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Miller ML, Dupree J, Monette MA, Lau EK, Peipert A. Health Equity and Perinatal Mental Health. Curr Psychiatry Rep 2024:10.1007/s11920-024-01521-4. [PMID: 39008146 DOI: 10.1007/s11920-024-01521-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE OF REVIEW Pregnancy and the postpartum period are vulnerable times to experience psychiatric symptoms. Our goal was to describe existing inequities in perinatal mental health, especially across populations, geography, and in the role of childbirth. RECENT FINDINGS People of color are at an increased risk for perinatal mental health difficulties and more likely to experience neglect, poor communication, and racial discrimination. LGBTQ + individuals encounter unique challenges, implicating the role of heteronormativity, cisnormativity, and gender dysphoria through pregnancy-related processes. Rural-dwelling women are significantly less likely to seek care, be screened for, or receive treatment for perinatal mental health conditions. Trauma-informed, comprehensive mental health support must be provided to all patients during pregnancy, childbirth, and the postpartum period, especially for racially and ethnically minoritized individuals that have often been omitted from care. Future research needs to prioritize inclusion of perinatal populations not well represented in the literature, including rural-dwelling individuals.
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Affiliation(s)
- Michelle L Miller
- Indiana University School of Medicine, Goodman Hall / IU Health Neuroscience Center, Suite 2800 355 W. 16 St. Indianapolis, IN, 46202, Indiana, United States.
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LaFave LA, Clemmons N, Kotelchuck M, Morales Cozier N, Geltman A, Browne DR, Kenyon K. Activating Life Course Theory through a Whole System Prevention Framework to Address the Wicked Problem of Maternal and Infant Morbidity and Mortality. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:349-364. [PMID: 37271730 PMCID: PMC11143759 DOI: 10.1177/2752535x231170737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Racial/ethnic disparities in maternal and infant morbidity and mortality (MIM&M) is a wicked problem that is reinforced and perpetuated by our system[s] of care. Life Course Theory (LCT) helps to explain drivers of health disparities, but its application is challenged. An upstream approach that promotes systemic change requires the implementation of an expanded prevention framework that includes primordial and quaternary prevention. RESEARCH DESIGN We developed an innovative expanded Whole System Prevention Framework (WSPF) that incorporates LCT, prevention (including primordial and quaternary prevention) and systems thinking. STUDY SAMPLE We implemented this new conceptual Framework with two Healthy Start community partnerships through training, service mapping, and strategic planning to address upstream drivers of MIM&M. DATA COLLECTION AND ANALYSIS Service mapping revealed few Healthy Start upstream activities/services with the predominance being delivered downstream at the program (microsystem) level. RESULTS Service mapping provided a snapshot of the current service distribution of services across the systems. The preponderance were primary, secondary and tertiary prevention activities (75.5% and 65.6%) delivered at the program level (58.2% and 68%), revealing opportunities for upstream strategies to promote equity. The implementation process provided a new way to frame strategic planning and develop upstream strategies to promote health equity and reduce MIM&M. CONCLUSION The Whole System Prevention Framework and its implementation methodology could be applied to address other wicked problems.
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Affiliation(s)
- Lea Ayers LaFave
- JSI Research and Training Institute, Inc. (JSI), Boston, MA, USA
| | - Naomi Clemmons
- JSI Research and Training Institute, Inc. (JSI), Boston, MA, USA
| | | | | | - Ana Geltman
- JSI Research and Training Institute, Inc. (JSI), Boston, MA, USA
| | - Dianne R. Browne
- Southern New Jersey Perinatal Cooperative (SNJPC), Pennsauken, NJ, USA
| | - Katie Kenyon
- The Foundation for Delaware County (TFDC), Eddystone, PA, USA
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McCarthy D. Gendered anti-blackness, maternal health & chattel slavery: OB/Gyn knowledge as a determinant of death of black women. Soc Sci Med 2024; 353:117038. [PMID: 38936105 DOI: 10.1016/j.socscimed.2024.117038] [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: 11/14/2023] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/29/2024]
Abstract
This archival investigation of the Southern Medical and Surgical Journal (SMSJ) focuses on the construction of the American Ob/Gyn profession's medical knowledge system alongside chattel slavery, between 1834 and 1860. I find that language, methods of clinical management of bodies and decision-making processes illustrate the pathways that obstetrical knowledge served as a determinant of death for Black women under chattel slavery. These are byproducts of the condition of possibility, my theoretical framework. The condition, or use of gendered anti-Black logic/practice, specifically the social death and biological indispensability of Black women in the context of chattel slavery, shapes the subjective nature of medical knowledge into a determinant of maternal death for Black women. Using the condition of possibility as a theoretical framework, I will lay the groundwork to reframe the Ob/Gyn knowledge system as a current and ever-present threat to Black women and girls' health. This study's sociological contribution lies in examining medical knowledge construction as a series of social interactions, informed by gendered and racial ideologies, that determine health outcomes for Black women.
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Bradley DL, Kramer CT, Sufrin CB, Scott KA, Hayes CM. "Because I Was a Criminal and Drug Addict.": Experiences of Anti-Black Gendered Racism and Reproductive Injustice Among Black Pregnant and Postpartum Women with a Substance Use Disorder and Incarceration and Family Policing Histories. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02042-9. [PMID: 38862844 DOI: 10.1007/s40615-024-02042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Abstract
Racism pervades the US criminal legal and family policing systems, particularly impacting cases involving women with a history of a substance use disorder (SUD). Laws criminalizing SUD during pregnancy disproportionately harm Black women, as do family policing policies around family separation. Discrimination within intersecting systems may deter Black pregnant women with a SUD from seeking evidence-based pregnancy and substance use care. This convergent parallel mixed-methods study aimed to illuminate how systemic oppression influenced the lived experiences of Black mothers with a SUD, facing dual involvement in the criminal legal and family policing systems. Using convenience and snowball sampling techniques, we recruited 15 Black mothers who were incarcerated, used substances while pregnant, and had a history with family policing systems. We conducted semi-structured interviews and developed and distributed a scale questionnaire to describe participants' experiences navigating overlapping systems of surveillance and control. Drawing on models of systemic anti-Black racism and sexism and reproductive justice, we assessed participants' experiences of racism and gender-based violence within these oppressive systems. Participants described how intersecting systems of surveillance and control impeded their prenatal care, recovery, and abilities to parent their children in gender and racially specific ways. Although they mostly detailed experiences of interpersonal discriminatory treatment, particularly from custody staff while incarcerated and pregnant, participants highlighted instances of systemic anti-Black gendered racism and obstetric racism while accessing prenatal care and substance use treatment in carceral and community settings. Their narratives emphasize the need for action to measure and address the upstream macro-level systems perpetuating inequities.
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Affiliation(s)
- Denae L Bradley
- Department of Sociology and Criminology, Howard University, Washington, DC, USA.
| | - Camille T Kramer
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolyn B Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Crystal M Hayes
- School of Social Work, Sacred Heart University, Fairfield, CT, USA
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Mollard E, Elya A, Gaines C, Salahshurian E, Riordan E, Moore T, Maloney S, Balas MC, Shah N, Cooper Owens D. Reclaiming narratives of empowerment around Black maternal health: a strengths-based, community-informed focus group study. ETHNICITY & HEALTH 2024:1-17. [PMID: 38805258 DOI: 10.1080/13557858.2024.2359384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES Research on Black maternal populations often focuses on deficits that can reinforce biases against Black individuals and communities. The research landscape must shift towards a strengths-based approach focused on the protective assets of Black individuals and communities to counteract bias. This study engaged the local Black community using a strengths-based approach to discuss the assets of Black maternal populations and to inform the design of a future clinical trial focused on reducing Black maternal health disparities. DESIGN Guided by the Theory of Maternal Adaptive Capacity, we conducted three purposive focus group sessions with Black adult community members. The focus groups were semi-structured to cover specific topics, including the strengths of the local community, strengths specific to pregnant community members, how the strengths of community members can support pregnant individuals, and how the strengths of pregnant community members can facilitate a healthy pregnancy. The focus group interviews were transcribed verbatim and analyzed using thematic content analysis. RESULTS Three focus group sessions were conducted with sixteen female individuals identifying as Black or African American. Central themes include (1) the power of pregnancy and motherhood in Black women, (2) challenging negative perceptions and media representation of Black mothers, (3) recognizing history and reclaiming cultural traditions surrounding birth, and (4) community as the foundation of Black motherhood. CONCLUSION Black community members identified powerful themes on Black maternal health through a strengths-based lens. These focus groups fostered relationships with the Black community, elucidated possible solutions to improve Black women's health and wellness, and offered direction on our research design and intervention.
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Affiliation(s)
- Elizabeth Mollard
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anabelle Elya
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Cydney Gaines
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Erin Salahshurian
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Elizabeth Riordan
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tiffany Moore
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shannon Maloney
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michele C Balas
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Neel Shah
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
- Maven Clinic, New York, NY, USA
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Morris SY, Barrera AZ. A decolonized mental health framework for black women and birthing people. JOURNAL OF LESBIAN STUDIES 2024:1-14. [PMID: 38780643 DOI: 10.1080/10894160.2024.2356994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Black perinatal mental health is an area that has received less focus in psychotherapy research in the United States. This area is especially important as recent attacks on Reproductive Justice impact not only birthing people's rights and freedoms but also their mental health and emotional well-being. Current psychotherapy interventions are rooted in evidence-based treatments (EBTs) that may not always align with the values and practices of frameworks like radical healing and liberation psychology that are meant to emphasize collective healing and empower individuals. To date, psychological research involving radical healing and liberation psychology approaches have not had a specific focus on birthing people. Psychotherapeutic interventions have also largely excluded the unique intersectional identities and healing of Black birthing people. In moving toward decolonizing psychotherapy, this conceptual paper will propose a multi-pronged framework for addressing racial stressors and other mental health concerns during the perinatal period. The proposed framework, The Three Cs of Decolonization, includes three components: Community, Creativity, and Connection to Self. These components of the framework are meant to address and highlight culturally relevant ways of healing for Black birthing people. Larger systemic changes are needed and necessary for the desired change across mental health, medical, and other integrated systems of care that have been impacted by racism and discrimination. The current framework is dedicated to healing and empowering Black birthing people with approaches and considerations that are consistent with Reproductive Justice.
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Tucker CM, Ma C, Mujahid MS, Butwick AJ, Girsen AI, Gibbs RS, Carmichael SL. Trends in racial/ethnic disparities in postpartum hospital readmissions in California from 1997 to 2018. AJOG GLOBAL REPORTS 2024; 4:100331. [PMID: 38919705 PMCID: PMC11197112 DOI: 10.1016/j.xagr.2024.100331] [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] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Postpartum readmission is an important indicator of postpartum morbidity. The likelihood of postpartum readmission is highest for Black individuals. However, it is unclear whether the likelihood of postpartum readmission has changed over time according to race/ethnicity. Little is also known about the factors that contribute to these trends. OBJECTIVE This study aimed to: (1) examine trends in postpartum readmission by race/ethnicity, (2) examine if prenatal or clinical factors explain the trends, and (3) investigate if racial/ethnic disparities changed over time. STUDY DESIGN We examined trends in postpartum readmission, defined as hospitalization within 42 days after birth hospitalization discharge, using live birth and fetal death certificates linked to delivery discharge records from 10,711,289 births in California from 1997 to 2018. We used multivariable logistic regression models that included year and year-squared (to allow for nonlinear trends), overall and stratified by race/ethnicity, to estimate the annual change in postpartum readmission during the study period, represented by odds ratios and 95% confidence intervals. We then adjusted models for prenatal (eg, patient demographics) and clinical (eg, gestational age, mode of birth) factors. To determine whether racial/ethnic disparities changed over time, we calculated risk ratios for 1997 and 2018 by comparing the predicted probabilities from the race-specific, unadjusted logistic regression models. RESULTS The overall incidence of postpartum readmission was 10 per 1000 births (17.4/1000 births for non-Hispanic Black, 10/1000 for non-Hispanic White, 7.9/1000 for non-Hispanic Asian/Pacific Islander, and 9.6/1000 for Hispanic individuals). Odds of readmission increased for all groups during the study period; the increase was greatest for Black individuals (42% vs 21%-29% for the other groups). After adjustment for prenatal and clinical factors, the increase in odds was similar for Black and White individuals (12%). The disparity in postpartum readmission rates relative to White individuals increased for Black individuals (risk ratio, 1.68 in 1997 and 1.90 in 2018) and more modestly for Hispanic individuals (risk ratio, 1.02 in 1997 and 1.05 in 2018) during the study period. Asian/Pacific Islander individuals continued to have lower risk than White individuals during the study period (risk ratio, 0.87 in 1997 and 0.82 in 2018). CONCLUSION The rate of postpartum readmissions increased from 1997 to 2018 in California across all racial/ethnic groups, with the greatest increase observed for Black individuals. Racial/ethnic differences in the trend were more modest after adjustment for prenatal and clinical factors. It is important to find ways to prevent further increases in postpartum readmission, especially among groups at highest risk.
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Affiliation(s)
- Curisa M. Tucker
- Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, Columbia, SC (Dr Tucker)
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA (Dr Tucker, Ms. Ma, and Dr Carmichael)
| | - Chen Ma
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA (Dr Tucker, Ms. Ma, and Dr Carmichael)
| | - Mahasin S. Mujahid
- School of Public Health, University of California Berkeley, Berkeley, CA (Dr Mujahid)
| | - Alexander J. Butwick
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA (Dr Butwick)
| | - Anna I. Girsen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA (Drs Girsen, Gibbs, and Carmichael)
| | - Ronald S. Gibbs
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA (Drs Girsen, Gibbs, and Carmichael)
| | - Suzan L. Carmichael
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA (Drs Girsen, Gibbs, and Carmichael)
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. J Obstet Gynecol Neonatal Nurs 2024; 53:e10-e48. [PMID: 38363241 DOI: 10.1016/j.jogn.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Anyiam S, Woo J, Spencer B. Listening to Black Women's Perspectives of Birth Centers and Midwifery Care: Advocacy, Protection, and Empowerment. J Midwifery Womens Health 2024. [PMID: 38689459 DOI: 10.1111/jmwh.13635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/01/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Black women in Texas experience high rates of adverse maternal outcomes that have been linked to health inequities and structural racism in the maternal care system. Birth centers and midwifery care are highlighted in the literature as contributing to improved perinatal care experiences and decreased adverse outcomes for Black women. However, compared with White women, Black women underuse birth centers and midwifery care. Black women's perceptions in Texas of birth center and midwifery care are underrepresented in research. Thus, this study aimed to highlight the views of Black women residing in Texas on birth centers and midwifery care to identify their needs and explore ways to increasing access to perinatal care. METHODS Semistructured interviews were conducted with 10 pregnant and postpartum Black women residing in Texas. Questions focused on the women's access, knowledge, and use of birth centers and midwifery care in the context of their lived maternal care experiences. Interview transcripts were reviewed and analyzed using inductive, qualitative content analysis. RESULTS The Black women interviewed all shared experiences of discrimination and bias while receiving obstetric care that affected their interest in and overall perceptions of birth center and midwifery care. Participants also discussed financial and institutional barriers that impacted their ease of access to birth center and midwifery care services. Additionally, participants highlighted the need for culturally sensitive and respectful perinatal health care. DISCUSSION The Black women interviewed in this study emphasized the prevalence of racism and discrimination in perinatal health care encounters, a reflection consistent with current literature. Black women also expressed a desire to use birth centers and midwifery care but identified the barriers in Texas that impede access. Study findings highlight the need to address barriers to promote equitable perinatal health care access for Black women.
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Affiliation(s)
- Shalom Anyiam
- College of Nursing, Texas Woman's University, Dallas, Texas
| | - Jennifer Woo
- College of Nursing, Texas Woman's University, Dallas, Texas
| | - Becky Spencer
- College of Nursing, Texas Woman's University, Dallas, Texas
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. Nurs Womens Health 2024; 28:e1-e39. [PMID: 38363259 DOI: 10.1016/j.nwh.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Johnson JD. Black Pregnancy-Related Mortality in the United States. Obstet Gynecol Clin North Am 2024; 51:1-16. [PMID: 38267121 DOI: 10.1016/j.ogc.2023.11.005] [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: 01/26/2024]
Abstract
The maternal mortality rate for non-Hispanic Black birthing people is 69.9 deaths per 100,000 live births compared with 26.6 deaths per 100,000 live births for non-Hispanic White birthing people. Black pregnancy-related mortality has been underrepresented in research and the media; however, there is growing literature on the role of racism in health disparities. Those who provide care to Black patients should increase their understanding of racism's impact and take steps to center the experiences and needs of Black birthing people.
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Affiliation(s)
- Jasmine D Johnson
- Division of Maternal-Fetal Medicine, Indiana University School of Medicine, 550 North University Bloulevard, Suite 2440, Indianapolis, IN 46202, USA.
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Goh AH, Altman MR, Canty L, Edmonds JK. Communication Between Pregnant People of Color and Prenatal Care Providers in the United States: An Integrative Review. J Midwifery Womens Health 2024; 69:202-223. [PMID: 37961941 DOI: 10.1111/jmwh.13580] [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: 09/16/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Racism and discrimination negatively affect patient-provider communication. Yet, pregnant people of color consistently report being discriminated against, disrespected, and ignored. The purpose of this integrated review was to identify studies that examined communication between pregnant people of color and their prenatal care providers and evaluate the factors and outcomes arising from communication. METHODS We searched the PubMed, Embase, CINAHL, and PsychINFO databases for studies published between 2001 and 2023. Articles were eligible for inclusion if they reported on primary research conducted in the United States, were written in English, and focused on patient-provider communication with a sample that included pregnant people of color, defined as those who self-identified as Black, African American, Hispanic, Latina/x/e, Indigenous, American Indian, Asian, Asian American, Native Hawaiian, and/or Pacific Islander American. Twenty-six articles were included in the review. Relevant data were extracted and compiled into an evidence table. We then applied the rating scale of the Johns Hopkins Evidence-Based Practice model to assess the level of evidence and quality of the studies. Themes were identified using a memoing technique and organized into 3 a priori categories: factors, outcomes, and recommendations. RESULTS Two overarching themes emerged from our analysis: racism/discrimination and unmet information needs. Subthemes were then identified as factors, outcomes, or recommendations. Factors included provider behaviors, language barriers, structural barriers, provider type, continuity of care, and fear. Outcome themes were disrespect, trust, decision-making power, missed appointments, and satisfaction with care. Lastly, culturally congruent care, provider training, and workforce development were categorized as recommendations. DISCUSSION Inadequate communication between prenatal care providers and pregnant people of color continues to exist. Improving access to midwifery education for people of color can contribute to delivering perinatal care that is culturally and linguistically aligned. Further research about digital prenatal health communication is necessary to ensure equitable prenatal care.
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Affiliation(s)
- Amy H Goh
- Boston College Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Molly R Altman
- School of Nursing, University of Washington, Seattle, Washington
| | - Lucinda Canty
- College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Joyce K Edmonds
- Boston College Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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Major-Kincade TL. Obstetric Racism, Education, and Racial Concordance. MCN Am J Matern Child Nurs 2024; 49:74-80. [PMID: 38108513 DOI: 10.1097/nmc.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
ABSTRACT The United States holds the distinction of being the developed country with the worst perinatal outcomes despite spending the most per capita on health care. Black women are three to four times more likely than White women to experience adverse birth outcomes. These outcomes persist despite access to prenatal care, insurance, and college education. A long overdue racial reckoning has arrived, beginning with acknowledging the fallacy of race-based medicine and the role of enduring systemic racism as foundational to obstetric racism in the reproductive lives of Black women. Centering voices of Black women and honoring their lived experiences are essential to providing respectful maternity care. Naming micro- and macroaggressions experienced by Black women allows for dismantling of systemic barriers which perpetuate inequitable outcomes and enable substandard care. Racial concordance (shared racial identity) is one tool to consider in creating safe health care spaces for Black women. Improving diversity of the nursing workforce specifically, and the health care workforce in general, is necessary to affect racial concordance. Application of skills in cultural humility can mitigate challenges associated with adverse patient encounters for Black women as diversity pipeline strategies are explored. Histories of foundational fallacy, their impact on care and outcomes, and patient-driven indicators for improving pregnancy care experiences for women of color are explored through the lens of a Black physician and the collective reproductive health workforce.
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Affiliation(s)
- Terri L Major-Kincade
- Terri L. Major-Kincade is an Associate Professor, Department of Pediatrics, Director, Pediatric Palliative Care Service Memorial Hermann Children's Hospital, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX. Dr. Major-Kincade can be reached at
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Nelson TJ, Butcher BDC, Delgado A, McLemore MR. Perspectives of Certified Nurse-Midwives and Physicians on the Structural and Institutional Barriers that Contribute to the Reproductive Inequities of Black Birthing People in the San Francisco Bay Area. J Midwifery Womens Health 2024. [PMID: 38369871 DOI: 10.1111/jmwh.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/31/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Black birthing people in the United States disproportionately endure inequitable experiences and outcomes during pregnancy and childbirth via structural, interpersonal, and obstetric racism. In this study, the researchers explore provider perspectives of how racism is perpetuated in institutional perinatal and reproductive health care. METHODS Critical Race Theory, Reproductive Justice, and midwifery theory were operationalized through secondary thematic analysis of existing qualitative data from the Community Racial Equity and Training Interventions and Evaluation of Current and Future Healthcare Clinicians Study. Twenty-four perinatal providers (certified nurse-midwives [n = 7] and physicians [n = 17]) voluntarily participated in interviews. A comparative approach was used to determine how professional identity and model of care influence physicians' and certified nurse-midwives' perceptions of equity. RESULTS Thematic analysis produced 5 themes: racism as a comorbidity, health care systems' inability to address the needs of Black birthing people, health care systems prioritizing providers over patients are failed systems, patients are the experts in the optimal health care model, and benefits of interprofessional teams grounded in Reproductive Justice. Additionally, both physicians and midwives expressed a need for a new care model. DISCUSSION With these findings, our team proposes a modification of the midwifery model for application by all provider types that could radically shift the experience and outcomes of perinatal and reproductive health care and reduce mortality. Using a human rights approach to care, a Reproductive Justice-Public Health Critical Race praxis-informed midwifery model may be operationalized by all perinatal and reproductive health care providers. This novel model reflects an iterative process that may offer institutions and providers methods to build on past research supporting midwifery-centered care for improving outcomes for all patients by specifically focusing on improving care of Black birthing people. The implications of this work offer broad application in current clinical practice, quality improvement, research, technology, and patient resources.
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Affiliation(s)
- Tamara J Nelson
- Department of Family Health Care Nursing School of Nursing, University of California San Francisco, San Francisco, California
| | - Brittany D Chambers Butcher
- Department of Human Ecology, Human Development and Family Studies, University of California Davis, Davis, California
| | - Ana Delgado
- Department of Family Health Care Nursing School of Nursing, University of California San Francisco, San Francisco, California
| | - Monica R McLemore
- Department of Family Health Care Nursing School of Nursing, University of California San Francisco, San Francisco, California
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Rhodes EC, Zahid M, Abuwala N, Damio G, LaPlant HW, Crummett C, Surprenant R, Pérez-Escamilla R. Experiences of breastfeeding peer counseling among women with low incomes in the US: a qualitative evaluation. BMC Pregnancy Childbirth 2024; 24:120. [PMID: 38336607 PMCID: PMC10854050 DOI: 10.1186/s12884-023-06213-0] [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: 04/13/2023] [Accepted: 12/17/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Person-centered breastfeeding counseling is a key but often overlooked aspect of high-quality services. We explored women's experiences of the Breastfeeding Heritage and Pride™ program, an evidence-based breastfeeding peer counseling program serving women with low incomes in the United States. METHODS This study was conducted through an equitable community-clinical-academic partnership and guided by the World Health Organization (WHO) quality of care framework for maternal and newborn health, which highlights three domains of positive experiences of care: effective communication; respect and dignity; and emotional support. In-depth interviews were conducted with a purposive sample of women participating in the Breastfeeding Heritage and Pride™ program. Women were asked to describe their experiences with the program including examples of when good quality counseling was or was not provided. Each interview was conducted in English or Spanish, audio-recorded, and transcribed verbatim. Data were analyzed using reflexive thematic analysis. Once themes were generated, they were organized according to the three care experience domains in the WHO quality of care framework. RESULTS Twenty-eight in-depth interviews were conducted with a racially/ethnically and socio-economically diverse sample of women. Three themes described effective communication practices of peer counselors: tailoring communication to meet women's individual needs; offering comprehensive and honest information about infant feeding; and being timely, proactive, and responsive in all communications across the maternity care continuum. Two themes captured why women felt respected. First, peer counselors were respectful in their interactions with women; they were courteous, patient, and non-judgmental and respected women's infant feeding decisions. Second, peer counselors showed genuine interest in the well-being of women and their families, beyond breastfeeding. The key theme related to emotional support explored ways in which peer counselors offered encouragement to women, namely by affirming women's efforts to breastfeed and by providing reassurance that alleviated their worries about breastfeeding. These positive experiences of counseling were appreciated by women. CONCLUSIONS Women described having and valuing positive experiences in their interactions with peer counselors. Efforts to expand access to high-quality, person-centered breastfeeding counseling should, as part of quality assurance, include women's feedback on their experiences of these services.
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Affiliation(s)
- Elizabeth C Rhodes
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
| | - Mahrukh Zahid
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA
| | - Nafeesa Abuwala
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA
| | - Grace Damio
- Hispanic Health Council, 175 Main Street, Hartford, CT, 06106, USA
| | | | - Carrianne Crummett
- Saint Francis Hospital and Medical Center, Trinity Health Of New England, 114 Woodland Street, Hartford, CT, 06105, USA
| | - Rebecca Surprenant
- Saint Francis Hospital and Medical Center, Trinity Health Of New England, 114 Woodland Street, Hartford, CT, 06105, USA
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Turchioe MR, Hermann A, Benda NC. Recentering responsible and explainable artificial intelligence research on patients: implications in perinatal psychiatry. Front Psychiatry 2024; 14:1321265. [PMID: 38304402 PMCID: PMC10832054 DOI: 10.3389/fpsyt.2023.1321265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024] Open
Abstract
In the setting of underdiagnosed and undertreated perinatal depression (PD), Artificial intelligence (AI) solutions are poised to help predict and treat PD. In the near future, perinatal patients may interact with AI during clinical decision-making, in their patient portals, or through AI-powered chatbots delivering psychotherapy. The increase in potential AI applications has led to discussions regarding responsible AI and explainable AI (XAI). Current discussions of RAI, however, are limited in their consideration of the patient as an active participant with AI. Therefore, we propose a patient-centered, rather than a patient-adjacent, approach to RAI and XAI, that identifies autonomy, beneficence, justice, trust, privacy, and transparency as core concepts to uphold for health professionals and patients. We present empirical evidence that these principles are strongly valued by patients. We further suggest possible design solutions that uphold these principles and acknowledge the pressing need for further research about practical applications to uphold these principles.
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Affiliation(s)
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States
| | - Natalie C. Benda
- School of Nursing, Columbia University School of Nursing, New York, NY, United States
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Sump C, Sauley B, Patel S, Riddle S, Connolly E, Hite C, Maiorella R, Thomson JE, Beck AF. Disparities in the Diagnosis and Management of Infants Hospitalized With Inadequate Weight Gain. Hosp Pediatr 2024; 14:21-29. [PMID: 38087957 DOI: 10.1542/hpeds.2023-007188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Abstract
OBJECTIVES To evaluate the association between race and the named etiology for inadequate weight gain among hospitalized infants and assess the differences in management. METHODS This single-center retrospective cohort study of infants hospitalized for the workup and management of inadequate weight gain used infant race and neighborhood-level socioeconomic deprivation as exposures. The etiology of inadequate weight gain was categorized as nonorganic, subjective organic (ie, gastroesophageal reflux and cow's milk protein intolerance), or objective organic (eg, hypothyroidism). The management of inadequate weight gain was examined in secondary outcomes. RESULTS Among 380 infants, most were white and had a nonorganic etiology of inadequate weight gain. Black infants had 2.3 times higher unadjusted odds (95% credible interval [CI] 1.17-4.76) of a nonorganic etiology of inadequate weight gain compared with white infants. After adjustment, there was no association between race and etiology (adjusted odds ratio 0.8, 95% CI [0.44-2.08]); however, each 0.1 increase in neighborhood-level deprivation was associated with 80% increased adjusted odds of a nonorganic etiology of inadequate weight gain (95% CI [1.37-2.4]). Infants with a nonorganic etiology of inadequate weight gain were more likely to have social work and child protective service involvement and less likely to have nasogastric tube placement, gastroenterology consults, and speech therapy consults. CONCLUSIONS Infants from neighborhoods with greater socioeconomic deprivation were more likely to have nonorganic causes of inadequate weight gain, disproportionately affecting infants of Black race. A nonorganic etiology was associated with a higher likelihood of social interventions and a lower likelihood of medical interventions.
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Affiliation(s)
- Courtney Sump
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Beau Sauley
- Murray State University, Department of Economics, Murray, Kentucky
| | - Shivani Patel
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sarah Riddle
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emilia Connolly
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Partners In Health, Malawi, Abwenzi Pa Za Umoyo/Partners In Health, Neno, MW
| | - Corinne Hite
- Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - RosaMarie Maiorella
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joanna E Thomson
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew F Beck
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Medical Center, Cincinnati, Ohio
- General and Community Pediatrics, Cincinnati Children's Medical Center, Cincinnati, Ohio
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Lucas A, Mlawer S, Weaver K, Caldwell J, Baig A, Zasadazinski L, Saunders M. Chicago Neighborhood Context and Racial/Ethnic Disparities in Maternal Diabetes. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01892-z. [PMID: 38157197 PMCID: PMC11229170 DOI: 10.1007/s40615-023-01892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To determine if rates of maternal diabetes vary by race, ethnicity, and neighborhood hardship. METHODS We conducted a secondary analysis of live births in Chicago from 2010 to 2017. Our sample was restricted to Non-Hispanic White, Non-Hispanic Black, Mexican, Non-Hispanic Asian, and Other Hispanic mothers between the ages of 15 and 50, with singleton births. The addresses of mothers were geocoded to specific neighborhoods, which we stratified into tertiles using the Economic Hardship Index. We used generalized logit mixed models to examine the interaction between race/ethnicity, neighborhood economic hardship, and maternal diabetes. RESULTS In our cohort of 299,053 mothers, 4.75% were diagnosed with gestational diabetes. Asian mothers had the highest frequency of gestational diabetes (8.3%), followed by Mexican mothers (6.8%). Within their respective racial/ethnic groups, Asian and Mexican mothers living in medium hardship neighborhoods had the highest odds of gestational diabetes compared to the reference group (OR 2.80, 95%CI 2.53, 3.19; OR 2.30, 95%CI 2.12, 2.49 respectively). Overall rates of preexisting diabetes were 0.9% and were highest among Mexican and Black mothers (1.26% and 1.06%, respectively). Asian mothers in medium hardship neighborhoods had the greatest odds of preexisting diabetes, among all Asian mothers and compared to the reference (OR 4.71 95% CI 3.60, 6.16). CONCLUSIONS For racial and ethnic minoritized mothers, gestational and preexisting diabetes do not increase in a step-wise fashion with neighborhood hardship; rates were often higher in low and medium hardship neighborhoods.
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Affiliation(s)
- Anika Lucas
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Durham Veterans Affairs Medical Center, Durham, NC, USA.
| | - Sophia Mlawer
- Data Science and Analytics, University of Chicago Medicine, Chicago, IL, USA
| | | | - Julia Caldwell
- Department of Public Health Los Angeles County, Los Angeles, CA, USA
| | - Arshiya Baig
- General Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
| | | | - Milda Saunders
- General Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
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Santoro CM, Farmer MC, Lobato G, James M, Herring SJ. Antiracism Training for Nutrition Professionals in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): a Promising Strategy to Improve Attitudes, Awareness, and Actions. J Racial Ethn Health Disparities 2023; 10:2882-2889. [PMID: 36472807 PMCID: PMC9734826 DOI: 10.1007/s40615-022-01465-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/12/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Women, Infants and Children (WIC) nutrition professionals serve as frontline providers for Black families who disproportionately experience poor perinatal outcomes. With racism driving inequities, we developed an antiracism training tailored to WIC. This report describes the training framework, design, components, and evaluation. METHODS In 2019, with feedback from WIC providers, we created a 3-h antiracism training for Philadelphia WIC nutrition professionals that included an identity reflection, key concept definitions, workplace scenario and debrief, a model for repair and disruption, and an action tool. We implemented this training in August 2019 and surveyed WIC staff trainees' awareness of racism and skills to address bias before, immediately after, and 6 months post-training, comparing responses at each time point. RESULTS Among 42 WIC staff trainees, mean age was 30 years, 56% were white, 91% female, and 74% had no prior antiracism training. Before the training, 48% felt quite a bit or extremely aware of the role of racism in the healthcare system; this increased to 91% immediately after and was 75% 6 months later. Similar increases in confidence identifying and addressing interactions that perpetuate racism were achieved immediately after training, although the magnitude decreased by 6 months. One-third felt quite a bit or extremely confident the training improved participant interactions at the 6-month timepoint. Qualitative feedback reinforced findings. DISCUSSION Results suggest antiracism training may improve WIC nutrition professionals' attitudes, awareness, and actions and could be valuable in efforts to advance health equity. More work is needed to examine how changes translate into improvements for WIC participants.
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Affiliation(s)
- Christine M Santoro
- Program for Maternal Health Equity, Center for Urban Bioethics, Department of Urban Health and Population Science, Lewis Katz School of Medicine at Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, USA.
| | - Mari-Carmen Farmer
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gloria Lobato
- Program for Maternal Health Equity, Center for Urban Bioethics, Department of Urban Health and Population Science, Lewis Katz School of Medicine at Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, USA
- NORTH, Inc., Managers of the Philadelphia WIC Program, Philadelphia, PA, USA
| | - Monica James
- NORTH, Inc., Managers of the Philadelphia WIC Program, Philadelphia, PA, USA
| | - Sharon J Herring
- Program for Maternal Health Equity, Center for Urban Bioethics, Department of Urban Health and Population Science, Lewis Katz School of Medicine at Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, USA
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Rubashkin N. Epistemic Silences and Experiential Knowledge in Decisions After a First Cesarean: The case of a vaginal birth after cesarean calculator. Med Anthropol Q 2023; 37:341-353. [PMID: 37459454 PMCID: PMC10993819 DOI: 10.1111/maq.12784] [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: 09/24/2022] [Accepted: 05/01/2023] [Indexed: 12/02/2023]
Abstract
Evidence-based obstetrics can employ statistical models to justify greater use of cesareans, sometimes excluding experiential elements from informed decision making. Over the past decade, prenatal providers adopted a vaginal birth after cesarean (VBAC) calculator designed to support patients in making informed decisions about their births by estimating their probability for a VBAC. Among other factors, the calculator used race and ethnicity to make its estimate, assigning lower probabilities for a successful VBAC to Black and Hispanic patients. I analyze how a diverse group of women and their providers engaged with the VBAC calculator. Some providers used low calculator scores to remove a shared decision-making model by prescriptively counseling Black and Hispanic women who desired a VBAC into undergoing repeat cesareans. Consequently, women racialized by the calculator as Black or Hispanic used experiential knowledge to challenge the calculator's assessment of their supposed lesser ability to give birth vaginally.
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Affiliation(s)
- Nicholas Rubashkin
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California at San Francisco, San Francisco, United States
- Institute for Global Health Sciences, University of California at San Francisco, San Francisco, United States
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James KF, Hicks M, Choi KR, Tobin CST. Discrimination during childbirth and postpartum care utilization among Black birthing people in California, United States. Birth 2023; 50:1018-1024. [PMID: 37548262 DOI: 10.1111/birt.12755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 12/02/2022] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between discrimination during childbirth hospitalization and postpartum care utilization among Black birthing people in California, United States. METHODS This was a secondary analysis of data from the Listening to Mothers in California survey, a population-based survey of individuals with a singleton hospital-based birth in California in 2016. The primary outcome was number of postpartum care visits. The primary exposures were racial, language, and insurance discrimination. A multiple linear regression model was used to estimate associations between discrimination and postpartum care use, adjusting for sociodemographic covariates. RESULTS Black birthing people in the sample had an average of two postpartum visits. Almost 15% of the sample reported one or more forms of discrimination during hospital-based childbirth. In adjusted models, racial discrimination (β = 0.09, 95% CI = 0.04-0.14, p < 0.01) and language discrimination (β = 1.03, 95% CI = 0.98-1.07, p < 0.01) were associated with increased postpartum visits, while insurance discrimination was linked to decreased postpartum visits (β = -0.96, 95% CI = -1.04 to -0.89, p < 0.01). CONCLUSION Among Black birthing people in California, the drivers of postpartum care utilization after childbirth are complex. There are multiple negative drivers (e.g., experiencing racial and language discrimination and unmet needs), barriers (e.g., insurance discrimination), and positive drivers (e.g., clinician type and education) that affect postpartum care utilization among Black birthing people.
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Affiliation(s)
- Kortney Floyd James
- National Clinician Scholars Program, Los Angeles David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Megan Hicks
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Kristen R Choi
- Los Angeles School of Nursing, University of California, Los Angeles, California, USA
- Department of Health Policy and Management, Los Angeles Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Courtney S Thomas Tobin
- Department of Community Health Sciences, Los Angeles Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California, USA
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Rost M, Stuerner Z, Niles P, Arnold L. Between "a lot of room for it" and "it doesn't exist"-Advancing and limiting factors of autonomy in birth as perceived by perinatal care practitioners: An interview study in Switzerland. Birth 2023; 50:1068-1080. [PMID: 37593797 DOI: 10.1111/birt.12757] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Numerous studies show that negative birth experiences are often related to birthing people's loss of autonomy. We argue that a fetal-focused decision-making framework and a maternal-fetal conflict lens are often applied, creating a false dichotomy between autonomy and fetal beneficence. Given the high prevalence of autonomy-depriving decision-making, it is important to understand how autonomy can be enhanced. METHODS We interviewed 15 Swiss perinatal care practitioners (eight midwives, five physicians, and two doulas) and employed reflexive thematic analysis. We offer a reflection on underlying assumptions and researcher positionality. RESULTS We generated two descriptive themes: advancing and limiting factors of autonomy. Numerous subthemes, grouped at the levels of companion, birthing person, practitioners, birthing person-practitioner relationship, and structural determinants are also defined. The most salient advancing factors were practitioners' approaches to decision-making, antenatal contacts, and structural determinants. The most salient limiting factors were various barriers within birthing people (e.g., expertise, decisional capacity, and awareness of own rights), practitioners' attitudes and behavior, and structural determinants. DISCUSSION The actualization of autonomy is multifactorially determined and must be understood against the background of power structures both underlying and inherent to decision-making in birth. Practitioners attributed a significant proportion of limited autonomy to birthing people themselves. This reinforces a "mother-blame" narrative that absolves obstetrics of primary responsibility. Practitioners' recognition of their contributions to upholding limits on autonomy should be leveraged to implement training towards rights-based practice standards. Most importantly, autonomy can only fully materialize if the underlying sociocultural, political, and medical contexts undergo a fundamental change.
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Affiliation(s)
- Michael Rost
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Zelda Stuerner
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Paulomi Niles
- Rory Meyers College of Nursing, New York University, New York, USA
| | - Louisa Arnold
- Institute of Psychology, Friedrich-Schiller University Jena, Jena, Germany
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Main EK, Chang SC, Tucker CM, Sakowski C, Leonard SA, Rosenstein MG. Hospital-level variation in racial disparities in low-risk nulliparous cesarean delivery rates. Am J Obstet Gynecol MFM 2023; 5:101145. [PMID: 37648109 PMCID: PMC10873027 DOI: 10.1016/j.ajogmf.2023.101145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Nationally, rates of cesarean delivery are highest among Black patients compared with other racial/ethnic groups. These observed inequities are a relatively new phenomenon (in the 1980s, cesarean delivery rates among Black patients were lower than average), indicating an opportunity to narrow the gap. Cesarean delivery rates vary greatly among hospitals, masking racial disparities that are unseen when rates are reported in aggregate. OBJECTIVE This study aimed to explore reasons for the current large Black-White disparity in first-birth cesarean delivery rates by first examining the hospital-level variation in first-birth cesarean delivery rates among different racial/ethnic groups. We then identified hospitals that had low first-birth cesarean delivery rates among Black patients and compared them with hospitals with high rates. We sought to identify differences in facility or patient characteristics that could explain the racial disparity. STUDY DESIGN A population cross-sectional study was performed on 1,267,493 California live births from 2018 through 2020 using birth certificate data linked with maternal patient discharge records. Annual nulliparous term singleton vertex cesarean delivery (first-birth) rates were calculated for the most common racial/ethnic groups statewide and for each hospital. Self-identified race/ethnicity categories as selected on the birth certificate were used. Relative risk and 95% confidence intervals for first-birth cesarean delivery comparing 2019 with 2015 were estimated using a log-binomial model for each racial/ethnic group. Patient and hospital characteristics were compared between hospitals with first-birth cesarean delivery rates <23.9% for Black patients and hospitals with rates ≥23.9% for Black patients. RESULTS Hospitals with at least 30 nulliparous term singleton vertex Asian, Black, Hispanic, and White patients each were identified. Black patients had a very different distribution, with a significantly higher rate (28.4%) and wider standard deviation (7.1) and interquartile range (6.5) than other racial groups (P<.01). A total of 29 hospitals with a low first-birth cesarean delivery rate among Black patients were identified using the Healthy People 2020 target of 23.9% and compared with 106 hospitals with higher rates. The low-rate group had a cesarean delivery rate of 19.9%, as opposed to 30.7% in the higher-rate group. There were no significant differences between the groups in hospital characteristics (ownership, delivery volume, neonatal level of care, proportion of midwife deliveries) or patient characteristics (age, education, insurance, onset of prenatal care, body mass index, hypertension, diabetes mellitus). Among the 106 hospitals that did not meet the target for Black patients, 63 met it for White patients with a mean rate of 21.4%. In the same hospitals, the mean rate for Black patients was 29.5%. Among Black patients in the group that did not meet the 23.9% target, there were significantly higher rates of all cesarean delivery indications: labor dystocia, fetal concern (spontaneous labor), and no labor (eg, macrosomia), which are all indications with a high degree of subjectivity. CONCLUSION The statewide cesarean delivery rate of Black patients is significantly higher and has substantially greater hospital variation compared with other racial or ethnic groups. The lack of difference in facility or patient characteristics between hospitals with low cesarean delivery rates among Black patients and those with high rates suggests that unconscious bias and structural racism potentially play important roles in creating these racial differences.
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Affiliation(s)
- Elliott K Main
- California Maternal Quality Care Collaborative, Stanford, CA (Drs Main and Chang, Ms Sakowski, and Drs Leonard and Rosenstein); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Main and Leonard).
| | - Shen-Chih Chang
- California Maternal Quality Care Collaborative, Stanford, CA (Drs Main and Chang, Ms Sakowski, and Drs Leonard and Rosenstein); Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA (Drs Chang and Tucker and Ms Sakowski)
| | - Curisa M Tucker
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA (Drs Chang and Tucker and Ms Sakowski)
| | - Christa Sakowski
- California Maternal Quality Care Collaborative, Stanford, CA (Drs Main and Chang, Ms Sakowski, and Drs Leonard and Rosenstein); Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA (Drs Chang and Tucker and Ms Sakowski)
| | - Stephanie A Leonard
- California Maternal Quality Care Collaborative, Stanford, CA (Drs Main and Chang, Ms Sakowski, and Drs Leonard and Rosenstein); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Main and Leonard)
| | - Melissa G Rosenstein
- California Maternal Quality Care Collaborative, Stanford, CA (Drs Main and Chang, Ms Sakowski, and Drs Leonard and Rosenstein); Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, CA (Dr Rosenstein)
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James KF, Klomhaus AM, Elliott T, Mensah M, Jeffers KS, Choi KR. Structural Factors in Health Care Associated With the Mental Health Needs of Black Women in California During the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2023; 52:481-490. [PMID: 37634545 DOI: 10.1016/j.jogn.2023.08.002] [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] [Received: 04/23/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE To identify structural factors associated with the receipt of mental health care treatment among Black women in California during pregnancy and after childbirth. DESIGN Secondary analysis of data from the population-based Listening to Mothers in California survey. PARTICIPANTS The sample included 194 non-Latina Black women in the postpartum period. METHODS We used descriptive statistics, including differences between means and logistic regression, to conduct a series of bivariate analyses. RESULTS Most respondents (84.4%, n = 163) reported symptoms of perinatal mood and anxiety disorders prenatally, and half (50% n = 97) reported symptoms of perinatal mood and anxiety disorders in the postpartum period. Only 12.3% to 14.6% of those who reported symptoms received mental health care treatment. Furthermore, 21.2% (n = 38) of respondents were not screened for postpartum depression. Respondents with private insurance coverage were more likely to report receipt of mental health care after childbirth (OR = 4.6; 95% confidence interval [1.5, 13.5]) compared to respondents with public insurance coverage. CONCLUSION Our results suggest a high prevalence of unmet mental health needs among non-Latina Black women who lived in California during the perinatal period. Practitioners in clinical settings may be more likely to make referrals to mental health care for women with private insurance coverage in the postpartum period.
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Van Baak B, Powell A, Fricas J, Caupain Sanderson A. Essential Nursing Actions to Reduce Inequities for Black Women in the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2023; 52:454-466. [PMID: 37597534 DOI: 10.1016/j.jogn.2023.07.002] [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] [Received: 03/29/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 08/21/2023] Open
Abstract
Perinatal nurses play a critical role in the care of, advocacy for, and research with Black women in the perinatal period. Despite awareness of inequities in the perinatal health care system that stem from racism in the United States, many nurses report feeling detached from the crisis. In this critical commentary, we provide a five-step nursing action guide to address this health disparity that is aligned with the Future of Nursing report and the American Nurses Association Code of Ethics. We recommend nursing activities in each step: understand drivers of health inequities among Black women, reflect on implicit bias, use respectful care frameworks with Black women, conduct ethical research, and advocate for change. The article includes a sharable and printable action sheet that can be used in the work environment to remind nurses of their roles in enacting change.
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Dovel K, Paneno R, Balakasi K, Hubbard J, Magaço A, Phiri K, Coates T, Cornell M. Health care workers' perceptions and bias toward men as HIV clients in Malawi and Mozambique: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001356. [PMID: 37874781 PMCID: PMC10597488 DOI: 10.1371/journal.pgph.0001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Abstract
Men are underrepresented in HIV services throughout sub-Saharan Africa. Little is known about health care worker (HCW) perceptions of men as clients, which may directly affect the quality of care provided, and HCWs' buy-in for male-specific interventions. Focus group discussions (FGDs) were conducted in 2016 with HCWs from 15 facilities across Malawi and Mozambique and were originally conducted to evaluate barriers to universal treatment (not HCW bias). FGDs were conducted in local languages, recorded, translated to English, and transcribed. For this study, we focused on HCW perceptions of men as HIV clients and any explicit bias against men, using inductive and deductive coding in Atlas.ti v.8, and analyzed using constant comparison methods. 20 FGDs with 154 HCWs working in HIV treatment clinics were included. Median age was 30 years, 59% were female, and 43% were providers versus support staff. HCWs held strong explicit bias against men as clients. Most HCWs believed men could easily navigate HIV services due to their elevated position within society, regardless of facility-level barriers faced. Men were described in pejorative terms as ill-informed and difficult clients who were absent from health systems. Men were largely seen as "bad clients" due to assumptions about men's 'selfish' and 'prideful' nature, resulting in little HCW sympathy for men's poor use of care. Our study highlights a strong explicit bias against men as HIV clients, even when gender and bias were not the focus of data collection. As a result, HCWs may have little motivation to implement male-specific interventions or improve provider-patient interactions with men. Framing men as problematic places undue responsibility on individual men while minimizing institutional barriers that uniquely affect them. Bias in local, national, and global discourses about men must be immediately addressed.
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Affiliation(s)
- Kathryn Dovel
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, United States of America
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Rose Paneno
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, United States of America
| | | | - Julie Hubbard
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, United States of America
| | - Amílcar Magaço
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Manhiça Health Research Center, Manhiça, Mozambique
| | - Khumbo Phiri
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Thomas Coates
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, United States of America
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
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Reading Turchioe M, Harkins S, Desai P, Kumar S, Kim J, Hermann A, Joly R, Zhang Y, Pathak J, Benda NC. Women's perspectives on the use of artificial intelligence (AI)-based technologies in mental healthcare. JAMIA Open 2023; 6:ooad048. [PMID: 37425486 PMCID: PMC10329494 DOI: 10.1093/jamiaopen/ooad048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/24/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023] Open
Abstract
This study aimed to evaluate women's attitudes towards artificial intelligence (AI)-based technologies used in mental health care. We conducted a cross-sectional, online survey of U.S. adults reporting female sex at birth focused on bioethical considerations for AI-based technologies in mental healthcare, stratifying by previous pregnancy. Survey respondents (n = 258) were open to AI-based technologies in mental healthcare but concerned about medical harm and inappropriate data sharing. They held clinicians, developers, healthcare systems, and the government responsible for harm. Most reported it was "very important" for them to understand AI output. More previously pregnant respondents reported being told AI played a small role in mental healthcare was "very important" versus those not previously pregnant (P = .03). We conclude that protections against harm, transparency around data use, preservation of the patient-clinician relationship, and patient comprehension of AI predictions may facilitate trust in AI-based technologies for mental healthcare among women.
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Affiliation(s)
| | - Sarah Harkins
- Columbia University School of Nursing, New York, New York, USA
| | - Pooja Desai
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | | | - Jessica Kim
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Rochelle Joly
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Natalie C Benda
- Columbia University School of Nursing, New York, New York, USA
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Igbinosa II, Leonard SA, Noelette F, Davies-Balch S, Carmichael SL, Main E, Lyell DJ. Racial and Ethnic Disparities in Anemia and Severe Maternal Morbidity. Obstet Gynecol 2023; 142:845-854. [PMID: 37678935 PMCID: PMC10510811 DOI: 10.1097/aog.0000000000005325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To evaluate antepartum anemia prevalence by race and ethnicity, to assess whether such differences contribute to severe maternal morbidity (SMM), and to estimate the contribution of antepartum anemia to SMM and nontransfusion SMM by race and ethnicity. METHODS We conducted a population-based cohort study using linked vital record and birth hospitalization data for singleton births at or after 20 weeks of gestation in California from 2011 through 2020. Pregnant patients with hereditary anemias, out-of-hospital births, unlinked records, and missing variables of interest were excluded. Antepartum anemia prevalence and trends were estimated by race and ethnicity. Centers for Disease Control and Prevention criteria were used for SMM and nontransfusion SMM indicators. Multivariable logistic regression modeling was used to estimate risk ratios (RRs) for SMM and nontransfusion SMM by race and ethnicity after sequential adjustment for social determinants, parity, obstetric comorbidities, delivery, and antepartum anemia. Population attributable risk percentages were calculated to assess the contribution of antepartum anemia to SMM and nontransfusion SMM by race and ethnicity. RESULTS In total, 3,863,594 births in California were included. In 2020, Black pregnant patients had the highest incidence of antepartum anemia (21.5%), followed by Pacific Islander (18.2%), American Indian-Alaska Native (14.1%), multiracial (14.0%), Hispanic (12.6%), Asian (10.6%), and White pregnant patients (9.6%). From 2011 to 2020, the prevalence of anemia increased more than100% among Black patients, and there was a persistent gap in prevalence among Black compared with White patients. Compared with White patients, the adjusted risk for SMM was high among most racial and ethnic groups; adjustment for anemia after sequential modeling for known confounders decreased SMM risk most for Black pregnant patients (approximated RR 1.47, 95% CI 1.42-1.53 to approximated RR 1.27, 95% CI 1.22-1.37). Compared with White patients, the full adjusted nontransfusion SMM risk remained high for most groups except Hispanic and multiracial patients. Within each racial and ethnic group, the population attributable risk percentage for antepartum anemia and SMM was highest for multiracial patients (21.4%, 95% CI 17.5-25.0%), followed by Black (20.9%, 95% CI 18.1-23.4%) and Hispanic (20.9%, 95% CI 19.9-22.1%) patients. The nontransfusion SMM population attributable risk percentages for Asian, Black, and White pregnant patients were less than 8%. CONCLUSION Antepartum anemia, most prevalent among Black pregnant patients, contributed to disparities in SMM by race and ethnicity. Nearly one in five to six SMM cases among Black, Hispanic, American Indian-Alaska Native, Pacific Islander, and multiracial pregnant patients is attributable in part to antepartum anemia.
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Affiliation(s)
- Irogue I Igbinosa
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, and the Department of Pediatrics, School of Medicine, Stanford University, Stanford, and the BLACK Wellness & Prosperity Center, Fresno, California
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Wycoff KL, Coleman JG, Santoro CM, Zullig LL, Darden N, Holland PM, Cruice JF, Mitchell S, Smith M, McNeil SJ, Herring SJ. Multilevel Community Engagement to Inform a Randomized Clinical Trial. Obstet Gynecol 2023; 142:929-939. [PMID: 37734093 PMCID: PMC10510772 DOI: 10.1097/aog.0000000000005344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To explore how patients, community-based perinatal support professionals, and health system clinicians and staff perceived facilitators and barriers to implementation of a randomized clinical trial (RCT) designed to optimize Black maternal heart health. METHODS This article describes the formative work that we believed needed to occur before the start of the Change of H.E.A.R.T (Here for Equity, Advocacy, Reflection and Transformation) RCT. We used a qualitative, descriptive design and community-based, participatory approach, the latter of which allowed our team to intentionally focus on avoiding harm and equalizing power dynamics throughout the research process. Data were collected between November 2021 and January 2022 through six semistructured focus groups that included attending physicians and midwives (n=7), residents (n=4), nurses (n=6), support staff (n=7), community-based perinatal support professionals (n=6), and patients (n=8). RESULTS Four primary themes emerged. The first three themes were present across all groups and included: 1) Trauma in the Community and Health System, 2) Lack of Trust, and 3) Desire to Be Heard and Valued. The fourth theme, Hope and Enthusiasm, was expressed predominantly by patients, community-based perinatal support professionals, residents, and support staff, and less so by the attending physician group. CONCLUSION Participants articulated a number of key sentiments regarding facilitators and barriers to implementing Change of H.E.A.R.T. We noted variability in perceptions from different groups. This has important implications for health equity efforts in similarly underresourced health systems where Black birthing people experience the greatest morbidity and mortality. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT05499507.
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Affiliation(s)
- Kirby L Wycoff
- Department of Counseling and Behavioral Health, College of Health Professions, Thomas Jefferson University, the Maternal Wellness Village, the Program for Maternal Health Equity, Center for Urban Bioethics, the Department of Urban Health and Population Science, and the Department of Internal Medicine, Lewis Katz School of Medicine at Temple University, and the Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and the Department of Urban Health and Population Science, Duke University, Durham, North Carolina
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Batman S, Rivlin K, Robinson W, Brown O, Carter EB, Lindo E. A Rubric to Center Equity in Obstetrics and Gynecology Research. Obstet Gynecol 2023; 142:772-778. [PMID: 37678908 PMCID: PMC10510789 DOI: 10.1097/aog.0000000000005336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 09/09/2023]
Abstract
The Steering Committee for the Obstetrics & Gynecology special edition titled "Racism in Reproductive Health: Lighting a Path to Health Equity" formed a working group to create an equity rubric. The goal was to provide a tool to help researchers systematically center health equity as they conceptualize, design, analyze, interpret, and evaluate research in obstetrics and gynecology. This commentary reviews the rationale, iterative process, and literature guiding the creation of the equity rubric.
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Affiliation(s)
- Samantha Batman
- University of Texas MD Anderson Cancer Center, Houston, Texas; University of Chicago Medicine, Chicago, Illinois; Duke University School of Medicine, Durham, North Carolina; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Washington University School of Medicine in St. Louis, St. Louis, Missouri; and University of Washington Medicine, Seattle, Washington
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Barry MJ, Nicholson WK, Silverstein M, Cabana MD, Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Li L, Ogedegbe G, Rao G, Ruiz JM, Stevermer J, Tsevat J, Underwood SM, Wong JB. Screening for Hypertensive Disorders of Pregnancy: US Preventive Services Task Force Final Recommendation Statement. JAMA 2023; 330:1074-1082. [PMID: 37721605 DOI: 10.1001/jama.2023.16991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Importance Hypertensive disorders of pregnancy are among the leading causes of maternal morbidity and mortality in the US. The rate of hypertensive disorders of pregnancy has been increasing from approximately 500 cases per 10 000 deliveries in 1993 to 1021 cases per 10 000 deliveries in 2016 to 2017. Objective The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for hypertensive disorders of pregnancy. Population Pregnant persons without a known diagnosis of a hypertensive disorder of pregnancy or chronic hypertension. Evidence Assessment The USPSTF concludes with moderate certainty that screening for hypertensive disorders in pregnancy with blood pressure measurements has substantial net benefit. Recommendation The USPSTF recommends screening for hypertensive disorders in pregnant persons with blood pressure measurements throughout pregnancy. (B recommendation).
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Affiliation(s)
| | | | | | | | | | | | - Esa M Davis
- University of Maryland School of Medicine, Baltimore
| | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- University of Texas Health Science Center, San Antonio
| | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Combs EL. Raising the Bar for Optimal Maternal Health. J Obstet Gynecol Neonatal Nurs 2023; 52:329-332. [PMID: 37562459 DOI: 10.1016/j.jogn.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
The Raising the Bar for Maternal Health Equity and Excellence initiative supports the implementation of transformative measures that address the underlying factors that contribute to the maternal health crisis.
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Mane HY, Doig AC, Gutierrez FXM, Jasczynski M, Yue X, Srikanth NP, Mane S, Sun A, Moats RA, Patel P, He X, Boyd-Graber JL, Aparicio EM, Nguyen QC. Practical Guidance for the Development of Rosie, a Health Education Question-and-Answer Chatbot for New Mothers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:663-670. [PMID: 37478093 PMCID: PMC10372746 DOI: 10.1097/phh.0000000000001781] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
Communities of color experience higher maternal and infant mortality, as well as a host of other adverse outcomes, during pregnancy and postpartum. To address this, our team is developing a free, user-friendly, question-answering chatbot called Rosie. Chatbots have gained significant popularity due to their scalability and success in individualizing resources. In recent years, scientific communities and researchers have started recognizing this technology's potential to inform communities, promote health outcomes, and address health disparities. The development of Rosie is an interdisciplinary project, with teams focused on the technical build of the application (app), the development of machine learning models, and community outreach, making Rosie a chatbot built with the input from the communities it aims to serve. From June to October 2022, more than 20 demonstration sessions were conducted in Washington, District of Columbia, Maryland, and Virginia, where a total of 109 pregnant women and new mothers of color could interact with Rosie. Results from the live demonstrations showed that 75% of mothers searched for maternity and baby-related information at least once a week and more than 90% of participants expressed the likelihood to use the app. Most of the participants inquired about their baby's development, nutrition for babies, and identifying and addressing the causes of certain symptoms and conditions, accounting for about 80% of the total questions asked. Mother-related questions in the community demonstrations were mainly about pregnancy. The high level of interest in the chatbot is a clear indication of the need for more resources. Rosie aims to help close the racial gap in maternal and infant health disparities by providing new mothers with easy access to reliable health information.
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Affiliation(s)
- Heran Y. Mane
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
| | - Amara Channell Doig
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
| | - Francia Ximena Marin Gutierrez
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
| | - Michelle Jasczynski
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
| | - Xiaohe Yue
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
| | - Neha Pundlik Srikanth
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
| | - Sourabh Mane
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
| | - Abby Sun
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
| | - Rachel Ann Moats
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
| | - Pragat Patel
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
| | - Xin He
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
| | - Jordan Lee Boyd-Graber
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
| | - Elizabeth M. Aparicio
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
| | - Quynh C. Nguyen
- Department of Epidemiology and Biostatistics (Mss H. Y. Mane, Yue, and Moats Drs He and Nguyen), Department of Behavioral and Community Health (Drs Doig, Jasczynski, and Aparicio and Ms Gutierrez), and Public Health Science Program (Ms Sun), University of Maryland School of Public Health, College Park, Maryland; Department of Computer Science, UMIACS (Ms Srikanth and Dr Boyd-Graber), College of Information Studies (Mr S. Mane), and Department of Biology (Mr Patel), University of Maryland, College Park, Maryland
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Gourevitch RA, Zera C, Martin MW, Zhou RA, Bates MA, Baicker K, McConnell M. Home Visits With A Registered Nurse Did Not Affect Prenatal Care In A Low-Income Pregnant Population. Health Aff (Millwood) 2023; 42:1152-1161. [PMID: 37549328 DOI: 10.1377/hlthaff.2022.01517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
There is an urgent need to improve maternal and neonatal health outcomes and decrease their racial disparities in the US. Prenatal nurse home visiting programs could help achieve this by increasing the use and quality of prenatal care and facilitating healthy behaviors during pregnancy. We conducted a randomized controlled trial of 5,670 Medicaid-eligible pregnant people in South Carolina to evaluate how a nurse home visiting program affected prenatal health care and health outcomes. We compared outcomes between the treatment and control groups and found little evidence of statistically significant differences in the intensity of prenatal care use, receipt of guideline-based prenatal care services, other health care use, or gestational weight gain. Nor did we find treatment effects in subgroup analyses of socially vulnerable participants (46.9 percent of the sample) or non-Hispanic Black participants (52.0 percent of the sample). Compared with the broader Medicaid population, our trial participants had more health and social risk factors, more engagement with prenatal care, and similar pregnancy outcomes. Delivering intensive nurse home visiting programs to the general Medicaid population might not be an efficient method to improve prenatal care for those who need the most support during pregnancy.
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Affiliation(s)
- Rebecca A Gourevitch
- Rebecca A. Gourevitch , University of Maryland, College Park, College Park, Maryland
| | - Chloe Zera
- Chloe Zera, Beth Israel Deaconess Medical Center and Harvard University, Boston, Massachusetts
| | - Michelle W Martin
- Michelle W. Martin, Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts
| | | | - Mary Ann Bates
- Mary Ann Bates, State of California, Sacramento, California
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Shaikh H, Billimoria Z, Vandeleur D, Weiss EM, Batra M, Hedstrom AB. Transmission of negative biases through social commentary included in neonatal intensive care unit progress notes. J Perinatol 2023; 43:903-908. [PMID: 36841888 PMCID: PMC9959939 DOI: 10.1038/s41372-023-01635-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To determine how the perception of families elicited after reading progress note social commentary differs by patient race. STUDY DESIGN We retrospectively performed content analysis of social commentary in physician progress notes for neonatal intensive care unit patients hospitalized from 2018-2019. Neonatologists blinded to patient race rated how commentary impacted their perception of the patient's family on a 5-point Likert scale. Frequency of negative ratings was compared across reported race using chi-squared tests. RESULTS We reviewed charts of 460 neonates. In total, 225 (49%) contained social commentary beyond parents' names. Twelve neonatologists rated how commentaries impacted their perception of the patient's family; 79%, 18%, and 3% were rated neutrally, negatively, and positively, respectively. Frequency of negative ratings was significantly greater among American Indian/Alaska Native than other patients (35% vs. 22%, p < 0.001). CONCLUSIONS Physician documentation of social commentary in patient notes may reflect and perpetuate implicit biases that contribute to race-based healthcare disparities.
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Affiliation(s)
- Henna Shaikh
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Zeenia Billimoria
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Daron Vandeleur
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Elliott M Weiss
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | - Maneesh Batra
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Anna B Hedstrom
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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Suplee PD, D'Oria R, Larson K, Kilday D, Eymold C, Onokpise B. An Initiative to Improve Postpartum Discharge Education. Nurs Womens Health 2023:S1751-4851(23)00125-3. [PMID: 37336492 DOI: 10.1016/j.nwh.2023.04.007] [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: 12/05/2022] [Revised: 04/18/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To evaluate an online POST-BIRTH Warning Signs (PBWS) project focused on improving nurses' knowledge and how they teach individuals in the postpartum period about potential complications. DESIGN Quality improvement project with exploratory pretest/posttest. SETTING Seventy hospitals with maternity services throughout the United States. PARTICIPANTS A sample of 2,363 registered nurses. INTERVENTION/MEASUREMENTS An online educational program with four surveys and a chart audit tool were used as evaluation measures. RESULTS There was an 11% increase in nurses' knowledge after the online course intervention. A majority of nurses reported that they would improve how they educate patients and families about PBWS, that they would change their clinical practice based on what they learned, and that their facility implemented a protocol to educate patients about PBWS after the implementation of the course. The nurses' reported confidence in their teaching increased 59% after implementation of the course. CONCLUSION The majority of maternal deaths in the United States occur during the postpartum period. Therefore, it is vital that nurses provide standardized and structured educational messaging when teaching individuals in the postpartum period about signs and symptoms of potential complications. This quality improvement project demonstrated that the PBWS online education course was associated with an increase in nurses' knowledge and confidence when teaching about potential complications that can arise during the postpartum period.
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Lemke MK, Brown KK, Fallah-Fini S, Hall A, Obasanya M. Complex systems and participatory approaches to address maternal health disparities: Findings from a system dynamics group model building project in North Texas. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 71:303-316. [PMID: 36378746 DOI: 10.1002/ajcp.12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/23/2022] [Accepted: 11/03/2022] [Indexed: 06/06/2023]
Abstract
Focusing on non-Hispanic Black women (NHBW) in North Texas, this study employed participatory system dynamics modeling to explore three hypotheses: (1) stakeholders will conceptualize structural racism is a pervasive macrostructural force that exerts downstream impacts to shape and perpetuate maternal health disparities among NHBW; (2) stakeholders will identify key causal forces and leverage points that exist across levels of influence; and (3) stakeholders will identify complex interactions, in the form of circular causality, that are present among the key causal forces and leverage points that shape NHBW maternal health disparities. Nine participants engaged in a virtual system dynamics group model-building session that focused on eliciting key variables, behavior-over-time graphs (BOTGs), causal loop diagram (CLD), and targets for action. Participants identified 83 key variables. BOTGs included an average of 6.56 notations and time horizons that, on average, started in 1956. The CLD featured 11 reinforcing and seven balancing feedback loops. Eleven targets for action were identified. Structural racism was revealed as a pervasive macrostructural force that shaped maternal health outcomes among NHBW. Key causal forces and leverage points were identified across levels of influence. Finally, feedback loops within the CLD exhibited circular causality.
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Affiliation(s)
- Michael K Lemke
- Department of Social Sciences, University of Houston-Downtown, Houston, Texas, USA
| | - Kyrah K Brown
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
| | - Saeideh Fallah-Fini
- Industrial and Manufacturing Engineering Department, California State Polytechnic University, Pomona, Pomona, California, USA
| | - Ariel Hall
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
| | - Mercy Obasanya
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
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Moody SN, Phan JM, Shirtcliff EA, Wang W, Drury S, Theall K. Transgenerational effect of Mothers' experiences of discrimination on Black youths' hormone coupling in response to laboratory stress. RESEARCH IN HUMAN DEVELOPMENT 2023; 20:25-47. [PMID: 37484485 PMCID: PMC10358998 DOI: 10.1080/15427609.2023.2215130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Exposure to pervasive racial discrimination of Black Americans is transgenerational in that mothers' experiences of discriminatory violence impacts their children. This study explored whether stress-related biomarkers reflect transgenerational racial stress by implementing a "dual activation" framework to probe how adrenal and gonadal hormones underlying adolescent development are co-regulated during a laboratory stressor. Data were collected from 120 Black families in the United States. Children completed the Trier Social Stress Task (TSST-C) and provided 4 saliva samples across 2 days that were assayed for cortisol (C), dehydroepiandrosterone (DHEA), and testosterone (T). Mothers reported their experiences of total discrimination and racial discrimination related to skin color/race. Thirty four percent reported experiences of discrimination and on average 46.7% reported experiences of discrimination due to their race or skin tone. Mothers' experiences of racial discrimination were associated with their child's hormonal reactivity to and recovery from the TSST-C. Youth showed stronger positive hormone coupling between C-T if their mother experienced greater discrimination. Mothers' experiences of racial discrimination influenced both C-T coupling and youths' cortisol recovery from the TSST-C. For youths with high testosterone, cortisol recovery was blunted. Results suggest that associations between racism and hormonal stress response may be transgenerational. Mothers' experiences of discrimination had a profound impact on their children's hormonal co-regulation.
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Affiliation(s)
- Shannin N. Moody
- Department of Neurology, Louisiana State University Health Sciences Center, New Orleans (LA), USA
- Department of Human Development and Family Studies, Iowa State University, Ames, (IA), USA
| | - Jenny M. Phan
- Center for Autism Spectrum Disorders, Children’s National Hospital, Washington (D.C.) USA
| | - Elizabeth A. Shirtcliff
- Center for Translational Neuroscience, Department of Psychology, University of Oregon, Eugene (OR), USA
| | - Wen Wang
- Center for Translational Neuroscience, Department of Psychology, University of Oregon, Eugene (OR), USA
| | - Stacy Drury
- Department of Pediatrics, Tulane University, New Orleans, (LA), USA
| | - Katherine Theall
- Departments of Social, Behavioral, and Population Sciences and Epidemiology, Tulane University, New Orleans, (LA), USA
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Niles PM, Baumont M, Malhotra N, Stoll K, Strauss N, Lyndon A, Vedam S. Examining respect, autonomy, and mistreatment in childbirth in the US: do provider type and place of birth matter? Reprod Health 2023; 20:67. [PMID: 37127624 PMCID: PMC10152585 DOI: 10.1186/s12978-023-01584-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/16/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Analyses of factors that determine quality of perinatal care consistently rely on clinical markers, while failing to assess experiential outcomes. Understanding how model of care and birth setting influence experiences of respect, autonomy, and decision making, is essential for comprehensive assessment of quality. METHODS We examined responses (n = 1771) to an online cross-sectional national survey capturing experiences of perinatal care in the United States. We used validated patient-oriented measures and scales to assess four domains of experience: (1) decision-making, (2) respect, (3) mistreatment, and (4) time spent during visits. We categorized the provider type and birth setting into three groups: midwife at community birth, midwife at hospital-birth, and physician at hospital-birth. For each group, we used multivariate logistic regression, adjusted for demographic and clinical characteristics, to estimate the odds of experiential outcomes in all the four domains. RESULTS Compared to those cared for by physicians in hospitals, individuals cared for by midwives in community settings had more than five times the odds of experiencing higher autonomy (aOR: 5.22, 95% CI: 3.65-7.45), higher respect (aOR: 5.39, 95% CI: 3.72-7.82) and lower odds of mistreatment (aOR: 0.16, 95% CI: 0.10-0.26). We found significant differences across birth settings: participants cared for by midwives in the community settings had significantly better experiential outcomes than those in the hospital settings: high- autonomy (aOR: 2.97, 95% CI: 2.66-4.27), respect (aOR: 4.15, 95% CI: 2.81-6.14), mistreatment (aOR: 0.20, 95% CI: 0.11-0.34), time spent (aOR: 8.06, 95% CI: 4.26-15.28). CONCLUSION Participants reported better experiential outcomes when cared for by midwives than by physicians. And for those receiving midwifery care, the quality of experiential outcomes was significantly higher in community settings than in hospital settings. Care settings matter and structures of hospital-based care may impair implementation of the person-centered midwifery care model.
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Affiliation(s)
- P. Mimi Niles
- New York University, 433 First Avenue, Room 644, New York, NY 10010 USA
| | - Monique Baumont
- Every Mother Counts, 333 Hudson St Suite 1006, New York, NY 10013 USA
| | - Nisha Malhotra
- University of British Columbia, BC Women’s Hospital, Shaughnessy Building E416 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Kathrin Stoll
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Suite 320-5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Nan Strauss
- Every Mother Counts, 333 Hudson St Suite 1006, New York, NY 10013 USA
| | - Audrey Lyndon
- New York University, 433 First Avenue, Room 644, New York, NY 10010 USA
| | - Saraswathi Vedam
- University of British Columbia, BC Women’s Hospital, Shaughnessy Building E416 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
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Iradukunda F, Canty L. Decolonizing nursing education and research to address racial disparities in maternal health. J Adv Nurs 2023. [PMID: 36882975 DOI: 10.1111/jan.15624] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/08/2023] [Accepted: 02/19/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE In this paper, we discuss the need to move beyond theoretical explorations of social determinants of health (SDoH) to addressing systemic racism and its effect on Black maternal health outcomes. We also address the importance of connecting nursing research, education and practice and offer suggestions on how to transform the teaching, research and clinical practice specific to Black maternal health. KNOWLEDGE DEVELOPMENT A critical analysis of current Black maternal health teaching and research practices in nursing informed by the authors' experience in Black/African diasporic maternal health and reproductive justice. DISCUSSION There is a need for nursing to be more intentional in addressing the effects of systemic racism on Black maternal health outcomes. In particular, there is still a substantial focus on race rather than racism as a risk factor. The focus on racial and cultural differences rather than systems of oppression continues to pathologize racialized groups while failing to address the impact of systemic racism on the health outcomes of Black women. CONCLUSION Using a social determinant of health framework to examine maternal health disparities is useful; however, focusing on SDoH without challenging systems of oppression producing these disparities does not produce substantial changes. We suggest adding frameworks grounded in intersectionality, reproductive and racial justice and moving beyond biological assumptions about race that pathologize Black women. We also recommend a deliberate commitment to reshaping nursing research and education to centre anti-racist and anti-colonial practices that value community knowledge and practices. NO PATIENT OR PUBLIC CONTRIBUTION The discussion in this paper is based on the author's expertise.
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Affiliation(s)
- Favorite Iradukunda
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Lucinda Canty
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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Delker E, Ramos GA, Bandoli G, LaCoursiere DY, Ferran K, Gallo LC, Oren E, Gahagan S, Allison M. Associations Between Preconception Glycemia and Preterm Birth: The Potential Role of Health Care Access and Utilization. J Womens Health (Larchmt) 2023; 32:274-282. [PMID: 36796052 PMCID: PMC9993162 DOI: 10.1089/jwh.2022.0256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Background: Preconception diabetes is strongly associated with adverse birth outcomes. Less is known about the effects of elevated glycemia at levels below clinical cutoffs for diabetes. In this study, we estimated associations between preconception diabetes, prediabetes, and hemoglobin A1c (HbA1c) on the risk of preterm birth, and evaluated whether associations were modified by access to or utilization of health care services. Materials and Methods: We used data from Add Health, a US prospective cohort study with five study waves to date. At Wave IV (ages 24-32), glucose and HbA1c were measured. At Wave V (ages 32-42), women with a live birth reported whether the baby was born preterm. The analytic sample size was 1989. Results: The prevalence of preterm birth was 13%. Before pregnancy, 6.9% of women had diabetes, 23.7% had prediabetes, and 69.4% were normoglycemic. Compared to the normoglycemic group, women with diabetes had 2.1 (confidence interval [95% CI]: 1.5-2.9) times the risk of preterm birth, while women with prediabetes had 1.3 (95% CI: 1.0, 1.7) times the risk of preterm birth. There was a nonlinear relationship between HbA1c and preterm birth such that risk of preterm birth emerged after HbA1c = 5.7%, a standard cutoff for prediabetes. The excess risks of preterm birth associated with elevated HbA1c were four to five times larger among women who reported unstable health care coverage and among women who used the emergency room as usual source of care. Conclusion: Our findings replicate prior research showing strong associations between preconception diabetes and preterm birth, adding that prediabetes is also associated with higher risk. Policies and interventions to enhance access and utilization of health care among women before pregnancy should be examined.
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Affiliation(s)
- Erin Delker
- Department of Public Health, San Diego State University, Joint Doctoral Program in Public Health, San Diego, California, USA
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Gladys A. Ramos
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, California, USA
| | - Gretchen Bandoli
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - D. Yvette LaCoursiere
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, California, USA
| | - Karen Ferran
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Eyal Oren
- Division of Preventive Medicine, University of California San Diego, La Jolla, California, USA
| | - Sheila Gahagan
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Matthew Allison
- Division of Preventive Medicine, University of California San Diego, La Jolla, California, USA
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Garrett SB, Walia A, Miller F, Tahir P, Jones L, Harris J, Powell B, Chambers B, Simon MA. Antibias Efforts in United States Maternity Care: A Scoping Review of the Publicly Funded Health Equity Intervention Pipeline. Clin Obstet Gynecol 2023; 66:110-123. [PMID: 36583638 PMCID: PMC9851967 DOI: 10.1097/grf.0000000000000761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Antibias training is increasingly identified as a strategy to reduce maternal health disparities. Evidence to guide this work is limited. We conducted a community-guided scoping review to characterize new antibias research. Four of 508 projects met our criteria: US-based, publicly funded, initiated from January 1, 2018 to June 30, 2022, and featuring an intervention to reduce bias or racism in maternal health care providers. Training was embedded in multicomponent interventions in 3 projects, limiting its evaluation as a stand-alone intervention. Major public funders have sponsored few projects to advance antibias training research in maternal health. More support is needed to develop a rigorous and scalable evidence base.
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Affiliation(s)
- Sarah B. Garrett
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | - Anjali Walia
- School of Medicine, University of California, San Francisco, CA
| | - Fiona Miller
- School of Medicine, University of California, San Francisco, CA
| | - Peggy Tahir
- University of California San Francisco Library, University of California, San Francisco, CA
| | - Linda Jones
- California Preterm Birth Initiative, University of California, San Francisco, CA
| | - Julie Harris
- California Preterm Birth Initiative, University of California, San Francisco, CA
| | - Breezy Powell
- California Preterm Birth Initiative, University of California, San Francisco, CA
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Soled KRS, Niles PM, Mantell E, Dansky M, Bockting W, George M. Childbearing at the margins: A systematic metasynthesis of sexual and gender diverse childbearing experiences. Birth 2023; 50:44-75. [PMID: 36198035 PMCID: PMC9991943 DOI: 10.1111/birt.12678] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/12/2022] [Accepted: 09/02/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The reproductive and perinatal health of sexual and gender-diverse (SGD) individuals is a research priority area for the National Institutes of Health. Over the past decade, this childbearing population has been the focus of several qualitative studies providing the opportunity to evaluate and synthesize the qualitative literature on SGD childbearing experiences in a metasynthesis. METHODS We conducted a literature search of four databases to identify original research published from January 2011 through June 2021. These results were augmented by forward and backward searching strategies. Two authors independently screened studies. All qualitative studies of the childbearing experience were eligible. Data were extracted and inductively coded using conventional content analysis, and studies underwent a quality appraisal by two authors. RESULTS From 2396 articles, 127 full-text articles were screened, and 25 were included in this synthesis. Three overarching themes were identified: (a) Systematic Invisibility; (b) Creating Personhood Through Parenthood; and (c) Resilient Narratives of Childbearing. CONCLUSIONS Relative to heterosexual and cisgender parents, SGD childbearing parents experience unique structural and interpersonal challenges and employ critically important resilience strategies and coping techniques to manage an overwhelming heterocisnormative experience. These findings provide an important target for health care organizations and professionals to improve SGD perinatal health. In addition, this metasynthesis identified persistent gaps in our understanding of this marginalized childbearing population, which have important implications for reducing health disparities that SGD parents experience.
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Affiliation(s)
- Kodiak Ray Sung Soled
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Columbia University School of Nursing, New York, New York, USA
| | - Paulomi Mimi Niles
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Elise Mantell
- Columbia University School of Nursing, New York, New York, USA
| | - Mars Dansky
- The Institute of Family Health, New York, New York, USA
| | - Walter Bockting
- New York State Psychiatric Institute/Columbia Psychiatry and the Columbia University School of Nursing, New York, New York, USA
| | - Maureen George
- Columbia University Medical Center, New York, New York, USA
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Canty L. Decolonizing nursing through the lens of Black maternal health. Nurs Philos 2023; 24:e12424. [PMID: 36799084 DOI: 10.1111/nup.12424] [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: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023]
Abstract
In the United States, there is a long history of racial disparities in maternal health, with Black women disproportionately representing poor maternal health outcomes. Black women are three to four times more likely to die from a pregnancy-related complication and twice as likely to experience severe maternal morbidity when compared to white women. Where are nurses in the development of knowledge to improve maternal health outcomes among Black birthing people? This dialogue discusses how decolonizing nursing can occur by examining the history of Black maternal health in the United States and using the works of nursing scholars of color to inform nursing education, research, and clinical practice.
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Affiliation(s)
- Lucinda Canty
- Department of Nursing, Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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Assessing the impact of telehealth implementation on postpartum outcomes for Black birthing people. Am J Obstet Gynecol MFM 2023; 5:100831. [PMID: 36496115 PMCID: PMC9726646 DOI: 10.1016/j.ajogmf.2022.100831] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/10/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The COVID-19 pandemic led to the rapid uptake of telemedicine services, which have been shown to be potentially cost-saving and of comparable quality to in-person care for certain populations. However, there are some concerns regarding the feasibility of implementation for marginalized populations, and the impact of widespread implementation of these services on health disparities has not been well studied. OBJECTIVE This study aimed to assess the impact of telehealth implementation on postpartum care during the COVID-19 pandemic on racial disparities in visit attendance and completion of postpartum care goals. STUDY DESIGN In this retrospective cohort study at a single tertiary care center, differences in outcomes between all Black and non-Black patients who had scheduled postpartum visits before and after telehealth implementation for postpartum care were compared. The primary outcome was postpartum visit attendance. The secondary outcomes included postpartum depression screening, contraception selection, breastfeeding status, completion of postpartum 2-hour glucose tolerance test, and cardiology follow-up for hypertensive disorders of pregnancy. In multivariable analysis, interaction terms were used to evaluate the differential impact of telehealth implementation by race. RESULTS Of 1579 patients meeting the inclusion criteria (780 in the preimplementation group and 799 in the postimplementation group), 995 (63%) self-identified as Black. In the preimplementation period, Black patients were less likely to attend a postpartum visit than non-Black patients (63.9% in Black patients vs 88.7% in non-Black patients; adjusted odds ratio, 0.48; 95% confidence interval, 0.29-0.79). In the postimplementation period, there was no difference in postpartum visit attendance by race (79.1% in Black patients vs 88.6% in non-Black patients; adjusted odds ratio, 0.74; 95% confidence interval, 0.45-1.21). In addition, significant differences across races in postpartum depression screening during the preimplementation period became nonsignificant in the postimplementation period. Telehealth implementation for postpartum care significantly reduced racial disparities in postpartum visit attendance (interaction P=.005). CONCLUSION Telehealth implementation for postpartum care during the COVID-19 pandemic was associated with decreased racial disparities in postpartum visit attendance.
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OjiNjideka Hemphill N, Crooks N, Zhang W, Fitter F, Erbe K, Rutherford JN, Liese KL, Pearson P, Stewart K, Kessee N, Reed L, Tussing-Humphreys L, Koenig MD. Obstetric experiences of young black mothers: An intersectional perspective. Soc Sci Med 2023; 317:115604. [PMID: 36549014 PMCID: PMC9854070 DOI: 10.1016/j.socscimed.2022.115604] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In Chicago, maternal morbidity and mortality is six times more likely among Black birthing people than white, despite policy initiatives to promote maternal health equity. Disparities in maternal morbidity and mortality reflect experiences of structural inequities - including limited quality obstetric care, implicit bias, and racism resulting patient mistrust in the health care system, inadequate social support, and financial insecurity. Although there is published literature on Black women's experiences with obstetric care, including experiences with individual and structural racism, little is known about the intersection of age and race and experiences with health care. The purpose of this study was to explore the maternal health and pregnancy experiences of young Black women utilizing an intersectional theoretical lens. METHODS In this study, we conducted two focus groups in a sample of 11 young Black pregnant people. We conducted a thematic analysis to identify codes, themes, and subthemes of the data. RESULTS We developed two overarching themes: obstetric racism and obstetric resistance. To elucidate how obstetric racism framed our participants' healthcare experiences, we identified sub-themes: intersectional identities as young Black women, medical mistrust, and pregnancy trauma. The second major theme describes ways in which participants protected themselves against obstetric racism to engender positive health experiences. These methods of resistance included identifying advocates and relying on trusted providers. CONCLUSIONS The current standard of obstetric care in the US is suboptimal due to individual and structural racism. This study provides unique data on the experiences with health care for young, Black pregnant individuals and delivers valuable insight into how individual and structural racism impacts obstetric care for young Black women.
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Affiliation(s)
- Nefertiti OjiNjideka Hemphill
- Department of Kinesiology and Nutrition, University of Illinois Chicago 1747 W Roosevelt Road, Chicago, IL, 60608, USA.
| | - Natasha Crooks
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Wenqiong Zhang
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Fareeha Fitter
- College of Liberal Arts and Sciences, University of Illinois Chicago 601 S. Morgan St., 4th Floor UH, Chicago, IL, 60607, USA.
| | - Katherine Erbe
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Julienne N Rutherford
- Biobehavioral Health Science Division at the University of Arizona, PO Box 210203, Tucson, AZ, 85721, USA.
| | - Kylea L Liese
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Pamela Pearson
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Karie Stewart
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Nicollette Kessee
- Department of Kinesiology and Nutrition, University of Illinois Chicago 1747 W Roosevelt Road, Chicago, IL, 60608, USA.
| | | | - Lisa Tussing-Humphreys
- Department of Kinesiology and Nutrition, University of Illinois Chicago 1747 W Roosevelt Road, Chicago, IL, 60608, USA.
| | - Mary Dawn Koenig
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
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Zhuang J, Goldbort J, Bogdan-Lovis E, Bresnahan M, Shareef S. Black mothers' birthing experiences: in search of birthing justice. ETHNICITY & HEALTH 2023; 28:46-60. [PMID: 35263206 DOI: 10.1080/13557858.2022.2027885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Previous studies have suggested that often, Black mothers' birthing experiences are not what they expected because of how they were treated by healthcare providers during labor and birth. Our goal in this study was to ask Black mothers who had recently given birth about the quality of their birthing experiences as well as their level of respect from, trust in, and satisfaction with their maternity healthcare providers. DESIGN This study gathered data from Black mothers (N = 209) who had given birth within the past two years, using a cross-sectional online survey measuring several variables about the birthing experience including types of healthcare provider communication, provider respect for the mother, trust, birth satisfaction, and emotional responses to birth. RESULTS Provider-centered communication, although preferred by some mothers, was associated with lower birth satisfaction and stronger negative emotions whereas positive birth satisfaction was linked to patient-centered communication which resulted in positive emotions. While most mothers reported overall satisfaction with their birth experience, nearly half reported experiencing some degree of disrespect from their healthcare providers during labor and birth. Moreover, trust and respect mediated the relationship for patient-centered communication with positive emotion and birth satisfaction. Over one-third of participants gave birth with a certified nurse midwife attending. There were no differences in perception of being respected or the quality of birth given the professional identity of the provider as an Obstetrician/Gynecologist or as a midwife. The advice suggested by Black mothers for their healthcare providers was instructive in identifying ways those providers could better serve their patients during birth. CONCLUSION This study showed that there is still additional work that needs to be done for racial equity and respect during birth. Practical implications for addressing health inequities are discussed.
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Affiliation(s)
- Jie Zhuang
- Department of Communication Studies, Texas Christian University, Fort Worth, TX, USA
| | - Joanne Goldbort
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | | | - Mary Bresnahan
- Department of Communication, Michigan State University, East Lansing, MI, USA
| | - Sameerah Shareef
- Sexual Assault Healthcare Program, Michigan State University, East Lansing, MI, USA
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Royce CS, Morgan HK, Baecher-Lind L, Cox S, Everett EN, Fleming A, Graziano SC, Sims SM, Morosky C, Sutton J, Sonn T. The time is now: addressing implicit bias in obstetrics and gynecology education. Am J Obstet Gynecol 2022; 228:369-381. [PMID: 36549568 DOI: 10.1016/j.ajog.2022.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/29/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Obstetrician-gynecologists can improve the learning environment and patient care by addressing implicit bias. Accumulating evidence demonstrates that racial and gender-based discrimination is woven into medical education, formal curricula, patient-provider-trainee interactions in the clinical workspace, and all aspects of learner assessment. Implicit bias negatively affects learners in every space. Strategies to address implicit bias at the individual, interpersonal, institutional, and structural level to improve the well-being of learners and patients are needed. The authors review an approach to addressing implicit bias in obstetrics and gynecology education, which includes: (1) curricular design using an educational framework of antiracism and social justice theories, (2) bias awareness and management pedagogy throughout the curriculum, (3) elimination of stereotypical patient descriptions from syllabi and examination questions, and (4) critical review of epidemiology and evidence-based medicine for underlying assumptions based on discriminatory practices or structural racism that unintentionally reinforce stereotypes and bias. The movement toward competency-based medical education and holistic evaluations may result in decreased bias in learner assessment. Educators may wish to monitor grades and narratives for bias as a form of continuous educational equity improvement. Given that practicing physicians may have little training in this area, faculty development efforts in bias awareness and mitigation strategies may have significant impact on learner well-being.
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Affiliation(s)
- Celeste S Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
| | - Helen Kang Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Susan Cox
- Department of Medical Education, The University of Texas at Tyler School of Medicine, Tyler, TX
| | - Elise N Everett
- Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Larner College of Medicine, The University of Vermont, Burlington, VT
| | - Angela Fleming
- Department of Obstetrics and Gynecology, Michigan State University College of Osteopathic Medicine, East Lansing, MI
| | - Scott C Graziano
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Christopher Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT
| | - Jill Sutton
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Tammy Sonn
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
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Trends and inequities in severe maternal morbidity in Massachusetts: A closer look at the last two decades. PLoS One 2022; 17:e0279161. [PMID: 36538524 PMCID: PMC9767362 DOI: 10.1371/journal.pone.0279161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/01/2022] [Indexed: 01/04/2023] Open
Abstract
It is estimated that 50,000-60,000 pregnant people in the United States (US) experience severe maternal morbidity (SMM). SMM includes life-threatening conditions, such as acute myocardial infarction, acute renal failure, amniotic fluid embolism, disseminated intravascular coagulation, or sepsis. Prior research has identified both rising rates through 2014 and wide racial disparities in SMM. While reducing maternal death and SMM has been a global goal for the past several decades, limited progress has been made in the US in achieving this goal. Our objectives were to examine SMM trends from 1998-2018 to identify factors contributing to the persistent and rising rates of SMM by race/ethnicity and describe the Black non-Hispanic/White non-Hispanic rate ratio for each SMM condition. We used a population-based data system that links delivery records to their corresponding hospital discharge records to identify SMM rates (excluding transfusion) per 10, 000 deliveries and examined the trends by race/ethnicity. We then conducted stratified analyses separately for Black and White birthing people. While the rates of SMM during the same periods steadily increased for all racial/ethnic groups, Black birthing people experienced the greatest absolute increase compared to any other race/ethnic group going from 69.4 in 1998-2000 to 173.7 per 10,000 deliveries in 2016-2018. In addition, we found that Black birthing people had higher rates for every individual condition compared to White birthing people, with rate ratios ranging from a low of 1.11 for heart failure during surgery to a high of 102.4 for sickle cell anemia. Obesity was not significantly associated with SMM among Black birthing people but was associated with SMM among White birthing people [aRR 1.18 (95% CI: 1.02, 1.36)]. An unbiased understanding of how SMM has affected different race/ethnicity groups is key to improving maternal health and preventing SMM and mortality among Black birthing people. SMM needs to be addressed as both a medical and public health challenge.
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Garrett SB, Simon MA. The Social Contexts of Birthing People with Public- and Private-Payer Prenatal Care: Illuminating an Understudied Aspect of the Patient Experience. Health Equity 2022; 6:898-908. [PMID: 36636111 PMCID: PMC9811847 DOI: 10.1089/heq.2021.0168] [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] [Accepted: 11/01/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose In pursuit of more equitable and person-centered health care, patients and professional medical societies increasingly call for better clinician understanding of patients' perspectives and social contexts. A foundational but understudied aspect of patients' social contexts are the ideas they encounter about health-related behaviors. We investigated this aspect of the social contexts of birthing people, comparing those with public versus private insurance to discover setting-specific insights. Methods Based on ethnographic fieldwork, we created an original survey featuring 29 statements about 12 prenatal, perinatal, and postpartum health behaviors (e.g., drinking alcohol, epidural use, breastfeeding). Participants were 248 individuals receiving prenatal care in Northern California in 2009-2011, split evenly between public- and private-payer coverage. Participants reported whether they were familiar or unfamiliar with each statement. Results Ninety-eight percent of all participants had heard contradictory ideas about ≥1 health behavior (mean=3.9 behaviors for public- and 5.4 for private-coverage respondents). For 20 of the 29 behavior-related ideas, exposure varied significantly by coverage type. Among other differences, public-coverage respondents were much more familiar with ideas related to risk and constrained autonomy (e.g., that serious perinatal complications are common; that new mothers should try to breastfeed even if they do not want to). Conclusions Birthing people are exposed to a wide range of ideas about health behaviors, many of which vary by the structural systems in which they are embedded. Understanding and engaging this complexity can help clinicians to provide more respectful, person-centered, and equitable maternity care.
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Affiliation(s)
- Sarah B. Garrett
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA.,*Address correspondence to: Sarah B. Garrett, PhD, Philip R. Lee Institute for Health Policy Studies, 490 Illinois Street, Floor 7, San Francisco, CA 94158, USA,
| | - Melissa A. Simon
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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