The author challenges women's mental health researchers to critically examine the categories of race available for research participants, surveillance data, and medical records.
The author challenges women's mental health researchers to critically examine the categories of race available for research participants, surveillance data, and medical records.
The authors describe four important strategies to improve women's mental health during the perinatal period and across the life course.
Objective: To explore perceptions of policies and laws on sexual and reproductive health among women in recovery from opioid use disorder (OUD).
Design: Qualitative descriptive.
Setting: Telephone interviews conducted in a midsized urban area in the midwestern region of the United States.
Participants: Twenty-two women ages 18 to 49 years who self-identified as being in recovery from OUD.
Methods: We conducted individual, semistructured telephone interviews and analyzed the data using reflexive thematic analysis.
Results: We identified three themes: Barriers to OUD Treatment and Recovery, Pregnancy as a Gateway to Treatment and Recovery, and The Dobbs Effect. Participants described OUD treatment barriers such as inadequate recovery resources for women and the criminalization of drug use. Many participants described pregnancy as a gateway to recovery because of improved access to treatment services and enhanced motivation for engaging in recovery. Participants described unintended pregnancy as a threat to recovery that made them seek woman-controlled contraceptive methods they could use without negotiating with a partner (e.g., intrauterine devices) after the Supreme Court overturned constitutionally protected access to abortion.
Conclusion: Opioid use disorder is a public and mental health crisis in the United States that affects reproductive-age women. Participants in our study closely connected recovery from OUD with sexual and reproductive health policy and laws. There is a need for regulation to support the unique needs of women in OUD treatment. The recent Supreme Court decision that overturned constitutionally protected abortion creates challenges for women in recovery from OUD. Nurses are ideally positioned to advocate for recovery and sexual and reproductive health policies and laws that improve the physical and mental health of women in recovery.
Objective: To examine associations among endorsement of elements of the superwoman schema (the obligation to manifest strength and the obligation to help others) and health outcomes and to test if stress mediates the association between the obligation to manifest strength and depression in adult Black women.
Design: Cross-sectional design.
Setting: Community space in the Chicago metropolitan area.
Participants: Ninety-one adult Black women.
Methods: Participants completed questionnaires to assess endorsement of superwoman schema roles, physical activity, healthy eating, weight satisfaction, depression, and stress. Height and weight were collected by research assistants. We used descriptive statistics, bivariate correlations, multiple regression models, and linear mediation analysis to analyze data.
Results: Higher levels of obligation to suppress emotions were associated with lower physical activity, r(88) = -0.25, p < .05. Obligation to manifest strength was associated with higher levels of stress, r(79) = 0.53, p < .01, and symptoms of depression, r(71) = 0.36, p < .01. Stress mediated the relationship between the obligation to manifest strength and depression with a significant indirect effect, β = 0.37, SE = 0.10, 95% confidence interval [0.20, 0.60].
Conclusion: Our findings offer insight into the psychological and social processes that affect Black women and may aid in the development of culturally responsive prevention and intervention programs at individual and community levels to reduce chronic diseases.
Objective: To more clearly understand the use of stigmatizing and nonstigmatizing language in electronic health records in hospital birth settings and to broaden the understanding of discrimination and implicit bias in clinical care.
Design: A secondary qualitative analysis of free-text clinical notes from electronic health records.
Setting: Two urban hospitals in the northeastern United States that serve patients with diverse sociodemographic characteristics during the perinatal period.
Participants: A total of 1,771 clinical notes from inpatient birth admissions in 2017.
Methods: We used Krippendorff's content analysis of categorial distinction to identify stigmatizing and nonstigmatizing language. We based our categories for the content analysis on our pilot study and preexisting categories described by other researchers. We also explored new language categories that emerged during analysis.
Results: We reviewed 1,771 notes and identified 10 categories that demonstrated stigmatizing language toward patients, nonstigmatizing language toward patients, and stigmatizing language among clinicians. We identified a new stigmatizing language category, Unjustified Descriptions of Social and Behavioral Risks. Positive or Preferred Language and Patient Exercising Autonomy for Birth are two new categories that represent language that empowers patients. Clinician Blame and Structural Care Barriers are new language categories that imply complex interprofessional dynamics and structural challenges in health care settings that can adversely affect the provision of care.
Conclusions: The results of this study provide a foundation for future efforts to reduce the use of stigmatizing language in clinical documentation and can be used to inform multilevel interventions to reduce bias in the clinical care in birth settings.
Dysphoric milk ejection reflex (D-MER) is a dysregulation of emotions (dysphoria) that can occur during the milk ejection reflex and during breastfeeding or expressing breast milk. Symptoms of D-MER present suddenly and can include hopelessness, sadness, nervousness, irritability, nausea, dread, palpitations, and a hollow feeling in the stomach. Although D-MER was first reported in 2007, it remains understudied to date and should not be confused with postnatal depression or anxiety disorders. Knowing that they are experiencing symptoms of a named condition is very supportive for women who experience D-MER. It is important that health care professionals who interact with the breastfeeding dyad be aware of D-MER so they can provide supportive care, manage symptoms, and protect the breastfeeding relationship. In this article, we describe the case of a woman who experienced D-MER while she breastfed her newborn.
Objective: To develop a deeper understanding of the health care experiences of women of color affected by severe maternal morbidity (SMM) or birth complications in the United States and opportunities to improve the delivery of maternal health care.
Data sources: PubMed, CINAHL, Embase, and Scopus.
Study selection: We included qualitative studies on the experiences of pregnancy or childbirth among women of color in the United States published within the past 10 years (to reflect recent societal events and obstetric practices) in which researchers examined women's experiences of SMM or birth complications.
Data extraction: Five reports of qualitative research studies met inclusion criteria. We assessed the methodological quality of each study using the JBI (Joanna Briggs Institute) critical appraisal checklist for qualitative research. We extracted the following data from the included studies: participants' demographic characteristics (i.e., race/ethnicity, age, experiences), methodological characteristics of the studies (i.e., sample size, research design, data collection, data analysis), and individual study metaphors (i.e., concepts, phrases, participant quotes) related to the overarching themes.
Data synthesis: We used the meta-ethnographic approach of Noblit and Hare (1988) to critically examine studies, translate the studies into one another, and synthesize reciprocal translations. Four overarching themes emerged from the meta-synthesis: Lack of Knowledge; Stigma, Discrimination, and/or Bias; Provider Communication Issues; and Barriers to Care and Services. Each overarching theme had complicating factors, which represented factors that exacerbated problems, and mitigating factors, which represented factors that alleviated some negative experiences. Complex layers of varying demographic characteristics and social determinants of health shaped women's individual experiences.
Conclusion: The experiences of women of color with SMM or complications during pregnancy and/or childbirth reveal shortcomings in the delivery of maternal health care. Findings suggest opportunities for improvement across various levels of the health care system. Further qualitative studies using high-quality methodology are needed on this topic given that the research is limited.
The author describes a lifespan-based approach to understanding maternal depression and the statistical considerations essential for evaluating interventions.
Objective: To identify lifetime discrimination typologies and examine their associations with psychological health outcomes among Black and Hispanic women after birth.
Design: Secondary analysis of the Community and Child Health Network study data.
Participants: A total of 1,350 Black and 607 Hispanic women.
Methods: We built two latent class models for Black and Hispanic women using eight indicator variables from different life domains of discrimination (childhood, family, work, police, education, housing, health care, and loans). We used bivariate and multiple regression analyses to examine the association among the identified typologies and postpartum depression and perceived stress at 6 months postpartum.
Results: We selected the three-class model with best fit indices and interpretability: no lifetime discrimination (n = 1,029; 76.22%), high childhood-family racial discrimination (n = 224, 16.59%), and moderate lifetime discrimination (n = 97, 7.19%) among Black women and no lifetime discrimination (n = 493, 81.22%), high childhood-family racial discrimination (n = 93, 15.32%), and high education discrimination (n = 21, 3.46%) among Hispanic women. The adjusted postpartum depression and perceived stress scores were significantly greater in Typologies 2 and 3 than Typology 1 in Black women. The adjusted perceived stress scores were significantly greater in Typologies 2 and 3 than Typology 1 in Hispanic women.
Conclusion: Lifetime discrimination experiences manifested in complex patterns. Women who experienced moderate to high discrimination across all or specific life domains had worse postpartum depression and perceived stress at 6 months after birth. It is crucial to address lifetime discrimination to improve maternal mental health.
Objective: To describe the mental health experiences of Muslim American women in the perinatal period.
Design: Qualitative descriptive.
Setting: Telephone interviews.
Participants: Eighteen Muslim American women who gave birth in the last 12 months.
Methods: We used a semistructured guide to conduct individual interviews and thematic network analysis to identify key themes across the interviews.
Results: Participants had a mean age of 32.5 years, 83% were White, and 17% were Asian. Educational attainment ranged from high school diploma to doctorate degree (83% completed a bachelor's degree or higher), and 83% reported U.S. citizenship. We identified four organizing themes: Need for Tailored Mental Health Support; Challenging Screening Experiences; Mental Health Experiences That Affect Maternal-Infant Bonding; and Faith, Culture, and Mental Health.
Conclusion: Findings underscore the need for culturally responsive mental health screening and enhanced support tailored to Muslim American women during the perinatal period. Health care providers should use culturally sensitive care approaches to build trust and enhance mental health outcomes.
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