Obstetric Experience Research Articles

Tracking Obstetrical and Gynecological Experiences Using Mobile Devices [19P

INTRODUCTION: Tracking clinical experiences is important toward progression of entrustable professional activities required by medical schools. The purpose of this study was to determine the effectiveness of using an innovative real-time mobile device tracker for medical student clinical experiences compared with the traditional tracking using a passport log. METHODS: A prospective single cohort observational study was performed using third year medical students in obstetrics and gynecology rotations. Participants downloaded the obstetrics and gynecology (OBG) tracker and recorded their clinical experiences; procedures, number, and degree of involvement. Results were compared with data from the passport log. Outcomes included data comparison from both tracking methods and end of clerkship student surveys. Internal review board exemption was obtained. Paired t-tests were used for data analysis. RESULTS: Thirty-six students participated in the study over 6 months. The OBG tracker recorded 269 entries, the passport recorded 187. The OBG tracker recorded higher numbers of procedures compared to the passport (procedure type, 56 OBG tracker, 8 passport, p<0.001; degree of involvement, 30 OBG tracker, 0 passport, p<0.001). OBG tracker also tabulated student involvement in cases; 40.2% vaginal deliveries, 41.2% delivered placentas, 62.0% coached patients, 50.9% inserted catheters, 35.8% sutured, 33.3% pelvic exam, 23.3% breast exams. Student surveys rated OBG tracker more useful than the passport (OBG tracker 1.29, passport 4.06, p<0.001). CONCLUSION: The use of a mobile device tracker for clinical experiences allowed for more meaningful real-time data of learners than the traditional passport logs. Tracking detailed experiences and degree of involvement is important to entrustment decisions in medical education.

Introduction of an undergraduate interprofessional simulation based skills training program in obstetrics and gynaecology in India

Interprofessional simulation based education (SBE) improves core clinical skills and team training in obstetrics and gynaecology. In this innovative study, the introduction of an undergraduate interprofessional SBE program for teaching obstetrics and gynaecology skills in India was evaluated. The study attempted to evaluate the feasibility and benefit of the interprofessional skills training workshop in obstetrics and gynaecology, which was introduced for medical and midwifery students in a secondary level hospital in India. The program focuses on improving “hands-on” clinical skills and can be explained by the “skills acquisition theory”. Using a survey, participants rated relevance, pitch and confidence (on a 5-point Likert scale) and described the contextualisation and teaching of core clinical skills through the workshop using free-text. Descriptive analysis of quantitative Likert scale responses and thematic analysis of the free-text data was conducted and themes identified. Ninety-five medical and midwifery students attended the inaugural workshop, in a low-resource setting. The clinical experience in obstetrics and gynaecology across both groups was minimal, neither were they exposed to any prior SBE. Both health professional groups found the workshop useful, relevant and improved their confidence in performing vaginal examination and births. The key theme, which emerged from qualitative analysis, was “getting hands-on” experience. Other themes included learning by simulation without clinical time constraints, retaining the ability to make mistakes, bridging theory to practice, valuing interprofessional experience and ensuring equal learning opportunities for all participating professional groups. The advantages of interprofessional SBE, for medical and midwifery students, are reproducible in a low-resource setting, and may be be helpful for learning intimate clinical examination, obstetric procedures and team training.

Strange expectations: Cameroonian migrants and their German healthcare providers debate obstetric choices

ABSTRACT When Cameroonian women migrate to Germany, they expect a different obstetric experience than they would have met in Cameroon. They bemoan the loss of family support, but do not yearn for village midwives. These largely urban, educated women expect better and more easily accessible medical care, free of the shortages and corruption plaguing Cameroon’s public health system. Their expectations—that bearing children is medically easier but socially harder than in Cameroon—are shaped by obstetrical stories circulating among their fellow migrants. Most migrant mothers celebrate the medicalisation, thoroughness, and even bureaucratic tracking, of German perinatal health care. In contrast, German healthcare providers draw from two models imagining their African clients’ obstetric concerns and desires. Some combine a Western feminist critique of biomedicine with dehumanising stereotypes of Africans as ‘nature-near.’ Imagining that African women find highly regulated, medicalized German perinatal care alienating, these providers assume that their African clients have witnessed births in rural settings and share broad female knowledge of ‘natural’ childbirth. Other providers differentiate among African clients by nationality and education level to assess their comfort regarding medicalized prenatal and obstetric care. Cameroonian migrant mothers and German medical humanitarians confirm, reconfigure, and transform stereotypes of each other’s obstetric desires.

Four maternal characteristics determine the 12-month course of chronic severe postpartum depressive symptoms.

Postpartum depression is a heterogeneous disorder in phenotype and etiology. Characterizing the longitudinal course of depressive symptoms over the first year after birth and identifying variables that predict distinct symptom trajectories will expedite efficient mental health treatment planning. The purpose was to determine 12-month trajectories of postpartum depressive symptoms, identify characteristics that predict the trajectories, and provide a computational algorithm that predicts trajectory membership. A prospective cohort of women delivering at an academic medical center (2006-2011) was recruited from an urban women's hospital in Pittsburgh, PA. Women with a postpartum depressive disorder (n = 507) participated and completed symptom severity assessments at 4-8 weeks (intake), 3 months, 6 months, and 12 months. Women were predominantly Caucasian (71.8%), married (53.3%), and college educated (38.7%). Clinician interviews of depressive symptom severity, medical and psychiatric history, assessment of function, obstetric experience, and infant status were conducted. Analyses resulted in identification of three distinct trajectories of depressive symptoms: (1) gradual remission (50.4%), (2) partial improvement (41.8%), and (3) chronic severe (7.8%). Key predictive characteristics of the chronic severe versus gradual remission and partial improvement trajectories included parity, education, and baseline global functioning and depression severity. We were able to predict trajectory membership with 72.8% accuracy from these characteristics. Four maternal characteristics predicted membership in the chronic severe versus gradual remission and partial improvement trajectories with 72.8% accuracy. The trajectory groups comprise clinically relevant subgroups with the potential for tailored treatments to reduce the disease burden of postpartum depression.

Investigation of Nursing Student Satisfaction with the First Clinical Education Experience in Universities of Medical Sciences in Iran.

Satisfaction with the experience gained in clinical settings is of great significance to nursing students and novice first-year students in particular and contributes significantly to developing basic clinical skills and competence. Accordingly, the present study aimed to examine nursing student satisfaction with the first clinical education experience.A total of 390 second- and third-semester nursing students gaining clinical experience in general surgery, internal medicine, gynecological surgery, orthopedics, emergency, obstetrics and gynecology, ophthalmology, andrological surgery, post-CCU, and otorhinolaryngology departments participated in this analytical cross-sectional study from March to June 2017. The research instrument included the “Assessment of nursing student’s Satisfaction with First Clinical Practical Education Questionnaire: Modified Version”, consisting of three parts: demographic characteristics, 37 items, and a 10-degree visual analog scale to assess student satisfaction. Descriptive statistics were used to hypothesis test in SPSS 22.The highest rate of student satisfaction was related to the third domain labeled “Instructor’s behavior”, and the lowest rate of student satisfaction was related to the fifth and seventh domains labeled “Emotional atmosphere and learning in the clinical setting” and “Creating appropriate learning opportunities”, respectively. The results of statistical tests suggested a statistically significant relationship between the mean satisfaction score (based on the 10-degree scale) and gender (p=0.01). However, no statistically significant relationship was observed between the mean satisfaction score and other demographic characteristics such as age, grade point average (GPA), and university type.Student satisfaction rate varies in different domains of the questionnaire. Accordingly, it is recommended that schools of nursing and midwifery incorporate the findings of this study into their first clinical, educational experience planning and take into account the educational needs of students to bring greater satisfaction.

Obstetric Care among Refugees: The Complex Interplay of Barriers to Care, Culture, Health Resources and the Healthcare Infrastructure of Host Countries

There is a worldwide increase in the rate of caesarean sections. With recent migration patterns and the influx of refugees into high-income countries, migrants and refugees are also subjected to the increase in caesarean section rates. This article explores known information about the obstetrical experiences of refugee and displaced women. Pregnancy care varies depending on the location of the displaced women. Obstetrical care in refugee centers in Greece is examined as an example of the overall challenges facing European countries as they juggle the influx of refugees. Challenges to obstetrical care include physician shortage and the ongoing economic crisis in Greece. Refugees are some of the world’s most vulnerable populations and overall their obstetrical outcomes are worse than women of the host communities. Providers in refugee centers must be supported and educated in best obstetrical practices including labor management and a judicious use of caesarean deliveries. Increased outreach and training of maternal health worker can improve reproductive healthcare for refugees in non-camp environments.

Birth to Discharge: Neonatal Simulation Clinical Experiences

With an increase in nursing programs to combat the projected nursing shortage, there is more competition for clinical sites for Obstetric-Neonatal clinical rotations. Obstetric and neonatal simulation clinical experiences are being substituted for hospital clinical rotations and for lack of patients during clinical rotations. A technical college in Southeastern United States is using five-hour simulation clinical experiences, in which Obstetric and Neonatal high-fidelity manikins are utilized, as substitutes for hospital clinical rotations or lack of Obstetric-Neonatal patients. Neonatal nursing care is related to the type of disorder the pregnant patient is admitted with to the Antepartum/ Intrapartum Simulation Laboratory Hospital Unit. Three patient scenarios are used for the clinical experiences: neonates born to mothers with gestational diabetes, preeclampsia, or preterm labor. Neonatal complications such as hypoglycemia and prematurity are incorporated into the scenarios. Nursing students use fetal monitoring to identify fetal complications to provide appropriate nursing care to the neonate after delivery. This use of simulation clinical experiences has been endorsed by the National Council of State Boards of Nursing and the National League of Nursing as a substitute for hospital clinical rotations. The significance of using Obstetric-Neonatal simulation clinical experiences is increased understanding by nursing students of the entire antepartum through postpartum nursing care and discharge process. Using the high-fidelity manakins and fetal monitoring, nursing students can obtain hands-on experience when unable to obtain the clinical experience due to lack of a hospital rotation site or lack of patients during their hospital clinical rotation.

The Experience of Women with Obstetric Fistula following Corrective Surgery: A Qualitative Study in Benadir and Mudug Regions, Somalia.

Obstetric fistula is a severe maternal morbidity which can have devastating consequences for a woman's life and is generally associated with poor obstetric services leading to prolonged obstructed labour. The predisposing factors and consequences of obstetric fistula differ from country to country and from community to community. The World Health Organization estimated that more than 2 million women in sub-Saharan Africa, Asia, the Arab region, Latin America, and the Caribbean are living with the fistula, and some 50,000 to 100,000 new cases develop annually with 30,000–90,000 new cases developing each year in Africa alone. This study aimed at describing and exploring the experiences of women living with obstetric fistulas following corrective surgery in Benadir and Mudug regions, Somalia. Women living with obstetric fistula who had surgical repairs at Daynile and GMC fistula centers and key informants were identified purposively. Twenty-one individual in-depth interviews among women with obstetric fistula and eight key informant interviews were conducted. Thematic analyses were used. Codes were identified, and those codes with similar connections were organized together as to form themes. Detailed reading and rereading of the transcribed interviews were employed in order to achieve and identify themes and categories. Themes, categories, and subcategories illustrating the experiences of women living with obstetric fistula emerged from the thematic analysis of individual in-depth and key informant interviews. These were challenges of living with OBF which include “wounds around genitalia, bad odour, incontinences of urine and feces, stigma, isolation, divorce, powerlessness, dependency, financial constraints, and loss of healthy years” and coping mechanisms which include “withdrawal from the community and improved personal hygiene.” Women with obstetric fistula experience serious health and social consequences which prevents them fulfill social, family, and personal responsibilities. We recommend expansion of BEmONC services to underserved areas, capacity building for local OBF surgeons, and improved media campaign and birth preparedness at community levels.

Understanding and Practices of Gynaecologists Related to Breast Cancer Screening, Detection, Treatment and Common Breast Diseases: A Study from India.

The knowledge of breast cancer risk factors and screening practices in a community is largely influenced by the practising gynaecologist in that area. We assessed the understanding and knowledge of gynaecologists about breast cancer: screening, risk factors, clinical signs, management and common benign breast diseases. This cross-sectional study was carried out in Uttar Pradesh, India, from April to September 2017. One hundred and fifty-two gynaecologists were assessed using a self-designed and validated questionnaire to assess the knowledge of risk factors, clinical signs, screening practices and management of breast cancer as well as common benign breast diseases. Further, the results were compared based on their education: undergraduates (UGs; no residency experience in obstetrics and gynaecology) versus postgraduates (PGs; residency experience in obstetrics and gynaecology). 67 and 82.2% of gynaecologists possess excellent to very good knowledge of risk factors and clinical signs of breast cancer, respectively. The knowledge of PGs seems to be better than UGs (p < 0.01). 84.9% participants were aware that breast cancer screening decreases breast cancer-related mortality, and 61.2% considered CBE as most relevant screening investigation (66.1% PGs and 41.9% UGs; p = 0.04). 30.2% regularly offer breast cancer screening at their centre. 58.5% did not consider screening mammography as cost-effective for their patients (57.9% PGs and 61.3% UGs; p = 0.72), and 41.4% considered it to be a time-consuming process (39.7% PGs and 48.4% UGs; p = 0.38). 99.3% like to follow up a patient with familial breast cancer by themselves, and 0.7% like to refer them to specialist. 51.9% gynaecologists were convinced of breast conservation surgery (BCS) as a surgical option, however 51.3% feared leaving diseased breast behind. Despite the knowledge regarding risk factors, clinical signs and treatment of breast cancer and benign breast diseaseswas found adequate amongst the gynaecologists, this did not apply to their clinical practice. Structured and continuous training of gynaecologists is needed to improve the outcome of patients with breast diseases in terms of better management and reference.

Birth to Discharge: Neonatal Simulation Clinical Experiences

With an increase in nursing programs to combat the projected nursing shortage, there is more competition for clinical sites for Obstetric-Neonatal clinical rotations. Obstetric and neonatal simulation clinical experiences are being substituted for hospital clinical rotations and for lack of patients during clinical rotations. A technical college in Southeastern United States is using five-hour simulation clinical experiences, in which Obstetric and Neonatal high-fidelity manikins are utilized, as substitutes for hospital clinical rotations or lack of Obstetric-Neonatal patients. Neonatal nursing care is related to the type of disorder the pregnant patient is admitted with to the Antepartum/ Intrapartum Simulation Laboratory Hospital Unit. Three patient scenarios are used for the clinical experiences: neonates born to mothers with gestational diabetes, preeclampsia, or preterm labor. Neonatal complications such as hypoglycemia and prematurity are incorporated into the scenarios. Nursing students use fetal monitoring to identify fetal complications to provide appropriate nursing care to the neonate after delivery. This use of simulation clinical experiences has been endorsed by the National Council of State Boards of Nursing and the National League of Nursing as a substitute for hospital clinical rotations. The significance of using Obstetric-Neonatal simulation clinical experiences is increased understanding by nursing students of the entire antepartum through postpartum nursing care and discharge process. Using the high-fidelity manakins and fetal monitoring, nursing students can obtain hands-on experience when unable to obtain the clinical experience due to lack of a hospital rotation site or lack of patients during their hospital clinical rotation.

Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews

BackgroundGlobal migration is at an all-time high with implications for perinatal health. Migrant women, especially asylum seekers and refugees, represent a particularly vulnerable group. Understanding the impact on the perinatal health of women and offspring is an important prerequisite to improving care and outcomes. The aim of this systematic review was to summarise the current evidence base on perinatal health outcomes and care among women with asylum seeker or refugee status.MethodsTwelve electronic database, reference list and citation searches (1 January 2007–July 2017) were carried out between June and July 2017. Quantitative and qualitative systematic reviews, published in the English language, were included if they reported perinatal health outcomes or care and clearly stated that they included asylum seekers or refugees. Screening for eligibility, data extraction, quality appraisal and evidence synthesis were carried out in duplicate. The results were summarised narratively.ResultsAmong 3415 records screened, 29 systematic reviews met the inclusion criteria. Only one exclusively focussed on asylum seekers; the remaining reviews grouped asylum seekers and refugees with wider migrant populations. Perinatal outcomes were predominantly worse among migrant women, particularly mental health, maternal mortality, preterm birth and congenital anomalies. Access and use of care was obstructed by structural, organisational, social, personal and cultural barriers. Migrant women’s experiences of care included negative communication, discrimination, poor relationships with health professionals, cultural clashes and negative experiences of clinical intervention. Additional data for asylum seekers and refugees demonstrated complex obstetric issues, sexual assault, offspring mortality, unwanted pregnancy, poverty, social isolation and experiences of racism, prejudice and stereotyping within perinatal healthcare.ConclusionsThis review identified adverse pregnancy outcomes among asylum seeker and refugee women, representing a double burden of inequality for one of the most globally vulnerable groups of women. Improvements in the provision of perinatal healthcare could reduce inequalities in adverse outcomes and improve women’s experiences of care. Strategies to overcome barriers to accessing care require immediate attention. The systematic review evidence base is limited by combining heterogeneous migrant, asylum seeker and refugee populations, inconsistent use of definitions and limited data on some perinatal outcomes and risk factors. Future research needs to overcome these limitations to improve data quality and address inequalities.Systematic registrationSystematic review registration number: PROSPERO CRD42017073315.

Does medical students’ gender affect their clinical learning of gynaecological examination? A retrospective cohort study

IntroductionMedical graduates should be competent in gynaecological examination as well as associated skills including speculum use and swabbing. Male and female medical students may have different opportunities to practise these...

Review Article on Emergency Obstetric Care

Maternal death was once a common occurrence worldwide but today, 99% of maternal deaths occur in low income countries. Most of the maternal deaths are due to direct obstetric complications. Emergency obstetric care is the intervention required to save the lives of these women. It is based on a tripod of signal functions, skilled birth attendants and a functional health system. The objective of this article was to discuss the role of Emergency obstetric care in maternal mortality reduction. A systematic review of available articles on Emergency obstetric care; and Emergency obstetric care training materials, experience and observations used/made between 2003 and 2017 in Nigeria was used for this work. Emergency obstetric care is the nucleus on which all other maternal mortality reduction activities are hinged. The paradigm evolvement of Emergency obstetric care offers the last hope for a woman with direct obstetric complication. However, the skilled birth attendant must have the right attitude in addition to her/his professional skills for effective implementation of these interventions. Women need access to and availability of Emergency obstetric care as well as a continuum of care that includes antenatal, intra-partum and postnatal care, newborn care and family planning services to reduce maternal mortality.

Obstetric Trauma and Surgical Emergencies in the Military Operational Environment

Military medicine operates globally to deliver health service support to U.S. Servicemembers while also delivering healthcare to allies, enemy combatants, local civilians, and displaced persons. Military medical assets provide support during combat operations and in operations other than war. Obstetric trauma can and does occur in all of these populations and mission sets. This review focuses on obstetric trauma experience and perspectives in the context of military operational medicine. Comprehensive review and analysis of military operational medicine during the periods of war in Iraq and Afghanistan have informed general trauma management principles but have not contributed to significant evidence or management guidance pertinent to management of trauma in the obstetric population. Austere, foreign, focused, or low-resourced environments are challenging places to manage obstetric trauma. Fundamental trauma management principles still apply.

Service provider perceptions of the trend in severity of symptoms and complications in women admitted following an incomplete abortion.

Background:Sri Lankan abortion law which dates back to the year 1883, and still unchanged, only allows a legal termination when the mother's life is in danger. Many studies undertaken in the country estimates that even in the light of such a backdrop, and with a high contraceptive prevalence rate, many women attempt an abortion when faced with an unwanted pregnancy. This study aims to describe the changes in abortion-related complications in the country over a period of time and explore the reasons for any changes in severity of symptoms among women hospitalized following an abortion based on the perceptions of healthcare service providers.Method:Using an interviewer guide, in-depth interviews were carried out among 30 service providers of post abortion care with more than 5 years of experience in obstetrics and gynecology in Sri Lanka.Results:Service providers perceived that the number of women presenting to hospitals after an induced abortion caused by a mechanical method is minimal or not at all at present. Over time, a significant reduction is seen in the number of women presenting with any abortion-related complications and the severity of complications has also reduced significantly. The common method of termination at present identified by the providers was the use of “drugs” or “the drug – Misoprostol.”Conclusion:Over the years, women appear to have switched from surgical and mechanical methods to medical means (drugs) to induce an abortion and this change has contributed to reduce the severity of complications.

Effectiveness of different numbers of simulation training models on medical students' cervical examination performance.

To estimate whether different numbers of simulation training models affect medical students' cervical examination performance. In a prospective study at Peking Union Medical College Hospital, Beijing, China, between August 1, 2016, and April 30, 2017, fifth-year medical students without obstetric experience were randomly assigned to the large or small number training groups. Participants in the large number group performed cervical examinations on 10 dilation models and nine effacement/consistency models; those in the small number group practiced on four dilation models and three effacement/consistency models. In the examination, both groups evaluated 10 models in the same sequence and reported findings. Participants also completed confidence surveys. Mann-Whitney U test was used to compare the assessment accuracy and confidence improvement between the groups. There were 91 students randomized to the large (n=45) or small (n=46) number training groups. As compared with the small number group, the large number group demonstrated higher accuracy in assessing exact dilation (P=0.028), exact effacement (P=0.002), effacement within 0.5cm (P=0.017), and consistency (P=0.045). There was no difference in assessing dilation within 1cm or in confidence improvement between the groups. A small number of simulation training models was sufficient to improve students' accuracy and confidence in assessing cervical dilatation, although a large number was needed to improve accuracy in cervical effacement and consistency.

EXPLORATION OF THE HEALTH IMPACT OF DOUBLE BURDEN OF MALNUTRITION AMONG BANGLADESHI WOMEN

Double burden of malnutrition (DBM) is a growing concern, which refers to the coexistence of under nutrition and over nutrition within the same population. The recent increase in the prevalence of overweight and existing prevalence of underweight among Bangladeshi women clearly indicates the advent of a double burden of malnutrition in Bangladesh. Women’s nutritional status is extremely important for a nation because it affects not only their own health but also the health of their children. Both under nutrition and over nutrition have the potential to make women vulnerable to various adverse health conditions as well as adverse obstetric experience and poor birth outcome. It is a timely need for policy makers of this country to come up with specific interventions for both undernourished and overnourished women considering all these factors.

Research on near-miss maternal mortality in Latin America

The near miss approach in obstetrics represents an opportunity to understand the role that structural, psychosocial and cultural determinants play in the critical obstetric experiences of women who, at the risk of death, saved their lives. This article shows the results of a narrative and critical review of the studies that have been developed from this approach in Latin America in the last 6 years. Seven international databases and 19 different journals were reviewed, originating in 7 countries. It was found that there is little production around the subject and predominated the clinical approximations referring to the diagnostic and therapeutic procedures used with this population. The predominant paradigm is positivist and most are descriptive, retrospective and cross-sectional, ranging from secondary sources of information (archives, records). It is urgent to carry out research from this approach with women, recovering the experiences they have experienced in the critical episode.

Testing a biopsychosocial model of the basic birth beliefs.

Women perceive what birth is even before they are pregnant for the first time. Part of this conceptualization is the basic belief about birth as a medical and natural process. These two separate beliefs are pivotal in the decision-making process about labor and birth. Adapting Engel's biopsychosocial framework, we explored the importance of a wide range of factors which may contribute to these beliefs among first-time mothers. This observational study included 413 primiparae ≥24weeks' gestation, recruited in medical centers and in natural birth communities in Israel. The women completed a questionnaire which included the Birth Beliefs Scale and a variety of biopsychosocial characteristics such as obstetric history, birth environment, optimism, health-related anxiety, and maternal expectations. Psychological dispositions were more related to the birth beliefs than the social or biomedical factors. Sociodemographic characteristics and birth environment were only marginally related to the birth beliefs. The basic belief that birth is a natural process was positively related to optimism and to conceiving spontaneously. Beliefs that birth is a medical process were related to pessimism, health-related anxiety, and to expectations that an infant's behavior reflects mothering. Expectations about motherhood as being naturally fulfilling were positively related to both beliefs. Psychological factors seem to be most influential in the conceptualization of the beliefs. It is important to recognize how women interpret the messages they receive about birth which, together with their obstetric experience, shape their beliefs. Future studies are recommended to understand the evolution of these beliefs, especially within diverse cultures.

Obstetric clinicians' experiences and educational preparation for caring for pregnant women with physical disabilities: A qualitative study

BackgroundWomen with physical disabilities (WPD) experience major barriers to care during pregnancy. Lack of education about disability in health professionals' education is a pervasive barrier to quality care. In an effort to explore this issue, this study examined the issue from the perspective of obstetric clinicians who provide care to WPD. ObjectiveThis qualitative descriptive study explored perspectives of obstetric clinicians who provide perinatal care for WPD to inform the educational preparation of clinicians to care for women with disabilities. MethodWe contacted 33 obstetric clinicians who care for pregnant WPD. Thirteen obstetricians and one nurse midwife participated in semi-structured telephone interviews. Interview transcriptions were content analyzed to identify initial themes. Investigators discussed and revised the themes as additional transcripts were reviewed and new themes were identified. ResultsThemes identified from transcript analyses included: lack of education at any level including during postgraduate residency and fellowship on care of pregnant WPD, unplanned career pathway, educating other clinicians, and positive and negative experiences providing obstetrical care to women with physical disability. Several clinicians provided this care because of requests from other clinicians and did not begin their careers with the goal of providing obstetric care to women with physical disabilities. None had received formal education or training including during their residencies or fellowships. The clinicians described very rewarding experiences caring for WPD. ConclusionsThe experiences reported by this study's participants suggest the need to include disability in undergraduate and postgraduate education and training to improve obstetric care to WPD.