Do Black birthing persons prefer a Black health care provider during birth? Race concordance in birth.

BACKGROUND: For many years in the United States, there has been an active discussion about whether race concordance between care providers and patients contributes to better health outcomes. Although beneficial provider-patient communication effects have been associated with concordance, there is minimal evidence for concordance benefits to health outcomes. METHODS: A cross-sectional survey was conducted including 200 Black mothers who had given birth within the last 2 years asking about the perceived racial identity of their birth health provider, whether they preferred to have Black women providers, and the intersection between race and gender concordance on birth outcomes. In addition to race and gender concordance, other variables were tested for their impact on birth satisfaction including respect, trust for the care provider, perceived competence, care provider empathy, and inclusive communication. RESULTS: Forty-one percent of the mothers in this study were assisted in birth by a Black woman provider. Although patient-provider concordance did not result in measurable health outcomes, it is clear that compared to other studies of birth satisfaction among Black birthing persons, this study showed relatively higher levels of satisfaction, perceived trust, empathy, perceived provider competence, inclusive communication, and equal respect for both concordant and discordant care providers. CONCLUSIONS: Although many participants showed a preference for race concordance, participants equally valued respect, competence, and trust with their care providers. Further community-based research needs to be conducted to examine whether race, gender, and cultural concordance results in other beneficial health outcomes.

Black mothers' birthing experiences: in search of birthing justice.

OBJECTIVES: Previous studies have suggested that often, Black mothers' birthing experiences are not what they expected because of how they were treated by healthcare providers during labor and birth. Our goal in this study was to ask Black mothers who had recently given birth about the quality of their birthing experiences as well as their level of respect from, trust in, and satisfaction with their maternity healthcare providers. DESIGN: This study gathered data from Black mothers (N = 209) who had given birth within the past two years, using a cross-sectional online survey measuring several variables about the birthing experience including types of healthcare provider communication, provider respect for the mother, trust, birth satisfaction, and emotional responses to birth. RESULTS: Provider-centered communication, although preferred by some mothers, was associated with lower birth satisfaction and stronger negative emotions whereas positive birth satisfaction was linked to patient-centered communication which resulted in positive emotions. While most mothers reported overall satisfaction with their birth experience, nearly half reported experiencing some degree of disrespect from their healthcare providers during labor and birth. Moreover, trust and respect mediated the relationship for patient-centered communication with positive emotion and birth satisfaction. Over one-third of participants gave birth with a certified nurse midwife attending. There were no differences in perception of being respected or the quality of birth given the professional identity of the provider as an Obstetrician/Gynecologist or as a midwife. The advice suggested by Black mothers for their healthcare providers was instructive in identifying ways those providers could better serve their patients during birth. CONCLUSION: This study showed that there is still additional work that needs to be done for racial equity and respect during birth. Practical implications for addressing health inequities are discussed.

Medical and Nursing Students' Perceptions of and Advice for Extended Breastfeeding: An Exploratory Study.

Although the health benefits to both mother and child produced by breastfeeding have been documented, and numerous efforts have been made to promote breastfeeding rates in the United States, extended breastfeeding (breastfeeding beyond 12 months) research has been largely overlooked. Guided by the Framework of Integrative Normative Influences on Stigma, this study examined how extended breastfeeding was perceived among medical and nursing students and how perceptions of extended breastfeeding were translated into stigmatizing outcomes including attitudes, behavioral predispositions, and behavioral intention to encourage weaning. One hundred and sixteen medical and nursing students enrolled at a large mid-western University completed an online survey. Participants were asked to provide answers to questions regarding their knowledge of extended breastfeeding, attitudes toward it, perception about stigma associated with breastfeeding, and their behavioral intention to encourage future patients to wean. A lack of knowledge about extended breastfeeding was evident among the medical and nursing students; they also exhibited increasingly negative attitudes toward extended breastfeeding as the child's age increased. Medical and nursing students' behavioral intention to encourage weaning is associated with their pre-dispositional stigma of extended breastfeeding. Addressing stigma and negative attitudes toward extended breastfeeding in pre-healthcare students' curriculum may help future healthcare providers understand that while cultural norms in the United States do not tend toward extended breastfeeding, it is more common in other parts of the world, as well as help them understand health benefits to the child and to the mother.

Awe and Trepidation: The Role of Perinatal Care Providers in Black Fathers' Experiences of Childbirth in the U.S.

Care provider communication with Black birthing families is impactful. This cross-sectional study asked 216 Black fathers to recall treatment by birthing care providers and tested variables contributing to birth satisfaction and fathering identity salience. Most fathers reported that care providers were respectful resulting in a positive birthing experience; however, 15% reported negative experiences with care providers. Perceived social support was shown to be a mediator between disrespect, mistreatment, inclusive communication, trust, and positive emotion with birth satisfaction and fathering identity salience. Care provider disrespect served as a "spoiler" of the birthing experience and subsequently diminished positive fathering identity salience. Analysis of open-ended comments showed that contrary to stereotypes about absent, disengaged Black fathers, fathers in this study were caring toward their newborns, present for them, and engaged in fathering. More work needs to be done with care provider communication to make every birth a positive and inclusive experience for Black fathers and their partners.

Navigating Uncertain Times: Information Management about Pregnancy and Breastfeeding during the COVID-19 Pandemic.

Pregnant women are especially vulnerable to COVID-19 while the short- and long-term impact of COVID-19 on maternal and infant health is only partially understood. We assessed the amount of uncertainty and anxiety pregnant women experienced about COVID-19 and whether, and the extent to which, they engaged in information seeking about COVID-19. In total, 320 pregnant women from 38 states took part in this research. The results showed that pregnant women experienced uncertainty and anxiety about pregnancy and breastfeeding and engaged in information seeking from their healthcare providers. Pregnant women's uncertainty influenced information seeking via anxiety, but the effect varied depending on participants' assessments of coping, communication, and target efficacy. While healthcare providers need to discuss ways to avoid COVID-19 infection, participants were assured that their providers had a plan to help them if they became infected with COVID-19.

Promoting Sustained and Exclusive Breastfeeding among Chinese American Pregnant Women.

This study investigated prenatal goal setting and breastfeeding attitudes and intentions for 210 Chinese American pregnant women. In addition, this study assessed impact of person-centered versus factual messages on breastfeeding attitudes and intentions. While pregnant women reported receiving information about Baby-Friendly designated hospitals from healthcare providers, most received no breastfeeding information from those same providers. Although women had positive attitudes toward breastfeeding, they showed lack of knowledge about colostrum, general approval for using infant formula, as well as early introduction of complementary foods. By extension, these attitudes suggested they misunderstood the meaning of exclusive breastfeeding. No differences were observed based on parity, trimester of pregnancy, level of education or income. Person-centered and factual messages were judged as equally effective messages, but intention to breastfeed was more affected by the factual message. Reasons for this result are discussed. Healthcare providers are positioned to proactively engage in maternal preparedness for exclusive breastfeeding. These results suggested a missed opportunity for healthcare providers to communicate the value of sustained exclusive breastfeeding for the recommended first 6 months of an infant's life and underscore a need for all antenatal healthcare providers to collaboratively ensure that breastfeeding information is comprehensively provided throughout the span of antenatal care.

Too Old to Be Breastfed? Examination of Pre-Healthcare Professionals' Beliefs About, and Emotional and Behavioral Responses toward Extended Breastfeeding.

While breastfeeding seems to be widely accepted in the United States, extended breastfeeding (defined as breastfeeding beyond 12 months of age) tends to be stigmatized. Healthcare professionals are assumed to play a significant role in supporting women who desire to practice extended breastfeeding; however, how healthcare professionals react to extended breastfeeding has not been well understood. This research surveyed 116 healthcare students, who majored in nursing and human medicine, and examined their perceived advantages and disadvantages, emotional responses to, and advice that they would provide to future mothers regarding extended breastfeeding. The results indicated that students responded predominantly with negative emotions and neutral responses to extended breastfeeding, with a small number of participants responding with positive emotions. Many participants believed that it would bring benefits to the child and that it would be burdensome to the mother. Participants displayed a variety of behavioral responses when asked about advice that they would provide to future mothers with whom they will interact in a clinical setting. Practical implications are discussed.

Keep Doing the Good Work: Impact of Coworker and Community Support on Continuation of Breastfeeding.

Returning to work poses a challenge to new mothers' breastfeeding success during the first 6 months postpartum. While previous research has shown that breastfeeding-related workplace policy plays a significant role in women's decision to continue breastfeeding, the extent to which interpersonal factors such as coworkers' (lack of) support and stigma affect women's breastfeeding behavior is less understood. Through a cross-sectional survey with 500 working mothers, this research found that female coworker support of other women played an important role in affecting mothers' decision to continue breastfeeding after returning to work and contributed to breastfeeding self-efficacy. The findings suggest that mothers' perception of supportive coworker communication has an impact on sustained breastfeeding. Workplaces need to enhance the mother-friendly climate by encouraging and rewarding coworkers and providing support necessary for breastfeeding colleagues.

Breastfeeding but not Exclusively: Exploration of Chinese American Mothers' Infant Feeding Practices.

BACKGROUND: Previous qualitative researchers have shown that Chinese American mothers experienced high rates of suboptimal breastfeeding, especially early introduction of other foods before the recommended 6-month period of exclusive breastfeeding. RESEARCH AIMS: (1) To explore attitudes that Chinese American mothers have about the meaning and practice of exclusive breastfeeding; (2) to evaluate the extent of family pressure and support to maintain exclusive breastfeeding; and (3) to examine the influence of breastfeeding self-efficacy and the intention to continue exclusive breastfeeding. METHOD: Guided by the theory of planned behavior, this descriptive cross-sectional prospective online survey was conducted with Chinese American breastfeeding mothers (N = 401). Participants' attitudes, subjective norms, and perceived behavioral control for exclusive breastfeeding behaviors were measured. RESULTS: The M (SD) age of participants was 29.14 (SD = 6.90). Just over 50% reported receiving family support for exclusive breastfeeding. While participants had positive attitudes about exclusive breastfeeding and the value of colostrum, 64% (n = 257) had already introduced foods other than mother's own milk before their infant was 6-months old. Participants also expressed concern that their infants did not receive enough nutrition from exclusive mother's milk. Participants with more than one child had significantly greater intention to continue exclusive breastfeeding compared to participants with only one child. Perception of approval by others for exclusive breastfeeding and breastfeeding self-efficacy were significantly related to behavioral intention to continue exclusive breastfeeding. CONCLUSION: Suboptimal infant feeding is a problem for Chinese American women and may also be a problem for mothers in other ethnic groups. We found a lack of adherence with standard recommendations for sustaining 6-months of exclusive breastfeeding.

Made to Feel Like Less of a Woman: The Experience of Stigma for Mothers Who Do Not Breastfeed.

Background: Breastfeeding has become the recognized standard for good parenting, with social costs for not breastfeeding, but not every mother wants to or is able to breastfeed. Objectives: This study investigated social and personal costs with no breastfeeding. Materials and Methods: An in-depth survey was conducted with 250 mothers with infants who were not breastfeeding. Situated in the Framework Integrating Normative Influences on Stigma model for stigma, the study analyzed internalized stigma and perception of stigma from others, maternal feelings of warmth for the infant, and hiding formula use. Results: Mothers who chose not to breastfeed reported little personal or public stigma. In comparison, mothers who were unable to breastfeed experienced relatively more internalized stigma and perceived that other people saw them as failures. Mothers who experienced more internalized and perceived social network stigma were likely to hide use of infant formula from others and had lower feelings of warmth for their infants. Knowledge about formula use and availability of support resulted in less stigma and more warmth for the infant. Conclusions: These results suggest that public responses causing a mother to feel guilty for using infant formula result in negative feelings of self-worth and dysfunctional maternal behaviors.

A Proactive Approach to Quantification of Blood Loss in the Perinatal Setting.

OBJECTIVE: To educate nurses and physicians on changing practice from visual estimation of blood loss to quantification of blood loss (QBL) and to replace estimation of blood loss with QBL for at least 85% of vaginal births during a 3-month period. DESIGN: Quality improvement project. SETTING/LOCAL PROBLEM: A midwestern U.S. urban community hospital with 1,200 annual births, where postpartum blood loss was being measured by using visual estimation. PARTICIPANTS: A convenience sample of 43 intrapartum nurses and 17 physicians. INTERVENTION/MEASUREMENTS: A goal was set to use the QBL method for at least 85% of vaginal births for 3 consecutive months. Study participants were surveyed at baseline to assess their knowledge of the QBL method; they then received a 10-minute educational presentation by the clinical nurse specialist (CNS) on QBL. The CNS attended births on both 12-hour shifts to give support, evaluate correct use of the new drapes, and answer questions. Midway through the project, a brief survey was distributed to participants for their feedback. The CNS conducted a chart audit to determine the compliance rate for the QBL process. RESULTS: Data analysis indicated an average 89% compliance rate with the QBL process for the time period studied. CONCLUSION: Education on the QBL method increased nurses' and physicians' awareness of the importance of using this method as the new standard of care for assessment of postpartum blood loss. Accuracy of postpartum blood loss measurement is critical to help prevent maternal morbidity and mortality. Nurses play a key role in the development and implementation of practice changes to use QBL measurement.

Transcultural analysis of postpartum depression.

Postpartum depression (PPD) strikes about 1 in 10 Western women. Studies of Western women have demonstrated that this emotional experience can occur during pregnancy and/or after delivery, and even in women who adopt an infant. Is PPD a universal experience or a morbid condition that is culture specific to Western/industrialized countries? The purpose of this literature review was to examine other cultures to ascertain whether PPD is a universal experience. The literature describes women throughout the world experiencing degrees of sadness postnatally, which persist up to 1 year. The risk factors for PPD also share similar themes cross-culturally, with one notable exception--the impact that the sex of the infant had on PPD, for a higher value for male children over female offspring was reported in literature from China, Turkey, and India. This literature review demonstrated that, although PPD is an experience that women in all cultures experience, the underlying cause for this malady in non-Western cultures is not attributed to biologic causes, and treatment is not generally based on a Western medical model.

Lessons learned from implementation of a perinatal documentation system.

Implementation of an electronic medical record (EMR) system is a complex process with broad implications. In a Midwestern hospital perinatal setting, EMR implementation involved several critical steps: strategic planning and project goal setting; project structure and governance; system requirements analysis; vendor selection and contract negotiation; and EMR training. No difference in patient care activities and communications among clinicians was found between pre- and post-EMR implementation; however, nurses' perceptions of EMR were more negative afterward. Lessons learned and implications are provided.

Intrapartum nurses' lived experience in a traumatic birthing process.

PURPOSE: To describe the essence of nine nurses' participation in an unexpected/traumatic birthing process to ascertain what impact this experience had on the nurse. STUDY DESIGN: Descriptive phenomenology was the qualitative research design used. METHODS: A four-person team analyzed the transcribed interviews of each nurse's experience using Colaizzi's method of analysis. We recruited nine intrapartum nurses from a call-out to Indiana Association of Women's Health, Obstetric and Neonatal Nurses Section Chapter members. RESULTS: One overarching theme, From Behind Closed Doors, and the following six subthemes described the essence of the participants' experiences: (1) Feeling the Chaos; (2) Expect the Unexpected; (3) It's Hard to Forget; (4) All Hands on Deck; (5) Becoming; and (6) For the Love of OB (Obstetrics). CLINICAL IMPLICATIONS: Intrapartum nurses in this study clearly demonstrated that the impact of an unexpected event can be emblazoned on one's memory for many years, with an immediate response of secondary traumatic stress disorder symptoms.

Women's lived experience of their unexpected birthing process.

PURPOSE: To describe the essence of women's unexpected birthing experiences. METHODS: Descriptive phenomenology using interviews with 10 women who had birthing experiences that were not what they had expected, including (1) an instrumentally assisted vaginal delivery either by forceps and/or by a vacuum extractor, (2) a third- or fourth-degree tear, (3) birth by an emergency cesarean birth, or (4) women who perceived that their delivery was incongruent with their expectations. Interviews of each woman's birth experience were transcribed using Colaizzi's method of analysis. RESULTS: The findings reflected the absence of three critical elements-caring, connection, and control-that the women believed were missing from their birthing experiences. The lack of caring was demonstrated by the statement: "They were there to take care of your baby and not you and that's the end of it." The lack of connection was demonstrated by the statement "I just didn't have a nurse who was really there." The lack of control was demonstrated by this statement: "You're not in control of the experience." CLINICAL IMPLICATIONS: Perinatal nurses have an opportunity to influence a caring environment in which women feel connected to their nurse and in control of their labor and birth. Tailoring nursing care to meet the needs of each mother, especially women who are experiencing things they had not expected in labor or during birth, may be the key ingredient to ensure optimal birthing experiences.