frederick Road Campus, Salford M6 6PU, United Kingdom.
| | - Jenny Hall
- Independent midwifery educator and researcher, Formerly Centre for Excellence In Learning, Bournemouth University, United Kingdom
| | - Vanora Hundley
- Professor of Midwifery, Centre for Midwifery, Maternity & Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, Poole BH12 5BB, United Kingdom
| | - Jillian Ireland
- Professional Midwifery Advocate, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Visiting Associate, Centre for Midwifery, Maternity & Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, Poole BH12 5BB, United Kingdom
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12
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Brown HK, Chen S, Guttmann A, Havercamp SM, Parish S, Ray JG, Vigod SN, Tarasoff LA, Lunsky Y. Neonatal Outcomes of Mothers With a Disability. Pediatrics 2022; 150:e2021055318. [PMID: 35934737 PMCID: PMC9694113 DOI: 10.1542/peds.2021-055318] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the risk of neonatal complications among women with a disability. METHODS This population-based cohort study comprised all hospital singleton livebirths in Ontario, Canada from 2003 to 2018. Newborns of women with a physical (N = 144 187), sensory (N = 44 988), intellectual or developmental (N = 2207), or ≥2 disabilities (N = 8823) were each compared with 1 593 354 newborns of women without a disability. Outcomes were preterm birth <37 and <34 weeks, small for gestational age birth weight (SGA), large for gestational age birth weight, neonatal morbidity, and mortality, neonatal abstinence syndrome (NAS), and NICU admission. Relative risks were adjusted for social, health, and health care characteristics. RESULTS Risks for neonatal complications were elevated among newborns of women with disabilities compared with those without disabilities. Adjusted relative risks were especially high for newborns of women with an intellectual or developmental disability, including preterm birth <37 weeks (1.37, 95% confidence interval 1.19-1.58), SGA (1.37, 1.24-1.59), neonatal morbidity (1.42, 1.27-1.60), NAS (1.53, 1.12-2.08), and NICU admission (1.53, 1.40-1.67). The same was seen for newborns of women with ≥2 disabilities, including preterm birth <37 weeks (1.48, 1.39-1.59), SGA (1.13, 1.07-1.20), neonatal morbidity (1.28, 1.20-1.36), NAS (1.87, 1.57-2.23), and NICU admission (1.35, 1.29-1.42). CONCLUSIONS There is a mild to moderate elevated risk for complications among newborns of women with disabilities. These women may need adapted and enhanced preconception and prenatal care, and their newborns may require extra support after birth.
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Affiliation(s)
- Hilary K. Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Astrid Guttmann
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin HS Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Susan M. Havercamp
- Center for Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
| | - Susan Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Joel G. Ray
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Simone N. Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lesley A. Tarasoff
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Yona Lunsky
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
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Mitchell RJ, Ryder T, Matar K, Lystad RP, Clay-Williams R, Braithwaite J. An overview of systematic reviews to determine the impact of socio-environmental factors on health outcomes of people with disabilities. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1254-1274. [PMID: 34850472 DOI: 10.1111/hsc.13665] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/05/2021] [Accepted: 11/18/2021] [Indexed: 06/13/2023]
Abstract
People with disabilities are often subject to intersecting layers of social and economic disadvantage and other barriers that drive health inequity. As a result, they frequently experience worse health than people without disabilities, beyond the direct effects of their health condition or impairment. The aim of this overview of systematic reviews was to summarise the evidence on the impact of socio-environmental factors (i.e. social, physical or attitudinal) on the health outcomes of disabled people. A systematic search of five databases (MEDLINE, PsycINFO, Embase, CINAHL and Scopus) for English-language articles from January 2000 to April 2021 was conducted. Abstracts were screened by two reviewers and reviews were critically appraised. Key data were extracted by topic, population, disability type, critical appraisal method, socio-environmental themes and health outcomes. There were 23 systematic reviews identified examining adult (60.9%) or child and young (8.7%) disabled people, with 30.4% not specifying an age range. Reviews examined people with neurological or physical (39.1%), intellectual (17.4%), sensory (8.7%) or a range of (34.8%) disabilities. Three key health outcomes (i.e. access to healthcare, health-promoting behaviour and care quality) and several recurring socio-environmental themes related to the health outcomes of disabled people were identified. Disabled people encounter common social, physical and attitudinal factors that hinder their health outcomes in terms of access to services and quality healthcare. Many preventive health services were identified as either inaccessible or not meeting the needs of disabled people. Greater involvement of disabled people in service design and awareness raising is essential.
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Affiliation(s)
- Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tayhla Ryder
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Katia Matar
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Smeltzer SC, Tina Maldonado L, McKeever A, Amorim F, Arcamone A, Nthenge S. Qualitative Descriptive Study of Childbirth Educators' Perspectives on Prenatal Education for Women With Physical Disability. J Obstet Gynecol Neonatal Nurs 2022; 51:302-312. [PMID: 35331670 DOI: 10.1016/j.jogn.2022.02.002] [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] [Accepted: 02/02/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the knowledge, experiences, and perceptions of childbirth educators about providing childbirth education to women with physical disability. DESIGN Qualitative descriptive design. SETTING Telephone interviews. PARTICIPANTS Seventeen childbirth educators. METHODS We used a semistructured interview guide to explore participants' knowledge, experiences, and perceptions of providing childbirth education to women with physical disability. We audio recorded, transcribed, and analyzed the interviews using content analysis. RESULTS We identified four themes: Importance of Childbirth Education for All Women, Inadequate Knowledge About Physical Disability, Willingness to Learn About Physical Disability, and Misconceptions and Assumptions About Women With Physical Disability. CONCLUSION Participants reported little knowledge about the needs of pregnant women with physical disability and limited experience with them in childbirth education classes. They reported eagerness to learn about disability and its effect on pregnancy to help provide meaningful education to women with physical disability. Childbirth educators need to develop and implement innovative approaches to reach women with physical disability, provide information relevant to their needs, and address the misconceptions and assumptions they may have about women with physical disability and pregnancy.
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16
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Respectful Maternity Care Framework and Evidence-Based Clinical Practice Guideline. J Obstet Gynecol Neonatal Nurs 2022; 51:e3-e54. [PMID: 35101344 DOI: 10.1016/j.jogn.2022.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Brown HK. Disparities in Severe Maternal Morbidity and Mortality-A Call for Inclusion of Disability in Obstetric Research and Health Care Professional Education. JAMA Netw Open 2021; 4:e2138910. [PMID: 34910156 DOI: 10.1001/jamanetworkopen.2021.38910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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