Race, ethnicity, and indications for primary cesarean birth: Associations within a national birth center registry.

BACKGROUND: Racial and ethnic disparities in cesarean rates in the United States are well documented. This study investigated whether cesarean inequities persist in midwife-led birth center care, including for individuals with the lowest medical risk. METHODS: National registry records of 174,230 childbearing people enrolled in care in 115 midwifery-led birth center practices between 2007 and 2022 were analyzed for primary cesarean rates and indications by race and ethnicity. The lowest medical risk subsample (n = 70,521) was analyzed for independent drivers of cesarean birth. RESULTS: Primary cesarean rates among nulliparas (15.5%) and multiparas (5.7%) were low for all enrollees. Among nulliparas in the lowest-risk subsample, non-Latinx Black (aOR = 1.37; 95% CI, 1.15-1.63), Latinx (aOR = 1.51; 95% CI, 1.32-1.73), and Asian participants (aOR = 1.48; 95% CI, 1.19-1.85) remained at higher risk for primary cesarean than White participants. Among multiparas, only Black participants experienced a higher primary cesarean risk (aOR = 1.49; 95% CI, 1.02-2.18). Intrapartum transfers from birth centers were equivalent or lower for Black (14.0%, p = 0.345) and Latinx (12.7%, p < 0.001) enrollees. Black participants experienced a higher proportion of primary cesareans attributed to non-reassuring fetal status, regardless of risk factors. Place of admission was a stronger predictor of primary cesarean than race or ethnicity. CONCLUSIONS: Place of first admission in labor was the strongest predictor of cesarean. Racism as a chronic stressor and a determinant of clinical decision-making reduces choice in birth settings and may increase cesarean rates. Research on components of birth settings that drive inequitable outcomes is warranted.

Development of a culturally informed protocol for hair cortisol sampling in Black women.

This article describes the development of a culturally informed hair collection protocol for cortisol research with Black women. We first conducted a formative research study investigating the acceptability of hair cortisol sampling for African-American college women, where acceptance reached 54%. Findings, including the reasons reported for participation, were then used to develop a culturally informed hair sampling protocol for two studies in a community setting where acceptance improved to 75%. Specific barriers to hair sampling for research in this population were supported. Recommendations to increase participation in hair sampling are provided.

Finding what is hidden: a method to measure implicit attitudes for nursing and health-related behaviours.

AIM: To discuss a research method, the Implicit Association Test, for use in nursing research. The Implicit Association Test measures implicit attitudes, which may mediate health-related and caregiving behaviours. BACKGROUND: Implicit attitudes are automatic and often unconscious, but may affect the behaviours of nurses and their patients. The Implicit Association Test has been used to measure implicit attitudes in fields from health care to marketing, but has seldom appeared in nursing. The Implicit Association Test is a computer-based tool consisting of a series of categorization tasks. Implicit Association Tests are scored based on the speed of matching either words or images to categories. Assumptions of the Implicit Association Test method, its administration, psychometrics and potential use in nursing research are reviewed. DESIGN: Discussion paper. DATA SOURCES: PubMed, the Cumulative Index to Nursing and Allied Health Literature, PsychINFO® and Health and Psychosocial Instrument databases were searched from the Implicit Association Test's introduction in 1998-April 2013. Search terms used were 'Implicit Association Test' OR 'IAT'. IMPLICATIONS FOR NURSING: Nursing theories include attitudes as mediators of behaviour and health, but measurement has been limited to explicit attitudes. A reliable, valid and flexible tool is available to measure implicit attitudes. This tool largely circumvents self-report bias related to socially sensitive topics. CONCLUSION: Nursing research is needed to investigate implicit attitudes held by nurses and patients when these may influence health-related behaviours and outcomes. The Implicit Association Test can measure implicit attitudes and is suitable for adoption in nursing research.

Ethical Care for Patients with Self-Managed Abortion After Roe.

ABSTRACT: The 2022 Supreme Court decision leaving the regulation of abortion to the states is sure to result in a complex regulatory environment for patients and nurses. In states where abortion is illegal, patients may self-manage abortions using medications they obtain through the mail or by other means. Nurses may care for these patients in multiple settings and may wonder about their own legal and ethical obligations. This article reviews patient privacy as it relates to self-managed abortion, ethical reporting requirements for nurses, and best practices for treating complications of self-managed abortion using a harm reduction framework, with a focus on protecting patients' rights. Recommendations for ethical patient care are also provided.

Racial Discrimination, Racial Identity, and Obesity in Collegiate African American Women.

OBJECTIVE: To investigate relationships among racial discrimination, explicit racial identity, and obesity in young collegiate African American (AA) women aged 18-25. DESIGN: Researchers recruited 136 women who self-identified as AA from a large Midwestern university. Racial discrimination (RD) was measured using lifetime overt experiences of discrimination, recent microaggressions, and vicarious RD directed towards close others. Explicit racial identity included dimensions of private regard, public regard, and centrality. Generalized obesity (elevated body mass index) and abdominal obesity (increased fat distribution in the midsection) were measured biometrically using kg/m2 and waist circumference, respectively. Hierarchical multiple regression was employed to explore main and interaction effects. RESULTS: After controlling for adverse life events and income, overt RD, recent microaggressions, and private regard directly accounted for variance in both BMI and waist circumference. Public regard and centrality moderated relationships between RD variables and waist circumference. CONCLUSIONS: RD and racial identity accounted for up to 13% of variance in BMI and waist circumference in main effects models among young collegiate AA women. While obesity is a multifactorial phenomenon, racial discrimination and racial identity may affect observed racial disparities in obesity rates among young women.

Hair Cortisol Concentration and Perceived Chronic Stress in Low-Income Urban Pregnant and Postpartum Black Women.

Black women are more likely to experience short- or long-term health consequences from their labor and delivery and die from pregnancy-related causes than White women. Similarly, infants born to Black women also have heightened health risks. Developing research suggests that a contributing factor to Black health disparities may be maternal chronic stress. A widely used biomarker for chronic stress is hair cortisol concentration (HCC). Few prior studies have explored the HCC of pregnant Black women or comprehensively examined perceived chronic stress in this population. Using a mixed-methods focus group framework, we assessed HCC and perceived chronic stress among low-income pregnant and postpartum Black women. Four focus groups were conducted (N = 24). The mean HCC for our pregnant Black participants was greater than pregnant White women in reviewed published studies. The high levels of stress evidenced at all pregnancy stages indicate that many of these women are experiencing chronic stress, which can contribute to higher Black maternal morbidity and mortality rates, and possibly infant mortality rates. From the open coding of the focus group transcripts, 4 themes emerged: chronic stress, experiences of racism, experiences of trauma, and negative thinking. Selective coding based on these themes revealed cumulative experiences of chronic stress, various traumatic experiences, and frequent encounters with racism. Negative thinking styles were observed across the 4 focus groups. More studies of HCC and perceived stress among pregnant Black women are encouraged. Findings suggest the need for tailored multi-level interventions given the layers of stressors present in this population.

Bacterial vaginosis and preterm birth.

Although it has been clear for more than 2 decades that bacterial vaginosis increases the risk for preterm birth in some women, it is not yet fully understood why this association exists or how best to modify the risk. Incomplete understanding of this polymicrobial condition and difficulties in classification contribute to the challenge. The relationship between altered vaginal microflora and preterm birth is likely mediated by host immune responses. Because treatment of bacterial vaginosis during pregnancy does not improve preterm birth rates, and may in fact increase them, screening and treatment of asymptomatic pregnant women is discouraged. Symptomatic women should be treated for symptom relief. This article reviews the pathophysiology of bacterial vaginosis and controversy surrounding management during pregnancy. Agents currently recommended for treatment of this condition are reviewed.