Statewide Perinatal Quality Improvement, Teamwork, and Communication Activities in Oklahoma and Texas.

BACKGROUND AND OBJECTIVE: The purpose of this study was to describe statewide perinatal quality improvement (QI) activities, specifically implementation of Alliance for Innovation on Maternal Health (AIM) patient safety bundles and use of teamwork and communication tools in obstetric units in Oklahoma and Texas. METHODS: In January-February 2020, we conducted a survey of AIM-enrolled hospitals in Oklahoma (n = 35) and Texas (n = 120) to gather data on obstetric unit organization and QI processes. Data were linked to hospital characteristics information from the 2019 American Hospital Association survey and hospitals' maternity levels of care from state agencies. We generated descriptive statistics for each state and created an index to summarize adoption of QI processes. We fitted linear regression models to examine how this index varied by hospital characteristics and self-reported ratings for patient safety and AIM bundle implementation. RESULTS: Most obstetric units had standardized clinical processes for obstetric hemorrhage (94% Oklahoma; 97% Texas), massive transfusion (94% Oklahoma; 97% Texas), and severe hypertension in pregnancy (97% Oklahoma; 80% Texas); regularly conducted simulation drills for obstetric emergencies (89% Oklahoma; 92% Texas); had multidisciplinary QI committees (61% Oklahoma; 83% Texas); and conducted debriefs after major obstetric complications (45% Oklahoma; 86% Texas). Few obstetric units offered recent staff training on teamwork and communication to their staff (6% Oklahoma; 22% Texas); those who did were more likely to employ specific strategies to facilitate communication, escalate concerns, and manage staff conflicts. Overall, adoption of QI processes was significantly higher in hospitals in urban than rural areas, teaching than nonteaching, offering higher levels of maternity care, with more staff per shift, and greater delivery volume (all P < .05). The QI adoption index scores were strongly associated with respondents' ratings for patient safety and implementation of maternal safety bundles (both P < .001). CONCLUSIONS: Adoption of QI processes varies across obstetric units in Oklahoma and Texas, with implications for implementing future perinatal QI initiatives. Notably, findings highlight the need to reinforce support for rural obstetric units, which often face greater barriers to implementing patient safety and QI processes than urban units.

Support for Breastfeeding Employees: Assessing Statewide Worksite Lactation Support Recognition Initiatives in the United States.

BACKGROUND: Although the reasons for discontinued breastfeeding are multifactorial, an unsupportive work environment is consistently reported as a barrier to continued breastfeeding. In the United States, several state breastfeeding advocates have taken a distinctive approach to promote worksite lactation support by developing statewide recognition initiatives aimed at incentivizing employers to support breastfeeding employees by offering public recognition for the worksites' efforts. RESEARCH AIM: To identify and describe statewide worksite lactation support recognition initiatives in the United States. METHODS: Between May 2016 and June 2017, semi-structured phone interviews were conducted with breastfeeding experts in each U.S. state (N = 60 participants) for this cross-sectional study. Experts in states with a recognition initiative were asked about the background, structure, and requirements of the initiative. RESULTS: Twenty-six states had a current initiative, and some had requirements for providing a private space (n = 19; 73%) and time (n = 18; 69%) for employees to express human milk, as well as a written worksite lactation support policy (n = 10; 38%). CONCLUSIONS: This was the first study in which researchers systematically identified ongoing worksite lactation support recognition initiatives in the United States. The results of this work also served to highlight both the similarities and the variety between initiatives. Future researchers should aim to determine the components of an initiative that increase employer support and, in turn, breastfeeding rates.

Maternal Mortality in Texas.

A commentary on maternal mortality in Texas is provided in response to a 2016 article in Obstetrics & Gynecology by MacDorman et al. While the Texas Department of State Health Services and the Texas Maternal Mortality and Morbidity Task Force agree that maternal mortality increased sharply from 2010 to 2011, the percentage change or the magnitude of the increase in the maternal mortality rate in Texas differs depending on the statistical methods used to compute and display it. Methodologic challenges in identifying maternal death are also discussed, as well as risk factors and causes of maternal death in Texas. Finally, several state efforts currently underway to address maternal mortality in Texas are described.

Men's attitudes toward breastfeeding: findings from the 2007 Texas Behavioral Risk Factor Surveillance System.

Past research on breastfeeding demonstrates that male partners' support is a significant factor in mothers' decisions to breastfeed. This study explored the diversity of men's opinions about breastfeeding, for the purpose of increasing breastfeeding support among men. This study used the Texas sample of the 2007 Behavioral Risk Factor Surveillance System (BRFSS) to examine whether men's attitudes toward breastfeeding varied by their demographic characteristics and whether fathers' breastfeeding attitudes were related to couples' choice of infant feeding method. Descriptive statistics and linear regression estimated the influence of each demographic characteristic on breastfeeding attitudes. Among a subsample of fathers, multinomial logistic regression analyzed the influence of men's breastfeeding attitudes on their choice of infant feeding method. Findings showed that Spanish-speaking Hispanic men were most likely to agree that breastfeeding had social limitations (e.g. interfere with social life) for mothers, yet they viewed public images of breastfeeding as more acceptable compared with other men. In comparison to U.S.-born men, foreign-born men were in greater agreement that employers should accommodate breastfeeding. Among fathers, support of public images of breastfeeding and attitudes toward employers' accommodations were positively associated with the choice to use breast milk. Men's ethnicity, country of origin, education level, and socioeconomic status all contribute to different norms and expectations about breastfeeding. Men's attitudes about public images of breastfeeding and employers' accommodations for breastfeeding mothers influence the choice of breast milk as the sole infant-feeding method.

Breast-feeding attitudes and behavior among WIC mothers in Texas.

OBJECTIVE: This study explored the influence of demographic characteristics on attitudes toward the benefits of breast-feeding, approval of public breast-feeding, and the use of infant formula. Additionally, the study examined whether attitudes were related to infant feeding practices among mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Texas. DESIGN: This study used a cross-sectional design. SETTING: Participants completed questionnaires at WIC clinic sites across Texas. PARTICIPANTS: Mothers of young children who were receiving WIC benefits. MAIN OUTCOME MEASURE(S): Attitudes toward the benefits of breast-feeding, attitudes toward public breast-feeding, attitudes toward infant formula, and the choice of infant feeding practice. ANALYSIS: Descriptive statistics, multivariate ordinary least squares regression, and multinomial logistic regression. RESULTS: A key finding was that many Hispanic mothers held favorable attitudes toward both breast milk and infant formula. Younger and less educated mothers were least likely to agree with the benefits of breast-feeding. Mothers with positive attitudes toward the benefits of breast-feeding were likely to exclusively breastfeed and use both formula and breast milk. CONCLUSIONS AND IMPLICATIONS: Attitudes toward breast-feeding, public breast-feeding, and infant formula and their influence on breast-feeding behavior should inform the curriculum of breast-feeding promotion programs.

Learning to lobby for probreastfeeding legislation: the story of a Texas bill to create a breastfeeding-friendly physician designation.

Legislation can reduce institutional barriers to breastfeeding. Lobbying is the process by which legislation is influenced by a special interest group. While generally thought of as an activity available only to the rich and powerful, lobbying by lactation activists can be an effective way to change public policy. A breastfeeding coalition in central Texas has been involved with lobbying efforts since 1995. Tactical lessons learned are shared to inspire and assist others seeking to pass probreastfeeding legislation.