- Abstract: Predictors and the prevalence of adverse birth outcomes among 237 homeless women interviewed at 78 shelters and meal programs in Los Angeles in 1997 were assessed. It was hypothesized that they would report worse outcomes than national norms, that African Americans would report the worst outcomes because of their greater risk in the general population, and that homelessness severity would independently predict poorer outcomes beyond its association with other adverse conditions. Other... Show More
- Abstract: Objective: To examine the influence of provider encouragement on breast-feeding among women of different social and ethnic backgrounds in the United States. Methods: A nationally representative sample of 2017 parents with children younger than 3 years was surveyed by telephone. The responses of the 1229 women interviewed were included in the analysis. Respondents were asked to recall whether their physicians or nurses had encouraged or discouraged them from breast-feeding. The effects of... Show More
- Abstract: To examine the influence of provider encouragement on breast-feeding among women of different social and ethnic backgrounds in the United States. A nationally representative sample of 2017 parents with children younger than 3 years was surveyed by telephone. The responses of the 1229 women interviewed were included in the analysis. Respondents were asked to recall whether their physicians or nurses had encouraged or discouraged them from breast-feeding. The effects of provider encouragement... Show More
- Abstract: Lifetime contraceptive use as reported by a representative sample of 764 homeless women in Los Angeles was examined overall and for different age and ethnic subgroups and contrasted with expressed willingness to use specific methods. Over 80% of the women reported condom use. However, less than 5% had ever used female condoms, although 38% of the overall sample and 73% of the teenagers said they were willing to try them. Similar gaps between reported use and endorsement were found for other... Show More
- Abstract: This study examined the association between self-identified childhood sexual abuse and breastfeeding initiation. A nationally representative sample of 2017 parents with children younger than 3 years was surveyed by telephone about child-rearing needs. Respondents were asked to report childhood sexual abuse and breastfeeding practices. Responses of 1220 biological mothers were analyzed. A possible association between self-reported childhood sexual abuse and breastfeeding initiation was... Show More
- Abstract: A small pilot trial of a multicomponent (behavioral strategies, simplified patient information, and social support) and multidisciplinary (cognitive-behavioral therapy and nursing) medication adherence intervention was conducted for HIV-infected adults prescribed antiretrovirals. Patients (N = 33) were randomly assigned to the intervention condition or standard care. Compared to the control group, patients in the intervention condition had significantly higher self-efficacy to communicate... Show More
- Abstract: Despite the growing number of homeless women of reproductive age, little is known about their reproductive health and contraceptive use. A representative sample of 974 currently homeless women surveyed in Los Angeles County in 1997 included 229 who were chronically homeless and at risk for unintended pregnancy. The relationships between perceived deterrents among these women and their frequency of contraceptive use were evaluated using chi-square tests. Logistic regression analyses were... Show More
- Abstract: Our purpose was (1) to describe use of the postpartum visit among US women of different social and ethnic backgrounds and to identify risk factors for nonuse and (2) to determine the association between postpartum care and breast- feeding duration. The responses of a nationally representative sample of 9,953 women who had a live birth in 1988 surveyed by the National Maternal and Infant Health Survey were included for our secondary analysis. Risk factors for nonuse of the postpartum visit,... Show More
- Abstract: In the United States, Black infants have significantly worse birth outcomes than do White infants. The cause of these persisting racial disparities remains unexplained. Most extant studies focus on differential exposures to protective and risk factors during pregnancy, such as current socioeconomic status, maternal risky behaviors, prenatal care, psychosocial stress, or perinatal infections. These risk factors during pregnancy, however, do not adequately account for the disparities. We... Show More
- Abstract: To examine sociodemographic disparities in attendance at childbirth classes, and to evaluate the association of attendance with breastfeeding initiation. Parents of a nationally representative, cross-sectional sample of 2068 children ages 4-35 months were surveyed by telephone. The responses of 1540 mothers were included in the analysis. They were asked whether they had attended a childbirth class before giving birth. Disparities in attendance at childbirth classes and the association... Show More
- Abstract: The purpose of this study was to examine racial-ethnic disparities in stressful life events before and during pregnancy and to assess the relationship between stressful life events and racial-ethnic disparities in preterm birth. Using data from the Pregnancy Risk Assessment Monitoring System, we conducted a retrospective cohort analysis of a sample of 33,542 women from 19 states who were delivered of a live-born infant in 2000. Principal component analysis was used to group 13 stressful life... Show More
- Abstract: The object of the study was to evaluate the research designs of social support interventions for prevention of low birth weight (LBW). A literature search of published articles identified 12 randomized controlled trials of social support to prevent LBW birth. These were evaluated using specific methodological criteria for effective intervention research. Only one study showed a significant reduction in LBW. However, none of the studies met all of the proposed criteria for rigorous... Show More
- Abstract: Because postpartum hemorrhage may result from factors related to obstetrical practice patterns, we examined the variability of postpartum hemorrhage and related risk factors (obstetrical trauma, chorioamnionitis, and protracted labor) across hospital types and hospitals in California. Linked birth certificate and hospital discharge data from 507,410 births in California in 1997 were analyzed. Cases were identified using International Classification of Diseases, Ninth Edition, Clinical... Show More
- Abstract: In 2003, the Agency for Healthcare Quality and Research (AHRQ) published its Quality Indicators for healthcare, and set out methodological criteria for the evaluation of potential candidates. Because perinatal infections may result from poor obstetrical practices, we intended to describe the variability of maternal and congenital neonatal infections across different types of hospital ownership (e.g., not for profit, government), and to assess whether rates of these infections meet criteria... Show More
- Abstract: In collaboration with the California Department of Health Maternal and Child Health Branch, the authors formed a Working Group to identify potential clinical indicators that could be used to inform decision making regarding maternal health care quality. To develop potential indicators for the assessment of maternal health care quality. A Working Group was convened to review information from the published literature and expert opinion. Selection of potential indicators was guided by the... Show More
- Abstract: Inpatient conditions that might be avoided through improved outpatient services are called Ambulatory Care Sensitive Indicators, and they include pyelonephritis in nonpregnant adults. No such indicators have been developed for pregnant women. We examine whether hospital-specific rates of gestational pyelonephritis may serve as a measure of the quality of ambulatory maternal care. The California Department of Health Services provided an administrative data set linking maternal and newborn... Show More
- Abstract: For more than two decades, prenatal care has been a cornerstone of our nation's strategy for improving pregnancy outcomes. In recent years, however, a growing recognition of the limits of prenatal care and the importance of maternal health before pregnancy has drawn increasing attention to preconception and internatal care. Internatal care refers to a package of healthcare and ancillary services provided to a woman and her family from the birth of one child to the birth of her next child.... Show More
Publications citing this author (2297)
[Show abstract] [Hide abstract] ABSTRACT: Although the evaluation of caesarean delivery rates has been suggested as one of the most important indicators of quality in obstetrics, it has been criticized because of its controversial ability to capture maternal and neonatal outcomes. In an "ideal" process of labor and delivery auditing, both caesarean (CD) and assisted vaginal delivery (AVD) rates should be considered because both of them may be associated with an increased risk of complications. Standardized data on 15,189 deliveries from 11 centers were prospectively collected. Multiple logistic regression was used to estimate the risk-adjusted probability of a woman in each center having an AVD or a CD. Centers were classified as "above", "below", or "within" the expected rates by considering the observed-to-expected rates and the 95% confidence interval around the ratio. Adjusted maternal and neonatal outcomes were compared among the three groupings. Centers classified as "above" or "below" the expected CD rates had, in both cases, higher adjusted incidence of composite maternal (2.97%, 4.69%, 3.90% for "within", "above" and "below", respectively; p = 0.000) and neonatal complications (3.85%, 9.66%, 6.29% for "within", "above" and "below", respectively; p = 0.000) than centers "within" CD expected rates. Centers with AVD rates above and below the expected showed poorer and better composite maternal (3.96%, 4.61%, 2.97% for "within", "above" and "below", respectively; p = 0.000) and neonatal (6.52%, 9.77%, 3.52% for "within", "above" and "below", respectively; p = 0.000) outcomes respectively than centers with "within" AVD rates. Both risk-adjusted CD and AVD delivery rates should be considered to assess the level of obstetric care. In this context, both higher and lower-than-expected rates of CD and "above" AVD rates are significantly associated with increased risk of complications, whereas the "below" status for AVD showed a "protective" effect on maternal and neonatal outcomes.
- Third, there is no wide agreement on which indicators of outcome need to be evaluated to assess obstetric quality. In this regard, we considered the short term clinically meaningful indicators that are included in the Agency for Health Care Research and Quality report, in the Adverse Outcome Index and in the recent model proposed by Sibanda et al. on behalf of the Royal College of Obstetricians and Gynaecolo- gists33343536. Finally, a further limitation of our study was the inability to assess what factors contributed to adverse outcomes in the outlier settings.
[Show abstract] [Hide abstract] ABSTRACT: From a purely educationist perspective, gaining a deeper understanding of several aspects related to the prevalence of autism/ASD in a given population is of great value in planning and improving educational and psychological intervention for treatment, training, and teaching of children with this disorder. In this article, I present and discuss numerous facets of prevalence studies, beginning with assessing the changes in diagnostic manuals (DSM and ICD) over time. Based on the existing available research literature and empirical studies published during 2000 to 2016, I address the geographical-dimension and age-dimension of prevalence of autism/ASD. Over 50 studies from 21 countries reveals that prevalence rates of autism/ASD among children are on rise. There are international and intra-national, regional/territorial variations with regard to prevalence rates, and I present and discuss possible factors/factor-groups that can explain these variations. Regardless of their geographic location, children with autism/ASD can be treated, trained, and taught, but to do so effectively requires reliable prevalence studies that can properly inform policy makers and higher institutions about the steps that must be taken in the field in order to improve the learning conditions of these children with special needs. Moving forward, it's essential that studies of geographical dimension and age dimension of prevalence of autism/ASD must be supplemented by other (i.e. gender, socioeconomic , ethnic, cultural, and language) dimensions to help give us the perspective we need to grapple with this increasingly common disorder.
- hnic minority and/or linguistic minority backgrounds can also play a significant role in prevalence rates found in many countries or areas. Several researchers have addressed this factor by showing that these groups are under-represented, under-diagnosed, and thus under-supported by professional services (Begeer et al., 2009; Özerk and Özerk, 2015; Blumberg et. al, 2013; Zablotsky et al. 2015; Christiansen et al., 2016). I feel it necessary to mention this factor group although I did not address this aspect of prevalence in this article.
[Show abstract] [Hide abstract] ABSTRACT: The purpose of this article is to discuss the importance of implementing a life course perspective model that includes a reproductive life plan to improve health outcomes, especially in populations at risk for adverse outcomes. A reproductive life plan is a comprehensive strategy that can be incorporated into nursing practice at all levels to improve birth outcomes. Health care providers, especially nurses, should incorporate reproductive life planning into their daily encounters with patients. © 2010 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
- Thus, nurses should ask every patient about possible psychosocial stressors and suggest strategies for stress reduction. Nurses at all practice levels should be proactive, as many women do not realize the potential negative impact of stressors on pregnancy and birth outcomes (Klerman et al., 2008). The CDC encourages the inclusion of men in preconception planning (2006).
[Show abstract] [Hide abstract] ABSTRACT: Maternal behavior before and after conception affects maternal and child health. Limited awareness of adolescents in preconception health may be addressed through school education. The aim of this intervention is to assess preconception health awareness among adolescents in Lebanese high schools and to test the effectiveness of a one-time educational session in improving preconception knowledge. The intervention consisted of a 30-minute educational session about good practices in preconception health, developed by the National Collaborative Perinatal Neonatal Network’s (NCPNN) research team. A convenience sample of high school Lebanese students in grades 10 to 12, aged 14 to 26 years old, from 70 private and public schools in all six Lebanese provinces, participated in the intervention in 2011 and 2012. A multiple-choice questionnaire administered prior to and 2 months after the session was used to assess knowledge improvement among the students. A total of 7,290 students were enrolled. After the session, mean scores of correct answers increased from 4.36 to 6.42 out of 10, representing a 47.2% improvement (p < 0.001). The percent of correct answers increased for all the questions regarding health practices (p < 0.001). The greatest improvement was observed for questions about Trisomy 21, folic acid intake and toxoplasmosis with percentages improvement of 96%, 172% and 83% respectively. Being female or in private school was a significant predictor of higher scores in both pre-test and post-test (p < 0.001). Awareness campaigns in schools increased the preconception health knowledge among high school students. We recommend expanding the scope of this intervention into universities in Lebanon.
- Adolescence is a particularly important point in the reproductive, maternal, newborn and child health (RMNCH) continuum to promote preconception health . Educating young women about healthy lifestyles not only empowers them as individuals in their own right, but also it can result in healthier maternal and newborn outcomes should they become pregnant101112. Evidence from Lebanon highlights a need for promoting preconception health awareness. In a national survey of married Lebanese women aged 18 to 45 years, Nasr et al. found that 40% of the participants had not heard about pre-pregnancy folic acid and its prevention of neural tube defects (NTD) .
[Show abstract] [Hide abstract] ABSTRACT: Objective: To describe the prevalence and predictors of breastfeeding intent and outcomes in women with histories of childhood maltreatment trauma (CMT), including those with posttraumatic stress disorder (PTSD). Design: Secondary analysis of a prospective observational cohort study of the effects of PTSD on perinatal outcomes. Setting: Prenatal clinics in three health systems in the Midwestern United States. Participants: Women older than 18 years expecting their first infants, comprising three groups: women who experienced CMT but did not have PTSD (CMT-resilient), women with a history of CMT and PTSD (CMT-PTSD), and women with no history of CMT (CMT-nonexposed). Results: Intent to breastfeed was similar among the three groups. Women in the CMT-resilient group were twice as likely to breastfeed exclusively at 6 weeks (60.5%) as women in the CMT-PTSD group (31.1%). Compared with women in the CMT-nonexposed group, women in the CMT-resilient group were more likely to exclusively breastfeed. Four factors were associated with increased likelihood of any breastfeeding at 6 weeks: prenatal intent to breastfeed, childbirth education, partnered, and a history of CMT. Four factors were associated with decreased odds of breastfeeding: African American race, PTSD, major depression, and low level of education (high school or less). Conclusion: Posttraumatic stress disorder is more important than childhood maltreatment trauma history in determining likelihood of breastfeeding success. Further research on the promotion of breastfeeding among PTSD-affected women who have experienced CMT is indicated.
- Similar to breastfeeding, smoking is a complex health behavior with long-term implications and well-known potential sequelae, and therefore the research on the relationships between PTSD and smoking may provide guidance for considering the relationships between CMT/PTSD and breastfeeding behaviors. Some previous researchers associated a history of trauma (specifically childhood sexual abuse) with an increased likelihood of breastfeeding initiation (Prentice et al., 2002), but other researchers found no difference in breastfeeding duration with and without a history of childhood sexual abuse (Coles, Anderson, & Loxton, 2015). However, these researchers did not consider the specific characteristics of PTSD, which may mediate trauma history and breastfeeding intent and/or continuation (Seng, 2002).
[Show abstract] [Hide abstract] ABSTRACT: Background While there is considerable variability with respect to attendance at the postpartum visit, not much is known about women’s preferences with respect to postpartum care. Likewise, there is also limited information on providers’ practices regarding the postpartum visit and care including the delivery of contraception. To understand and address deficits in the delivery and utilization of postpartum care, we examined the perceptions of low-income postpartum women with respect to barriers to and preferences for the timing and location of the postpartum visit and receipt of contraception. We also examined providers’ current prenatal and postnatal care practices for promoting the use of postpartum care and their attitudes toward alternative approaches for delivering contraceptive services in the postpartum period. Methods Qualitative face-to-face interviews were completed with 20 postpartum women and in-depth qualitative phone interviews were completed with 12 health care providers who had regular contact with postpartum women. Interviews were coded using Atlas.ti software and themes were identified. Results Women believed that receiving care during the postpartum period was an important resource for monitoring physical and mental health and also strongly supported the provision of contraception earlier than the 6-week postpartum visit. Providers reported barriers to women’s use of postpartum care on the patient, provider, and system levels. However, providers were receptive to exploring new clinical practices that may widen the reach of postpartum care and increase access to postpartum contraception. Conclusion Approaches that increase the flexibility and convenience of postpartum care and the delivery of postpartum contraception may increase the likelihood that women will take advantage of essential postpartum services.
- This is in line with some previous studies and suggested guidelines [6, 26] , which recommend that the timing of postpartum visits be tailored to best fit each woman's needs. In particular, prior arguments for earlier and more frequent postpartum visits are based on increased maternal satisfaction, decreased risk of postpartum depression, increased adherence to breastfeeding, and an earlier connection to services for contraception [1, 2, 14, 20, 26, 33, 38]. In our study, many women expressed a desire to obtain or discuss contraception earlier than the standard 6-week visit in order to prevent unintended pregnancies and to facilitate birth spacing.
[Show abstract] [Hide abstract] ABSTRACT: Background In several developed countries women with a low risk of complications during pregnancy and childbirth can make choices regarding place of birth. In the Netherlands, these women receive midwife-led care and can choose between a home or hospital birth. The declining rate of midwife-led home births alongside the recent debate on safety of home births in the Netherlands, however, suggest an association of choice of birth place with psychological factors related to safety and risk perception. In this study associations of pregnancy related anxiety and general anxious or depressed mood with (changes in) planned place of birth were explored in low risk women in midwife-led care until the start of labour. Methods Data (n = 2854 low risk women in midwife-led care at the onset of labour) were selected from the prospective multicenter DELIVER study. Women completed the Pregnancy Related Anxiety Questionnaire-Revised (PRAQ-R) to assess pregnancy related anxiety and the EuroQol-6D (EQ-6D) for an anxious and/or depressed mood. Results A high PRAQ-R score was associated with planned hospital birth in nulliparous (aOR 1.92; 95% CI 1.32–2.81) and parous women (aOR 2.08; 95% CI 1.55–2.80). An anxious or depressed mood was associated with planned hospital birth (aOR 1.58; 95% CI 1.20–2.08) and with being undecided (aOR 1.99; 95% CI 1.23–2.99) in parous women only. The majority of women did not change their planned place of birth. Changing from an initially planned home birth to a hospital birth later in pregnancy was, however, associated with becoming anxious or depressed after 35 weeks gestation in nulliparous women (aOR 4.17; 95% CI 1.35–12.89) and with pregnancy related anxiety at 20 weeks gestation in parous women (aOR 3.91; 95% CI 1.32–11.61). Conclusion Low risk women who planned hospital birth (or who were undecided) more often reported pregnancy related anxiety or an anxious or depressed mood. Women who changed from home to hospital birth during pregnancy more often reported pregnancy related anxiety or an anxious or depressed mood in late pregnancy. Anxiety should be adequately addressed in the process of informed decision-making regarding planned place of birth in low risk women.
- Maternity care providers should explore any pregnancy related or general distress and should acknowledge its role during the process of decision-making regarding planned place of birth. They might also consider referral to antenatal psychological and childbirth educational interventions [69, 70] that seem promising for women with (a higher risk of) maternal distress . This may reduce the influence of anxiety on the choice of place of birth.
[Show abstract] [Hide abstract] ABSTRACT: Little is known about the patterns of risk factors experienced by communities of color and how diverse community contexts shape the health trajectory of women from the early childhood period to the time of their pregnancies. Thus, we conducted a focus group study to identify social risks over the life course that contribute to maternal and child health from the perspective of community members residing in low income urban areas. Ten community-based participatory focus groups were conducted with residents from selected communities in Tampa, Florida, from September to November 2013. We used the life course perspective to illuminate and explain the experiences reported by the interviewees. A total of 78 residents participated in the focus groups. Children and adolescents’ health risks were childhood obesity, lack of physical activity, and low self-esteem. Women’s health risks were low self-esteem, low educational level, low health literacy, inadequate parenting skills, and financial problems. Risks during pregnancy included stress, low self-esteem, inadequate eating patterns, lack of physical activity, healthcare issues, lack of social support, and lack of father involvement during pregnancy. Multiple risk factors contribute to maternal and child health in low income communities in Tampa Bay. The intersection of risk factors in different life periods suggest possible pathways, cumulative, and latent effects, which must be considered in future longitudinal studies and when developing effective maternal and child health programs and policies.
- Maternal and child health professionals should dedicate efforts to enhance the integration and coordination of family-centered services to support caregivers in order to help reduce stress and increase family support services across the life span (Lu & Halfon, 2003). Yet, the current system for family support service delivery remains fragmented (Lu, 2010). Strengthening African American families and communities and strengthening father involvement in African American families should be a priority for MCH programs.
[Show abstract] [Hide abstract] ABSTRACT: Background: Substance use, housing instability, and transactional sex all contribute to HIV risk engagement among homeless women. Because of the increased risk of HIV among homeless women, this study sought to understand the context of sexual behaviors and condom use among homeless women and elucidate modifiable factors that can be targeted by interventions. Methods: Homeless women (n = 45) participated in focus groups (n = 6) at shelters throughout Los Angeles County. Thematic analyses revealed that similar to other high-risk women, homeless women engage in sex with multiple types of partners (steady, casual, and transactional). Findings: Our findings indicate that, similar to use among other high-risk women, condom use by homeless women varied by type of partner. Substance use also contributed to condom non-use. In a departure from previous research, homeless women reported overarching feelings of hopelessness. Participants spoke of hopelessness contributing to risk engagement, specifically the number of ongoing stressors experienced because of homelessness contributing to despair. Without acknowledgement of this unique quality of homelessness, women felt their risk reduction needs would never truly be understood. Conclusions: Interventions involving homeless women should include self-esteem building, acknowledgment and use of inherent resilience qualities gained during homelessness, respect for current knowledge and skills, and an exploration of when women choose to trust their partners and how they make safer sex choices.
- Studies have found homeless women are more likely to engage in sexual intercourse without a condom with steady partners (Kennedy et al., 2010). Homeless women with a history of and/or current drug use also are more likely to have low condom use self-efficacy (Gelberg et al., 2002) and high engagement in unprotected sex (Kidder et al., 2008; Ryan et al., 2009). Type of partner and perceived trust are also associated with condom use among homeless women (Ryan et al., 2009).
[Show abstract] [Hide abstract] ABSTRACT: Background Breastfeeding is a complex relational act that takes place within the context of women’s lives and histories, which can include childhood maltreatment trauma (CMT) and its sequelae, including PTSD. Little is known about how a history of abuse affects breastfeeding outcomes. This study looks at breastfeeding outcomes using both public health and woman- centered outcome measures using a trauma-informed theoretical approach that incorporates any history of CMT and PTSD. A second aim of the dissertation is to develop a woman-centered adjunct outcome measurement of breastfeeding success, called “concordance”. This refers to the degree to which the woman’s intended feeding method matches her actual feeding method. Traditional measurement of breastfeeding success assesses compliance with public health recommendations that include duration and exclusivity. While acknowledging the benefits of breastfeeding, concordance instead centers the woman and her decision about the optimal approach to feeding her infant and subsequent experience in following her intention. This acts as an opportunity for women to create ownership both of the breastfeeding experience, and of her success as a breastfeeding woman. Concordance (positive) was defined as whether the woman breastfed at least as much as intended. Methods This study was a secondary analysis of 519 women, with data collected at three points in the perinatal year. Bivariate analyses compared whether the woman was breastfeeding at 6 x weeks with each variable. These variables were entered into two hierarchical stepwise logistic regressions based on a trauma-informed theoretical framework, using both the traditional public health and concordance woman-centered outcome measures. Findings Women with a history of CMT were more likely to intend to breastfeed than those without. Women with a history of CMT who did not have PTSD were more likely to breastfeed their infants than were other women. There were no significant differences in the woman- centered outcome between groups. Significantly, the majority of women did not have concordant outcomes. In the regression analyses, eight variables accounted for 60.6% of the variance in the public health outcome measure, and three variables accounted for 19.1% of the variance in the woman- centered outcome measure. In the public health regression, both CMT and PTSD are predictive of breastfeeding outcomes – CMT is associated with a threefold increase in the likelihood of breastfeeding, and PTSD reduces the likelihood by half. Other variables that are positively associated with breastfeeding in the regression are having a partner and attending childbirth education classes. Variables that are negatively associated are low education, race, and history of major depressive disorder. In the woman-centered measure, neither CMT nor PTSD is predictive of breastfeeding outcomes. Reduced odds of concordance are associated with depression and African American race, while having a partner increases those odds. Discussion Women with a history of both CMT and PTSD are significantly less likely to be breastfeeding their infants at 6 weeks, even though they are equally likely to intend to breastfeed. Women with a history of only CMT and not PTSD are more likely to be breastfeeding their infants, which suggests that PTSD, not abuse itself, is the salient factor. Concordance shows promise as a woman-centered measure of breastfeeding success, but has significant limitations xi related to the nature of secondary analysis. More research is needed to explore a) the meaning of breastfeeding success, b) possible interventions to improve breastfeeding success, and c) best clinical practices for RNs and IBCLCs.
- Just over half (54.3%) of all women attended prenatal classes/childbirth education of some kind; of these women, 89.7% were breastfeeding at the 6 week interview, compared to 68.6% of all women (χ 2 =127.90, df=2, p<.001). Intent and attendance at childbirth classes were previously associated with increased odds of breastfeeding (Lu et al., 2003; Piper & Parks, 1996; Semenic, Loiselle, & Gottlieb, 2008).
[Show abstract] [Hide abstract] ABSTRACT: For a seven-year period, the disparity in birth outcomes between Blacks and non-Hispanic Whites in one Wisconsin county closed for reasons not epidemiologically explainable. Examination of the ecology of organizations offered promise for considering the environmental factors influencing African American mothers and birth outcomes during this time. Qualitative analysis of interview data from representatives of health, social service, and advocacy organizations in the county focused on three themes: organizational and network change, organizational philosophies and orientations, and organizational coordination and competition. Results suggest that organizations collaborated variably during this time as adaptations to a changing ecology of funding, political influence, and dominant philosophical orientations. Peak levels of organizational collaborations fostered systems-level orientations to relational, community-centered work and coordinated, holistic service provision for underserved mothers and families. Ecological factors promoting collaboration among organizations, and the development of an interorganizational collaborative in particular, influenced further system changes with implications for birth outcomes. Additional analyses discuss systems-level implications for interorganizational endeavors from the lens of organizational ecology. C
- It is precisely this combination of " access plus trust " (Conant, 2009, October) that r 713 the integrated systems that developed in Dane County in the 1990s are believed to have facilitated. Such integration may also facilitate the production of women's personal capital (internal and social resources; Wakeel, Witt, Wisk, Lu, & Chao, 2013), which is important to mediating the stress engendered through African American women's experience of racism and discrimination, powerful predictors of preterm birth (Collins et al., 2000; Rosenthal & Lobel, 2011). In addition, the cross-sectoral collaboration that developed was important in expanding resources for expecting and new mothers beyond narrow conceptualizations of prenatal care, thus helping address the broader contextual determinants of preterm birth and infant mortality (Walford et al., 2011).
[Show abstract] [Hide abstract] ABSTRACT: This study examined what innovative strategies, including the use of health information technology (health IT), have been or can be used to reduce disparities in prenatal care quality in underresourced settings. Based on literature review and key informant interviews, the authors identified 17 strategies that have been or can be used to (a) increase access to timely prenatal care, (b) improve the content of prenatal care, and (c) enhance the organization and delivery of prenatal care. Health IT can be used to (a) increase consumer awareness about the importance of preconception and early prenatal care, facilitate spatial mapping of access gaps, and improve continuity of patient records; (b) support collaborative quality improvement, facilitate performance measurement, enhance health promotion, assist with care coordination, reduce clinical errors, improve delivery of preventive health services, provide decision support, and encourage completeness of documentation; and (c) support data integration and engineer collaborative innovation.
- The only prenatal care " performance measures " currently in use are the two Healthcare Effectiveness Data and Information Set (HEDIS) measures (rate of first trimester prenatal care; rate of postpartum visit; Korst et al., 2005). There has been some work recently on the development of performance measures for " ambulatory care sensitive conditions , " that is, conditions that require hospitalization but may be preventable with better quality ambulatory care, such as hospital admissions for gestational pyelonephritis (Korst et al., 2006) or uncontrolled diabetes (AHRQ, 2008), but such measures still require some refinement and have not been widely adopted for performance measurement in prenatal care. Further research on the use of performance measurement to improve the quality of prenatal care and reduce perinatal disparities is needed.
- The types of spiritual interventions described by FCNs reported in the professional literature include instilling hope, showing compassion, emphasizing the worth of every person, and offering spiritual or emotional support (Kuhn 1997; Coenen, Weis, Schank & Matheus, 1999; Tuck, Wallace & Pullen, 2001b; Burkhart, Konicek, Moorhead & Androwich, 2005; ANA-HMA 2005;). Spiritual care interventions can also include religious rituals (Mendelson, McNeese-Smith, Koniak-Griffin, Nyamathi & Lu, 2008; Miskelly 1995; Coenen et al. 1999; Chase-Ziolek & Iris 2002; Bitner & Woodward 2004; Burkhart & Androwich 2004; Burkhart et al. 2005; Mosack et al. 2006; Bard 2006; Ziebarth, 2007; Koenig 2008; Bokinskie & Kloster 2008; Hinton 2009; King & Tessaro 2009; Bokinskie & Evanson 2009; McCabe & Somers 2009(Naylor et al 1999; 2004; 2011;). These interventions include medication reconciliation, patient self-management support, caregiver support, and education interventions.
[Show abstract] [Hide abstract] ABSTRACT: Background While there is a significant focus on the health and well-being of women during pregnancy, labour and birth, much less emphasis is placed on the care of postpartum women and their infants in primary care following the birth. Some studies have investigated the role of GPs in postpartum care, and others examined facilitators and barriers to mothers accessing care. However there is little information available to investigate the effect of practice related factors on access to care of mothers and infants at this time. Methods A 20-item questionnaire for completion by the practice managers was mailed to 497 general practices in Southern Queensland, Australia between February and July 2013. Questionnaire items included practice demographics, practice procedures and personnel including appointment scheduling, billing, practice nurse function and qualifications and a free-text option for comments. Descriptive statistics are presented as numbers and percentages. Chi Squared test compared practice location with methods of identification of postpartum women, practice size with other Queensland data and ANOVA compared practice size with the number of postpartum appointments. Logistic regression was used to predict variables that were related to booked appointment times. Free text responses were grouped in common themes. Results The response rate was 27.4 %. At 67.2 % of the practices, mothers had to self-identify as needing a postpartum consultation and most consultations were allocated 15 minutes or less. Only 20 % of practices accepted the government insurance payment (bulk-billing) for all maternal and infant services, with more practices bulk-billing children only. Out-of-pocket expenses ranged from $10-$60. Nearly 80 % of practice nurses saw postpartum mothers or infants ‘nearly always’ or ‘sometimes’. Approximately 30 % had midwifery or child health training. There were higher odds of longer booked appointment times for solo practitioner practices (unadj OR 3.30 95%CI 1.03-10.57), but no other variables predicted booked appointment times Conclusions This study identified a number of practice related factors that, if addressed, could positively impact on postpartum care. These include ensuring ongoing practice relationships to assist with booking appropriate consultation times and guaranteeing that there are no financial impediments to women accessing care. Some factors can easily be adapted within practices. Others would require changes of policy at a local or national level. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1508-1) contains supplementary material, which is available to authorized users.
- While each practice can determine who it charges and how much, mothers are vulnerable at this time and should not be discouraged to seek care if needed, by financial impediments. This is especially important for mothers from a lower socio-economic background who tend to have more complex health care needs and are less likely to seek postpartum care . We were unable to correlate cost with area of practice.
University of California, DavisDavis, California, United States