Journal of midwifery & women's health最新文献

{"title":"Perinatal Health Care Preferences in a Rural Mennonite Community: A Mixed-Methods Study.","authors":"April E Ward, Barbara K Hackley, Emily C McGahey","doi":"10.1111/jmwh.13746","DOIUrl":"https://doi.org/10.1111/jmwh.13746","url":null,"abstract":"<p><strong>Introduction: </strong>A rapidly growing rural community of Old Order Mennonites in upstate New York abruptly lost midwifery services in 2018, causing a crisis in perinatal care access. A mixed-methods study was undertaken to explore health status, perinatal needs, and preferences in this culturally homogenous group.</p><p><strong>Methods: </strong>An anonymous survey mailed to 650 Mennonite families assessed demographic characteristics, general health, perinatal optimality, perinatal care characteristics, stress and anxiety related to rural childbearing, and preferences for a perinatal health care system. Voluntary follow-up telephone interviews explored recent perinatal experiences and desires for future care.</p><p><strong>Results: </strong>Surveys were returned by 218 Mennonite women, a 33.5% response rate. Home birth was preferred by 94.6% of participants. The mean (SD) Perinatal Background Index score was 86.7% (11.7), indicating a high level of optimality. Elevated levels of stress and anxiety, as measured by the Rural Pregnancy Experience Scale, were reported by 12 participants (6.6%). Qualitative descriptive analysis of 21 interviews revealed a strong desire to preserve home birth, receive care that was respectful of Mennonite cultural norms, and maintain a personal choice of birth attendants.</p><p><strong>Discussion: </strong>According to participants, an ideal perinatal care system would ensure locally available, skilled midwives willing to maintain the community's traditional childbearing practices. Despite rural remoteness, distance from inpatient perinatal services was not associated with increased stress and anxiety. Access to care could be improved by state-level initiatives to expand the licensure of midwives and to remove barriers to birth center development.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665738","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}

{"title":"Preventing Type 2 Diabetes in Women With Gestational Diabetes: Three Theoretical Perspectives on Behavior Change.","authors":"Lotte Elton, Ann-Kristin Porth, Julie L O'Sullivan, Jan C Zoellick, Paul Gellert, Andy Guise, Alexandra Kautzky-Willer","doi":"10.1111/jmwh.13747","DOIUrl":"https://doi.org/10.1111/jmwh.13747","url":null,"abstract":"","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665739","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}

{"title":"Variation in the Use of Guideline-Based Care by Prenatal Site: Decomposing the Disparity in Preterm Birth for Non-Hispanic Black Women.","authors":"Patricia McGaughey, Renata E Howland","doi":"10.1111/jmwh.13745","DOIUrl":"https://doi.org/10.1111/jmwh.13745","url":null,"abstract":"<p><strong>Introduction: </strong>Despite longstanding status as a public health priority, preterm birth rates continue to be higher among non-Hispanic Black women compared with other racial and ethnic groups. A growing body of literature highlights the site of care as a key factor in pregnancy outcomes. Although research shows that many individuals do not receive guideline-based prenatal care, little is known about site-level variation in the use of recommended prenatal services and its potential relationship with Black-White preterm birth disparities.</p><p><strong>Methods: </strong>In this cross-sectional cohort study, we analyzed variation in site-level use of 4 key prenatal services: tetanus, diphtheria, and pertussis (Tdap) vaccination, [per the CDC website] and screening for bacteriuria, diabetes, and group Beta streptococcus, using administrative data from New York State Medicaid and the American Community Survey. We used multivariable logistic regressions to estimate the odds of attending a low-use site (mean <2 services per patient) by race and ethnicity, controlling for age, high-poverty residential address, and low prenatal care attendance. We performed Fairlie decomposition analyses to quantify the contribution of individual and site-level factors to the observed difference in preterm birth rates among Black and White non-Hispanic women.</p><p><strong>Results: </strong>Site-level use of recommended prenatal services ranged from an average of 1 to 3.6 services per patient. Non-Hispanic Black women had more than twice the odds (adjusted odds ratio, 2.42; 95% CI, 2.32-2.52) of attending a low-use site compared with non-Hispanic White women. Among factors in the decomposition analysis, site-level screening for bacteriuria and diabetes accounted for the highest proportion of the explained variance in the observed preterm birth rates for non-Hispanic Black (10.7%) and non-Hispanic White (6.7%) women.</p><p><strong>Discussion: </strong>Results from this research support immediate improvement in guideline-based prenatal care to narrow the gap in preterm birth for non-Hispanic Black women. Research is needed to identify and correct site-level barriers to recommended prenatal services.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652894","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}

{"title":"Feasibility of Remote Intensive Monitoring: A Novel Approach to Reduce Black Postpartum Maternal Cardiovascular Complications.","authors":"Michelle Villegas-Downs, Tara A Peters, Jared Matthews, Anne M Fink, Alicia K Matthews, Judith Schlaeger, Aiguo Han, William D O'Brien, Joan E Briller, Woon-Hong Yeo, Barbara L McFarlin","doi":"10.1111/jmwh.13743","DOIUrl":"https://doi.org/10.1111/jmwh.13743","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately 53% of maternal mortality occurs in the postpartum period, a time with little monitoring and health surveillance. The objective of this study was to test the feasibility, usability, appropriateness, and acceptability of remote low-burden physiologic monitoring of Black postpartum women, using a novel soft wearable patch and home vital sign monitoring for the first 4 weeks postpartum.</p><p><strong>Methods: </strong>A prospective longitudinal cohort feasibility study of 20 Black postpartum women was conducted using home monitoring equipment and a wearable patch with physiologic sensors measuring temperature, pulse oximetry, blood pressure, electrocardiogram (ECG), heart rate, and respiration twice daily during the first 4 weeks postpartum. Feasibility, acceptability, appropriateness, and usability were measured at the end of the study with the Feasibility of Intervention Measure, Acceptability of Intervention Measure, Intervention Appropriateness Measure, and System Usability Scale.</p><p><strong>Results: </strong>Twenty Black women were recruited and consented to participate in the study. Remote physiologic monitoring using a wearable patch and home monitoring equipment was rated as feasible (93%), acceptable (93%), appropriate (92%), and useable (80%). During the first 2 weeks postpartum, remote home monitoring detected that 60% of the women had blood pressures exceeding 140/90 mm Hg. The wearable patch provided useable data on ECG, heart rate, heart rate variability, pulse oximetry, and temperature.</p><p><strong>Discussion: </strong>Our research suggests that remote monitoring in the first 4 weeks postpartum has the potential to identify Black women at risk for postpartum complications.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517734","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}

{"title":"Managing Bias in the Care of Pregnant and Parenting People with Substance Use Disorder.","authors":"Briana E Kramer, Nicole Warren, Mishka Terplan, Andreea A Creanga, Kelly M Bower","doi":"10.1111/jmwh.13744","DOIUrl":"https://doi.org/10.1111/jmwh.13744","url":null,"abstract":"<p><strong>Background: </strong>Unintentional overdose is the leading cause of pregnancy-associated death in Maryland and is preventable. Stigma contributes to birthing peoples' disengagement with the health care system, and health care professionals may participate in stigmatizing processes. We aimed to develop and evaluate a training on stigma and bias related to substance use disorder (SUD) for maternal health care professionals in Maryland.</p><p><strong>Methods: </strong>We used a community-engaged process to develop a training on stigma and bias related to SUD in pregnancy and implemented it with Maryland maternal health care professionals employed in birth hospital settings. We conducted a multimethod pre-post training evaluation, using a quantitative analysis of implementation reach, a pre-post knowledge test, a satisfaction survey, and a qualitative analysis of hospital facilitation meeting logs.</p><p><strong>Results: </strong>The training was completed by 1145 health care professionals. Knowledge test scores increased significantly after training, with the greatest change noted in the safety of medications for opioid use disorder during pregnancy. Over 90% of participants found the training relevant and planned to actively use what they learned. Qualitative feedback indicated the training may increase empathy with the patient population and contribute to practice changes.</p><p><strong>Discussion: </strong>Our evaluation suggests that this training is valuable, effective at increasing knowledge, and a potential catalyst for practice change among health care professionals working with pregnant and postpartum patients with SUD.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477275","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}

{"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":" ","pages":""},"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}