Elizabeth Darling

Elizabeth Darling
McMaster University | McMaster · Department of Obstetrics and Gynaecology

BArts&Sc, BHSc, MSc, PhD

About

70
Publications
7,016
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
1,172
Citations
Introduction
Dr. Darling's research focuses on maternal-newborn health services. Areas of interest include midwifery services, health disparities, access to care, organization of care, midwifery scope of practice, health policy, and perinatal surveillance. Her research uses mixed methods. She has particular expertise in conducting large cohort studies using administrative health data, and with the midwifery data collected in Ontario’s perinatal registry (BORN-Ontario). Current projects include evaluation of the Markham-Stouffville Hospital Alongside Midwifery Unit; non-indicated transfers of care from midwives to obstetricians; access to midwifery care and socioeconomic status; outcomes associated with mifepristone implementation; evaluation of the Crown Point Midwifery Project; defining "low risk".
Additional affiliations
January 2017 - present
McMaster University
Position
  • Head of Faculty

Publications

Publications (70)
Article
Full-text available
Background: Very early discharge from hospital is an element of Ontario midwifery care. Our aim in the present study was to describe the frequency of very early hospital discharge for newborns in Ontario midwifery care over time. Methods: We conducted a retrospective population-based cohort study, including all midwife-attended singleton term ce...
Article
Full-text available
Midwifery care is associated with health benefits for disadvantaged groups but continues to be accessed less frequently in Ontario by people who are of lower socioeconomic status (SES). We conducted a qualitative descriptive study investigating the work midwives do to make midwifery care accessible to people of low SES and explored the barriers the...
Article
Full-text available
Objective: To describe access to Ontario midwifery care based on socioeconomic status (SES). Design: Two retrospective cohort studies. Setting: Ontario, Canada. Participants: 1. All Ontario midwifery billable courses of care discharged between April 1, 2006 and March 31, 2017 (N=187,009). 2. All Ontario residents who gave birth (≥ 20 weeks) in Onta...
Article
Full-text available
Increasing access to midwifery care for disadvantaged groups was an explicit goal of the regulation of midwifery in Ontario. However, people of low socio-economic status (SES) remain less likely to receive midwifery care. We conducted a qualitative descriptive study to explore the work midwives do to make midwifery care accessible to people of low...
Article
Full-text available
Background: In July 2018, Canada's first midwife-led alongside midwifery unit (AMU) opened at Markham Stouffville Hospital (MSH) in Markham, Ontario. Our objectives were to examine how the conditions at MSH made it possible for the hospital to create the first AMU in Canada and to identify lessons to inform spread by examining how characteristics...
Article
Full-text available
Kawasaki disease (KD) is a common childhood vasculitis associated with coronary artery aneurysms (CAA). However, there is limited published data on other cardiovascular events diagnosed during acute KD hospitalizations. Our objectives were to determine the incidence of cardiovascular events during acute KD hospitalizations, stratified by age at adm...
Article
BACKGROUND : Both gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are common, and each are associated with adverse maternal and perinatal outcomes. Midwives may be the first point of care when these conditions arise. This study evaluated the experiences of midwives when providing care to women and people with pregn...
Article
Full-text available
Introduction: On a global scale, women and childbearing people and neonates continue to die from preventable causes related to pregnancy or childbirth. Sustained and accelerated efforts are critical to improve maternal and neonatal health and well-being. Globally, youth are a growing population and have strength in their numbers. Youth are critica...
Article
Objective Globally, midwife-led units are associated with improved clinical outcomes and childbirth satisfaction, but little is known about the impact of the model on health professionals themselves and interprofessional collaboration. The aim of this research was to describe the experiences of health professionals providing care in Canada's first...
Article
Background The shifting landscape of abortion care from a hospital-only to a distributed service including primary care has implications for how to identify abortion cohorts for research and surveillance. The objectives of this study were to 1) create an improved approach to define abortion cohorts using linked administrative data sets and 2) evalu...
Article
(Abstracted from N Engl J Med 2022;386:57–67) A medical abortion regimen of mifepristone and misoprostol is safe. In the United States, mifepristone is approved for use only with onerous Risk Evaluation and Mitigation Strategy (REMS) restrictions, which include mandatory prescriber certification, observed dispensing of doses by the prescriber or me...
Article
Full-text available
Introduction: Rates of perinatal cannabis use are rising, despite clinical evidence about the potential for harm. Accordingly, pregnant and lactating people who perceive a benefit from cannabis use may have a difficult time making informed decisions about cannabis use. Methods: We conducted a systematic review of mixed-methods research to synthe...
Article
Objectives Kawasaki disease (KD) is a common childhood vasculitis with increasing incidence in Canada. Acute KD hospitalizations are associated with high health care costs. However, there is minimal health care utilization data following initial hospitalization. Our objective was to determine rates of health care utilization and costs following KD...
Article
Background In the United States, mifepristone is available for medical abortion (for use with misoprostol) only with Risk Evaluation and Mitigation Strategy (REMS) restrictions, despite an absence of evidence to support such restrictions. Mifepristone has been available in Canada with a normal prescription since November 2017. Methods Using popula...
Article
OBJECTIVE The growing prevalence of obesity is a concern for midwives. In Canada, the absence of regulatory standards, varying protocols and consultant preferences shape clinical decision making for the midwife and may lead to inconsistent practice. Our aim was to understand the barriers, enablers, and knowledge gaps that influenced experiences of...
Article
Background Perinatal cannabis use is increasing, and clinician counselling is an important aspect of reducing the potential harm of cannabis use during pregnancy and lactation. To understand current counselling practices, we conducted a systematic review and integrative mixed-methods synthesis to determine “how do perinatal clinicians respond to pr...
Article
Full-text available
Background In Haiti where there are high rates of maternal and neonatal mortality, efforts to reduce mortality and improve maternal newborn child health (MNCH) must be tracked and monitored to measure their success. At a rural Haitian hospital, local surveillance efforts allowed for the capture of MNCH indicators. In March 2018, a new stand-alone m...
Article
Full-text available
Background In Canada, as is found globally, women of reproductive age are a growing demographic of persons living with HIV. Combination antiretroviral therapy (cART) treatment enables women living with HIV (WLWH) to become pregnant without perinatal transmission, and they are increasingly planning to become pregnant. Since 2014, Canadian guidelines...
Preprint
Full-text available
Abstract Introduction: A pillar to the profession, midwifery associations support midwives in order to improve the experience of pregnancy and childbirth and eliminate maternal and newborn mortality and morbidity. Our objective was to generate concepts and theory and a theoretical framework of the range of factors that impact midwifery associatio...
Article
Full-text available
Introduction Midwifery associations are organisations that represent midwives and the profession of midwifery. They support midwives to reduce maternal and newborn mortality and morbidity by promoting the overall integration of midwifery in health systems. Our objective was to generate a framework for evidence-informed midwifery association strengt...
Article
Objectives Canadian policy allowing mifepristone medication abortion without regulations limiting practice is globally unique. The objective of this study was to examine the impact of Canadian deregulated medication abortion policy on abortion utilization and complications. Methods We used linked administrative data (billing, hospital, ambulatory...
Article
Objectives In Haiti, efforts to improve maternal newborn child health must be tracked and monitored to measure their success. At a rural Haitian hospital, health system changes took place that resulted in the opening of a newly-constructed maternity unit, with increased personnel, and physical space. We aimed to determine if the new maternity led t...
Article
Full-text available
The number of polyamorous people in Canada is growing steadily, and many polyamorous people are of childbearing age and report living with children. Experiences of polyamorous families, particularly those related to pregnancy and childbirth, have thus far been underrepresented in the literature. The POLYamorous Childbearing and Birth Experiences St...
Article
Background Kawasaki disease (KD) incidence is increasing in Ontario. Cardiovascular sequelae following KD are well-described. However, there are limited data on non-cardiovascular outcomes. Objectives To determine the risk of hearing loss, anxiety, developmental disorders, intellectual disabilities and attention-deficit/hyperactivity disorder (ADH...
Article
Full-text available
The archaic definition and registration processes for stillbirth currently prevalent in Canada impede both clinical care and public health. The situation is fraught because of definitional problems related to the inclusion of induced abortions at ≥20 weeks’ gestation as stillbirths: widespread uptake of prenatal diagnosis and induced abortion for s...
Preprint
Full-text available
Background: Cannabis use during the perinatal period is rising. Objectives: To synthesize existing knowledge on the perspectives of pregnant people and their partners about cannabis use in pregnancy and lactation. Search strategy: We searched MEDLINE, APA PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Social Science Citation In...
Article
Kawasaki disease (KD) is a childhood vasculitis with conflicting reported North American trends in incidence and patient characteristics. Objectives: (1) determine KD incidence between 1995 and 2017; (2) compare patient characteristics by era and age group; (3) determine complication and cardiovascular follow-up rates. We used population-based heal...
Article
People at higher risk of poverty or social exclusion are less likely to receive adequate prenatal care (PNC) and have a higher risk of poor perinatal outcomes. Appropriate PNC may help to reduce adverse outcomes. We conducted a systematic review of randomized controlled trials in high income countries on the impact of PNC delivery models targeting...
Article
Full-text available
Introduction In 2014, 2 new freestanding midwifery‐led birth centers opened in Ontario, Canada. As one part of a larger mixed‐methods evaluation of the first year of operations of the centers, our primary objective was to compare the experiences of women receiving midwifery care who intended to give birth at the new birth centers with those intendi...
Article
Background Kawasaki disease (KD) is a common pediatric vasculitis with rising global incidence. Associated coronary artery aneurysms (CAA) can result in significant long-term morbidity and mortality. However, our understanding of the trends in incidence along with patient and disease characteristics for North American children over the past two dec...
Article
Background: There are limited data at a population level on the burden, risk factors, and long-term outcomes of neonatal renal vein thrombosis (nRVT). We conducted a population-based cohort study to understand the epidemiology and outcomes of nRVT over a 25-year period in Ontario. Methods: Using linked administrative health databases, all hospitali...
Article
Full-text available
Background: Ontario's birth Registry (BORN) was established in 2009 to collect, interpret, and share critical data about pregnancy, birth and the early childhood period to facilitate and improve the provision of healthcare. Since the use of routinely-collected health data has been prioritized internationally by governments and funding agencies to...
Article
Objective: This study sought to describe the incidence inadequate prenatal care (IPNC) at an urban level II hospital in Hamilton, Ontario, and to compare the characteristics and outcomes of mothers who received IPNC and their newborns with those who received adequate prenatal care (APNC). This study is the first part of a mixed-methods research pr...
Article
Full-text available
Background: Despite public funding of midwifery care, people of low-socioeconomic status are less likely to access midwifery care in Ontario, Canada, but little is known about barriers that they experience in accessing midwifery care. The purpose of this study was to examine the barriers and facilitators to accessing midwifery care experienced by...
Article
Objective: This study aimed to explore the attitudes of obstetrics and gynaecology residents in Canada towards interventions that influence Caesarean section rates. The study looked at residents' attitudes towards four guidelines that support vaginal and assisted delivery (vaginal birth after Caesarean section, induction of labour, operative vagin...
Article
Full-text available
Background: As many as 1 in 5 adults practise some type of consensual nonmonogamy such as polyamory; many are married, have children, or both. Polyamorous families face unique challenges when accessing care during pregnancy and birth, and qualitative descriptive studies are needed to understand their experiences and inform health care providers' p...
Article
Objective: This study sought to compare clinical outcomes of midwifery clients who had postdates induction of labour with oxytocin under midwifery care with those transferred to obstetrical care. Methods: This was a retrospective cohort study using 2006-2009 Ontario Midwifery Program data. All low-risk Ontario midwifery clients who had postdates...
Article
Full-text available
Background: There is no international consensus on the definition and components of severe maternal morbidity (SMM). Objectives: To propose a comprehensive definition of SMM, to create an empirically justified list of SMM types and subtypes, and to use this to examine SMM in Canada. Methods: Severe maternal morbidity was defined as a set of he...
Article
Objective: To describe the characteristics, health service utilization, and clinical outcomes of Ontario residents who are not covered by the Ontario Health Insurance Plan and receive services from Ontario midwives. Design: Retrospective cohort study. Setting: Ontario, Canada. Participants: All midwifery courses of care resulting in births b...
Article
Background Prenatal care (PNC) is a frequently accessed Canadian healthcare service, yet 5–20% of women obtain inadequate PNC. An understanding of neonatal outcomes associated with inadequate prenatal care will assist in developing appropriate guidelines for these at risk infants and identifying the importance of engaging hard-to-reach pregnant pat...
Article
Objectives Non-indicated transfer of care may be associated with increased health-care costs, poor inter-professional relationships, and decreased client satisfaction. Our objective was to examine the rates of consultation and transfer of care between Ontario physicians and midwives, and determine what proportion are non-indicated under the College...
Article
Objective: This study sought to quantify temporal trends and provincial and territorial variations in severe maternal morbidity (SMM) in Canada. Methods: The study used data on all hospital deliveries in Canada (excluding Québec) from 2003 to 2016 to examine temporal trends and from 2012 to 2016 to study regional variations. SMM was identified u...
Article
Full-text available
Background As part of a larger study examining the effectiveness of the Maternal Newborn Dashboard, an electronic audit and feedback system to improve maternal-newborn care practices and outcomes, the purpose of this study was to increase our understanding of factors explaining variability in performance after implementation of the Dashboard in Ont...
Article
Background: Despite greater contact with the healthcare system during the perinatal period, detection and treatment of perinatal mental health conditions remain suboptimal. Aim: To explore midwives’ and midwifery clients’ perceptions of factors that impede access to perinatal mental health care in high resource settings. Design: Scoping review. Met...
Article
Full-text available
Introduction In 2014, Ontario opened 2 stand‐alone midwifery‐led birth centers. Using mixed methods, we evaluated the first year of operations for quality and safety, client experience, and integration into the maternity care community. This article reports on our study of safety and quality of care. Methods This descriptive evaluation focused on...
Article
Full-text available
Introduction In 2014, 2 freestanding, midwifery‐led birth centers opened in Ontario, Canada. The purpose of this study was to qualitatively investigate the integration of the birth centers into the local, preexisting intrapartum systems from the perspective of health care providers and managerial staff. Methods Focus groups or interviews were cond...
Article
Introduction There is little research done on mental health among pregnant Aboriginal women. Therefore, the purpose of the study was to examine the prevalence of postpartum depression (PPD) and its determinants, including pre-existing depression among non-Aboriginal and Aboriginal women in Canada. Methods The Maternity Experiences Survey (MES) is...
Article
Introduction On dispose de peu de recherches sur la santé mentale chez les femmes autochtones enceintes, ce qui nous a conduit à examiner dans cette étude la prévalence de la dépression post-partum (DPP) et ses déterminants, en tenant compte des antécédents de dépression chez les femmes non autochtones et autochtones du Canada. Méthodologie L’Enqu...
Article
Objective: To explore what factors midwifery care recipients perceive to prevent or facilitate access to mental health care in the perinatal period. Design: A qualitative descriptive study based on semi-structured individual interviews and focus groups. Setting: Ottawa, Ontario, Canada. Participants: Sixteen mothers who had received or were...
Article
Background: The purpose of this study was to develop assessment criteria that could be used to examine the level of integration of home birth within larger health care systems in developed countries across 11 international jurisdictions. Methods: An expert panel developed criteria and a definition to assess home birth integration within health c...
Article
Full-text available
Objectives To assess the effect of the Maternal Newborn Dashboard on six key clinical performance indicators in the province of Ontario, Canada. Design Interrupted time series using population-based data from the provincial birth registry covering a 3-year period before implementation of the Dashboard and 2.5 years after implementation (November 2...
Article
Methods: In this rapid review, studies were identified through the Medline database. The main outcomes of interest were severe hyperbilirubinemia and encephalopathy. A subset of articles was double screened and all articles were critically appraised using the SIGN and AMSTAR checklists. This review investigated if systems approach is likely to red...
Article
Objective: To determine whether implementation of universal bilirubin screening in Ontario, Canada is associated with improved rates of recommended follow-up care across socioeconomic status (SES). Methods: We conducted a retrospective population-based cohort study of all babies born at ≥35 weeks' gestation and discharged to home within 72 hours...
Article
Full-text available
Background There are wide variations in maternal-newborn care practices and outcomes across Ontario. To help institutions and care providers learn about their own performance, the Better Outcomes Registry & Network (BORN) Ontario has implemented an audit and feedback system, the Maternal-Newborn Dashboard (MND), for all hospitals providing maternal...
Article
Full-text available
Background Low or high prepregnancy body mass index (BMI) and inadequate or excess gestational weight gain (GWG) are associated with adverse neonatal outcomes. This study estimates the contribution of these risk factors to preterm births (PTBs), small-for-gestational age (SGA) and large-for-gestational age (LGA) births in Canada compared to the con...
Article
Objective: To evaluate the impact of the implementation of universal bilirubin screening on neonatal health care use in the context of a large jurisdiction with universal health insurance. Methods: We conducted a population-based retrospective cohort study of all newborns discharged after birth between April 2003 and February 2011 from 42 hospit...
Article
Full-text available
Overweight and obese women are known to be at increased risk of caesarean birth. This study estimates the contribution of prepregnancy body mass index (BMI) and gestational weight gain (GWG) to caesarean births in Canada. We analyzed data from women in the Canadian Maternity Experiences Survey who had a singleton term live birth in 2005-2006. Adjus...
Article
Full-text available
In 2007, the Canadian Paediatric Society (CPS) published guidelines aimed at preventing severe hyperbilirubinemia. To determine whether hospitals had implemented these guidelines; to investigate how guideline-recommended care is organized; and to understand the factors influencing guideline implementation. The present study was an online survey con...
Article
In Canada maternity care is publicly funded, and although women may choose their care providers, choices may be limited. The purpose of this study was to compare perceptions of maternity outcomes and experiences of those who received care from midwives with those who received care from other providers. Based on the 2006 Canadian census, a random sa...
Article
This article examines whether a policy of mandatory neonatal eye prophylaxis is ethically justified within the Canadian context. An existing framework for public health ethics is used to examine criteria that would justify state intervention in parental decision-making authority in order to protect public health. The benefits, harms, and utility of...
Article
Full-text available
Introduction: Neonatal eye prophylaxis has been routine in North America for more than a century. Contextual changes justify reexamining this practice, and prompted a systematic review of the efficacy of prophylactic agents. Methods: We searched MEDLINE (1966-2008), EMBASE (1980-2008), CINAHL (1982-2008), and the Cochrane library (the first quar...
Article
Many publications have examined the reasons behind the rising cesarean delivery rate around the world. Women's responses to the Maternity Experiences Survey of the Canadian Perinatal Surveillance System were examined to explore correlates of having a cesarean section on other experiences surrounding labor, birth, mother-infant contact, and breastfe...
Chapter
This chapter analyses the collaborative work and professional boundaries in maternity care, focusing on Canada and exploring the significance of institutional contexts that shape the opportunities for social inclusion and collaboration across macro and meso levels of governance. This case, specifically on the province of Ontario, is particularly in...
Chapter
Introduction There is a growing interest in collaborative models of healthcare – or what has alternatively been referred to as ‘interprofessionalism’ – as a means to address a range of concerns within healthcare systems, not the least of which are shortages of healthcare professionals (DH, 2000; Institute of Medicine, 2003; Health Council of Canada...
Article
Full-text available
Randomized clinical trials (RCTs) that stop earlier than planned because of apparent benefit often receive great attention and affect clinical practice. Their prevalence, the magnitude and plausibility of their treatment effects, and the extent to which they report information about how investigators decided to stop early are, however, unknown. To...

Network

Cited By