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Status of Horizontal Violence, Level of Psychological Empowerment, and Their Correlation Among Obstetric Nurses: A Cross-Sectional Survey. 产科护士的横向暴力状况、心理授权水平及其相关性:一项横断面调查。
IF 2.8 3区 医学 Q1 NURSING Pub Date : 2024-10-27 DOI: 10.1111/birt.12879
Shan Huang, Ganxia Kong, Qiumei Li, Hamza Saidi Lilenga, Jinguo Zhai

Background: China's maternity policy has led to an increase in work pressure, which has prompted horizontal violence among obstetric nurses. To understand this phenomenon better, we attempted to identify the factors that influence horizontal violence as well as the level of psychological empowerment among obstetric nurses.

Methods: This cross-sectional survey was conducted among 522 obstetric nurses from December 2022 to February 2023.

Results: The findings revealed that 40.42% (211) of the obstetric nurses had experienced horizontal violence in the past 3 months. The overall level of psychological empowerment of obstetric nurses was relatively low. Regression analysis indicated that being a formal worker, being from the area where one serves, the meaning attributed to work, and perceptions of autonomy, self-efficacy, and work impact acted as protective factors against the risk of horizontal violence among obstetric nurses. When compared with the 20-29-year-old age group, those in the 30-39-year-old age group showed a lower risk of experiencing horizontal violence (odds ratio [OR] = 0.369, p < 0.01). Compared with nurses who had worked in obstetrics for < 3 years, those who had worked for 3-5, 6-10, 11-20, and > 20 years showed lower risks of experiencing horizontal violence than the reference level (OR = 0.234, p < 0.05; OR = 0.182, p < 0.05; OR = 0.105, p < 0.05; and OR = 0.056, p < 0.05, respectively).

Discussion: The incidence of horizontal violence among obstetric nurses is high, and the overall level of psychological empowerment is low. Nursing managers can alleviate the occurrence of horizontal violence by augmenting the psychological empowerment level of obstetric nurses.

背景:中国的生育政策导致了工作压力的增加,从而引发了产科护士中的横向暴力。为了更好地了解这一现象,我们试图找出影响横向暴力的因素以及产科护士的心理赋权水平:方法:我们于 2022 年 12 月至 2023 年 2 月对 522 名产科护士进行了横断面调查:调查结果显示,40.42%(211人)的产科护士在过去3个月中经历过横向暴力。产科护士的整体心理赋权水平相对较低。回归分析表明,正规工作者、来自服务地区、工作的意义以及对自主性、自我效能感和工作影响的看法是产科护士遭遇横向暴力风险的保护因素。与 20-29 岁年龄组相比,30-39 岁年龄组发生横向暴力的风险较低(比值比 [OR] = 0.369,p 20 岁年龄组发生横向暴力的风险低于参考水平(比值比 = 0.234,p 讨论):产科护士的横向暴力发生率较高,总体心理授权水平较低。护理管理者可以通过提高产科护士的心理授权水平来减少横向暴力的发生。
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引用次数: 0
Wait, What? What's Going On?- Pregnancy Experiences of Deaf and Hard of Hearing Mothers Who Do Not Sign. 等等,什么?不会手语的聋人和重听母亲的怀孕经历。
IF 2.8 3区 医学 Q1 NURSING Pub Date : 2024-10-27 DOI: 10.1111/birt.12881
Sanjana Ratakonda, Tiffany L Panko, Sasha Albert, Lauren D Smith, Margarita M Cooley, Monika Mitra, Michael McKee

Objective: Deaf and hard of hearing (DHH) women experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared to their hearing peers. This study explores the pregnancy experiences of DHH women who do not sign to better understand their barriers and facilitators to optimal perinatal health care.

Design: Qualitative study using thematic analysis.

Setting: Semi-structured, individual remote, or in-person interviews in the United States.

Sample: Twenty-two DHH English speakers (non-signers) who gave birth in the United States within the past 5 years.

Methods: Semi-structured interviews explored how DHH women experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access, and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted.

Main outcome measures: The barriers and facilitators related to a positive perinatal care experience among DHH women.

Results: Five key themes emerged. For barriers, healthcare communication breakdowns and loss of patient autonomy highlighted DHH women's struggle with perinatal health care. In contrast, DHH participants outlined the importance of accessible health communication practices and accommodations, use of patient advocacy or self-advocacy, and assistive technologies for DHH parents for more positive perinatal care experiences.

Conclusions: Perinatal healthcare providers and staff should routinely inquire about ways to ensure an inclusive and accessible healthcare experience for their DHH patients and provide communication accommodations for optimal care. Additionally, healthcare providers should be more aware of the unique parenting needs and resources of their DHH patients.

目的:与听力正常的妇女相比,聋人和听力障碍(DHH)妇女在生殖保健方面遇到的障碍和不良生育结果的发生率更高。本研究探讨了不会手语的聋哑妇女的怀孕经历,以更好地了解她们获得最佳围产期保健的障碍和促进因素:设计:采用主题分析法进行定性研究:在美国进行的半结构化远程个人访谈或面对面访谈:22 名在过去 5 年中在美国分娩的讲英语的 DHH(非签署者):半结构式访谈探讨了 DHH 妇女如何经历怀孕和分娩,包括获得围产期信息和资源、与医疗保健提供者的关系、沟通途径以及她们在整个怀孕期间与医疗保健系统的关系。我们进行了专题分析:主要结果测量:与 DHH 女性积极的围产期护理体验相关的障碍和促进因素:结果:出现了五个关键主题。在障碍方面,医疗保健沟通障碍和患者自主权的丧失突出了 DHH 女性在围产期医疗保健方面的挣扎。与此相反,DHH 参与者强调了无障碍医疗沟通实践和便利措施、使用患者权益或自我倡导以及辅助技术对 DHH 父母获得更积极的围产期保健体验的重要性:结论:围产期医疗服务提供者和工作人员应定期询问如何确保为 DHH 患者提供包容性和无障碍的医疗保健体验,并提供沟通便利,以获得最佳护理。此外,医疗服务提供者应更多地了解 DHH 患者独特的育儿需求和资源。
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引用次数: 0
Low Social Support is Associated With Postpartum Depression Symptoms Among Illinois Postpartum Women. 伊利诺伊州产后妇女的低社会支持与产后抑郁症状有关。
IF 2.8 3区 医学 Q1 NURSING Pub Date : 2024-10-18 DOI: 10.1111/birt.12889
Abigail Holicky, Ashley Horne, Amanda C Bennett

Background: Postpartum depression (PPD) occurs after delivery, with severity and onset varying by individual. Women with low social support may be at higher risk for PPD. This study examined the association between social support and self-reported postpartum depression symptoms (PDS) among Illinois postpartum women.

Methods: Using 2016-2020 data from the Illinois Pregnancy Risk Assessment Monitoring System (PRAMS) (n = 5886), instrumental support (physical, hands-on support) and partner emotional support were each categorized as high/low and were combined in a composite measure (high = high on both types, moderate = high on one type, and low = low on both types). PDS were self-reported. Crude and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using logistic regression.

Results: Overall, 9.6% (95% CI = 8.8-10.4) of Illinois postpartum women experienced PDS. Of Illinois postpartum women, 63.5% (95% CI = 62.1-64.9) had high composite support, 29.3% (95% CI = 28.0-30.6) had moderate composite support, and 7.1% (95% CI = 6.4-7.9) had low composite support. After adjustment for maternal characteristics, instrumental support, partner emotional support, and a composite measure of support were each significantly associated with PDS. Compared to women with high composite support, women with low composite support had six times the odds of PDS (aOR = 6.1, 95% CI = 4.5-8.2), and women with moderate composite support had nearly three times the odds of PDS (aOR = 2.7, 95% CI = 2.2-3.4).

Conclusion: PDS was associated with instrumental support, partner emotional support, and a composite measure of support in Illinois postpartum women. This suggests the importance of addressing social support for postpartum individuals.

背景:产后抑郁症(PPD)发生在产后,严重程度和发病时间因人而异。社会支持少的妇女患产后抑郁症的风险可能更高。本研究调查了伊利诺伊州产后妇女的社会支持与自我报告的产后抑郁症状(PDS)之间的关系:利用伊利诺伊州妊娠风险评估监测系统(PRAMS)(n = 5886)中的 2016-2020 年数据,将工具性支持(身体、动手支持)和伴侣情感支持分别归类为高/低,并将其合并为一项综合指标(高 = 两种类型都高;中等 = 一种类型都高;低 = 两种类型都低)。PDS 均为自我报告。采用逻辑回归法计算了粗略和调整后的几率比(aOR)以及 95% 的置信区间(CI):总体而言,9.6%(95% CI = 8.8-10.4)的伊利诺伊州产后妇女经历过 PDS。在伊利诺伊州的产后妇女中,63.5%(95% CI = 62.1-64.9)的综合支持度较高,29.3%(95% CI = 28.0-30.6)的综合支持度中等,7.1%(95% CI = 6.4-7.9)的综合支持度较低。在对产妇特征进行调整后,工具性支持、伴侣情感支持和综合支持均与 PDS 显著相关。与获得高综合支持的女性相比,获得低综合支持的女性发生 PDS 的几率是后者的六倍(aOR = 6.1,95% CI = 4.5-8.2),获得中等综合支持的女性发生 PDS 的几率是后者的近三倍(aOR = 2.7,95% CI = 2.2-3.4):结论:伊利诺伊州产后妇女的 PDS 与工具支持、伴侣情感支持和综合支持措施有关。这表明为产后妇女提供社会支持的重要性。
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引用次数: 0
Postpartum Women's Experiences of Postnatal Care in Sub-Saharan Africa: A Qualitative Evidence Synthesis. 撒哈拉以南非洲产后妇女的产后护理经历:定性证据综述》。
IF 2.8 3区 医学 Q1 NURSING Pub Date : 2024-10-17 DOI: 10.1111/birt.12872
Enos Moyo, Perseverance Moyo, Tafadzwa Dzinamarira, Andrew Ross

Background: Postnatal care (PNC) is a critical service for the health and well-being of new mothers and newborns. However, in sub-Saharan Africa (SSA), most efforts to improve maternal and child health have been directed toward enhancing skilled birth attendance and urgent obstetric and neonatal care. This is despite the fact that more than half of maternal deaths globally occur in the postnatal period, with 65% of these occurring in the first week following birth. One of the health system factors influencing PNC utilization is the women's previous PNC experience at healthcare facilities. The aim of this review was to gain a better understanding of women's experiences of PNC in SSA.

Methods: This study followed a qualitative evidence synthesis design. The phenomenon of interest was postpartum women's experiences of PNC in SSA. PubMed, CINAHL, EMBASE, Science Direct, Africa Journals Online (AJOL), SCOPUS, and Google Scholar were searched for peer-reviewed articles published in English between 2013 and 2023. To assess the quality of the included studies, we used an appraisal tool developed by the Evidence for Policy and Practice Information and Co-ordinating Centre. Two authors independently extracted relevant data from the included studies. Thomas and Harden's thematic synthesis framework was used to synthesize the data.

Results: Eight articles were used in this review. Seven articles reported on qualitative studies, and one reported on a mixed-method study. All the included studies fully or partially met the 12 quality assessment criteria. Synthesis of the data resulted in the development of five analytical themes. The five themes were the adequacy of physical examination and communication of the findings, adequacy of PNC information, the quality of interactions with healthcare workers (HCWs), the availability of resources and adequacy of HCWs, and denial of care. The overall confidence in the review's findings was either moderate or high.

Conclusion: Based on our findings, we recommend that countries in the region address staff shortages, implement task shifting, electronic medicine stock management systems, optimal supply chain policies, and train HCWs on PNC and interpersonal communication skills.

背景:产后护理 (PNC) 是新生儿母亲和新生儿健康和福祉的关键服务。然而,在撒哈拉以南非洲地区(SSA),改善母婴健康的大多数努力都是为了加强熟练助产护理和紧急产科及新生儿护理。尽管全球一半以上的孕产妇死亡发生在产后,其中 65% 发生在产后第一周。影响产前护理利用率的卫生系统因素之一是妇女以前在医疗机构接受产前护理的经历。本综述旨在更好地了解撒哈拉以南非洲地区妇女的 PNC 经验:本研究采用定性证据综合设计。方法:本研究采用定性证据综合设计,关注的现象是 SSA 地区产后妇女对 PNC 的体验。研究人员在 PubMed、CINAHL、EMBASE、Science Direct、Africa Journals Online (AJOL)、SCOPUS 和 Google Scholar 上检索了 2013 年至 2023 年间发表的经同行评审的英文文章。为了评估所收录研究的质量,我们使用了政策与实践证据信息和协调中心(Evidence for Policy and Practice Information and Co-ordinating Centre)开发的评估工具。两位作者独立提取了纳入研究的相关数据。我们采用托马斯和哈登的主题综合框架对数据进行了综合:本综述使用了八篇文章。其中七篇报告了定性研究,一篇报告了混合方法研究。所有纳入的研究都完全或部分符合 12 项质量评估标准。对数据进行综合后,形成了五个分析主题。这五个主题分别是体格检查的充分性和检查结果的传达、新生儿护理信息的充分性、与医护人员(HCWs)互动的质量、资源的可用性和医护人员的充分性以及拒绝护理。审查结果的总体可信度为中等或高等:根据我们的研究结果,我们建议该地区各国解决人员短缺问题,实施任务转移、电子药品库存管理系统、优化供应链政策,并对医护人员进行 PNC 和人际沟通技能培训。
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引用次数: 0
Self-Advocacy Among Black Women During the Perinatal Period: Prevalence and Relationship to Patient Experiences. 围产期黑人妇女的自我辩护:围产期黑人妇女的自我倡导:普遍性及与患者经历的关系。
IF 2.8 3区 医学 Q1 NURSING Pub Date : 2024-10-16 DOI: 10.1111/birt.12885
Teresa Hagan Thomas, Savannah Vetterly, Elizabeth B Kaselitz, Willa Doswell, Betty Braxter

Introduction: Black women experience many barriers to receiving high-quality maternal healthcare. The ability of Black women to self-advocate may mitigate these threats to their health. Limited research describes Black women's self-advocacy during the perinatal period and how self-advocacy related to other relevant concepts. The aim of this study was to describe the relationship between self-advocacy, patient-provider relationships, and mental health outcomes among Black women in the perinatal period.

Methods: This cross-sectional descriptive pilot study recruited Black women who were either in their 3rd trimester of pregnancy or within a year postpartum to complete surveys describing their self-advocacy (Female Self-Advocacy in Cancer Survivorship Scale adapted for perinatal period) and maternal health outcomes (trust and comfort with maternal healthcare providers-Patient-Provider Relationship Scale; abuse and disrespect during childbirth-Mothers of Respect Index; experiences of discrimination-Experiences of Discrimination scale; depression-Edinburgh Postnatal Depression Scale; and postpartum posttraumatic stress-City Birth Trauma Scale).

Results: N = 40 participants were recruited between January and September 2022. Participants reported moderate levels of self-advocacy which were associated with trust and comfort with healthcare providers (r = 0.57-0.76, p < 0.001). Feeling respected by healthcare providers was positively associated with two self-advocacy subscales (r = 0.42-0.44, p < 0.01). Depression was inversely related to all self-advocacy subscales (r = -0.47-0.62, p < 0.001).

Conclusion: Black women's self-advocacy during the perinatal period is associated with trust and comfort with healthcare providers, perceptions of respect from their providers, and perinatal depression. Future research should focus on promoting trusting, respectful relationships between Black women and their maternal health providers.

导言:黑人妇女在接受高质量的孕产妇保健服务时会遇到许多障碍。黑人妇女的自我倡导能力可能会减轻这些对其健康的威胁。有关黑人妇女在围产期的自我主张以及自我主张与其他相关概念的关系的研究有限。本研究的目的是描述围产期黑人妇女的自我倡导、患者-提供者关系和心理健康结果之间的关系:这项横断面描述性试点研究招募了怀孕三个月或产后一年内的黑人妇女,让她们完成自我倡导(根据围产期改编的癌症幸存者女性自我倡导量表)和孕产妇健康结果(与孕产妇医疗保健提供者的信任和舒适度--患者-提供者关系量表;分娩过程中的虐待和不尊重--母亲受尊重指数;歧视经历--歧视经历量表;抑郁--爱丁堡产后抑郁量表;以及产后创伤后应激--城市分娩创伤量表)。结果:2022 年 1 月至 9 月间招募了 N = 40 名参与者。参与者报告了中等水平的自我倡导能力,这与对医疗服务提供者的信任和舒适度有关(r = 0.57-0.76,p 结论:黑人妇女的自我倡导能力与对医疗服务提供者的信任和舒适度有关:黑人妇女在围产期的自我主张与对医疗服务提供者的信任和舒适度、对医疗服务提供者尊重的感知以及围产期抑郁症有关。未来的研究应侧重于促进黑人妇女与孕产妇保健提供者之间相互信任、相互尊重的关系。
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引用次数: 0
One Hundred Years of Seeking Respectful Maternity Care: History and Evolution. 寻求尊重产妇护理的百年历程:历史与演变。
IF 2.8 3区 医学 Q1 NURSING Pub Date : 2024-10-16 DOI: 10.1111/birt.12876
Ellen L Tilden, Rebecca Jungbauer, Erica L Hart, Amy G Cantor

Growing awareness of poor maternal health outcomes and maternal health disparities in the United States has heightened urgency around the need to promote Respectful Maternity Care (RMC) as a fundamental tenet of obstetric/midwifery care and standardize efforts to improve safety, eliminate obstetric violence and racism, and optimize health outcomes for all birthing people. The historical context of prior and contemporary perspectives around childbirth influences our understanding of RMC and are shaped by varying scholarly, clinical, and community standards (e.g., religion, human rights, government, public health, midwifery, ethics, activism, and the law), which have changed significantly since the mid-19th century. In this commentary, we share results of a contextual question scoped as part of a larger systematic review of RMC to help inform consensus around a shared definition and development of a metric to standardize delivery and evaluation of RMC. Synthesis of this literature identified landmark historical influences on RMC over the past 100 years, highlighting the multidisciplinary scholarship and historical context influencing the progress toward RMC. Further understanding of this history may also inform policies and guidance for ongoing efforts to center respect and accountability in all aspects of maternity care, with particular attention to populations who are disproportionally impacted by disrespectful care.

在美国,人们越来越意识到孕产妇健康结果不佳和孕产妇健康不平等的问题,这就更加迫切地需要将 "尊重产妇护理"(RMC)作为产科/助产护理的一项基本原则加以推广,并使其标准化,以提高安全性,消除产科暴力和种族主义,优化所有分娩者的健康结果。自 19 世纪中叶以来,不同的学术、临床和社区标准(如宗教、人权、政府、公共卫生、助产、伦理、激进主义和法律)已发生了显著变化。在这篇评论中,我们分享了一个背景问题的研究结果,该问题是对 RMC 进行更广泛的系统性回顾的一部分,目的是帮助就 RMC 的共同定义和标准制定达成共识,以规范 RMC 的实施和评估。通过对这些文献的综合分析,我们发现了过去 100 年来对 RMC 具有里程碑意义的历史影响,突出了影响 RMC 进展的多学科学术和历史背景。对这一历史的进一步了解也可为政策和指导提供参考,以便在孕产妇护理的各个方面将尊重和问责作为中心工作,并特别关注那些受到不尊重护理过度影响的人群。
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引用次数: 0
Counseling About Cannabis Use During Pregnancy and Lactation: A Qualitative Study of Patient and Clinician Perspectives 关于孕期和哺乳期吸食大麻的咨询:对患者和临床医生观点的定性研究。
IF 2.8 3区 医学 Q1 NURSING Pub Date : 2024-10-11 DOI: 10.1111/birt.12873
Alexandra Cernat, Andrea Carruthers, Shipra Taneja, Anuoluwa Popoola, Devon Greyson, Janelle Panday, Elizabeth Darling, Sarah D. McDonald, Morgan Black, Beth Murray-Davis, Meredith Vanstone

Introduction

Legalization in many jurisdictions has increased the prevalence of cannabis use, including during pregnancy and lactation. Accordingly, clinicians providing perinatal and infant care are increasingly required to counsel about this topic, even if they do not feel comfortable or prepared for this conversation. The aim of this research was to explore how prenatal clinicians and pregnant and lactating women interact with cannabis consumption.

Methods

Using qualitative description, we conducted semi-structured interviews with 75 individuals in Canada: 23 clinicians who provide pregnancy and lactation care, and 52 individuals who made cannabis consumption decisions during pregnancy and/or lactation. Data were analyzed using inductive content analysis.

Results

Three phases of the clinical encounter influenced decision-making about cannabis consumption: initiation of a discussion about cannabis, sense-making, and the outcome of the encounter. Patients and clinicians described similar ideals for a counseling encounter about cannabis consumption during pregnancy or lactation: open, patient-centered conversation grounded in an informed decision-making model to explore the benefits, risks, and alternatives to cannabis. While clinicians described these values as reflecting real clinical interactions, patients reported that in their experience, actual interactions did not live up to these ideals.

Conclusion

Clinicians and pregnant and lactating people report desiring the same things from a counseling interaction about cannabis: sharing of information, identification of values, and facilitation of a decision. Both groups endorse an open, nonjudgemental counseling approach that explores the reasons why a patient is considering cannabis consumption and reflects these reasons against available evidence and alternatives known to be safe.

导言:大麻在许多地区的合法化增加了大麻使用的普遍性,包括在孕期和哺乳期。因此,提供围产期和婴幼儿护理的临床医生越来越多地需要就这一话题提供咨询,即使他们对这种对话感到不自在或没有做好准备。本研究旨在探讨产前临床医生与孕妇和哺乳期妇女如何就大麻消费进行互动:采用定性描述法,我们对加拿大的 75 名个人进行了半结构化访谈:23 名提供孕期和哺乳期护理的临床医生,以及 52 名在孕期和/或哺乳期做出大麻消费决定的个人。我们使用归纳内容分析法对数据进行了分析:临床接触的三个阶段影响了关于吸食大麻的决策:开始关于大麻的讨论、感性认识和接触的结果。患者和临床医生对孕期或哺乳期吸食大麻咨询的理想描述相似:开放、以患者为中心的对话,以知情决策模式为基础,探讨大麻的益处、风险和替代品。虽然临床医生认为这些价值观反映了真实的临床互动,但患者报告说,在他们的经历中,实际的互动并没有达到这些理想:结论:临床医生和孕妇及哺乳期妇女都希望从有关大麻的咨询互动中获得相同的东西:分享信息、确定价值观和促进做出决定。这两类人都赞同开放、不做评判的咨询方法,这种方法可以探究患者考虑吸食大麻的原因,并根据现有证据和已知安全的替代品来反映这些原因。
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引用次数: 0
Return-on-Investment Analysis of an Enhanced Community Doula Program: Pre- and Post-COVID-19 Considerations. 强化社区 Doula 计划的投资回报分析:COVID-19 前后的考虑因素。
IF 2.8 3区 医学 Q1 NURSING Pub Date : 2024-10-11 DOI: 10.1111/birt.12886
Julie Mottl-Santiago, Dmitry Dukhovny, Emily Feinberg, Jennifer Moore, Victoria Parker, Howard Cabral, Diana Bowser, Gene Declercq

Background: Community doulas are perinatal health workers who provide peer education, resource navigation, and support during pregnancy, childbirth, and the postpartum period. Evidence suggests that doulas improve the experience of care, reduce cesarean birth, and improve breastfeeding outcomes. However, people with low incomes cannot access affordable community doula support in most states due to lack of insurance reimbursement. To determine the affordability of Medicaid reimbursement for doula services, there is a need to fill a gap in research that employs real-world data and a return-on-investment (ROI) analysis approach.

Methods: We conducted a ROI analysis from the healthcare perspective of an enhanced community doula intervention, Best Beginnings for Babies (BBB). Healthcare and program cost data were collected alongside clinical outcomes from a randomized controlled trial of routine maternity care at Boston Medical Center with and without BBB. ROI was calculated as the net healthcare savings divided by the investment costs. Post-COVID-19 program costing estimates were also performed.

Results: Average healthcare costs per patient were $18,969 for the BBB group compared with $20,121 for routine care, a savings of $1,152. BBB program costs were an average of $971 per person. There was an 18% ROI. Lower costs for the birth hospitalization and NICU stays accounted for the largest areas of savings. Per-person program costs using proposed MassHealth fees produced a positive return on investment, although 2023 hospital doula program wages and salaries did not.

Discussion: The BBB-enhanced community doula program was cost-saving to payers and increased access to doula support for low-income people. Even with post-COVID-19 increases in program costs, analysis demonstrated doula support was still financially feasible. This study should reassure budget-conscious Medicaid payers that doula services are affordable.

背景:社区朵拉是围产期保健工作者,她们在怀孕、分娩和产后期间提供同伴教育、资源导航和支持。有证据表明,朵拉可改善护理体验、减少剖宫产并改善母乳喂养结果。然而,在大多数州,由于缺乏保险报销,低收入人群无法获得负担得起的社区朵拉支持。为了确定医疗补助(Medicaid)报销朵拉服务的可负担性,有必要填补采用真实世界数据和投资回报率(ROI)分析方法的研究空白:我们从医疗保健的角度对增强型社区朵拉干预--"婴儿的最佳开端"(BBB)--进行了投资回报率分析。我们收集了医疗保健和项目成本数据,以及波士顿医疗中心常规产科护理随机对照试验的临床结果。投资回报率的计算方法是:节省的医疗费用除以投资成本。此外,还对 COVID-19 后的项目成本进行了估算:BBB组每位患者的平均医疗成本为18,969美元,而常规医疗成本为20,121美元,节省了1,152美元。BBB 计划的平均成本为每人 971 美元。投资回报率为 18%。分娩住院和新生儿重症监护室住院费用的降低是最大的节省领域。尽管2023年医院朵拉项目的工资和薪金没有产生正的投资回报,但使用建议的MassHealth费用计算的人均项目成本产生了正的投资回报:讨论:BBB增强型社区朵拉项目为支付者节约了成本,并增加了低收入人群获得朵拉支持的机会。即使COVID-19后项目成本增加,分析表明朵拉支持在经济上仍然是可行的。这项研究应该让有预算意识的医疗补助支付者放心,朵拉服务是负担得起的。
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引用次数: 0
Birth Outcomes and Prenatal Care Use in the U.S. During the COVID-19 Pandemic in 2020 and 2021. 2020 年和 2021 年 COVID-19 大流行期间美国的分娩结果和产前护理使用情况。
IF 2.8 3区 医学 Q1 NURSING Pub Date : 2024-10-11 DOI: 10.1111/birt.12890
Wei Lyu, George L Wehby

Background: The COVID-19 pandemic has posed substantial social and economic disruptions that may have had adverse effects on maternal and infant health. This study examines the changes in birth outcomes and prenatal care use during the COVID-19 pandemic in 2020 and 2021 compared to pre-pandemic years.

Methods: Data come from birth certificates from the U.S. Vital Statistics Natality Files. The analytical sample includes 18,678,327 births in the 50 states and Washington, DC between 2017 and 2021. An event study is employed to examine changes in multiple birth outcomes and prenatal care use over years adjusting for demographic/socioeconomic characteristics and state of residence.

Results: There were very small changes in birth outcomes during pandemic years in 2020 and 2021. Specifically, low birth weight odds were lower in 2020 (OR = 0.99; 95 CI: 0.98-0.99) but higher in 2021 (OR = 1.03; 95% CI: 1.03-1.04) compared to 2019. C-section odds were higher in 2021 (OR = 1.01, 95% CI: 1.002-1.008) than in 2019. The mean number of prenatal visits in both 2020 and 2021 relative to 2019 was lower by about 0.3 visits (95% CI: -0.31 to -0.30 in 2021).

Conclusion: Overall, there is no evidence of broad pandemic effects on low birth weight and preterm birth in 2020-2021.

背景:COVID-19 大流行造成了严重的社会和经济混乱,可能会对母婴健康产生不利影响。本研究探讨了 2020 年和 2021 年 COVID-19 大流行期间与大流行前相比,出生结果和产前护理使用情况的变化:数据来自美国生命统计出生档案的出生证明。分析样本包括 2017 年至 2021 年期间 50 个州和华盛顿特区的 18,678,327 例新生儿。研究采用事件研究的方法,在对人口/社会经济特征和居住州进行调整后,考察多年来多胎分娩结果和产前护理使用情况的变化:结果:在 2020 年和 2021 年的大流行年,出生结果的变化非常小。具体而言,与 2019 年相比,2020 年的低出生体重几率较低(OR = 0.99; 95 CI: 0.98-0.99),但 2021 年的几率较高(OR = 1.03; 95 CI: 1.03-1.04)。2021 年的剖腹产几率(OR = 1.01,95% CI:1.002-1.008)高于 2019 年。与 2019 年相比,2020 年和 2021 年的平均产前检查次数减少了约 0.3 次(95% CI:2021 年为-0.31 至-0.30):总体而言,没有证据表明 2020-2021 年大流行会对低出生体重儿和早产儿产生广泛影响。
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引用次数: 0
Settler Midwifery: A Colonial Tool in Canada's Reproductive Healthcare System. 定居者助产术:加拿大生殖保健系统中的殖民工具》(Settler Midwifery: A Colonial Tool in Canada's Reproductive Healthcare System)。
IF 2.8 3区 医学 Q1 NURSING Pub Date : 2024-10-11 DOI: 10.1111/birt.12888
Melanie Murdock, Sarah Durant

Introduction: The land we call Canada is a settler colonial country where reproductive healthcare is used as a mechanism to control, subjugate, and erase Indigenous people and to advance the White settler state. Healthcare providers play an integral role in the healthcare system and contribute to Canada's colonization. In this piece, we critically analyze how settler midwifery is complicit with colonialism in reproductive healthcare by exploring the history of midwifery in Canada, midwifery education, and contemporary settler midwifery.

Discussion: European settlers omitted the history of Indigenous midwifery in Canada and to justify their erasure, they conceptualized Indigenous Peoples as uncivilized and their birthing practices as substandard. To establish a colonial healthcare system, settler midwives replaced traditional Indigenous birth attendants. When midwifery became regulated, midwives were required to train in formal post-secondary institutions that sustain colonial logics, systems, and practices. Midwifery education programs maintain colonialism by reinforcing medicalized Western practices and sustaining barriers to the growth of Indigenous midwifery. As a result, Western birthing practices are widespread among settler midwives and Indigenous Peoples face barriers to comprehensive and culturally sensitive care. To decolonize Canadian midwifery, we must dismantle stereotypes about Indigenous Peoples and their birthing practices in historical narratives, implement an anti-colonial approach to midwifery education, support Indigenous midwives in returning birth home, and improve the provision of culturally sensitive care.

Conclusion: Settler midwifery in Canada is complicit in colonialism; building anti-colonial alliances can help support Indigenous midwives in leading a decolonial future for reproduction and birthing.

导言:我们称之为加拿大的这片土地是一个殖民者定居的国家,在这里,生殖保健被用作控制、征服和抹杀土著人以及推进白人定居者国家的一种机制。医疗保健提供者在医疗保健系统中扮演着不可或缺的角色,为加拿大的殖民化做出了贡献。在这篇文章中,我们通过探讨加拿大助产历史、助产教育和当代定居者助产,批判性地分析了定居者助产如何在生殖医疗中与殖民主义同流合污:欧洲定居者遗漏了加拿大土著助产士的历史,为了证明他们的遗漏是合理的,他们将土著居民概念化为未开化的人,并将他们的分娩方式视为不合格。为了建立殖民时期的医疗保健体系,定居者的助产士取代了传统的土著助产士。当助产受到管制后,助产士必须在正规的中学后教育机构接受培训,这些机构维持着殖民逻辑、制度和做法。助产士教育计划通过强化医疗化的西方做法和持续阻碍土著助产士的发展来维护殖民主义。因此,西式分娩方法在定居者助产士中非常普遍,而土著居民在获得全面的、文化敏感的护理方面面临障碍。要实现加拿大助产服务的非殖民化,我们必须消除历史叙事中对土著居民及其分娩方式的成见,在助产教育中采用反殖民主义的方法,支持土著助产士将分娩带回家,并改善文化敏感性护理的提供:结论:加拿大的定居助产士与殖民主义同流合污;建立反殖民主义联盟有助于支持土著助产士引领生殖和分娩的非殖民化未来。
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引用次数: 0
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Birth-Issues in Perinatal Care
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