Obstetric Providers Research Articles

Are Neonatal Birth Weights Reduced in Low-Risk Patients Diagnosed with COVID-19 during Pregnancy?

Studies have shown that the 2019 novel coronavirus disease (COVID-19) may be associated with an increased risk of adverse pregnancy outcomes including preeclampsia, preterm birth, and stillbirth. However, the relationship between COVID-19 and abnormal fetal growth (i.e., low neonatal birth weight) has not been elucidated. Because other viruses affect fetal growth, obstetrical providers began to recommend ultrasound studies during the third trimester to assess fetal growth in patients with COVID-19 during pregnancy. The aim of this study was to determine if neonatal birth weight was different between low-risk patients diagnosed with COVID-19 during pregnancy and low-risk patients without COVID-19 in pregnancy, to ascertain if third trimester growth ultrasound is warranted in this patient population. We performed a retrospective cohort study of low-risk pregnant patients (who had no other indications for sonographic fetal surveillance during the third trimester) with and without COVID-19 during pregnancy. Patient demographics, gestational dating, neonatal birth weights, and corresponding Alexander growth curve birth weight percentiles were collected. The primary outcome was small-for-gestational age (SGA) neonates, defined as birth weight < 10th percentile for gestational age at delivery (SGA10). Our cohort (N = 513) included 248 COVID-19-exposed patients and 265 patients who did not have COVID-19 during pregnancy. Gestational age at delivery and average neonatal birth weights were similar in COVID-19-exposed (38 weeks 5 days, 3,266 g) and unexposed patients (38 weeks 4 days, 3,224 g; p = 0.434, 0.358). Rates of SGA10 neonates were similar in the COVID-19-exposed (22/248, 8.9%) and -unexposed (23/265, 8.7%, p = 0.939) groups. Timing and severity of COVID-19 during pregnancy also were not associated with rates of SGA neonates. In a cohort of low-risk patients, rates of SGA neonates were similar in patients with and without COVID-19 during pregnancy. These findings suggest that ultrasound surveillance to detect fetal growth restriction in low-risk patients with COVID-19 during pregnancy is not warranted. · COVID-19 may be associated with fetal growth restriction.. · There are normal infant weights in patients with COVID-19 in pregnancy.. · Growth ultrasound is not needed in patients with COVID-19..

Assessment of surgical, anesthesia, and obstetric workforce in Somalia.

One of the core indicators recommended by the Lancet Commission is surgical workforce density, aiming to improve the number of surgery, anesthetists, and obstetric (SAO) providers to 20 per 100,000 population by 2030. We assessed SAO workforce capacity in Somalia and made recommendations for improvement. A cross-sectional study was conducted using a structured questionnaire from the WHO Program for Global Surgery and Social Change (PGSSC) Surgical Assessment Tool. All hospitals that offer surgical care services were included. A descriptive analysis was conducted using the statistical software SPSS. Of the 55 surveyed facilities providing surgical care services, 28 (50.9%) were public, mainly in urban areas. We found that there were 474 SAO specialists and non-specialists (SAO providers) and 446 other important personnel (e.g., midwives, radiologists, and pathologists). Out of 474 SAOs, Banadir had 288. Overall, surgery specialties were the most prevalent profession among SAO providers' workforce, accounting for 160 (33.7%) surgery specialists, with 1.2 per 100,000 population. The six states of Somalia have 54 OB/GYN specialists (0.4 per 100,000 population). There were a total of 22 anesthesia specialists, with a ratio of 0.2 anesthesia specialists per 100,000 population. We found a serious shortage of the SAO workforce in Somalia, and it is unlikely to meet the 2030 Lancet Commission on Global Surgery targets. There is a need for additional training of SAO providers who can offer effective leadership in surgical care services to combat the extremely avoidable surgical-related morbidities and mortalities.

Educational results of the Japan Maternal Emergency Life-Saving (J-MELS) simulation training organized by Japan Council for the Implementation of the Maternal Emergency Life-Saving System (J-CIMELS): a 12-month longitudinal follow-up study in Japan.

This study aimed to evaluate the long-term results of Japan Maternal Emergency Life-Saving (J-MELS) simulation training on obstetric healthcare providers, over a 12-month follow-up period. A total of 273 trainees from 17 J-MELS Basic courses conducted between August 2021 and October 2023 were included. The trainees' responses to the pre- and post-tests, questionnaires, and self-reports on the usefulness of the J-MELS scenarios in actual clinical settings at 1, 6, and 12 months after the training were analyzed. Multivariate logistic regression analysis was also conducted to identify the factors influencing knowledge retention. We found an overall improvement in clinical knowledge acquisition after J-MELS training and a significant retention of this improvement at least until 12 months later. However, these scores gradually declined over. Trainees reported increased usefulness of J-MELS scenarios in actual clinical practice at 1, 6, and 12 months after training, particularly in managing obstetric emergencies such as atonic postpartum hemorrhage. Knowledge retention was influenced by several specific factors, such as years of clinical experience, affiliated institutions, qualifications, and especially pre-test scores. Our longitudinal follow-up study demonstrated, for the first time, the long-term results of J-MELS simulation training using post-tests and self-report data. Our findings provide valuable insight into the impact of J-MELS simulation training on maternal emergency care. By elucidating the factors influencing knowledge retention and practical utility, the findings offer actionable recommendations for optimizing training strategies and improving maternal outcomes in actual clinical practice.

Perspective of obstetric care-providers on being involved in cervical cancer screening during antenatal care in the Netherlands.

The aim of this study was to determine attitude of Dutch midwifes, gynecologists and general practitioners (GPs) towards involvement in antenatal cervical cancer screening (CCS) in the Netherlands. In 2021, Dutch midwives, gynecologists, and GPs were offered a single digital questionnaire assessing perceived feasibility, benefits, and harms of antenatal CCS. A total of 6943 Questionnaires were send and response rate was 18% (N = 1260). Of all respondents, 78% considered antenatal CCS via obstetric care providers feasible. Most respondents (85%) agreed that offering CCS in person can increase motivation to attend. Most midwives (93%) considered that women would feel less encumbered if cervical sampling would be performed by obstetric care providers, rather than by GPs. Results indicate that introduction of antenatal CCS is considered feasible by a majority of Dutch midwifes, gynecologists, and GPs. Considered benefits include improved motivation to attend and reduced test related barriers.

Obstetric anesthesia considerations in pregnancy-associated myocardial infarction: a focused review

Pregnancy-associated myocardial infarction (PAMI) is a rare but serious complication that can occur either during pregnancy or postpartum. The etiologies of PAMI are atherosclerosis, spontaneous coronary artery dissection, coronary thrombosis, coronary embolism, and coronary vasospasm. Therapy of acute PAMI depends largely on the ECG presentation, hemodynamic stability, and suspected etiology of myocardial infarction. Anesthetic management during delivery in patients with PAMI should consist of early and carefully titrated neuraxial analgesia and anesthesia, maintenance of normal sinus rhythm, preservation of afterload, and monitoring for and avoiding myocardial ischemia. To improve the care of women with PAMI, a multidisciplinary team of cardiologists, maternal fetal medicine specialists, obstetric providers, neonatologists, and anesthesiologists must work collectively to manage these complex patients.

Knowledge, Attitudes and Practices of Obstetric Care Providers Regarding Pre-Eclampsia in the Yaoundé IV District

Knowledge, Attitudes and Practices of Obstetric Care Providers Regarding Pre-Eclampsia in the Yaoundé IV District

A mixed-methods evaluation of an HIV pre-exposure prophylaxis educational intervention for healthcare providers in a NYC safety-net hospital-based obstetrics and gynecology clinic

ABSTRACT Cisgender women and transgender men are less likely to be assessed for PrEP eligibility, prescribed PrEP, or retained in PrEP care. Thus, this pilot PrEP educational intervention was tailored for healthcare providers (HCPs) in obstetrics/gynecology who provide care to cisgender women and transgender men in an academically-affiliated, public hospital women’s health clinic. The three-lecture educational curriculum designed for HCPs focused on PrEP eligibility and counseling, formulations and adherence, and prescription and payment assistance programs. Pre- and post-intervention surveys assessed HCP knowledge and barriers to PrEP counseling and prescription. Among n = 49 participants (mean age = 32.8 years; 85.7% cisgender women, mean years practicing = 4.2 years) pre-intervention, 8.7% had prior PrEP training and 61.2% felt very/somewhat uncomfortable prescribing PrEP. Post-intervention, knowledge of PrEP contraindications, eligibility, follow-up care, and assistance programs all increased. HCPs identified key barriers to PrEP care including lack of a dedicated PrEP navigator, culturally and linguistically appropriate patient materials on PrEP resources/costs, and PrEP-related content integrated into EHRs. Ongoing PrEP educational sessions can provide opportunities to practice PrEP counseling, including information on financial assistance. At the institutional level, incorporating PrEP screening in routine clinical practice via EMR prompts, facilitating PrEP medication monitoring, and enhancing telehealth for follow-up care could enhance PrEP prescription.

Patient Decision Making Surrounding Epidural Use in Labor

Introduction/Objectives: Labor is thought to be one of the most painful experiences in a woman’s life, similar to pain caused by complex regional pain syndromes. Epidural analgesia has been proven to provide excellent pain relief, and many women in the United States choose this during their labor course. The decision to use, or not to use, neuraxial analgesia is complex and multifactorial, and has historically generated debate amongst patients and obstetric providers. In addition, many patients will also change their minds about desiring an epidural in labor during their admission to Labor &amp; Delivery based on various factors encountered. This study aimed to determine the number of patients who change their mind about epidural in labor. We also aimed to characterize the factors involved in patients’ decision about epidural analgesia during labor and to determine if these factors change throughout the labor and delivery course. Methods: This study was a single-center, non-randomized, cross-sectional study that was performed at Loyola University Medical Center in the Labor &amp; Delivery unit. The study population included all full-term nulliparous patients that were admitted to Labor &amp; Delivery for full term labor or induction of labor. Patients were eligible if they were 18 years of age or older, and able to read, speak, and complete the study questionnaire in English. Exclusion criteria included previous vaginal delivery, contraindication to vaginal delivery, no plan to deliver during admission, and contraindication to epidural analgesia. The patients completed one questionnaire about preferences for epidural and influencing factors prior to delivery, and one questionnaire after delivery with similar questions. Demographics were collected, as well as data about complications and details of their labor and delivery course. Results: A total of 199 patients completed the study. The epidural rate was higher in patients who planned to receive it (n = 141/144 or 97.9%) than in patients who did not plan to receive an epidural (n = 49/55 or 89.1%). Further, there was significant discordance between patients’ plans for an epidural and receipt of the medication. That is, only three (1.5%) patients who planned to receive an epidural did not receive one. Conversely, 49 (24.6%) patients who did not plan to receive an epidural received one. Compared to patients who did not plan to receive an epidural, those who planned to receive the medication reported that their OBGYN physician (OR = 3.31, 95% CI: 1.80 – 6.06; p &lt; .001), Anesthesiology physician (OR = 2.73, 95% CI: 1.50 – 4.96; p = .001), and labor nurse (OR = 2.50, 95% CI: 1.38 – 4.53; p =.002) were more important sources of information. Further, when compared to patients who did not plan to receive an epidural, those who planned to receive the medication reported they wanted to be more comfortable during the course of labor (OR = 4.84, 95% CI: 2.50 – 9.39; p &lt; .001), that receiving an epidural would make their labor experience more enjoyable (OR = 27.17, 95% CI: 11.72 – 63.00; p &lt; .001), and that getting an epidural was safe (OR = 5.91, 95% CI: 2.96 – 11.80; p &lt; .001). Conclusions: In conclusion, this study found that the majority of patients in our study population chose to receive an epidural in labor, regardless of their plans at the start of their admission. The most important factors in the decision were discussions with the OBGYN and Anesthesiology physicians. Patients who decided to receive an epidural, despite planning not to, reported that they wanted to be more comfortable during their labor course and that receiving an epidural would make their labor experience more enjoyable.

Standardizing Patient and Provider Education to Address Breastfeeding Inequity

Introduction: Breastfeeding provides many infant, maternal and societal benefits. Breastfeeding reduces maternal and infant risks for a number of diseases, encourages maternal-infant bonding, is more environmentally friendly and lowers healthcare costs. Based on the most recent Women, Infants and Children (WIC) program data, the obstetrical patient population served by the Department of Ob/Gyn at Southern Illinois University School of Medicine (SIU-SM) was significantly lacking in breastfeeding initiation rates (~16% in 2020) when compared to the Healthy People 2020 goal for ever breastfed infants of 81.9%. We aimed to assess areas of patient care that could be improved upon when counseling our patients about breastfeeding. Purpose: Our primary goal was to evaluate current breastfeeding initiation rates and whether these improved after implementation of the standardized breastfeeding education materials that were to be provided to both healthcare professionals and patients. Methods: In partnership with the Illinois Public Health Institute (IPHI), all patients who received prenatal care at SIU-SM, Department of Ob/Gyn were offered standardized brochures that supplemented our prenatal counseling regarding breastfeeding. Nurses, residents, and other healthcare providers were also provided information on counseling patients. Breastfeeding rates were assessed in our prenatal population prior to and after implementing standardized breastfeeding educational materials (IRB# 22-133) and compared with Chi-square tests. Results: Patient demographics were as follows: 55.9% White, 31.8% Black/African American; 95.7% non-Hispanic; 93.4% utilized Medicaid services for insurance; the mean age was 26.8 ± 6.1 years of age. Baseline breastfeeding initiation rates of ever breastfed infants were significantly higher in the interventional group compared to the control group (75% vs.60%; p=0.002). Breastfeeding rates at the first postpartum visit were also significantly increased after the intervention (65% vs. 43%; p=0.008). A significant increase in the percentage of breast pumps provided in the prenatal clinic was also noted (28.4% vs. 0%; p&lt;0.0001). Conclusions: Breastfeeding rates in our patient population were significantly lower than the Healthy People’s 2020 goal. Raising awareness through this initiative and improving our educational tools via the partnership with IPHI improved breastfeeding initiation rates. As obstetrical providers, we are optimistic about this data, but acknowledge additional interventions may be necessary to improve health equity across our disadvantaged patient population. Future directions include looking at data for ever breastfed infants vs. continuation of breastfeeding through the American Academy of Pediatrics recommended 6 months of exclusive breastfeeding. We would also like to explore how partner involvement and occupation type might impact breastfeeding initiation rates.

Attitudes and Likelihood of Outpatient Cervical Ripening via Single Balloon Foley Catheter Among OB/GYN Providers, Nurse Practitioners, and Obstetric Labor &amp; Delivery Nurses

Introduction/Objectives: In certain parts of the United States and other developed nations, cervical ripening using the Foley catheter has already been introduced into the outpatient setting. An approved protocol exists at Loyola University Medical Center (LUMC), however usage is nonexistent. The primary aim of this study was to determine the current level of knowledge and familiarity regarding outpatient cervical ripening among OBGYN physicians and labor and advanced practice nurses at LUMC. The secondary aim of the study was to elucidate willingness to offer outpatient cervical ripening and potential reasons for support and hesitancy of this practice. Methods: We created an 8-question anonymous survey to elucidate the current level of knowledge regarding outpatient cervical ripening and potential reasons that a provider may have in support of and against outpatient cervical ripening. The survey was distributed among General OBGYN attendings, fellows, residents, labor and delivery (LD) and advanced practice (APN) nurses at LUMC. Descriptive statistics and Fisher’s exact test was performed on categorical data. An ordinal logistic regression model was used to compare the odds of being more likely to offer outpatient cervical ripening between attendings and resident physicians and the odds of being familiar with outpatient cervical ripening. Results: 45 obstetric care providers completed the survey (comprising 20 OB/GYN residents, 10 General OB/GYN attendings, 13 LD, and 2 APN nurses). The response rate was 72%. 73% of all respondents had some degree of familiarity with outpatient cervical ripening, while 84% were familiar with the current body of research on this practice. Overall, the willingness to offer outpatient cervical ripening was 55% for the group, with only 11% unwilling. There was no difference in the willingness to offer outpatient cervical ripening between attendings and resident physicians (OR = 1.25, 95% CI: 0.32 – 4.88; p = .75) (Table 1). Major factors that drove willingness to offer were decreased induction to delivery time (77%) and patient convenience (85%). Major factors that drove unwillingness to offer OP cervical ripening were lack of fetal monitoring (66%), increased communication from patients (66%), and additional utilization of clinic resources/time for protocol implementation (66%). Resident physicians were significantly more likely to report familiarity with the current research on outpatient cervical ripening than nurses (OR=5.04; 95% CI: 1.24-20.45; p=.02) and attending physicians (OR=4.13; 95% CI: 1.05-17.78; p=.04). There was no difference in familiarity with research behind the practice between physicians and nurses respondents (p=.85). There was no association between those who reported the level of familiarity with the concept of outpatient cervical ripening and their willingness to offer (OR = 1.52, 95% CI: 0.40 – 5.78; p = .54) (Table 2). Conclusions: Moving preinduction cervical ripening to an outpatient setting is equally efficacious and safe when compared to inpatient cervical ripening. However, despite having an existing protocol for cervical ripening using a Foley Balloon, this practice is not currently utilized at LUMC. Our survey suggests that though physicians and nurses are familiar with the concept and the research behind the practice, there are limiting factors for use. Further education regarding outpatient cervical ripening are essential for increasing practice adoption.

The Uptake of Partner Participation in Sequential Preconception Carrier Screening

Introduction: Carrier screening that is performed in the preconception period allows for couples at risk for having children affected with certain single gene (Mendelian) conditions to be identified. This is the most optimal timeframe to perform such screening. Most obstetric providers utilize a sequential process in which the patient first undergoes screening and their partner is only offered testing if the initial results reveal that the first is a carrier for one or more autosomal recessive (AR) deleterious variants. If the partner fails to undergo screening, the couple cannot obtain meaningful and actionable risk information for future or current pregnancies. In this study, we sought to assess the frequency of completed carrier screening risk assessment among individuals and couples who were undergoing preconception screening at two prenatal screening programs staffed by genetic counselors and geneticists. Materials and Methods: We reviewed the screening outcomes for individuals and couples who presented for preconception carrier screening from January 1, 2020 through December 30, 2021 at Insight Medical Genetics and the clinical genetics program at Northwestern Medicine. All individuals received pretest genetic counseling prior to screening and posttest counseling after results were available. We evaluated individuals who were found to be a carrier of at least one deleterious variant and whether the partner of that person underwent carrier screening, and, if so, which type of screening. Results: 548 patients who identified as women underwent preconception carrier screening during the study period, along with 3 men presenting for initial screening. These screens consisted of a panel containing primarily autosomal recessive conditions with a few X-linked conditions. 247 individuals (45.1%) were positive for at least one pathogenic variant; of these, 244 (98.8%) were variants in genes associated with autosomal recessive conditions. A total of 219 partners (88.7%) underwent carrier screening, including the 3 female partners of the men who initiated carrier screening. Of note, 4 of the patients who underwent carrier screening reported not having a partner at the time of screening; accordingly, the partners who underwent screening represent 89.8% of individuals eligible for partner screening following an initial positive result. Of the 219 partners who underwent carrier screening, 201 (91.8%) chose a carrier screening panel of 150+ conditions, while 18 chose a more limited panel that included the gene(s) of relevance based on their partner’s results, with or without additional genes relevant to their learned/self-identified ethnicity or race. Conclusions: Approximately 10% of couples presenting for preconception genetic counseling and carrier screening found to be at potential risk for a child with an autosomal recessive condition did not obtain the requisite information to fully assess their risk of having an affected child. It is possible that the frequency of couples who do not obtain complete and actionable screening information is even higher when carrier screening is provided without the assistance of certified genetic counselors or geneticists. Recently, cell free DNA-based maternal screening has been introduced that assesses the risk for a limited number of genetic conditions in the fetus that may not require assessment of the partner. Nonetheless, providers must communicate to their patients that meaningful risk information can only be obtained when the partner undergoes screening in cases where the initial member of the couple is found to be a carrier of at least one autosomal recessive condition. Laboratories and professional societies need to develop effective educational outreach to patients and providers alike to improve the screening process for couples who want to determine if they are at risk to have a child with an inherited condition.

Determinants of puerperal sepsis among postpartum women: a case–control study in East Shoa Zone public hospitals, Central Ethiopia

ObjectiveTo identify determinants of puerperal sepsis among postpartum women attending East Shoa Zone public hospitals, Central Ethiopia, 2023.Design and settingAn institutional-based, unmatched case–control study was conducted from 19 June 2023...

Prevalence of depression and associated factors among obstetric care providers at public health facilities in the West Arsi Zone, Ethiopia: Cross-sectional study.

Depression is a severe and treatable mental illness that significantly affects individuals' daily activities. Obstetric care providers are the most vulnerable group for depression because they work in an emergency to save two lives at a time, share the stress of women during labor, and are at great risk for contamination. To assess depression and associated factors among obstetric care providers working in public health facilities. A cross-sectional study was conducted among 423 obstetric care providers working in public health facilities found in the West Arsi Zone, Ethiopia, from June 1 to 30, 2023. Study participants were selected through a simple random sampling technique. A pretested, face-to-face interviewer-administered structured questionnaire was used to collect data. Bi-variable and multivariable logistic regression analyses were employed to identify factors associated with depression. The level of statistical significance was declared at P < 0.05 with a 95% CI. Overall, the prevalence of depression among obstetric care providers was 31.1% (95% CI: 26.6%, 35.5%). Marital status not in union (AOR = 2.86, 95%CI: 1.66, 4.94), working more than 40 hours per week (AOR = 2.21, 95%CI: 1.23, 3.75), current substance use (AOR = 2.73, 95%CI: 1.64, 4.56), not being satisfied with their job (AOR = 3.52, 95%CI: 2.05, 6.07) and having burnout symptoms (AOR = 5.11, 95%CI: 2.95, 8.83) were factors significantly associated with depression. We recommend that health professionals take care of themselves and avoid substance use. We also recommended that stakeholders enhance job satisfaction and avoid burnout by implementing various programs, like raising wages for workers, increasing staff members, offering various benefits, and regularly monitoring issues that arise.

Evaluation of the Effects of Epidural Labour Analgesia on Mode of Delivery in 250 Bedded District Hospital, Bagerhat, Bangladesh

Background: Labor pain is intensely severe, often leading to hyperventilation and hormonal releases that can harm the fetus by reducing oxygen supply and causing metabolic acidosis. Effective pain management during childbirth is crucial for both physical and mental health. Various pharmacologic and non-pharmacologic methods are available, with epidural analgesia being a prominent choice. It is widely used in high-income countries, provides substantial pain relief, and benefits uterine contractions and placental perfusion. Epidural analgesia has potential side effects and controversies, such as delayed labor and higher intervention rates. Aim of the Study: The study aimed to examine the impact of epidural analgesia on the mode of delivery. Methods: This observational study, conducted from July 2021 to June 2022 at the Department of Gynecology and Obstetrics in a 250-bed District Hospital in Bagerhat, Bangladesh, included 50 participants divided into two groups of 25 each: Group A (with epidural analgesia) and Group B (without epidural analgesia). Approved by the Ethical Committee, the study included women aged 18-35 years, 37-41 weeks gestation, in labor with regular contractions, at least 4 cm cervical dilatation, and a regular fetal heart rate pattern. Excluded were women with medical or obstetrical complications, uterine scars, or spinal deformities. Data were collected via interviews, observations, and clinical examinations. Result: In this study of 50 participants (25 per group), most women were under 30 years old, with mean ages of 22.4±4.5 and 22.9±5.2 years in groups A and B, respectively. Gestational ages ranged from 37 to 40 weeks, and BMIs were 18.5-24.9 kg/m². Both groups had similar parity distributions. Normal vaginal births occurred in 84% (Group A) and 88% (Group B), with LSCS rates at 4%. Group A had 60% male neonates with average birth weights of 2.86±0.27 kg, and Group B had 56% males with weights of 2.88±0.26 kg. APGAR scores were high in both groups. Conclusion: Epidural labor analgesia is safe and does not increase instrumental deliveries or affect neonatal outcomes, making it a viable pain management option. Obstetric care providers can use this information to counsel women.

The implications of using maternity care deserts to measure progress in access to obstetric care: a mixed-integer optimization analysis

BackgroundLack of access to risk-appropriate maternity services, particularly for rural residents, is thought to be a leading contributor to disparities in maternal morbidity and mortality. There are several existing measures of access to obstetric care in the literature and popular media. In this study, we explored how current measures of obstetric access inform the number and location of additional obstetric care facilities required to improve access.MethodsWe formulated two facility location optimization models to determine the number of new facilities required to minimize the number of reproductive-aged women who lack access to obstetric care. We define regions with a lack of access as either maternity care deserts, designated by the March of Dimes to be counties with no obstetric care facility or obstetric providers, or regions further than 50 miles from critical care obstetric (CCO) services. We gathered information on hospitals with obstetric services from Georgia Department of Public Health public reports and estimated the female reproductive-age population by census block group using the American Community Survey.ResultsOut of the 1,910,308 reproductive-aged women who live in Georgia, 104,158 (5.5%) live in maternity care deserts, 150,563 (7.9%) reproductive-aged women live further than 50 miles from CCO services, and 38,202 (2.0%) live in both maternity care desert and further than 50 miles from CCO services. Our optimization analysis suggests that at least 56 new obstetric care facilities (a 67% increase) would be required to eliminate maternity care deserts in Georgia. However, the expansion of 8 facilities would ensure all women in Georgia live within 50 miles of CCO services.ConclusionsCurrent measures of access to obstetric care may not be sufficient for evaluating access and planning action toward improvements. In a state like Georgia with a large number of small counties, eliminating maternity care deserts would require a prohibitively large number of new obstetric care facilities. This work suggests that additional measures and tools are needed to estimate the number and type of obstetric care facilities that best match practical resources to meet obstetric care needs.

CORE LINK: “COLLABORATIVE OBSTETRICAL RESOURCE” PROPOSAL FOR LOW RISK OBSTETRICAL SHARED CARE CLINICS

As a growing number of women and their families seek low risk obstetrical care, the number of maternity care providers falls. For family physicians, this is due in large measure to an unsustainable model of practice that includes constraints on lifestyle, prohibitive malpractice insurance and unsatisfactory remuneration. Ontario, British Columbia, Manitoba, Quebec and Alberta have regulations in place for midwifery to address this growing problem. However, due to the limited scope of practice for midwives, the small number of practitioners, and the profession's attrition rate in general, there continues to be an enormous gap between the demand for access and the supply of low risk obstetrical care providers and services.i It is proposed that CORe LINK, Collaborative Obstetrical Resource Link, will develop shared-care clinics across the country, called Maternity CORe sites. These clinics will work within an interdisciplinary model developed to harness the unique skills and expertise of all community based, primary care professionals who work with the low risk obstetrical population, while addressing the barriers and challenges that these practitioners face in doing their work. CORe LINK is currently seeking approval in Ontario to pilot this project. A proposal for the CORe LINK project was submitted in November 2003 to the Primary Health Care Transition Fund.ii CORe LINK approval is pending to begin a fully integrated model of service delivery. As an interim approach, a two-phase process has been proposed that does not interfere with existing models of care. CORe LINK will utilize common clinical and evaluation tools to ensure that there will be a multi-centred approach to data collection and analysis across all Maternity CORe sites. This article will discuss how the CORe LINK project can both entice new practitioners to practice family centred obstetrics and conserve and protect established professionals from leaving through the development of an interdisciplinary approach to practice, funded through an Alternative Payment Plan within a shared liability model.

Reporting Perinatal Substance Use to Child Protective Services: Obstetric Provider Perspectives on the Impact on Care.

Objective: To understand obstetric provider perspectives on child protective services (CPS)-mandated reporting requirements and how they affect care for pregnant and postpartum patients with opioid use disorder (OUD). Methods: Key informant interviews were conducted virtually with obstetricians, nurse practitioners, and social workers caring for obstetric patients (n = 12). Providers were asked about their experience as mandated reporters working with patients with OUD. Transcripts were independently coded by two staff, and content analysis was used to identify themes. Results: Our analysis resulted in six thematic areas, including CPS-mandated strengths, concerns related to CPS reporting requirements, implementation of mandates, supporting patients after CPS report, communication between stakeholders, and the impact on care. Providers noted that the fear of CPS involvement causes some patients to delay or not engage in care. Other patients are hesitant to accept medications for OUD for fear of CPS involvement. The inconsistencies in how reporting mandates are applied and how CPS handles cases make communication about the policies challenging for providers and create anxiety for patients. Conclusions: The results of this study indicate that mandated reporting requirements and the potential for CPS involvement are perceived to have minimal positive effects on perinatal individuals with OUD and may negatively affect patients and their care. Clinicaltrials.gov number: NCT04240392.

Perinatal loss in Tanzania: Perspectives of maternal-child healthcare providers.

Over 98% of stillbirths and neonatal deaths occur in Low- and Middle-Income Countries, such as Tanzania. Despite the profound burden of perinatal loss in these regions, access to facility or community-based palliative and psychosocial care is poor and understudied. In this study we explore perinatal loss through the lens of front-line healthcare providers, to better understand the knowledge and beliefs that guide their engagement with bereaved families. A Knowledge Attitudes and Practices survey addressing perinatal loss in Tanzania was developed, translated into Swahili, and administered over a 4-month period to healthcare professionals working at the Kilimanjaro Christian Medical Center (KCMC). Results were entered into REDCap and analyzed in R Studio. 74 providers completed the survey. Pediatric providers saw a yearly average of 5 stillbirths and 32.7 neonatal deaths. Obstetric providers saw an average of 11.5 stillbirths and 13.12 neonatal deaths. Most providers would provide resuscitation beginning at 28 weeks gestational age. Respondents estimated that a 50% chance of survival for a newborn occurred at 28 weeks both nationally and at KCMC. Most providers felt that stillbirth and neonatal mortality were not the mother's fault (78.4% and 81.1%). However, nearly half (44.6%) felt that stillbirth reflects negatively on the woman and 62.2% agreed that women are at higher risk of abuse or abandonment after stillbirth. A majority perceived that women wanted hold their child after stillbirth (63.0%) or neonatal death (70.3%). Overall, this study found that providers at KCMC perceived that women are at greater risk of psychosocial or physical harm following perinatal loss. How women can best be supported by both the health system and their community remains unclear. More research on perinatal loss and bereavement in LMICs is needed to inform patient-level and health-systems interventions addressing care gaps unique to resource-limited or non-western settings.

Simulation training on respectful emergency obstetric and neonatal care in north-western Madagascar: a mixed-methods evaluation of an innovative training program

BackgroundThe rates of maternal and neonatal deaths in Madagascar are among the highest in the world. In response to a request for additional training from obstetrical care providers at the Ambanja district hospital in north-eastern Madagascar, a partnership of institutions in Switzerland and Madagascar conducted innovative training on respectful emergency obstetric and newborn care using e-learning and simulation methodologies. The training focused on six topics: pre-eclampsia, physiological childbirth, obstetric maneuvers, postpartum hemorrhage, maternal sepsis, and newborn resuscitation. Cross-cutting themes were interprofessional communication and respectful patient care. Ten experienced trainers participated in an e-training-of-trainers course conducted by the Swiss partners. The newly-trained trainers and Swiss partners then jointly conducted the hybrid remote/in-person training for 11 obstetrical care providers in Ambanja.MethodsA mixed methods evaluation was conducted of the impact of the training on participants’ knowledge and practices. Trainees’ knowledge was tested before, immediately after, and 6 months after the training. Focus group discussions were conducted to elicit participants’ opinions about the training, including the content and pedagogical methods.ResultsTrainees’ knowledge of the six topics was higher at 6 months (with an average of 71% correct answers) compared to before the training (62%), although it was even higher (83%) immediately after the training. During the focus group discussions, participants highlighted their positive impressions of the training, including its impact on their sense of professional effectiveness. They reported that their interprofessional relationships and focus on respectful care had improved. Simulation, which was a new methodology for the participants native to Madagascar, was appreciated for its engaging and active format, and they enjoyed the hybrid delivery of the training. Participants (including the trainers) expressed a desire for follow-up engagement, including additional training, and improved access to more equipment.ConclusionThe evaluation showed improvements in trainees’ knowledge and capacity to provide respectful emergency care to pregnant women and newborns across all training topics. The hybrid simulation-based training method elicited strong enthusiasm. Significant opportunity exists to expand the use of hybrid onsite/remote simulation-based training to improve obstetrical care and health outcomes for women and newborns in Madagascar and elsewhere.

Intention to Use Mobile-Based Partograph and Its Predictors Among Obstetric Health Care Providers Working at Public Referral Hospitals in the Oromia Region of Ethiopia in 2022: Cross-Sectional Questionnaire Study.

A partograph is a pictorial representation of the relationship between cervical dilatation and the time used to diagnose prolonged and obstructed labor. However, the utilization of paper-based partograph is low and it is prone to documentation errors, which can be avoided with the use of electronic partographs. There is only limited information on the proportion of intention to use mobile-based partographs and its predictors. The objective of this study was to determine the proportion of obstetric health care providers at public referral hospitals in Oromia, Ethiopia, in 2022 who had the intention to use mobile-based partographs and to determine the predictors of their intention to use mobile-based partographs. We performed an institution-based cross-sectional study from June 1 to July 1, 2022. Census was conducted on 649 participants. A self-administered structured English questionnaire was used, and a 5% pretest was performed. Data were entered into EpiData version 4.6 and exported to SPSS version 25 for descriptive analysis and AMOS (analysis of moment structure; version 23) for structural and measurement model assessment. Descriptive and structural equation modeling analyses were performed. The hypotheses developed based on a modified Technology Acceptance Model were tested using path coefficients and P values <.05. About 65.7% (414/630; 95% CI 61.9%-69.4%) of the participants intended to use mobile-based electronic partographs, with a 97% (630/649) response rate. Perceived usefulness had a positive influence on intention to use (β=.184; P=.02) and attitude (β=.521; P=.002). Perceived ease of use had a positive influence on attitude (β=.382; P=.003), perceived usefulness (β=.503; P=.002), and intention to use (β=.369; P=.001). Job relevance had a positive influence on perceived usefulness (β=.408; P=.001) and intention to use (β=.185; P=.008). Attitude positively influenced intention to use (β=.309; P=.002). Subjective norms did not have a significant influence on perceived usefulness (β=.020; P=.61) and intention to use (β=-.066; P=.07). Two-thirds of the obstetric health care providers in our study intended to use mobile-based partographs. Perceived usefulness, perceived ease of use, job relevance, and attitude positively and significantly influenced their intention to use mobile-based electronic partographs. The development of a user-friendly mobile-based partograph that meets job and user expectations can enhance the intention to use.