"An extra layer of pressure to be my best self”: Healthcare provider perspectives on how doulas foster accountability and bridge gaps in pregnancy-related care

This analysis contributes to the broader literature on doula care by describing mechanisms through which doulas improve pregnancy-related care. Doulas may be critical for birthing people who are most likely to experience mistreatment due to racism and other dimensions of oppression.

A Cost-Benefit Analysis of Doula Care from a Public Health Framework

This report seeks to present a broad cost-benefit analysis of public reimbursement for doula services nationally with a public health and Reproductive Justice lens. It summarizes the cost of recent maternal and infant morbidity and mortality; outlines the cost savings from doula support; describes the health benefits of doulas across the pregnancy, birth, and postpartum continuum; and provides recommendations/conclusions for allies and advocates across disciplines.

A History Of The Impacts Of Discriminatory Policies On Housing And Maternal And Infant Health In An Ohio Neighborhood

Community-level disinvestment and de facto segregation rooted in decades of discriminatory race-based policies and racism have resulted in unacceptably large infant mortality rates in racial minority neighborhoods across the US. This research article details how state and local policies have affected the Linden neighborhood in Columbus, OH, and shaped neighborhood-level demographics and resources during the past 100 years.

A Visit to the Pediatrician as a Part of Comprehensive Prenatal Care?

The study examines the underutilization of pediatric prenatal visits (PPV) recommended by medical associations during the prenatal period. While research supports the effectiveness of these visits in improving child health, only 22% of expectant parents utilize them (with racial and income disparities). Educating providers about the benefits, insurance coverage, and guidelines could help reduce disparities and increase overall PPV utilization.

A systematic review of clinical psychological guidance for perinatal mental health

Guidelines on psychological and/or psychosocial assessment and intervention in the perinatal period can provide benefcial practice guidance for healthcare professions to reduce maternal distress and potential mortality. As little is known about the similarities in recommendations across guidelines, which could impact the quality of therapeutic intervention women receive, this systematic review was conducted to draw out the consistent guidance for perinatal psychological and/or psychosocial therapeutic input

Addressing anti-black racism in an academic preterm birth initiative: Perspectives from a mixed methods case study

The case study evaluates the California Preterm Birth Initiative's (PTBi) Anti-Racism Action Plan, established in response to growing awareness of racism in academic settings. The study aimed to gauge perspectives on anti-racism competencies, identifying areas of success and potential improvements within the initiative, ultimately focusing on achieving racial equity. Qualitative data from interviews and surveys were analyzed, highlighting common themes across various assessment domains.

Adverse childhood experiences and prescription opioid use during pregnancy: an analysis of the North and South Dakota PRAMS, 2019–2020

Utilizing data from 2,999 individuals in the 2019 and 2020 Pregnancy Risk Assessment Monitoring System from two US states, researchers examined the association between adverse childhood experiences (ACEs) and prescription opioid use during pregnancy. This study highlights the negative effects that adverse childhood experiences can have on the health of individuals over their lifetime, especially during the vulnerable period of pregnancy.

Aligning Pregnancy-Related Medicaid Coverage Extensions and Medicaid Doula Coverage to Improve Maternal Health

Medicaid plays a crucial role in ensuring access to care during and after pregnancy. States can help alleviate maternal mortality and severe morbidity by putting in place both Medicaid pregnancy related extensions and Medicaid coverage for doula care. This issue brief shares an update of current state implementation efforts around pregnancy related Medicaid coverage extensions and Medicaid coverage for doula care. The brief analyses how these two efforts address maternal and infant mortality and why aligning twelve month pregnancy related Medicaid extensions and Medicaid coverage for doula care can improve maternal health.

Analysis of Heat Exposure During Pregnancy and Severe Maternal Morbidity

In this cohort study with 403 602 pregnancies from 2008 to 2018 in Southern California, statistically significant associations were observed between both long- and short-term maternal heat exposure during pregnancy and increased risks of severe maternal morbidity.

Analysis of research on interventions for the prevention of safety accidents involving infants: a scoping review

This study aimed to conduct a scoping review of studies on interventions for the prevention of safety accidents involving infants.

Association Between Publicly Funded Contraceptive Services and the Abortion Rate in Texas, 2010-2015

This study researches how the availability of contraceptive services was associated with a change in the abortion rate before and after Texas' legislative changes to the family planning budget in 2011 and abortion access in 2013.

Association between adverse childhood experiences and perinatal depressive symptoms: a cross-sectional analysis of 16,831 women in Iceland

Using data on 16,831 female participants from the Stress-And-Gene-Analysis (SAGA) cohort in Iceland, researchers sought to examine whether women with any out of 13 different types of adverse childhood experiences (ACEs) were more likely to experience depressive symptoms during their pregnancy and/or postpartum. This cross-sectional analysis indicated a positive association between the accumulative number of ACEs and perinatal depression (PND) symptoms in a dose–response manner. This study provides additional evidence of the relationship between ACE history and risk of perinatal depression.

Association between maternity care practitioner type and postpartum depression screening

The study investigated postpartum depression (PPD) screening among California residents who gave birth in 2016, using data from the Listening to Mothers in California 2018 dataset. The primary focus was on the type of maternity care professional provided during pregnancy and its association with PPD screening. Self-reported depression or anxiety during pregnancy and attendance at postpartum office visits were also examined. Results showed that participants cared for by midwives had 2.6 times higher odds of being screened for PPD compared to those cared for by obstetricians, after adjusting for covariates. No significant differences were found in PPD screening rates when comparing care from other practitioner types to obstetricians. Additionally, reporting depression or anxiety during pregnancy was associated with lower odds of attending a postpartum office visit. The study concludes that receiving care from a midwife during pregnancy increases the likelihood of PPD screening. Furthermore, it highlights that even with universal screening, there remains a vulnerable population at high risk for PPD who are less likely to attend postpartum care visits.

Association between placental location and cord insertion site with pre-eclampsia: a retrospective cohort study

This retrospective cohort study conducted at a single tertiary hospital between January 2019 and June 2022 aimed to investigate the relationship between placental location, abnormal cord insertion, and adverse pregnancy outcomes in nulliparous women. The study suggests that anterior placenta and marginal cord insertion may be linked to an elevated risk of pre-eclampsia in nulliparous women, emphasizing the need for further research in prospective cohorts to validate these findings.

Barriers and Facilitators to the Implementation of a Community Doula Program for Black and Pacific Islander Pregnant People in San Francisco: Findings from a Partnered Process Evaluation

Increasingly, community-based models of doula care are receiving attention as possible interventions to address racial inequities in maternal health care experiences and outcomes. In 2018, community-based organization SisterWeb launched to provide free culturally congruent community doula care to advance birth equity for Black and Pacific Islander pregnant people, with funding from the San Francisco Department of Public Health. We conducted a process evaluation of SisterWeb’s first 1.5 years of existence to identify multilevel barriers and facilitators to implementation of their programs. Guided by the Equitable Evaluation Framework™, this study conducted 46 in-depth interviews with individuals from 5 groups: SisterWeb leadership, doulas, doula mentors, and clients, and external stakeholders.

Benefits of maternally-administered infant massage for mothers of hospitalized preterm infants: a scoping review

Infant massage (IM) is a well-studied, safe intervention known to benefit infants born preterm. Less is known about the benefits of maternally-administrated infant massage for mothers of preterm infants who often experience increased rates of anxiety and depression in their infants’ first year of life. This scoping review summarizes the extent, nature, and type of evidence linking IM and parent-centered outcomes.

Benzylpenicillin concentrations in umbilical cord blood and plasma of premature neonates following intrapartum doses for group B streptococcal prophylaxis

Dutch obstetrics guideline suggest an initial maternal benzylpenicillin dose of 2,000,000 IU followed by 1,000,000 IU every 4 h for group-B-streptococci (GBS) prophylaxis. The objective of this study was to evaluate whether concentrations of benzylpenicillin reached concentrations above the minimal inhibitory concentrations (MIC) in umbilical cord blood (UCB) and neonatal plasma following the Dutch guideline.

Black Women's Maternal Health - A Multifaceted Approach to Addressing Persistent and Dire Health Disparities

Regardless of socioeconomic status, Black women and birthing individuals in the United States are three times more likely to die from pregnancy than their white counterparts. This disparity widens in various cities and states. Black women are also disproportionately affected by severe maternal morbidity– unexpected outcomes in labor and delivery (e.g., hypertension and anxiety) that result in significant short- or long-term consequences to the childbearing person’s health and well-being.

Breastfeeding Aversion Response (BAR): A Descriptive Study

Some women have reported negative sensations such as an overwhelming need to unlatch while breastfeeding. This phenomenon is known as breastfeeding aversion response (BAR). This study therefore aimed to expand the understanding of BAR using an online survey targeting those who have experienced feelings of aversion while breastfeeding.

Breastfeeding Report Card

CDC’s Breastfeeding Report Card, 2022 provides a compilation of data on breastfeeding practices and supports in all states, the District of Columbia, and Puerto Rico.

Breastfeeding duration and associations with prevention of accelerated growth among infants from low-income, racially, and ethnically diverse backgrounds

In this prospective cohort study involving 256 low-income, racially diverse mother-infant pairs in the Southeastern US, breastfeeding patterns and their impact on infant growth were investigated. Most participants were African American or Latina, with 81% enrolled in a nutritional program for women and infants. The study found that infants breastfed beyond 6 months had slower growth rates compared to those breastfed for shorter periods, indicating a link between extended breastfeeding and reduced rapid weight gain. Infants breastfed for 2 months or less were more likely to experience rapid weight gain than those breastfed for 6 months or more, suggesting that prolonged breastfeeding may contribute to more equitable health outcomes among diverse populations, potentially aiding in preventing accelerated growth and childhood obesity.

Brief of “An extra layer of pressure to be my best self”: Healthcare provider perspectives on Doula Care

To create opportunities for bidirectional feedback between doulas and healthcare providers, SisterWeb developed the Champion Dyad Initiative, which fosters the support of one or two staff “champions” at labor and delivery sites. As part of an evaluation of SisterWeb’s community doula programs, researchers at UC Berkeley interviewed physicians, midwives, and nurses who worked at hospitals and clinicswhere SisterWeb doula clients receive care.

Building Capacity for Research on Community Doula Care: A Stakeholder-Engaged Process in California

The study focuses on addressing disparities in maternal and infant health by expanding access to doula care, particularly community-based models, which are essential for marginalized communities. Through stakeholder engagement, the study aims to build capacity for client-centered, community-informed research on doula care in California. The process involved establishing a Steering Committee representing various stakeholders, conducting a needs assessment, identifying research priorities, and offering training to increase community doulas' research engagement. The study highlights the importance of including diverse perspectives in research and provides valuable insights for policymakers, funders, and researchers interested in promoting equitable maternal and infant health outcomes through doula care.

CalAIM Experiences: Implementer Views After 18 Months of Reforms

CalAIM, the multiyear effort to reform the state’s Medi-Cal system, is now in its second year. To gain a clearer picture of how implementation is occurring on the ground, CHCF commissioned an online survey, which was conducted July 21 to September 12, 2023, among 1,196 people working at managed care plans, behavioral health organizations, community-based organizations, social services organizations, and other types of people to produce this report.

CalAIM Explained: Caring for Californians Leaving Incarceration

This guide, developed by the Center for Health Care Strategies in partnership with Community Oriented Correctional Health Services and the California Health Care Foundation, can support California stakeholders looking to partner with the criminal legal system. While developed for the California context, the lessons within are applicable for health care professionals everywhere interested in learning the basics of the correctional system, the reentry process, and finding key partnership opportunities to serve and improve the health outcomes of this population.

Care plan for individuals at risk for preeclampsia: shared approach to education, strategies for prevention, surveillance, and follow-up (2023)

This report provides a groundbreaking approach to preeclampsia, one of the most pressing issues in maternal health today, and will translate the prediction of risk into prevention of disease.

Challenges and Opportunities for Clinician Implicit Bias Training: Insights from Perinatal Care Stakeholders

In response to health disparities, several U.S. states have explored mandating implicit bias training (IBT) for healthcare providers. California's 'Dignity in Pregnancy and Childbirth Act' requires IBT for perinatal clinicians to enhance outcomes for Black women and birthing individuals. However, the effectiveness of IBT remains unclear. Through a comprehensive community-based study involving Black women who recently gave birth and perinatal clinicians in the San Francisco Bay Area, significant challenges and recommendations emerged for successful IBT implementation. These findings provide essential guidance for policymakers, healthcare leaders, and curriculum developers aiming to advance antibias interventions in healthcare settings.

Childhood trauma and fear of childbirth: findings from a birth cohort study

This retrospective cohort study of 2556 women aimed to examine the relationship between childhood trauma and fear of childbirth (FOC). The study found that emotional abuse, emotional neglect, and a higher total burden of childhood trauma (as measured by the TADS total score) increased the risk of FOC. However, there was no evidence of a significant association between physical abuse, physical neglect, sexual abuse, and FOC.

Children with Trans Parents: Parent–Child Relationship Quality and Psychological Well-being

This exploratory study offers the first quantitative assessment of parent–child relationship quality and child socio-emotional and behavioral adjustment in families with a self-identified trans parent with school-aged children. The study concluded that parents and children in trans parent families had good quality relationships and children showed good psychological adjustment. The findings of this exploratory study challenge commonly held concerns about the potentially negative effects on children of growing up with a trans parent.

Chronic Hypertension in Pregnancy and Racial–Ethnic Disparities in Complications

In this study, women with chronic hypertension or antepartum anemia were more likely to experience severe maternal morbidity, which is defined as a life-threatening complication that occurs during pregnancy, childbirth, or the postpartum period. The study also found that Black and Hispanic women were disproportionately affected by these conditions.

Comparison of maternal outcomes in caring by Doula, trained lay companion and routine midwifery care

This study compared maternal outcomes in labor and obstetric care provided by a doula, a trained lay companion, and routine midwifery care. It involved 150 low-risk pregnant women in Arak, Iran. The study suggests that doula care is more effective in reducing the duration of labor and enhancing maternal satisfaction, while lay companions may help reduce anxiety in mothers who cannot afford doula services. Further research on pain severity and different care models is recommended.

Complementary Feeding Interventions for Infants and Young Children Under Age 2: Scoping of Promising Interventions to Implement at the Community or State Level

In response to a request from the Centers for Disease Control and Prevention, the National Academies Health and Medicine Division convened the Committee on Complementary Feeding Interventions for Infants and Young Children under Age 2 to conduct a consensus study scoping review of peer-reviewed literature and other publicly available information on interventions addressing complementary feeding of infants and young children.

Complicating the dominant morality discourse: mothers and fathers’ constructions of substance use during pregnancy and early parenthood

This article examines the complex perceptions of substance use during pregnancy and the transition to parenthood. It highlights that while many mothers and fathers view abstinence as the ideal during this period, they also recognize the autonomy of women to make decisions about substance use for themselves. The study emphasizes the need for health and social service providers to understand and address these competing perspectives in order to effectively support vulnerable families and promote well-being within individual definitions of problematic substance use.

Confronting Racism in Pediatric Care

In this essay, Ben Danielson, MD, clinical professor in the Department of Pediatrics at the University of Washington School of Medicine, recounts the painful story of a Black pediatric patient and his mother as they navigate a hospital stay. Tragically, the hospitalization ends with the child being temporarily placed in a medical foster home due to bias and racism that hospital staff did not see playing out before them.

Delays in the vaccination of infants between 2 and 18 months of age: associated factors in Chile

This study contained two parts. In Part One, a questionnaire was created by the research team and then validated by a committee of experts in the field and a group of parents. It included the following contents: sociodemographic variables, features of the vaccination services, history of vaccination, and attitudes and perceptions about vaccination. Part Two was a cross-sectional study, recruiting private and public healthcare centers to explore the psychometrics features of the instrument, performing exploratory factor analysis, and determining the associated factors with DTaP vaccination delay throughout multivariable regression models.

Developing Financially Sustainable Child Health Transformation: Lessons from Primary Care Innovators

This brief from the Center for Health Care Strategies describes existing payment barriers and opportunities for primary care providers serving children to work toward financially sustaining care transformation. It draws from interviews with pediatric practices and subject matter experts engaged in the national Accelerating Child Health Transformation initiative.

Disparities by race/ethnicity in unplanned cesarean birth among healthy nulliparas: a secondary analysis of the nuMoM2b dataset

In this study, researchers aimed to conduct a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) dataset to examine self-identification of race/ethnicity and unplanned cesarean birth. The results indicated that the unplanned cesarean birth rate in percentage was about 19.6%. The cesarean birth rate was significantly higher in Black and Hispanic mothers in comparison to those who self-identified as White, even after controlling for pertinent clinical factors associated with cesarean birth.

Early Lessons from CalAIM Initiatives to Address Behavioral Health Needs

The California Department of Health Care Services has launched the CalAIM (California Advancing and Innovating Medi-Cal) program in 2022 to transform the fragmented delivery of Medi-Cal services, particularly for individuals with behavioral health needs. To better understand the early implementation and enhance care coordination for adult Medi-Cal members with serious behavioral health conditions, the Center for Health Care Strategies conducted interviews with stakeholders across five counties between December 2022 and March 2023. The interviews provided insights into improving processes for developing contracts, identifying eligible members, reducing duplication, and delivering Enhanced Care Management (ECM) and Community Supports to eligible members within the CalAIM framework.

Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study

Lower respiratory tract infections (LRTIs) in early childhood are known to influence lung development and lifelong lung health, but their link to premature adult death from respiratory disease is unclear. This study aimed to estimate the association between early childhood LRTI and the risk and burden of premature adult mortality from respiratory disease.

Early predictors for maltreatment-related injuries in infancy and long-term mortality- a population-based study

Incidence, health consequences, and social burden associated with child maltreatment appeared to be borne disproportionately by very young children. We conducted a population-based data linkage study to explore child- and family-level factors that affect receiving different diagnoses of maltreatment injuries and investigate excessive mortality throughout toddlerhood.

Effect of implementing a birth plan on maternal and neonatal outcomes: a randomized controlled trial

This study aimed to investigate the effect of birth plan on maternal and neonatal outcomes. This study was a randomized controlled clinical trial performed on 106 pregnant women, 32–36 weeks of pregnancy, referring to Taleghani educational hospital in Tabriz city-Iran.

Effect of maternal nutrition education on early initiation and exclusive breast-feeding practices in south Ethiopia: a cluster randomised control trial

Optimal breast-feeding practices make a major contribution to the promotion of healthy growth and development through much prevention of diarrheal and respiratory diseases which majorly cause morbidity and mortality in under-five children. However, breast-feeding practices remain suboptimality in Ethiopia. The study objective was to determine the effect of maternal nutrition education on early initiation and exclusive breast-feeding practice in the Hawela Tulla sub-city.

Effects of armed conflict on maternal and infant health: a mixed-methods study of Armenia and the 2020 Nagorno-Karabakh war

This mixed-methods study explored the effects of the 2020 armed conflict between Armenia and Azerbaijan on maternal and infant health. Relying on ecological data to evaluate health trends in conflict, as well as interviews with 10 key informants about unmet needs, maternal health-seeking behaviors and priorities during the war, researchers found that both maternal and infant health measures showed adverse trends during the 2020 Nagorno-Karabakh war, including increases in neonatal mortality and maternal morbidity in 2020 compared with 2019.

Engaging Communities of Color to Promote Health Equity: Five Lessons from New York-Based Health Care Organizations

This brief outlines considerations for healthcare organizations to improve partnership relationships with patients of color to inform program and policy design. This brief expands on how Partnering with patients and community members of color to understand needs and preferences is an important step in improving health outcomes and advancing health equity.

Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents

As a traditionally underserved population that faces numerous health disparities, youth who identify as transgender and gender diverse (TGD) and their families are increasingly presenting to pediatric providers for education, care, and referrals. The need for more formal training, standardized treatment, and research on safety and medical outcomes often leaves providers feeling ill equipped to support and care for patients that identify as TGD and families. In this policy statement, we review relevant concepts and challenges and provide suggestions for pediatric providers that are focused on promoting the health and positive development of youth that identify as TGD while eliminating discrimination and stigma

Equity in CalAIM: How to Identify the Patients Who Will Benefit Most

The brief, developed by the Center for Health Care Strategies with Rachel Davis Consulting, draws on a literature review and interviews with national and local experts to outline strategies for identifying high-need populations. While geared toward the California landscape, this resource can inform stakeholders in other states seeking to develop nuanced and inclusive approaches for identifying individuals most in need of care and services.

Examination of maternal near-miss experiences in the hospital setting among Black women in the United States

The high rate of maternal mortality among Black women in the United States continues to gain attention; yet research has not yet fully illuminated the precursors to these events, most impactful among them being “maternal near misses.” Researchers have focused on reviewing patient medical records after sentinel maternal events to help determine major contributors to them; however, qualitative studies with near-miss survivors, especially among Black women, may be a more useful approach.

Examining the impact of a change in maternity leave policy in Canada on maternal mental health care visits to the physician

This study aimed to investigate the impact of an extended maternity leave policy on maternal use of mental health services and prescription drugs in a universal public healthcare system. Analyzing administrative medical records of 18,000 randomly selected women who gave birth three months before and after the policy extension, the research revealed that mothers with the extended maternity leave (50 weeks) had 0.12 fewer medical visits and incurred Can$5 less in mental health service costs compared to those with shorter leave (26 weeks). These differences were observed specifically during the extended maternity leave period. The findings suggest that the additional time away from work provided by an extended maternity leave policy may contribute to a better balance in new family dynamics, potentially resulting in decreased demand on the healthcare system.

Experiences of childbirth care among immigrant and non-immigrant women: a cross-sectional questionnaire study from a hospital in Norway

This cross sectional study of 680 women aimed to investigate the childbirth experiences of immigrant and non-immigrant women, specifically focusing on perceived quality of care and the fulfillment of healthcare needs. The findings highlight the importance of further research to assess immigrant women's childbirth experiences and the need for healthcare providers to deliver optimal care that is sensitive to cultural backgrounds and individual expectations.

Exploring the intersection between country context and priority setting to prevent maternal mortality: A multi-methods study comparing expected vs observed priorities in five countries to validate the obstetric transition model

In this mixed-methods study design, researchers aimed to validate the obstetric transition model using data from six diverse low- and middle-income countries representing self-identified priorities for improving maternal health and measurement compiled in a multi-stakeholder process. Using multiple data sources from Bangladesh, Cote d’Ivoire, India, Mexico, Nigeria, and Pakistan, the authors conducted a four-phased analysis: examining the country’s contextual profile, mapping the key themes and indicators to the model, exploring stakeholder prioritization, and examining reasons for divergence from the model. They found the obstetric transition model to be a useful guide to aid decision-makers in prioritizing attention towards addressing maternal mortality.

Factors associated with short birth interval in low- and middle-income countries: a systematic review

There is ample evidence of associations between short birth interval and adverse maternal and child health outcomes, including infant and maternal mortality. This is a systemic review to systematize evidence on risk factors for short birth interval in low- and middle-income countries.

Fathers, Breastfeeding, and Infant Sleep Practices: Findings From a State-Representative Survey

A study published in June 2023 affirmed that fathers are an important factor in whether breastfeeding is successful and whether babies sleep in safe environments. This study suggests that it may be important to focus on the education of fathers regarding the benefits of breastfeeding and safe sleep.

Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity

Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity analyzes how past and current federal policies may create, maintain, and/or amplify racial, ethnic, and tribal health inequities. This report identifies key features of policies that have served to reduce inequities and makes recommendations to help achieve racial, ethnic, and tribal health equity.

GDF15 linked to maternal risk of nausea and vomiting during pregnancy

Nausea and vomiting (NVP) affect approximately 70% of pregnancies and can be debilitating, sometimes resulting in risks to the health of both mother and baby. In this study, researchers share their findings that fetal production of GDF15, a hormone acting on the brainstem, and maternal sensitivity to it, both contribute substantially to the risk of Hyperemesis Gravidarum (HG), the most severe form of NVP. This landmark study provides concrete evidence of a cause of nausea and vomiting in pregnancy as well as a potential mechanism for treating and preventing HG.

Grandparental Support and Maternal Postpartum Mental Health

This narrative review and meta-analysis, the scientific evidence on the association between grandparental support and maternal perinatal mental health is reviewed.

Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana

In this cluster randomized trial based in the Eastern Region of Ghana, researchers sought to determine the effect of group antenatal care (G-ANC) on increasing maternal health literacy. This study enrolled a total of 1761 participants over 5 years, and found that women enrolled in the group antenatal care intervention improved their health literacy scores significantly more than the control group, and were more likely to attend 8 or more ANC visits. This study provides promising findings of the potential benefits of implementing group antenatal care options for improving health literacy.

Inaugural Maternal Mental Health State Report Card (2023)

The inaugural Maternal Mental Health Report Card provides the first-ever comprehensive view into the state of maternal mental health in America. The report card grades states in three domains: 1) Providers and Programs, 2) Screening and Screening Reimbursement, 3) Insurance Coverage and Payment

Incorporating Racial Equity into Trauma-Informed Care

This brief offers practical considerations to help health systems and provider practices incorporate a focus on racial equity to enhance trauma-informed care efforts. It draws from the experiences of two federally qualified health centers - the Stephen and Sandra Sheller 11th Street Family Health Services in Philadelphia and Bread for the City in Washington, D.C.

Interpregnancy intervals and adverse birth outcomes in high-income countries: An international cohort study

Most evidence for interpregnancy interval (IPI) and adverse birth outcomes come from studies that are prone to incomplete control for confounders that vary between women. Comparing pregnancies to the same women can address this issue.

Interventions to Improve Safer Sleep Practices in Families With Children Considered to Be at Increased Risk for Sudden Unexpected Death in Infancy: A Systematic Review

Advice to families to follow infant care practices known to reduce the risks of Sudden Unexpected Death in Infancy (SUDI) has led to a reduction in deaths across the world. This reduction has slowed in the last decade with most deaths now occurring in families experiencing social and economic deprivation. A systematic review of the literature covered three areas: interventions to improve engagement with support services, parental decision-making for the infant sleep environment, and interventions to improve safer sleep practices in families with infants considered to be at risk of SUDI.

Issue Brief: Black Maternal Mental Health

This brief discusses the prevalence and repercussions of maternal mental health disorders, specifically focusing on maternal depression and anxiety during the perinatal or postpartum period. Approximately 20% of women experience these disorders, leading to an estimated economic cost of $14.2 billion over five years for untreated cases. The societal impact extends to early childhood development, pediatric mental health, and overall family well-being. Women of color, particularly Black women, face heightened vulnerability due to increased rates of trauma exposure, reaching 87% during the perinatal period. Coupled with a higher likelihood of perilous birth complications, Black women are 3-4 times more susceptible to maternal mental health disorders, including birth trauma and post-traumatic stress disorder. Additional risk factors encompass exposure to adverse health determinants, chronic stress, and gendered racism throughout their lifespan.

Key Learnings from the Doula and Perinatal Community Health Worker in Medicaid Learning Series

The report aims to support the creation and strengthening of pathways for Medicaid agencies and health plans, provider groups, and professional associations to expand access to quality, respectful, and equitable maternity care.

March of Dimes Report Card (2023)

The 2023 March of Dimes Report Card highlights key indicators to describe the current state of maternal and infant health. It provides updated rates and grades for preterm birth and data on infant mortality and maternal health. New this year is the inclusion of maternal mortality, leading causes of infant death, and data describing selected risk factors for preterm birth. Indicators by maternal race/ethnicity are included to call attention to the need for addressing racism in our systems and communities in order to eliminate health disparities. Detailed analyses of these measures inform the development of policies and programs that move us towards improving health for birthing people and the millions of babies born each year in the U.S., D.C. and Puerto Rico. The Report Card presents policies like Medicaid extension and programs like Maternal Mortality Review Committees, which can help to achieve equity in maternal and infant health outcomes.

Maternal Migration Background and Mortality Among Infants Born Extremely Preterm

This cross-sectional study of live births in the Netherlands examines the associations between migration background and infant mortality.

Maternal childhood maltreatment and perinatal outcomes: A systematic review

This review explores the impact of MCM on four perinatal outcome domains: pregnancy and obstetric; maternal mental health; infant; and the quality of the care-giving environment. Mechanisms identified in the included studies are discussed in relation to the maternal programming hypothesis and directions for future research.

Maternal complications and risk factors associated with assisted vaginal delivery

This retrospective analysis of 3500 cases of vaginal delivery aimed to identify maternal complications and risk factors associated with assisted vaginal delivery. The study found that the most common complication in vaginal deliveries was postpartum hemorrhage, occurring in 7.3% of cases, and various factors were identified that increased the risk of this complication.

Maternal interventions to decrease stillbirths and neonatal mortality in Tanzania: evidence from the 2017-18 cross-sectional Tanzania verbal and social autopsy study

Using data from the 2015-2016 Demographic and Health Survey in Tanzania, researchers assessed causes and social factors contributing to stillbirths and neonatal deaths. The study highlighted the importance of quality antenatal care (ANC) and its association with hospital deliveries for mothers facing complications. The findings underscored the need for improved care quality, especially in urban and rural areas, emphasizing early detection and management of complications during pregnancy and childbirth, and emphasizing newborn resuscitation.

Medi-Cal Access to Community Midwifery Care: Midwives' Perspectives

While low-income communities in California continue to be hardest hit by the recent wave of hospital maternity ward closures, community midwives say they face overwhelming barriers to becoming Medi-Cal providers, according to a study by researchers at the UCSF Osher Center for Integrative Health. Without increasing the number of midwives who are Medi-Cal providers, access to perinatal care will worsen in a state already grappling with a maternal mortality crisis. This policy brief summarizes the findings of the research study.

Mental Distress Among Female Individuals of Reproductive Age and Reported Barriers to Legal Abortion Following the US Supreme Court Decision to Overturn Roe v Wade

The Supreme Court of the US (SCOTUS) ruling in Dobbs v Jackson Women’s Health Organization (hereafter, the SCOTUS decision), issued on June 24, 2022, overturned Roe v Wade, allowing states to set their own abortion laws, including outright bans. The American Psychological Association expressed alarm that eliminating the constitutional right to abortion would harm women’s mental health and exacerbate the ongoing mental health crisis in the US. This report assessed whether the SCOTUS decision was associated with mental distress among female individuals of reproductive age and how this association varied by barrier to legal abortion.

Music Therapy in Preterm Infants Reduces Maternal Distress

Preterm delivery is often a stressful event for mothers, exposing them to a greater risk for post-traumatic stress reactions. This study examined the degree of depressive symptoms and the levels of post-traumatic stress in mothers of preterm infants born before 32 gestational weeks. Conclusions were based on whether the infant received music therapy in the neonatal intensive care unit (NICU) or not.

Neighborhood Disadvantage, Race and Ethnicity, and Postpartum Depression

This study examined neighborhood effects on postpartum depression (PPD) among 122,995 individuals in California. It found that greater neighborhood disadvantage was linked to a higher risk of PPD, particularly pronounced among Black individuals. Interestingly, this association wasn't observed among Hispanic individuals. The study suggests that residing in more disadvantaged neighborhoods correlates with poorer postpartum mental health, indicating a need for targeted geographic interventions to reduce mental health disparities in the postpartum period.

Neighborhood gentrification, displacement, and severe maternal morbidity in California

This study examined the associations between neighborhood-level gentrification and severe maternal morbidity (SMM) using data from all live hospital births in California between 2006 and 2017. Using three separate metrics for gentrification exposure, they conducted mixed-effects logistic regression analysis to explore associations between gentrification and SMM. After adjustment, they found differing associations between gentrification type and SMM risk, with some indicating a protective relationship and others indicating a higher risk of SMM. The influence of gentrification on SMM was similar across racial and ethnic groups. This study explores a complex, under-researched area of maternal health.

Perceptions of Social Support from Pregnant and Parenting Teens Using Community-Based Doulas

This descriptive study was designed to explore and describe the perceptions of disadvantaged pregnant and parenting teens who received support from culturally matched, community-based doulas. Their reported perceptions included enhanced knowledge about childbearing, support during childbirth, self-care, and early attachment to the newborn. Participants concurred that the community-based doula intervention had a positive impact on their supportive networks. This innovative model can supplement perinatal programs through utilization of culturally sensitive, community-based doulas that provide comprehensive relationship-based caring.

Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review

While childbirth appears to be a potent trigger of severe mood disorders, the precise mechanisms by which postpartum psychosis occurs are poorly understood. This review examines the current evidence with respect to potential aetiology and childbirth-related triggers of postpartum psychosis.

Physician Perspectives and Workforce Implications Following the Repeal of Roe v. Wade

The National Academies Standing Committee on Reproductive Health, Equity, and Society and the National Academy of Medicine, committed to equitable access to quality reproductive health, hosted a webinar, After Roe: Physician Perspectives and Workforce Implications, in May 2023. Discussions increased awareness and promoted dialogue in the medical, public health, societal, and general population. This proceedings document summarizes the discussions held during the webinar.

Potential Epigenetic Effects of Human Milk on Infants’ Neurodevelopment

This narrative review provides an updated analysis of the relationship between breast milk feeding and infants’ neurodevelopment via epigenetics, pointing out how breast milk’s bioactive components could have an impact on the neurodevelopment of both full-term and preterm babies.

Prenatal Stress and Externalizing Behaviors in Childhood and Adolescence:
A Systematic Review and Meta-Analysis

Children whose mothers are highly stressed, anxious or depressed during pregnancy may be at higher risk for mental health and behavior issues during their childhood and teen years, according to research published by the American Psychological Association.

Prenatal iron supplementation adjusted to maternal iron stores reduces behavioural problems in 4-year-old children

A study conducted in Tarragona, Spain, involving 230 non-anemic pregnant women and their children explored the impact of adjusting prenatal iron supplements based on maternal iron levels on children's behavior. The authors conclude that tailoring prenatal iron supplementation based on maternal iron levels and hemoglobin can help reduce behavioral problems in 4-year-old children.

Psychological effects of breastfeeding on children and mothers

This review aims to provide a broad overview of existing findings on the psychological effects of breastfeeding, highlighting the important role that breastfeeding plays across several dimensions of psychological functioning. We also discuss the potential mechanisms that may underpin the observed effects, provide a constructive commentary on the limitations of the existing work, and put forth some considerations when evaluating this line of research.

Psychosocial predictors of post-natal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, health care professional support, post-natal guilt and shame, and post-natal anxiety and depression within an infant feeding context

This study explores the connections between post-natal emotional well-being, infant feeding methods, and the social context experienced by mothers. The research, involving 876 mothers, found that feelings of guilt and shame were strong predictors of post-natal anxiety and depression. Poor support from healthcare professionals and high pressure to breastfeed were linked to increased anxiety and depression, partially through their effects on guilt and shame. Interestingly, exclusive formula feeding was associated with lower post-natal anxiety symptoms, potentially due to relief from observed infant weight gain and shared feeding responsibilities. However, this was offset by an indirect pathway in which greater formula feeding exclusivity increased feelings of guilt, leading to higher post-natal anxiety scores. The study also highlights the distinct roles of guilt and shame in influencing post-natal emotional well-being, offering insights for healthcare practitioners and support networks for new mothers.

Racial and Ethnic Inequities in Development of Type 2 Diabetes After Gestational Diabetes Mellitus

Researchers sought to estimate racial and ethnic disparities in type 2 diabetes mellitus after gestational diabetes mellitus (GDM) and to investigate baseline pregnancy clinical and social or structural characteristics as mediators. With linked hospital and registry data in New York City, they used Cox proportional hazards models to estimate associations between race and ethnicity and 8-year type 2 diabetes incidence, and tested for mediation of pregnancy characteristics. They found population-based racial and ethnic inequities are substantial in type 2 diabetes after GDM. These findings contribute valuable knowledge to the field of maternal health racial disparities and suggest opportunities for intervention and further research.

Racial disparities in EEG research and their implications for our understanding of the maternal brain

Racial disparities in maternal health are alarming and persistent. Use of electroencephalography (EEG) and event-related potentials (ERPs) to understand the maternal brain can improve our knowledge of maternal health by providing insight into mechanisms underlying maternal well-being, including implications for child development. However, systematic racial bias exists in EEG methodology—particularly for Black individuals—and in psychological and health research broadly. This paper discusses these biases in the context of EEG/ERP research on the maternal brain.

Racial disparities in adequacy of prenatal care during the COVID-19 pandemic in South Carolina, 2018-2021

This study investigates the impact of the COVID-19 pandemic on prenatal care utilization in South Carolina, particularly focusing on racial disparities. The research, based on birth certificate data from 2018 to 2021, reveals that during the pandemic, there was a higher prevalence of inadequate prenatal care (24.1% vs. 21.6%) and delayed prenatal care initiation (27.2% vs. 25.0%) compared to pre-pandemic. Notably, the disparities were significant, with Black women experiencing a 26% increase in the odds of inadequate care and a 18% increase in the odds of delayed care initiation during the pandemic, while White women had a 10% increase in inadequate care odds and a 9% increase in delayed care initiation odds. These findings underscore the need for tailored interventions to address these disparities in prenatal care access and quality.

Screening fathers for postpartum depression in a maternal-child health clinic: a program evaluation in a midwest urban academic medical center

Dads can suffer from postpartum depression, and a new pilot study at the University of Illinois Chicago suggests they can and should be screened for the condition. Given the intertwined effects of mothers' and fathers' physical and mental health, addressing the health of fathers may be a powerful untapped tool in improving the nation's ongoing maternal health crisis.

Screening for postpartum depression and risk of suicidality with obstetrical patients

This study aimed to investigate the prevalence and risk factors associated with postpartum depression (PPD) and the risk of suicidality among individuals who gave birth during the COVID-19 pandemic. The researchers surveyed individuals who had given birth at The Ottawa Hospital between March and June 2020. Of the 216 respondents, 30% screened positive for PPD, and 8% screened positive for the risk of suicidality. Factors associated with PPD included negative coping strategies and pre-existing anxiety/depression. Risk of suicidality was associated with pre-existing anxiety/depression. These findings highlight the importance of mental health screening and promoting positive coping strategies to improve postpartum mental health for individuals who gave birth during the pandemic.

Severe Maternal Morbidity and Mortality in Sickle Cell Disease in the National Inpatient Sample, 2012-2018

The objective of this study was to tabulate adverse pregnancy outcomes among patients with SCD, comparing outcomes of deliveries among Black people with SCD with those of Black people without SCD and a control non-Black population, and to measure the association of racial disparities with adverse outcomes in SCD pregnancies.

Shifting the Power Balance:Creating Health System Accountability Through Trusted Community Partnerships

By prioritizing collaborative relationships with community partners, health systems can better understand and be more responsive to community needs. This report, produced by the Center for Health Care Strategies and the Center for Health + Justice Transformation, shares practical approaches to guide health systems in more meaningfully involving community members in decision making and being more accountable to the communities they serve.

Status of Maternal Cardiovascular Health in American Indian and Alaska Native Individuals: A Scientific Statement From the American Heart Association

In this statement from the American Heart Association, scientists look at the state of maternal cardiovascular health among AI/AN individuals and highlight under-recognized risks and social determinants of health that disproportionally affect AI/AN individuals, including the impact of institutional and structural racism and historical trauma.

Stillbirths, miscarriages and early losses in armed conflict contexts. The modification effect of violence. The Colombian case

This study uses data from the National Centre of Historic Memory (NCHM) and the Vital Statistics Survey to assesses the odds of stillbirths and miscarriages in regions exposed to violence in Colombia. The research reveals that living in the most violent regions is associated with a higher risk of stillbirths, miscarriages, or early losses. The protective effect of university education on live births is diminished for mothers in violent regions and periods, suggesting that the stress caused by violence has a more significant impact on educated mothers in such environments. This study sheds light on the previously overlooked influence of regional violence on the protective benefits of maternal education in Colombia's conflict-affected areas.

Structural Racism, Mass Incarceration, and Racial and Ethnic Disparities in Severe Maternal Morbidity

This cross-sectional study investigates the relationship between racial disparities in county-level jail incarceration rates and the risk of severe maternal morbidity (SMM) among birthing individuals in California. Utilizing data from over 10 million births spanning two decades, researchers found that residing in counties with high inequities in jail incarceration rates, particularly for Black and Hispanic or Latinx individuals, was associated with increased odds of SMM compared to counties with lower inequities. These findings underscore the detrimental impact of structural racism within the criminal-legal system on maternal health outcomes, emphasizing the urgent need for community-based alternatives to punitive practices.

Substance Use in Women Research Report - Substance Use While Pregnant and Breastfeeding

This article from the National Institute on Drug Abuse discusses the risks associated with substance use during pregnancy and breastfeeding, emphasizing the harmful effects it can have on both the mother and the child's health. It also highlights the importance of seeking medical help and support for women struggling with substance use disorders during these critical periods.

Supporting Birthing People and Supporting Doulas: The Impact of the COVID-19 Pandemic on a Community-Based Doula Organization in San Francisco

Beginning in March 2020, health care systems in the United States restricted the number of support people who could be present during pregnancy-related care to reduce the spread of COVID-19. This study aimed to describe how SisterWeb, a community-based doula organization that employs Black, Pacific Islander, and Latinx doulas in San Francisco, California, adapted to the COVID-19 pandemic.

Supporting breastfeeding equity: A cross-sectional study of US birthing facility administrators:

Disparities in breastfeeding have continued in the United States (US) despite efforts to increase breastfeeding rates. Hospitals are in a unique position to enable breastfeeding and help reduce disparities; however, it is unclear whether hospital administration is supportive of breastfeeding equity practices or plans. This study aimed to assess birthing facility plans to support breastfeeding among women of low income and women of color across the US.

The Impact of Congestive Heart Failure on Outcomes in Patients Hospitalized With Preeclampsia

The purpose of this study was to determine the prevalence of congestive heart failure (CHF) among patients admitted with preeclampsia as well as to analyze the independent association of CHF with in-hospital outcomes among women with preeclampsia.

The Impact of Substance Use Disorders on Families and Children: From Theory to Practice

This article discusses how SUDs develop, are maintained, and can be treated within a family context. It emphasizes the importance of family systems theory, attachment theory, and understanding the family's developmental stage for assessing impairment and planning interventions. The article also outlines ways in which social workers can address SUDs to support affected families.

The U.S. Maternal Health Divide: The Limited Maternal Health Services and Worse Outcomes of States Proposing New Abortion Restrictions

This brief assesses the current state of maternal and infant health in states that have passed "trigger laws", identifies weaknesses in perinatal care systems, and considers how abortion bans may exacerbate these weaknesses. It compares states that have current or proposed abortion bans or restrictions with states that are unlikely to pass such restrictions.

The effect of family integrated care on preparing parents with premature infants hospitalized in the neonatal intensive care unit for discharge

The study was designed as a randomized controlled experimental trial to determine the effect of the Family Integrated Care (FICare) model on the readiness of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) for discharge and home care of the infants.

The effect of sexual education on the postpartum women’s sexual self-confidence and self-efficacy: a theory-based intervention

A randomized interventional study was conducted on 115 primiparous women who were at least 6 weeks post-partum in Iran. The intervention group received over the course of one month, six 90-minute long sessions based on the sexual self-concept model (the control group received only routine care). Using ANOVA results, researchers found a substantial increase in sexual self-confidence and self-efficacy scores in the intervention group both immediately after participating in the training sessions as well as one month later. The study authors recommend implementing the use of this model in order to improve self-confidence, self-image, sexual self-confidence and feelings towards sexuality and sexual function following childbirth.

The interaction effect of pre-pregnancy body mass index and maternal age on the risk of pregnancy complications in twin pregnancies after assisted reproductive technology

This retrospective cohort study examined the interaction between pre-pregnancy body mass index (BMI) and maternal age in women with twin pregnancies after assisted reproductive technology (ART) and their risk of pregnancy complications. The study found that a combination of higher maternal age and higher pre-pregnancy BMI was associated with an increased risk of total pregnancy complications.

The role of doulas in providing breastfeeding support during the COVID-19 pandemic

The COVID-19 pandemic, subsequent lockdowns, and social isolation created challenges for nursing mothers to access doulas' services, usually provided in person. In this study, they examined the role of doulas in providing breastfeeding support during the COVID-19 pandemic, exploring adaptation to COVID-19 guidelines and the challenges doulas face in providing breastfeeding support during the pandemic.

The social predictors of paternal antenatal mental health and their associations with maternal mental health in the Queensland Family Cohort prospective study

Antenatal depression (AND) affects 1 in 10 fathers, potentially negatively impacting maternal mental health and well-being during and after the transition to parenthood. However, few studies have assessed the social predictors of paternal AND or their possible associations with maternal mental health. This study analysed data from 180 couples participating in the Queensland Family Cohort longitudinal study.

The volume and monetary value of human milk produced by the world's breastfeeding mothers: Results from a new tool

The Mothers' Milk Tool was developed to make more visible the economic value contributed to society by women's unpaid care work through breastfeeding infants and young children. This article describes the development and display key features of the tool, and reports results for selected countries.

Treating Mild Chronic Hypertension During Pregnancy: A Cost-Effectiveness Analysis

This study aimed to evaluate the cost effectiveness of targeting a blood pressure of less than 140/90 mm Hg compared to 160/105 mm Hg in treating chronic hypertension during pregnancy. Using a decision-analytic model for a theoretical cohort of 180,000 patients, the study found that treating at mild-range blood pressures resulted in significant benefits.

Understanding the lived experience of pregnancy and birth for survivors of rape and sexual assault

This qualitative study aimed to understand how sexual violence relates to healthcare during pregnancy by conducting in depth interviews with 14 women in England who survived rape or sexual assault and went through pregnancy and childbirth afterward. The study concludes that survivors of sexual violence have specific maternity care needs that are often unmet, leading to negative or re-traumatizing experiences. It urges improvements in funding, staffing, and the adoption of trauma-informed care in maternity services to better support these individuals.

Variations over time in mode of birth and perinatal outcomes in women with one previous cesarean in the Netherlands: A 20-year population-based study

This nationwide study in the Netherlands aimed to observe trends in mode of birth and perinatal outcomes for second-pregnancy women with a prior cesarean birth. Adverse perinatal outcomes were more frequent in women aiming for VBAC compared to those planning a cesarean birth, although perinatal mortality remained stable after 2009 despite the decrease in VBAC intentions. In conclusion, the proportion of women intending VBAC after one previous cesarean birth and no prior vaginal birth has decreased markedly. Particularly from 2009 onwards, this decrease was not accompanied by a synchronous reduction in perinatal mortality.

Vital Signs: Maternity Care Experiences

The CDC released a report titled "Vital Signs: Maternity Care Experiences", outlining the mistreatment mothers face during maternity care and highlighting severe rates of racial discrimination among Black, Hispanic, and multiracial mothers. This report emphasizes the importance of implementing quality improvement initiatives and provider training to increase respectful maternity care.

What are the barriers to sustaining a safe sleep program for infants within hospital settings: An integrative review of the literature

This article highlights the need for continued safe sleep practices within hospital settings, continuing education is needed for both families and staff, and education needs to fit the cultural context of each situation

What, when, and how long? Doula time use in a community doula program in San Francisco, California

Community doulas are increasingly promoted as an evidence-based intervention to advance birth equity. However, neither community doulas’ scope of work nor the distribution of time among their different work activities has been clearly defined or enumerated; therefore, this project sought to describe the work activities and time use of doulas in one community-based doula organization. This study calculated descriptive statistics for activities community doulas reported in their time diaries and each visit/interaction logged in the case management system.

“My 9 to 5 Job Is Birth Work”: A Case Study of Two Compensation Approaches for Community Doula Care

This case study explores two different approaches for compensating doulas (contractor versus hourly employment with benefits) utilized by SisterWeb San Francisco Community Doula Network in San Francisco, California. This study conducted qualitative interviews with SisterWeb doulas in 2020 and 2021 and organizational leaders in 2020. This study study suggests that efforts to promote community doula care must integrate structural solutions to provide appropriate compensation and benefits to doulas, simultaneously advancing birth equity and equitable labor conditions for community doulas.

“They’re gonna be there to advocate for me so I’m not by myself”: A qualitative analysis of Black women’s motivations for seeking and experiences with community doula care

Community doula support may improve birth outcomes and experiences, including lower rates of preterm birth and low birthweight and increases in positive birthing experiences. Few studies have explored client experiences with doula care, specifically community doula care. This study conducted two rounds of qualitative interviews with doula clients who identified as Black or Pacific Islander between August 2019 and March 2020. Interviews explored clients’ knowledge of, experiences with, and motivations for seeking doula care and their perceptions of the services they received.