Reduced prevalence of small-for-gestational-age and preterm birth for women of low socioeconomic position: a population-based cohort study comparing antenatal midwifery and physician models of care

McRae, Daphne N.; Janssen, Patricia A.; Vedam, Saraswathi; Mayhew, Maureen; Mpofu, Deborah; Teucher, Ulrich; Muhajarine, Nazeem

doi:10.1136/bmjopen-2018-022220

Cited by 26 publications

(30 citation statements)

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“…Since data suggest that institutional racism is a contributing factor, place of birth, or model of maternity care, may also modulate these outcomes [ 41 ]. A recent population-level analysis in Canada described associations between midwifery care of at-risk populations and significantly reduced incidence of pre-term birth, low birth weight, and other adverse outcomes [ 54 ]. In our study, lower MISS scores were associated with significantly higher rates of neonatal mortality among Hispanic, black and white babies when examining race-specific outcomes.…”

Section: Discussionmentioning

confidence: 99%

Mapping integration of midwives across the United States: Impact on access, equity, and outcomes

et al. 2018

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Poor coordination of care across providers and birth settings has been associated with adverse maternal-newborn outcomes. Research suggests that integration of midwives into regional health systems is a key determinant of optimal maternal-newborn outcomes, yet, to date, the characteristics of an integrated system have not been described, nor linked to health disparities.MethodsOur multidisciplinary team examined published regulatory data to inform a 50-state database describing the environment for midwifery practice and interprofessional collaboration. Items (110) detailed differences across jurisdictions in scope of practice, autonomy, governance, and prescriptive authority; as well as restrictions that can affect patient safety, quality, and access to maternity providers across birth settings. A nationwide survey of state regulatory experts (n = 92) verified the ‘on the ground’ relevance, importance, and realities of local interpretation of these state laws. Using a modified Delphi process, we selected 50/110 key items to include in a weighted, composite Midwifery Integration Scoring (MISS) system. Higher scores indicate greater integration of midwives across all settings. We ranked states by MISS scores; and, using reliable indicators in the CDC-Vital Statistics Database, we calculated correlation coefficients between MISS scores and maternal-newborn outcomes by state, as well as state density of midwives and place of birth. We conducted hierarchical linear regression analysis to control for confounding effects of race.ResultsMISS scores ranged from lowest at 17 (North Carolina) to highest at 61 (Washington), out of 100 points. Higher MISS scores were associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, and breastfeeding, and significantly lower rates of cesarean, preterm birth, low birth weight infants, and neonatal death. MISS scores also correlated with density of midwives and access to care across birth settings. Significant differences in newborn outcomes accounted for by MISS scores persisted after controlling for proportion of African American births in each state.ConclusionThe MISS scoring system assesses the level of integration of midwives and evaluates regional access to high quality maternity care. In the United States, higher MISS Scores were associated with significantly higher rates of physiologic birth, less obstetric interventions, and fewer adverse neonatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Mapping integration of midwives across the United States: Impact on access, equity, and outcomes

et al. 2018

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“…In high resource countries, pregnant people who are recent immigrants, Indigenous, and/or disenfranchised by their lower socioeconomic status, race/ethnicity, incarceration, substance dependence, or housing instability have been reported to be at increased risk for poor health outcomes, and reduced access to high quality care [18–22]. Few investigators have examined whether experiences of RMC differ by sociodemographic factors, but one U.S. national study identified racial disparities in the treatment of childbearing women in hospitals [23].…”

Section: Introductionmentioning

confidence: 99%

The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States

et al. 2019

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Background Recently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with NGOs, clinicians, and researchers, to design and conduct the Giving Voice to Mothers (GVtM)–US study. Methods Our multi-stakeholder team distributed an online cross-sectional survey to capture lived experiences of maternity care in diverse populations. Patient-designed items included indicators of verbal and physical abuse, autonomy, discrimination, failure to meet professional standards of care, poor rapport with providers, and poor conditions in the health system. We quantified the prevalence of mistreatment by race, socio-demographics, mode of birth, place of birth, and context of care, and describe the intersectional relationships between these variables. Results Of eligible participants ( n = 2700), 2138 completed all sections of the survey. One in six women (17.3%) reported experiencing one or more types of mistreatment such as: loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests for help. Context of care (e.g. mode of birth; transfer; difference of opinion) correlated with increased reports of mistreatment. Experiences of mistreatment differed significantly by place of birth: 5.1% of women who gave birth at home versus 28.1% of women who gave birth at the hospital. Factors associated with a lower likelihood of mistreatment included having a vaginal birth, a community birth, a midwife, and being white, multiparous, and older than 30 years. Rates of mistreatment for women of colour were consistently higher even when examining interactions between race and other maternal characteristics. For example, 27.2% of women of colour with low SES reported any mistreatment versus 18.7% of white women with low SES. Regardless of maternal race, having a partner who was Black also increased reported mistreatment. Conclusion This is the first study to use indicators developed by service users to describe mistreatment in childbirth in the US. Our findings suggest that mistreatment is experienced more frequently by women of colour, when birth occurs in hospitals, and among those with social, economic or health challenges. Mistreatment is exacerbated by unexpected obstetric interventions, and by patient-provider disagreements. Electronic supplementary material The online version of this article (10.1186/s12978-019-0729-2) contains supplementary material, which is available to authorized users.

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“…This midwifery-led continuity model is often promoted as the gold standard for maternity care for low risk women [14] who report fewer interventions and higher satisfaction than with other models such as medical-led or shared care [15]. It is also touted as a major contributor to the reduction of inequity [16, 17], even so, maternal health inequity persists in outcomes, care processes, and women’s experience within the New Zealand health system.…”

Section: Introductionmentioning

confidence: 99%

Barriers to equitable maternal health in Aotearoa New Zealand: an integrative review

Dawson

Jaye

Gauld

et al. 2019

Int J Equity Health

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BackgroundThe purpose of this review was to examine the literature for themes of underlying social contributors to inequity in maternal health outcomes and experiences in the high resource setting of Aotearoa New Zealand. These ‘causes of the causes’ were explored and compared with the international context to identify similarities and New Zealand-specific differences.MethodA structured integrative review methodology was employed to enable a complex cross disciplinary analysis of data from a variety of published sources. This method enabled incorporation of diverse research methodologies and theoretical approaches found in the literature to form a unified overall of the topic.ResultsSix integrated factors – Physical Access, Political Context, Maternity Care System, Acceptability, Colonialism, and Cultural factors – were identified as barriers to equitable maternal health in Aotearoa New Zealand. The structure of the maternal health system in New Zealand, which includes free maternity care and a woman centred continuity of care structure, should help to ameliorate inequity in maternal health and yet does not appear to. A complex set of underlying structural and systemic factors, such as institutionalised racism, serve to act as barriers to equitable maternity outcomes and experiences. Initiatives that appear to be working are adapted to the local context and involve self-determination in research, clinical outreach and community programmes.ConclusionsThe combination of six social determinants identified in this review that contribute to maternal health inequity is specific to New Zealand, although individually these factors can be identified elsewhere; this creates a unique set of challenges in addressing inequity. Due to the specific social determinants in Aotearoa New Zealand, localised solutions have potential to further maternal health equity.

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Reduced prevalence of small-for-gestational-age and preterm birth for women of low socioeconomic position: a population-based cohort study comparing antenatal midwifery and physician models of care

Cited by 26 publications

References 22 publications

Mapping integration of midwives across the United States: Impact on access, equity, and outcomes

Mapping integration of midwives across the United States: Impact on access, equity, and outcomes

The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States

Barriers to equitable maternal health in Aotearoa New Zealand: an integrative review

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