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Gender and Sex Inclusive Approaches for Discussing Predicted Fetal Sex: A Call for Reflection and Research. 讨论预测胎儿性别的性别和性别包容方法:呼吁反思与研究。
Pub Date : 2024-07-18 DOI: 10.1111/jmwh.13663
Hannah Llorin, Tiffany Lundeen, Elizabeth Collins, Claudia Geist, Kyl Myers, Susanna R Cohen, Kimberly Zayhowski
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引用次数: 0
Antenatal Care Visits, Institutional Births, and Associated Risk Factors in Afghanistan: Insights from the Multiple Indicator Cluster Survey 2022-2023. 阿富汗的产前护理就诊率、住院分娩率及相关风险因素:2022-2023 年多指标类集调查的启示》。
Pub Date : 2024-07-12 DOI: 10.1111/jmwh.13666
Jahar Bhowmik, Lakma Gunarathne, Sunil Bhar, Udayan Bhowmik, Raaj Kishore Biswas

Introduction: Insufficient use of antenatal care (ANC) services and institutional births services can elevate the maternal mortality risk in limited resource settings. Hence, the key objective of this study was to evaluate the potential association between the frequency of ANC visits and institutional birth services in Afghanistan, while also identifying other sociodemographic factors that may exert influence. Furthermore, we explored factors associated with the attendance of women at ANC visits during their pregnancy.

Methods: We employed data from the most recent Multiple Indicator Cluster Survey conducted in Afghanistan in 2022 to 2023 with a total of 8096 women aged 15 to 49. A complex survey weight-adjusted logistic regression model was used to examine factors related to institutional births, and a multinomial logistic regression model was fitted to assess the relationships between sociodemographic factors and ANC visits, adjusting for survey weights, cluster effects, and strata.

Results: Approximately 40% of the sample (n = 3247) had undergone 4 or more ANC visits, and 74.4% (n = 6,022) had opted for institutional birth. Women's higher education was found to be associated with ANC visits. The area of residence, wealth index, education levels of women, ownership of mobile phones, number of children, and number of ANC visits were associated with institutional births. Compared with women with no or one ANC visit, those with more than 3 visits had 31% higher odds (adjusted odds ratio, 1.31; 95% CI, 1.10-1.57) of accessing institutional births.

Discussion: Our findings indicate a significant association between ANC visits and use of institutional birth care. These findings carry implications for advancing safe motherhood and childbirth by enhancing women's social status.

导言:在资源有限的情况下,产前检查(ANC)服务和住院分娩服务使用不足会增加孕产妇死亡风险。因此,本研究的主要目的是评估阿富汗产前检查频率与住院分娩服务之间的潜在关联,同时确定可能产生影响的其他社会人口因素。此外,我们还探讨了妇女在怀孕期间接受产前检查的相关因素:我们采用了 2022 年至 2023 年在阿富汗进行的最新多指标类集调查的数据,共调查了 8096 名 15 至 49 岁的妇女。我们采用了一个复杂的调查权重调整逻辑回归模型来研究住院分娩的相关因素,并拟合了一个多叉逻辑回归模型来评估社会人口学因素与产前保健就诊之间的关系,同时对调查权重、集群效应和分层进行了调整:约 40% 的样本(n = 3247)接受过 4 次或更多次产前检查,74.4% 的样本(n = 6022)选择了住院分娩。研究发现,妇女接受高等教育与产前检查次数有关。居住地区、财富指数、妇女教育水平、手机拥有量、子女数量和产前检查次数与住院分娩有关。与未接受过产前检查或仅接受过一次产前检查的妇女相比,接受过 3 次以上产前检查的妇女接受住院分娩的几率要高出 31%(调整后的几率比为 1.31;95% CI 为 1.10-1.57):讨论:我们的研究结果表明,产前检查次数与使用住院分娩护理之间存在重大关联。这些发现对通过提高妇女的社会地位来促进安全孕产具有重要意义。
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引用次数: 0
Midwives' and Obstetric Physicians' Practices Related to Pregnancy Nutrition Counseling: A Scoping Review. 助产士和产科医生的孕期营养咨询实践:范围审查。
Pub Date : 2024-07-10 DOI: 10.1111/jmwh.13661
Katherine Erbe, Kylea Liese, Lisa Tussing-Humphreys, Elizabeth Lerner Papautsky, Julienne Rutherford, Mary Dawn Koenig

Introduction: Dietary intake during pregnancy impacts short- and long-term maternal and fetal health outcomes. Dietary habits are highly individualized and influenced by contextual factors and social determinants of health within each person's lived environment. Midwives and other health care providers are well positioned to facilitate nutrition conversations and interventions with patients related to recommendations and modifications before and during pregnancy. This scoping review synthesizes the literature on perinatal care providers' attitudes and practices related to antenatal nutrition counseling.

Methods: An electronic database literature search was conducted in March 2023 using the following inclusion criteria: English language, published between 1990 and 2023, completed in high-income countries, and evaluated provider practices related to educating pregnancy patients on nutrition. Exclusion criteria included comparison or interventional studies as well as those focused on patient perspectives, specialty diets, comorbidities, or pregnancy complications. Thematic analysis was completed to identify common themes and subthemes across studies related to perinatal care providers' perspectives of pregnancy nutrition.

Results: Thirty-six articles were included in the final review. Although providers acknowledged the importance of nutrition for pregnancy outcomes, few reported being able to cover the topic in-depth during antenatal visits. Counseling was usually generalized, limited in scope, and lacked consideration of patient-specific contextual factors such as dietary restrictions, preferences, or access to resources needed to follow recommendations. Provider barriers to comprehensive nutrition counseling included lack of training and time during clinic visits and limited availability of guidelines.

Discussion: Multiple gaps in current pregnancy nutrition counseling practices exist. Despite nutrition being viewed by perinatal care providers as an important part of pregnancy, multiple barriers lead to it being overlooked during patient-provider interactions. Contextual factors for both providers and patients contribute to failure of current interventions to consistently and significantly impact dietary habits of pregnant people.

导言:怀孕期间的饮食摄入会影响孕产妇和胎儿的短期和长期健康结果。饮食习惯是高度个性化的,受到每个人生活环境中的环境因素和决定健康的社会因素的影响。助产士和其他医疗服务提供者能够很好地促进与患者的营养对话,并就孕前和孕期的建议和调整进行干预。本综述综述了围产期保健提供者对产前营养咨询的态度和做法的相关文献:于 2023 年 3 月进行了电子数据库文献检索,纳入标准如下:英语,发表于 1990 年至 2023 年之间,在高收入国家完成,评估了医疗服务提供者对孕期患者进行营养教育的相关实践。排除标准包括对比研究或干预研究,以及关注患者观点、特殊饮食、合并症或妊娠并发症的研究。研究人员完成了主题分析,以确定与围产期保健提供者对孕期营养的看法有关的各项研究的共同主题和次主题:结果:36 篇文章被纳入最终综述。尽管医疗服务提供者承认营养对妊娠结果的重要性,但很少有人报告说他们能够在产前检查中深入探讨这一主题。咨询通常是泛泛而谈,范围有限,没有考虑到患者的具体情况,如饮食限制、偏好或获得遵循建议所需的资源。提供者进行全面营养咨询的障碍包括缺乏培训和门诊时间,以及指南的可获得性有限:讨论:目前的孕期营养咨询实践存在多种缺陷。尽管围产期保健提供者认为营养是孕期的重要组成部分,但多种障碍导致营养问题在患者与提供者的互动中被忽视。服务提供者和患者的环境因素导致目前的干预措施无法持续、显著地影响孕妇的饮食习惯。
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引用次数: 0
The Role of Midwives in US Perinatal Palliative Care: A Scoping Review. 助产士在美国围产期姑息治疗中的作用:范围审查。
Pub Date : 2024-07-09 DOI: 10.1111/jmwh.13664
Robyn Schafer, Jenna A LoGiudice, Pamela Hargwood, Abigail Wilpers

Introduction: Perinatal palliative care (PPC) is a rapidly growing and essential reproductive health care option for pregnant persons with a diagnosed life-limiting fetal condition who continue their pregnancy. The provision of PPC is within the scope of basic midwifery competencies, and midwives are well-positioned to make unique and valuable contributions to interprofessional PPC teams. However, little is known about midwives' past or current involvement in PPC in the United States.

Methods: This scoping review of the literature investigated what is known about the role of midwives in PPC in the United States. Multiple databases of published literature were used for this review: PubMed, CINAHL, Embase, Web of Science, ProQuest, Google Scholar, and relevant citations from identified studies. All types of English language publications addressing midwives' involvement in PPC in the United States were included, without any limitations on publication date.

Results: The role and contributions of midwives in PPC is not well represented in existing literature. Of the 259 results identified, 7 publications met criteria for inclusion. These included 5 case reports, one quantitative research article, and one conference abstract. Midwives are involved in PPC through the provision of direct clinical care (including antepartum, intrapartum, postpartum, neonatal, bereavement, postmortem, and follow-up care) and care planning and coordination as part of an interprofessional team.

Discussion: Despite midwives being uniquely positioned to provide holistic, family-centered, and person-centered care in situations of pregnancy with life-limiting fetal conditions, there is limited literature about their involvement in PPC in the United States. PPC should be incorporated into midwifery education and training programs. Midwives should play a central role in shaping future research and policies to ensure the accessibility and quality of PPC.

简介:围产期姑息治疗(PPC)是一种快速发展的重要生殖健康护理方式,适用于已确诊胎儿患有危及生命的疾病并继续妊娠的孕妇。提供姑息治疗属于助产士的基本能力范围,助产士完全有能力为跨专业姑息治疗团队做出独特而宝贵的贡献。然而,在美国,人们对助产士过去或现在参与 PPC 的情况知之甚少:本文献综述调查了美国助产士在全科护理中的作用。本综述使用了多个已发表文献的数据库:PubMed、CINAHL、Embase、Web of Science、ProQuest、Google Scholar,以及已确定研究的相关引文。所有涉及助产士在美国参与人流手术的英文出版物均被纳入,对出版日期没有任何限制:结果:助产士在 PPC 中的作用和贡献在现有文献中并没有得到很好的体现。在确定的 259 项结果中,有 7 篇出版物符合纳入标准。其中包括 5 篇病例报告、1 篇定量研究文章和 1 篇会议摘要。助产士通过提供直接临床护理(包括产前、产中、产后、新生儿、丧亲、死后和后续护理)以及作为跨专业团队的一部分进行护理规划和协调来参与 PPC:尽管助产士具有独特的优势,能够在妊娠期胎儿出现危及生命的情况下提供全面、以家庭为中心、以人为本的护理,但在美国,有关助产士参与全人护理的文献却十分有限。助产士教育和培训计划中应纳入 PPC。助产士应在制定未来的研究和政策方面发挥核心作用,以确保 PPC 的可及性和质量。
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引用次数: 0
Patient-Provider Trust as a Key Component of Prenatal Screening for Adverse Childhood Experiences (ACES): A Concept Analysis. 患者与医疗服务提供者之间的信任是产前筛查儿童不良经历 (ACES) 的关键要素:概念分析。
Pub Date : 2024-06-30 DOI: 10.1111/jmwh.13660
Paige D Gilliland, Jennifer E Phipps, Breän Derret, Indira D'Souza, Stephanie Ha, Shwetha Patil, Leigh Ann Simmons

Introduction: The concept of patient-provider trust in prenatal adverse childhood experiences (ACEs) screening remains unexplored. This concept analysis illuminates the role of trust in prenatal ACE screening to improve patient-provider relationships, increase patient uptake of ACE screening, and ensure that ACE screening is implemented in a strengths-based, trauma-informed way.

Methods: A concept analysis was conducted using the Rodgers' evolutionary method to define the antecedents, attributes, and consequences of this construct. The databases searched were PubMed, PsychInfo, and Scopus between 2010 and 2021. A total of 389 articles were retrieved using the search terms prenatal, adverse childhood experiences screening, adverse childhood experiences, and adverse childhood experiences questionnaire. Included articles for detailed review contained prenatal screening, trauma screening (ACE or other), trust or building trust between patient and health care provider, patient engagement, and shared decision making. Excluded articles were those not in the context of prenatal care and that were exclusively about screening with no discussion about the patient-provider relationship or patient perspectives. A total of 32 articles were reviewed for this concept analysis.

Results: We define trust in prenatal ACE screening as a network of evidence-based attributes that include the timing of the screening, patient familiarity with the health care provider, cultural competence, demystifying trauma, open dialogue between the patient and health care provider, and patient comfort and respect.

Discussion: This concept analysis elucidates the importance of ACE screening and provides suggestions for establishing trust in the context of prenatal ACE screening. Results give insight and general guidance for health care providers looking to implement ACE screening in a trauma-informed way. Further research is needed to evaluate pregnant patients' attitudes toward ACE screening and how a health care provider's trauma history might influence their care. More inquiry is needed to understand the racial, ethnic, and cultural barriers to ACE screening.

导言:在产前儿童不良经历(ACE)筛查中,患者与医疗服务提供者之间的信任概念仍未得到探讨。本概念分析阐明了信任在产前 ACE 筛查中的作用,以改善患者与提供者之间的关系,提高患者对 ACE 筛查的接受度,并确保 ACE 筛查以优势为基础、创伤知情的方式实施:方法:采用罗杰斯进化法进行了概念分析,以确定该结构的前因、属性和后果。检索的数据库包括 PubMed、PsychInfo 和 Scopus(2010 年至 2021 年)。以产前、童年不良经历筛查、童年不良经历和童年不良经历问卷为检索词,共检索到 389 篇文章。纳入详细审查的文章包括产前筛查、创伤筛查(ACE 或其他)、信任或建立患者与医疗服务提供者之间的信任、患者参与和共同决策。被排除在外的文章不包括产前护理方面的文章,也不包括只涉及筛查而未讨论患者与医护人员关系或患者观点的文章。本次概念分析共审阅了 32 篇文章:我们将产前 ACE 筛查中的信任定义为基于证据的属性网络,其中包括筛查时机、患者对医疗服务提供者的熟悉程度、文化能力、揭开创伤的神秘面纱、患者与医疗服务提供者之间的坦诚对话以及患者的舒适感和尊重:本概念分析阐明了 ACE 筛查的重要性,并为在产前 ACE 筛查中建立信任提供了建议。研究结果为希望以创伤知情方式实施 ACE 筛查的医疗服务提供者提供了见解和一般指导。还需要进一步的研究来评估孕妇对 ACE 筛查的态度,以及医疗服务提供者的创伤史会如何影响他们的治疗。还需要进行更多的调查,以了解 ACE 筛查的种族、民族和文化障碍。
{"title":"Patient-Provider Trust as a Key Component of Prenatal Screening for Adverse Childhood Experiences (ACES): A Concept Analysis.","authors":"Paige D Gilliland, Jennifer E Phipps, Breän Derret, Indira D'Souza, Stephanie Ha, Shwetha Patil, Leigh Ann Simmons","doi":"10.1111/jmwh.13660","DOIUrl":"https://doi.org/10.1111/jmwh.13660","url":null,"abstract":"<p><strong>Introduction: </strong>The concept of patient-provider trust in prenatal adverse childhood experiences (ACEs) screening remains unexplored. This concept analysis illuminates the role of trust in prenatal ACE screening to improve patient-provider relationships, increase patient uptake of ACE screening, and ensure that ACE screening is implemented in a strengths-based, trauma-informed way.</p><p><strong>Methods: </strong>A concept analysis was conducted using the Rodgers' evolutionary method to define the antecedents, attributes, and consequences of this construct. The databases searched were PubMed, PsychInfo, and Scopus between 2010 and 2021. A total of 389 articles were retrieved using the search terms prenatal, adverse childhood experiences screening, adverse childhood experiences, and adverse childhood experiences questionnaire. Included articles for detailed review contained prenatal screening, trauma screening (ACE or other), trust or building trust between patient and health care provider, patient engagement, and shared decision making. Excluded articles were those not in the context of prenatal care and that were exclusively about screening with no discussion about the patient-provider relationship or patient perspectives. A total of 32 articles were reviewed for this concept analysis.</p><p><strong>Results: </strong>We define trust in prenatal ACE screening as a network of evidence-based attributes that include the timing of the screening, patient familiarity with the health care provider, cultural competence, demystifying trauma, open dialogue between the patient and health care provider, and patient comfort and respect.</p><p><strong>Discussion: </strong>This concept analysis elucidates the importance of ACE screening and provides suggestions for establishing trust in the context of prenatal ACE screening. Results give insight and general guidance for health care providers looking to implement ACE screening in a trauma-informed way. Further research is needed to evaluate pregnant patients' attitudes toward ACE screening and how a health care provider's trauma history might influence their care. More inquiry is needed to understand the racial, ethnic, and cultural barriers to ACE screening.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141474019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Economic, Psychological, and Emotional Well-Being of Pregnant Women During the COVID-19 Pandemic. COVID-19 大流行期间孕妇的经济、心理和情感福祉。
Pub Date : 2024-06-23 DOI: 10.1111/jmwh.13659
Kamal M Eldeirawi, Victoria W Persky, Cameron Zielke, Ellen Goldstein, Olivia Bimbi, Jennifer Saenz, Zane Mustafa, Tamara A Jumah, Xavier R Ramirez, Ali Aldirawi, Laurie Quinn, Rosalba Hernandez

Introduction: The intersection between perinatal mental health and the coronavirus disease 2019 (COVID-19) pandemic remains of significant public health importance. The current study examined the emotional and financial well-being and predictors of elevated depressive symptoms among pregnant women during the COVID-19 pandemic.

Methods: This online survey was conducted with 2118 women ≥18 years old who were pregnant at the time of the survey and living in the United States or Puerto Rico. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale, with scores ≥10 indicative of elevated depressive symptoms. The final logistic regression model included housing insecurity, financial distress, COVID-19 diagnosis, exposure to COVID-19, and demographic covariates.

Results: More than half the sample (53.8%) had elevated depressive symptoms. In logistic regression analyses, the odds of having elevated depressive symptoms were significantly higher for participants reporting housing insecurity (adjusted odds ratio [aOR], 1.56; 95% CI, 1.22-2.01), financial distress (aOR, 1.57; 95% CI, 1.17-2.12), COVID-19 diagnosis (aOR, 2.53; 95% CI, 1.53-4.17), and COVID-19 exposure (aOR, 1.41; 95% CI, 1.07-1.86), after adjusting for covariates. The association of elevated depressive symptoms with housing insecurity was especially strong among those who experienced COVID-19 (aOR, 6.04; 95% CI, 2.15-17.0).

Discussion: Our findings are consistent with previous literature revealing that diagnosis, exposure, concerns about family, and effects on financial stability were related to depressive symptoms during the pandemic. The relationships between financial and housing concerns with elevated depressive symptoms, independent of concerns about infection in family members, suggest that there may be direct and indirect effects of the pandemic on mental health.

导言:围产期心理健康与 2019 年冠状病毒病(COVID-19)大流行之间的交叉点仍然具有重要的公共卫生意义。本研究调查了 COVID-19 大流行期间孕妇的情绪和财务状况以及抑郁症状升高的预测因素:这项在线调查的对象是 2118 名年龄≥18 岁的女性,她们在接受调查时已经怀孕,并居住在美国或波多黎各。抑郁症状采用流行病学研究中心抑郁量表(Center for Epidemiologic Studies Depression Scale)进行评估,得分≥10 分表示抑郁症状加重。最终的逻辑回归模型包括住房不安全、经济窘迫、COVID-19 诊断、COVID-19 暴露和人口统计学协变量:结果:半数以上的样本(53.8%)有加重的抑郁症状。在逻辑回归分析中,报告住房无保障的参与者抑郁症状加重的几率明显更高(调整后的几率比 [aOR],1.56;95% CI,1.22-2.01)、经济窘迫(aOR,1.57;95% CI,1.17-2.12)、COVID-19 诊断(aOR,2.53;95% CI,1.53-4.17)和 COVID-19 暴露(aOR,1.41;95% CI,1.07-1.86)。在经历过 COVID-19 的人群中,抑郁症状升高与住房不安全的关系尤为密切(aOR,6.04;95% CI,2.15-17.0):我们的研究结果与之前的文献一致,这些文献显示,诊断、接触、对家庭的担忧以及对经济稳定性的影响与大流行期间的抑郁症状有关。经济和住房问题与抑郁症状升高之间的关系与对家庭成员感染的担忧无关,这表明大流行病可能会对心理健康产生直接和间接的影响。
{"title":"Economic, Psychological, and Emotional Well-Being of Pregnant Women During the COVID-19 Pandemic.","authors":"Kamal M Eldeirawi, Victoria W Persky, Cameron Zielke, Ellen Goldstein, Olivia Bimbi, Jennifer Saenz, Zane Mustafa, Tamara A Jumah, Xavier R Ramirez, Ali Aldirawi, Laurie Quinn, Rosalba Hernandez","doi":"10.1111/jmwh.13659","DOIUrl":"https://doi.org/10.1111/jmwh.13659","url":null,"abstract":"<p><strong>Introduction: </strong>The intersection between perinatal mental health and the coronavirus disease 2019 (COVID-19) pandemic remains of significant public health importance. The current study examined the emotional and financial well-being and predictors of elevated depressive symptoms among pregnant women during the COVID-19 pandemic.</p><p><strong>Methods: </strong>This online survey was conducted with 2118 women ≥18 years old who were pregnant at the time of the survey and living in the United States or Puerto Rico. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale, with scores ≥10 indicative of elevated depressive symptoms. The final logistic regression model included housing insecurity, financial distress, COVID-19 diagnosis, exposure to COVID-19, and demographic covariates.</p><p><strong>Results: </strong>More than half the sample (53.8%) had elevated depressive symptoms. In logistic regression analyses, the odds of having elevated depressive symptoms were significantly higher for participants reporting housing insecurity (adjusted odds ratio [aOR], 1.56; 95% CI, 1.22-2.01), financial distress (aOR, 1.57; 95% CI, 1.17-2.12), COVID-19 diagnosis (aOR, 2.53; 95% CI, 1.53-4.17), and COVID-19 exposure (aOR, 1.41; 95% CI, 1.07-1.86), after adjusting for covariates. The association of elevated depressive symptoms with housing insecurity was especially strong among those who experienced COVID-19 (aOR, 6.04; 95% CI, 2.15-17.0).</p><p><strong>Discussion: </strong>Our findings are consistent with previous literature revealing that diagnosis, exposure, concerns about family, and effects on financial stability were related to depressive symptoms during the pandemic. The relationships between financial and housing concerns with elevated depressive symptoms, independent of concerns about infection in family members, suggest that there may be direct and indirect effects of the pandemic on mental health.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Perspectives of Certified Nurse-Midwives and Physicians on the Structural and Institutional Barriers that Contribute to the Reproductive Inequities of Black Birthing People in the San Francisco Bay Area. 注册助产士和医生对造成旧金山湾区黑人生育不平等的结构性和制度性障碍的看法。
Pub Date : 2024-02-18 DOI: 10.1111/jmwh.13614
Tamara J Nelson, Brittany D Chambers Butcher, Ana Delgado, Monica R McLemore

Introduction: Black birthing people in the United States disproportionately endure inequitable experiences and outcomes during pregnancy and childbirth via structural, interpersonal, and obstetric racism. In this study, the researchers explore provider perspectives of how racism is perpetuated in institutional perinatal and reproductive health care.

Methods: Critical Race Theory, Reproductive Justice, and midwifery theory were operationalized through secondary thematic analysis of existing qualitative data from the Community Racial Equity and Training Interventions and Evaluation of Current and Future Healthcare Clinicians Study. Twenty-four perinatal providers (certified nurse-midwives [n = 7] and physicians [n = 17]) voluntarily participated in interviews. A comparative approach was used to determine how professional identity and model of care influence physicians' and certified nurse-midwives' perceptions of equity.

Results: Thematic analysis produced 5 themes: racism as a comorbidity, health care systems' inability to address the needs of Black birthing people, health care systems prioritizing providers over patients are failed systems, patients are the experts in the optimal health care model, and benefits of interprofessional teams grounded in Reproductive Justice. Additionally, both physicians and midwives expressed a need for a new care model.

Discussion: With these findings, our team proposes a modification of the midwifery model for application by all provider types that could radically shift the experience and outcomes of perinatal and reproductive health care and reduce mortality. Using a human rights approach to care, a Reproductive Justice-Public Health Critical Race praxis-informed midwifery model may be operationalized by all perinatal and reproductive health care providers. This novel model reflects an iterative process that may offer institutions and providers methods to build on past research supporting midwifery-centered care for improving outcomes for all patients by specifically focusing on improving care of Black birthing people. The implications of this work offer broad application in current clinical practice, quality improvement, research, technology, and patient resources.

导言:在美国,由于结构性、人际关系和产科方面的种族主义,黑人分娩者在怀孕和分娩期间承受了过多不公平的经历和结果。在本研究中,研究人员探讨了医疗服务提供者对种族主义如何在机构围产期和生殖健康护理中长期存在的看法:研究方法:通过对 "社区种族平等和培训干预以及当前和未来医疗保健临床医生评估研究 "中的现有定性数据进行二次专题分析,将批判性种族理论、生殖正义和助产理论具体化。24 名围产期医疗服务提供者(注册助产士 [n = 7] 和医生 [n = 17])自愿参加了访谈。采用比较法确定专业身份和护理模式如何影响医生和注册助产士对公平的看法:专题分析产生了 5 个主题:种族主义是一种并发症、医疗保健系统无法满足黑人分娩者的需求、医疗保健系统将提供者置于患者之上是失败的系统、患者是最佳医疗保健模式中的专家,以及以生殖正义为基础的跨专业团队的益处。此外,医生和助产士都表示需要一种新的医疗模式:讨论:根据上述研究结果,我们的团队提出了一种助产士模式的修改方案,供所有类型的医疗服务提供者使用,该方案可从根本上改变围产期和生殖健康护理的体验和结果,并降低死亡率。利用人权护理方法,所有围产期和生殖健康服务提供者都可以操作以生殖正义-公共卫生关键种族实践为基础的助产模式。这种新颖的模式反映了一个迭代过程,可为医疗机构和医疗服务提供者提供方法,在过去支持以助产为中心的护理的研究基础上,通过特别关注改善对黑人分娩者的护理来改善所有患者的治疗效果。这项工作的意义可广泛应用于当前的临床实践、质量改进、研究、技术和患者资源。
{"title":"Perspectives of Certified Nurse-Midwives and Physicians on the Structural and Institutional Barriers that Contribute to the Reproductive Inequities of Black Birthing People in the San Francisco Bay Area.","authors":"Tamara J Nelson, Brittany D Chambers Butcher, Ana Delgado, Monica R McLemore","doi":"10.1111/jmwh.13614","DOIUrl":"https://doi.org/10.1111/jmwh.13614","url":null,"abstract":"<p><strong>Introduction: </strong>Black birthing people in the United States disproportionately endure inequitable experiences and outcomes during pregnancy and childbirth via structural, interpersonal, and obstetric racism. In this study, the researchers explore provider perspectives of how racism is perpetuated in institutional perinatal and reproductive health care.</p><p><strong>Methods: </strong>Critical Race Theory, Reproductive Justice, and midwifery theory were operationalized through secondary thematic analysis of existing qualitative data from the Community Racial Equity and Training Interventions and Evaluation of Current and Future Healthcare Clinicians Study. Twenty-four perinatal providers (certified nurse-midwives [n = 7] and physicians [n = 17]) voluntarily participated in interviews. A comparative approach was used to determine how professional identity and model of care influence physicians' and certified nurse-midwives' perceptions of equity.</p><p><strong>Results: </strong>Thematic analysis produced 5 themes: racism as a comorbidity, health care systems' inability to address the needs of Black birthing people, health care systems prioritizing providers over patients are failed systems, patients are the experts in the optimal health care model, and benefits of interprofessional teams grounded in Reproductive Justice. Additionally, both physicians and midwives expressed a need for a new care model.</p><p><strong>Discussion: </strong>With these findings, our team proposes a modification of the midwifery model for application by all provider types that could radically shift the experience and outcomes of perinatal and reproductive health care and reduce mortality. Using a human rights approach to care, a Reproductive Justice-Public Health Critical Race praxis-informed midwifery model may be operationalized by all perinatal and reproductive health care providers. This novel model reflects an iterative process that may offer institutions and providers methods to build on past research supporting midwifery-centered care for improving outcomes for all patients by specifically focusing on improving care of Black birthing people. The implications of this work offer broad application in current clinical practice, quality improvement, research, technology, and patient resources.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139901028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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