Midwives Uniquely Suited to Deliver Woman-Centered Care and Decrease Stigma for Women With Substance Use Disorders

Examining the Relationship Between Stress, Barriers to Healthcare, and Alcohol Use in the US Agricultural Community

OBJECTIVE

Farming is a high-risk, physically challenging occupation. Considering farmers report high stress and barriers to seeking healthcare, it is important to understand factors influencing alcohol use to tailor interventions and healthcare resources for alcohol use in rural areas.

METHODS

An online survey was distributed to the agricultural community in the United States (n = 1045). Data was collected through QualtricsXM, and SPSS 28.0 was used for data analysis.

RESULTS

Both formal healthcare challenges (β = 0.112, p = .004) and stigma (β = 0.328, p < .001) were identified as predictors of increased perceived stress, while resilience (β = -0.137, p < .001) was identified as a protective factor against perceived stress. Higher perceived stress was identified as a predictor of binge drinking behavior (β = 0.151, p < .001), and formal healthcare challenges were associated with higher drinking volume (β = 0.174, p < .001), and engaging in more frequent alcohol consumption (β = 0.123, p = .004) over the last three months. Resilience was identified as a protective factor against increased alcohol consumption (β = -0.084, p = .032). Stigmatization of help-seeking for mental health challenges was associated with fewer instances of alcohol consumption over the last three months (β = -0.169, p < .001).

CONCLUSION

Interventions to address stress and alcohol consumption should focus on promoting resilience, reducing stigma, and encouraging peer support to address cultural norms around mental health and alcohol use. Rural practitioners should develop cultural competence to better serve agricultural communities to prevent alcohol use disorders. To discuss ways to reduce stigma and encourage peer support to address alcohol and mental health disorders in rural farming populations.

Outcomes of Cannabis Use During Pregnancy Within the American Association of Birth Centers Perinatal Data Registry 2007-2020: Opportunities Within Midwifery-Led Care

BACKGROUND

Healthcare providers require data on associations between perinatal cannabis use and birth outcomes.

METHODS

This observational secondary analysis come from the largest perinatal data registry in the United States related to the midwifery-led birth center model care (American Association of Birth Centers Perinatal Data Registry; N = 19 286). Births are planned across all birth settings (home, birth center, hospital); care is provided by midwives and physicians.

RESULTS

Population data show that both early and persistent self-reports of cannabis use were associated with higher rates of preterm birth, low-birth-weight, lower 1-minute Apgar score, gestational weight gain, and postpartum hemorrhage. Once controlled for medical and social risk factors using logistic regression, differences for childbearing people disappeared except that the persistent use group was less likely to experience "no intrapartum complications" (adjusted odds ratio [aOR] = 0.49; 95% confidence interval [CI], 0.32-0.76; P < .01), more likely to experience an indeterminate fetal heart rate in labor (aOR = 3.218; 95% CI, 2.23-4.65; P < .05), chorioamnionitis (aOR = 2.8; 95% CI, 1.58-5.0; P < .01), low-birth-weight (aOR = 1.8; 95% CI, 1.08-3.05; P < .01), and neonatal intensive care unit (NICU) admission (aOR = 2.4; 95% CI, 1.30-4.69; P < .05).

CONCLUSIONS

Well-controlled data demonstrate that self-reports of persistent cannabis use through the third trimester are associated with an increased risk of low-birth-weight and NICU admission.