Development of a Maternal Equity Safety Bundle to Eliminate Racial Inequities in Massachusetts.

OBJECTIVE: The PNQIN (Perinatal-Neonatal Quality Improvement Network of Massachusetts) sought to adapt the Reduction of Peripartum Racial and Ethnic Disparities Conceptual Framework and Maternal Safety Consensus Bundle by selecting and defining measures to create a bundle to address maternal health inequities in Massachusetts. This study describes the process of developing consensus-based measures to implement the PNQIN Maternal Equity Bundle across Massachusetts hospitals participating in the Alliance for Innovation on Maternal Health Initiative. METHODS: Our team used a mixed-methods approach to create the PNQIN Maternal Equity Bundle through consensus including a literature review, expert interviews, and a modified Delphi process to compile, define, and select measures to drive maternal equity-focused action. Stakeholders were identified by purposive and snowball sampling and included obstetrician-gynecologists, midwives, nurses, epidemiologists, and racial equity scholars. Dedoose 9.0 was used to complete an inductive analysis of interview transcripts. A modified Delphi method was used to reach consensus on recommendations and measures for the PNQIN Maternal Equity Bundle. RESULTS: Twenty-five interviews were completed. Seven themes emerged, including the need for 1) data stratification by race, ethnicity and language; 2) performance of a readiness assessment; 3) culture shift toward equity; 4) inclusion of antiracism and bias training; 5) addressing challenges of nonacademic hospitals; 6) a life-course approach; and 7) selection of timing of implementation. Twenty initial quality measures (structure, process, and outcome) were identified through expert interviews. Group consensus supported 10 measures to be incorporated into the bundle. CONCLUSION: Structure, process, and outcome quality measures were selected and defined for a maternal equity safety bundle that seeks to create an equity-focused infrastructure and equity-specific actions at birthing facilities. Implementation of an equity-focused safety bundle at birthing facilities may close racial gaps in maternal outcomes.

Risky, Dramatic, and Unrealistic: Reality Television Portrayals of Pregnancy and Childbirth and their Effects on Women's Fear and Self-Efficacy.

Because portrayals of pregnancy and childbirth on reality television (TV) often highlight risk, drama, and the use of medical interventions, it is possible that exposure to this content could influence women's fear of childbirth and childbirth self-efficacy. To test this question, we conducted an experiment among 213 undergraduate women who were assigned to view a video clip of either medicalized births from reality TV, midwife-attended births from reality TV, or a neutral childbirth education clip. Findings indicated that childbirth attitudes did vary across conditions, with participants in the medicalized condition reporting the highest fear of childbirth and lowest childbirth self-efficacy. Participants' feelings about potential pregnancy also varied depending on the clip viewed. Because the likelihood of witnessing a birth in person before becoming pregnant is lower than in previous years, these findings have significant implications for how women form their understandings of pregnancy and childbirth.