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1.
BMC Public Health ; 24(1): 1094, 2024 Apr 20.
Article in English | MEDLINE | ID: mdl-38643069

ABSTRACT

BACKGROUND: Perinatal mental health is a major public health problem that disproportionately affects people from racial and ethnic minority groups. Community-based perinatal mental health programs, such as peer support groups, are essential tools for the prevention and treatment of perinatal depression. Yet, little is known about racial and ethnic disparities in accessibility and utilization of community-based perinatal mental health programs. METHODS: We conducted a cross-sectional study using an online survey with program administrators representing perinatal mental health community-based services and support programs throughout New Jersey. Descriptive analysis and mapping software was used to analyze the data. RESULTS: Thirty-three program administrators completed the survey. Results showed substantial racial and ethnic disparities in availability and utilization of community-based programs. In the majority of programs, Black, Hispanic, and Asian individuals made up less than 10% of total annual participants and less than 10% of facilitators. There were also geographic disparities in program accessibility and language availability across counties. Program administrators identified mental health stigma, lack of support from family, fear of disclosure of mental health challenges, social determinants, lack of language-concordant options in programs, and limited awareness of programs in the community as significant barriers to participation of racial and ethnic minorities. Strategies to address barriers included adding language options, improving program outreach, and increasing diversity of facilitators. CONCLUSIONS: This study provides new evidence on racial and ethnic disparities in access to community-based perinatal mental health programs. Efforts to build the resources and capacities of community-based programs to identify equity gaps, increase diversity of staff, and address barriers to participation is critical to reducing racial and ethnic inequities in perinatal mental health.


Subject(s)
Ethnicity , Mental Health , Humans , Cross-Sectional Studies , Health Services Accessibility , Healthcare Disparities , Hispanic or Latino , Minority Groups , United States , New Jersey , Black or African American , Asian
2.
Matern Child Health J ; 28(2): 274-286, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37943397

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has had significant impacts on maternal mental health. We explored the lived experiences of women with perinatal depression and anxiety to elucidate their perceptions of how the pandemic influenced their mental health and access to care. METHODS: We conducted a qualitative descriptive study using semi-structured interviews. From March to October 2021, purposive sampling was used to recruit a socio-demographically diverse sample of women with self-reported perinatal depression or anxiety who were pregnant or within one year postpartum between March 2020 and October 2021. Interviews were conducted remotely and thematically analyzed. RESULTS: Fourteen women were interviewed. Three major themes arose. Theme 1, Negative impacts of COVID-19 on symptoms of depression and anxiety, described how the pandemic magnified underlying symptoms of depression and anxiety, increased social isolation, generated anxiety due to fears of COVID-19 infection, and caused economic stress. In theme 2, Negative impacts of COVID-19 on access to and quality of health care, women described stressful and isolating delivery experiences, negative psychological impact of partners not being able to participate in their perinatal health care, interruptions and barriers to mental health treatment, and challenges in using telehealth services for mental health care. Theme 3, Positive impacts of COVID-19 on mental health, identified advantages of increased telehealth access and ability to work and study from home. CONCLUSIONS FOR PRACTICE: The COVID-19 pandemic negatively affected women with perinatal depression and anxiety by magnifying underlying symptoms, increasing stress and social isolation, and disrupting access to mental health care. Findings provide support for policies and interventions to prevent and address social isolation, as well as optimization of telehealth services to prevent and address gaps in perinatal mental health treatment.


Subject(s)
COVID-19 , Pregnancy , Female , Humans , COVID-19/epidemiology , Pandemics , Depression/epidemiology , Depression/etiology , Anxiety/epidemiology , Anxiety Disorders
3.
Nurs Womens Health ; 27(4): 270-282, 2023 Aug.
Article in English | MEDLINE | ID: mdl-37336492

ABSTRACT

OBJECTIVE: To evaluate an online POST-BIRTH Warning Signs (PBWS) project focused on improving nurses' knowledge and how they teach individuals in the postpartum period about potential complications. DESIGN: Quality improvement project with exploratory pretest/posttest. SETTING: Seventy hospitals with maternity services throughout the United States. PARTICIPANTS: A sample of 2,363 registered nurses. INTERVENTION/MEASUREMENTS: An online educational program with four surveys and a chart audit tool were used as evaluation measures. RESULTS: There was an 11% increase in nurses' knowledge after the online course intervention. A majority of nurses reported that they would improve how they educate patients and families about PBWS, that they would change their clinical practice based on what they learned, and that their facility implemented a protocol to educate patients about PBWS after the implementation of the course. The nurses' reported confidence in their teaching increased 59% after implementation of the course. CONCLUSION: The majority of maternal deaths in the United States occur during the postpartum period. Therefore, it is vital that nurses provide standardized and structured educational messaging when teaching individuals in the postpartum period about signs and symptoms of potential complications. This quality improvement project demonstrated that the PBWS online education course was associated with an increase in nurses' knowledge and confidence when teaching about potential complications that can arise during the postpartum period.


Subject(s)
Nurses , Patient Discharge , Humans , Pregnancy , Female , Clinical Competence , Postpartum Period , Learning
4.
Matern Child Health J ; 25(3): 353-359, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33492587

ABSTRACT

OBJECTIVES: To examine the mental health of women in the perinatal period prior to and during the COVID-19 pandemic. METHODS: We use provisional vital statistics data for births occurring in the central region of New Jersey. The Edinburgh Postnatal Depression Scale is employed to assess depressive symptoms. Our focal analysis uses linear regression models to test whether giving birth during the pandemic is associated with elevated depressive symptoms. All analyses are performed using time-matched (September 2019-April 2020; n = 18,531) and month-matched (January 2019-April 2019 and January 2020- April 2020; n = 18,346) samples. RESULTS: Women who gave birth in March and not in April reported higher levels of depressive symptoms than those who gave birth prior to the pandemic in our time-matched (b = 0.09) and month-matched (b = 0.09) samples. The magnitude of this association is approximately one-third the magnitude of the association between preterm birth and depressive symptoms. CONCLUSION: These findings suggest that researchers and practitioners should pay special attention to signs of postpartum depression and women's adaptive coping responses in the early stages of pandemics.


Subject(s)
COVID-19/epidemiology , Depression, Postpartum/psychology , Mothers/psychology , Adaptation, Psychological , Adult , Depression, Postpartum/epidemiology , Female , Humans , New Jersey/epidemiology , Pandemics , Premature Birth/epidemiology , Psychiatric Status Rating Scales , SARS-CoV-2
5.
J Matern Fetal Neonatal Med ; 34(21): 3629-3630, 2021 Nov.
Article in English | MEDLINE | ID: mdl-31718373

ABSTRACT

Maternal mortality improvement depends on the proper classification used in defining maternal deaths. Since there are several definitions of maternal deaths depending upon the proximate cause of the death, if the death is related to the physiologic changes during pregnancy or not and the timing of the death, some opportunities for improvement may be missed to decrease the overall maternal mortality rate in the USA if the correct definition is not utilized appropriately.


Subject(s)
Maternal Death , Maternal Mortality , Cause of Death , Female , Humans , New Jersey , Pregnancy , United States/epidemiology
6.
Obstet Gynecol ; 137(1): 33-40, 2021 01 01.
Article in English | MEDLINE | ID: mdl-33278281

ABSTRACT

In the weeks after childbirth, a woman navigates multiple challenges. She must recover from birth, learn to care for herself and her newborn, and cope with fatigue and postpartum mood changes as well as chronic health conditions. Alongside these common morbidities, the number of maternal deaths in the United States continues to increase, and unacceptable racial inequities persist. One third of pregnancy-related deaths occur between 1 week and 1 year after delivery, with a growing proportion of these deaths due to cardiovascular disease; one fifth occur between 7 and 42 days postpartum. In addition, pregnancy-associated deaths due to self-harm or substance misuse are increasing at an alarming rate. Rising maternal mortality and morbidity rates, coupled with significant disparities in outcomes, highlight the need for tailored interventions to improve safety and well-being of families during the fourth trimester of pregnancy, which includes the period from birth to the comprehensive postpartum visit. Targeted support for growing families during this transition can improve health and well-being across generations.


Subject(s)
Patient Care Bundles , Patient-Centered Care/standards , Postnatal Care/standards , Postpartum Period , Female , Humans , Pregnancy
7.
Obstet Gynecol ; 134(2): 365-375, 2019 08.
Article in English | MEDLINE | ID: mdl-31306323

ABSTRACT

The opioid epidemic is a public health crisis, and pregnancy-associated morbidity and mortality due to substance use highlights the need to prioritize substance use as a major patient safety issue. To assist health care providers with this process and mitigate the effect of substance use on maternal and fetal safety, the National Partnership for Maternal Safety within the Council on Patient Safety in Women's Health Care has created a patient safety bundle to reduce adverse maternal and neonatal health outcomes associated with substance use. The Consensus Bundle on Obstetric Care for Women with Opioid Use Disorder provides a series of evidence-based recommendations to standardize and improve the quality of health care services for pregnant and postpartum women with opioid use disorder, which should be implemented in every maternity care setting. A series of implementation resources have been created to help providers, hospitals, and health systems translate guidelines into clinical practice, and multiple state-level Perinatal Quality Collaboratives are developing quality improvement initiatives to facilitate the bundle-adoption process. Structure, process, and outcome metrics have also been developed to monitor the adoption of evidence-based practices and ensure consistency in clinical care.


Subject(s)
Obstetrics/standards , Opioid-Related Disorders , Patient Safety/standards , Pregnancy Complications/psychology , Women's Health/standards , Female , Humans , Maternal Health Services/standards , Pregnancy
8.
J Midwifery Womens Health ; 63(3): 366-376, 2018 05.
Article in English | MEDLINE | ID: mdl-29684258

ABSTRACT

Racial and ethnic disparities exist in both perinatal outcomes and health care quality. For example, black women are 3 to 4 times more likely to die from pregnancy-related causes and have more than a 2-fold greater risk of severe maternal morbidity than white women. In an effort to achieve health equity in maternal morbidity and mortality, a multidisciplinary workgroup of the National Partnership for Maternal Safety, within the Council on Patient Safety in Women's Health Care, developed a concept article for the bundle on reduction of peripartum disparities. We aimed to provide health care providers and health systems with insight into racial and ethnic disparities in maternal outcomes, the etiologies that are modifiable within a health care system, and resources that can be used to address these etiologies and achieve the desired end of safe and equitable health care for all childbearing women.


Subject(s)
Black People/statistics & numerical data , Healthcare Disparities/organization & administration , Maternal Health/standards , Patient Care Bundles/standards , Pregnancy Complications/prevention & control , White People/statistics & numerical data , Female , Health Services Accessibility , Humans , Pregnancy , Prenatal Care/standards , United States
9.
J Obstet Gynecol Neonatal Nurs ; 47(3): 275-289, 2018 05.
Article in English | MEDLINE | ID: mdl-29699722

ABSTRACT

Racial and ethnic disparities exist in both perinatal outcomes and health care quality. For example, Black women are three to four times more likely to die from pregnancy-related causes and have more than a twofold greater risk of severe maternal morbidity than White women. In an effort to achieve health equity in maternal morbidity and mortality, a multidisciplinary workgroup of the National Partnership for Maternal Safety, within the Council on Patient Safety in Women's Health Care, developed a concept article for the bundle on reduction of peripartum disparities. We aimed to provide health care providers and health systems with insight into racial and ethnic disparities in maternal outcomes, the etiologies that are modifiable within a health care system, and resources that can be used to address these etiologies and achieve the desired end of safe and equitable health care for all childbearing women.


Subject(s)
Healthcare Disparities , Maternal Health Services/standards , Safety Management , Black or African American/statistics & numerical data , Consensus , Female , Healthcare Disparities/organization & administration , Healthcare Disparities/standards , Humans , Peripartum Period , Pregnancy , Pregnancy Complications/mortality , Quality Improvement , Safety Management/methods , Safety Management/organization & administration , United States , White People/statistics & numerical data , Women's Health
10.
Anesth Analg ; 123(4): 942-9, 2016 10.
Article in English | MEDLINE | ID: mdl-27636577

ABSTRACT

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.


Subject(s)
Maternal Death/prevention & control , Patient Safety , Pregnancy Complications/epidemiology , Pregnancy Complications/prevention & control , Venous Thromboembolism/epidemiology , Venous Thromboembolism/prevention & control , Delivery, Obstetric/adverse effects , Delivery, Obstetric/methods , Delivery, Obstetric/standards , Female , Humans , Maternal Mortality/trends , Patient Safety/standards , Postpartum Hemorrhage/diagnosis , Postpartum Hemorrhage/epidemiology , Postpartum Hemorrhage/prevention & control , Pregnancy , Pregnancy Complications/diagnosis , Risk Factors , United States/epidemiology , Venous Thromboembolism/diagnosis
11.
J Obstet Gynecol Neonatal Nurs ; 45(5): 706-17, 2016.
Article in English | MEDLINE | ID: mdl-27619099

ABSTRACT

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.


Subject(s)
Maternal Mortality , Venous Thromboembolism , Consensus , Female , Humans , Maternal Death , Practice Guidelines as Topic , Pregnancy , Risk Factors
12.
J Obstet Gynecol Neonatal Nurs ; 45(6): 885-893, 2016.
Article in English | MEDLINE | ID: mdl-27644072

ABSTRACT

The rate of maternal mortality is rising in the United States, and patient education is key to help women recognize signs and symptoms of complications of pregnancy. Health care providers should always ask a woman of childbearing age if she has experienced a recent pregnancy or birth, and women should remind health care providers at every encounter of a pregnancy or birth during the past year. It may make the difference between life and death.


Subject(s)
Maternal Mortality , Postnatal Care , Adult , Female , Humans , Patient Education as Topic , Pregnancy , Prenatal Care , Young Adult
13.
J Midwifery Womens Health ; 61(5): 649-657, 2016 09.
Article in English | MEDLINE | ID: mdl-29473681

ABSTRACT

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into 4 domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.


Subject(s)
Maternal Death , Pregnancy Complications/prevention & control , Venous Thromboembolism/prevention & control , Consensus , Female , Humans , Maternal Mortality , Patient Safety , Pregnancy , Pregnancy Complications/etiology , Risk Factors , Venous Thromboembolism/etiology
14.
Obstet Gynecol ; 124(4): 782-786, 2014 Oct.
Article in English | MEDLINE | ID: mdl-25198266

ABSTRACT

Case reviews of maternal death have revealed a concerning pattern of delay in recognition of hemorrhage, hypertensive crisis, sepsis, venous thromboembolism, and heart failure. Early-warning systems have been proposed to facilitate timely recognition, diagnosis, and treatment for women developing critical illness. A multidisciplinary working group convened by the National Partnership for Maternal Safety used a consensus-based approach to define The Maternal Early Warning Criteria, a list of abnormal parameters that indicate the need for urgent bedside evaluation by a clinician with the capacity to escalate care as necessary in order to pursue diagnostic and therapeutic interventions. This commentary reviews the evidence supporting the use of early-warning systems and describes The Maternal Early Warning Criteria, along with considerations for local implementation.


Subject(s)
Early Diagnosis , Maternal Welfare , Patient Safety , Prenatal Care , Preventive Medicine/organization & administration , Adult , Awareness , Female , Humans , Maternal Mortality , Pregnancy , Risk Assessment
15.
J Obstet Gynecol Neonatal Nurs ; 43(6): 771-9, 2014.
Article in English | MEDLINE | ID: mdl-25203897

ABSTRACT

Case reviews of maternal death have revealed a concerning pattern of delay in recognition of hemorrhage, hypertensive crisis, sepsis, venous thromboembolism, and heart failure. Early-warning systems have been proposed to facilitate timely recognition, diagnosis, and treatment for women developing critical illness. A multidisciplinary working group convened by the National Partnership for Maternal Safety used a consensus-based approach to define The Maternal Early Warning Criteria, a list of abnormal parameters that indicate the need for urgent bedside evaluation by a clinician with the capacity to escalate care as necessary in order to pursue diagnostic and therapeutic interventions. This commentary reviews the evidence supporting the use of early-warning systems, describes The Maternal Early Warning Criteria, and provides considerations for local implementation.


Subject(s)
Early Medical Intervention/standards , Maternal Death , Time-to-Treatment/standards , Critical Illness/therapy , Early Diagnosis , Female , Health Services Needs and Demand , Humans , Maternal Death/etiology , Maternal Death/prevention & control , Maternal Death/statistics & numerical data , Maternal Mortality , Patient Care Team , Population Surveillance/methods , United States
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