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González-Mesa E, González-Cazorla A, González-Cazorla E, Mozas-Moreno J, Gokce Isbir G, Abreu W, Lubián-López D. Contribution of the abbreviated CAVE-st questionnaire in Spanish: the attitudes toward childbirth experiences. J Psychosom Obstet Gynaecol 2024; 45:2380860. [PMID: 39044401 DOI: 10.1080/0167482x.2024.2380860] [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: 11/16/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024] Open
Abstract
There are several factors that influence women's childbirth experience, and personal interactions with health professionals are of particular significance. The main objective of this study was to present the validation of an abbreviated form of an existing questionnaire on attitudes about childbirth in medical and nursing students. We used a sample of 512 perinatal medicine and nursing students who received the original 52-item CAVE-st questionnaire to obtain a shorter version with proper psychometric properties. We used Cronbach's alpha coefficient to evaluate the new version's internal consistency. The Kaiser- Meyer-Olkin test and the Barlett sphericity test were performed to assess the suitability of exploratory factor analysis (EFA). Subsequently, confirmatory factor analysis (CFA) was performed using structural equation models in a second sample of 139 medical students. We obtained a 15-item version with a Cronbach's alpha of 0.82. The EFA revealed a four-dimensional structure, similar to the full 52-item version. In the CFA the adjustment indexes showed good model fitness, RMSEA= 0.046 [CI 0.00-0.07]; CFI = 0.978. We can conclude that the 15-item version is a valid tool for evaluating the attitude of students toward childbirth, pointing out the matters that should be improved in their training to avoid obstetric trauma by the promotion of a positive experience in women during childbirth.
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Affiliation(s)
- Ernesto González-Mesa
- School of Medicine, Obstetrics and Gynecology Department, University of Malaga, Málaga, Spain
- Grupo de investigación en Medicina Materno-fetal, epigenética, enfermedades de la mujer y salud reproductiva, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, Spain
- UGC Obstetricia y Ginecología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Ana González-Cazorla
- School of Medicine, Obstetrics and Gynecology Department, University of Malaga, Málaga, Spain
| | | | - Juan Mozas-Moreno
- School of Medicine, Obstetrics and Gynecology Department, University of Granada, Granada, Spain
| | | | - Wilson Abreu
- Psychology School, Centro de Investigacao en Tecnologias y Servicios de Saude, Porto University, Porto, Portugal
| | - Daniel Lubián-López
- Obstetrics and Gynecology Department, University Hospital of Jerez de la Frontera, Cádiz, Spain
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Garcia LM, Jones J, Scandlyn J, Thumm EB, Shabot SC. The meaning of obstetric violence experiences: A qualitative content analysis of the Break the Silence Campaign. Int J Nurs Stud 2024; 160:104911. [PMID: 39366331 DOI: 10.1016/j.ijnurstu.2024.104911] [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: 02/10/2024] [Revised: 09/09/2024] [Accepted: 09/13/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND Obstetric violence involves the mistreatment, disrespect, and abuse of birthing people and the problem has been recognized in healthcare systems worldwide. Obstetric violence is a gendered, sex-specific form of violence against women that is a public health problem and a violation of human rights. There are an unknowable number of online posts and social media messages that describe obstetric violence experiences. There are no known studies about self-published experiences of obstetric violence in the US maternity care system. OBJECTIVE To understand the meaning of obstetric violence experiences in the US maternity care system from a naturally occurring, purposive sample. DESIGN A secondary analysis of the textual data from the original Break the Silence social media campaign using qualitative content analysis. The theory of social justice in nursing provided a theoretical framework. A healthcare systems approach was used for a wide-angle view of the multidirectional structure, processes, and outcome of obstetric violence. SETTING The study setting is the public Facebook page where the Break the Silence social media campaign can be seen. Break the Silence was an online activism response to the problem of obstetric violence in the US maternity care system with signboard messages posted from 31 known US states. The setting is bounded by the digital page where the campaign is published. PARTICIPANTS There were 139 participants, and 11 of them posted more than one signboard message. Most participants were birthing people (n = 125) followed by doulas (n = 10). METHODS Krippendorff's methodology for qualitative content analysis was applied to 156 signboard messages posted on Break the Silence from 2014 to 2016. Qualitative content analysis was supported by Atlas.ti 23. RESULTS Four themes illustrated the meaning of obstetric violence in US maternity care: 1) pregnancy and birth as a battle with healthcare providers and the healthcare system, 2) sacrifice of the maternal body normalized and assumed as a gender stereotype, 3) disrupted rites of passage from childbirth, and 4) abuse of fiduciary power by healthcare providers. CONCLUSIONS This study demonstrated thematic meanings for the experience of obstetric violence in US maternity care with a healthcare systems approach that included structural and organizational considerations to increase understanding. Categories and forms of obstetric violence from the existing literature were expanded and strengthened by findings from this study. Themes were validated in principle with consistency in findings across the international evidence base on obstetric violence. TWEETABLE ABSTRACT The meaning of #obstetricviolence experiences is interpersonal and structural with thematic consistency across international studies.
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Affiliation(s)
- Lorraine M Garcia
- University of Colorado, Anschutz Medical Campus College of Nursing, Aurora, CO, USA.
| | - Jacqueline Jones
- University of Colorado, Anschutz Medical Campus College of Nursing, Aurora, CO, USA
| | - Jean Scandlyn
- University of Colorado, Department of Health and Behavioral Sciences, Denver, CO, USA
| | - E Brie Thumm
- University of Colorado, Anschutz Medical Campus College of Nursing, Aurora, CO, USA
| | - Sara Cohen Shabot
- The University of Haifa, The Women's and Gender Studies Program, Haifa, Israel
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Frankham LJ, Thorsteinsson EB, Bartik W. Factors Associated with Birth-Related Post-Traumatic Stress Disorder Symptoms and the Subsequent Impact of Traumatic Birth on Mother-Infant Relationship Quality. Behav Sci (Basel) 2024; 14:808. [PMID: 39336023 PMCID: PMC11428547 DOI: 10.3390/bs14090808] [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: 07/12/2024] [Revised: 09/04/2024] [Accepted: 09/05/2024] [Indexed: 09/30/2024] Open
Abstract
This study aimed to investigate factors associated with birth-related PTSD symptoms and the subsequent impact on mother-infant relationship quality, exploring what women felt they needed to be different about their birth process to further understand the problem. Participants were recruited using social media advertising. A multi-method approach, using qualitative and quantitative analyses, was employed. The study included 142 pregnant women residing in Australia aged between 19 and 42 years (M = 31.24; SD = 4.70). High extraversion significantly predicted greater birth-related PTSD symptoms. There was a significant relationship between birth-related PTSD symptoms and poorer mother-infant relationship quality. The content analysis of the responses from women who reported a desire for a different or improved birth experience generated four themes: (1) less intrusive intervention, (2) better communication, (3) access to more supportive intervention, and (4) better post-birth care. The findings highlight the importance of supporting women's choices during birth by promoting informed and respectful woman-centred care. Postnatally, the screening and assessment of women should go beyond mood screening and include an assessment of the woman's response to her birth experience.
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Affiliation(s)
| | - Einar B. Thorsteinsson
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW 2350, Australia; (L.J.F.); (W.B.)
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Findlay HJ, Anderson JK, Francis KL, Clegg LM, Maria SJ. The significance of paramedic communication during women's birth experiences: A scoping review. Australas Emerg Care 2024; 27:218-226. [PMID: 38734501 DOI: 10.1016/j.auec.2024.04.002] [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: 02/12/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Internationally, over one-third of women experience birth trauma, leading to adverse mental health outcomes. Poor communication with healthcare professionals is a primary contributing factor. Paramedics attend various clinical presentations, including childbirth, yet their potential impact on women's birth experiences has been largely overlooked. METHODS A systematic literature search was conducted following the Joanna Briggs Institute methodological framework. The search identified 1015 potentially suitable articles, and 5 articles met the inclusion criteria. Data was analysed using reflexive thematic analysis from a feminist standpoint. RESULTS Three themes were generated: 1. First Impressions Count: paramedic demeanour impacted the woman's sense of safety and perception of paramedic clinical competence. 2. Choice as a Pathway to Control: when paramedics involved women in decision-making, it led to empowerment, while non-involvement led to women becoming passive participants. 3. Exposed, Violated and Disempowered: some paramedics disrespected and abused women, treating them solely as objects for the purpose of producing a baby. CONCLUSIONS This review highlights the influence of paramedic communication on women's birth experiences. While some paramedics communicated respectfully, other paramedics were the perpetrators of Obstetric Violence. Future research should inform paramedic education and improve outcomes for birthing women.
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Affiliation(s)
- Haley J Findlay
- Charles Sturt University, Panorama Avenue Bathurst, School of Nursing, Paramedicine and Healthcare Sciences, Panorama Avenue, Bathurst, NSW 2795, Australia.
| | - Judith K Anderson
- Charles Sturt University, Panorama Avenue Bathurst, School of Nursing, Paramedicine and Healthcare Sciences, Panorama Avenue, Bathurst, NSW 2795, Australia
| | - Karen L Francis
- Charles Sturt University, School of Nursing, Paramedicine and Healthcare Sciences, Wagga Wagga, NSW 2627, Australia
| | - Lisa M Clegg
- Charles Sturt University, School of Nursing, Paramedicine and Healthcare Sciences, 7 Major Innes Rd, Port Macquarie, NSW 2444, Australia
| | - Sonja J Maria
- Charles Sturt University, Panorama Avenue Bathurst, School of Nursing, Paramedicine and Healthcare Sciences, Panorama Avenue, Bathurst, NSW 2795, Australia
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Levett KM, Sutcliffe KL, Vanderlaan J, Kjerulff KH. The First Baby Study: What women would like to have known about first childbirth. A mixed-methods study. Birth 2024. [PMID: 39166782 DOI: 10.1111/birt.12854] [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: 06/01/2022] [Revised: 02/06/2024] [Accepted: 07/24/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Although prenatal care providers aim to prepare women for first childbirth, little research has explored retrospectively what birthing people would like to have known before first childbirth. AIM To describe women's reports of what they would like to have known before first childbirth but feel they were not told. METHODS This is a secondary analysis of the First Baby Study, a large prospective cohort study conducted in Pennsylvania, USA. Telephone interviews were conducted with 3006 women 1 month after their first childbirth. Women were first asked: "Was there anything that you would have liked to have known before your delivery that you were not told?". If "yes" they were asked a second question: "Please tell me what you would have liked to have known before your delivery". ANALYSIS A convergent mixed-methods analysis including descriptive analytics to compare characteristics of women by answers to the first question, and qualitative content analysis of women's open-ended answers to the second question. FINDINGS A total of 441 women (14.7%) reported there was something they would like to have known before their first childbirth. Women described that communication with care providers was their main concern. They would have liked a better understanding of their options before birth, more agency in decision-making, and more information about the topics of their body, their birth, their baby, and what to expect beyond birth. CONCLUSIONS Results highlight important topics for childbirth education, and the impact of gaps in shared decision-making, patient-provider communication, and supportive care practices for first childbirth, especially where women have identified vulnerabilities.
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Affiliation(s)
- Kate M Levett
- National School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
- NICM Health Research Institute, and THRI, Western Sydney University, Sydney, New South Wales, Australia
- Collective for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Kerry L Sutcliffe
- National School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | | | - Kristen H Kjerulff
- Department of Public Health Sciences and Obstetrics and Gynecology, College of Medicine, Penn State University, University Park, Pennsylvania, USA
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Mayra K, Matthews Z, Sandall J, Padmadas SS. "I have to listen to them or they might harm me" and other narratives of why women endure obstetric violence in Bihar, India. Birth 2024. [PMID: 38840384 DOI: 10.1111/birt.12828] [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: 07/18/2023] [Revised: 03/28/2024] [Accepted: 05/01/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Evidence suggests that obstetric violence has been prevalent globally and is finally getting some attention through research. This human rights violation takes several forms and is best understood through the narratives of embodied experiences of disrespect and abuse from women and other people who give birth, which is of utmost importance to make efforts in implementing respectful maternity care for a positive birthing experience. This study focused on the drivers of obstetric violence during labor and birth in Bihar, India. METHODS Participatory qualitative visual arts-based method of data collection-body mapping-assisted interviews (adapted as birth mapping)-was conducted to understand women's perception of why they are denied respectful maternity care and what makes them vulnerable to obstetric violence during labor and childbirth. This study is embedded in feminist and critical theories that ensure women's narratives are at the center, which was further ensured by the feminist relational discourse analysis. Eight women participated from urban slums and rural villages in Bihar, for 2-4 interactions each, within a week. The data included transcripts, audio files, body maps, birthing stories, and body key, which were analyzed with the help of NVivo 12. FINDINGS Women's narratives suggested drivers that determine how they will be treated during labor and birth, or any form of sexual, reproductive, and maternal healthcare seeking presented through the four themes: (1) "I am admitted under your care, so, I will have to do what you say"-Influence of power on care during childbirth; (2) "I was blindfolded … because there were men"-Influence of gender on care during childbirth; (3) "The more money we give the more convenience we get"-Influence of structure on care during childbirth; and (4) "How could I ask him, how it will come out?"-Influence of culture on care during childbirth. How women will be treated in the society and in the obstetric environment is determined by their identity at the intersections of age, class, caste, marital status, religion, education, and many other sociodemographic factors. The issues related to each of these are intertwined and cross-cutting, which made it difficult to draw clear categorizations because the four themes influenced and overlapped with each other. Son preference, for example, is a gender-based issue that is part of certain cultures in a patriarchal structure as a result of power-based imbalance, which makes the women vulnerable to disrespect and abuse when their baby is assigned female at birth. DISCUSSION Sensitive unique feminist methods are important to explore and understand women's embodied experiences of trauma and are essential to understand their perspectives of what drives obstetric violence during childbirth. Sensitive methods of research are crucial for the health systems to learn from and embed women's wants, to address this structural challenge with urgency, and to ensure a positive experience of care.
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Affiliation(s)
- Kaveri Mayra
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zoë Matthews
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Kings College London, London, UK
| | - Sabu S Padmadas
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
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Marian M, Barker KM, Reed E, McClain AC, Lundgren R, Hurst S, Pérez RL. Prevalence of different variations of non-consented care during the childbirth process in Mexico by geographical regions: comparing ENDIREH survey data from 2016 to 2021. BMC Pregnancy Childbirth 2024; 24:353. [PMID: 38741050 DOI: 10.1186/s12884-024-06549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Non-consented care, a form of obstetric violence involving the lack of informed consent for procedures, is a common but little-understood phenomenon in the global public health arena. The aim of this secondary analysis was to measure the prevalence and assess change over time of non-consented care during childbirth in Mexico in 2016 and 2021, as well as to examine the association of sociodemographic, pregnancy-, and childbirth-factors with this type of violence. METHODS We measured the prevalence of non-consented care and three of its variations, forced sterilization or contraception, forced cesarean section, and forced consent on paperwork, during childbirth in Mexico for 2016 (N = 24,036) and 2021 (N = 19,322) using data from Mexico's cross-sectional National Survey on the Dynamics of Household Relationships (ENDIREH). Weighted data were stratified by geographical regions. We performed adjusted logistic regression analyses to explore associations. RESULTS The national prevalence of non-consented care and one of its variations, pressure to get a contraceptive method, increased from 2016 to 2021. A decrease in the prevalence was observed for forced contraception or sterilization without knowledge, forcing women to sign paperwork, and non-consented cesarean sections nationally and in most regions. Women between the ages of 26 and 35 years, married, cohabiting with partner, living in urban settings, who do not identify as Indigenous, and who received prenatal services or gave birth at the Mexican Institute of Social Security (IMSS) facilities experienced a higher prevalence of non-consented care. Being 26 years of age and older, living in a rural setting, experiencing stillbirths in the last five years, having a vaginal delivery, receiving prenatal services at IMSS, or delivering at a private facility were significantly associated with higher odds of reporting non-consented care. CONCLUSION While a decrease in most of the variations of non-consented care was found, the overall prevalence of non-consented care and, in one of its variations, pressure to get contraceptives, increased at a national and regional level. Our findings suggest the need to enforce current laws and strengthen health systems, paying special attention to the geographical regions and populations that have experienced higher reported cases of this structural problem.
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Affiliation(s)
- Marian Marian
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
- San Diego State University School of Public Health, San Diego, CA, USA.
| | - Kathryn M Barker
- Center on Gender Equity and Health, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Elizabeth Reed
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Amanda C McClain
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Rebecka Lundgren
- Center on Gender Equity and Health, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Samantha Hurst
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA
| | - Ramona L Pérez
- Department of Anthropology, San Diego State University, San Diego, CA, USA
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Fox D, Coddington R, Levett KM, Scarf V, Sutcliffe KL, Newnham E. Tending to the machine: The impact of intrapartum fetal surveillance on women in Australia. PLoS One 2024; 19:e0303072. [PMID: 38722999 PMCID: PMC11081371 DOI: 10.1371/journal.pone.0303072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
Qualitative research about women and birthing people's experiences of fetal monitoring during labour and birth is scant. Labour and birth is often impacted by wearable or invasive monitoring devices, however, most published research about fetal monitoring is focused on the wellbeing of the fetus. This manuscript is derived from a larger mixed methods study, 'WOmen's Experiences of Monitoring Baby (The WOMB Study)', aiming to increase understanding of the experiences of women and birthing people in Australia, of being monitored; and about the information they received about fetal monitoring devices during pregnancy. We constructed a national cross-sectional survey that was distributed via social media in May and June, 2022. Responses were received from 861 participants. As far as we are aware, this is the first survey of the experiences of women and birthing people of intrapartum fetal monitoring conducted in Australia. This paper comprises the analysis of the free text survey responses, using qualitative and inductive content analysis. Two categories were constructed, Tending to the machine, which explores participants' perceptions of the way in which clinicians interacted with fetal monitoring technologies; and Impressions of the machine, which explores the direct impact of fetal monitoring devices upon the labour and birth experience of women and birthing people. The findings suggest that some clinicians need to reflect upon the information they provide to women and birthing people about monitoring. For example, freedom of movement is an important aspect of supporting the physiology of labour and managing pain. If freedom of movement is important, the physical restriction created by a wired cardiotocograph is inappropriate. Many participants noticed that clinicians focused their attention primarily on the technology. Prioritising the individual needs of the woman or birthing person is key to providing high quality woman-centred intrapartum care. Women should be provided with adequate information regarding the risks and benefits of different forms of fetal monitoring including how the form of monitoring might impact her labour experience.
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Affiliation(s)
- Deborah Fox
- Collective for Midwifery, Child and Family Health (CMCFH), University of Technology Sydney, NSW, Australia
| | - Rebecca Coddington
- Collective for Midwifery, Child and Family Health (CMCFH), University of Technology Sydney, NSW, Australia
| | - Kate M. Levett
- Collective for Midwifery, Child and Family Health (CMCFH), University of Technology Sydney, NSW, Australia
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
- NICM Health Research Institute and THRI, Western Sydney University, Penrith, NSW, Australia
| | - Vanessa Scarf
- Collective for Midwifery, Child and Family Health (CMCFH), University of Technology Sydney, NSW, Australia
| | - Kerry L. Sutcliffe
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Elizabeth Newnham
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
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Long T, Aggar C, Grace S. Trauma-informed care education for midwives: Does education improve attitudes towards trauma-informed care? Midwifery 2024; 131:103950. [PMID: 38359645 DOI: 10.1016/j.midw.2024.103950] [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: 04/02/2023] [Revised: 12/13/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Continuing education is important to improve midwives' attitudes to trauma-informed care in addressing the needs of women during the perinatal period. This study aimed to evaluate if there was a significant difference in attitudes towards trauma-informed care between midwives who participated in a 2-day trauma-informed care education program and those who did not. METHOD A static group comparison design was adopted with a convenience sample of midwives to analyse differences in attitudes towards trauma-informed care between midwives who received a 2-day TIC education (n = 19, intervention group) and their peers who did not receive the education (n = 18, comparison group). RESULTS The results suggest that midwives who participated in a 2-day trauma-informed care education program had significantly higher scores for positive attitudes towards trauma-informed care compared to those who did not take part in the program and that this effect was sustained at 6 months. CONCLUSION To minimise perinatal trauma for mothers and babies, midwives require specific trauma-informed care education. This study proposes that trauma-informed care education is a foundational pathway for implementing a trauma-informed care framework across a maternity service.
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Affiliation(s)
- Trish Long
- Northern NSW Local Health District, Australia.
| | - Christina Aggar
- Northern NSW Local Health District, Australia; Southern Cross University, Faculty of Health, Australia
| | - Sandra Grace
- Southern Cross University, Faculty of Health, Australia
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Keedle H, Dahlen HG. Incorporating co-design principles and social media strategies to enhance cross-sectional online survey participation: The Birth Experience Study. J Nurs Scholarsh 2024; 56:341-350. [PMID: 37984985 DOI: 10.1111/jnu.12945] [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] [Received: 08/27/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
AIM To use co-design principles to design a nationwide maternity experiences survey and to distribute the survey through social media. DESIGN A co-designed, cross sectional, and national online survey. METHODS Using co-design principles from study design and throughout the research process a cross-sectional, online, national survey of Australian women's experiences of maternity care was designed. Four validated survey instruments were included in the survey design. RESULTS An extensive social media strategy was utilized, which included paid advertising, resulting in 8804 surveys for analysis and 54,896 comments responding to open text questions. DISCUSSION The inclusion of co-design principles contributed to a well-designed survey and consumer involvement in distribution and support of the online survey. The social media distribution strategy contributed to high participation rates with overall low marketing costs. CLINICAL RELEVANCE Maternity services should be designed to provide woman-centered, individualized care. This survey was co-designed with maternity users and maternity organizations to explore women's recent experiences of maternity care in Australia. The outcomes of this study will highlight the factors that contribute to positive and negative experiences in maternity services. PATIENT OR PUBLIC CONTRIBUTION As a co-designed study, there was consumer engagement from the design of the study, throughout the research process.
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Affiliation(s)
- Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
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Kasaye H, Scarf V, Sheehy A, Baird K. The mistreatment of women during maternity care and its association with the maternal continuum of care in health facilities. BMC Pregnancy Childbirth 2024; 24:129. [PMID: 38350892 PMCID: PMC10863180 DOI: 10.1186/s12884-024-06310-8] [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: 07/24/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Mistreatment of childbearing women continues despite global attention to respectful care. In Ethiopia, although there have been reports of mistreatment of women during maternity care, the influence of this mistreatment on the continuum of maternity care remains unclear. In this paper, we report the prevalence of mistreatment of women from various dimensions, factors related to mistreatment and also its association to the continuum of maternity care in health facilities. METHODS We conducted an institution-based cross-sectional survey among women who gave birth within three months before the data collection period in Western Ethiopia. A total of 760 women participated in a survey conducted face-to-face at five health facilities during child immunization visits. Using a validated survey tool, we assessed mistreatment in four categories and employed a mixed-effects logistic regression model to identify its predictors and its association with the continuum of maternity care, presenting results as adjusted odds ratios (AORs) with their 95% confidence intervals (CIs). RESULTS Over a third of women (37.4%) experienced interpersonal abuse, 29.9% received substandard care, 50.9% had poor interactions with healthcare providers, and 6.2% faced health system constraints. The odds of mistreatment were higher among women from the lowest economic status, gave birth vaginally and those who encountered complications during pregnancy or birth, while having a companion of choice during maternity care was associated to reduced odds of mistreatment by 42% (AOR = 0.58, 95% CI: [0.42-0.81]). Women who experienced physical abuse, verbal abuse, stigma, or discrimination during maternity care had a significantly reduced likelihood of completing the continuum of care, with their odds decreased by half compared to those who did not face such interpersonal abuse (AOR = 0.49, 95% CI: [0.29-0.83]). CONCLUSIONS Mistreatment of women was found to be a pervasive problem that extends beyond labour and birth, it negatively affects upon maternal continuum of care. Addressing this issue requires an effort to prevent mistreatment through attitude and value transformation trainings. Such interventions should align with a system level actions, including enforcing respectful care as a competency, enhancing health centre functionality, improving the referral system, and influencing communities to demand respectful care.
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Affiliation(s)
- Habtamu Kasaye
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Vanessa Scarf
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Annabel Sheehy
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Kathleen Baird
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Pelak H, Dahlen HG, Keedle H. A content analysis of women's experiences of different models of maternity care: the Birth Experience Study (BESt). BMC Pregnancy Childbirth 2023; 23:864. [PMID: 38102547 PMCID: PMC10722666 DOI: 10.1186/s12884-023-06130-2] [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: 06/04/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Pregnancy, birth, and early parenthood are significant life experiences impacting women and their families. Growing evidence suggests models of maternity care impact clinical outcomes and birth experiences. The aim of this study was to explore the strengths and limitations of different maternity models of care accessed by women in Australia who had given birth in the past 5 years. METHODS The data analysed and presented in this paper is from the Australian Birth Experience Study (BESt), an online national survey of 133 questions that received 8,804 completed responses. There were 2,909 open-ended comments in response to the question on health care provider/s. The data was analysed using content analysis and descriptive statistics. RESULTS In models of fragmented care, including standard public hospital care (SC), high-risk care (HRC), and GP Shared care (GPS), women reported feelings of frustration in being unknown and unheard by their health care providers (HCP) that included themes of exhaustion in having to repeat personal history and the difficulty in navigating conflicting medical advice. Women in continuity of care (CoC) models, including Midwifery Group Practice (MGP), Private Obstetric (POB), and Privately Practising Midwifery (PPM), reported positive experiences of healing past birth trauma and care extending for multiple births. Compared across models of care in private and public settings, comments in HRC contained the lowest percentage of strengths (11.94%) and the highest percentage of limitations (88.06%) while comments in PPM revealed the highest percentage of strengths (95.93%) and the lowest percentage of limitations (4.07%). CONCLUSIONS Women across models of care in public and private settings desire relational maternity care founded on their unique needs, wishes, and values. The strengths of continuity of care, specifically private midwifery, should be recognised and the limitations for women in high risk maternity care investigated and prioritised by policy makers and managers in health services. TRIAL REGISTRATION The study is part of a larger project that has been retrospectively registered with OSF Registries Registration DOI https://doi.org/10.17605/OSF.IO/4KQXP .
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Affiliation(s)
- Helen Pelak
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 167 Great Western Highway, Blackheath, Penrith, NSW, 2751, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 167 Great Western Highway, Blackheath, Penrith, NSW, 2751, Australia
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 167 Great Western Highway, Blackheath, Penrith, NSW, 2751, Australia.
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Kloester J, Brand G, Willey S. How midwives facilitate informed decisions in the third stage of labour - an exploration through portraiture. Midwifery 2023; 127:103868. [PMID: 37931464 DOI: 10.1016/j.midw.2023.103868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
PROBLEM Midwifery philosophy promotes informed decision-making. Despite this, midwives report a lack of informed decision-making in standard maternity care systems. BACKGROUND Previous research has shown a woman's ability to make informed decisions within her maternity care significantly impacts her childbearing experience. When informed decision-making is facilitated, women report positive experiences, whereas when lacking, there is an increased potential for birth trauma. AIM To explore midwives' experiences of facilitating informed decision-making, using third-stage management as context. METHODS Five midwives from Victoria, Australia, were interviewed about their experiences with informed decision-making. These interviews were guided by portraiture methodology whereby individual narrative portraits were created. This paper explores the shared themes among these five portraits. FINDINGS Five individual narrative portraits tell the stories of each midwife, providing rich insight into their philosophies, practices, barriers and enablers of informed decision-making. These are then examined as a whole dataset to explore shared themes, and include; 'informed decision-making is fundamental to midwifery practice' 'the system', and 'navigating the system'. The system contained the sub-themes; hierarchy in hospitals, the medicalisation of birth, and the impact on midwifery practice, and 'navigating the system' - contained; safety of the woman and safety of the midwife, and the gold-standard of midwifery. DISCUSSION AND CONCLUSION Midwives in this study valued informed decision-making as fundamental to their philosophy but also faced barriers in their ability to facilitate it. Barriers to informed decision-making included: power-imbalances; de-skilling in physiological birth; fear of blame, and interdisciplinary disparities. Conversely enablers included continuity models of midwifery care, quality antenatal education, respectful interdisciplinary collaboration and an aim toward a resurgence of fundamental midwifery skills.
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Affiliation(s)
- Joy Kloester
- Monash Nursing and Midwifery, Monash University, Melbourne Victoria, Australia.
| | - Gabrielle Brand
- Monash Nursing and Midwifery, Monash University, Melbourne Victoria, Australia. https://twitter.com/https://twitter.com/GabbyBrand6
| | - Suzanne Willey
- Monash Nursing and Midwifery, Monash University, Melbourne Victoria, Australia. https://twitter.com/https://twitter.com/SueWilley5
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Runyon MC, Irby MN, Pascucci C, Rojas Landivar P. Exposing the Role of Labor and Delivery Nurses as Active Bystanders in Preventing or Perpetuating Obstetric Violence. Nurs Womens Health 2023; 27:330-336. [PMID: 37572697 DOI: 10.1016/j.nwh.2023.05.002] [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: 02/14/2023] [Revised: 05/08/2023] [Accepted: 07/12/2023] [Indexed: 08/14/2023]
Abstract
Obstetric violence is an issue of global scope and magnitude. Its widespread and continued presence indicates cultural tolerance enabled by policies and procedures that uphold paternalism. Labor and delivery nurses are the health care professionals who spend the most time at the point of care during birth, and their role must be examined. As active bystanders, labor and delivery nurses are uniquely positioned to prevent or perpetuate obstetric violence during labor and birth. Reflection on the nurse role is necessary to provide optimal care, enhance relationships with patients, and continue to evolve as a professional discipline. Perinatal nurses must lead the change to trauma-informed care practices to mitigate obstetric violence and reduce birth trauma.
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Keedle H, Lockwood R, Keedle W, Susic D, Dahlen HG. What women want if they were to have another baby: the Australian Birth Experience Study (BESt) cross-sectional national survey. BMJ Open 2023; 13:e071582. [PMID: 37666545 PMCID: PMC10496680 DOI: 10.1136/bmjopen-2023-071582] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/04/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVES To explore if Australian women would do anything differently if they were to have another baby. DESIGN AND SETTING The Birth Experience Study (BESt) online survey explored pregnancy, birth and postnatal experiences for women who had given birth during 2016-2021 in Australia. PARTICIPANTS In 2021, 8804 women responded to the BESt survey and 6101 responses to the open text responses to the survey question 'Would you do anything different if you were to have another baby?' were analysed using inductive content analysis. RESULTS A total of 6101 women provided comments in response to the open text question, resulting in 10 089 items of coding. Six categories were found: 'Next time I'll be ready' (3958, 39.2%) described how women reflected on their previous experience, feeling the need to better advocate for themselves in the future to receive the care or experience they wanted; 'I want a specific birth experience' (2872, 28.5%) and 'I want a specific model of care' (1796, 17.8%) highlighted the types of birth and health provider women would choose for their next pregnancy. 'I want better access' (294, 2.9%) identified financial and/or geographical constraints women experience trying to make choices for birth. Two categories included comments from women who said 'I don't want to change anything' (1027, 10.2%) and 'I don't want another pregnancy' (142, 1.4%). Most women birthed in hospital (82.9%) and had a vaginal birth (59.2%) and 26.7% had a caesarean. CONCLUSION Over 85% of comments left by women in Australia were related to making different decisions regarding their next birth choices. Most concerningly women often blamed themselves for not being more informed. Women realised the benefits of continuity of care with a midwife. Many women also desired a vaginal birth as well as better access to birthing at home.
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Affiliation(s)
- Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
| | - Risharda Lockwood
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
| | - Warren Keedle
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
| | - Daniella Susic
- Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
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Johansson M, Jansson O, Lilja F, Ekéus C, Volgsten H. Freebirth, the only option for women who do not fit into common practice- A Swedish national interview study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100866. [PMID: 37295181 DOI: 10.1016/j.srhc.2023.100866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/20/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore women's experience of freebirth, as giving birth without the presence of a skilled healthcare professional such as a midwife. METHODS Online semi-structured interviews with nine multiparous women in Sweden. A qualitative experiential approach, as described by Burnard, was followed for data analysis. RESULTS The five main categories explored were: (i) previous negative experiences of hospital care as a reason for freebirth; (ii) receiving support for the decision of freebirth was crucial; (iii) longing for individual midwifery-assisted home-birthing support; (iv) to give birth in peace and in self-control, in the safe home environment; and (v) helpful support during labor and birth was appreciated. CONCLUSIONS The women in the study had a powerful and positive experience of freebirth, but individual midwifery birthing support was also requested. Easily available and respectful midwifery support should be offered to all childbearing women.
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Affiliation(s)
- Margareta Johansson
- Uppsala University, Department of Women's and Children's Health, Akademiska University Hospital, SE-751 85 Uppsala, Sweden.
| | - Olivia Jansson
- Akademiska University Hospital, Department of Obstetrics and Gynaecology, SE-751 85 Uppsala, Sweden.
| | - Fanny Lilja
- BB Stockholm Family Kungsholmen, Sankt Eriksgatan 44, SE-112 34 Stockholm, Sweden.
| | - Cecilia Ekéus
- Uppsala University, Department of Women's and Children's Health, SE-751 85 Uppsala, Sweden.
| | - Helena Volgsten
- Uppsala University, Department of Public Health and Caring Sciences, SE-75122 Uppsala University, Uppsala, Sweden.
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Kumar-Hazard B, Dahlen HG. Setting a human rights and legal framework around 'the ethics of consent during labour and birth: episiotomies'. JOURNAL OF MEDICAL ETHICS 2023; 49:634-635. [PMID: 37620137 DOI: 10.1136/jme-2023-109251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Bashi Kumar-Hazard
- Law, University of Sydney SCIL, Sydney, New South Wales, Australia
- Human Rights in Childbirth, (NGO), San Francisco, California, USA
| | - Hannah Grace Dahlen
- Midwifery, University of Western Sydney, Penrith South, New South Wales, Australia
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Salter C, Wint K, Burke J, Chang JC, Documet P, Kaselitz E, Mendez D. Overlap between birth trauma and mistreatment: a qualitative analysis exploring American clinician perspectives on patient birth experiences. Reprod Health 2023; 20:63. [PMID: 37085888 PMCID: PMC10121072 DOI: 10.1186/s12978-023-01604-0] [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: 09/17/2022] [Accepted: 03/27/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Research exploring the mistreatment of birthing people in the United States is emerging rapidly within the context of increasingly poor maternal health outcomes that include unacceptable racial disparities. Previous research has explored overlap between psychological birth trauma and mistreatment using patient descriptions of birth experiences, but no previous studies have explored these issues from the perspectives of clinicians. The aim of this study was to explore whether maternity care providers' descriptions of patient birth trauma overlap with categories of mistreatment from a globally accepted typology. METHODS Content analysis was performed on a qualitative data set of 28 semi-structured interviews about patient birth trauma, completed in 2018-2019 with U.S. maternity care clinicians, including obstetricians, family physicians, midwives and labor/delivery nurses. The interviews were part of a larger study exploring maternity clinician perspectives and experiences of patient birth trauma. For this analysis Krippendorff's method of categoric distinction was used, with categories from a globally recognized typology of maternity patient mistreatment. RESULTS Clinicians' descriptions of their experiences with patient birth trauma mapped onto all seven mistreatment categories, although no interview questions specifically asked about mistreatment. In more than 30 hours of interviews, transcribed to more than 800 pages, the word mistreatment appears only once, suggesting that some healthcare providers may use the phrase "birth trauma" as a euphemism to describe mistreatment. Eighteen of 28 interviews included at least one description that fit into a mistreatment category. "Failure to meet professional standards of care" was the category with the most mapped clinician statements, followed by "Stigma and discrimination" and "Poor rapport between women and providers." CONCLUSIONS This study contributes new insight into maternity clinicians' conceptualization of patient trauma and how their descriptions of birth trauma overlap with mistreatment. Clinicians implicitly connected mistreatment with some patient experiences of birth trauma, even when they were not specifically asked about mistreatment. Findings point to a need for further research into mistreatment, including routinized "everyday care" that may include mistreatment, particularly for marginalized and historically excluded birthing people. Future research also must explore the potential role of mistreatment in poor and inequitable U.S. birth outcomes.
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Affiliation(s)
- Cynthia Salter
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 6135 Public Health Building, 6th Floor Public Health,130 DeSoto St, Pittsburgh, PA 15216 USA
| | - Kristina Wint
- Association of Maternal and Child Health Programs, 1825 K St NW, Washington, DC 20006 USA
| | - Jessica Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 6135 Public Health Building, 6th Floor Public Health,130 DeSoto St, Pittsburgh, PA 15216 USA
| | - Judy C. Chang
- Department of Obstetrics, Gynecology & Reproductive Sciences, Internal Medicine, and the Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, 300 Halket St., Pittsburgh, PA 15213 USA
| | - Patricia Documet
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 6135 Public Health Building, 6th Floor Public Health,130 DeSoto St, Pittsburgh, PA 15216 USA
| | - Elizabeth Kaselitz
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 6135 Public Health Building, 6th Floor Public Health,130 DeSoto St, Pittsburgh, PA 15216 USA
| | - Dara Mendez
- Department of Epidemiology, University of Pittsburgh School of Public Health, 5130 Public Health, 130 DeSoto St, Pittsburgh, PA 15216 USA
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