American Public Health Association. Supporting access to midwifery services in the United States (position paper)

The Birth Education Starts Today Video on Birth Care Options: Evaluation With University Students

Despite evidence indicating that midwife-attended birth is safe and satisfactory, few U.S. families have credentialed midwives as their birth care providers. In the context of person-centered health care and improving maternity care, we evaluated how an author-constructed video featuring evidence and personal narratives on midwifery care affected attitudes and care preferences/intentions for a hypothetical future birth among university students who had not become parents. Students (114 women, 30 men) completed care attitude and preference items before and after viewing the video. Significant (p < .001) changes indicated significantly improved attitudes toward midwives and out-of-hospital birth and related preferences. We discuss the educational framework of the video and plans to determine whether short-term effects translate into care-seeking behavior across diverse populations.

Developing the Learning about Midwives and Birth Settings Video for Teaching About Birth Care Options

BACKGROUND

U.S. women's reports have indicated misconceptions about midwifery care and related birth options, yet these care approaches are associated with healthy birth outcomes. From the perspective of person-centered care, we aimed to address existing knowledge gaps on midwifery care by creating an accessible learning tool help inform future parents and community educators of evidence-based birth care options.

METHOD

Applied action research (AR) principles to develop a learning tool for public use. We conducted focus groups with nulliparous young adults who were university students, those who were nonstudent community members, and medical professionals to build content. We collected pre–post viewing data on knowledge, attitudes, and future behavioral intentions with university and community samples.

RESULTS

Our resultant 17-minute video contains content in three areas: (a) narratives from midwives, (b) narratives from parents, (c) information on midwives' credentialing and scope of care, birth settings, and safety studies. Evaluation data indicated that the video positively influenced viewers' related knowledge, attitudes, and future behavioral intentions.

DISCUSSION

Our iterative developmental process yielded a learning tool responsive to viewer input on communicating about nonnormative, safe birth care options. Initial data indicated promise of positively influencing viewers' attitudes and behavioral intentions toward midwife-attended birth in- and out-of-hospital. Future plans include publicly releasing the video and assessing long-term learning impact with initial study samples.

The United States Does CAIR About Cultural Safety: Examining Cultural Safety Within Indigenous Health Contexts in Canada and the United States

PURPOSE

This article examines the concept and use of the term cultural safety in Canada and the United States.

DESIGN

To examine the uptake of cultural awareness, cultural sensitivity, cultural competence, and cultural safety between health organizations in Canada and the United States, we reviewed position statements/policies of health care associations.

FINDINGS

The majority of selected health associations in Canada include cultural safety within position statements or organizational policies; however, comparable U.S. organizations focused on cultural sensitivity and cultural competence.

DISCUSSION

Through the work of the Center for American Indian Resilience, we demonstrate that U.S. researchers engage with the tenets of cultural safety-despite not using the language.

CONCLUSIONS

We recommend that health care providers and health researchers consider the tenets of cultural safety.

IMPLICATIONS FOR PRACTICE

To address health disparities between American Indian populations and non-American Indians, we urge the adoption of the term and tenets of cultural safety in the United States.

Racial disparities in birth care: Exploring the perceived role of African-American women providing midwifery care and birth support in the United States

BACKGROUND

Midwifery care has been linked to positive birth outcomes. Despite the broad racial disparities in maternal and infant outcomes in the United States (US), little is known about the role of minority women in either providing or receiving this type of care. A vibrant community of minority women, who self-identify as providing these services, exists online. In this exploratory study we ask how they describe their role; view their practice; and position themselves in the broader discussions of racial health disparities in the US.

METHODS

Using an internet mediated qualitative design we analyse online narratives from self-described African-American nurse-midwives, lay midwives and birth assistants; we found 28 unique websites. We collected and analysed narrative material from each site. We used a thematic analysis approach to identify recurrent and emergent themes in relation to the study question.

RESULTS

Narratives identified a strong link to the past, as providers viewed their practice in a historical perspective linking African roots, to the diaspora, and to current African-American struggles. Providers engaged both in direct clinical work, and in activist roles. Advocacy efforts sought to expand numbers of minority birth care workers and to extend the benefits of woman-centred birth care to underserved communities.

CONCLUSION

Results demonstrate the continued existence and important role of diverse types of African-American birth care providers in minority communities in the US. Recognition, support, and increasing the number of midwives of colour is important in tackling racial inequalities in health. Further research should explore minority access to woman-centred care.