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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; 29:703-719. [PMID: 38805258 DOI: 10.1080/13557858.2024.2359384] [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] [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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Manns-James L, Vines S, Alliman J, Hoehn-Velasco L, Stapleton S, Wright J, Jolles D. Race, ethnicity, and indications for primary cesarean birth: Associations within a national birth center registry. Birth 2024; 51:353-362. [PMID: 37929686 DOI: 10.1111/birt.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/03/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Racial and ethnic disparities in cesarean rates in the United States are well documented. This study investigated whether cesarean inequities persist in midwife-led birth center care, including for individuals with the lowest medical risk. METHODS National registry records of 174,230 childbearing people enrolled in care in 115 midwifery-led birth center practices between 2007 and 2022 were analyzed for primary cesarean rates and indications by race and ethnicity. The lowest medical risk subsample (n = 70,521) was analyzed for independent drivers of cesarean birth. RESULTS Primary cesarean rates among nulliparas (15.5%) and multiparas (5.7%) were low for all enrollees. Among nulliparas in the lowest-risk subsample, non-Latinx Black (aOR = 1.37; 95% CI, 1.15-1.63), Latinx (aOR = 1.51; 95% CI, 1.32-1.73), and Asian participants (aOR = 1.48; 95% CI, 1.19-1.85) remained at higher risk for primary cesarean than White participants. Among multiparas, only Black participants experienced a higher primary cesarean risk (aOR = 1.49; 95% CI, 1.02-2.18). Intrapartum transfers from birth centers were equivalent or lower for Black (14.0%, p = 0.345) and Latinx (12.7%, p < 0.001) enrollees. Black participants experienced a higher proportion of primary cesareans attributed to non-reassuring fetal status, regardless of risk factors. Place of admission was a stronger predictor of primary cesarean than race or ethnicity. CONCLUSIONS Place of first admission in labor was the strongest predictor of cesarean. Racism as a chronic stressor and a determinant of clinical decision-making reduces choice in birth settings and may increase cesarean rates. Research on components of birth settings that drive inequitable outcomes is warranted.
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Affiliation(s)
| | | | - Jill Alliman
- Frontier Nursing University, Versailles, Kentucky, USA
| | | | - Susan Stapleton
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Jennifer Wright
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Diana Jolles
- Frontier Nursing University, Versailles, Kentucky, USA
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Sanchez J, Prabhu R, Guglielminotti J, Landau R. Racial and Ethnic Concordance Between the Patient and Anesthesia Team and Patients' Satisfaction With Pain Management During Cesarean Delivery. Anesth Analg 2024:00000539-990000000-00821. [PMID: 38768069 DOI: 10.1213/ane.0000000000006764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Racial and ethnic concordance between patients and health care providers increases patient satisfaction but has not been examined in obstetric anesthesia care. This study evaluated the association between racial and ethnic concordance and satisfaction with management of pain during cesarean delivery (PDCD). METHODS This was a secondary analysis on a cohort of patients undergoing cesarean deliveries under neuraxial anesthesia that examined PDCD. The outcome was satisfaction, recorded within 48 hours after delivery using the survey question, "Overall, how satisfied are you with the anesthesia care during the C-section as it relates to pain management?" Using a 5-point Likert scale, satisfaction was defined with the answer "very satisfied." Participants were also asked, "If you have another C-section, would you want the same anesthesia team?" The exposure was racial and ethnic concordance between the patient and anesthesia team members (attending with a resident, nurse anesthetist, or fellow) categorized into full concordance, partial concordance, discordance, and missing. Risk factors for satisfaction were identified using a multivariable analysis. RESULTS Among 403 participants, 305 (78.2%; 95% confidence interval [CI], 73.8-82.1) were "very satisfied," and 358 of 399 (89.7%; 95% CI, 86.3-92.5) "would want the same anesthesia team." Full concordance occurred in 18 (4.5%) cases, partial concordance in 117 (29.0%), discordance in 175 (43.4%), and missing in 93 (23.1%). Satisfaction rate was 88.9% for full concordance, 71.8% for partial concordance, 81.1% for discordance, and 78.5% for missing (P value = .202). In the multivariable analysis, there was insufficient evidence for an association of concordance with satisfaction. Compared to full concordance, partial concordance was associated with a nonsignificant 57% (95% CI, -113 to 91) decrease in the odds of being satisfied, discordance with a 29% (95% CI, -251 to 85) decrease, and missing with a 39% (95% CI, -210 to 88) decrease. Risk factors for not being "very satisfied" were PDCD, anxiety disorders, pregnancy resulting from in vitro fertilization, intravenous medication administration, intrapartum cesarean with extension of labor epidural, having 3 anesthesia team members (instead of 2), and a higher intraoperative blood loss. CONCLUSIONS Our inability to identify an association between concordance and satisfaction is likely due to the high satisfaction rate in our cohort (78.2%), combined with low proportion of full concordance (4.5%). Addressing elements such as PDCD, anxiety, intravenous medication administration, and use of epidural anesthesia for cesarean delivery, and a better understanding of the interplay between concordance and satisfaction are warranted.
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Affiliation(s)
- Jose Sanchez
- From the Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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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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Thompson-Lastad A, Harrison JM, Taiwo TK, Williams C, Parimi M, Wilborn B, Chao MT. Postpartum care for parent-infant dyads: A community midwifery model. Birth 2024. [PMID: 38590170 DOI: 10.1111/birt.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/23/2024] [Accepted: 03/16/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Postpartum health is in crisis in the United States, with rising pregnancy-related mortality and worsening racial inequities. The World Health Organization recommends four postpartum visits during the 6 weeks after childbirth, yet standard postpartum care in the United States is generally one visit 6 weeks after birth. We present community midwifery postpartum care in the United States as a model concordant with World Health Organization guidelines, describing this model of care and its potential to improve postpartum health for birthing people and babies. METHODS We conducted semi-structured interviews with 34 community midwives providing care in birth centers and home settings in Oregon and California. A multidisciplinary team analyzed data using reflexive thematic analysis. RESULTS A total of 24 participants were Certified Professional Midwives; 10 were certified nurse-midwives. A total of 14 midwives identified as people of color. Most spoke multiple languages. We describe six key elements of the community midwifery model of postpartum care: (1) multiple visits, including home visits; typically five to eight over six weeks postpartum; (2) care for the parent-infant dyad; (3) continuity of personalized care; (4) relationship-centered care; (5) planning and preparation for postpartum; and (6) focus on postpartum rest. CONCLUSION The community midwifery model of postpartum care is a guideline-concordant approach to caring for the parent-infant dyad and may address rising pregnancy-related morbidity and mortality in the United States.
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Affiliation(s)
- Ariana Thompson-Lastad
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Jessica M Harrison
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
| | | | - Chanda Williams
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
| | - Mounika Parimi
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Briana Wilborn
- Department of Family Health Care Nursing (*alum), School of Nursing, University of California, San Francisco, California, USA
| | - Maria T Chao
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, California, USA
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Bresnahan M, Zhuang J. Culturally safe healthcare: changing the lens from provider control to patient agency. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024:1-10. [PMID: 38426444 DOI: 10.1080/17538068.2024.2323856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND GOAL Marginalized patients often feel unwelcome in healthcare. The concept of culturally safe healthcare (CSH) represents an important paradigm shift from provider control to patients who feel safe voicing health concerns and believe that they are heard by providers. This study has five goals: review works describing CSH, identify CSH themes, describe provider behaviors associated with CSH, describe interventions, and discuss how health communication can advance CSH. METHODS A scoping review was conducted for articles published between 2019 and 2023 following modified PRISMA guidelines. Online databases included Pubmed (Medline), CINAHL, Web of Science, Google Scholar, and Redalyc. Thematic analysis was also conducted. RESULTS Twenty-one articles meeting inclusion criteria were identified and analyzed. Of these, five explained features of CSH, four were empirical studies, seven were content analyses, and five were interventions. Five themes were identified including (1) how patients perceive CSH, (2) sociocultural determinants of health inequity, (3) mistrust of care providers, (4) issues with the biomedical model of healthcare, and (5) the importance of provider-patient allyship. Care provider communication behaviors fostering CSH were discussed. Three CSH interventions were highlighted. Finally, there was a discussion for how health communication scholars can contribute to CSH. CONCLUSIONS CSH offers a paradigm shift from provider control to marginalized patients' experience of patient-provider communication. Recommendations for how health communication scholars can contribute to the implementation of CSH included developing guiding theories and measurement, evaluation of CSH outcomes, and conducting focus groups with patients to assess the meaning of cultural safety.
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Affiliation(s)
- Mary Bresnahan
- Department of Communication, Michigan State University, East Lansing, MI, USA
| | - Jie Zhuang
- Department of Communication Studies, Texas Christian University, Fort Worth, TX, USA
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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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Safon CB, McCloskey L, Estela MG, Gordon SH, Cole MB, Clark J. Access to perinatal doula services in Medicaid: a case analysis of 2 states. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae023. [PMID: 38756922 PMCID: PMC10986220 DOI: 10.1093/haschl/qxae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/15/2024] [Accepted: 02/29/2024] [Indexed: 05/18/2024]
Abstract
Doula services support maternal and child health, but few Medicaid programs reimburse for them. Through qualitative interviews with key policy informants (n = 20), this study explored facilitators and barriers to Medicaid reimbursement through perceptions of doula-related policies in 2 states: Oregon, where doula care is reimbursed, and Massachusetts, where reimbursement is pending. Five themes characterize the inclusion of doula services in Medicaid. In Theme 1, stakeholders recognized an imperative to expand access to doula services. Subsequent themes represent complications in accomplishing that imperative. In Theme 2, perceptions that doula services were not valued by health care providers resulted in conflict between doulas and the health care system. In Theme 3, complex billing processes created friction and impeded reimbursement. In Theme 4, internal conflict presented barriers to policymaking. In Theme 5, structural fragmentation between state government and doula communities was prominent in Massachusetts, presenting tensions during policymaking. Informants reported on problems demanding resolution to establish equitable and robust doula care policies. Medicaid coverage of doula services requires ongoing collaboration with doulas, providers, and health care advocates.
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Affiliation(s)
- Cara B Safon
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA 02118, United States
| | - Lois McCloskey
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, United States
| | | | - Sarah H Gordon
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA 02118, United States
| | - Megan B Cole
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA 02118, United States
| | - Jack Clark
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA 02118, United States
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Quiñónez ZA, Benitez-Melo A, Diaz LM, Lennig M, Char D, Smith C. Geospatial Analysis of the Proportion of Persons Defined as Underrepresented in Medicine for Each Medical School and Their Surrounding Core-Based Statistical Area. Health Equity 2024; 8:132-137. [PMID: 38435025 PMCID: PMC10908325 DOI: 10.1089/heq.2023.0221] [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: 01/23/2024] [Indexed: 03/05/2024] Open
Abstract
Background The current approach to increasing diversity in medical education fails to consider local community demographics when determining medical school matriculation. Purpose We propose that medical schools better reflect their surrounding community, both because racially/ethnically concordant physicians have been shown to provide better care and to repair the historical and current racist impacts of these institutions that have criminalized, displaced, and excluded local Black and Brown communities. Methods and Results In this study, we used geospatial analysis to determine that medical school enrollments generally fail to reflect their surrounding community, represented as their core-based statistical area, within which the individual medical schools reside.
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Affiliation(s)
- Zoel A. Quiñónez
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Graduate Division, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Angel Benitez-Melo
- Department of Biology, University of San Diego, San Diego, California, USA
| | - Laura M. Diaz
- Division of Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Michael Lennig
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Danton Char
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Charlotte Smith
- Division of Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, California, USA
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Jolles DR, Niemczyk N, Hoehn Velasco L, Wallace J, Wright J, Stapleton S, Flynn C, Pelletier-Butler P, Versace A, Marcelle E, Thornton P, Bauer K. The birth center model of care: Staffing, business characteristics, and core clinical outcomes. Birth 2023; 50:1045-1056. [PMID: 37574794 DOI: 10.1111/birt.12745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 02/28/2023] [Accepted: 06/24/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES Interest in expanding access to the birth center model is growing. The purpose of this research is to describe birth center staffing models and business characteristics and explore relationships to perinatal outcomes. METHODS This descriptive analysis includes a convenience sample of all 84 birth center sites that participated in the AABC Site Survey and AABC Perinatal Data Registry between 2012 and 2020. Selected independent variables include staffing model (CNM/CM or CPM/LM), legal entity status, birth volume/year, and hours of midwifery call/week. Perinatal outcomes include rates of induction of labor, cesarean birth, exclusive breastfeeding, birthweight in pounds, low APGAR scores, and neonatal intensive care admission. RESULTS The birth center model of care is demonstrated to be safe and effective, across a variety of staffing and business models. Outcomes for both CNM/CM and CPM/LM models of care exceed national benchmarks for perinatal quality with low induction, cesarean, NICU admission, and high rates of breastfeeding. Within the sample of medically low-risk multiparas, variations in clinical outcomes were correlated with business characteristics of the birth center, specifically annual birth volume. Increased induction of labor and cesarean birth, with decreased success breastfeeding, were present within practices characterized as high volume (>200 births/year). The research demonstrates decreased access to the birth center model of care for Black and Hispanic populations. CONCLUSIONS FOR PRACTICE Between 2012 and 2020, 84 birth centers across the United States engaged in 90,580 episodes of perinatal care. Continued policy development is necessary to provide risk-appropriate care for populations of healthy, medically low-risk consumers.
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Affiliation(s)
- Diana R Jolles
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
- Clinical Faculty, Frontier Nursing University, Hyden, Kentucky, USA
| | - Nancy Niemczyk
- Nurse-Midwife Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Jacqueline Wallace
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Jennifer Wright
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Susan Stapleton
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Cynthia Flynn
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | | | | | - Ebony Marcelle
- Community of Hope, Washington, District of Columbia, USA
| | | | - Kate Bauer
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
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Neerland CE, Delkoski SL, Skalisky AE, Avery MD. Prenatal care in US birth centers: Midwives' perceptions of contributors to birthing People's confidence in physiologic birth. Birth 2023; 50:535-545. [PMID: 36226921 DOI: 10.1111/birt.12676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 07/19/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to describe US freestanding birth center models of prenatal care and to examine how the components of this care contribute to birthing people's confidence in their ability to have a physiologic birth. DESIGN This was a qualitative descriptive study utilizing semi-structured interviews with birth center midwives. Data were analyzed using thematic analysis, constant comparative method and consensus coding to ensure rigor. SETTING AND PARTICIPANTS Midwives from six urban and rural freestanding birth centers in a Midwestern US state were interviewed. Twelve birth center midwives participated. FINDINGS Six themes emerged: the birth center physical space and organization of care, dimensions of midwifery care within the birth center, continuity of care and seamless service, the empowered birthing person, physiologic birth as normative, and the hospital paradigm and US cultures of birth. KEY CONCLUSIONS We identified significant components of birth center models of prenatal care that midwives believe enhance birthing people's confidence for physiologic childbirth. These components may be considered for application to other settings and may improve perinatal care and outcomes.
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Affiliation(s)
- Carrie E Neerland
- The University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | | | - Arielle E Skalisky
- The University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | - Melissa D Avery
- The University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
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Thumm EB, Emeis CL, Snapp C, Doublestein L, Rees R, Vanderlaan J, Tanner T. American Midwifery Certification Board Certification Demographic and Employment Data, 2016 to 2020: The Certified Nurse-Midwife and Certified Midwife Workforce. J Midwifery Womens Health 2023; 68:563-574. [PMID: 37283414 DOI: 10.1111/jmwh.13511] [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: 06/08/2023]
Abstract
INTRODUCTION Expansion and diversification of the midwifery workforce is a federal strategy to address the maternal health crisis in the United States. Understanding characteristics of the current midwifery workforce is essential to creating approaches to its development. Certified nurse-midwives and certified midwives (CNMs/CMs) certified by the American Midwifery Certification Board (AMCB) constitute the largest portion of the US midwifery workforce. This article aims to describe the current midwifery workforce based on data collected from all AMCB-certified midwives at the time of certification. METHODS Midwife initial certificants and recertificants were administered an electronic survey about personal and practice characteristics at the time of certification by AMCB between 2016 and 2020 for administrative purposes. Given the standard 5-year certification cycle, every midwife certified during this period completed the survey once. The AMCB Research Committee conducted a secondary data analysis of deidentified data to describe the CNM/CM workforce. RESULTS In 2020 there were 12,997 CNMs/CMs in the United States. The workforce was largely White and female with an average age of 49. There has been a slow increase (15% to 21%) of initial certificants identifying as midwives of color. The proportion of CMs to all AMCB-certified midwives remained less than 2%. Physician-owned practices were the most common employer. Approximately 60% of midwives attend births, and hospitals were the most common birth setting. Over 10% of those certified to practice reported not working within the discipline of midwifery. DISCUSSION Targeted recruitment and retention of midwives must take into consideration not just expansion but dispersion, scope of practice, and diversification. The proportion of midwives attending births was lower than reported in previous years. Expansion of the CM credential and accessible educational pathways are 2 potential solutions to workforce growth. Developing strategies to retain those who are trained but not practicing presents an opportunity for workforce maintenance.
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Affiliation(s)
- E Brie Thumm
- American Midwifery Certification Board Research Committee, College of Nursing, University of Colorado, Aurora, Colorado
| | - Cathy L Emeis
- School of Nursing, Oregon Health & Science University, Portland, Oregon
- College of Nursing and Public Health, Chamberlain University, Addison, Illinois
| | - Carol Snapp
- College of Nursing and Public Health, Chamberlain University, Addison, Illinois
- School of Nursing, University of Nevada, Las Vegas, Nevada
| | | | - Rebecca Rees
- American Midwifery Certification Board Research Committee, College of Nursing, University of Colorado, Aurora, Colorado
| | | | - Tanya Tanner
- American Midwifery Certification Board Research Committee, College of Nursing, University of Colorado, Aurora, Colorado
- Frontier Nursing University, Versailles, Kentucky
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Bresnahan M, Zhuang J, Elam K, Goldbort J, Shareef S, Bogdan-Lovis E. Awe and Trepidation: The Role of Perinatal Care Providers in Black Fathers' Experiences of Childbirth in the U.S. HEALTH COMMUNICATION 2023:1-9. [PMID: 37580862 DOI: 10.1080/10410236.2023.2247607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Care provider communication with Black birthing families is impactful. This cross-sectional study asked 216 Black fathers to recall treatment by birthing care providers and tested variables contributing to birth satisfaction and fathering identity salience. Most fathers reported that care providers were respectful resulting in a positive birthing experience; however, 15% reported negative experiences with care providers. Perceived social support was shown to be a mediator between disrespect, mistreatment, inclusive communication, trust, and positive emotion with birth satisfaction and fathering identity salience. Care provider disrespect served as a "spoiler" of the birthing experience and subsequently diminished positive fathering identity salience. Analysis of open-ended comments showed that contrary to stereotypes about absent, disengaged Black fathers, fathers in this study were caring toward their newborns, present for them, and engaged in fathering. More work needs to be done with care provider communication to make every birth a positive and inclusive experience for Black fathers and their partners.
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Affiliation(s)
| | - Jie Zhuang
- Department of Communication Studies, Texas Christian University
| | - Kendra Elam
- College of Nursing, Michigan State University
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14
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Thomas K, Quist S, Peprah S, Riley K, Mittal PC, Nguyen BT. The Experiences of Black Community-Based Doulas as They Mitigate Systems of Racism: A Qualitative Study. J Midwifery Womens Health 2023; 68:466-472. [PMID: 37057730 DOI: 10.1111/jmwh.13493] [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: 08/03/2022] [Revised: 02/01/2023] [Accepted: 02/19/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Black pregnant individuals endure a disproportionate burden of preventable morbidity and mortality due to persistent, racially mediated social and systemic inequities. As patient advocates, Black community-based doulas help address these disparities via unique services not provided by conventional doulas. However, Black doulas themselves may encounter obstacles when providing care to Black perinatal clients. We characterized the barriers encountered by Black community-based doulas in Los Angeles, California. METHODS We partnered with a Black community-based doula program to conduct semistructured interviews with its community doulas and program directors, covering the following topics: motivations for becoming a doula, services provided, and challenges faced as a Black doula in perinatal settings. Interview transcripts were reviewed via directed content analysis, with attention to the influence of systemic racism on service provision. Additionally, our research team used Camara Jones' Levels of Racism, which describes race-associated differences in health outcomes to code data. RESULTS We interviewed 5 Black community-based doulas and 2 program directors, who all shared experiences of inequitable care and bias against Black clients that could be addressed with the support and advocacy of culturally congruent doulas. The community doulas shared experiences of stigma as Black doulas, compounded by racial prejudice. Interviewees noted sources of structural racism affecting program development, instances of interpersonal racism as they interacted with the health care system, and internalized racism that was revealed during culturally based doula trainings. Additionally, the doulas emphasized the importance of cultural concordance, or a shared identity with clients, which they considered integral to providing equitable care. CONCLUSION Despite facing institutionalized, interpersonal, and internalized forms of racism, Black community-based doulas provide avenues for Black birthing individuals to navigate systemic racism experienced during the perinatal process. However, these forms of racism need to be addressed for Black community doulas to flourish.
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Affiliation(s)
- Kimeshia Thomas
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sasha Quist
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Sayida Peprah
- Frontline Doulas Centering the Community Program, Diversity Uplifts, Inc, Los Angeles, California
| | - Khefri Riley
- Frontline Doulas Centering the Community Program, Diversity Uplifts, Inc, Los Angeles, California
| | - Pooja C Mittal
- Department of Family and Community Medicine, University of California, San Francisco and HealthNet of California, San Francisco, California
| | - Brian T Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
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15
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Sayyad A, Lindsey A, Narasimhan S, Turner D, Shah P, Lindberg K, Mosley EA. "We really are seeing racism in the hospitals": Racial identity, racism, and doula care for diverse populations in Georgia. PLoS One 2023; 18:e0286663. [PMID: 37285338 DOI: 10.1371/journal.pone.0286663] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Poor birth outcomes are more prevalent for Black communities, but strong evidence shows that doula care can improve those outcomes. More evidence is needed to understand racial differences, discrimination, and equity in doula care. METHODS The current study's objective was to describe the experiences of Black doulas as well as the challenges and facilitators of providing doula care to communities of color in Georgia. From Fall 2020-Fall 2021, 20 surveys and in-depth interviews were conducted with doulas as part of a community-based participatory study co-led by Healthy Mothers, Healthy Babies Coalition of Georgia and academic researchers. RESULTS Doula participants were diverse in age (5% under 25, 40% 25-35, 35% 36-45, and 20% 46+) and race/ethnicity (45% white, 50% Black, 5% Latinx). Most (70%) Black doulas reported that more than 75% of their clientele is Black, while most (78%) white doulas reported that less than 25% of their clientele is Black. Doulas noted the alarming Black maternal mortality rate and how mistreatment causes Black clients to lose trust in medical staff, leaving them in need of advocates. Black doulas were passionate about serving and advocating with Black clients. Participants also described how language and cultural barriers, particularly for Asian and Latinx people, reduce clients' ability to self-advocate, increasing the need for doulas. Doulas also discussed the ways that race influences their connections with clients and their dissatisfaction with the lack of cultural humility or sensitivity training in standard doula training. CONCLUSION Our findings indicate that Black doulas provide essential and supportive services to Black birthing people, and those services are more urgently needed than ever following the overturn of Roe v. Wade. Doula training must be improved to address the cultural needs of diverse clients. Increasing access to doula care for Asian and Latinx communities could also address language and cultural barriers that can negatively impact their maternal and child health outcomes.
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Affiliation(s)
- Ayeesha Sayyad
- Health Promotion and Behavior Concentration, School of Public Health, Georgia State University, Atlanta, GA, United States of America
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Alyssa Lindsey
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Subasri Narasimhan
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Daria Turner
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Priya Shah
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Ky Lindberg
- Healthy Mothers Healthy Babies Coalition of Georgia, Atlanta, GA, United States of America
| | - Elizabeth A Mosley
- Department of Behavioral, Social and Health Education Sciences, Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- Department of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
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Liese K, Stewart K, Pearson P, Lofton S, Mbande T, Patil C, Liu L, Geller S. Reply to: Comment on Melanated Group Midwifery Care: Centering the Voices of the Black Birthing Community. J Midwifery Womens Health 2023; 68:405-406. [PMID: 37254457 DOI: 10.1111/jmwh.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Kylea Liese
- Human Development Nursing Science, University of Illinois Chicago College of Nursing, Chicago, Illinois, USA
| | - Karie Stewart
- Department of Obstetrics and Gynecology, University of Illinois Chicago College of Medicine, Chicago, Illinois, USA
| | - Pam Pearson
- Human Development Nursing Science, University of Illinois Chicago College of Nursing, Chicago, Illinois, USA
| | - Saria Lofton
- Population Health Nursing Science, University of Illinois College of Nursing, Chicago, Illinois, USA
| | - Tayo Mbande
- Chicago Birthworks Collective, Chicago, Illinois, USA
| | - Crystal Patil
- Human Development Nursing Science, University of Illinois Chicago College of Nursing, Chicago, Illinois, USA
| | - Li Liu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Stacie Geller
- Center for Research on Women and Gender, Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
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Chambers BD, Fontenot J, McKenzie-Sampson S, Blebu BE, Edwards BN, Hutchings N, Karasek D, Coleman-Phox K, Curry VC, Kuppermann M. "It was just one moment that I felt like I was being judged": Pregnant and postpartum black Women's experiences of personal and group-based racism during the COVID-19 pandemic. Soc Sci Med 2023; 322:115813. [PMID: 36881972 PMCID: PMC9968447 DOI: 10.1016/j.socscimed.2023.115813] [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: 03/10/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Racial inequities in maternal and child health outcomes persist: Black women and birthing people experience higher rates of adverse outcomes than their white counterparts. Similar inequities are seen in coronavirus disease (COVID-19) mortality rates. In response, we sought to explore the intersections of racism and the COVID-19 pandemic impact on the daily lives and perinatal care experiences of Black birthing people. METHODS We used an intrinsic case study approach grounded in an intersectional lens to collect stories from Black pregnant and postpartum people residing in Fresno County (July-September 2020). All interviews were conducted on Zoom without video and were audio recorded and transcribed. Thematic analysis was used to group codes into larger themes. RESULTS Of the 34 participants included in this analysis, 76.5% identified as Black only, and 23.5% identified as multiracial including Black. Their mean age was 27.2 years [SD, 5.8]. Nearly half (47%) reported being married or living with their partner; all were eligible for Medi-Cal insurance. Interview times ranged from 23 to 96 min. Five themes emerged: (1) Tensions about Heightened Exposure of Black Lives Matter Movement during the pandemic; (2) Fear for Black Son's Safety; (3) Lack of Communication from Health Care Professionals; (4) Disrespect from Health Care Professionals; and (5) Misunderstood or Judged by Health Care Professionals. Participants stressed that the Black Lives Matter Movement is necessary and highlighted that society views their Black sons as a threat. They also reported experiencing unfair treatment and harassment while seeking perinatal care. CONCLUSIONS Black women and birthing people shared that exposure to racism has heightened during the COVID-19 pandemic, increasing their levels of stress and anxiety. Understanding how racism impacts Black birthing people's lives and care experiences is critical to reforming the police force and revising enhanced prenatal care models to better address their needs.
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Affiliation(s)
- Brittany D Chambers
- Department of Human Ecology, College of Agricultural and Environmental Sciences, University of California, Davis, Davis, CA, USA; California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Jazmin Fontenot
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Bridgette E Blebu
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Brittany N Edwards
- Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno. Fresno, CA, USA
| | | | - Deborah Karasek
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly Coleman-Phox
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Venise C Curry
- Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno. Fresno, CA, USA
| | - Miriam Kuppermann
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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18
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Mehra R, Alspaugh A, Joseph J, Golden B, Lanshaw N, McLemore MR, Franck LS. Racism is a motivator and a barrier for people of color aspiring to become midwives in the United States. Health Serv Res 2023; 58:40-50. [PMID: 35841130 PMCID: PMC9836944 DOI: 10.1111/1475-6773.14037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To understand motivators and barriers of aspiring midwives of color. DATA SOURCES AND STUDY SETTING Primary data were collected via a national online survey among people of color in the United States interested in pursuing midwifery education and careers between February 22 and May 2, 2021. STUDY DESIGN Cross-sectional survey consisted of 76 questions (75 closed-ended and 1 open-ended questions) including personal, familial, community, and societal motivators and barriers to pursuing midwifery. DATA COLLECTION/EXTRACTION METHODS We recruited respondents 18 years and older who identified as persons of color by posting the survey link on midwifery, childbirth, and reproductive justice listservs, social media platforms, and through emails to relevant midwifery and doula networks. We conducted descriptive and bivariate analyses by demographic characteristics and used exemplar quotes from the open-ended question to illustrate findings from the descriptive data. PRINCIPAL FINDINGS The strongest motivating factors for the 799 respondents were providing racially concordant care for community members (87.7 percent), reducing racial disparities in health (67.2 percent), and personal experiences related to midwifery care (55.4 percent) and health care more broadly (54.6 percent). Main barriers to entering midwifery were direct (58.2 percent) and related (27.5 to 52.8 percent) costs of midwifery education, and lack of racial concordance in midwifery education and the midwifery profession (31.5 percent) that may contribute to racially motivated exclusion of people of color. Financial and educational barriers were strongest among those with lower levels of income or education. CONCLUSIONS Structural and interpersonal racisms are both motivators and barriers for aspiring midwives of color. Expanding and diversifying the perinatal workforce by addressing the financial and educational barriers of aspiring midwives of color, such as providing funding and culturally-competent midwifery education, creating a robust pipeline, and opening more midwifery schools, is a matter of urgency to address the maternal health crisis.
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Affiliation(s)
- Renee Mehra
- Department of Family Health Care NursingSchool of Nursing, University of CaliforniaSan FranciscoCaliforniaUSA
| | - Amy Alspaugh
- Department of Family Health Care NursingSchool of Nursing, University of CaliforniaSan FranciscoCaliforniaUSA,College of NursingUniversity of TennesseeKnoxvilleTennesseeUSA
| | | | - Bethany Golden
- Department of Family Health Care NursingSchool of Nursing, University of CaliforniaSan FranciscoCaliforniaUSA
| | - Nikki Lanshaw
- Department of Family Health Care NursingSchool of Nursing, University of CaliforniaSan FranciscoCaliforniaUSA
| | - Monica R. McLemore
- Department of Family Health Care NursingSchool of Nursing, University of CaliforniaSan FranciscoCaliforniaUSA
| | - Linda S. Franck
- Department of Family Health Care NursingSchool of Nursing, University of CaliforniaSan FranciscoCaliforniaUSA
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Jolles D, Hoehn‐Velasco L, Ross L, Stapleton S, Joseph J, Alliman J, Bauer K, Marcelle E, Wright J. Strong Start Innovation: Equitable Outcomes Across Public and Privately Insured Clients Receiving Birth Center Care. J Midwifery Womens Health 2022; 67:746-752. [PMID: 36480161 PMCID: PMC10107204 DOI: 10.1111/jmwh.13439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/15/2022] [Accepted: 10/19/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The Birth Center model of care is a health care delivery innovation in its fourth decade of demonstration across the United States. The purpose of this research was to evaluate the model's potential for decreasing poverty-related health disparities among childbearing families. METHODS Between 2013 and 2017, 26,259 childbearing people received care within the 45 Center for Medicare and Medicaid Innovation Strong Start birth center sites. Secondary analysis of the prospective American Association of Birth Centers Perinatal Data Registry was conducted. Descriptive statistics described sociobehavioral, medical risk factors, and core clinical outcomes to inform the logistic regression model. Privately insured consumers were independently compared with 2 subgroups of Medicaid beneficiaries: Strong Start enrollees (midwifery-led care with peer counselors) and non-Strong Start Medicaid beneficiaries (midwifery-led care without peer counselors). RESULTS After controlling for medical risk factors, Strong Start Medicaid beneficiaries achieved similar outcomes to privately insured consumers with no significant differences in maternal or newborn outcomes between groups. Perinatal outcomes included induction of labor (adjusted odds ratio [aOR], 0.86; 95% CI 0.61-1.13), epidural analgesia use (aOR, 1.00; 95% CI, 0.68-1.48), cesarean birth (aOR, 1.16; 95% CI, 0.87-1.53), exclusive breastfeeding on discharge (aOR, 1.11; 95% CI, 0.48-2.56), low Apgar score at 5 minutes (aOR, 1.23; 95% CI, 0.86-1.83), low birth weight (aOR, 1.12; 95% CI, 0.77-1.64), and antepartum transfer of care after the first prenatal appointment (aOR, 1.53; 95% CI, 0.97-2.40). Medicaid beneficiaries who were not enrolled in the Strong Start midwifery-led, peer counselor program demonstrated similar results except for having higher epidural analgesia use (aOR, 1.30; 95% CI, 1.10-1.53) and significantly lower exclusive breastfeeding on discharge (aOR, 0.57; 95% CI, 0.40-0.81) than their privately insured counterparts. DISCUSSION The midwifery-led birth center model of care complemented by peer counselors demonstrated a pathway to achieve health equity.
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Affiliation(s)
| | | | - Lisa Ross
- American Association of Birth CentersPerkiomenvillePennsylvania
| | - Susan Stapleton
- American Association of Birth CentersPerkiomenvillePennsylvania
| | | | | | - Kate Bauer
- American Association of Birth CentersPerkiomenvillePennsylvania
| | | | - Jennifer Wright
- American Association of Birth CentersPerkiomenvillePennsylvania
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20
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Kivlighan KT, Gardner T, Murphy C, Reiss P, Griffin C, Migliaccio L. Grounded in Community: Development of a Birth Justice-Focused Volunteer Birth Companion Program. J Midwifery Womens Health 2022; 67:740-745. [PMID: 36269037 DOI: 10.1111/jmwh.13407] [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: 03/04/2022] [Revised: 06/14/2022] [Accepted: 08/07/2022] [Indexed: 12/01/2022]
Abstract
Continuous labor support is an evidence-based practice demonstrated to improve birth outcomes, particularly when provided by a trained doula or birth companion. Access to doula services designed to meet the needs of historically underserved and diverse communities can mitigate the negative effects of structural racism and health disparities in perinatal care. Unfortunately, continuous labor support by a companion of choice is not universally supported. This leaves individuals with limited resources unable to access services from a trained doula. Volunteer birth companion programs are one model for increasing access to continuous labor support by bringing the community into the hospital. This article describes a birth justice-focused volunteer birth companion program that evolved out of a multistakeholder collaboration between community birth workers, local reproductive justice organizations, and hospital-based providers, staff, and administrators in direct response to community needs. This program is unique in its collaborative development, grounding in core values, and design of a reproductive justice-focused curriculum that includes training in diversity, inclusion, and care for clients with a history of trauma or perinatal substance use. Key takeaways include recommendations to center client needs, consider sustainability, and embrace flexibility and change. Discussion includes recognition of the strengths and limitations of a volunteer-based model, including acknowledgment that volunteer birth work, while filling an important gap, necessitates the privilege of having sufficient time, economic freedom, and social support. Ensuring universal insurance coverage for doula services has the potential to increase access to continuous labor support, improve birth outcomes, and diversify the birth workforce.
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Affiliation(s)
- Katie T Kivlighan
- College of Nursing, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Volunteer Birth Companion Program, University of New Mexico Hospital, Albuquerque, New Mexico
| | - Tamara Gardner
- Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Volunteer Birth Companion Program, University of New Mexico Hospital, Albuquerque, New Mexico
| | - Carrie Murphy
- Birthmark Doulas, New Orleans, Louisiana.,Volunteer Birth Companion Program, University of New Mexico Hospital, Albuquerque, New Mexico
| | - Paula Reiss
- Volunteer Birth Companion Program, University of New Mexico Hospital, Albuquerque, New Mexico
| | - Carrie Griffin
- With Open Arms Reproductive Healthcare, Eureka, California
| | - Laura Migliaccio
- College of Nursing, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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21
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Attanasio LB, Ranchoff BL, Paterno MT, Kjerulff KH. Person-Centered Maternity Care and Health Outcomes at 1 and 6 Months Postpartum. J Womens Health (Larchmt) 2022; 31:1411-1421. [PMID: 36067084 PMCID: PMC9618378 DOI: 10.1089/jwh.2021.0643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Person-centered care has been increasingly recognized as an important aspect of health care quality, including in maternity care. Little is known about correlates and outcomes of person-centered care in maternity care in the United States. Materials and Methods: Data were from a prospective cohort of more than 3000 individuals who gave birth to a first baby in a Pennsylvania hospital. Person-centered maternity care was measured via a 13-item rating scale administered 1-month postpartum. Content validity was established through exploratory factor analysis. The resulting scale had scores ranging from 13 to 54, with Cronbach's alpha of 0.86. Using linear and logistic regression models to control for covariates, we examined associations between participants' characteristics and person-centered maternity care and between person-centered maternity care and postpartum outcomes. Results: Participants had a mean total score of 47.80 on the person-centered maternity care scale. Patient factors independently associated with more person-centered maternity care included older age, more positive attitude toward vaginal birth during pregnancy, and spontaneous vaginal birth. In adjusted models, higher person-centered maternity scale scores were strongly associated with many positive physical and mental health outcomes at 1 and 6 months postpartum. Conclusions: Our findings underscore the importance of person-centered maternity not just due to its intrinsic value but also because it may be associated with both mental and physical health outcomes through the postpartum period. Results suggest that policy efforts are necessary to ensure person-centered maternity care, especially for delivery hospitalization experience.
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Affiliation(s)
- Laura B. Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Brittany L. Ranchoff
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Mary T. Paterno
- Cooley Dickinson ObGyn and Midwifery, Cooley Dickinson Medical Group, Northampton, Massachusetts, USA
| | - Kristen H. Kjerulff
- Department of Public Health Sciences and Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania, USA
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22
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Standard V, Jones-Beatty K, Joseph-Lemon L, Marcelle E, Morris CE, Williams T, Brown T, Oura HS, Stapleton S, Jolles DR. Progesterone and Preterm Birth: Using Empirical Research to Explore Structural Racism Within Midwifery-Led Care. J Perinat Neonatal Nurs 2022; 36:256-263. [PMID: 35894722 DOI: 10.1097/jpn.0000000000000664] [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: 10/16/2022]
Abstract
BACKGROUND Progesterone has been the standard of practice for the prevention of preterm birth for decades. The drug received expedited Food and Drug Administration approval, prior to the robust demonstration of scientific efficacy. METHODS Prospective research from the American Association of Birth Centers Perinatal Data Registry, 2007-2020. Two-tailed t tests, logistic regression, and propensity score matching were used. RESULTS Midwifery-led care was underutilized by groups most at risk for preterm birth and was shown to be effective at maintaining low preterm birth rates. The model did not demonstrate reliable access to progesterone. People of color are most at risk of preterm birth, yet were least likely to receiving progesterone treatment. Progesterone was not demonstrated to be effective at decreasing preterm birth when comparing the childbearing people with a history of preterm birth who used the medication and those who did not within this sample. CONCLUSIONS This study adds to the body of research that demonstrates midwifery-led care and low preterm birth rates. The ineffectiveness of progesterone in the prevention of preterm birth among people at risk was demonstrated.
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Affiliation(s)
- Venus Standard
- Department of Family Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Ms Standard); Integrated Research Center for Fetal Medicine, GYN/OB Department, School of Medicine, Johns Hopkins University, Baltimore, Maryland (Dr Jones-Beatty); El Rio Health, Tucson, Arizona (Ms Joseph-Lemon); Midwifery Melanated, LLC, Washington, District of Columbia (Dr Marcelle); Midwifery and Women's Health, Frontier Nursing University, Versailles, Kentucky (Drs Morris and Jolles); Midwifery Collective, Brooklyn, New York (Ms Williams); Community of Hope, Washington, District of Columbia (Ms Brown); Mel and Enid Zuckerman College of Public Health at the University of Arizona, Tucson (Ms Oura); and American Association of Birth Centers Perinatal Data Registry, Perkiomenville, Pennsylvania (Dr Stapleton)
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23
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Bogdan-Lovis E, Zhuang J, Goldbort J, Shareef S, Bresnahan M, Kelly-Blake K, Elam K. Do Black birthing persons prefer a Black health care provider during birth? Race concordance in birth. Birth 2022; 50:310-318. [PMID: 35635034 DOI: 10.1111/birt.12657] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 04/24/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND For many years in the United States, there has been an active discussion about whether race concordance between care providers and patients contributes to better health outcomes. Although beneficial provider-patient communication effects have been associated with concordance, there is minimal evidence for concordance benefits to health outcomes. METHODS A cross-sectional survey was conducted including 200 Black mothers who had given birth within the last 2 years asking about the perceived racial identity of their birth health provider, whether they preferred to have Black women providers, and the intersection between race and gender concordance on birth outcomes. In addition to race and gender concordance, other variables were tested for their impact on birth satisfaction including respect, trust for the care provider, perceived competence, care provider empathy, and inclusive communication. RESULTS Forty-one percent of the mothers in this study were assisted in birth by a Black woman provider. Although patient-provider concordance did not result in measurable health outcomes, it is clear that compared to other studies of birth satisfaction among Black birthing persons, this study showed relatively higher levels of satisfaction, perceived trust, empathy, perceived provider competence, inclusive communication, and equal respect for both concordant and discordant care providers. CONCLUSIONS Although many participants showed a preference for race concordance, participants equally valued respect, competence, and trust with their care providers. Further community-based research needs to be conducted to examine whether race, gender, and cultural concordance results in other beneficial health outcomes.
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Affiliation(s)
| | - Jie Zhuang
- Department of Communication Studies, Texas Christian University, Fort Worth, Texas, USA
| | - Joanne Goldbort
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Sameerah Shareef
- Sexual Assault Healthcare Program, Michigan State University, East Lansing, Michigan, USA
| | - Mary Bresnahan
- Department of Communication, Michigan State University, East Lansing, Michigan, USA
| | - Karen Kelly-Blake
- College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Kendra Elam
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
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24
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Neerland CE, Skalisky AE. A Qualitative Study of US Women's Perspectives on Confidence for Physiologic Birth in the Birth Center Model of Prenatal Care. J Midwifery Womens Health 2022; 67:435-441. [PMID: 35246924 DOI: 10.1111/jmwh.13349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this study was to increase understanding of the components of the US birth center model of prenatal care and how the birth center prenatal care model contributes to birthing people's confidence for physiologic childbirth. METHODS This was a qualitative descriptive study using semistructured interviews with individuals who gave birth in freestanding birth centers. Birthing people were recruited from freestanding birth centers in a Midwestern US state and were between the ages of 18 and 42, were English-speaking, and had experienced a birth center birth within the previous 6 months. Interviews were transcribed and analyzed using Glaser's constant comparative method. RESULTS Twelve women who gave birth in birth centers, representing urban and rural settings, participated. Four core categories were identified encompassing the components of birth center prenatal care and how the birth center model contributes to women's confidence for physiologic birth: birth center culture and processes, midwifery model of care within the birth center, internal influences, and outside influences. DISCUSSION Women who gave birth in birth centers believed that the birth center culture and environment, the midwifery model of care in the birth center, internal influences including the belief that birth is a normal physiologic process, and outside influences including family support and positive birth stories contributed to their confidence for physiologic birth.
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25
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Leath S, Wright P, Charity-Parker B, Stephens E. Exploring Black Women's Pathways to Motherhood Within a Reproductive Justice Framework. QUALITATIVE HEALTH RESEARCH 2022; 32:694-709. [PMID: 34984946 DOI: 10.1177/10497323211066869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Amidst the increasing push to address racial disparities in maternal health equity, fewer studies have considered Black women's perspectives on their needs, concerns, and priorities regarding family planning care. Such evidence might help address the lack of support and information that many Black women report in patient-provider encounters, and broaden empirical knowledge on the contextual factors that influence Black women's reproductive decisions. In the present qualitative study, we explored Black women's pathways to motherhood within a reproductive justice framework. We drew on individual, semi-structured interview data from 31 Black mothers (25-50 years, Mage = 35 years) across the United States. Using consensual qualitative research methods, we elaborated on three themes: (1) intentional family planning, (2) unintended pregnancy, and (3) othermothering. The findings challenge deficit-based stereotypes of Black mothers' reproductive choices and illuminate how health practitioners can facilitate humanizing conversations that prioritize Black women's family planning goals and decision-making.
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Affiliation(s)
- Seanna Leath
- Psychology Department, 2358University of Virginia, Charlottesville, VA, USA
| | - Patrice Wright
- Sociology Department, 2358University of Virginia, Charlottesville, VA, USA
| | | | - Erica Stephens
- Psychology Department, 2358University of Virginia, Charlottesville, VA, USA
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26
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The Impact of Culturally-Centered Care on Peripartum Experiences of Autonomy and Respect in Community Birth Centers: A Comparative Study. Matern Child Health J 2021; 26:895-904. [PMID: 34817759 PMCID: PMC9012707 DOI: 10.1007/s10995-021-03245-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 11/23/2022]
Abstract
Objective National studies report that birth center care is associated with reduced racial and ethnic disparities and reduced experiences of mistreatment. In the US, there are very few BIPOC-owned birth centers. This study examines the impact of culturally-centered care delivered at Roots, a Black-owned birth center, on the experience of client autonomy and respect. Methods To investigate if there was an association between experiences of autonomy and respect for Roots versus the national Giving Voice to Mothers (GVtM) participants, we applied Wilcoxon rank-sum tests for the overall sample and stratified by race. Results Among BIPOC clients in the national GVtM sample and the Roots sample, MADM and MORi scores were statistically higher for clients receiving culturally-centered care at Roots (MADM p < 0.001, MORi p = 0.011). No statistical significance was found in scores between BIPOC and white clients at Roots Birth Center, however there was a tighter range among BIPOC individuals receiving care at Roots showing less variance in their experience of care. Conclusions for Practice Our study confirms previous findings suggesting that giving birth at a community birth center is protective against experiences of discrimination when compared to care in the dominant, hospital-based system. Culturally-centered care might enhance the experience of perinatal care even further, by decreasing variance in BIPOC experience of autonomy and respect. Policies on maternal health care reimbursement should add focus on making community birth sustainable, especially for BIPOC provider-owners offering culturally-centered care.
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27
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Canty L. The lived experience of severe maternal morbidity among Black women. Nurs Inq 2021; 29:e12466. [PMID: 34636106 DOI: 10.1111/nin.12466] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
Black women are 3-4 times more likely to die from a pregnancy-related complication and twice as likely to experience severe maternal morbidity when compared to white women in the United States. The risks for pregnancy-related maternal mortality are well documented, yet Black women's experiences of life-threatening morbidity are essentially absent in the nursing literature. The purpose of this interpretive phenomenological study was to understand the experiences of Black women who developed severe maternal morbidity. Face-to-face, one-to-one, in-depth conversational interviews were conducted with nine Black women who experienced life-threatening complications during childbirth or postpartum. Five essential themes emerged (1) I Only Know What I Know; (2) How You Cared for Me; (3) Race Matters; (4) Faced with Uncertainty; and (5) Still Healing. These themes illuminate the complexity of Black women's subjective interpretations of severe maternal morbidity, and reveal ways in which racism, not race, places Black women at risk for poor maternal health outcomes. The author envisions greater equity for Black mothers entrusted to nursing care, guided by nursing theories informed by these study findings.
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Affiliation(s)
- Lucinda Canty
- Department of Nursing, School of Interdisciplinary Health and Science, University of Saint Joseph, West Hartford, Connecticut, USA
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28
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Vines S. The Trust Gap Between the Coronavirus Vaccine and Communities of Color: What Midwives Can Do To Help. J Midwifery Womens Health 2021; 66:295-297. [PMID: 34061434 PMCID: PMC8242551 DOI: 10.1111/jmwh.13248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Shaughanassee Vines
- Department of Midwifery and Women's Health, Frontier Nursing University, Versailles, Kentucky
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