Reflective Capacity: An Antidote to Structural Racism Cultivated Through Mental Health Consultation.

Effecting a paradigm shift from "reproductive health" to "reproductive justice" within the perinatal field requires changes simultaneously at the levels of the individual healthcare provider and the system of care. The Infant-Parent Program at the University of California, San Francisco (UCSF) has extended its pioneering infant and early childhood mental health consultation to perinatal service systems applying an infant mental health approach to programs caring for expecting and new parents. In partnership with two nursing programs, UCSF consultants direct their efforts at supporting reflective practice capacities and use-of-self in patient-provider relationships. Both nursing programs serve vulnerable groups of expectant and new parents who grapple with challenges to health and well-being stemming from structural racism. As reflective capacities are supported within the consultation case conferences, providers spontaneously identify the need for tools to effectively address issues of race, class, and culture and to combat structural racism throughout the healthcare system. Policies and procedures that uphold structural racism cease to be tolerable to providers who bring their full selves to the work that they are trained to do. Using these nurse consultation partnerships as organizational case studies, this article describes a range of challenges that arise for providers and delineates steps to effective engagement toward reproductive justice.

Llevar a cabo un cambio de paradigma de "salud reproductiva" a "justicia reproductiva" dentro del campo perinatal requiere cambios simultáneamente al nivel individual del proveedor de cuidados de salud y el sistema de cuidado. El Programa Infante-Progenitor de la Universidad de California en San Francisco (UCSF) ha extendido su pionera consulta de salud mental infantil y la primera infancia a sistemas de servicio perinatal con la aplicación de un acercamiento de salud mental infantil a programas que les sirven a progenitores nuevos y que esperan un niño. En colaboración con dos programas de enfermería, los consultores de UCSF dirigen sus esfuerzos al apoyo de las capacidades de la práctica con reflexión y el uso de sí mismo en las relaciones entre proveedor y paciente. Ambos programas de enfermería les sirven a grupos vulnerables de padres nuevos y que esperan los cuales luchan con retos a la salud y el bienestar provenientes del racismo estructural. A medida que las capacidades de reflexión son apoyadas dentro de las conversaciones de casos consultados, los proveedores espontáneamente identifican la necesidad de herramientas para hablar con efectividad de asuntos de raza, clase social y cultura y combatir el racismo estructural dentro del sistema de cuidado de salud. Políticas y procedimientos que sostienen el racismo estructural dejan de ser tolerables para proveedores que se dan por completo al trabajo para el cual han sido entrenados. Por medio de usar estas colaboraciones de consulta con enfermeras como casos de estudio organizacionales, este artículo describe una gama de retos que surgen para los proveedores y delinean los pasos para un involucramiento eficaz hacia la justicia reproductiva.

Procéder à un déplacement de paradigme d'une "santé reproductive" vers une "justice reproductive" dans le domaine périnatal exige des changements à la fois au niveau du service de soin individuel et et du système de soins. Le programme Nourisson-Parent de l'Université de Californie à San Francisco (abrégée avec ses initiales UCSF) aux Etats-Unis a élargi sa consultation pionière de santé mentale du nourrisson et de la petite enfance aux systèmes de soins périnatals en appliquant une approche de santé mentale du nourrissons à des programmes s'occupant de parents attendant un enfant ou à de nouveaux parents. En partenatia avec deux programmes de soins infirmières, les consultants de l'UCSF dirigent leurs efforts vers le soutien de capacités de réflection sur la pratique et l'utilisation de soi dans la relation patient/prestataire. Ces deux programmes de soins infirmiers servent des groupes vulnérables de parents attentant un enfant ou de nouveaux parents qui rencontrent des difficultés et des défis à leur santé et bien-être du fait d'un racisme structural. Puisque les capacités de réflexion sont soutenues au sein des conférences discutant les cas de consultation, les prestataires identifient spontanément le besoin d'outils afin d'aborder de manière efficace les problèmes de race, de classe et de culture et afin de combattre le racisme structurel au sein du système de soins médicaux. Les mesures et les procédures qui maintiennent le racisme structurel cesse d'être tolérable pour les prestataires qui amènent au travail pour lequel ils ont été éduqués leur être tout entier. En utilisant ces partenariat de consultation avec les infirmières en tant qu'études de cas organisationnelles, cet article décrit un éventail de défis qui se posent aux prestataires et présente les étapes nécessaires pour un engagement efficace vers la justice reproductive.

Meeting Women Where They Are: Integration of Care As the Foundation of Treatment for At-Risk Pregnant and Postpartum Women.

Purpose In these times of rapidly changing health care policies, those involved in the health care of women, especially during the reproductive years, have a unique and daunting opportunity. There is great potential to positively impact women's health through focus on prevention, attention to addressing disparities, and new focus on the integration of behavioral health care in primary care settings. Description In this report from the field, we suggest that the integration of mental health care into other health services and addressing underlying social needs by partnering with community-based organizations should be a top priority for all settings seeking to provide excellent health care for women. Assessment We describe our experience in a diverse, urban, safety net system to draw attention to four areas of innovation that others might adapt in their own systems: (1) addressing social support and other social determinants of health; (2) tailoring services to the specific needs of a population; (3) developing integrated and intensive cross-disciplinary services for high-risk pregnant women; and (4) bridging the divide between prenatal and postpartum care. Conclusion Women are more likely to be engaged with healthcare during their pregnancy. This engagement, however limited, may be a unique "window of opportunity" to help them address mental health concerns and implement positive behavior change. Future work should include research and program evaluation of innovative programs designed to serve the entire family and meeting at-risk women where they are.

Integrating a Nurse-Midwife-Led Oral Health Intervention Into CenteringPregnancy Prenatal Care: Results of a Pilot Study.

INTRODUCTION: National and professional organizations recommend oral health promotion in prenatal care to improve women's oral health. However, few prenatal programs include education about oral health promotion. The objective of this study was to determine if women receiving a brief, low-cost, and sustainable educational intervention entitled CenteringPregnancy Oral Health Promotion had clinically improved oral health compared to women receiving standard CenteringPregnancy care. METHODS: Women attending CenteringPregnancy, a group prenatal care model, at 4 health centers in the San Francisco Bay Area, participated in this nonrandomized controlled pilot study in 2010 to 2011. The intervention arm received the CenteringPregnancy Oral Health Promotion intervention consisting of two 15-minute skills-based educational modules addressing maternal and infant oral health, each module presented in a separate CenteringPregnancy prenatal care session. The present analysis focused on the maternal module that included facilitated discussions and skills-building activities including proper tooth brushing. The control arm received standard CenteringPregnancy prenatal care. Dental examinations and questionnaires were administered prior to and approximately 9 weeks postintervention. Primary outcomes included the Plaque Index, percent bleeding on probing, and percent of gingival pocket depths 4 mm or greater. Secondary outcomes were self-reported oral health knowledge, attitudes (importance and self-efficacy), and behaviors (tooth brushing and flossing). Regression models tested whether pre to post changes in outcomes differed between the intervention versus the control arms. RESULTS: One hundred and one women participated in the study; 49 were in the intervention arm, and 52 were in the control arm. The control and intervention arms did not vary significantly at baseline. Significant pre to post differences were noted between the arms with significant improvements in the intervention arm for the Plaque Index, bleeding on probing, and pocket depths 4 mm or greater. DISCUSSION: Providing brief oral health education and skills-building activities within prenatal care may be effective in improving women's oral health during pregnancy. These findings provide support for developing a full-scale randomized clinical trial of the CenteringPregnancy Oral Health Promotion intervention.

Making Room at the Table for Obstetrics, Midwifery, and a Culture of Normalcy Within Maternity Care.

The principle of avoiding the worst possible outcomes guided the enormous successes of modern obstetrics in reducing the morbidity and mortality of childbirth. The challenges of improving the quality of childbirth today has prompted health care providers, policymakers, and patients to ask whether this principle is in fact preventing us from supporting the normal processes of childbirth, resulting in undue intervention and potentially causing harm. In this commentary, we suggest that recognizing the strengths of the medical model of childbirth does not preclude looking outside of it to meet the maternity care needs of the majority of healthy, low-risk women. Obstetricians have the good fortune to have a partner in their work among midwives, who hail from a long tradition of incorporating a perspective of "normalcy" in the care of childbearing women. Given the many evidence-based practices demonstrating the strengths of midwifery to actualize patient-centered, low-intervention birth, we advocate for the explicit establishment of professional standards for team-based physician-midwife care. More than merely introducing midwives into a physician-dominated setting, this means elevating the contributions of midwives and meaningfully incorporating a culture of normalcy to standardize practices such as intermittent auscultation, continuous birth support, nonpharmacologic pain management, and positional flexibility in labor. The literature suggests that a woman's health care provider is the most powerful determinant of her birth outcomes; striking the balance between averting poor outcomes and normalcy compels us to make room at the table for both obstetricians and midwives.

Great minds don't think alike: collaborative maternity care at San Francisco General Hospital.

For more than 30 years the collaboration between obstetrician-gynecologists and certified nurse-midwives at San Francisco General Hospital has led to the provision of high-quality care to women and families. This enduring partnership has been sustained by shared goals and values, most notably a commitment to excellence in both providing care to the underserved and training the next generation of physicians and nurse-midwives. Success has also depended on a mutual respect for differences that has enabled the collaborative to capitalize on the distinct expertise of each partner. The balance struck between independence and interdependence of the practice groups has led to innovation and successes that might otherwise not have come to being, while also enabling the collaborative to overcome the inevitable conflicts and challenges that arise within this type of long-standing partnership. This model holds promise for replication in other settings and informs broader considerations of health policy and regulation.